OB Guideline 13: Availability of Clinician and Case Load in Labor and Delivery

In Labor

Once active labor has begun, the responsible clinician should be immediately available to return to Labor and Delivery if needed.

Immediately available assistance by a qualified clinician from the obstetrical service is mandatory when a clinician’s case load exceeds three low-risk patients in active labor; or when the intensity of the care for the case load exceeds the clinician’s capacity to provide safe patient care.

The patients and the nurses caring for them should be notified about any change in status of the responsible clinician. If a clinician becomes unavailable for reasons that would not permit timely return to labor and delivery (such as surgery or involvement in a complex medical case), then that clinician must provide the nursing staff with the name of an alternate clinician who has agreed to assume responsibility and be immediately available for that clinician’s laboring patients.

At all times when there is an actively laboring patient on the labor floor, a physician credentialed to perform emergency operative delivery must be readily available.

Alternative Coverage

When a clinician cannot be contacted or, if after being appropriately notified, a clinician does not see a patient in a timely fashion, and/or if a clinician has made no arrangements for alternative coverage, the nursing staff or another involved party shall report this occurrence through appropriate institutional procedures. Each institution shall devise a system by which alternative clinician coverage is provided in such situations; and the system of clinician coverage should be clearly communicated and available to all members of the labor and delivery staff.