On February 2011, Missouri resident Arteisha Betts visited a physician, where the baby’s father, Travis Ammonette, was also present. The physician told the couple that the baby’s “abdomen was too large for a normal birth.” The physician then told Betts that the alternative was to deliver the baby by caesarian section.
A month after the visit, on March 22, 2011, Betts went into labor. Betts was admitted to a nearby hospital in Missouri. At the time, Betts was only 28 weeks pregnant.
According to the NY Daily News article, Betts requested that the attending doctor deliver her baby by caesarian section. The doctor, however, refused to perform a caesarian section. Instead, Betts and Ammonette allege that the doctor insisted on attempting to deliver the baby vaginally.
The parents also claim that the physician did not let them go to a different hospital. In fact, the couple alleges that the doctor forced Betts to agree and consent to a natural birth, notwithstanding Betts’s objections.
During the vaginal delivery, the baby's head delivered, but the rest of the body got stuck in the birth canal. The physician then tried to release the baby from the position by applying traction to the baby’s head.
The lawsuit by the parents allege that the doctor used such force that he “‘separated (the boy’s) head from his cervical spine.’”
To make matters worse, the parents also allege in their lawsuit that the doctor attempted to cover up the horrific insult and tried to put the baby’s head and decapitated body back into the birth canal. The patient was then rushed into an emergency c-section. The article describing the lawsuit claims that during the c-section, the physician surgically removed the baby’s head from his body and tried to conceal the baby’s injuries before he gave the deceased baby to the couple. Neither the article nor the lawsuit allegations detail how this was attempted.
COMMENTARY
If the allegations described in the lawsuit and the article are true, this represents a horrendous and horrific incident that never should have occurred.
Let's go through the details to understand better what may have happened.
First, mom was told not to have a vaginal delivery because her baby was too big.
That indicates that the physician believed that either the birth canal was too small to accommodate the baby during delivery, or conversely, the baby's head and shoulders were simply too large for the mom's pelvic anatomy. There may be other medical reasons where the physician would recommend that mom have a C-section rather than a vaginal delivery.
An example of this would be the location of where the placenta is located in the uterus. The placenta is the organ that provides nutrition and blood to the baby as it is growing in mom's womb. If the placenta is obstructing the outlet for the baby's delivery, this might create a mechanical problem requiring a C-section.
Prermaturity
The fact that the baby is premature at 28 weeks is also significant as opposed to delivering a full term baby.
A Judgment Call
Let's assume that the delivering obstetrician made a judgment call and believed that because the baby was premature and his own clinical examination of the mother's pelvis, he believed there would be no problem doing a vaginal delivery.
A Medical Judgment Call in NY
In New York, if a doctor exercises his best medical judgment using information gained during his clinical examination together with his knowledge and experience and that judgment is within acceptable standards of care, then it would be difficult to show at trial that choosing that course of treatment was unacceptable.
However, if the doctor's choice of treatment represented a departure from good and accepted medical care, then even though he was exercising his “best judgment” he still could be held responsible for choosing a level and course of treatment that departed from good and accepted medical care.
This Happened in Missouri
Since this happened in Missouri and I only practice law in New York, I cannot comment on the legality and the requirements necessary to prove a medical malpractice case or wrongful death case in the state of Missouri.
However, when a baby's shoulder gets stuck in the mother's birth canal, there are five different ways that physicians are taught to attempt to release the stuck shoulder.
What is Shoulder Dystocia?
In this case the baby's head was delivered but the shoulders apparently became stuck. This is known as shoulder dystocia. This is a true obstetrical emergency and requires a physician with the most experience to be present in an attempt to save the baby. The reality is that if a physician is mechanically unable to get the baby out, the baby will die within the birth canal. Likewise, the longer the baby sits in the birth canal with the head already delivered, that can deprive the baby of necessary oxygen leading to brain damage. That is why this represents a true obstetrical emergency.
How to Treat Shoulder Dystocia
Let's go through the five different methods that doctors are taught in an attempt to undo a stuck shoulder during delivery:
- McRoberts maneuver. This is where the doctors will have mom push her legs all the way back up so that her knees are virtually touching her chest. This allows for greater curvature of the birth canal in an attempt to let the baby pass through.
- Attempt to grab and rotate the baby's posterior arm. The doctor takes his hand and places it into the vagina in an attempt to grab the posterior arm and gently pull to try and release the shoulder from within the mom's pelvis and pubic bone. This does not involve any attempt at pulling on or rotating the baby's head.
- Applying gentle traction to the baby's head and rotating it can sometimes assist the doctor with relieving the shoulder dystocia.
- Fracturing the baby's clavicle. There are instances where an obstetrician will intentionally break the baby's clavicle in an attempt to collapse the broad shoulders that are preventing the baby from passing through the birth canal. There is usually no long-term permanent effect from intentionally fracturing the clavicle, although this is not something that is pleasant for either the doctor or the infant.
- Zavanelli maneuver. This is a very rare procedure. It involves fracturing the mother's pelvis in an attempt to open up the birth canal to allow the baby to pass through.
In this reported incident, if the doctor is applying excessive traction to the baby's head in an attempt to release the shoulder, causing the baby's head to become severed from the spinal cord, that would suggest the physician was using an excessive amount force on the head. If the allegations are true, this incident represents every pregnant mom's worst nightmare.
