The purpose of Strategies for Liability Risk Reduction is risk management: the recognition of conditions, situations, and outcomes that may be associated with professional liability claims. Once these risks are recognized, clinical and administrative practices are identified which enhance patient care, decrease professional liability claims, and/or increase the defensibility of a claim.
Risk reduction strategies are neither a form of clinical education nor a set of mandatory standards or protocols. Rather, they are recommendations for increased awareness and/or focus, improved communication and/or documentation, and reinforcement of the management process.
Risk reduction strategies highlight areas that require midwifery attention and appropriate responses. Strategies are designed to reduce the risks of a negative outcome for the patient and to decrease the risk of a cause of action against the midwife. Strategies do not mandate specific clinical interventions; rather, they serve as guidelines.
For ease of use, Strategies for Liability Risk Reduction are organized according to areas of practice.
General Liability Risk Reduction Strategies:
Individualized risk assessment based on a comprehensive history and physical examination,
appropriate laboratory, imaging studies, and other surveillance methods
An individualized management plan
Involvement of patient and family members in decision-making
Education regarding outcomes, benefits and risks of treatments, potential side effects and
alternatives
Thorough documentation including the informed consent process
Documentation of consultation, collaborative management, and/or referral as appropriate
Antepartum Liability Risk Reduction Strategies:
Performance and evaluation of a comprehensive history and physical examination
Assessment of nutritional status
Utilization of appropriate laboratory studies and antepartum surveillance methodology
Confirmation and documentation of estimated due date by 20 weeks gestation
Identification of risk by initial and interval assessments
Counseling for individual risks
Implementation and documentation of an individualized management plan
Involvement of patient and family members in decision-making
Education regarding anticipated outcomes, benefits and risks of treatments, potential side
effects and alternatives
Thorough documentation including the informed consent process
Documentation of consultation, collaborative management, and/or referral as appropriate
Intrapartum Liability Risk Reduction Strategies:
Documentation of a comprehensive history and physical examination
Identification of risk by initial and interval assessments
Counseling and education regarding expectations and individual risks for birth
Assessment and documentation of gestational age, fetal maturity, presentation and estimated
fetal weight
Utilization of appropriate laboratory and imaging studies and surveillance methodology
Ongoing evaluation of labor pattern and fetal and maternal well-being
Determination of location and route of birth based on assessment of risk
Management of labor and delivery in accordance with practice and/or institutional guidelines
Education regarding anticipated outcomes, benefits and risks of treatments, potential side
effects and alternatives
Thorough documentation including the informed consent process
Provision for immediately available maternal/neonatal resuscitation and life support
Documentation of consultation, collaborative management, and/or referral as appropriate
Postpartum Liability Risk Reduction Strategies:
Assessment of maternal and infant status
Utilization of appropriate level of neonatal care
Evaluation, management, and follow-up of complications
Assistance with maternal efforts to establish and maintain lactation
Facilitation of maternal/family attachment
Documentation of education concerning needs and care of the mother and infant
Education regarding benefits and risks of treatments, potential side effects and alternatives
Thorough documentation including the informed consent process
Documentation of consultation, collaborative management, and/or referral as appropriate
Well-Woman Liability Risk Reduction Strategies:
Performance and evaluation of a comprehensive history and physical examination
Utilization of appropriate laboratory and imaging studies and surveillance methodology
Identification of risk by initial and interval assessments based on recommended guidelines
Counseling and education regarding individual risks
Implementation and documentation of an individualized management plan
Education regarding benefits and risks of treatments, potential side effects and alternatives
Thorough documentation including the informed consent process
Documentation of consultation, collaborative management, and/or referral as appropriate
Source: ACNM DOSP Professional Liability Section
Approved: 6/96
Revised: 12/03
