During her pregnancy, a Wisconsin woman received care from a nurse-midwife. In late July 2001, misoprostol was administered to induce labor. The woman was admitted to the hospital in active labor at approximately 2 pm. She was 6 cm dilated. Dilation arrested three times, and then there was a two-hour failure to dilate.
The nurse-midwife then tried putting the mother in a water-birthing tub to stimulate contractions, without success. Oxytocin was then administered. Immediately thereafter, the patient developed uterine hyperstimulation, and the fetal heart rate strip showed late decelerations, indicative of fetal distress.
Despite these abnormalities, the nurse-midwife continued increasing oxytocin throughout labor, which continued for about 12 hours. The oxytocin dose exceeded the hospital’s recommended protocols. The patient reached a point at which she was having strong contractions every 1.5 min. Full dilation was not reached until 10:38 pm.
Around midnight, the electronic fetal monitor allegedly showed an abnormal heart pattern, with decelerations with almost every contraction. The mother was allowed to continue with labor, and the fetal monitoring equipment was removed at 1:26 am so the mother could be placed in the water-birthing tub again. Nurses took the fetal heart rate during this time and recorded it as normal.
When the child was delivered at approximately 2 am, she had a heart rate of 80 beats/min; she was apneic, cyanotic, and virtually lifeless. Apgar scores were recorded as 1 at one minute and 3 at five minutes. Arterial blood gas/pH was 7.165.
An attending physician was called and arrived within 20 min. The infant was resuscitated, intubated, and transferred to another hospital. A CT scan taken at 56 hours of life was read as normal. An MRl at nine months was also read as normal.
The child was subsequently diagnosed as having cerebral palsy. She requires a walker for ambulation and has arm and leg impairments and significant cognitive deficits, necessitating 24-hour assistance.
The plaintiff claimed that if oxytocin had been discontinued, she would have reached full dilation hours earlier than she did. She also claimed that a cesarean delivery or operative vaginal delivery should have been performed when the fetal monitor indicated an abnormal heart pattern. (She contended that the “normal” heart rate recorded around this time was actually the maternal heart rate.)
The parties did not dispute that the infant had experienced a hypoxic/ischemic event but disagreed on when it occurred. The plaintiff claimed that the ischemic event occurred during delivery. The defendants claimed that it occurred in utero prior to delivery. The plaintiff also disputed the MRI findings, which the plaintiff argued showed significant brain injury.
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