A new study published in Risk Analysis: An International Journal entitled “Clinical capital and the risk of maternal labor and delivery complications: Hospital scheduling, timing and cohort turnover effects” found that the quantity of delivery complications in hospitals are substantially higher during nights, weekends and holidays, and in teaching hospitals.
The researchers analyzed more than two million cases from 2005 to 2010 using detailed data obtained from the Texas Department of State Health Services. The researchers focused only on women with a single birth (i.e., not twins) who had gestation of more than 20 weeks, a delivery attended by a physician, and a normal labor onset. The study looked at labor or delivery complications including third- or fourth-degree perineal laceration, ruptured uterus, unplanned hysterectomy, admission to intensive care unit and unplanned operating room procedure following delivery.
The study evaluated whether delivery complications (1) vary by work shift (day vs night), (2) increase as the hours pass within work shifts, and (3) increase on weekends (Friday evening to Monday morning) and holidays (Christmas, New Year’s Eve and the Fourth of July). The study also evaluated whether delivery complication rates are higher in teaching hospitals and whether they increase when a new cohort of residents enter teaching hospitals in July, causing abrupt declines in physician experience and coordination between members of the healthcare team.
The study found the following:
• The odds of a mother experiencing a delivery complication are 21.3 percent higher during the night shift, and that the odds of a delivery complication increase 1.8 percent with every hour worked within a shift.
• A mother delivering an infant on a weekend is 8.6 percent more likely to encounter a complication than a mother delivering on a weekday.
• Births occurring on holidays are particularly susceptible to labor or delivery complications, with holiday births being 29.0 percent more likely to have a complication.
• Mothers delivering their infants in teaching hospitals are 2.2 times more likely to experience a delivery complication than mothers birthing at non-teaching hospitals.
• The risk also increases by a multiplicative factor of 1.3 at teaching hospitals in July, when new residents join the staff rotation. By June, after a full year of training and integration, the risk of a delivery complication at these same hospitals is statistically indistinguishable from chance.
Each year, nearly four million women give birth in U.S. hospitals, making childbirth the most common cause of hospitalization. Serious but preventable complications occur at the point of delivery, with approximately 700 women dying every year in the U.S. from preventable causes related to pregnancy and childbirth.
The researchers stated that obstetric care in hospital settings is a team effort and ineffective teamwork has been implicated in an estimated 75% of preventable medical errors. They hypothesize that hospitals could decrease the risk of harm to mothers by putting more emphasis on scheduling inexperienced physicians with more senior health professionals, among other things.
If you or your baby suffered a birth injury (or worse) during labor and/or delivery in the United States, you should promptly find a birth injury lawyer in your state who may investigate your birth injury claim for you and represent you and your child in a birth injury medical malpractice case, if appropriate.
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