Can One Voice Make a Difference in Birth Safety?

The field of obstetrics and gynecology has been slow to push forward into more standardized care.  A recent article published in The Atlantic has caused many to ask – “Can one voice make a difference in birth safety”? One obstetrician seems to think so, and is doing everything in his influence to make obstetrics and the labor and delivery process safer for mothers and their babies.

Making Waves in Obstetrics

Steve Clark was trained in obstetrics and gynecology at the University of Southern California (USC) in the 1970s and 1980s.  During his early years practicing at USC, Clark primarily worked with patients who were immigrants from Central America, where uninsured, and often had very poor health.  He learned to care for patients with many health conditions unfamiliar to most U.S.  doctors, such as typhoid, malaria, and even the bubonic plague.

This experience caused Clark to practice medicine much differently than many of his peers.  His experience led to competence that was valuable and recognized, and he climbed the ranks to eventually become a leader.  He obtained a series of leadership roles at Intermountain Health System in Utah, where we met another doctor who was a pioneer of the patient-safety movement.  The patient-safety movement urged doctors to care for patients with the same conditions in the same way, even if scientific evidence was lacking.

Clark applied this idea to his work in obstetrics and encouraged his colleagues to work toward preventing some of the rare but possible complications of labor and delivery.  Clark was among those who addressed the correlation between elective deliveries and poor fetal outcomes, which has become a concern across the healthcare sector.  Clark also was one of the pioneers in standardizing the use of oxytocin and establishing protocols for safe and effective use.

By 1999, Clark was a leader in obstetric safety, and in 2004, the Hospital Corporation of America (HCA) requested he lead their obstetric safety program across 115 individual programs, representing around 220,000 deliveries each year (approximately 5 percent of all U.S.  deliveries).  During his time leading the programs, Clark was able to start measuring the effectiveness of his policies on birth safety.  The results of his work were undeniable – Clark was making a difference in birth safety that could save lives.

Some of the most notable and undeniable results include:

  • Clark and colleagues were influential in reducing the maternal death rate at HCA by 6.4 percent per 100,000 live births.
  • Clark’s practical use of inflatable cuffs for women undergoing Cesarean section (c-section) reduced the number of pulmonary embolism related maternal deaths. Since then, his approach to clot prevention has been adopted by many national obstetrical organizations, and has become the standard of care in hospitals across the U.S.
  • Clark’s approach to shoulder dystocia has been implemented in hospitals, and is an example that consistency in treatment (despite scientific evidence) can be beneficial.
  • Lawsuits and litigation-related damages paid by HCA and it’s physicians were reduced.

The Facts about Birth Safety and Maternal and Fetal Mortality Rates

Maternal Mortality Rates

In 1990, the maternal mortality rate in the U.S.  was just over one out of every 100,000 patients.  In 2015, that number increased dramatically to 26.4 out of every 100,000.  That makes the U.S.  among the nation’s with the highest maternal mortality rate in the world, and the highest among developed nations.  Research by NPR and ProPublica identified the following as serious issues plaguing the U.S.  healthcare system in terms of maternal mortality rates:

  • Hospitals are inconsistent in their protocols for managing potentially deadly complications or birth injuries, which often allows treatable conditions to escalate to dangerous or deadly levels.
  • Hospitals across the U.S., including those with neonatal intensive care units (NICU) and neonatologists on staff are ill prepared to manage maternal emergencies.
  • Some doctors who enter the field of maternal-fetal medicine completed their “training” without spending time in a labor and delivery unit.
  • Only an estimated 6 percent of state and federal block grants allocated for “maternal and child health” go toward maternal healthcare.

Fetal Mortality Rates

According to the U.S.  Centers for Disease Control and Prevention (CDC), fetal mortality is one of the major, yet often overlooked, public health concerns facing the U.S.  healthcare system.  Fetal mortality rates are often an umbrella term that includes perinatal mortality rates also.  These two terms are distinguished as follows:

  • Fetal Mortality: Refers to intrauterine fetal deaths before delivery. Fetal mortality is divided into three categories, which are:
    • Early: Less than 20 weeks gestation
    • Intermediate: 20-27 weeks gestation
    • Late: 28 weeks gestation or more
  • Perinatal Mortality: Refers to fetal/infant death occurring during or following delivery. The two categories of perinatal mortality commonly observed include:
    • Definition I: Death in the period between 28 weeks gestation and 7 days old post delivery.
    • Definition II: Death in the period between 20 weeks gestation and 28 days old post delivery.

Most states only document records for fetal mortality occurring during the intermediate and late stages of pregnancy.  Therefore, most data available will refer to 20 weeks or more gestation.

The Heart of the Matter

The field of obstetrics has been compared to aviation.  Years may pass without a significant incident among even the worst airlines.  Similarly, even the most “cavalier” hospitals may go years without a mother or baby being injured or dying due to a serious birth injury.  The fact of the matter is, however, that birth injuries do occur, they do claim the lives of mothers and babies, and often, they can be prevented with the right prevention and treatment methods.

Doctors like Steve Clark are making significant progress toward improving birth safety and outcomes.  Unfortunately, injurious or fatal birth injuries are still far too common.  If you or someone you love has been harmed due to a birth injury that could have been prevented, you may find it helpful to explore your legal rights.  Contact the medical malpractice and birth injury attorneys at Brown & Brothers to find out more about your rights and options.  Fill out our online form to get started.

 

 

Sources:

https://www.theatlantic.com/health/archive/2017/05/steve-clark-america-obstetrics/528285/

http://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world

https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_08.pdf