Labor and delivery nurses and obstetricians share responsibility to avoid birth injuries

A recent opinion entered by the Corpus Christi—Edinburg Court of Appeals highlights the multidisciplinary relationship of labor and delivery nurses and obstetricians, which has to work seamlessly to preserve patient safety.

The case is styled Kimberly Jayne Baker v. Chiva Maria Chapa, No. 13-18-00667-CV, In the 13th Court of Appeals. You can read the opinion here.

As is often the case in medical malpractice claims, the underlying facts are tragic and sad.

The patient, Chapa, was an expecting mom in a high-risk pregnancy—she had been diagnosed with complete placenta previa. This is a condition where the placenta covers the mother’s cervix, and can lead to severe bleeding during pregnancy and delivery of the baby.

At 31 weeks gestation, she went to Christus Spohn Corpus Christi—South Hospital with complaints of vaginal bleeding. The next day, her membranes spontaneously ruptured. A labor and delivery nurse, Baker, notified the on-call obstetrician-gynecologist (OB/GYN), Dr. Terry Groff.

Around 6:15 p.m., Dr. Groff saw Chapa and ordered an urgent cesarean section (C-Section) within one hour. Baker’s 12-hour nursing shift ended at 7:00 p.m. At 7:30 p.m., the patient started having heavy vaginal bleeding and was immediately prepared for C-Section. Dr. Groff delivered the baby at 7:52 p.m.

The baby was born with severe anemia (blood loss) and required immediate blood transfusions. This led to permanent neurological injuries.

As with all medical malpractice cases filed in a Texas state court, the plaintiff had to comply with tort reform requirements to produce medical expert reports that identify the standard of care (what should have happened), violations the standard of care (what actually happened), and how the mistakes proximately caused harm to the patient.

The plaintiff served four expert reports by an OB/GYN. The defendant objected to the reports, arguing that they weren’t sufficiently detailed to provide fair notice of the claims and to demonstrate that the claim has merit. The court of appeals soundly rejected the objections, find that the expert opinions were sufficient.

What the OB/GYN expert had to say is a good reminder about how all labor and delivery units should perform.

• Obstetrical nurses must understand the signs and symptoms of potential threats to maternal and fetal wellbeing and ensure that timely intervention occurs.

• The labor and delivery nurse had a duty to identify conditions that would require urgent intervention by an obstetrician and delivery of the baby within an hour. This patient had several significant risk factors that pointed in this direction, including: (1) central placenta previa, (2) premature rupture of membranes, (3) a recently completed course of antenatal steroids with a booster injection, (4) a prior cesarean section, and (5) 30+ weeks into the pregnancy.

• When facing a clinical situation like this, the obstetrical nurse must immediately notify an available obstetrician and then prepare the patient, assemble operating room personnel, and transport the patient to the operating room for an expedited delivery.

• Nurse Baker had all the information and assessment available to her by 5:17 p.m. that should have triggered all of these tasks. There was no evidence that the labor and delivery nurse did anything at all to move toward a C-Section delivery during her care of the patient, up through the end of her shift at 7:00 p.m.

• If the nurse had complied with the standard of care, then the obstetrician would’ve seen the patient earlier, leading to a physician order for delivery to occur before 6:30 p.m. As result, the C-Section delivery would have occurred before the mom had severe bleeding episode, which would have spared the unborn baby from experiencing profound blood loss and the resultant neurological injuries.

• When there’s severe maternal blood loss, it can deprive the unborn baby of oxygen-rich cerebral circulation, causing brain cells to die.

Here at Painter Law Firm, will handle multiple cases where mismanagement by physician and nursing labor and delivery personnel led to tragic permanent brain injuries because of blood loss. In a recent case, the baby had lost over 90% of his red blood cells. Although he survived, he was left with a permanent hypoxic brain injury and cerebral palsy. In another case, the baby suffered a severe brain injury because of a maternal-fetal hemorrhage, and an emergency medical event where the mother’s blood mixes with the baby’s blood, triggering an immune response.

If your baby has been seriously injured because of poor obstetrical or labor and delivery care, then contact an experienced, top-rated Houston, Texas medical malpractice lawyer to discuss your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.