Legal Briefs: Why It Pays to Provide Good Documentation: Lawsuit Against Obstetrician Dismissed

Abstract

A 3,040-g, 386/7 weeks’ gestation girl is delivered by vacuum-assisted vaginal delivery to a 17-year-old, gravida 1 para 0 woman. Her pregnancy was uncomplicated. The labor was augmented by oxytocin. When the fetus was at 0 station, the obstetrician ruptured the membranes, and the fluid was clear. Shortly after the rupture of the membranes, the fetal heart rate (HR) decreased to the 60’s beats per minute for several minutes, at which point the obstetrician discontinued oxytocin administration, ordered a fluid bolus, and told the nurse to place the patient on her right side. The obstetrician was present during this deceleration and observed the fetal HR return to a normal rate with good variability. During the next 1 to 2 hours, a huge number of variable decelerations occurred, mostly with the HR down to the 60’s beats per minute; the variability became minimal, and the baseline fetal HR drifted lower. The nurse did not document these abnormalities and did not contact the obstetrician. During the ongoing decelerations, the nurse restarted and incrementally increased the oxytocin dosage and instructed the mother to push. The treating obstetrician stated in his deposition that he well remembered the case, that he was definitely not contacted about the decelerations, and that had not authorized the nurse to restart administration of the oxytocin. He also added that he called multiple times during the hours after rupture of the membranes for periodic updates, and the labor and delivery nurse assured him that all was going well. The obstetrician retained by the plaintiff pointed to the improper management of labor and stated that the nurse should have notified the obstetrician because of the profound decelerations. He pointed out that oxytocin administration should not have been restarted and should have been discontinued as the decelerations continued. Had …