In 2004, a Kansas woman presented to the hospital for delivery of her baby. The nurse-midwife managing the labor, sought an obstetrician’s intervention when the head did not descend easily. The obstetrician used forceps to assist the delivery. She applied traction, pulling gently with a contraction 3 times, then removed the forceps, and an 8 pound 8 ounce infant was delivered. The parents sued the obstetrician after the delivery alleging the infant suffered a skull fracture, lacerated ear, bruising around his scalp, and bleeding in the brain as a result of the forceps. They attributed his cognitive impairment and epilepsy to the injuries he received at birth. The lawsuit claimed the obstetrician’s use of forceps was below the standard; the forceps were misplaced; and she should have delivered the infant by cesarean. The obstetrician countered that the fact of the baby’s vaginal delivery negated the claim that he was too large for such a delivery, also there was some question as to whether the baby actually suffered a skull fracture. She maintained that she used proper procedure for application of the forceps and understood the position of the fetal head. She further argued that the normal forces of labor could account for the infant’s injuries at the time of birth, and that the epilepsy is not related to his delivery. The defense also argued the child’s developmental issues were mild – he participates in sports and is in the same grade as others his age.
Verdict: The jury found in favor of the defense.
In malpractice cases involving instruments used to assist with delivery of an infant such as vacuum and forceps, the 2 issues that come up are usually the actual use and placement of the instruments and the indication for their use. It is often difficult to prove that the instrument was negligently placed unless the injury is a skull fracture or some other head trauma, and it is then assumed that the instrument caused the injury. So, the case then focuses on the indication for using the device. With an appropriate indication for use of the instrument, it is possible to successfully defend a malpractice case. it is imperative that the indication for using vacuum or forceps for delivery be documented in the medical record along with any or no difficulty in placing the device.