Medical liability risks are driving change in ob-gyn care for both physicians and hospitals. According to a recent poll by the American Congress of Obstetricians and Gynecologists, 51 percent of surveyed ob-gyns reported making one or more changes to their practice, including reducing the number of gynecologic surgeries, dropping obstetrics, favoring cesarean deliveries, or abandoning private practice to become salaried employees of hospitals, the government and other institutions.

The 9,006 participants reported a total of 4,060 liability claims initiated between Jan. 1, 2009, and Dec. 31, 2011, with 42 percent saying one or more claims had been filed against them.

Physicians' limitations on which conditions they treat and which services they perform can create major hardships for patients, including extended wait times for appointments or surgery and little or no access to providers in some areas.

"You have to do a certain number of deliveries just to pay for the cost of your insurance," says James Breeden, M.D., ACOG president and a practitioner in a multispecialty group in Carson City, Nev. Breeden stopped practicing obstetrics a decade ago, but still provides gynecologic care.

Meanwhile, hospitals face a reduced number of patients being referred for care, and a more difficult time recruiting physicians. The medical liability climate "creates a serious problem for hospitals and patients alike,"says Brian Atchinson, president and CEO of the Physician Insurers Association of America in Rockville, Md.

To help remedy the situation, the Agency for Healthcare Research and Quality has offered grants for institutions to develop ways that could lower risks associated with deliveries.

Fairview Health Services in Minneapolis received a $2.9 million grant to create and test patient care checklists that would improve outcomes for mothers and newborns. Elective deliveries before 39 weeks' gestation should be avoided because pre-term babies tend to have problems requiring longer and costlier hospital stays, says Stan Davis, M.D., an ob-gyn and medical director of teamwork and simulation.

Another grant recipient, Ascension Health in St. Louis, offers e-learning modules on electronic fetal monitoring, shoulder dystocia training, in situ simulation education with high-fidelity mannequins, and disclosure communication and cause analysis. The interventions have been implemented for hundreds of nurses and physicians at five demonstration sites, says Ann Hendrich, R.N., chief nursing officer and senior vice president of clinical quality and safety.

"These tools, if spread across the nation, could provide ob-gyns a safer environment that could change outcomes for their patients and their practices for the better," Hendrich says.