Maureen Corry

To understand the experiences and views of childbearing women in the United States and trends over time, Childbirth Connection carried out the third national Listening to Mothers survey among 2,400 women who gave birth in U.S. hospitals to a single baby from mid-2011 to mid-2012 and could participate in English. Harris Interactive conducted the survey using a validated methodology that includes data weighting to ensure that results closely reflect the target population. Results of the initial survey describe experiences from before pregnancy through the early postpartum period, and were reported in Listening to Mothers III: Pregnancy and Birth. A follow-up survey directed to the same participants explored postpartum experiences, attitudes about maternity care, and some additional pregnancy and birth items.

The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or those who pay for maternity care. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are unlikely to meet the proposed criteria and contribute to needed improvements. A companion paper considers more promising strategies. We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability, when available, and considered other studies when unavailable. Fifteen strategies seem to have little potential to improve liability matters in maternity care. Despite support for capping non-economic damages, a series of studies has found a modest impact at best on maternity care. Maternity-specific studies also do not lend support to tort reforms collectively and several other specific tort reforms. Some tort alternative and liability insurance reform strategies have narrow aims and are not policy priorities. Caps on non-economic damages and other tort reforms have narrow aims and have been marginally effective at best in the context of maternity care. Several other possible reforms similarly are not promising. Continued focus on these strategies is unlikely to result in the high-performing liability system that maternity care stakeholders need.

This paper summarizes a new report presenting the best available research about the impact of the liability environment on maternity care, and policy options for improving this environment. Improved understanding of these matters can help to transcend polarized discourse and guide policy intervention. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable. The best available research does not support a series of widely held beliefs about maternity care and liability, including the economic impact of liability insurance premiums on maternity care clinicians, the existence of extensive defensive maternity care practice, and the impact of limiting the size of awards for non-economic damages in a malpractice lawsuit. In the practice of an average maternity caregiver, negligent injury of mothers and newborns seems to occur more frequently than any claim and far more frequently than a payout or trial. Many important gaps in knowledge relating to maternity care and liability remain. Some improvement strategies are likely to be more effective than others. Empirical research does not support many widely held beliefs about maternity care and liability. The liability system does not currently serve well childbearing women and newborns, maternity care clinicians, or those who pay for maternity care. A number of promising strategies might lead to a higher functioning liability system, whereas others are unlikely to contribute to needed improvements.

... Carol Sakala and Maureen P. Corry Co-published by Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund October 2008 ... References The Authors Selected Publications of the Milbank Memorial Fund Selected Publications of Childbirth Connection ...