Confronting safety gaps across labor and delivery teams

David G. Maxfield, Audrey Lyndon, Holly Powell Kennedy, Daniel F. O'Keeffe, Marya G. Zlatnik

Research output: Contribution to journalReview articlepeer-review


We assessed the occurrence of 4 safety concerns among labor and delivery teams: dangerous shortcuts, missing competencies, disrespect, and performance problems. A total of 3282 participants completed surveys, and 92% of physicians (906 of 985), 93% of midwives (385 of 414), and 98% of nurses (1846 of 1884) observed at least 1 concern within the preceding year. A majority of respondents said these concerns undermined patient safety, harmed patients, or led them to seriously consider transferring or leaving their positions. Only 9% of physicians, 13% of midwives, and 13% of nurses shared their full concerns with the person involved. Organizational silence is evident within labor-and-delivery teams. Improvement will require multiple strategies, used at the personal, social, and structural levels.

Original languageEnglish (US)
Pages (from-to)402-408.e3
JournalAmerican Journal of Obstetrics and Gynecology
Issue number5
StatePublished - Nov 2013


  • communication
  • organizational silence
  • patient safety
  • psychological safety

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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