Organizational strategies to optimize women’s safety during labor and birth: A scoping review

Abstract

Safety is a priority for organizations that provide maternity care, however, preventable harm and errors in maternity care remain. Maternity care is considered a high risk and high litigation area of health care. To mitigate risk and litigation, organizations have implemented strategies to optimize women's safety. Our objectives were to identify the strategies implemented by organizations to optimize women's safety during labor and birth, and to consider how the concept of safety is operationalized to measure and evaluate outcomes of these strategies. This scoping review was conducted using the Joanna Briggs Institute Scoping Review Methodology. Published peer-reviewed literature indexed in CINAHL, Medline, and Embase, databases from 2010 to 2020, were reviewed for inclusion. Fifty studies were included. Data were extracted and thematically analyzed. Three categories of organizational strategies were identified to optimize women's safety during labor and birth: clinical governance, models of care, and staff education. Clinical governance programs (n=30 studies), specifically implementing checklists and audits, models of care, such as midwifery led-care (n=11 studies), and staff training programs (n=9 studies), were predominately for the management of obstetric emergencies. Outcome measures included morbidity and mortality for woman and newborns. Three studies discussed women's perceptions of safety during labor and birth as an outcome measure. Organizations utilize a range of strategies to optimize women's safety during labor and birth. The main outcome measure used to evaluate strategies was focused on clinical outcomes for the mother and newborn.