Maternal Malpractice Claims: Learning From the Past, Planning a Safer Future

Maternal morbidity and mortality continue to raise significant concerns in the United States. Following a sharp rise in rates from 2018 to 2022, the U.S. maternal mortality rate has decreased. However, racial disparities persist, with Black women experiencing more maternal deaths per 100,000 live births than White, Asian, and Hispanic women together.

This analysis of medical malpractice claims evaluated allegations related to maternal morbidity and mortality, maternal injuries, and contributing factors with the aim of informing practitioners and thereby improving care.

Study Design

This study was descriptive and exploratory, utilizing an evidence-based taxonomy.¹ The analysis included The Doctors Company’s medical professional liability closed claims spanning the loss years of 2010 through 2023.

Selection criteria were: Major responsible service of obstetrics; major allegation; injury severity; major injuries with focus on maternal injury; contributing factors; primary drivers; the practice setting of the event that precipitated the malpractice allegation; average indemnity paid, if any; procedures, comorbidities, diagnostic tests, and/or medications involved, if any.

Study Results

The study findings included:

• Injuries: High-severity injuries occurred in 47 percent of the studied claims, including the almost 20 percent of the claims that followed maternal deaths.
• Allegations: The top three allegations were improper management of the postpartum patient, improper management of pregnancy, and improper performance of an operative delivery.
• Contributing factors: The top three contributing factors from this analysis were clinical judgment (60 percent), technical skill (48 percent), and communication (38 percent).*
• Communication: The claims studied highlighted the consequences of inadequate communication with other practitioners and inadequate communication with the patient or family.
• Ongoing risks from preventable sources of harm: Hemorrhage was the most common major injury, and retained foreign body in OB-related treatment was the fourth most common allegation. Systems-based approaches can mitigate both of these risks.
• Financial impact: Almost 44 percent of the claims reported a paid indemnity. The average indemnity payment was close to $500,000, with a median payment of approximately $250,000.

Risk Mitigation Strategies

The following patient safety and risk mitigation strategies can help improve maternal care and patient outcomes:

Diagnostic Focus

• Some medical diagnoses of conditions unrelated to pregnancy were missed or delayed. Diagnosis is a process influenced by workplace systems, as well as social and cognitive factors.

Patient Assessment

• Ensure all staff members are trained in taking accurate blood pressure readings (using the correct-sized cuff, patient’s legs uncrossed, patient’s feet on the ground, etc.).
• Recognize that patient assessment involves patient education. Many women may not recognize the signs of preeclampsia.
• In instances where the clinical signs of hemorrhage were present, denial-based delays were common. Taking a cognitive pause may have made a difference.

Communication

• Establish a patient safety culture that is not punitive in nature and encourages speaking up. One tool is the Institute for Healthcare Improvement’s Situation-Background-Assessment-Recommendation (SBAR).
• Establish effective, quality communication between the practitioner and the patient.

Simulation and Patient Safety Bundles

• Perform drills and simulations on the most common complications. Evidence-based national safety bundles have been developed for a variety of clinical conditions. For example, see the Alliance for Innovation on Maternal Health Patient Safety Bundles.

Retained Foreign Bodies

• Retained foreign bodies are one of the most frequently reported sentinel events. The Joint Commission (TJC) recommends having a policy in place for handling surgical miscounts. The use of technology, such as radiography, computer-aided detection, magnetic retrievers, and sharp detectors, is also suggested when and where available.

Conclusion

We invite practitioners to apply this study’s insights in clinical practice and to share these findings with their healthcare teams and managers.

Download Study and Risk Mitigation Tips

Download study infographic

Read our related study on perinatal closed claims

*Events leading up to medical malpractice allegations may have multiple contributing factors. Therefore, percentages total more than 100 percent.