Legal Briefs: Airway Obstruction or Botched Resuscitation?

A 38 5/7-weeks’-gestation male was born to a 23-year-old G1P0 woman who had received prenatal care and whose pregnancy was uncomplicated. Spontaneous rupture of membranes occurred at home, and the fluid was clear. Her group B streptococcus status was unknown. Because labor was ineffective, oxytocin was administered. The second stage of labor was slightly longer than 2 hours. The treating nurses noted variable and late decelerations, tachysystole, and intermittent sinusoidal fetal patterns on the fetal heart rate tracings. The anesthesiologist placed an epidural, and vaginal delivery was allowed to proceed. The infant had meconium staining. The arterial cord blood gas had a pH of 7.13, a Pco₂ of 64 mm Hg, a Po₂ of 12 mm Hg, and a base deficit of –8. The venous cord blood gas had a pH of 7.31, a Pco₂ of 41 mm Hg, a Po₂ of 22 mm Hg, and a base deficit of –5. The obstetric expert retained by the plaintiff maintained that the delivery by cesarean delivery should have occurred 6 hours before birth because signs of fetal intolerance to labor were obvious. He contended that the delivery should have occurred even before the second stage of labor began. The defense obstetrician disagreed and pointed to the fairly normal cord gas results as proof that the infant tolerated labor well.

The routine practice of the hospital was to call the resuscitation team for every delivery. The resuscitation team at this delivery consisted of a newborn nursery nurse (registered nurse [RN]) and a respiratory therapist (RT). The infant had a weak cry at birth but was limp, blue, and had meconium present on the skin. He was placed on the mother’s abdomen for bonding. The plaintiff neonatologist was critical of the resuscitation team for not placing the infant immediately …