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 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 actually 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.
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 is what 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 that midwife appears 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.