subject: An Examination Of Two Lawsuits Claiming Fetal Distress Went Unnoticed By Obstetricians [print this page] Serious complications that endanger the health of an unborn baby can develop when a pregnant woman begins labor. When a pregnant woman is admitted at a hospital for labor and delivery she expects that her progress will be closely monitored, that the physicians and nurses in charge of her care will be able to recognize any signs of complications, and will take the necessary action at the appropriate time. Labor is a particularly critical period of the pregnancy and a failure to react to a complication can result in permanent harm to the baby. Physicians and nurses responsible for such resulting harm to the child may liable for medical malpractice. Consider the two cases below.
In the first case, a hospital admitted a pregnant woman in active labor. A nurse monitored the woman's progress. The nurse interpreted the fetal heart rate monitor results as reassuring. This continued for nine hours. Then things changed. The fetal heart rate monitor showed a continuous increase in the unborn baby's heart rate. The rate reached 170-180 beats per minute. The obstetrician in charge of the woman's care was aware of the change in the rate at which the baby's heart was beating but interpreted this as a normal labor that did not require any emergency steps. In fact, the obstetrician eventually performed a vaginal delivery rather than a C-section.
After the delivery the baby was transferred to NICU. While there he was in a prolonged initial depression and experienced respiratory distress. Testing showed that he was bleeding in the brain and that there was an accumulation of blood under the scalp. Within days an MRI showed that the baby had brain damage. The type of brain damage was consistent with the loss of oxygen prior to birth - a situation that would account for the extreme fetal distress noted in the fetal heart rate monitor. A few days later the baby began having seizures. As the baby grew it became clear that he had serious difficulty with speech, and he had problems with motor control. The law firm that handled this case reported that they were able to obtain a settlement on behalf of the child and his family in the amount of $1 million.
In the second case, a hospital admitted a woman who had undergone a C-section in a previous pregnancy and was now in the 41st week of her current pregnancy. After she was admitted the nurse recorded that the woman had a normal ultrasound BPP and a non-reactive non-stress test.
The nurse also noted that the fetal heart rate monitor indicated that the baseline for the unborn baby's heart rate was in the 160's. The notes from the nurse indicated that, in discussion with the midwife and with the obstetrician, a vaginal delivery was planned. This is known as a VBAC and carries with it certain risks. The obstetrician's notes indicate that at one point the baby's heart rate went down to the 70's with a contraction. On examination of the woman's cervix the obstetrician decided that delivery was not imminent and applied a gel to induced labor. According to the nurse's notes after the application of the gel the woman began having mild irregular contractions.
The obstetrician then also noted intermittent late decelerations. Three and a half hours after her admission, the obstetrician transferred care to another physician who, having reviewed the fetal heart rate tracings, recommended that the mother be closely watched. Two and a half hours later there was a deceleration to 70-90s that lasted for 10 minutes. It still took another fifty-seven minutes before the physician delivered the baby via a C-section. The child suffers from physical and neurological deficits. She requires occupations, physical and speech therapy. The law firm that handled this matter reported a settlement of $900,000.
Discussion:
The two cases above show how doctors can completely blind themselves to the presence of signs indicating the presence of a serious complication during labor. In the first case, the obstetrician held on to the position that the unborn baby's heart rate tracings were normal even when they clearly exhibited tachycardia, a condition that indicates the baby is in severe distress. So the obstetrician never deviated from the planned vaginal delivery.
In the second case the obstetrician originally in charge had knowledge of multiple decelerations, at least one of which included a drop down to the 70s. The obstetrician knew that the woman had a C-section for a prior pregnancy. This places the mother at an increased risk of a rupture which can lead fetal distress as the unborn baby's oxygen supply is disrupted. It was not until there was a prolonged deceleration to the 70-90s that the delivery plan was changed to a C-section. This is a condition known as fetal bradycardia and is a clear indication of significant fetal distress. Even then, however, the doctor who had taken over was slow to react.
Attorneys who handle medical malpractice cases encounter this phenomenon from time to time. It is as if doctors simply fail to register a developing complication and their actions are totally consistent with the belief that everything is fine during labor. Sadly, instead of changing their behavior in the future, physicians will sometimes fight against any suggestion that their actions in any way deviated from the standard of care. Whether they admit their mistake or not, the guidelines clearly specify what action needs to be taken when a condition of fetal distress develops. And an experienced birth injury attorney can help protect the child's future by ensuring an appropriate recovery.
