In February 2005, at the time MRS. DOE began treating with DR. ROE, she was 31 years old and pregnant with her second child. Her first child had been born via spontaneous vaginal delivery at 40.1 weeks, and weighed 5 pounds. According to the labor and delivery records from that birth, there was no indication that the doctors were concerned that MRS. DOE would have difficulty delivering the baby vaginally even though the baby’s estimated weight was 7 lbs. 1 oz.

When Mrs. DOE first consulted with Dr. ROE, she provided Dr. ROE with all of the records from her previous delivery. Dr. ROE admitted it would have been her custom and practice to review Mrs. DOE’s previous deliveries to see the size of the baby, whether it was early or full-term, the length of labor and whether the baby was too big for the birth canal.

Sonograms performed by Dr. ROE on Mrs. DOE in June and September, 2005 showed the baby to be progressing well, with biparietal head measurements that were within the normal range. An estimated delivery date was given of October 20, 2005.

On October 4, 2005, according to Dr. ROE’s notes, she estimated Mrs. DOE’s pregnancy to be at 37 weeks, 5 days. At that point in time, Mrs. DOE had gained a total of 16.5 pounds during her pregnancy. Dr. ROE admits that at this office visit she advised Mr. and Mrs. DOE that the baby was big and that if it grew any larger, Mrs. DOE would not be able to deliver vaginally. She advised them that the safest thing to do for the mother and the baby was to take Mrs. DOE into the hospital and induce labor. Dr. ROE told them if she didn’t induce the baby, that it would get bigger and that there would be a problem.

Dr. ROE’s records, however, fail to document any indications for induction. There was no evidence of macrosomia (large for gestational age) or cephalopelvic disproportion (baby’s head too big for mother’s pelvis). In fact, according to Dr. ROE’s examination of Mrs. DOE, her pelvic outlet was unremarkable, and Dr. ROE’s obstetrics history and physical at the time of induction listed the estimated fetal weight at 6 pounds, smaller than the estimated fetal weight of Mrs. DOE’s first baby.

At the time of birth, the newborn records indicated that the baby’s head circumference at birth was only 12.99 inches, which was in the 10th percentile. The baby weighed 6 lbs., 3 oz., which is in the 25th percentile.

Despite no evidence of macrosomia and despite a standard of care that did not support early induction for suspected macrosomia, Dr. ROE convinced the DOEs to proceed with an early induction of labor.

Before proceeding with induction, the standard of care required that a physician disclose the additional risks from an induction, including an amniotomy (rupture of membranes), uterine hyperstimulation, fetal distress, abruptio placenta, cord prolapse and postpartum uterine atony, as well as the increased risk of Cesarean section. Dr. ROE did not explain these additional risks to the plaintiffs, nor did she explain the induction procedure, other than the need to give medications to induce contractions. There were no discussions regarding the potential need for Cesarean section, and the consent Mrs. DOE signed for the induction does not mention the possibility of a Cesarean section.

The Bishop scoring system is the standard of care to determine whether a patient is a good candidate for induction. Factors considered for the Bishop scoring system are dilation, effacement, station, cervical consistency and position of the cervix. In this case, Mrs. DOE was brought into the hospital in the early morning hours of October 11, 2005. Initial physical examination showed her cervix was dilated to 1, effacement was 50% and station was -3. The cervix was also posterior. Her Bishop score was 4. A Bishop score of <5 predicts a failed induction leading to Cesarean section.

Despite a physical examination showing that Mrs. DOE’s cervix was not inducible, lack of indications for induction, and in fact despite the presence of several contraindications, Dr. ROE performed an amniotomy (artificial rupture of the membranes) at 7:24 a.m. The standard of care for an amniotomy is that it be performed in the presence of a favorable cervix and/or active labor, neither of which was present at the time.

Dr. ROE did not tell plaintiff that she was going to perform the amniotomy. No one told plaintiff that they were going to rupture her membranes and that if the baby didn’t come down, they would have to do something else. She learned that Dr. ROE had ruptured her membranes after it was done. When Mr. DOE arrived in the delivery room, he saw and heard his wife roaring in pain during a vaginal exam. Dr. ROE was saying that she could not find or reach the cervix. Plaintiff was in pain and bleeding after the exam, witnessed by her husband, and later confirmed that she felt immediate pain when Dr. ROE performed the amniotomy.

Once an amniotomy is performed, there is literally no going back in terms of labor and delivery. The longer the child remains undelivered following the amniotomy, the higher the risk of the development of chorioamnionitis (infection).

Predictably, given the circumstances, Mrs. DOE’s labor was slow to develop and slow to advance. She developed a temperature of 102.7, consistent with the development of chorioamnionitis. Despite being advised of this, Dr. ROE did not order the administration of antibiotics for more than an hour.

At approximately 2056, Dr. ROE ordered that plaintiff be prepped for an emergency C-section. Dr. ROE did not come in and tell plaintiff that she was going to perform a Cesarean section; a nurse told her. In fact, no one ever explained anything to DOE about the procedure.

Dr. DOE’s operative note lists the indications for C-section primarily as fetal distress, as well as cephalopelvic disproportion and maternal fever. The only one of those items that is supported by the records is maternal fever.

Plaintiffs’ expert, Dr. Freedman, testified in his deposition that given these circumstances, it was contraindicated to perform the Cesarean section at that time in the presence of an obvious infection. Shortly before 2130, Dr. DOE performed the C-section. During the procedure, a paracervical laceration occurred. Baby DOE was delivered successfully at a gestational age of 38.4 weeks, weighing 6 lbs. 3 oz.

Shortly after plaintiff was transferred to the recovery room, the nurses noted that several blood clots were expelled through the vagina with fundal massage. The estimated blood loss was 800cc. Dr. ROE had already gone home. Once plaintiff began to bleed, the standard of care required Dr. ROE to rule out the paracervical laceration as the cause of the hemorrhage. Dr. ROE did nothing to see if the laceration was causing the bleeding.

Over the course of the next few hours, antibiotics were given as well as blood products. During this time frame, the nurses noted that the bleeding had slowed and had almost stopped. Dr. ROE was called back to see the patient. She felt that uterine atony was the cause of the bleeding. Uterine atony is a relaxation, flaccidity or lack of tone or tension.

When Dr. ROE returned, she offered plaintiffs a uterine embolization to stop the bleeding. They wished to take that offer to avoid a hysterectomy so that Mrs. DOE could have additional children. However, Dr. ROE quickly withdrew that offer, saying that the embolization team would take too long to get to the hospital to perform the procedure, despite the fact that she had known about Mrs. DOE’s bleeding before arriving at the hospital.

Instead, Dr. ROE told plaintiffs that the only option was to perform a complete hysterectomy and that if they didn’t agree to that very quickly, Mrs. DOE would bleed to death. Dr. ROE failed to advise them of the several other options available under the circumstances, and has admitted telling the plaintiffs that they had no choice other than to proceed with the hysterectomy or plaintiff would die – despite the likely possibility that the heavy bleeding originated from the cervical laceration. Dr. ROE had never ruled that out.