Minnesota Hospital Association

Patient Safety

Obstetrics and Newborn

Dr. N. and babyWhile many women do not experience complications with the birth of a child, labor and delivery raise several risks for both mother and infant. And obstetrical adverse events during this time can result in severe harm. According to the U.S. Department of Health & Human Services’ Partnership for Patients initiative, obstetrical adverse events occur in approximately 9 percent of all U.S. deliveries. These include perineal tears, hemorrhaging or even death for the mother and injuries to the skeleton or spinal cord of the infant as well as some neonatal intensive care unit admissions.

While not all adverse obstetrical events are preventable, some are. Obstetrical adverse events are one of the 10 areas of focus to improve quality of care and patient safety through the Partnership for Patients Hospital Engagement Network.

Download the Road Map to a Perinatal Patient Safety Program and its component, Perinatal Injuries Gap Analysis.


Ending Early Elective Deliveries

The health and safety of hospitals’ smallest patients is of the utmost importance and helping newborns get a strong start improves their health and well being later in life. Research shows that important development takes place to a baby’s brain and lungs during the last few weeks of pregnancy, yet according to the Centers for Medicare and Medicaid Services (CMS), early elective deliveries still account for 10 to 15 percent of all deliveries nationally. According to CMS, decreasing the rate of early elective deliveries means:

  • More mothers get safe, evidence-based care.
  • Infants improve their chances for good physical and developmental health.
  • Lower costs for public and private payers because there are fewer caesarian sections performed, they have less neonatal intensive care unit admissions, and less associated complications for the newborns.

Hospitals in Minnesota and across the nation are working to end elective deliveries prior to 39 weeks gestation, unless medically necessary. In fact, a law that took effect Jan. 1, 2012, requires hospitals in Minnesota to:

  • Implement policies and processes designed to minimize non-medically necessary inductions before 39 weeks gestation.
    • Hospitals must have a hard-stop policy in place restricting inductions before 39 weeks, which applies to all births.
    • A policy that encourages providers to document final estimated date of delivery by 20 weeks gestation (including data from ultrasound measurement as applicable). This final estimated due date must be shared with the patient.
    • A policy that encourages patient education regarding elective inductions and requires documentation of the education patients receive.
  • Report induction of labor data for all births covered by Minnesota Health Care Programs. Hospitals need to submit the policy to the Department of Human Services for verification. If the hospital does not have a policy in place, or the policy has not been verified, delivering providers must include a form with each delivery claim when the delivery.

Nearly all Minnesota birthing hospitals have adopted a hard stop policy, as required by law, restricting inductions prior to 39 weeks unless medically necessary. Minnesota hospitals have placed a strong focus on eliminating early elective deliveries and from 2010 through third quarter 2013, hospitals have reduced the number of elective deliveries prior to 39 weeks gestation by 92 percent. Click to expand the box below to view Minnesota hospitals who have been recognized for reducing early elective deliveries.

Tool Kit for Hospital Staff

This tool kit provides best practices that hospitals can use to implement the Perinatal Safety Road Map recommendations in their facilities. (Download the road map and its component.) Hospitals may copy, translate, distribute and present the following items as long as you reference the Minnesota Hospital Association as the source of this material. If the tool is hospital-specific, please also cite the hospital as a source.

Safety Teams and Organizational Structure

Access to Information

Facility Expectations

Engagement of Patients and Families

Patient Education

Elective Delivery

 Fetal/Uterine Assessment

Operative Vaginal Delivery

Maternal/Obstetric Mortality Reduction Strategies
1) Management of Hypertensive Emergencies:

2) Post-partum hemorrhage:

3) VTE Prevention

4) Peri-perative Infection Prevention Strategies

 5) Maternal Mortality Reporting

Trial of Labor after Previous Cesarean Section

ACOG Practice Bulletin No. 115, Aug. 2010, Vaginal Birth After Cesarean

ACOG Patient Safety Checklist No. 8, Nov. 2012, Appropriateness of Trial of Labor After Caesarean (Antepartum Period)

ACOG Patient Safety Checklist No. 9, Nov. 2012, Trial of Labor after Cesarean (Intrapartum Admission ) 

AAFP Guideline on Trial of Labor after Cesarean (TOLAC)

Physician and Nurse Training

Miller, Kristi. et. al., In situ simulation: a Method of Experiential Learning to Promote Safety and Team Behavior. J Perinat Neonat Nurs Vol. 22, No. 2, pp. 105–113

Miller, Lisa A; Miller, David A.; Tucker, Susan M  Mosby’s Pocket Guide to Fetal Monitoring:  A Multidisciplinary Approach. Seventh edition, 2013.

SnyderHansen, Sara, and Arafeh, Julie. Implementing and Sustaining in situ Drills to Improve Multidisciplinary Health Care Training. JOGNN 41, 559-571; 2012

Miller, Lisa A., Miller, David, Electronic Fetal heart Rate Monitoring: Applying Principles of Patient Safety, AJOG, April 2012

CORE II - general staff privileges in OB/GYN

Neonatal Abstinence Syndrome

Resources available on Minnesota Prematurity Coalition website

63 hospitals recognized for reducing early elective deliveries

MHA and the March of Dimes presented the following hospitals with a banner to display in their hospital for reducing early elective deliveries. Banner recipients were determined by reviewing the MHA Perinatal Safety Roadmap and Early Elective Delivery outcome data submitted to the Patient Safety Registry. All recipients had less than a 5 percent early elective delivery rate for four quarters, a hard stop policy with clearly defined medical indications for deliveries less than 39 weeks, and a process to monitor the scheduling of Cesarean sections and inductions of labor prior to 39 weeks gestational age.

Abbott Northwestern Hospital, Minneapolis
Avera Marshall Regional Medical Center
Buffalo Hospital
Cambridge Medical Center
CentraCare Health - Long Prairie
CentraCare Health - Melrose
CentraCare Health - Sauk Centre
Chippewa County-Montevideo Hospital
Community Memorial Hospital, Cloquet
Cuyuna Regional Medical Center, Crosby
District One Hospital, Faribault
Essentia Health St. Mary's Medical Center-Detroit Lakes
Essentia Health-Fosston
Essentia Health-St. Joseph's Medical Center, Brainerd
Essentia Health-St. Mary's Medical Center, Duluth
Fairview Lakes Health Services, Wyoming
Fairview Northland Medical Center, Princeton
Fairview Ridges Hospital, Burnsville
Fairview Southdale Hospital, Edina
Glencoe Regional Health Services
Grand Itasca Clinic and Hospital, Grand Rapids
Granite Falls Municipal Hospital & Manor
HealthEast St. John's Hospital, Maplewood
HealthEast St. Joseph's Hospital, St. Paul
HealthEast Woodwinds Health Campus, Woodbury
Hennepin County Medical Center, Minneapolis
Hutchinson Health
Lakeview Hospital, Stillwater
Lakewood Health System, Staples
LifeCare Medical Center, Roseau
Maple Grove Hospital
Meeker Memorial Hospital, Litchfield
Mercy Hospital, Coon Rapids
Mercy Hospital, Moose Lake
New Ulm Medical Center
Northfield Hospital
North Memorial Medical Center, Robbinsdale
Olmstead Medical Center, Rochester
Ortonville Area Health Services
Owatonna Hospital
Park Nicollet Methodist Hospital, St. Louis Park
Perham Health
Rainy Lake Medical Center, International Falls
Redwood Area Hospital, Redwood Falls
Regina Hospital, Hastings
Regions Hospital, St. Paul
Rice Memorial Hospital, Willmar
Ridgeview Medical Center, Waconia
River Falls Area Hospital, River Falls, WI.
Riverwood Healthcare Center, Aitkin
Sanford Canby Medical Center
St. Cloud Hospital
St. Francis Regional Medical Center, Shakopee
St. Gabriel's Hospital, Little Falls
St. Joseph's Area Health Services Inc., Park Rapids
St. Luke's Hospital, Duluth
Tri-County Health Care, Wadena
United Hospital District, Blue Earth
United Hospital, St. Paul
Unity Hospital, Fridley
University of Minnesota Medical Center, Fairview, Minneapolis
Windom Area Hospital