Labor And Delivery Nursing: Court Ruling On Standard Of Care For Post-Term Mother

Legal Eagle Eye Newsletter for the Nursing Profession


  Quick Summary: Post-term pregnancy calls for heightened vigilance by the labor and delivery nursing and medical staff, especially when decreased amniotic fluid or oligohydramnios has been detected.

  Labor and delivery nurses must adequately monitor and chart the information transmitted through the fetal heart monitor, normal findings as well as ominous signs like prolonged deceleration of the fetal heart rate. Again, the nurse’s duty is especially acute with a post-term mother with decreased amniotic fluid.

  The nurse must report any suspicious findings from the heart monitor to the physician immediately.

  Nurses must recognize that giving p.r.n. narcotics can slow the progress of labor.

  When post-term labor fails to progress, that is, when the cervix fails to dilate, a cesarean must be done. Nurses and physicians share responsibility for seeing that an emergency cesarean is done within thirty minutes of when it is called by the physician.  UNITED STATES DISTRICT COURT,  FLORIDA, 1996.

   The U.S. District Court for the Southern District of Florida recently awarded a substantial verdict to parents whose child was born with profound neurologic deficits stemming from hypoxic injury during labor and delivery. The court faulted the labor and delivery medical and nursing staff at the hospital for multiple departures from the applicable professional standards of care.

   Persistent prolonged decelerations of the fetal heart rate are an ominous sign indicating the fetus is suffering from lack of sufficient oxygen and is in neurological distress which could lead to permanent injury if the condition is not promptly resolved, according to the court.

   Labor and delivery nurses have the responsibility to closely monitor fetal heart monitor tracings, to recognize and appreciate the gravity of the risk to the fetus that abnormal signs can pose, and to communicate significant abnormal findings to the physician, according to the testimony which the court heard in this case from a perinatal nurse specialist who the court ruled was qualified as an expert witness.

   This is a general statement of a labor and delivery nurse’s legal responsibility. This responsibility becomes especially acute with a high-risk pregnancy. A post-term pregnancy, especially where a condition of decreased amniotic fluid has been detected by the physician, is a high-risk pregnancy, the court ruled.

   Nurses must recognize that failure of labor to progress, that is, failure of the cervix to dilate, is very dangerous in a high-risk pregnancy. Giving p.r.n. pain medications can impede the progress of labor, and it is a nurse’s responsibility to act accordingly, the court cautioned.

   When an emergency cesarean has been "called" by the physician, nursing and medical personnel are responsible for getting the procedure done within thirty minutes, under current ACOG standards, the court also ruled. Wareing vs. U.S., 943 F. Supp. 1504 (S.D. Fla., 1996).