Did CNM give too much oxytocin? Child has CP

WANTING A FEMALE PRACTITIONER, a pregnant woman chose a certified nurse midwife (CNM) at her family practice (FP) clinic. During labor, the mother’s cervix failed to dilate for 2 hours, and the CNM initiated oxytocin. She continued oxytocin for 1.5 hours after the mother was fully dilated, in the presence of repetitive fetal heart-rate decelerations. After the mother pushed for 3 hours, the CNM removed the monitor, placed the mother into a water-birthing tub, and the child was born 40 minutes later.

At delivery, the baby had a heart rate of 80 bpm, was not breathing, was blue in color, and appeared lifeless. Apgar scores were low and blood gas showed a pH of 7.165. The on-call FP physician was contacted and arrived 20 minutes later. The newborn was resuscitated and sent to another facility. A CT scan taken at 56 hours of life and an MRI at 9 months were both read as normal. The child has cerebral palsy with significant cognitive deficits and upper and lower extremity impairment.

PARENTS’ CLAIM The CNM continued oxytocin beyond what is normally recommended. The drug should have been stopped when nonreassuring fetal heart rates were seen. The FP physician should have been called earlier, and a cesarean delivery or operative vaginal delivery should have been performed. The initial blood gas drawn from the infant was actually venous gas, and did not reflect the child’s true metabolic state. A pediatric neuroradiologist found significant hypoxic ischemic injury on the MRI.

DEFENDANTS’ DEFENSE The continuation of oxytocin was appropriate. The fetal heart-rate monitor tapes were reassuring, and auscultation in the birthing tub was normal. There was no significant acidosis, although the CNM testified that she could not confirm which vessel she sampled, as she rarely drew blood gases. The initial CT scan was normal, indicating that the injury could not have occurred immediately prior to birth. An acute hypoxic insult occurred prior to the mother’s arrival at the hospital.

VERDICT A $13.6 million Wisconsin verdict was returned for the child.