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Midwifery Strategies for Liability Risk Reduction

The purpose of Strategies for Liability Risk Reduction is risk management: the recognition of conditions, situations, and outcomes that may be associated with professional liability claims. Once these risks are recognized, clinical and administrative practices are identified which enhance patient care, decrease professional liability claims, and/or increase the defensibility of a claim.

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.

Risk reduction strategies highlight areas that require midwifery attention and appropriate responses. Strategies are designed to reduce the risks of a negative outcome for the patient and to decrease the risk of a cause of action against the midwife. Strategies do not mandate specific clinical interventions; rather, they serve as guidelines.

For ease of use, Strategies for Liability Risk Reduction are organized according to areas of practice.

General Liability Risk Reduction Strategies:

• Individualized risk assessment based on a comprehensive history and physical examination,
  appropriate laboratory, imaging studies, and other surveillance methods
• An individualized management plan
• Involvement of patient and family members in decision-making
• Education regarding 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

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 risk by initial and interval assessments
• Counseling for individual risks
• Implementation and documentation of an individualized management plan
• 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
• Ongoing evaluation of labor pattern and fetal and maternal well-being
• Determination of location and route of birth based on assessment of risk
• Management of labor and delivery in accordance with practice and/or institutional guidelines
• 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 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

Well-Woman Liability Risk Reduction Strategies:

• Performance and evaluation of a comprehensive history and physical examination
• Utilization of appropriate laboratory and imaging studies and surveillance methodology
• Identification of risk by initial and interval assessments based on recommended guidelines
• Counseling and education regarding individual risks
• Implementation and documentation of an individualized management plan
• 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: 6/96
Revised: 12/03