Labor & delivery: court places independent professional responsibilities on nurses.


The US District Court for the District of Puerto Rico defined certain independent legal responsibilities that labor and delivery nurses owe to their patients irregardless of the orders, actions or inaction of the treating physicians.

The court did not try to compile an exhaustive list of nursing responsibilities beyond those relevant to the case at hand.


When Pitocin is in use the labor and delivery nurses have an independent legal duty to monitor the status of the fetus and must discontinue the Pitocin, or notify the physician to do so, if signs appear that the fetus is in distress, the court said.

Signs of fetal distress, for which the nurses should have stopped the Pitocin in this case were frequent contractions and a slow fetal heart rate.

Fetal Heart Monitor

According to the expert testimony endorsed by the court, when the external fetal heart monitor tracings become problematic it is a nursing responsibility to see that an internal monitor is started to obtain readings which will tell more reliably the true status of the fetus's condition.

Epidural Anesthetic

The patient needs to receive a bolus of IV fluid before an epidural is started, the court said, and the labor and delivery nurses are jointly responsible with the anesthesiologist for seeing it is done.

Once the epidural is going, the court went on to say, the labor and delivery nurses have the responsibility to watch the mother's and fetus's responses carefully. If the fetal heart rate drops the nurses must take the initiative and turn the mother...

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