01 April 2019

Childbirth Complications

Childbirth delivery
Call the Midwife

Welcome back. Maybe Vicki and I have watched too many episodes of Call the Midwife. Why else would I notice a study of birth delivery complications?

In any event, the study certainly raised a red flag, especially when I read that, every year, some 700 women in the U.S. die from preventable complications related to pregnancy and childbirth.

Welcome to the hospital’s
maternity department in the UK

Identifying Delivery Risk Factors
Research collaborators affiliated with Colorado State University, Abt Associates, Inc. and the U.S. Department of Agriculture set out to identify hospital-based risk factors that might be modified to improve maternal health.

Limiting their analysis to Texas, the researchers examined the State Health Services’ records of over 2 million childbirths from 2005 through 2010.

They focused on physician-attended deliveries of single baby births following gestations longer than 20 weeks and normal labor onset. Of principal concern were 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.

Among factors evaluated were timing and location. Specifically, did delivery complications vary by work shift (day vs. night), as hours pass within work shifts, and on weekends and holidays? Was there a difference between teaching and non-teaching hospitals? Did complications in teaching hospitals vary when new residents arrived, reducing physician experience and healthcare team coordination?

Labor and childbirth (photo by New Health
Advisor from www.smartparenting.com.ph/).
Key Drivers of Delivery Risk
The analysis of hospital-based risk factors affecting birth delivery found:

The likelihood of experiencing a delivery complication was 21.3% higher during the night shift, and the odds of a delivery complication increased by 1.8% with every hour worked within a shift.

Weekend deliveries were 8.6% more likely to experience a complication than were weekday deliveries.

Births occurring on holidays were particularly susceptible to labor or delivery complications. Holiday births were 29.0% more likely to experience a complication.

Deliveries at teaching hospitals were 2.2 times more likely to experience a complication than were deliveries at non-teaching hospital.

The risk of a delivery complication at teaching hospitals increased by a factor of 1.3 when new residents joined the staff rotation. After a year of training and integration, there was no added risk.

Wrap Up
The researchers note that ineffective teamwork was implicated in an estimated 75% of preventable medical errors. One possible remedy they suggest is scheduling inexperienced physicians with more senior health professionals.

Clearly, every effort should be made to reduce risk associated with childbirth. Though my hospital expertise is only as a patient and my support to deliveries is limited to whispering in Vicki’s right ear, it would seem the study has identified a number of areas that hospitals might target.

Thanks for stopping by.


Study of birth delivery complications in Risk Analysis journal: onlinelibrary.wiley.com/doi/abs/10.1111/risa.13273
Article on study on EurekAlert website: www.eurekalert.org/pub_releases/2019-02/sfra-srt022619.php

A version of this blog post appeared earlier on www.warrensnotice.com.

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