Don’t Leave Your On-Call Partner Out In the Cold

It’s hard enough for an on-call obstetrician to make all the right decisions when delivering for a patient he or she has never met before. That’s all the more reason for partners to share information on their patients as delivery dates approach.

Dr. O-C was the obstetrician on call for his partner, who provided all prenatal care to the patient. Another partner in the group had delivered the patient’s first child.

At 2:15 a.m. on a Saturday, Dr. O-C was called about the patient, who had a spontaneous rupture of the membranes some three hours earlier. Dr. O-C issued routine labor orders over the phone. When Dr. O-C was contacted at 10:45 that morning and advised that the patient was 6 cm dilated, 80 percent effaced, at 0 station and had moderate contractions at three to five minutes, he ordered that the labor be augmented with Pitocin.

By 12:25 p.m., Dr. O-C was in the unit talking to the patient and her family. By 2 p.m., the patient was completely dilated and pushing. Delivery was 45 minutes later.

Upon delivery of the baby’s head, Dr. O-C recognized a shoulder dystocia. Dr. O-C was unsuccessful with McRobert’s and Wood’s screw maneuvers but was finally able to deliver the posterior shoulder and then the baby. The baby boy weighed 11 pounds, 6 ounces.

In his history and physical report dictated the next day, Dr. O-C noted that the patient’s due date was two days prior to actual delivery and that she was at 40 weeks gestation. He stated the patient had told him during labor that her prenatal treating physician, Dr. P-N, told her the baby was “somewhat large.” She reported that an ultrasound three weeks earlier indicated the fetus was then seven pounds, 12 ounces and that her diabetic screen was negative. She also reported that she had gained 40 pounds during the pregnancy – versus 70 pounds for her first – and that her first baby had delivered vaginally at nine pounds, 2 ounces.

Dr. O-C reported that he did not have the patient’s prenatal flow sheets, even though a fax notation showed that the records had been sent from the medical group to the hospital early Friday afternoon.

Initially, experts reviewing Dr. O-C’s actions were critical that he did not discuss with the patient the option of a cesarean section delivery. Subsequently, however, the plaintiff attorney’s criticism turned to Dr. O-C’s colleagues.

The plaintiff attorney said that Dr. P-N, the prenatal physician, failed to appreciate the size of the baby and should have scheduled a C-section. Cementing this criticism was a discovery late in the work-up of the case: The partner of Dr. O-C who delivered the patient’s first child had actually encountered a shoulder problem during that first delivery. Dr. P-N, however, did not reflect that previous complication in his own prenatal records.

In this case, had the three partners developed a practice of holding short meetings to discuss the condition of their patients approaching labor, the obstetrician on call would have been better armed with information for his delivery-room decisions.

Gordon Ownby is general counsel at CAP-MPT.Comments on Case of the Month should be directed to gownby@cap-mpt.com