Second-shift doctor puts off preapproved Caesarean section

In August 2003, a patient, then 34, was expecting the birth of her first baby. All indications were for a normal vaginal delivery of a baby boy.

When the patient arrived at the hospital, her contractions had begun; a vaginal exam indicated that she was 4 to 5 centimeters dilated but that the baby was still very high in the womb. The obstetrician on call for the evening made the decision to use Pitocin to try to improve contractions and dilation, and bring the baby down.

Later that night, the physician told the family that there had been no further dilation. She was concerned that cephalopelvic disproportion likely existed, and if nothing changed within the next 90 minutes the plan would be to perform a Caesarean section, as trying to push the baby through the birth canal during CPD could cause trauma and hypoxia. The couple agreed.

The following morning, another physician took over and performed a vaginal exam. As the day progressed, the family asked why a C-section was not being initiated. The physician said that it was because there had been positive progress.

When the physician evaluated the situation at 12:00 p.m., she recognized that there had been no change in the last three hours and called for the C-section. The baby was delivered at 12:51 p.m.

At birth, the baby had a laceration on the left side of his forehead, significant caput, cephalohematoma, molding of his head and edematous eyes.

The following morning, he was noted to have apnea with lip smacking and left eye deviation as well as right upper and lower extremity tremors.

An EEG revealed seizure activity and the baby was given Phenobarbital. A head CT scan and MRI both indicated severe hypoxic ischemic encephalopathy and a left cerebral artery stroke. The baby’s care was then transferred to another hospital where he was diagnosed with microcephaly, infarct and a seizure disorder secondary to his HIE. Today, the boy suffers from profound neurological injuries.

The plaintiffs’ experts were prepared to testify that it was clear at 8:00 a.m. that the baby should not have been delivered vaginally. The experts were further prepared to testify that the defendant’s attempts to reduce the cervix and push it out of the way to aid vaginal labor were unacceptable.

The defendant was prepared to testify that the labor had progressed after he assumed care and that the baby suffered a stroke at some point prior to the labor and delivery.

The case settled at mediation for $3.25 million a week before trial.

Type of action: Medical malpractice

Injuries alleged: Brain damage

Date: February 2009

Submitted by: Andrew C. Meyer Jr. and Krysia J. Syska, Lubin & Meyer, Boston (for the plaintiffs)