Hoffer & Sheremet, PLC: Expert C-Section Malpractice Lawyers in Grand Rapids, Michigan

1. Failure to perform a C-section in time

The most commonly seen negligence in C-section cases is the failure to timely call for a C-section. This results in delay in delivering the baby. Many times, the baby is in a hypoxic uterine environment. Without enough oxygen, the baby suffers brain injury and may die. Babies that survive may have hypoxic ischemic encephalopathy (HIE), cerebral palsy, or other neurologic injuries and developmental delays. Sometimes, injuries are not apparent until years after birth. Luckily, the law recognizes this and gives families until the child reaches their tenth birthday to sue for medical malpractice for birth injuries.

The standard of care might require the doctor to do a C-section for reasons such as:

• Fetal distress: Fetal distress means that the baby is not doing well in the uterus, particularly during labor. This is the most common cause of C-section malpractice. If the baby is not doing well, the health care provider must deliver the baby as fast as possible to avoid injury.
• Prenatal conditions: Sometimes, the baby stops growing well in the uterus. If the doctor or midwife fails to recognize this and deliver the baby early, it would cause injury.
• Abnormal presentation: A baby might be too large to be delivered vaginally, or the baby might be breech or otherwise mal-positioned. A C-section might be necessary to avoid injuring the baby during delivery.
• Prolonged labor: Sometimes, mom's body stops laboring or the contractions are not strong enough to dilate the cervix or help position the baby for delivery. This is called "labor dystocia", "failure to progress" or "obstructed labor." Although babies can tolerate some level of labor dystocia, particularly in the first stage of labor, there sometimes comes a point where the baby can only be delivered by a C-section.

Doctors may be negligent if they fail to do a timely C-section and the baby dies or is injured before being born. Vaginal delivery is hard on babies. If the baby had difficulty tolerating labor, which we see through fetal monitoring strips as decelerations, bradycardia, or tachycardia in the fetal heart rate, the baby might lack sufficient fetal reserves to make it through delivery without suffering brain injury. A health care provider might negligently fail to properly monitor the baby before delivery, and therefore, not recognize fetal distress and the need for a C-section. Other times, the failure goes back further in the pre-natal period and the doctor or midwife fails to recognize that the baby is too large for a safe vaginal delivery. In those cases, the baby's shoulder may get stuck behind the mother's pubic bone, resulting in shoulder dystocia.

Common Reasons Why Doctors Negligently Fail to Perform a Timely C-section

Unfortunately, we see the same situations happen over and over again when there is a failure by a doctor to promptly deliver a baby by C-section.

• Failure to recognize complications: Babies should have their heart rate monitored during labor and delivery. The American College of Obstetrics and Gynecology (ACOG) has issued somewhat controversial and not particularly helpful categories for fetal heart rate patterns. These are the categories:
  • Category I: This is a "reassuring" heart rate pattern. Babies with a Category I tracing are unlikely to be in a hypoxic or acidotic uterine environment. No intervention is required. These babies generally have good heart rate variability and no decelerations.
  • Category III: This is a very concerning heart rate pattern and usually requires prompt delivery. It suggests that the baby is at high risk for acidemia. These babies have increased risk for encephalopathy and cerebral palsy. Resuscitation is likely going to be needed at birth. Category III tracings may show bradycardia (low heart rate), absent variability, recurrent late decelerations, sinusoidal pattern or recurrent variable decelerations.
  • Category II: This is the most common type of tracing and includes everything that is not Category I or Category III. This is why the ACOG categories are not particularly helpful. Many babies will experience Category II tracings before they are born. The health care providers must be vigilant and distinguish between babies that need to be delivered via C-section and those that can tolerate traditional labor and delivery for longer. Nurses and other health care providers may reposition mom, administer IV fluids, stop Pitocin, administer oxygen, or do an amnioinfusion to see if the baby will return to a Category I tracing.

Sometimes, healthcare providers negligently fail to monitor the baby's heart rate. They may remove the monitor to let mom sleep and forget to put it back on to check on the baby. Other times, the healthcare provider may not recognize a Category III tracing, could misinterpret the fetal monitoring strips, or could be overly dismissive of a Category II strip.

It is also important that a provider not overly rely on the tracings. The standard of care requires a doctor, nurse or midwife to monitor for other signs and symptoms that could negatively affect the baby before changes are seen on fetal monitoring, such as maternal infection, placental previa, placental abruption, or uterine rupture.

• Breakdown in Communication

There are multiple healthcare providers involved in labor and delivery. Mom will have a nurse, there will be a midwife, obstetrician or both, resident physicians, an anesthesiologist, and a second nurse for the baby. Other individuals may be involved "behind the scenes," such as charge nurses, scrub techs, and surgical schedulers. Mom's nurse is usually the key communicator. That nurse monitors mom's progress and watches for the development of risks to mom and baby. If the nurse has concerns, he or she must communicate those concerns to other healthcare providers.

Communication breakdowns can happen anywhere along the chain. The nurse might share concerns with an on-coming nurse during shift change and forget to report a change. A resident might get distracted by another patient and fail to communicate with an attending obstetrician. An attending might call for a C-section, but that call not be communicated to the surgical scheduler. There are countless ways communication breakdowns can occur. These can result in a C-section being delayed and result in birth injury.

• Indecisive Obstetricians

There is pressure on obstetricians not to perform C-sections unless they are sure it is necessary due to longer hospitalization and recovery periods for the mother, as well as increased risk of complications. This pressure could result in wishy-washy doctors that take the "wait and see" approach for too long. Notably, they never seem to ask the mother whether she would prefer to increase her own risk and have a longer recovery period or risk brain injury to the baby.

• Staffing Issues

Negligent hospitals can also be held liable for medical malpractice. Any hospital that holds itself out as able to deliver babies must have adequate staffing to properly care for mothers and newborn babies. The hospital must have enough nurses to monitor fetal heart rates. There must be sufficient staff to timely perform emergency C-sections. The staffing requirements vary by location, but in Grand Rapids, Lansing, Detroit, Muskegon, and Kalamazoo, there should always be an obstetrician, anesthesiologist, nurse and scrub tech available.