The plaintiff contended that the defendant ob/gyn negligently failed to recognize that a C-section should be seriously considered because of risk factors of a very large baby, including a macrosomic baby, and probably gestational diabetes of the mother, who gained a significant amount of wight during the pregnancy. The plaintiff maintained that when the mother commenced labor, the defendant was confronted with a very large baby and that in order to minimize the risks of shoulder dystocia, a C-section would have been indicated. The plaintiff also contended that during the vaginal delivery, the defendant encountered shoulder dystocia, but failed to use acceptable techniques to complete the delivery, resulting left-sided Erb’s Palsy that will permanently manifest in difficulties with movement and an approximate 10% arm length discrepancy.
The mother had previously given birth to a nine pound two ounce child and there were initial concerns of a brachial plexus injury to that child, which resolved. The plaintiff contended that once a mother had experienced macrosomia, the risk of such a birth in subsequent pregnancies is heightened. The plaintiff also maintained that since the mother had gained a very significant amount of weight during the subject pregnancy, that there should have been recognition of gestational diabetes, and that such a factor would have been another factor to prompt a C-section.
The plaintiff also maintained that the parents had expressed concern about the size of the baby and that the defendant assured them that the size wouldn’t create anything the mother’s body couldn’t handle. The evidence disclosed that ultrasounds for size were ordered by the defendants’ nurse practitioner after the mother expressed concern. Originally, it was supposed to be just one ultrasound until the mother arrived there and the radiologist reading the reports said she had to come back weekly. The plaintiff contended that the concern prompted the moving up of the date of the induction and that the mother actually had an ultrasound scheduled on the day after the infant plaintiff was born.
The plaintiff maintained that on the date of the delivery, the defendant stated that the baby was bigger than he had thought. The plaintiff contended that prior to the actual delivery, the defendant stated words to the effect, “get everyone on the floor not in active delivery because this is going to be a large baby.” The parents indicated that during and after the delivery, they heard the defendant say “shoulder dystocia” and he told them that he “skipped two steps of normal procedure because the baby had to come out.”
The defendant denied that this position was accurate. The defendant also contended that there were insufficient signs during the pregnancy to mandate the recommendation for a C-section. The defendant contended that the measurements such as fundal height were clearly consistent with a determination that a vaginal delivery would be indicated.
The plaintiff maintained that once shoulder dystocia was encountered, the defendant negligently failed to properly utilize appropriate maneuvers to free up the shoulder. The plaintiff contended that although the mother was in the McRoberts position, he did not call for the usual maneuvers with suprapubic pressure, or the performance of Woods’ Corkscrew maneuver. The plaintiff contended that rather than attempt these maneuvers, the defendant went directly to the delivery of the posterior arm and that the child suffered the Erb’s Palsy.
The plaintiff maintained that despite surgical interventions, the child will suffer permanent difficulties and will have impairments with shoulder movement, especially overhead and midline motion. The plaintiff also contended that the 10% arm length discrepancy will be permanent. The plaintiff maintained that the child will require regular physical therapy as she grows, and that although such therapy will be helpful, it will not prevent her from experiencing the effects of the Erb’s Palsy for the remainder of a very significant life expectancy. The plaintiff would have argued that the jury should consider that throughout her life, the infant plaintiff will face difficulties and challenges, including cosmetic embarrassment that will probably affect her dating as a teenager and day to day functional difficulties that will be heightened when she becomes a mother. The plaintiff made no income claims.
The case settled prior to trial for $850,000.
REFERENCE
Plaintiff’s life care planning expert: Valerie V. Parisi, RN CRRN CLCP from Doylestown, PA. Plaintiff’s ob/gyn expert: Alexander R. Smythe, II, M.D. from Columbia, SC. Plaintiff’s orthopedic surgical expert: Scott Kozin, M.D. from Philadelphia, PA.
A.M. v. Omitted Docket No. MRS-L-2372-09.
Attorney for plaintiff: Charles A. Cerussi of Cerussi & Gunn, P.C. in Shrewsbury, NJ.
COMMENTARY
The plaintiff argued that because of the mother’s history, including a prior macrosomic baby, which placed her at heightened risk for another unusually large baby, and signs of gestational diabetes, which would create the danger of a particularly large baby, it did not appear from the records that the defendant even considered or discussed the possibility of avoiding the risks by delivering through C-section. Additionally, the plaintiff would have emphasized that because of weakness associated with a prior fourth degree episiotomy scar, the benefits of a C-section would include reducing the risk of urinary incontinence to the mother, which did not occur, and that this factor provided an additional basis for the plaintiff’s claims that a C-section should have been considered. Finally, which respect to liability, the plaintiff pointed out that once shoulder dystocia was encountered, the records did not reflect the attempts at recognized maneuvers such as suprapubic pressure and the Wood’s Corkscrew maneuver.
Regarding damages, the plaintiff would have argued that the jury should consider that throughout a lengthy life expectancy, the infant plaintiff will be required to overcome challenges in everyday activities otherwise taken for granted, that it is likely that the cosmetic injury will impact on her dating when she becomes a teenager, and that activities, such as caring for her own child, will be cumbersome and difficult.
