Mom’s antenatal care was provided by a family doctor who, in a short rotation during his residency had some exposure to obstetrics, but had no experience with a vacuum extractor or forceps. When he was hired at the hospital, he pledged to update his designation to include obstetrics, which involved a four-week rotation at another hospital. About a month prior to Mom’s delivery, the doctor attended an obstetrics’ course to train family doctors on the proper use of vacuum extractions, and the appropriate circumstances in which to use a vacuum. Unfortunately, he did not digest this information correctly and breached these standards in many ways when delivering Mom’s baby. At no point did he ever take a course in fetal heart monitoring.
Mom was admitted to deliver her baby. There were only two documented checks on the dilation of the cervix, the last of which indicated that Mom was 9cm dilated and that the fetal head was unengaged.
When the nurse began to observe variable and late decelerations in the fetal heart rate, the doctor, contrary to hospital policy, ordered that Mom be induced with Oxytocin without even assessing her. Not surprisingly, this was followed almost immediately by a prolonged fetal heart rate deceleration. But the nurse did not discontinue the oxytocin, a decision which would cause the contractions induced by the drug to slowly suffocate the fetus. To make matters worse, the nurse doubled the infusion rate 45 minutes later and still did not discontinue the infusion when more bradycardia and distress was noted.
Eventually the doctor appeared to care for his patient. He decided to deliver the baby with a vacuum extractor despite the fetal head being unengaged, and made no arrangements to either consult a more experienced member of the staff or prepare a standby Caesarean section (C-section) before initiating the attempted vacuum delivery. In a statement confirming his misunderstanding of the standard of care, he testified that he had previously used a vacuum to deliver a baby with a high station on several occasions. It is basic obstetrical knowledge that vacuum delivery from a high station is unacceptable. The standard of care also provides that if there is no progress after three vacuum attempts another method of delivery must be attempted. After three unsuccessful vacuum attempts, the doctor decided to page a colleague for “backup”. No colleagues answered his call, so he made three further attempts with the vacuum extractor, during which time the fetal heart was admittedly tachycardic. Although the doctor eventually called an emergency C-section, the surgery took too long, a delay which grossly violated the standard of care.
The fetus suffered anoxic brain damage that causes him to suffer from spastic quadriplegia as a result of severe cerebral palsy. He uses a wheelchair and is dependent in most areas of self-care.
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