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Morrell v. Finke11/3/2005
ed that in her opinion, there was still no contraindication to proceeding with a vaginal delivery.
E. Evening
At 4:59 p.m., the fetal heart monitor strip documented another severe "biphasic" deceleration followed immediately by another deceleration before a return to baseline was achieved. Dr. Finke agreed that this tracing was "significant" because, if it became repetitive, it would be a sign that the baby was not tolerating labor. Another severe decel followed, and it took Madeline's heart approximately four minutes to re-establish some sort of baseline. Another decel immediately followed; Madeline's heart took over a minute to return to baseline. The strip showed decelerations that were becoming deeper, longer, and more frequent.
Experts testified that by 5:15 p.m., the fetal heart monitor strip documented "marked variability" in the decelerations, some lasting eighty seconds. "Marked variability" is significant because it means the baby is having a hard time compensating and is using more reserves. By 5:20 p.m., the strip showed a pattern of repetitive late decelerations, a nonreassuring, "ominous sign," requiring intervention.
Nurse Walker conducted vaginal exams at 5:10 p.m. and again just before 6:00 p.m., revealing that Donna's cervix was dilated to nine centimeters. During this time, the strip shows that Madeline continued to experience decels; one lasting almost three minutes. Nurse LaMont explained that at this point, every prolonged deceleration constituted an insult to the baby, causing the baby to lose its reserves. The fetal heart monitor strip was becoming more and more alarming; the decelerations were getting deeper, longer, and slower to return to baseline, documenting that the baby was developing more and more of an oxygen deficit.
At 6:30 p.m., the nurses had Donna try "pushing" a few times to help complete the cervix's dilation and move her to the second stage of labor, but the efforts were unsuccessful. As Donna attempted to push, Madeline experienced another prolonged deceleration followed by an increase in her heart rate to thirty beats per minute over baseline. The spike in Madeline's heart rate constituted another nonreassuring sign, according to Nurse LaMont, because "as your oxygen supply gets deleted, your heart beats faster because it's trying to make up in quality with quantity of getting oxygenated blood through." By 6:45 p.m., Donna's contractions were becoming stronger and closer together. The strip continued to document nonreassuring, deeper, longer, and more frequent decels. At trial, Dr. Finke explained the increase in variability and number of decels on the fetal heart monitor strip between 6:00 p.m. and 7:00 p.m. was normal because Donna had moved into the pushing phase of labor. Shortly before 7:00 p.m., Nurse Walker gave Dr. Finke a report on the mother's and the baby's status, and at 7:00 p.m., Dr. Finke examined Donna. Dr. Finke determined that the baby had moved past the posterior rim of the cervix, although not the anterior rim. Dr. Finke determined that the baby was making some progress but was in an occiput transverse (OT) position, at an angle that would make negotiation of the birth canal difficult. Dr. Finke attempted to rotate Madeline to the preferred occiput anterior (OA) face-down position but was unable to do so and rotated her, instead, to the less preferred occiput posterior (OP) face-up position. Dr. Finke noted that the baby continued to have variable decels but said these were caused by her efforts to turn the baby and did not concern her.
From 7:00 p.m. on, for the last hour of Donna's labor, the nurses stopped charting Donna's and Madeline's care. The last chart entry concerning th
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