Mutual Matters

Communication Breakdown Contributes to Shoulder Dystocia Claim

Posted by Marshaleen King, MD on Dec 14, 2017 2:24:58 PM

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The Case

A 29-year-old female patient (G2, P1) presented with a past history of shoulder dystocia in her first delivery. Her estimated delivery date (EDD) was 4/24/14. At her next prenatal visit on 4/5/14, she was seen by a certified nurse midwife (CNM). At that time, the patient weighed 226 pounds and the clinical assessment estimated the fetal weight to be over 8 pounds.

The patient was admitted on 4/13/14 at 6 a.m. for Pitocin induction. The attending obstetrician (Dr. "A") examined her at 8 a.m. then turned the induction over to the CNM and left the hospital.

At 11:30 a.m. Dr. "A" signed out to his partner, Dr. "B," due to a family emergency. Dr. "A" allegedly asked Dr. "B" to cover the call from 2 p.m. until he returned the next morning. However, Dr. "A" did not advise the patient, CNM or hospital nursing staff of his emergency. In contrast, Dr. "B" claims that Dr. "A" asked that he assume the call coverage only at 4 p.m., so Dr. "B" left the hospital to go to a previous social commitment.

The patient's labor progressed uneventfully until 2:05 p.m. when she began pushing, and the CNM noted shoulder dystocia. The CNM attempted to contact Dr. "A" but the doctor didn't respond to cell phone calls or return pages. The CNM then made three attempts to turn the baby, and finally delivered the posterior arm by reaching under the axilla and sweeping the arm over the chest.

The baby delivered rapidly after this maneuver. The female infant weighed 9 lbs. 10 ozs. The shoulder dystocia complication caused severe Erb's Palsy. Documentation confirmed that the patient intended the CNM to deliver the baby, but she had specifically requested that Dr. "A" be immediately available since she had a shoulder dystocia history.

For patient safety commentary and advice regarding this case and shoulder dystocia click below. 

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Topics: Patient Care and Interaction

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