Case underscores importance of adhering to standards of practice in labor and delivery

By | 2016-01-20T16:54:02-05:00 January 20th, 2016|2 Comments

During a patient’s labor and delivery, the importance of fetal monitoring cannot be overemphasized. In the following case, the focus was on the labor and delivery nurse’s conduct and the midwife’s fetal monitoring. Were either of them negligent? (1)

A minor was admitted to a local hospital‘s labor and delivery unit. During her labor, she was connected to a fetal heart rate monitor. No obstetrical residents were on duty because of an offsite conference. The patient was assigned to one of the unit’s RNs and a nurse midwife, who was qualified to manage vaginal deliveries. Should a cesarean section be required, the midwife was required to call the on-call obstetrician. (2)

Because the patient’s contractions became too close, Pitocin that was administered was discontinued for 25 minutes pursuant to the nursing protocol in the unit. It was started again at a lower rate, but the patient began to vomit. The fetal heart monitor showed fetal heart decelerations during the vomiting and Pitocin was again discontinued.

Despite turning the patient on her side to lessen the chances of further deceleration and starting oxygen, another did occur, so a fetal scalp electrode was placed in order to more accurately monitor the fetus’ heart rate. When another deceleration lasting two minutes occurred, the midwife took the paper strip from the monitor and consulted with an obstetrician in his office to determine if a vaginal delivery was still possible. (2)

The obstetrician decided to wait because of the mother’s age, but when continued decelerations occurred, the fetus was delivered by cesarean, but with neurologic brain injuries due to oxygen depletion to his brain.

The mother, the Guardian Ad Litem for the infant boy, and the boy’s father (the plaintiffs) sued the obstetrician and the hospital, alleging negligence. The trial court returned a verdict in favor of the defendants and the plaintiffs appealed.

The appellate court upheld the trial court’s decision, citing the expert testimony at the trial court level that supported all three of those who provided care during the labor of the patient. Most interesting was the testimony of the neonatalogist expert witness who examined the placenta of the baby boy.

His microscopic examination revealed the placenta was not healthy and had several problems that would decrease “fetal reserve.” The problems were the cause of injury to the baby and would have been undetectable by anyone who was caring for the mother and fetus. No negligence occurred.

The case underscores the importance of nurses in labor and delivery and nurse midwives adhering to their respective standards of practice and their overall standards of care. Doing so averted a decision against the hospital where they worked.

Standards of practice, such as those established by the Association of Women’s Health, Obstetrics and Neonatal Nurses are vital to your practice in this area of nursing.  You can review those standards, and more, at the association’s website.

1.       L.D.-M., K.D.-M., and Carlos Cabrera v. Injured Patients and Families Compensation Fund, Appeal No. 2014AP1358, Court of Appeals, District 1, Wisconsin, 2015.
2.        Id., at 3.

NOTE:  Nancy Brent’s posts are designed for educational purposes and are not to be taken as specific legal or other advice.


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About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.


  1. Avatar
    Vena Gunches January 22, 2016 at 7:42 am - Reply

    Can an LVN go into this field. I have 33 yrs as an LVN medical assistant prior CNA prior.

  2. Avatar
    Denise January 27, 2016 at 1:51 am - Reply

    Based on what has been presented here, I am sure that the midwife and nurses were closely monitoring the EFM…as is always done with the use of Pitocin. Still, one cannot help but ask if the Pitocin was truly needed in the case (Not enough info here to say). Pitocin is an overused intervention in general and, I believe, the ever present possibility of limited fetal reserve (unknown, as is usual, to the providers) should be a consideration in the use of this medication which can cause stress to mom and baby.

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