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According to the March of Dimes, a maternity care desert is any county in the U.S. without a hospital or birth center offering obstetric care and without any obstetric providers. In their 2022 report, Nowhere to go: Maternity Care Deserts Across the U.S., they estimate that more than 2.2 million women of childbearing age live in a maternity care desert (1,119 counties).
In maternity care deserts, there’s a higher risk for poor maternal and infant health outcomes. The report shows that in the U.S., an average of two women die every day from complications of pregnancy or childbirth, and two babies die every hour.
Their 2023 report, Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity, shows access to maternity care worsening with a 4% drop in birthing hospitals. Nationwide, more than 400 maternity services closed between 2006 and 2020.
In a review of our malpractice claims, diagnostic error is the #1 most frequent allegation and #1 most costly in emergency department (ED) claims; obstetrical (OB) claims are third in total cost despite representing only 4% of claims.
A 30-year-old woman presented to the ED of her local hospital four days postpartum with complaints of severe pain in her vagina, fever and a swollen perineum. She had a history of a 3rd-degree perineal laceration during delivery. She was examined by a nurse practitioner (NP) who noted a high white blood count (WBC) and low platelet count. The NP ordered an ultrasound that showed no products of conception were present, and the radiologist suggested a diagnosis of endometriosis. The NP discharged the woman with a diagnosis of endometriosis after prescribing IM Rocephin, an oral antibiotic and lidocaine for her perineum pain. The NP instructed the woman to follow up with her regular physician the next day.
The next day, the patient presented to the same ED with complaints of fainting, pain, nausea, dizziness, fever and swelling of her abdomen and legs. She was transferred to a tertiary hospital and was admitted to the ICU with a diagnosis of sepsis. Despite IV antibiotics and IV fluids, her condition deteriorated. A surgical consult was ordered, and she was taken to the operating room for a hysterectomy. She did poorly following surgery and died the next day. Her family filed a malpractice claim against the NP and the hospital for failing to timely diagnose and treat sepsis, resulting in death. The experts who reviewed the care were critical of the NP for failing to note the low platelet count, failing to refer the woman to a physician and for failing to timely diagnose and treat sepsis. The case was closed with a payment to the patient’s husband.
Many smaller and rural hospitals have stopped providing OB services due to low birth volumes, low reimbursement, staffing challenges and rising costs. However, just because a hospital has stopped offering OB services doesn’t mean there will be no deliveries or OB care, such as treating pregnant women in hypertensive crisis with postpartum hemorrhage or sepsis in the ED.
“It’s not just the process of having skilled clinicians and equipment to deliver a baby that makes it risky, but also before and after delivery. When a community lacks experienced clinicians and care teams with the appropriate education, training and monitoring equipment, the risk of failing to timely diagnose conditions (such as sepsis, as the case study illustrates) is much higher.”
Brandi Seys, Senior Risk Consultant at Curi and ERC Risk Solutions
Our risk reports analyze malpractice claim data on various topics and specialties, including family medicine, emergency medicine and obstetrics. Each risk report shares insights to help reduce harm events and malpractice claims.
Are you a client? Sign in to MyAccount to access exclusive client versions of our risk reports. The expanded risk reports share actionable insights and strategies you can utilize to help reduce harm events and malpractice claims. After you sign in to MyAccount, follow Risk Resources > Tools & Resources > Publications > Risk Reports. You also have access to a host of Bundled Solutions (in Risk Resources) that cover a wide variety of topics, such as obstetrics and preventing diagnostic error, to assist you in your risk mitigation efforts.
Resources
A review of our anesthesia malpractice claims reveals that most claims are related to improper patient management and involve technical skill issues, including known procedural risks. Learn strategies that can help reduce anesthesia-related harm.
Healthcare worker reports of bullying, verbal abuse and other “bad behaviors” from patients, families and coworkers have doubled since 2018. Learn how to protect your team.
Learn how to reduce malpractice risk in maternity care deserts—where there’s a higher risk for poor maternal and infant health outcomes.