Obstetrics represents a sliver of liability claims, but a new report suggests that many of these cases involve patient injuries of greater severity.
Coverys, a Boston-based liability insurer, analyzed 472 obstetrics claims from between 2013 and 2017 and found that 80% were high clinical severity cases. In 24%, either the mother, infant or both died.
Complications or injuries to mothers are less common than injuries to babies. Infant claims tended to fall in one of three categories: neurological or brain damage (41% of cases), shoulder injuries (37%) and death or stillbirth (34%), according to Coverys’ research.
“These claims are really severe and really expensive,” Marlene Icenhower, senior risk consultant at Coverys and the report’s author, told FierceHealthcare.
These injuries also often cause long-lasting effects, so the upfront claims are high and the patients—particularly in the case of infants—often need costly chronic care in the long term, according to the report.
The report also identifies risk areas that providers can focus on to improve outcomes for obstetric care. Pregnancy, labor and delivery are especially rife with miscommunication opportunities, according to Coverys, since many expectations about the experience are baked in.
Pregnant women often have images in mind of what their birth experience will be like that aren’t rooted in evidenced-based care but instead in folklore, culture, blogs and conversations with their peers, Icenhower said. Obstetricians need to address these expectations long before delivery, she said.
“Physicians have to anticipate and prepare for that,” she said. “Begin early, and have a good, communicative relationship with your patient. Discuss some of the things that can happen, and sort of work through the expectations in the context of a realistic birth plan.”
Midwives pose another communication risk, according to the report. For one, state-level regulations on licensing vary, so some may have a far lower level of clinical experience. That’s why it’s crucial for obstetrics departments to have clear agreements in place that outline responsibilities and emergency protocols.
Nearly half (40%) of obstetrics claims relate to management of labor and delivery, according to the report. More claims were tied to vaginal births than cesarean sections, and a vaginal birth following a previous C-section is especially risky, Icenhower said.
These procedures are especially linked to risk of obstetric hemorrhage, one of the major causes of death in childbirth, she said. So hospitals need to be prepared for these situations—including abandoning a vaginal birth if necessary—and should drill regularly to keep clinicians’ skills in top shape.
Another key risk factor during labor is poor monitoring of fetal heart patterns, Icenhower said, so that too should be a part of routine training and skill checks.
“We recommend that folks be trained consistently on fetal heart patterns when they first get hired at the hospital,” she said.