Legal Briefs: 3 Vacuum-Assisted Deliveries, 3 Bad Outcomes

Abstract

A 39 2/7–week gestational age female infant with a birthweight of 2,995 g was born to a 31-year-old gravida 3 para 2 woman with an unremarkable pregnancy. Membranes ruptured spontaneously 19 hours before delivery with clear fluid. Because labor was not progressing, oxytocin was used to “expedite” the process. The fetus was initially occiput transverse, then occiput posterior. The obstetrician applied vacuum on the fetal scalp twice, but no descent was recorded. It was unclear what station the fetus was in when the vacuum was applied because of lack of documentation. The obstetrician retained by the plaintiff was critical of the treating obstetrician for not documenting the station of the fetus and repeating the vacuum because no descent was found after the first pull. He stated that without descent, reapplication of the vacuum is below standard. The obstetrician requested Simpson forceps after the failed vacuum. The treating nurse, in her deposition, admitted that it was against hospital policy to use forceps after a failed vacuum and stated that she questioned the obstetrician but that he ignored her. The plaintiff obstetrical nurse said that the nurse should have refused to bring the forceps and should have called her supervisor . The fetal heart rate monitoring tracings were largely unreadable, even when an internal monitor was placed 2 hours before delivery. The plaintiff obstetrician was critical of this and said that the obstetrical team needed to ensure adequate monitoring . The forceps were applied and considered “partially effective,” as documented by the treating obstetrician, but the vacuum was reapplied. The plaintiff obstetrician was highly critical of using forceps after a failed vacuum attempt as well as the reapplication of the vacuum. The treating nurse said that she was uncomfortable with this process and tried to communicate this to the obstetrician. The treating …