A Mississauga mother and her fetus suffered unthinkable injuries after a violent and painful birth where forceps were used improperly.
Mom arrived at the Toronto area hospital in spontaneous labour at 38 weeks’ gestation. When Mom was 2 cm dilated, with baby’s head in her mid-pelvis, the doctor ruptured her membranes and placed a fetal scalp electrode on the baby. He ordered an epidural. Five hours later, the cervix was virtually unchanged at 3 cm dilated and Mom’s contractions were irregular, however, the fetal heart rate (FHR) remained normal. Oxytocin was ordered and the dosage increased. The contractions began to occur every three minutes. The doctor thought the situation might be caused by cephalopelvic disproportion which would warrant a caesarean section. Two hours later, though, the cervix was fully dilated with contractions occurring every two minutes. Mom was transferred to the delivery room to begin pushing, a step overseen by a trainee.
The doctor ordered a forceps delivery approximately an hour and a half later when the cervix had only marginally changed to 4 cm dilation and the vertex was not engaged in the pelvis, indicating that delivery would be still delayed. There were three attempts to deliver the baby with forceps which were so forceful that during each attempt Mom’s bottom was lifted off the bottom end of the delivery table requiring that she be pulled back into proper position. After the second time this happened, the doctor said that he did not think the forceps would work, noting “tight forceps”. This was clearly the case, as the rotation attempt caused the forceps to cut through the vaginal wall, urethra and bladder. On the third attempt, the baby was delivered.
The Kjelland forceps are technically challenging, and the highest level of expertise is demanded of an obstetrician in order to rotate a wrongly-positioned fetus. There was no indication as to why it was decided to perform a mid-pelvis rotation, since there was no evidence of significant fetal distress. Neither was there preparation for a caesarean section in case the forceps delivery failed.
The baby was severely depressed at birth. He required immediate resuscitation as he was apneic and cyanotic with bradycardia. The paediatrician, who should have been present at the delivery, arrived 3 minutes after birth and intubated the baby. The baby’s limbs were not moving normally, and subsequent imaging revealed a subdural haematoma, or a traumatic brain injury, a widening of the joint space between the facet joints of the cervical spine of vertebrae C1 and C2, and a severe spinal cord injury. The application of the forceps had been of such force that the unqualified trainee had broken the fetus’ neck in more than one place, causing bleeding into his brain.
Following delivery, Mom had persistent and disturbing incontinence, caused by a vesicovaginal fistula. This was a result of a laceration into the bladder, which tore most of the urethra and was not properly treated. This vesicovaginal fistula was allowed to heal spontaneously but ultimately, has resulted in persistent incontinence.
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