Is BPI always the doctors fault? (legally)

[Steff]

OK...

Yes, there are risk factors for shoulder dystocia, but you can't PREDICT shoulder dystocia (and BPIs only occur in a small portion of S.D. cases)... that's like saying you can predict that a person will certainly have a heart attack because they are overweight and have high cholesterol.. Some will, some will not. Would it be right to subject every obese person with high cholesterol to cardiac catheterization and stenting because they were at higher risk for heart attack? The cath procedure kills 1 to 2 out of every 100 people due to complications... so many people would have to face a risky procedure with a fairly high death rate to prevent 1 heart attack. This isn't even a great analogy because heart attacks are WAY more common than BPIs (and speaking from my own work experience as an internal medicine PA, despite a clinician's best efforts and recognition of all risk factors, attempts to control them/change them, and strict adherence to standards of care, we still can't prevent all heart attacks. We do the best we can.) You would have to do 150 risky C-sections with much more risk to both moms and babies, and some babies/moms would die, to prevent 1 shoulder dystocia. From a doctor's perspective they have to make the decision that is least risky for you, based on the statistics and their own experience. As for ultrasounds to predict fetal weight, they are only accurate to within about 1 pound or so, and there is a big difference between an 8 and 9 pounder, or a 9 and 10 pounder! Even if the US said my baby would be 9 lbs, I still would have wanted to try a vag. delivery and my OB would have agreed because I didn't have enough risk factors to warrant the risks of a C-section. Healthcare providers are not usually malicious people... most know their stuff well enough to correctly manage an event like S.D., but even when there is no deviation from the standard of care and every attempt is made to resolve the shoulder dystocia, there will still be some babies hurt. All I'm saying is that there are cases that weren't forseeable and the doc did everything they could, and an injury happened anyway. If your doc/midwife pulled so hard your baby's scalp tore and applied fundal pressure knowing he/she was stuck, didn't try any maneuvers and just panicked, then you might have a good case. And if your doc changed medical records, they should have their license revoked - even within the profession there is no tolerance of that... but I know some of you are so angry that you would disagree. Please remember that my baby has a BPI too, and please don't peg me as "the enemy" simply because I work in medicine. I'm not on the "doctor's side", I simply look at the facts and I understand both perspectives. I'm here for support and information, just like the rest of you.

[admin]

Steff, when my daughter was 12 weeks, I believed my OB did everything correct. But as time goes by you see the truth and you learn more about the rick factors and red flags. It is a defense mechanism to want to believe that your OB did eveything they could to protect you and your baby! You did have risk factors, they suspected a large baby and you were slow to descend. She only took 3 pulls....well it only takes one pull to injure. You said the OB is a friend so I think you are too close to see the truth. I hope and pray that your child has a full recovery.

[admin]

It would take me quite awhile to point out just how wrong Steff's post is. It is the party line that we hear from every defense expert, and it is simply not true. Predicition is a misused word. There are cases in which shoulder dystocia can be "predicted". There are recognized risk factors that will increase the risk of shoulder dystoica to such a great degree that cesearian section is required. The risk factors, and not all of them need to be present, are macrosmia, gestational diabetes, obesity in the mother, and/or a prior shoulder dystocia.

There is so much more incorrect information in the post, but this reply should be enough for now. Doctors are not bad people, but that is not the issue. The issue is medical errors. Errors that hurt children. Errors that should not occur.

The post I am responding to could have been written by an expert for the defense. Don't believe it or accept it.

If anyone has any questions, I would be pleased to reply.

Ken Levine
Klevine@Klevinelaw.com
617-566-2700

It is disgusting to hear the threat of death from cesearian section used in a shoulder dystocia argument. It is not a factor, but the defense experts use this fear to scare juries in every shoulder dystocia case. This argument is not supported by the numbers and is simply wrong.

Ultrasound can predict fetal weight if done correcty. It is true that in the third trimester ultrasound has a range. That is why a serial of ultrasounds- three ultrasounds should be done in the third trimested if there is an issue about fetal weight. This is the theory of Frank Manning, M.D., the most respected ob/gyn in the world.

[david'smom]

YES My first son was 6pds 10oz and was three weeks early almost didnt make it out MY DOCTOR SAID IF HE WAS ANY BIGGER HE WOULD NOT HAVE COME OUT !!!! second son 1 wk early knew he was already over 9pd on ultra sound told me i would have to push my ass off david was 10pd s2oz RTBPI..I had tons of ultra sounds ..it took me a year to be in my right mind and when david turned one we sued not so much for money but more for david so he would not think that what happened to him was okay ...

[admin]

Ken, that is true about the risk factors you mention.

But if every obese woman with a large baby had a c-section, I don't think that would be a good thing. The numbers would be huge. You say C section is not a risk, in obese women it is. As for baby size, even in the hands of a very experienced practitioner, ultrasound is not 100% accurate. Plus, although there are no proven negative effects from ultrasound, that does not mean there are no negative effects. Some researchers think frequent ultrasound is not a good thing. So frequent ultrasound and c esction for suspected macrosomia may not be the cure all you suggest. Over half of bpi babies are not large, I have no idea what proportion of mothers are large, not as many as these risk factors would have us believe.
When we have carried out polls here, some babies are large, some are not, some mothers were large, some were not, some had very fast labors, some did not, the one thing almost all of them had in common was laboring on their back, many if not most had pitocin or other induction drugs and many had an epidural. Those seem to be the commonest risk factors, and you couldn't give a c section to everyone who had those things. You could and should inform the parents of the risks of those procedures, has anyone without the large baby and mother risk factors ever sued on that basis? Was anyone here ever warned that back laboring is much more risky, induction can lead to laboring problems and that epidural can seriously affect a mothers ability to birth? These factors can affect any mother no matter what her baby's size.

What strikes me is that the risk factors most frequently mentioned everywhere are maternal size, baby size, pelvic shape and size. All of these are physical issues to do with the mother. Rarely if ever are risks of the above mentioned medical procedures discussed, they are all risks that are nothing to do with the mother and everything to do with the doctor or other birth caregiver. I think the focus needs to come off the poor mother. The doctors are responsible and it's their responsibility to tell parents the risks of every procedure they carry out, long before labor and birth so that an informed discussion can take place. My own research has shown me how dangerous these procedures can be, no doctor told me, before or after birth. Yet I never see them mentioned, you haven't mentioned them as risk factors in your post. What do you say to parents of a bpi child that weighed under 8 pounds born to an average size mother, do you accept that the size factor is by no means all that's going on?

[admin]

Yes, I believe the delivering health care provider, be it OB, midwife or nurse are at fault.

When my first child was born, I had gotten an epidural and believed it had slowed my labor a great deal. However, looking back, I now realize it was my son's size 8lbs 11oz (12days early) that didn't allow him to descend. The delivering OB even mentioned that he was "stuck" under my pelvic bone and that they would therefore use the vacuum extractor. I almost freaked but luckily he was uninjured. Now comes baby #2. My OB knew my second would be larger than my first and even joked that he/she would be 10lbs. Even though he knew the conditions surrounding my first birth, nothing was ever charted as shoulder dystocia, so it magically didn't exist! Well I went au naturel with my second, in hopes to prevent a slowed labor and hoping it would be the best for my unborn child, as my son was very lethargic from the epidural the first time around. Well just like my first, my daughter wouldn't descend and kept turtling when I pushed through my contractions. When she finally came after almost 2hrs of intense pushing, it was a nurse not an OB who delivered, the OB was across the hall. Not once did the nurse ever do a maneuver to get my daughter out safely, she just pulled her out. She had to be resusitated and bagged with O2 and by the grace of God she survived, but with an injury. The nurses blamed her injury on the fact that she presented with her hand on the side of her face. The nurse even went as far to say that it was an "easy" delivery when questioned weeks later by my OB! I delivered on my back even though I begged to change positions, but every nurse said no you have to be on your back....which is a load of crap!!! Now I have the pleasure of lawyers saying we really don't have a case because the nurse probably did the best she could under the circumstances and since nothing was charted about shoulder dystocia then we don't have any proof, again like magic it didn't exist!! I think a paralyzed arm at birth is enough proof to find negligence! Either way, I know in my heart as both a mother and a nurse that negligence existed, but how do I prove it when CYA (cover your a--) is in full effect!

How would people like it if I screwed up in surgery and said "oh well, can't prove it if I don't chart it"!! That's exactly the same thing even though some of you don't want to admit it!!!!!!!!! Negligence is negligence, labor and delivery should be no exception!

So yes, I completely agree with Ken. When risk factors exist other options should be explored or at least discussed. We mothers should damn well know what we are up against, even if the risk is small that an injury or worse could occur, especially if we have any of the risk factors!

[admin]

Amen Null!!!

And Ken thank you for posting also. Its nice to hear from a qualified attorney

[admin]

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[admin]

bump

[cadinc]

Dear Ann, I completely agree with you. I don't see how it can be anyone else's fault. The doctor is responsible for getting the baby out safely. There are maneuvers he can use and he failed. Or he should know the signs that the baby's too large or mother's pelvis is too small, then do a c-section. What else is there? mine did it twice, one to me and one of my friend. Who's fault is it the second time. How many others has he done that I just don't know about? Connie Cannon
cc@conniecannonart.com