4 Tips to Defend Against Claims Due to Childbirth Safety Risks
Expecting a new baby can be one of the most exciting times in a couple’s life. However, complications during delivery can make a much-anticipated event stressful and scary for the mother and family.
This claims study highlights the maternal complications of shoulder dystocia and how to defend your care team from claims based upon unpredictable childbirth safety risks.
The Complicated Delivery
At 39 weeks gestation, the mother spontaneously went into labor. Within six hours, she reached full dilation and began pushing. While pushing, she became exhausted and was unable to continue to push.
The doctor delivering the baby determined that the baby's head should be brought closer to delivery using forceps. The doctor informed the parents about the necessity of this intervention. He brought the head down to the perineum just short of delivery before removing the forceps. The mother then pushed the infant’s head a short distance until the head was delivered.
Immediately after, the physician noticed the turtle sign — indicative of probable shoulder dystocia. The nurses then pushed back the patient’s legs using a McRoberts maneuver and applied suprapubic pressure. The two maneuvers allowed for anterior shoulder delivery quickly followed by the complete delivery of the infant.
The baby’s initial Apgar was 3 at 1 minute. At 5 minutes, the score improved to 8. Shortly afterward, decreased movement of the right arm was observed. The baby suffered a right brachial plexus injury and avulsion nerve root injuries to C5, C6, and C7 that were identified later.
The Claim
The new parents filed a PCF complaint. The Medical Review Panel found no breach of the physician’s standard of care.
However, litigation ensued despite the panel’s decision. The parents and their attorney argued that the physician had breached the standard of care during delivery by causing injury to the baby. The physician’s position was that the injury was unavoidable to save both mother and child.
The plaintiffs appealed although the jury found no deviation in the standard of care. The appeal reversed the jury’s decision, awarding the plaintiffs more than $2 million in damages.
The defense appealed the appellate decision. The Supreme Court ordered the case back to trial to submit all the evidence once again to another jury.
Defending Your Care Team
Shoulder dystocia is an emergent situation when it occurs, and it is essential to deliver the baby from the birth canal to reduce the risk of hypoxia. Unfortunately, there is little time to educate the parents on what is happening in such situations. Just like the team in this claim study, your facility’s labor and delivery team must act promptly and effectively to successfully deliver the infant.
Here are four ways you can help defend your care team against claims that may arise due to childbirth safety risks and complications during delivery:
- Ensure all staff document their actions and the reasoning behind them.
Medical staff performed the necessary techniques correctly in the claim study above, but the maneuvers themselves may potentially cause physical injury while attempting to keep the baby alive. The baby in this situation lived, but they also suffered the residual effects of shoulder dystocia due to those life-saving measures. Despite known childbirth safety risks such as shoulder dystocia, claims may still arise even when medical professionals act to save lives. - Monitor mothers for conditions or history that would make them at higher risk for shoulder dystocia during the prenatal period.
Documentation should indicate a thorough review of the maternal history for risk factors such as previous shoulder dystocia. Documentation should also indicate close monitoring of the mother and fetus to ensure the best outcome for a vaginal delivery such as the size of the baby due to diabetes, macrosomia, or abnormal pelvic structure.
Identified risk factors help the physician better manage the birth plan moving forward and customize necessary education to the parents' needs in case of an emergency.
- Document how well the newborn tolerates labor and the progress of the delivery.
Documentation of emergencies during the labor and delivery process should be specific — indicating what is occurring, maneuvers/treatments prescribed, and the response of the mother and baby. Documentation should be reflective of best practices in the industry and organizational policies. - Implement a process of debriefing with the newborn’s family post-delivery.
This should be an opportunity for the clinicians and family to meet and discuss what happened during the delivery and why and allow the family to ask questions. This process shows the medical team’s compassion for the family and the new baby. It may help the family gain a better understanding of the events since there may not have been much time to explain during the emergency.
Understanding the Risks
Unfortunately, this claimant’s experience is not out of the ordinary. Pregnancy, labor, and delivery of a child may come with unexpected, life-changing risks. Educating the mother and family on those risks based on family history and conditions is vital. And if complications during delivery do occur, make detailed documentation and debriefing processes a priority to protect your patients, your employees, and your healthcare organization.
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Need more maternal health guidance? Explore our Maternal Health toolkit. LHA Trust Funds risk management experts supply resources to benefit and improve maternal health in your healthcare organization.
About the Authors
Jamie Lamb
Director of Claims Operations, LHA Trust Funds
Jamie Lamb began her career in claims in 1997. Her experience includes handling multi-line claims in the areas of general liability, medical malpractice, automobile liability, commercial and personal property, excess and umbrella policies, and professional liability. Her experience comes as a former Manager and Litigation Specialist for the American National family of companies. She has been highly involved in the education and training of both internal and external customers her entire career. Ms. Lamb attended both Evangel University in Springfield, Missouri, and Loyola University in New Orleans.
Stacie Jenkins, RN, MSN, CPSO
Vice President of Patient Safety and Risk, LHA Trust Funds
Stacie Jenkins is a registered nurse with a master’s degree in nursing informatics. She has more than 20 years of experience in healthcare, working in patient care and quality/performance improvement positions. As the Vice President of Patient Safety & Risk at LHA Trust Funds, she works closely with hospital administrators, risk managers, and nursing staff to improve patient safety and establish best practices. She conducts on-site assessments and gives presentations designed to help clients address their patient safety risk management challenges.