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Morrell v. Finke11/3/2005
be to perform a cesarean section. . . . You know, we also have a baby that's been stressed out already, is having a very difficult time, and I think that there would be a high risk of the baby not being able to tolerate anything that would be involved with this difficult of a forceps delivery.
By that time, he testified that the standard of care was "that this baby needs to have a cesarean section to be delivered. You need to have the baby out as soon as possible."
Dr. Rice explained that in a forceps delivery, pressure is applied to the baby, and if there has been a problem with the cord, continued interruptions of the blood supply may occur while the baby is being brought out through the vagina. Therefore, Dr. Rice said that the standard of care "absolutely" required a physician to avoid further stressing this baby through a vaginal delivery. The failure to perform a cesarean section as well as the additional mechanical stress of the forceps delivery were, according to Dr. Ater, proximate causes of the injuries sustained by Madeline.
By 7:42 p.m., after the second prolonged severe decel, the standard of care, in Dr. Rice's opinion, required that the baby should already have been born, " ut certainly, at this point in time, this baby needs to be born. . . . Ideally by a very rapid cesarean section [that has] already been set up." Dr. Rice said that if the nurses had prepared for a C-section, it would take about five minutes to wheel the mother to the operating room, pour on some antiseptic, drape her, and begin the C-section with a general anesthetic, and in this emergency situation, it would then take about two minutes to get the baby out.
Dr. Peter VanDorsten, board certified in obstetrics and gynecology with a subspecialty in high-risk maternal-fetal medicine, testified as an expert for Dr. Finke that the mechanism causing severe variable decels, such as those at 7:15 p.m. and 7:40 p.m. is believed to be "compression of the [umbilical] cord" that causes the heart to slow down. Although Dr. VanDorsten agreed with Dr. Rice that the 7:15 p.m. decel was cause for alert that the cord was "vulnerable" with a potential for total compression, he disagreed that a decision should have been made by 7:27 p.m. to deliver by C-section. The mother was pushing and, in his opinion, there was no reason to expect another severe decel. He interpreted the fetal heart monitor strip as showing mild decels with contractions superimposed by pushing by the mother. The question, he said, was whether they were "bothering the fetus." In his opinion, the baby was still "totally normal at this point."
Dr. VanDorsten agreed that the second decel at 7:40 p.m. was "sinister" and that the baseline of the heart rate was significantly different afterwards. The baby "can't handle" this one, he said. That decel required Dr. Finke's assessment, but he still did not believe it required an immediate C-section. In his opinion, it was appropriate for Dr. Finke to ask Donna to push a few more times while she assessed the situation. You are "wishing that she'd push the baby out," but OP labor "take longer." He saw no indications of hypoxia from the strip and nothing to indicate a progressive loss of reserves of the baby. In his opinion, Dr. Finke's decision to effect delivery of the baby after the second decel by forceps vaginal delivery, rather than by C-section, was within the standard of care.
The parties' experts disagreed not only on their interpretations of the fetal heart monitor strip and the standard of care it necessitated but also concerning the nature, cause, and origin of Madeline's neurological injuries. Dr. Jones, Plaintiffs' neuroradiologist, reviewed the CT scan ta
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