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Fetal Distress Leaves Clues: What Happens When Doctors Miss Them
Serious complications can occur after a pregnant woman goes into labor and before her baby is delivered. Physicians are responsible for monitoring the labor process. They also have the responsibility of being able to recognize signs that a complication has arisen that can pose a risk to the health of the unborn baby. And they have the responsibility of taking appropriate, timely action.
When they fail to do so, as when a physician stubbornly takes the position that the labor process is proceeding normally and that the unborn baby is doing well even in the face of data clearly showing otherwise, the result can be a child with a permanent disability - a disability that could have been prevented.
Consider the following cases:
Case 1:
In this case a pregnant woman was admitted to the hospital already in active labor. Over the course of the next nine hours the nurse noted that the tracing from the fetal heart rate monitor was reactive and reassuring. Then the unborn baby's heart rate began to climb. It actually reached the 170-180 bpm (beats per minute) range and yet the obstetrician steadfastly held that this was normal and that there was no need for any emergency action. The obstetrician eventually performed a vaginal delivery. The baby was taken to the NICU where he experienced respiratory distress after a prolonged initial depression. A CT scan revealed both a subarachnoid hemorrhage (bleeding under the membrane which covers the brain) and a left cephalohematoma (a collection of blood under the scalp).
Several days later an MRI showed damage to the brain consistent with hypoxic ischemic encephalopathy (a form of brain injury due to asphyxia or the loss of oxygen). Within days the baby experienced episodes suggestive of persistent metabolic acidosis and seizures. As a result of these injuries the child suffers from serious speech difficulty and from physical (motor) limitations. The law firm that handled this matter indicated a settlement in the amount of $1 million.
Case 2:
In this case a woman in the 41st week of her pregnancy was admitted to the hospital. She underwent an ultrasound BPP which the nurse noted was normal and a non-stress test which the nurse reported was non-reactive. The fetal heart rate was noted to have a baseline in the 160s. The woman's history included a C-section from a prior pregnancy. The labor nurse's notes nonetheless recorded that the plan, as discussed with the obstetrician and midwife, was for a vaginal delivery (VBAC). For three minutes, the fetal heart rate dropped to the 70s with a contraction. This was noted by the obstetrician who then induced labor by administering a gel after concluding that delivery was not imminent based on the condition of the woman's cervix.
After the administration of the gel, the labor nurse noted 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. Yet it took 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.
These two cases 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 badycardia and is a clear indication of significant fetal distress. Even then, however, the doctor who had taken over was slow to react.
The two obstetricians actually acted as though they truly believed that everything was fine during labor. Attorneys who handle medical malpractice cases see this phenomenon all too frequently. Sadly, instead of learning from their mistake, these same physicians will sometimes fight any suggestion that they did anything improper. 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.
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