Labor And Delivery: Nurse’s Employer Dismissed From Case.

Labor And Delivery: Nurse’s Employer Dismissed From Case.

Legal Eagle Eye Newsletter for the Nursing Profession

December 2018

The critical legal issue in the labor and delivery nurse’s favor is the lack of any proof that advocacy by the nurse would have informed the physicians of any salient facts they did not already know and would have altered their course of action in favor of a less catastrophic outcome.

The nurse knew from her own review of the mother’s prenatal chart that she had a low-lying placenta and the baby’s head was at a high station. She also knew that the obstetrician and the residents were planning to induce labor. The nurse was not aware of the ultra-sound that showed vasa previa.

However, even if the labor and delivery nurse had advocated against the insertion of an intrauterine pressure catheter, there are no facts in the record to establish that the obstetrician would have changed her plan to proceed toward a vaginal delivery in time and would have gone ahead sooner with a cesarean. There is also no proof that the labor and delivery nurse was the one who actually inserted the intrauterine pressure catheter that caused the massive bleeding that led to a fetal stroke. COURT OF APPEALS OF MICHIGAN November 1, 2018

The mother’s post-term delivery went badly soon after rupture of her membranes in anticipation of an induced vaginal delivery. Vaginal bleeding began with insertion of an intrauterine pressure catheter (IUPC) right after rupture of the membranes. When the bleeding could not be staunched the physicians dropped the plan for vaginal delivery and did a cesarean.

The infant nevertheless suffered neurological birth injuries and now has cerebral palsy. A CT scan at age nine days traced the infant’s birth injuries to a cerebral arterial stroke related to lack of blood flow due to the mother’s profuse bleeding following insertion of the IUPC. The expert medical testimony at trial focused on the inappropriateness of an IUPC with a post-term mother with a low-lying placenta and a prenatal ultrasound showing vasa previa.

The Court of Appeals of Michigan found no case of negligence against the labor and delivery nurse and dismissed her employer, the hospital, from the lawsuit. The expert nursing testimony on the mother’s and baby’s behalf sought to fault the nurse for failing to advocate against the use of the IUPC with a mother for whom that should have been seen as contraindicated. The IUPC was clearly what caused the bleeding and the bleeding clearly injured the fetus.

While acknowledging the nurse was probably aware of some contraindicating factors, and agreeing that the IUPC was inappropriate, the Court still ruled there was no proof that advocacy by the nurse would have swayed the obstetrician and the obstetric residents against the IUPC. The Court also ruled it was only speculation that the nurse was the one who actually inserted the IUPC after the mother’s membranes were ruptured. The nurse entered into the computer file a very detailed record of all the events as they transpired in the labor and delivery suite. She was apparently doing her job competently by monitoring and recording the case but was not directly involved with her own hands. Irwin v. Med. Ctr., 2018 WL 5726706 (Mich. App., November 1, 2018).