Are Current Measures of Neonatal Birth Trauma Valid Indicators of Quality of Care?

P Kumar; L-A Papile; K Watterberg


J Perinatol. 2015;35(11):903-906. 

In This Article

Opportunities for Change and Research

The limitations detailed above underscore the need for clear, consistent definitions and a reliable, feasible approach to determine the birth trauma rate before it can be used as a benchmark for comparison of the quality of obstetric care delivered across different providers, institutions and regions of the country. It is also important that the denominator include all live births, regardless of gestation, transfer or death prior to discharge. As birth traumas vary greatly in severity and extent, as well as in long-term consequences, these differences must be acknowledged to improve the scientific acceptability and usability of birth injury as a performance indicator. Therefore, we propose a classification of birth traumas based on severity and potential impact on functional outcome (Figure 1). This classification can allow a more objective assessment of birth traumas and provide a framework for conducting root-cause analyses.

Figure 1.

A proposed framework to evaluate neonatal birth injury based on extent, severity and outcome of injury.

More research is also needed to address some of the significant knowledge gaps in this field, such as the true background rate of neonatal birth trauma after an uncomplicated vaginal delivery, the proportion of birth traumas that remain undiagnosed using the current system, and potential unintended consequences of proposed strategies to reduce rates of birth traumas.

In recent years, several novel approaches, such as Adverse Outcome Index, Weighted Adverse Outcome Score and Severity Index, have been proposed to assess the quality of obstetric care.[17,19,20] These strategies use a comprehensive, multicomponent patient safety indicator comprised of inter-related maternal and neonatal outcomes to compare quality of care. These tools can be especially useful for avoiding some of the unintended consequences of an initiative to reduce one single-adverse outcome. Nonetheless, prospective evaluations of these multicomponent patient safety indicators will be necessary before these can be accepted as a valid measure of quality of care. We also recommend that in addition to outcome measures, process measures, such as implementation of practices intended to reduce birth traumas, should be part of any future report card.