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Labor Pains: Unraveling the Complexity of OB Decision Making

Hamilton, Emily MDCM, FACOG; Wright, Elizabeth MSN, RN, CNM


While a discussion of technology and childbirth seems paradoxical, the use of statistical modeling can extend the capacity of the human mind to quantify risk, to communicate clearly, and to recognize when action is necessary in an obstetrical setting. These models provide clinicians envelopes that define safe and reasonable clinical paths. They obviate the myriad of environmental, experiential, and individual factors that inevitably affect the process of identifying and responding to unsafe situations. As the number of variables increases, the ability of the human mind to analyze multiple, interrelated factors diminishes and is not consistent across place and time. The top obstetrical problems leading to birth-related injury and litigation are discussed: shoulder dystocia, hypoxic ischemic encephalopathy, and prolonged or difficult labor. Two case histories are presented to demonstrate the factors promoting medical error and the application of these new technologies.

Department of Obstetrics and Gynecology, McGill University (Dr Hamilton), and LMS Medical Systems (Dr Hamilton and Ms Wright), Montreal, Quebec, Canada.

Corresponding author: Emily Hamilton, MDCM, FACOG, LMS Medical Systems, 5252 de Maisonneuve W, Suite 314, Montreal, Quebec, H4A 3S5 Canada (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.