After an uneventful pregnancy, Mom, a Toronto resident, was allowed to go past term to 42 weeks’ gestation. The pregnancy was high-risk due to advanced maternal age and a prior pregnancy loss. During the first stage of labour, which lasted about 5 hours, Mom received an epidural after which the doctor noted that the “baby is very high”, meaning the baby was not positioned for delivery. Her membranes were artificially ruptured. Foul-smelling meconium-stained liquor was found, a sign of fetal distress.
However, electronic fetal monitoring, at the Toronto area hospital, was not initiated despite the high-risk factors associated with the pregnancy and labour. Mom’s husband remembered that one nurse intermittently used a device to listen to the baby’s heart, some sort of “antiquated fetoscope attached to a wooden stick”. Forceps were used during the second stage of labour, which lasted about 2 hours. Qualified neonatal resuscitation personnel, including a paediatrician, anaesthetist, or respiratory therapist, did not attend the delivery. By all indications, the fetus suffered intrapartum asphyxia which went undetected. Neonatology was not called to attend the delivery.
At birth the baby did not cry, was blue and required resuscitation, which was delayed. At one hour of age, the infant was still profoundly acidotic and hypoxemic. By 2 ½ hours of life, the baby still did not have enough oxygen. The baby was transferred to a tertiary care centre, with evidence of meconium aspiration and intractable seizures and low blood glucose levels. The baby suffered permanent neurological deficits due to birth asphyxia.
Please see the News & Events section of our website for the Toronto Star article relating to this case. A link to the Court of Appeal decision appears below.
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