“The Weekend Effect” – Why Weekend Deliveries Are More Dangerous and What You Can Do

It’s the one question that an experienced birth injury lawyer will always ask – “Was your baby born on a weekend?”

While some obstetrical health care providers deny there is any reduced quality of care and increased risk of injury in weekend deliveries, with every potential new case, one of the first things a seasoned birth trauma attorney will do – look at the perpetual calendar to see what days of the week were involved. While anecdotal, in our experience, more than a majority of our cases involve weekend care and delivery.

This concern was confirmed in “Association Between Day of Delivery and Obstetric Outcomes: Observational Study” published in the British Medical Journal in November 2015. The researchers concluded that the risk of newborn injury or death were greater on the weekend:

We found statistically significant associations… consistent with a lower standard of care for women admitted and babies born at weekends. The largest effects were seen in the higher rates of perinatal mortality… and injury to neonates.

Why the Increased Risk?

Some of the concerns and factors for weekend deliveries include:

• No attending OB present if the hospital is staffed by residents – the attending OBs are at home for the weekend and often only arrive as delivery approaches, or when called to come in due to a developing problem;
• Residents could be drunk with fatigue – after their first year of training, residents are permitted to work 24-hour shifts. Scientific studies have demonstrated that doctors working 24 hours without sleep function at the same level as someone with a blood alcohol level or 0.10%, or legally intoxicated.
• Residents and nurses are reluctant to call the attending OB on the weekend to ask them to come to the hospital, particularly in the middle of the night. Or, no one wants to bother the Fire Department Chief until the house is going up in flames;
• Weekend nursing staff is more apt to include part-timers – the regular staff works regular hours and during the weekdays.

What Can Mom and Dad Do to Protect their Baby? 

• Educate yourself. Today there are classes for expectant parents. Learn all you can about normal and abnormal labor and delivery;
• Ask questions. Concerned and questioning parents get the labor teams attention. From personal experience, if you are standing next to the fetal heart monitor machine watching the fetal heart rate and contractions and the nurse asks what you’re looking at, and your response is, “I’m looking for late or variable decelerations”; guaranteed – the room will be packed with physicians in minutes. This goes to the above point – educate yourself enough to ask good questions that will increase the staff’s attention and the level of care;
• Listen carefully to the comments and conversation of the delivery team. If there is a problem developing, comments of concern are often made between staff members;
• Ask the staff to call your attending OB and ask that they come to the hospital if you are concerned or not getting answers. If they won’t call – you can call. If you don’t have their direct number, at least call their answering service, and let the delivery team know you’ve called;
• Video the delivery with your cell phone. While some hospitals have internal rules prohibiting videotaping deliveries, many encourage videos; you should check in advance. High tech young fathers can quietly pull their iPhone and take a delivery video. Be discreet and turn off all sounds. Later, if there is a problem, the video is often a far more accurate “picture” of what really happened than the invariably well scripted medical note often written days after delivery documenting no problems.
• Take notes of times, what was done, and who said and did what keeps the family focused and is far better than one’s memory six months later trying to reconstruct what happened.
• Always be respectful and polite, even when concerned. The delivery team is also human, and they will respond better to people they like and respect.

Many parents wrongly blame themselves for not having done something more after a difficult labor and delivery where their baby is injured. If you educate yourself, are attentive to the labor, not socializing or reading text messages, and there is a problem, you will have fewer regrets later.

Remember, childbirth is likely one of the most physically traumatic events your baby will ever experience. Your attention and involvement could make all of the difference – for the rest of all of your lives.