MIDWIFERY STRATEGIES FOR
LIABILITY RISK REDUCTION IN INFORMED CONSENT

The purpose of Midwifery Strategies for Liability Risk Reduction in Informed Consent is risk management: the recognition of conditions and situations where special attention should be given to client education and informed consent.

Risk reduction strategies are neither a form of clinical education nor a set of mandatory standards or protocols. Rather, they are recommendations for increased awareness and/or focus, improved communication and/or documentation, and reinforcement of the management process. Strategies do not mandate specific clinical interventions; rather, they serve as guidelines.

General Liability Risk Reduction Strategies:

• Individualized risk assessment based on a comprehensive history and physical examination, appropriate laboratory, imaging studies, and other surveillance methods. This risk assessment is shared with the client
• An individualized management plan formed with the participation of the client
• Involvement of patient and family members in decision-making with the consent of the patient
• Education and counseling regarding benefits and risks of treatment options, potential side effects and alternatives
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate

Antepartum Liability Risk Reduction Strategies:

• Identification of risk by initial and interval assessments
• Education and counseling regarding individual risks based on performance and evaluation of a comprehensive history and physical examination, utilization of appropriate laboratory studies and antepartum maternal and fetal surveillance, and assessment of nutritional status
• Implementation and documentation of an individualized management plan
• Involvement of patient and family members in decision-making, as appropriate
• Education and counseling regarding potential fetal anomalies, fetal screening options, fetal treatment options, and the benefits and risks of treatment
• Education and counseling regarding potential maternal and fetal complications during pregnancy, labor, and birth
• Education and counseling regarding anticipated outcomes, benefits and risks of treatment options, potential side effects and alternatives
• Education and counseling regarding the potential site(s) of birth
• Education and counseling regarding infant nutrition options
• Education and counseling regarding providers who will be involved in prenatal care and levels of care given by different providers
• Education and counseling regarding providers who will be involved in newborn care and the levels of care given by different providers
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate

Intrapartum period Liability Risk Reduction Strategies:

• Education and counseling regarding expectations and individual risks for birth
• Determination of location and route of birth based on assessment of risk
• Education and counseling regarding anticipated outcomes, benefits and risks of treatment options, potential side effects and alternatives
• Education and counseling regarding providers who will be involved in the labor and birth and levels of care given by different providers
• Thorough documentation including the informed consent process
• Education and counseling regarding the availability of maternal/neonatal resuscitation and life support
• Documentation of consultation, collaborative management, and/or referral as appropriate

Postpartum Liability Risk Reduction Strategies:

• Documentation of education concerning needs and care of the mother and infant
• Education and counseling regarding benefits and risks of treatment options, potential side effects and alternatives
• Education and counseling regarding providers who will be involved in the postpartum period and levels of care given by different providers
• Documentation of education concerning needs and care of the mother and newborn
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate Newborn Liability Risk Reduction Strategies:
• Provision of resuscitation by appropriately trained professionals
• Identification of risk by initial physical assessment
• Education and counseling of parents regarding providers who will be involved in newborn care and the levels of care given by those providers
• Education and counseling of parent regarding screening, treatment options, and benefits and risk of treatment options
• Education and counseling of parents regarding infant nutrition options
• Formation, implementation, and documentation of an individualized management plan
• Education and counseling of parents regarding follow-up care
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate

Primary Care Liability Risk Reduction Strategies:

• Identification of risk by initial history and physical exam and interval assessments based on recommended guidelines
• Education and counseling regarding individual risks
• Implementation and documentation of an individualized management plan formed with the participation of the client based on findings during initial and interval assessments
• Education and counseling regarding recommended screening and treatment guidelines
• Education and counseling regarding benefits and risks of treatment options, potential side effects and alternatives
• Education and counseling regarding providers who will be involved in well-woman care and levels of care given by different providers
• Thorough documentation including the informed consent process
• Documentation of consultation, collaborative management, and/or referral as appropriate

Disclaimer: This statement was developed by the Division of Standards and Practices,
Professional Liability Section of the American College of Nurse-Midwives (ACNM). This is not intended to dictate an exclusive course of management nor to substitute for individual or professional judgment. It presents recognized methods and techniques on clinical practice, which midwives may consider incorporating into their practices. The needs of an individual patient or the resources and limitations of an institution or type of practice may appropriately lead to variations in clinical care.

Source: ACNM DOSP Professional Liability Committee
Approved: ACNM Board of Directors September, 2004