CNM failed to inquire re baby's 'position'.

Position:Nursing Law Case of the Month - Certified nurse midwife

CASE ON POINT: Wilson v. OB/GYN of Atlanta, P.C., A10A0169 GACA (5/21/2010)-GA

CASE FACTS: Lise Wilson was a patient at OB/GYN of Atlanta (OBGYNA) throughout her pregnancy. Dixie Lee Hare, a Certified Nurse Midwife (CNM), was employed by OBGYNA. On January 28,2001, approximately two-and-a-half weeks before her due date, Lise's water broke while she was attending a class at Northside Hospital. She called OBGYNA's answering service and CNM Hare returned her call. After Hare questioned Lise, she opted not to direct Lise to go to Northside's labor and delivery department, because she felt that Lise was not in active labor. Instead, without examination, or knowledge of the baby's presentation, Hare instructed Lise to go home and return to the hospital "around midnight." Lise returned home. However, her contractions started as got to her driveway. As instructed, Lise returned to Northside Hospital at approximately midnight and was admitted. On admission, she was given a vaginal exam by Northside's labor and delivery nurse. The nurse noted that the baby's station was "high" and placed a question mark in the box where she was to note the baby's presentation. Neither the nurse or any other person made an effort to determine the baby's actual position at the time. At approximately 12:45 a.m., the fetal heart monitor recorded the first episode of fetal heart deceleration. The nurse paged Hare twice and eventually spoke with her at approximately 1:35 a.m. Hare instructed the nurse to give the mother Cervidil. She further ordered that the mother be started on Pitocin. At 7:00 a.m., Before giving those instructions, Hare did not ask the nurse about the baby's presentation. However, she acknowledged that it would be "important to know," since neither Cervidil nor Pitocin are appropriate when a baby is in a breech position. The nurse administered the Cervidil, and four minutes later a second episode of fetal heart deceleration was recorded. The nurse decided it was not necessary to notify Hare at that time. However, after a third fetal heart rate deceleration, she notified Hare. When Hare arrived at the hospital she found that the baby was in a breech position and called for "any obstetrician available" to perform a cesarian section. Lise's baby was born clinically dead and had to be resuscitated. The baby's Apgar score was 0. However, she survived, albeit with severe brain damage. Lise and her husband brought suit against OBGYNA, CNA Hare, and Northside...

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