Closed Claims Analysis of Medical Malpractice Lawsuits Involving Midwives: Lessons Learned Regarding Safe Practices and the Avoidance of Litigation

Abstract

Recommendations for improving clinical practice and avoiding litigation based on findings from the closed claims analysis include, but are not limited to, the need for thorough and accurate documentation in practice, appropriate and timely consultation and collaboration, and the presence of practitioners whose clinical skills match the level of care assessed to be necessary for each woman for whom care is offered.

Maneuvering Through a Birth Complicated by Shoulder Dystocia

“…Simulation has been shown to be useful in preparing the intrapartum care team for emergency situations such as shoulder dystocia. 2,4,5,8,10,24,29 Simulations may include scripted drills and hands-on experiences with computerized simulation systems and mannequins. 4,7,11 Hands-on drills are beneficial in training intrapartum care providers in using the various maneuvers appropriately.…”

“…3,5 The risk of legal liability in the United States when caring for women and newborns has increased over the past 20 years. 8 It is reported that 15% of certified nurse-midwives and certified midwives (CNMs/CMs) and 91% of obstetriciangynecologists have been named in lawsuits. 8 Fear of litigation may result in changes in clinical management, such as a tendency toward higher intervention in pregnancy and labor, including cesarean birth.…”

“…8 It is reported that 15% of certified nurse-midwives and certified midwives (CNMs/CMs) and 91% of obstetriciangynecologists have been named in lawsuits. 8 Fear of litigation may result in changes in clinical management, such as a tendency toward higher intervention in pregnancy and labor, including cesarean birth. 8 The rate of cesarean birth increased by 68% between 1979 and 2010, despite no change in rates of complications in labor, leading to an increase of the repeat cesarean rate by 178%.…”

“…8 Fear of litigation may result in changes in clinical management, such as a tendency toward higher intervention in pregnancy and labor, including cesarean birth. 8 The rate of cesarean birth increased by 68% between 1979 and 2010, despite no change in rates of complications in labor, leading to an increase of the repeat cesarean rate by 178%. 18 These changes in labor management style and mode of birth contribute to rising health care costs.…”

“…[2][3][4][5][6] Shoulder dystocia may have profound psychological effects on the woman and intrapartum care provider and has legal implications. 5,[7][8][9] The cost burden associated with shoulder dystocia includes increased expense associated with treating short-and long-term injury resulting from the shoulder dystocia as well as legal costs to both the intrapartum care provider and the woman and her family. [4][5][6][7][8][9][10][11]…”