A Policy Matters Focus on Maternity Care and Liability

Abstract

Three years ago, Women's Health Issues published a special Transforming Maternity Care supplement with two direction-setting consensus reports: “2020 Vision for a High-Quality, High-Value Maternity Care System” and a “Blueprint for Action” to chart the path toward such a system. These reports emerged by consulting and involving leaders from across the U.S. health care system in multi-stakeholder, multidisciplinary, deliberative processes. The project, which continues in its implementation phase as Childbirth Connection's Transforming Maternity Care Partnership (available: http://transform.childbirthconnection.org), fosters a system that reliably delivers optimal maternity care to the nation's women, newborns, and families. From the initial Transforming Maternity Care key informant interviews and steering committee deliberations, there was consensus that work to improve liability matters is a core focal area for achieving a high-performing maternity care system. This Policy Matters section on Maternity Care and Liability advances the Blueprint's priority recommendations for Improved Functioning of the Liability System. The three articles in this section are derived from a larger report that Childbirth Connection is issuing simultaneously: Maternity Care and Liability: Pressing Problems, Substantive Solutions. Part I of that report looks broadly at how the liability system is impacting maternity care—with respect to liability insurance underwriting, availability, and affordability; claims and lawsuits involving maternity care; incidence of negligent injury and compensation for claims; defensive maternity care practice; career satisfaction and maternity care quality; and impact on maternal and newborn health outcomes (deterrent effect). This broad look led us to identify seven aims of a high-functioning liability system for maternity care as a framework for assessing merits of possible interventions. Part II holds 25 possible interventions up to this framework, identifying 15 that have not contributed or are not likely to contribute to diverse aims of a well-functioning liability system, and 10 that hold promise for meeting multiple aims and either preventing or responding well to possible harm. The report's best evidence approach uses empirical legal studies and health services research specific to maternity care when available, and other studies when unavailable. A lengthy appendix identifies many important questions that warrant further research, and a second provides concise fact sheets about a series of key issues for policy makers and other stakeholders. The full report is available at http://transform/childbirthconnection.org/reports/liability/. The open access Policy Matters articles published here make results of the full report readily accessible to a large audience. The first of three articles presents an overview of the full report (minus appendices), with key citations. The second article considers the strategies for improvement that do not hold up well to the seven criteria for a high-functioning liability system in maternity care. The third article considers strategies that seem to meet multiple aims of a high-functioning system and are candidates for demonstration and evaluation within states, health systems, or other appropriate entities. We are honored that Professors Sara Rosenbaum and William Sage have contributed a thoughtful and insightful commentary on these papers. We are once again grateful for the opportunity to work with editor Anne Markus and her Women's Health Issues team on pressing maternity care policy issues. We are also grateful to the Milbank Memorial Fund for financial support for the full report and to the many policy, academic, and clinical leaders who provided thoughtful appreciated feedback on a draft of the full report. For their helpful feedback, which enabled us to further improve our work, we thank the referees of the three articles that appear here, Paul Gluck, MD, and Kathleen Rice Simpson, PhD, RNC. These national quality and safety leaders served on the Transforming Maternity Care Steering Committee and Vision Team, respectively, and have again helped to further those efforts toward a high-functioning maternity care system. Carol Sakala, PhD, MSPH, is Director of Programs at Childbirth Connection, New York, where she works to improve the quality and value of maternity care through consumer engagement and health system transformation.