Failure to Diagnose Fetal Macrosomia Costs Minnesota Midwife $8.9 Million

In October, a birth injury malpractice verdict was awarded against a Minnesota midwife, which demonstrates the very real dangers of failing to accurately estimate the fetal size and weight before delivery. The plaintiff, a mother from a small town in Eastern Minnesota, sued the certified nurse-midwife from Allina Health negligently mishandling the delivery of her son in January 2016.

This was the plaintiff’s second child and throughout her pregnancy, she repeatedly told her midwife at Allina Health that the baby felt considerably larger with this pregnancy. The midwife reassured her that the baby was normal sized and estimated that he would be around 6 pounds at birth. Unfortunately for the midwife, this weight estimate turned out to be disastrously wrong.

Fetal Macrosomia

Fetal macrosomia is the medical term used to describe a baby that is oversized for their gestational age. Any full-term baby over 9 pounds is considered macrosomic. Advance diagnosis of fetal macrosomia before delivery is extremely important because it almost always requires a preemptive C-section. If the baby is too big (macrosomic) vaginal childbirth can be very dangerous. Big babies have trouble fitting through the mother’s birth and canal and tend to get dangerously stuck during delivery.

Diagnosis of fetal macrosomia may seem like a very simple task, but it is actually very difficult even with modern imaging technology. Estimating fetal weight during pregnancy is notoriously tricky. Even with sonograms and ultrasounds, there is no sound method of measuring a baby’s weight inside the womb. Instead, doctors must estimate fetal weight based on 2 points of measurement: (1) fundal height; and (2) amniotic fluid level. Even when these are accurately measured, however, they don’t give doctors a precise weight calculation.

This Case

The midwife in Minnesota came up with a fetal weight estimate of 6 lbs. This ended up being way off the mark because when the baby was eventually delivered at Allina Cambridge Medical Center he weighed in at a whopping 10.5 lbs. This was a classic case of failing to diagnose fetal macrosomia. If the midwife had accurately estimated the baby’s fetal weight to be anywhere close to 10.5 pounds, she would have known that vaginal delivery was not safe and scheduled the mother for a C-section.

The midwife’s failure to diagnose fetal macrosomia in advance basically created a ticking time-bomb which predictably exploded in her face when she tried to deliver the baby vaginally. That delivery room explosion came in the form of shoulder dystocia. Shoulder dystocia is an emergency complication that sometimes occurs during childbirth in which one or both of the baby’s shoulders become stuck behind the mother’s pelvic bone. When this occurs it is very dangerous because the baby’s head is essentially stuck in the birth canal. If the shoulder cannot be dislodged within a few minutes, that baby can suffer oxygen deprivation and brain damage. This causes permanent birth injuries such as cerebral palsy.

Not realizing how big the baby was, the midwife attempted a vaginal delivery. During that delivery, the baby’s shoulder became very firmly stuck behind the mother’s pelvis – a classic case of shoulder dystocia. Perhaps realizing that the baby was in fairly imminent danger at that point, the midwife appeared to have panicked. In her rush to dislodge the baby’s shoulder and deliver him to safety, the midwife gripped his head and tried to pull him out with excessive force. At trial, the plaintiff’s expert estimated that the midwife used 8 times the normal amount of force.

The midwife frantic pulling was not successful in dislodging the baby but it was enough to fracture his arm and damage his brachial plexus nerves (a group of nerves at the base of the neck that allows the brain to control the arm). A doctor was eventually called in to perform an episiotomy which successfully delivered the baby.

The baby’s nerve damage was fairly significant and required multiple corrective surgeries and extensive physical therapy to repair and restore some limited arm function. The mother’s medical malpractice case against the midwife went to trial, and a jury determined that the midwife breached the standard of medical care and awarded damages totaling $8.9 million.

Fetal Macrosomia Verdicts and Settlements




    2019 – California

    A newborn boy suffered oxygen deprivation, micro bleeding, and meconium aspiration at birth. He subsequently experienced developmental and cognitive delays, cerebral palsy, and ADHD. His parents alleged that the obstetrician’s negligent care caused these permanent injuries. They claimed he improperly addressed fetal macrosomia, failed to address breech presentation, and delayed the C-section. This case settled for $975,000.

    $975,000 – Settlement

    2019 – New York

    A newborn girl weighed over 11 pounds at birth. During her delivery, the nurse-midwife encountered shoulder dystocia. The girl subsequently experienced a brachial plexus injury and neuropathy. Her mother alleged that the nurse-midwife’s failure to consider and test for macrosomia caused her permanent injuries. This case settled for $926,358.

    $926,358 – Settlement

    2019 – New York

    A newborn boy sustained Erb’s palsy and a right brachial plexus injury at birth. He now experienced developmental delays.  The boy’s mother alleged that the physicians’ negligence caused his permanent injuries. She claimed they failed to appreciate her gestational diabetes as a macrosomia risk factor.  The boy’s mother also claimed the physicians failed to order a C-section and negligently used excessive force during a vacuum-assisted delivery. This case settled for $883,704.

    $883,704 – Settlement

    2018 – New Mexico

    A newborn boy weighed over nine pounds at birth. He suffered hypoxic-ischemic encephalopathy and a brachial plexus injury. His mother also suffered vaginal, rectal wall, and anal sphincter lacerations. The boy’s parents alleged that the hospital’s negligent care caused these injuries. They claimed its staff failed to test for macrosomia despite his mother’s diabetes. The parents also claimed they failed to offer a C-section and used excessive force during a vacuum-assisted delivery. The hospital denied liability. It argued that its staff met the standard of care. The jury awarded the family a $73,030,000 verdict.

    $73,030,000 – Verdict

    2018 – New York

    A newborn girl sustained a brachial plexus injury at birth. She developed Erb’s palsy. The girl’s left arm was left with limited mobility and strength. Her mother alleged that the hospital’s negligence caused her permanent injuries. She claimed its staff failed to appreciate a sonogram that revealed that the baby was large for her gestational age. The woman also claimed the physician applied excessive force in a vacuum-assisted delivery, improperly treated shoulder dystocia, and failed to offer a C-section. A jury awarded a $15,340,000 verdict.

    $15,340,000 – Verdict

    2018 – California

    A newborn girl suffered a hypoxic-ischemic brain injury at birth. She developed spastic quadriplegia, developmental delays, intellectual disabilities, and speech impairments. The girl now required lifelong assistance with daily activities. Her mother alleged that the hospital’s negligence caused her permanent injuries. She claimed they failed to recognize the rapid fetal size increase within the last gestation month as a macrosomia sign. The girl’s mother also claimed the initial attending physician abandoned her during labor and failed to tell the inexperienced covering physician of her high pregnancy risk. This case settled for $2,090,000.

    $2,090,000 – Settlement

    2016 – California

    A newborn boy weighed over 15 pounds at birth. He suffered hypoxic brain damage which resulted in developmental delays. The boy now required a feeding tube and round-the-clock nursing care. His mother alleged that the hospital’s negligence caused his permanent injuries. She claimed they failed to timely diagnose macrosomia, delayed a C-section, and failed to timely resuscitate and transfer him.  This case settled for $8,000,000.

    $8,000,000 – Settlement

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