March 17, 2010
Ten years of reviewing obstetrical malpractice cases has taught me that the incidence of newborn brain injuries can be greatly reduced if people would respond to emergencies in a timely manner. Therefore, every pregnant woman needs a contingency plan and should have a basic understanding of the three stages of labor. Pushing for more than two hours while giving birth suggests there might be an arrest of labor and the baby might be too big to be delivered vaginally.
Ideally, first-time pregnant moms should obtain the services of a doula for support and ask the doula if she is able to perform basic fetal monitor interpretations. Doulas and child birth educators can become powerful Labor Room Advocates if they are able to recognize reassuring and nonreassuring fetal tracings. Not only will this increase their marketability, but also help educate patients’ families if there is a problem during labor that is not being addressed by hospital staff in a timely manner.
Because a hospital is a 24-hour institution, there will most likely be a change of shift during the course of labor. During this change of shift, a transfer of information should occur but is not always successful. Is the incoming shift aware that the fetal tracing has been nonreactive for the past 20 to 30 minutes or that the patient’s blood pressure is now high? A Labor Room Advocate or doula should keep a list of all ordered tests and inquire about the results.
An admitted patient should receive some form of direct communication from their healthcare provider. The management of labor should not be solely delegated to a nurse or resident physician. Problems occur when the physician or midwife is missing in action or doesn’t show up until a patient is pushing. The physician or midwife needs to have “real-time” up-to-date information regarding your progress (or lack of) in labor. If the provider is not an obstetrician, inquire as to whether the provider will have an obstetrician on standby in the event of the need for an emergency c. section.
Labor is unpredictable. By taking these pro-active steps, you greatly improve the chances of delivering a healthy baby and making the hospital accountable for providing quality care. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what do.