Your Pregnancy Matters

Ob/Gyn checklists can make pregnancy care safer

Your Pregnancy Matters

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Using checklists in Labor & Delivery free up the Ob/Gyn team to provide the foundational and personalized care you and your baby need.

Pregnancy care should be customized. Doctors should listen to your questions, concerns, and stories and incorporate your needs into the birth experience.

So, the thought of your Ob/Gyn using a checklist, where certain things are done the same way for every patient, might seem impersonal. Actually, the opposite is true.

Checklists for pregnancy care and delivery preparation create space for your care team to provide the personal attention you need in the moment. For example, we can prepare a checklist of special medical needs you might have – such as allergies to medications – so we can quickly, safely prevent complications and focus our energy on supporting you.

As medicine advances, clinical care becomes more complicated and it depends on countless actions performed the right way at the right time. Small omissions can lead to mistakes – even the best doctors and nurses are subject to human error. Checklists serve as memory aids or itemized lists of tasks to be completed during a specific process or procedure, such as a cesarean (C-section) delivery.

In pregnancy care, an effective checklist:

  • Breaks complex tasks into simpler components
  • Lists the essential (critical) steps in a process
  • Promotes consistency in performance
  • Specifies which tasks can be delegated

In the Labor & Delivery unit, checklists works so well that the Society for Maternal-Fetal Medicine even advocates for C-section delivery checklists to be modified to include newborn care. Using checklists helps us provide the safest pregnancy care for you and your baby.

Checklists for routine, high-risk deliveries

The push for using checklists in clinical practice started to gain traction in 2009, when two publications highlighted the benefits of using them. Dr. Atul Gawande published the Checklist Manifesto – a call for all medical providers to support the use of checklists to ensure all patients received appropriate care.

That same year, the New England Journal of Medicine published a study from eight hospitals around the globe that compared complication rates and deaths before and after the introduction of the World Health Organization’s Surgical Safety Checklist prior to non-cardiac surgeries. The results were striking – inpatient complications declined from 11% to 7%, while the death rate was nearly cut in half.

We use checklists in routine deliveries at UT Southwestern, and even more intently when we are preparing for a high-risk delivery. For example, our team of maternal-fetal medicine experts created several checklists in 2020 while preparing to deliver quadruplets by C-section for a patient who had a brain tumor. The checklists outlined which care team was paired with which baby, and what medications or other equipment each baby would need. On delivery day, the nurses, doctors, and surgeons were prepared for the extra-special deliveries.

Four babies and a brain tumor

After being diagnosed and treated for a rare form of glioma during her pregnancy, Katie Sturm delivered quadruplets at UT Southwestern William P. Clements Jr. University Hospital, with the help of more than 20 UTSW doctors, nurses, and providers.

Read their story

Special moments, standard checklists

Over the last decade, the use of checklists has expanded to nonsurgical patient care in obstetrics. I often hear from patients and other Ob/Gyns that Labor and Delivery is a “special zone” that shouldn’t necessarily follow the same checklist-based standards as other procedural areas of the hospitals. Childbirth can be beautiful and momentous, a time to gather loved ones and meet the newest members of the families.

There are special considerations in obstetric settings, but not because our operating rooms must be made gentler or less institutional. It’s because we have two patients to care for – you and your new baby.

We follow checklists for your safety, first and foremost. Using checklists to make sure our standard protocols are covered gives our birth team additional mental space to focus on supporting you and providing everything you want out of your birth experience.

When exploring options for a hospital to deliver your baby, ask about their safety protocols. And if you notice posters of checklists in a delivery room or operating room, don’t worry your care will be impersonal – that level of planning means the nurses and doctors are making your safety a priority.

To talk with an Ob/Gyn, call 214-645-8300 or request an appointment online.