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Complications like shoulder dystocia are rare in obstetrics. Even when they occur, mothers and babies are overwhelmingly likely to do well. This sounds like a blessing, but it actually has long been the field’s most dangerous curse. Obstetric medicine is like aviation: As even the worst airlines go years without a crash, so can even the most cavalier, careless hospitals go years without a mother or a baby dying or being serious injured. But these rare catastrophes add up: In 1990, the maternal mortality rate in the United States was just over one in 10,000—on par with many Eastern European countries, but about double the rate in the “safest” countries, such as Canada.
Largely because of this statistical problem, obstetrics joined the medical safety movement later than most other specialties. Procedural changes and training initiatives designed to reduce rare clinical errors are unlikely to lead to statistical improvements, so subscribing to principles of safety has often required a leap of faith.
If obstetrics has caught up in the past decade—and there is evidence it has—it’s due significantly to the work of a doctor who was willing to make the leap...