Shoulder Dystocia: Nurse Midwife Faulted, Failed To Consider Patient’s Past History.

Shoulder Dystocia: Nurse Midwife Faulted, Failed To Consider Patient’s Past History.

Legal Eagle Eye Newsletter for the Nursing Profession

Neither the nurse midwife or the obstetrician reviewed the mother’s medical history before this delivery. The nurse midwife was actually present during the mother’s three previous deliveries in which shoulder dystocia occurred in two. Even though she herself had documented that aspect of the mother’s obstetric history, the nurse midwife did not remember that shoulder dystocia occurred during either delivery.

With a previous patient or a new one a nurse midwife should always review the mother’s obstetric history at her prenatal clinic visits. Further, a nurse midwife must take into account the expected weight of the fetus, in conjunction with the obstetric history and other relevant data. According to the mother’s medical experts, a cesarean would have been the safer way to proceed this time. When shoulder dystocia was encountered during this delivery, it was below the standard of care for the nurse midwife and the physician to continue with vacuum extraction after less drastic measures failed. UNITED STATES DISTRICT COURT GEORGIA August 5, 2016

The US District Court for the Middle District of Georgia awarded the child $5.7 million and the parents an additional $389,000 after the baby was born with a brachial plexus injury due to shoulder dystocia encountered during her delivery. The now four year-old child has had multiple shoulder surgeries which have not corrected her permanent disability.

During two of the three prior births shoulder dystocia had complicated the deliveries. For this pregnancy the nurse midwife, as well as the obstetrician, failed to review the patient’s past obstetric history. That review would have alerted the mother’s caregivers that shoulder dystocia was most likely going to be an issue. This nurse midwife actually wrote the progress notes for the two prior complicated deliveries. She cared for the mother prenatally and was present for the deliveries of all her other children, this one being the fourth.

However, the nurse midwife apparently had no personal recollection of having cared for the mother before this pregnancy and delivery. The nurse midwife was also faulted for failing to arrive at a correct estimate of the fetal weight and to take that into account in planning how the delivery should be approached.

During the vaginal delivery, when shoulder dystocia was encountered, the nurse midwife and the obstetrician were faulted by the mother’s medical experts for using excessive force to extract the baby with a vacuum extractor, after the fetal heart rate slowed abnormally and the McRoberts maneuver and suprapubic pressure failed to move the delivery forward. According to the mother’s medical experts, cesarean delivery would have been the safer way to proceed, rather than inducing labor with Pitocin and Cervidil, given the mother’s history. That alternative should have been recommended to the mother. Coleman v. US, 2016 WL 4161106 (M.D. Ga., August 5, 2016).