HOSPITAL LIABILITY FOR NURSING NEGLIGENCE DURING LABOR AND DELIVERY
Nurses attending a woman in labor in a hospital are employees of the hospital, and when labor and delivery nurse acts negligently and causes an injury to the unborn baby, the hospital is liable.
In a typical situation, the nurses make an assessment of the mother and baby, and use a fetal heart monitor to assess the well-being of the baby. The fetal heart monitor is the main tool to continuously assess that the baby is tolerating labor in a healthy fashion. At the outset, the fetal heart monitor will demonstrate that the baby is doing well (good variability, heart rate in the healthy range, and no ominous decelerations in heart rate). Labor is often a lengthy process, and vigilant monitoring of the fetal heart tracings is extremely important. The obstetrician is usually not present, and the obstetrician relies on the labor nurse to inform him/her if there are changes in the fetal heart tracing that indicate fetal distress.
Fetal distress is a term used to signify that something is going on to cause the baby to be unable to continue to tolerate labor. Things that can happen to cause the baby to become distressed include the following: compression of the umbilical cord, placenta abruption, rupture of the uterus, placenta break down, and prolapse of umbilical cord. If one of those conditions occurs, the baby will not be getting adequate oxygen, and if the lack of adequate oxygen goes on long enough or is severe enough, the baby can be compromised and suffer a brain injury. The labor nurse has to timely recognize the signs of fetal distress, document them, and notify the obstetrician. Time is of the essence. If the fetal distress is severe and unrelenting, the usual course of action is to perform an emergency Cesarean Section so that the baby can be resuscitated.
In the case of unrelenting fetal distress (loss of variability, repetitive late decelerations, and fetal bradycardia) failure to timely deliver and resuscitate the baby can lead to what is called hypoxic-ischemic encephalopathy (HIE), which is medical talk for brain injury due to lack of oxygen. If the HIE is severe (metabolic acidosis), the brain injury leads to cerebral palsy.
In many of the cases that I have handled, there was a failure of a labor nurse to either recognize the signs of fetal distress and/or to timely notify the obstetrician of the signs of fetal distress. Most all hospitals have clear written protocols for the labor nurse to follow on recognition of the signs of fetal distress and responding to them. Fetal distress also includes terms such as lack of fetal well-being.
Most hospitals have the ability to perform a Cesarean Section within 10 minutes of the need to do so. If the healthcare providers respond timely to signs of fetal distress, the outcome is usually a healthy baby. If there is delay, the outcome is often a baby with cerebral palsy.