A Mom and her baby have recovered just under $7 million dollars in damages from a doctor who persistently attempted to extract the fetus from the birth canal before the fetus was ready, ignoring basic training principles about this type of instrumental delivery.
Mom went to the Kingston, Ontario hospital to deliver her first child, after a normal and uneventful pregnancy. Her doctor, who had cared for her during the pregnancy, was unavailable, so Mom was cared for by a family practitioner who also did obstetrics. She was in active labour, 2-3 cm dilated, with the fetal head at spines —2, which was not the desired position for delivery. She was unchanged 2 hours later. Three hours later, the doctor ordered an increase in Oxytocin without re-examining Mom. The labour was still progressing very slowly, as Mom was only 4cm dilated. When Mom became 5-6 cm dilated about an hour after that, the nurses reduced the Oxytocin dosage since she began to contract every minute.
Soon afterwards, Mom began to develop irregular contractions which were doubling and tripling up, but the fetal head was still unengaged. The obstetrician on call found Mom to be 8 cm dilated and found that the fetus was positioned for delivery. He ordered the insertion of an intrauterine pressure catheter, a device to monitor and measure contractions, and ordered that the Oxytocin be increased. A nurse found that Mom had reached an anterior lip of cervix, where the cervix is swollen. Despite Mom’s incredibly slow progress and prolonged, irregular contractions, she was allowed to push for 3 hours, mostly in stirrups. Just over an hour into the pushing, there was clear tachycardia, but again the obstetrician was not consulted. After 3 hours, the doctor decided to attempt to deliver the baby with a vacuum extractor, prior to which there was no vaginal examination and no discussion of the risks of using a vacuum extractor with the patient.
Since Mom was experiencing shock-like sensations from the external FHR monitor, fetal monitoring during the vacuum extraction procedure was to be done by auscultation between contractions, or by listening with a stethoscope. No clear reading of the FHR was obtained throughout the lengthy procedure. The vacuum extractor was used three times. This contravened well-established guidelines which set time limits on its use and a limit to the number of “pop offs” that can occur during the extraction, as well as prescribing regular, adequate FHR monitoring. It also dictated that the position of the fetus be known. Just because the head is visible does not mean it is engaged and ready for delivery. Not only was there no evidence that the doctor examined Mom in order to determine this, but it is also common for patients experiencing prolonged labour to have the fetal head visible but not engaged.
After the initial vacuum attempt failed, a Caesarean section, or at least a forceps delivery, should have been initiated. Not performing an episiotomy in such a difficult and prolonged delivery was also a breach of the standard of care.
The baby was finally delivered, but had no heart rate, was not breathing and was discoloured from lack of oxygen. He suffered significant hypoxia and acidosis and intracranial trauma, or severe oxygen deprivation and brain damage, as a result of the prolonged and difficult delivery. After birth, it was found that he was viable and not compromised before the doctor attempted the vacuum extraction on him, when he was mid-pelvis and not ready for delivery. He suffers from severe cerebral palsy.
Sommers Roth & Elmaleh Professional Corporation has over 40 years of experience in medical malpractice litigation in the Greater Toronto Area (GTA), Ontario, and across Canada.
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