Risk Management Strategies for Addressing Maternal Healthcare Gaps in Louisiana’s OB Care Deserts

Louisiana’s growing number of OB deserts presents serious risks for both patients and providers. In areas with limited obstetric services, even routine emergencies can become high-stakes events.

In our latest article, we explore key exposures healthcare organizations face in these settings and how risk managers can strengthen readiness through protocols, training and facility-wide improvements that save lives.

​Louisiana faces some of the nation’s highest rates of maternal mortality and limited obstetric access. According to a 2025 March of Dimes data analysis, 26.6% of Louisiana parishes are currently classified as OB deserts. This limited access increases risk during emergencies and highlights the importance of readiness in non-OB facilities.

In OB deserts, patients often travel long distances for care, increasing the risk of delayed treatment for emergencies like hemorrhage, preeclampsia, or fetal distress. In facilities within these areas, risk managers must use proactive strategies at their disposal to reduce or eliminate adverse events from occurring. Let’s take a closer look at the role of risk managers and the potential exposures organizations may face in these situations.

How Risk Managers Elevate Maternal Health Safety

In regions where obstetric services are limited or nonexistent, risk managers are critical in protecting patients and supporting clinical teams. Their leadership and risk insights can directly impact how well an organization anticipates, responds to, and learns from obstetric emergencies, especially in facilities that do not routinely provide maternity care.

Even in non-OB hospitals, emergencies such as early deliveries, hemorrhage, preeclampsia, or fetal distress can arise without warning. These high-risk events require rapid coordination and clear processes to prevent adverse outcomes. This is precisely where a risk manager’s oversight becomes indispensable.

Risk managers help bridge the gap between clinical readiness and organizational resilience by:

• Assessing systemic vulnerabilities that could delay care or compromise outcomes.
• Developing and implementing evidence-based emergency protocols tailored to the facility’s capabilities.
• Facilitating ongoing staff education and competency training in obstetric and neonatal care.
• Ensuring preventive maintenance and availability of essential maternal and newborn equipment.
• Promoting documentation practices that support continuity and quality of care.

By taking a proactive approach, risk managers help create safer environments where staff are confident, patients are protected, and liability exposure is minimized. Now let’s look at specific areas where care gaps most commonly occur in OB deserts, and how today’s risk managers can take action to mitigate these exposures.

1. Delayed Treatment Due to Lack of Obstetric Emergency Protocols

Exposure: An organization may be faced with an obstetrical emergency or a woman who is in labor without the necessary protocols in place to effectively and efficiently manage the patient’s care.

Actionable Steps for Risk Managers:

• Implement telehealth triage protocols.
• Partner with EMS to ensure rapid transport and pre-arrival alerts.
• Ensure transfer agreements are in place for higher levels of care.
• Provide checklists and quick-reference tools for frontline staff.
• Implement evidence-based guidelines for obstetrical emergencies.
• Develop readiness kits that are available in the event of emergencies (such as for precipitous deliveries, neonatal resuscitation, etc.).

2. Inadequate Clinical Competency and Training

Exposure: In organizations without an obstetrics (OB) unit, staff may rarely encounter situations requiring the specialized skills needed to care for laboring women and newborns. This limited exposure can result in challenges such as difficulty recognizing obstetrical emergencies, inadequate experience in monitoring both mother and fetus, suboptimal clinical decision-making, and a higher risk of malpractice claims.

It’s not only critical to maintain competencies in managing labor and delivery complications, but also to be prepared for newborn care immediately after birth—especially in scenarios involving prematurity, respiratory distress, or meconium-stained deliveries.

Actionable Steps for Risk Managers:

• Promote simulation-based training for clinical teams, as well as conduct mock drills.
• Support continuing education emergency OB and newborn care.
• Use data to identify skill gaps and target training.
• Ensure staff are trained in Neonatal Resuscitation (NRP).
• Ensure competency with obstetrical equipment and neonatal care equipment since the use is low volume and high risk. This should be an annual competency.

3. Communication Breakdowns

Exposure: Poor communication among care teams is a leading contributor to adverse events, including OB-related injuries. When care teams fail to communicate critical information about a patient’s status or intervention needed, the patient may not receive the right intervention or intervention when needed, leading to adverse events.

Actionable Steps for Risk Managers:

• Standardize handoff protocols and use SBAR tools.
• Encourage team-based simulation and mock drills to improve coordination.

4. Documentation Deficiencies

Exposure: In OB deserts, documentation during obstetrical events can pose a significant exposure risk for organizations due to the infrequency of these cases and the high stakes involved. When staff are not routinely managing labor and delivery, there may be gaps in accurately capturing critical details such as clinical assessments, interventions, communication with consultants, and timing of decisions.

Incomplete or delayed documentation can hinder continuity of care, complicate legal defense in the event of a claim, and obscure the rationale behind clinical actions. Ensuring thorough, timely, and standardized documentation is essential to mitigate liability and support quality care in these high-risk, low-frequency situations.

Incomplete or Inaccurate Documentation: A lack of detail in describing the clinical situation, decision-making process, and interventions can be problematic. Failure to document timing of events (e.g., fetal heart rate changes, decision to deliver, neonatal resuscitation steps) may raise questions in legal reviews.

Delayed Documentation: In high-stress scenarios, documentation may be postponed or rushed, leading to errors or omissions. Encourage real-time charting when possible or immediate post-event debrief documentation.

Lack of Standardized Language: Use of vague or non-clinical terms (e.g., “baby looked okay”) instead of objective data (e.g., Apgar scores, oxygen saturation) can weaken the record. Ensure staff are trained to use clear, consistent terminology aligned with clinical standards.

Missing Documentation of Communication: Failure to record consultations, escalation efforts, or transfer attempts can be a liability. You should always document who was contacted (e.g., OB consultant, transport team), the time and method of contact, recommendations given, and actions taken.

Inadequate Documentation of Fetal Monitoring: If fetal monitoring was used, ensure tracings are saved and interpreted correctly. Document rationale for interventions based on monitoring data.

Lack of Documentation of Patient Education and Consent: Record any education provided to the patient/family about risks, options, and outcomes. Document verbal or written consent, especially in emergent situations.

Poor Documentation of Neonatal Care: Failure to properly document key neonatal care such as initial assessments and interventions, resuscitation steps, vital signs, or transfer arrangements can leave teams open to misinterpretation or liability if an adverse event occurs.

Actionable Steps for Risk Managers:

• Provide training on defensible charting, especially during labor and delivery.
• Integrate EMR prompts for high-risk OB scenarios.
• Implement event-specific documentation templates for OB emergencies.
• Conduct post-event chart audits and debriefs to identify gaps.
• Provide ongoing training on legal and clinical documentation standards.

5. Failure to Maintain Equipment or Facilities

Exposure: Facilities that rarely encounter obstetric emergencies may have missing or malfunctioning fetal monitors, ultrasound machines, emergency delivery kits, or radiant warmers. This lack of equipment poses a variety of risks in the event an OB emergency occurs.

Actionable Steps for Risk Managers:

• Ensure preventive maintenance inspections on ob/newborn-related equipment.
• Conduct monthly checks on readiness kits that are up-to-date and ready for use.

Additional Considerations for Closing the Gaps in Maternal Safety

While clinical training and emergency readiness are essential, sustaining safe maternal care in OB deserts requires a broader, systems-based approach. Beyond managing individual exposures, risk managers should ensure their organizations maintain the infrastructure, policies, and oversight needed to support quality care in unpredictable situations.

Conduct Comprehensive Risk Assessments

Regular risk assessments help identify gaps that may not surface during routine operations, such as outdated transfer agreements, limited telehealth coverage, or insufficient emergency supplies. Evaluating both clinical and operational vulnerabilities allows leadership to proactively strengthen response systems before a crisis occurs.

Maintain Up-to-Date Policies and Procedures

Policies and procedures should reflect current evidence-based practices, national safety standards, and Louisiana-specific regulatory requirements. These documents serve as the foundation for consistent decision-making and accountability, especially for facilities where OB-related visits are rare.

Strengthen Cross-Department Collaboration

Maternal emergencies often involve multiple departments like emergency, radiology, anesthesia, and pediatrics. Establishing clear lines of communication, defined roles, and mutual understanding of emergency protocols reduces confusion during high-pressure situations.

Monitor Regulatory Trends

Maternal safety standards and reporting expectations evolve rapidly. Staying aligned with national and state initiatives ensures your organization remains compliant and benefits from shared learning and improvement tools.

Foster a Culture of Safety

Finally, patient safety thrives in environments where staff feel empowered to raise concerns and report near misses. Building a non-punitive culture around reporting and debriefing strengthens learning and helps prevent repeat events.

Ready to strengthen your maternal safety strategy?

Access the LHA Trust Funds Maternal Health Toolkit for evidence-based guidance, training tools, and emergency readiness resources.