Objective: To test the psychometric soundness of a teamwork climate survey in labor and delivery, examine differences in perceptions of teamwork, and provide benchmarking data.Design: Cross-sectional survey of labor and delivery caregivers in 44 hospitals in diverse regions of the US, using the Safety Attitudes Questionnaire teamwork climate scale.Results: The response rate was 72% (3382 of 4700). The teamwork climate scale had good internal reliability (overall a ¼ 0.78). Teamwork climate scale factor structure was confirmed using multilevel confirmatory factor analyses (CFI ¼ 0. IntroductionAfter the release of To Err is Human, 1 many healthcare institutions and organizations began the process of moving safety improvement efforts forward. One principle in this report was the 'promotion of effective team functioning.' The American College of Obstetricians and Gynecologists (ACOG) responded with a set of safety-related objectives for clinical providers to follow in daily practice. 2 One objective stressed commitment to a patient safety culture through the daily practice of teamwork, communication, collaboration and strong leadership for providers.Effective teamwork is critical in high-risk settings where individuals interact with other persons to perform their job. In aviation, plane crashes resulting from flight crew discord prompted development of crew resource management (CRM) training to address team climate and improve performance. 3,4 In healthcare, researchers have identified and are investigating group hierarchy, stressful work environments, poor communication and varying perceptions of what comprises a team as some barriers to effective teamwork. 5,6 One outcome of poor team climate is medical error. The Joint Commission on Accreditation of Healthcare Organization's (JCAHO) sentinel event investigation in labor and delivery (L&D) found poor communication as a root cause in over 80% of perinatal deaths and injuries. 7 Additionally, the leading root cause of perinatal deaths and injuries tracked by JCAHO was communication breakdowns, which was cited in over 80% of events. 8 In another study, poor teamwork was attributed to 40% of maternal deaths and 45% of near miss morbidities. 9 Team performance is important in L&D because a normal situation can transition to an emergency rather quickly. A rescue team must assemble quickly, communicate clearly and collaborate effectively to avoid needless morbidity or mortality. 10,11

A multi-level ilioinguinal-iliohypogastric nerve block technique can reduce the amount of systemic morphine required to control post-Cesarean delivery pain but this reduction was not associated with a reduction of opioid related adverse effects in our study group.

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