Absent a scheduled cesarean section, women generally have no choice over the specific time they will deliver their baby. According to a recent study, the specific time a baby is delivered can have a significant impact on whether the delivery may result in a birth injury. The study found that there is a 32 percent to 47 percent greater likelihood of a birth injury or death during the night shift compared to daytime deliveries. These higher rates of birth injury and death not only compromise patient safety, they increase the number of costly medical malpractice lawsuits--particularly those that result in brain damage.
The recent birth injury study involved more than 700,000 births at all Dutch hospitals between 2000 and 2006. Researchers found that newborns born at small community hospitals between the evening and early morning hours, meaning between 6 pm and 8 am, were 32 percent to 47 percent more likely to die or suffer a birth injury than those born during the day. With larger hospitals, the rate of birth injury or newborn death was less pronounced during the night shift though the rate was still definitely higher compared to the daytime.
According to the study, there are two potential explanations for why birth injuries are higher at night. One explanation is that staff makeup is different during the day compared to the night shift. Unlike during the day, there are fewer senior staff members like neonatologists, obstetricians, and anesthesiologists present at night in hospitals. Thus, initial decisions about how to manage a delivery are often made by a resident physician--doctor who is still in training--rather than a more experienced physician. Another explanation for increased birth injuries and deaths at night and early morning hours is fatigue. That is, doctors and medical staff who work the night shift may experience increased fatigue because these hours run against the body's natural sleep rhythm.
Assuming physician experience and/or fatigue influence the higher rates of birth injury and death at night, how do hospitals use this information to create a safer system for nighttime deliveries? Regarding experience, hospitals should provide at least one hospital obstetrician and/or other specialist to during the night shift if at all feasible. Regarding fatigue, there have been plenty of studies showing the important relationship between proper sleep and effective job performance. Resident training programs must ensure residents are receiving sufficient sleep to perform their job properly. To the extent inexperienced and/or fatigue are driving higher birth injuries and deaths at night, hospitals should respond with appropriate precautions if they wish improve patient safety and reduce the number of medical malpractice lawsuits.
Reuters, Birth Complications More Common At Night, June 11, 2010.