OUTCOME
A jury found the nurse-midwife 80% at fault and the hospital 20% at fault. The jury awarded $13.5 million to the child and $100,000 to the plaintiff. An additional $110,000 in past medical expenses was added to the verdict.
COMMENT
Obstetrics/midwifery accounts for a significant percentage of malpractice cases filed and monetary damages awarded. In this case, a substantial $13.5 million verdict was awarded, with 80% of the verdict against the midwife for inappropriate use of oxytocin and failure to refer for cesarean delivery.
A detailed discussion of obstetric management is beyond the scope of this article (in part because we don’t have access to much data, including fetal heart rate tracings). However, there are a few points to consider.
First, consider surgical options when appropriate. Without doubt, operative delivery by cesarean section is overused for all the wrong reasons. Some mothers, families, and clinicians strongly desire a more natural childbirth and strive to create such an experience—forgoing traditional medications and anesthesia. Often, this is perfectly safe, reasonable, and preferable.
However, if the perinatal course is rocky, it is wise to monitor closely and adopt a collaborative approach. When prenatal screening suggests a difficult delivery, exercise caution and have a fallback plan. Known high-risk deliveries should have a team approach from the outset, with all assets available to bedside on short notice.
While operative delivery is overused, it shouldn’t be demonized either. When genuinely needed, it can be lifesaving. Some patients do not want a cesarean delivery, and both the patient and the clinician may equate operative delivery with personal failure. However, that view may present a barrier to calling for consultation when it is genuinely needed.
For natural childbirth enthusiasts, think of the surgical delivery option as sealed in a glass case. Break that glass for all the right reasons: to preserve life or avoid significant fetal morbidity. Discuss the indications for surgical management ahead of time, so the mother is not surprised by a sudden rush to the operating room, feeling frightened and out of control.
It is recognized that patients and clinicians have firmly held beliefs, and opinions are strong on this subject. Patients have a right to self-determination and to select the birthing experience that will suit them best. Yet there is tension because jurors will expect a clinician to fully communicate known risks to patients and use all available resources to safeguard the mother and fetus at all times. In this case, the jury concluded that the midwife failed to refer for cesarean delivery after about 10 hours of labor, when the fetal heart rate pattern was nonreassuring. One of the plaintiff’s expert witnesses who criticized the defendant midwife’s care was herself a highly regarded midwife.
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