Evelyn’s mother was 19 years old and 38 weeks pregnant when she was diagnosed with pre-eclampsia, a condition that can reduce blood and oxygen flow to the baby. Her OB/GYN sent her to the hospital for labor induction.
The OB/GYN should have known that Evelyn’s delivery could be risky. In addition to the pre-eclampsia, Evelyn was very small (growth restricted) despite her mother’s gestational diabetes (gestational diabetes usually causes a larger baby). A small or growth-restricted baby is less able to withstand the rigors of labor and delivery and at greater risk of suffering a birth injury.
On admission, Evelyn’s mom was connected to a fetal heart monitor, and the strips from this monitor allow hospital staff to gauge how well a baby is handling the stresses of labor and delivery by tracking changes in the baby’s heart rate over time. During delivery, a baby’s heart rate should be “variable,” increasing with each contraction, and returning to a resting rate (or baseline) between contractions. Changes in this pattern can be a warning. If a baby’s heart rate stays high between contractions (“lacks variability”), or the baby’s heart rate decreases after a contraction (“decelerates”), it can indicate the baby is in distress.
At first, Evelyn’s heart rate looked good, but labor was not progressing well, so Mom was given a medication – Pitocin — which can help move labor along. It can also make contractions stronger or faster, which can also make labor and delivery harder on a baby.
That evening, Evelyn’s heartrate increased and remained high (tachycardic) and she had late decelerations. Her heartrate remained tachycardic for over an hour and became concerning with prolonged late decelerations, but despite these troubling indicators, the labor and delivery nurses did not alert the midwife or doctor.
Over the next 6 hours, Evelyn’s fetal heart tracings showed numerous instances of prolonged periods of late decelerations, but no one informed the midwife or doctor. Finally, 9 hours after the trouble began, Evelyn was delivered. She was limp and pale and not breathing. Her head was badly bruised and distorted — more than usual.
A pediatrician was not called until after Evelyn was delivered, and then did not arrive for 9 minutes. When they finally got Evelyn to breathe on her own, her Apgar score was 1.
The initial examination was negative for neurological injury, but a few hours later, Evelyn started having seizures and times when she stopped breathing. She was rushed to another hospital (one with a neonatal intensive care unit), where she was immediately diagnosed as having suffered severe brain damage from lack of oxygen.
Why This Case Matters
Throughout labor, Evelyn’s fetal heart rate was monitored to assess her tolerance to labor and delivery. At first, her heart rate was normal, but as labor progressed and Pitocin was administered, her heart rate began showing signs of distress. A healthy fetal heart rate should show variability, but Evelyn’s displayed prolonged tachycardia and late decelerations—both warning signs of oxygen deprivation. Despite these clear indicators of distress, the labor and delivery nurses failed to notify the midwife or doctor in a timely manner.