If it takes an entire village to raise a child, it's going to take an entire country to raise maternal/fetal outcomes.
Everyone involved in maternity care – from payers and hospital administrators to laboring women and their nurses–needs to team up to improve the health of moms and newborns, even if that means admitting that mistakes can be made.
“Even the best people in obstetrical units can't do anything without leadership being willing to put moms' and babies' safety as the highest priority,” Maureen P. Corry said during a teleconference on patient safety. “Everyone needs to be respected, encouraged to speak up, and listened to. Right now, there is a hierarchy [in health care facilities] that makes people fear retaliation if they speak up – and this is an incredible barrier to improving care.”
Ms. Corry, executive director of Childbirth Connections, was one of several experts who spoke at the Partnership for Patients webinar, sponsored by the Department of Health and Human Services. Tasked with improving patient safety across the country, the initiative brings together all manner of health care stakeholders in webcast brainstorming sessions, with the aim of providing “take-home” strategies for systems improvement.
Wednesday's session focused on decreasing obstetrical adverse events. Although much of the data needed to succeed in this effort have long been available, many hospitals have yet to incorporate them into a cohesive obstetrical safety policy, the speakers said.
As cesarean section rates continue to rise (more than one-third of births in 2009), outcomes have continued to deteriorate, said Dr. Peter Cherouny, chair of the perinatal collaborative at the Institute for Healthcare Improvement. “No matter how much money we continue to throw at this, it's not a problem that has gone away. Maternal mortality in the United States has continued to increase at a rate of 2% per year for the last 20 years.”
Most mothers are healthy and leave the hospital with healthy babies, he said. But mistakes that put mothers and babies at risk continue to occur. The best way to view this is that all mistakes can be prevented.
“Communication errors are the sentinel event in the vast majority of perinatal adverse events,” he said. “That means up to 90% of birth trauma should be considered preventable.”
But people on the front line often ignore this possibility, partly because they resist the idea of being fallible and partly because they fear retaliation from someone higher in the administrative hierarchy.
This means that mothers can be intimidated by health care professionals, nurses can feel intimidated by physicians, physicians can fear administrators, and administrators fear those that make the hospital world go around – namely payers.
Instead of continuing this culture, Dr. Cherouny said, real change can only occur when everyone in the chain drops their shield against retaliation and adopts instead a stance of individual empowerment.
Mothers can be at the root of this cultural shift, Ms. Corry said, when they learn the risks and benefits of possible interventions and insist on having input into their own care.
Childbirth Connection recently published the results of its Listening to Mothers II survey. “We found that 97% of mothers wanted to know every or most of the possible complications of induction and cesarean, but that most of them couldn't correctly identify the adverse effects of either one,” Ms. Corry said.
The survey also showed that 45% of mothers with a prior cesarean section were interested in the option of a vaginal birth after cesarean, but were denied that option due to caregiver or facility unwillingness to perform it.
“Seventeen percent of the mothers reported that they also felt pressure from a health care professional to have an induction [before the onset of natural labor], and 25% felt pressure to have a cesarean section.”
Since risk increases with every unnecessary intervention, everyone would benefit by a more restrained approach to labor and delivery. Early induction of labor and elective cesareans are two good places to begin a shift toward safer childbirth.
Administrators sometimes fear that it may simply be too expensive to make institutional changes, the presenters agreed. But this is a short-sighted view, said Dr. Alan Fleischman, medical director of the March of Dimes.
“There are many published studies that reinforce the idea that this cultural change actually improves financial outcomes. Lawsuits decrease. Length of stay decreases. Overall costs decrease. And positive outcomes increase all the way around. These are good arguments that we can use to get these changes in motion.”
The Partnership for Patients webinar was sponsored by the Department of Health and Human Services.