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Morrell v. Finke11/3/2005
an upward movement of the head to complete its negotiation out of the birth canal.
Donna's mother, Mrs. Ellis, and Donna's husband, Robert, observed the delivery. Mrs. Ellis described Dr. Finke as turning her body "like this" (demonstrating), putting her leg "up against the bed like this" (again demonstrating), and "pull a lot" and "with a lot of force." She said Dr. Finke "turned to the side and braced herself." Mrs. Ellis testified that Dr. Finke was pregnant and that her stomach was very large. She said Dr. Finke pulled with such force that "it scared me to death." She also said that it was like a "tug-of-war." Robert testified that Dr. Finke shifted her weight and put one foot "in front of the edge of the bed" and started "tugging on her [Madeline] as hard as she could." Then, he said, Dr. Finke "braced her foot on the end of the bed." Robert testified that Madeline came out face-up; he could see Madeline's eyes pulled back by the forceps and her neck distended. He said Dr. Finke "couldn't have pulled her eyes back any further . . . . I thought her head was going to pop." He could see Dr. Finke "straining" and that Madeline was "all bloody" and bruised. Dr. Finke testified that she used "gentle traction" to deliver Madeline.
As Madeline's head emerged, a complication referred to as a "shoulder dystocia" developed, meaning that one of the baby's shoulders became stuck behind the pubic bone. Dr. Finke had two standard maneuvers performed to free Madeline's shoulder quickly. Using the "McRoberts" maneuver, the nurse pulled Donna's legs up to her chest to straighten the pelvis, and then she applied "suprapubic pressure" by downward vertical pressure of her doubled fist on Donna's abdomen. The shoulder was released in seconds, and Madeline was born at 8:06 p.m. Also at 8:06 p.m., Dr. Finke obtained some cord blood from Madeline to determine Madeline's blood type and to test for compatibility with Donna's blood. An analysis of this cord blood sample showed Madeline's pH to be 7.32. Dr. Finke's labor and delivery summary described the birth as a "low forceps delivery" for "severe variable decels."
G. Condition at Birth
Madeline did not start breathing upon delivery. She had bruising on her face and head with an indentation and a cut described by her father and grandmother as a "big gash" near her left temple. This wound to Madeline's skull was so severe that it eventually required debridement. Madeline also had extensive bruising over her entire body.
While Dr. Finke delivered the placenta and performed an episiotomy to repair a third-degree tear of Donna's vagina that extended into the rectal muscle, Nurse Walker began "bagging" Madeline, placing a mask over Madeline's face, and pushing oxygen into her lungs using a squeeze valve. Within two minutes of birth, the neonatal intensive care unit (NICU) was also called "stat" to send a team to the delivery room.
Nurse Walker assigned Madeline a one-minute Apgar score of two. "Apgar" scores are assigned based upon heart rate, respiration, muscle tone, reflex, and skin color on a scale of zero to ten and measure a newborn's ability to adapt to extra-uterine life immediately after birth, at five minutes, and continuing until at least a score of seven is achieved. Madeline was given a one for heart rate, a zero for respiration, a one for muscle tone, a zero for reflex, and a zero for skin color. By four minutes, Madeline was switched to one hundred percent "blowby" oxygen. Nurse Walker assessed her five-minute Apgar score at six.
Upon arrival of the NICU team, Madeline was still pale and blotchy peripherally but was centrally "pink." The NICU nurse's note in Donna's labor and delivery r
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