Obstetrics and Neonatal Safety

Most babies are born healthy, and most mothers experience labor and delivery without significant adverse events. Nevertheless, each of the nearly 4 million births that occur annually in the United States carries a risk of an adverse outcome for mother and infant (Grobman). Obstetrics/gynecology (OB/GYN) physicians in the United States practice in a challenging environment—on average, an obstetrician can expect to be sued 2.64 times during his or her career and face the possibility of multimillion-dollar adverse judgments.

In recent years, as malpractice insurance premiums rose to unaffordable levels and reimbursement diminished, obstetric physicians attempted to reduce their risk by curtailing their obstetric practices to practice gynecology only, avoiding acceptance of high-risk patients and performance of certain high-risk interventions, or retiring early (Perlman). Hospitals continue to close their obstetrics (OB) units, making it necessary for nearby hospitals that still have OB units to accommodate higher patient volumes. Relatively few family physicians provide OB care, and physicians who continue to care for pregnant women and deliver babies practice costly defensive medicine, ordering more tests than are medically necessary (Studdert et al.). Increasingly, nurse-midwives are filling the gap left by obstetricians, and their numbers are expected to increase (Angelini and Greenwald).

Against this grim backdrop, successful efforts are emerging within the OB profession, health systems, and hospitals and among professional liability insurers to support patient safety, reduce preventable errors and adverse outcomes, and reduce malpractice litigation by identifying best practices and implementing new approaches to safe patient care (Perlman; Knox et al.).

Professional society support for an OB patient safety program became evident in 2003 when the American College of Obstetricians and Gynecologists (ACOG) issued “Patient Safety in Obstetrics and Gynecology,” a committee opinion that outlined seven objectives to be adopted by providers and healthcare organizations to support patient safety, as follows:

This Risk Analysis discusses numerous projects, programs, and issues in perinatal safety that have been developed and implemented in U.S. hospitals and obstetric physician practices since 2003. Topics include...