Midwifery Strategies for Liability Risk Reduction Preterm Labor and Birth

Definition: A preterm birth is one that occurs prior to the completion of 36 weeks of gestation. Major complications for the premature infant may include respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis.

The etiology of preterm labor is poorly understood. Predisposing factors associated with preterm labor may include: maternal infections, subclinical chorioamnionitis, uterine abnormalities, and premature separation of the placenta. In the majority of preterm labor cases the cause is unknown. Despite three decades of increased prenatal infection treatment and increased use of tocolytic therapy, American preterm birth rates show little improvement.

Antepartum Liability Risk Reduction Strategies:

• Performance and evaluation of a comprehensive history and physical examination
• Assessment of nutritional status
• Utilization of appropriate laboratory studies and antepartum surveillance methodology
• Confirmation and documentation of estimated due date by 20 weeks gestation
• Identification of women at risk for preterm labor by initial assessment, use of a risk assessment tool or methodology, and interval assessments
• Counseling for individual risks and appropriate collaborative management or referral
• Implementation and documentation of an individualized management plan
• Documentation of maternal education regarding signs and symptoms of preterm labor
• Involvement of patient and family members in decision-making
• Education regarding anticipated outcomes, benefits and risks of treatments, potential side effects and alternatives
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate
  

Intrapartum Liability Risk Reduction Strategies:

• Documentation of a comprehensive history and physical examination
• Identification of risk by initial and interval assessments
• Counseling and education regarding expectations and individual risks for birth
• Assessment and documentation of gestational age, fetal maturity, presentation and estimated fetal weight
• Utilization of appropriate laboratory and imaging studies and surveillance methodology
• Utilization of appropriate tocolytic interventions, tocolytic medications, and medications to enhance fetal maturity
• Ongoing evaluation of labor pattern and fetal and maternal well-being
• Determination of location and route of birth based upon neonate’s risk of morbidity/mortality and maternal /family informed consent
• Management of preterm labor and delivery in accordance with practice and/or institutional guidelines
• Maternal/family education regarding risks and expectations for delivery of a preterm infant
• Education regarding anticipated outcomes, benefits and risks of treatments, potential side effects and alternatives
• Thorough documentation including the informed consent process
• Provision for immediately available maternal/neonatal resuscitation and life support
• Documentation of consultation, collaborative management, and/or referral as appropriate

Postpartum Liability Risk Reduction Strategies:

• Assessment of maternal and infant status
• Utilization of appropriate level of neonatal care
• Evaluation, management, and follow-up of maternal complications
• Assistance with maternal efforts to establish and maintain lactation
• Facilitation of maternal/family attachment
• Documentation of education concerning needs and care of the mother and infant
• Education regarding benefits and risks of treatments, potential side effects and alternatives
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate

Source: ACNM DOSP Professional Liability Section
Approved: 11/93
Revised: 12/03