Errors in maternity settings: a systematic review of causes, contributing factors, and prevention strategies

Errors in maternity settings can significantly affect maternal and neonatal safety; however, they remain less explored than surgical or medication errors. Aligning with international safety initiatives, this systematic review aims to identify the causes, contributing factors, and prevention strategies for errors within maternity care environments to inform systemic safety improvements. A comprehensive search of international and Iranian databases was conducted for peer-reviewed studies published in English or Persian between 2008 and 2024. In accordance with PRISMA guidelines, study selection was performed through a structured screening process. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS). Given the methodological heterogeneity among the included studies, data were synthesized using a narrative thematic approach, mapping findings across the individual, team, administrative, and organizational levels of the healthcare system. Nineteen studies, 18 of which demonstrated high methodological quality, were included in the review. The synthesis revealed that errors in maternity settings result from a dynamic interaction of multi-level factors. Organizational and policy-level vulnerabilities were the most frequently identified contributing factors (57.9%), followed by individual-level factors (42.1%), administrative stressors (26.3%), and team-level dynamics (15.8%). Primary drivers included punitive safety cultures, staff shortages, and clinical knowledge gaps, highlighting that these errors are predominantly consequences of systemic weaknesses rather than isolated incidents. Enhancing safety in maternity settings requires a multi-level paradigm shift from “person-centered blame” to “systems-oriented learning.” By directly mapping actionable interventions to their root causes-such as implementing non-punitive Root Cause Analysis (RCA), optimizing staffing ratios, and providing targeted clinical training-healthcare institutions may achieve more sustainable approaches to error prevention.