Are unintentional nurse-attended deliveries a patient safety issue?

Abstract

Unintentional nurse-attended deliveries occur on most labor and delivery units. Some precipitous deliveries are unavoidable, but others, occurring after admission with the expectation that the woman's designated provider would attend the delivery are, for a variety of reasons, still attended only by nursing staff. This study was undertaken to establish a benchmark for unintentional nurse-attended deliveries. Fifty perinatal units were studied with respect to their statistics regarding unintentional nurse-attended deliveries. Ten of the 50 perinatal units (20%) did not keep statistics on unintentional nurse-attended deliveries. The average percentage of unintentional nurse-attended deliveries in the 40 perinatal units that did keep this statistic was 1.38% (range 0-5.3%). This benchmark should be useful as the safety issues for these types of deliveries are analyzed. Audits regarding timing of examinations during labor, practices regarding notification of providers and other communication practices, provider arrival times, and involved personnel should help perinatal units develop policies, protocols, and strategies to minimize the chances for unintentional nurse-attended deliveries when there should be enough time and appropriate communication to allow the woman's provider to be present at the delivery.