Nursing Negligence and Birth Injuries

Child with NurseNurses play a critical role in the process of labor and delivery at modern hospitals. Women in labor often have more contact and interaction with the nurses that they do with the actual doctor(s). Maternity nurses today do more than just bring ice chips and check blood pressure. Being a nurse in the labor and delivery department requires a high level of expert knowledge and training on the childbirth process. In addition to medical expertise, nurses need to be skilled communicators because teamwork between the nurse and doctor is essential. Keeping the doctors adequately informed and reporting accurate assessment data is critical.

Nurses are considered "healthcare professionals" and can be liable for medical malpractice based on the same legal standards as doctors. In fact, nurses are frequently named as defendants in birth injury and other medical malpractice lawsuits. Medical malpractice claims against nurses are somewhat different than malpractice claims against doctors for a number of reasons. This page will look at the types of medical malpractice claims that are commonly brought against nurses in birth injury cases.

The great majority of birth injury cases involving nurse-related errors or negligent nursing care occur during the first stage of labor: from the first contractions to when the cervix is fully dilated. A much smaller percentage of nursing malpractice cases involve the second stage of labor. Relatively few nursing malpractice cases relate to the final stages of labor and delivery. The reason for this distribution is simple. During the initial stages of labor the nurse the nurse is primarily in the driver's seat. The doctor may periodically check in on how the patient's labor is progressing, but unless something goes nurses usually are the primary medical care providers during early labor. During this stage the nurse is basically the primary medical decision maker. When it comes time to actually deliver the baby and the doctor takes over the nurse is typically just following the doctor's instructions and not involved in the actual decision making.

The most common types of negligent nursing care leading to adverse outcomes and medical malpractice claims are: (1) communication negligence; (2) failure to ensure adequate care from doctor; (3) medication errors; (4) negligent assessment; and (5) negligent intervention. The chart below shows the percentage distribution of these categories of nursing negligence in birth injury cases.

Types of Nursing Malpractice
[1] Communication Negligence

Communication negligence primarily involves failing to adequately inform the physician of changes in maternal or fetal status or other complications or events arising during labor. Negligent communication is the most frequent type of nursing malpractice involved in birth injury cases. Recent data suggests that communication failure during labor and delivery accounts for about 41% of all birth injury malpractice claims against nurses. The overwhelming majority of negligent communication cases against nurses involve some type of failure to notify the doctor of fetal distress indicators on electronic monitoring devices.

Communication Case Example: woman is admitted to hospital in labor with her 2nd child and is under primary supervision of nurse. An hour after arriving her membranes spontaneously rupture and meconium staining of the fluid was obvious. At the same time the fetal monitoring strips indicate signs of fetal distress. The nurse fails to report these observations to the doctor. 3 hours later the doctor checks in and finds signs of fetal distress prompting an emergency C-section. A knot in the umbilical cord had formed depriving the baby oxygen resulting in brain damage. The nurse breached the standard of care by failing to promptly notify the doctors of the meconium staining and fetal monitoring warnings, which would have likely prevented the injuries to the baby.

[2] Failure to Ensure Adequate Doctor Care

The second most common theory of nurse malpractice in birth injury cases involves nursing negligence in failing to obtain adequate care and attention from the attending physician. These are cases where the nurse reports warning signs or problems to the doctor but fails to ensure that the patient receives the necessary care and attention in response. For instance, if the nurse reports signs of fetal distress but the doctor fails to respond (e.g., doctor is busy, cannot be reached, not at the hospital, etc.) then the nurse has a duty to appropriate action to ensure that the patient gets the required care. This may involve contacting another doctor, reporting to the nurse supervisor or following other hospital protocol.

Doctor Care Case Example: mother in active labor is admitted to hospital around 8:00 am. Indications of fetal distress are noted at 1:00 pm and the nurse promptly calls the doctor to report them. The doctor tells the nurse to "keep an eye on the patient" until he can arrive at the hospital. The fetal distress continues and the nurse makes 2 additional calls to the doctor but he does not arrive until 5:00 pm - 4 hours after the initial call. The baby suffers brain damage. The nurse is negligent in failing to notify her nurse supervisor of the situation and/or calling another doctor to perform an emergency C-section.

[3] Medication Error

Medication administration negligence is the third most common type of nurse malpractice claim in birth injury cases. Medication errors accounts for approximately 18% of all birth injury malpractice claims against nurses. The administration of medication when contraindicated is the most frequent type of drug-related error involving labor and delivery nurses. Pretty much all of these "contradiction" cases involve nurses who continue administration of the drug Pitocin despite signs of fetal stress and other circumstances which call for Pitocin to be stopped. Administering the wrong dose of a medication and giving the incorrect drug are the other 2 common forms of drug-related malpractice claim against nurses.

Medication Error Case Example: woman is admitted to hospital for labor with borderline signs of preeclampsia. Magnesium sulfate is administered by intravenous infusion. 2 hours after the infusion is started the woman displays classic signs and symptoms of magnesium sulfate poisoning. The nurse decreases the rate of infusion but provides no further care in terms of patient assessment. 30 minutes later the woman is found in full cardiopulmonary arrest. She is successfully resuscitated but suffers major brain damage and baby is delivered stillborn. Investigation later reveals that the nurse (a "floater") negligently administered 8 times the prescribed dosage of magnesium sulfate.

[4] Negligent Assessment

Negligent nursing assessment is another common type of nurse malpractice in birth injury cases. Problems with nurse assessments in labor and delivery account for around 16% of malpractice claims against nurses. Negligent assessment claims usually involve nurses who don't pay close enough attention to fetal monitor tracings and fail to notice warnings of fetal distress in a timely manner. This can involve nurses who don't bother to read the monitor tracings or who tend to ignore warnings. Failing to apply and set up the monitoring devices is another type of negligent nursing assessment.

Negligent Assessment Case Example: first time mother is in labor at the hospital and a Pitocin drip is administered when her labor is not progressing. Brow presentation is later diagnosed and doctors decide to deliver via C-section. At that point the Pitocin drip is discontinued and the nurse also removes the fetal monitoring strips. However, just before the monitoring strips are removed non-reassuring heart rates are noted. The C-section is not performed until 2 hours later and is diagnosed with severe brain damage. The nurse is negligent in prematurely removing the monitoring strips and failing to assess fetal heart rate for a period of 2 hours before delivery - resulting in a failure to detect fetal hypoxia.

[5] Nursing Intervention Negligence

The category of common types of birth injury malpractice claims against nurses involves negligent intervention. Problems with nursing intervention during labor and delivery account for about 5% of birth injury claims against nurses. These cases involve nurses who perform one of their functions incorrectly or without adequate skill. Setting up the fetal monitoring strips is usually the responsibility of the attending nurse. The most frequently seen example of negligent nurse intervention is when nurses set up or install the monitoring strips incorrectly.

Contact Miller & Zois about Nursing Negligence

If your child was born with a birth injury negligent nursing care may have been involved. The birth injury attorneys at Miller & Zois can investigate your case and help you take appropriate action. Call us at 800-553-8082 get an online case review.

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