COMMENT & CONTROVERSY

Force is a 2-way street

“Shoulder dystocia: What is the legal standard of care?” by Henry M. Lerner, MD

I have practiced obstetrics for 25 years and sometimes serve as an expert witness in the defense of physicians and nurses accused of below-standard care. In my experience, “excessive force” has no concrete definition and therefore very little defense. Moreover, force is not always applied by a health-care provider moving the fetal head away from the perineum to effect delivery. In some cases, the health-care provider is simply holding the infant’s head still, and it is the mother who is pulling back. These cases often involve a lack of good pain control or regional anesthesia. The mother often panics, pulling upward or closing her legs, obstructing further delivery of the fetus.