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Delivery Gone Bad

LEE S. GOLDSMITH, M.D., LLB

When I was in medical school, in my third year of training, we were assigned a month of training in obstetrics and gynecology. On my third evening, on call, about one o'clock in the morning we received a call from the Emergency Room that a woman in labor was being sent to the delivery room. I looked for the resident and could not find him. The nurses were there and they knew a heck of a lot more than I did. The patient arrived on the floor and looked at who was there. I must have been paler than pale. She stated: "Don't worry sonny, this is my twelfth ---- I will tell you what to do."

A scared medical student and a happy ending. Unfortunately all deliveries do not go that way. I had no expertise and training. The nurses were much more knowledgeable than I was or would ever be. This was the second time I was there for a delivery. The nurses had been involved in hundreds. However, if there was the need for a physician during the delivery then valuable time could have been lost waiting for one to arrive.

Fortunately there have been tremendous improvements since I went to medical school but even now we have repeated calls from families where an event that all were looking forward to turned into a lifelong tragedy for the family. Why?

There is no question that an unfortunate event can occur without anyone being at fault. There are genetic factors that can influence problems. There are innate abnormalities that might not be known prior to the delivery that can affect events during and immediately after the delivery leading to a disaster.

However, there are events that need not have occurred and their explanation can only be explained with a thorough review of the medical records prepared during the labor and delivery along with the fetal monitor strips. Errors occur and when they do a life will be damaged forever.

A fetal monitor is a machine that is supposed to monitor of follow the heartbeat of the fetus. That monitor may be placed externally, on the mother, or internally, inside the mother's vagina. The nurses and staff are required to watch the monitor to see if there are any changes that should not occur. One problem we have seen while using an external monitor is that the staff did not realize that the monitor was picking up the mother's heart rate and not that of the baby. When the baby's started to have problems, no one realized what was going on and when they finally did, it was too late.

Another problem with monitors is that someone has to look at the monitor and know what the results mean. Staff gets busy. Other patients may be in labor and a mother in labor gets neglected. Changes occur that are ominous. No one is there, no one is looking and a problem that could be corrected through intervention does not occur. If an umbilical cord wraps around the neck it will cause changes on the monitor strips. Cords wrapping around the neck are not uncommon and are usually noticed. However, when they are not, there may be a justifiable reason for litigation.

Another part of the labor and delivery requires carefully looking at the timing of events. When did the mother go into labor, how did the labor progress, was the progression normal and if not why not. If not, when should there have been intervention and what intervention would have been appropriate?

No one wants to see a baby born with brain damage. However, when it occurs we all want to know why. Is it a "why" because of natural events or is it a "why" due to someone's error.

We are available to answer questions and we will always attempt to provide clear and complete answers through our free consultations.

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