Avoidable Childbirth Injuries Remain an Issue at Hospitals

Injuries to babies also varied widely by geographic region, with those born in rural areas and the Northeast having 2 injuries per 1,000 deliveries versus those born in the West, 1.4, and those born in large metropolitan areas, 1.5.

White babies were injured more often (1.9 babies per 1,000) than babies in other racial groups (1.4 to 1.5 per 1,000 births.)

Hospital officials also couldn't explain some of the report's statistics. At Sharp Mary Birch Hospital for Women in San Diego, the hospital that delivers more babies than any other in California, 8,698 infants last year, Mary Henrikson, senior vice president and CEO, offered a few guesses.

For starters, rates of injury might be worse in hospitals "where you don't have 24/7 obstetrician coverage" in case complications arise. "Or maybe you have a physician using forceps who has never really gotten the technique," she says.

Henrikson says a hospital should own the responsibility for tracking down its own statistics so it can compare the facility with other hospitals and discover any potential problems.

"You've got to know the issues and know what you need to do to fix them," Henrikson says. "You need to know what's expected for your population, and if those numbers don't look right, start pulling those cases and look for trends, either with individual practitioners or with certain types of technology," she says.

"You may have started using a new type of vacuum extractor and the rates (of injuries) go up. If that's the only variable introduced in the situation, you may have to relook at what you buy to use," she adds.

An attorney who has won big money awards against hospitals in birth litigation also weighed in on the issue. Brian McKeen, former co-chair of the birth trauma litigation group for the American Association of Justice, was asked what he would do to lower obstetrical complications if he were a hospital CEO.

First and foremost, he says, he'd limit or stop allowing "young inexperienced doctors, some of them still in training" to be left alone when delivering a baby. "They don't always appreciate manifestations of fetal distress on the monitor and they don't always know that things are going awry," he says.

"In community hospitals, there's a pattern I see over and over again. The attending physician seems to think their role is to come in and catch the baby, and allow the nurses to oversee the management of labor and delivery," he adds.

Nurses also should be better educated, he says.

Most of all, however, is what he calls a failure of hospitals to perform appropriate introspective analysis of a case that went bad. "They should take these failures as a teaching opportunity to explain to the staff how they should be avoided."

Another issue that has brought lawsuits is what he describes as a failure of hospital staff to follow or even have appropriate chains of command when a patient's labor becomes troublesome. This could include "a chain of command that's regarded as hypothetical gobbledegook that's not really practiced in the real world. To the extent staff knows that there is one, they don't have a good understanding of when to invoke it or what steps are in the chain," he says.

Years ago, hospitals allowed physicians to rush to cesarean sections, sometimes for their own scheduling convenience. These days, he says doctors seem to want to avoid cesarean sections even when they're indicated, in part, because of a perception that they're associated with increased cost for the hospital and because now many hospitals are advertising their low c-section rates as a marketing tool, he adds.

"Have we gone too far the other way? Yes," McKeen says.