Safety team cuts birth trauma rates 93%

Any risk manager with hopes of reducing birth trauma rates should look to The Seton Family of Hospitals, based in Austin, TX, for lessons in what can yield dramatic results. The system, which includes eight hospitals in central Texas as well as other clinics, is seeing great success with an initiative to reduce preventable birth injuries.

The program resulted in a 93% reduction in birth trauma rates from 0.3% for 2001-2003 to 0.02% in 2006, says Seton President and CEO Charles J. Barnett.

"We were already at about half the national birth trauma rate, but we knew we needed to do better," he says. "Through the good work of our nurses and physicians, we've been able to reduce our rates even more. In fact, over the past year, we've experienced zero birth traumas, which is truly remarkable."

The Seton initiative began with the formation of the Perinatal Safety (PNS) team, a multidisciplinary workgroup, Barnett says. An analysis completed by both PNS and an intensive failure mode and effect analysis (FMEA) workgroup of physicians and nurses identified high-risk elements of the process. New protocols and policies were instituted, including no vacuum delivery prior to 36 weeks gestation, no combined usage of vacuum and forceps, and no elective induction prior to 39 weeks gestation.

In addition to reducing birth trauma rates, Seton decreased prematurity rates to 0.16% in 2004-2006 from 0.25% in 2001-2003; reduced instrumented delivery rate to 4.7% in 2004-2006 from 7.4% in 2001-2003; and reduced elective labor inductions prior to 39 weeks of gestational age to zero by October 2005, down from 3.2%.

The latest results from Seton show continuing improvement, says Frank Mazza, MD, a pulmonary and critical care physician with Seton who was a leader of the team to reduce birth trauma. Data recently published by Mazza and his colleagues show the rate of vacuum and forceps delivery at the end of 2007 was 4.1%. During the first three project years (fiscal years 2004 to 2006), the average length of stay for infants admitted to the neonatal intensive care unit for birth injury declined by 80% compared with the previous three years, from 15.8 to 3.1 days.

The effort began in October 2003, Mazza says. An interdisciplinary team from the four hospitals that provide obstetrical services met monthly to develop best practices to be used throughout the system. The team continues to meet monthly to share results and review the best practices.

Forceps and vacuum deliveries were an immediate focus because of the potential for causing birth trauma in an effort to speed the delivery. When the team implemented the protocols that sharply restrict the use of those two methods, it made clear that the rules were mandatory.

"We saw an immediate and dramatic drop in our birth trauma associated with assisted delivery," he says. "That impressed the physicians and staff, but it also empowered our team by showing us that we were on the right track."

The team then tackled another issue that can drive risk managers to distraction: the induction of babies before full term, which can greatly increase the risk of complications related to prematurity. Once the rule was implemented to prohibit inductions before 39 weeks, Seton saw a dramatic drop in prematurity. That led to a dramatic cost savings in the neonatal intensive care unit (NICU).

"We went from $4 million per year for babies that had iatrogenic prematurity, to $186,000, literally a 93% reduction in costs for taking care of these babies," Mazza says. "We did the right thing for the patient, but we killed the costs in that area, too. The risk managers loved it."

The Seton team then tackled other causes of birth trauma and got the number of incidents down to zero for about 15 months, even though the system does more than 10,000 deliveries a year. There were an average of 29 birth traumas per year in the Seton system before the project began, Mazza says.

"The efforts to reduce birth trauma also have resulted in a dramatic reduction in our insurance premiums," Mazza says. "So much risk is concentrated in the perinatal area, and achieving such dramatic drops in birth trauma can produce a significant, tangible result for the organization."


1. Mazza F, Kitchens J, Akin M, et al. The road to zero preventable birth injuries. Jt Comm J Qual Patient Saf 2008; 34:201-205.


For more information on the Seton effort to reduce birth trauma, contact:

  • Charles J. Barnett, President and CEO, The Seton Family of Hospitals, Austin, TX. Telephone: (512) 324-7000. E-mail:
  • Frank Mazza, MD, Pulmonary and Critical Care Physician, The Seton Family of Hospitals. Telephone: (512) 459-6599. E-mail: