Forced Csection??

Published

The Citizens Voice

Woman hits hospitals' stance that she agree to C-section

By Lisa Napersky , Citizens' Voice Staff Writer 01/17/2004

A Plymouth woman who was ordered by a Luzerne County judge to consent to a Caesarean section delivery of her baby said Friday she was appalled by the treatment she received at two area hospitals.

While she was in labor Tuesday night, Amber Marlowe, Academy Street, Plymouth, said she spent hours defending her right to deliver her baby lady partslly.

She and her husband, John, drove to three different hospitals before she found a doctor who would respect her wishes.

"It was very upsetting," stated Marlowe, who gave birth lady partslly to a healthy baby girl Thursday morning in Moses Taylor Hospital, Scranton. "All this just because I didn't want an operation."

After Marlowe refused to consent to a C-section and checked herself out of Wilkes-Barre General Hospital Wednesday morning, the hospital took legal action against her.

Hospital workers claimed that an ultrasound indicated Marlowe's fetus weighed 13 pounds and the lives of the mother and the baby would be in jeopardy if the operation weren't performed.

At the request of Wyoming Valley Health Care Systems, Luzerne County President Michael Conahan signed an order Wednesday appointing the hospital as legal guardian for the unborn child.

Judge Conahan also ordered that the parents "are hereby temporarily restrained from refusing to consent to a C-section delivery of their unborn fetus if the professional medical judgment of WVHCS and the treating obstetrician is that such a procedure is necessary."

The preliminary injunction ordering Marlowe to submit to the C-section was delivered to her residence, but she never received the document.

"They kept wanting to cut me open to get the baby. I think they may have actually sent police to our house, but we weren't home," said Marlowe. "I kept telling them I've already had six kids, and the biggest one weighed 12 pounds and there were no problems."

Marlowe said when she started having contractions Tuesday night, she went to Mercy Hospital, Wilkes-Barre, because it was close to her home. After medical personnel performed an ultrasound, Marlowe said she was informed the baby was going to weigh more than 11 pounds and a doctor insisted that she undergo a C-section operation, even though there were no apparent problems.

"They told me there was no way they would let me deliver the baby naturally because the doctor didn't want a lawsuit," said Marlowe. "I had a friend who died during a C-section, and I was afraid to do it that way."

Even when the couple offered to sign papers promising not to file a lawsuit, the doctor refused, explained Marlowe. She said staff members at Mercy Hospital called security when she told them she was leaving.

She and her husband next drove to Wilkes-Barre General Hospital. Marlowe was admitted at 10 p.m., and a second ultrasound was done.

Doctors there reached the same conclusion as those at Mercy Hospital. They also refused to deliver the baby lady partslly, claiming it was too dangerous because of the size of the fetus.

Throughout the night, said Marlowe, nurses and doctors told her "horror stories" about how her baby was going to be handicapped if she didn't have the operation. She checked herself out at 11 a.m.

"I told them, forget it - I'm leaving. Then I came up here (Moses Taylor) and had my baby the proper way," she stated. "The doctor here never even suggested a C-section.

They did an ultrasound and blood work and continued to monitor me, and there was no problem."

In the civil complaint filed against the Marlowes, who are referred to as Jane and John Doe in court documents because of patient confidentiality, plaintiffs are listed as the WVHCS and Baby Doe.

"Even in the absence of present fetal distress and even with ongoing fetal monitoring, a lady partsl delivery of this size fetus could result in complications occurring during the delivery ... and result in unavoidable death or serious impairment to the baby," states the complaint. "Baby Doe, a full term viable fetus, has certain rights, including the right to have decisions made for it, independent of its parents, regarding its health and survival."

According to the suit, John and Amber Marlowe cited religious reasons for not wanting to have the operation. The complaint also states that during one of Marlowe's previous pregnancies, the baby suffered shoulder impairment because of the size of the fetus. The couple said neither allegation is true, and that the main reason for wanting lady partsl delivery was fear of having an operation.

Marlowe said she and her husband are contemplating filing a lawsuit against Mercy and General hospitals for causing them distress.

©The Citizens Voice 2004

www.zwire.com/site/news.cfm?newsid=10824225&BRD=2259&PAG=461&dept_id=455154&rfi=6

Specializes in Case Mgmt; Mat/Child, Critical Care.
Originally posted by imenid37

I saw an article today that stated the dad "might" seek a monetary settlement from the hospital.

Oh gee...BIG, BIG surprise!:chuckle

As I have been reading throught these posts, I kept thinking...something is really fishy here, where is this woman's primary care OB...where had she obtained her prenatal care, etc, etc...

Obviously, there are quite a few pieces to this puzzle that are missing!

Even so, I don't understand what all the fuss is about, this woman was not strapped down against her will and operated on. She was given sound medical advice by physicians/medical staff at 2 different hospitals. (At least as far as the facts presented in the article). As per her right, she refused and left AMA.

I don't know why people can't understand why medical personnel must protect themselves from our sue happy society! As we all know, OB is one of the most highly litiguous areas of medicine!:eek:

Why is it so bizarre that the physicians/hospital protect themselves? As for that "release" she wanted to sign...uh, yeah, right!

So now papa wants money! Oh please! These kinds of people truly peeve me off!

End of rant now...:roll

Death is rare because of interventions by Nurses and doctors (C/S is one of those interventions). The interventions nurses can do at birth are often effective but not always and with a kid that big I'd bet money it was worked on and at least baged for a while and that carries even more risk to the baby.

Shoulder dystocia is one of the many things that used to kill a large percentage of babies. Shoulder dystocia is also one of the biggest reasons patients sue. Also a big cause of CP.

For those that are lurkers or don't work in OB, shoulder dystocia is when the baby gets stuck with just its head out. During the time its stuck, no oxygen is going to the babies brain. There are various opinions on how long this can take place before brain damage happens but none of them say it's very long and non of them think it's a good thing to have a child like this for any amount of time.

As for the injuries to the shoulder, yes a good amount of them heal quickly but there are also studies saying that children with those injuries lag developmentally and of course they have pain while it's healing. Also some don't heal. Ever seen an adult walking around with 1 tiny arm? sometimes thats caused by shoulder dystocia also paralysis is a risk.

I am by no means a C/S lover in fact I don't like them much and hate to see patients going under the knife. However, in this situation the risks of C/S are greatly overshadowed by the risks of lady partsl delivery.

I still don't think the court order is legal or moral in any sense and agree that patients can refuse treatment even if the result will be death but I can't agree with that decision or see a doctor refusing to help her take those risks as wrong.

Sometimes we grumble about birth plans but we still do the best we can to support the patient and do what they ask (even when its silly). This isn't the same situation at all. Md's and Rn's working on a lady partsl delivery of this type would be taking huge risks. Setting aside the risks of litigation and risk to ones license (which aren't small) I'd also see it as participating in something harmful. I guess it would be a different story if the patient was in spontaneous labor and imminently going to deliver I mean you would have no choice but to act.

Thats another good question is'nt it? How did a G7 P6 have time to run around to 3 hospitals in labor after spending the night at the first one?

I think the key in this case would be instead of forcing the woman to undergo a c-section (which sounds like to me the doctor was looking after his pocketbook more that the welfare of mom and baby) would be to BE PREPARED and educate..... educate.... educate. For instance if the delivery was conducted in the OR with full C/S set-up and staff on standby. I am sure that most poor outcomes occuring from shoulder dystocia is when the dystocia is unsuspected. As far as the weight of the child.... we had a severe dystocia recently where the child was 7lbs 3oz. Did we have disproportion in this case? I think that is doubtful since she had delivered large babies before. However, I agree that this case sounds strange because sounds like she did not have a regular OB doc......

Just speaking to the comment about the parents "signing away" any rights to sue.

It's kinda like this. If I were an OB and said I wanted to do a c-section on you, but I didn't wanna be sued and yet you demanded it... You could sign a paper stating that no matter the outcome I would not be liable for damages. When you are discharged, the janitor can also write you a script for Percocet to help with post op pain.

Neither one of those papers will get you very far.

And neither one is worth the paper it's printed on.

Dave

Originally posted by Dayray

[b

Thats another good question is'nt it? How did a G7 P6 have time to run around to 3 hospitals in labor after spending the night at the first one? [/b]

Thats what I was thinking!!!! I would love the whole story!!

Wow, what a mess! I, too, think that a big chunk of the story is missing. If she is a G7 P6, it seems like she would have been educated previously about the POSSIBILITY of a c-section. I know when I checked into the hospital to deliver my son, I signed a consent form stating that I was consenting to a lady partsl delivery but in the case of an emergency I was consenting to a c-section. I had no problem with this, because I was EDUCATED about the possibility.

This is really scary. As a non-medically educated mom, I would be too scared for my baby's health to disagree with 2 different physician's opinions on what was the SAFEST method of delivery.

As a nurse, I would be scared of shoulder dystocia and complications to the fetus. Not to mention possible lady partsl prolapse later on in life!

My brother weighed 10 lbs. 10 oz. when he was born, and he had shoulder dystocia. very scary for all involved. Complications are especially scary.

As someone else pointed out, I am sure that this case wouldn't have been the first time a pt. delivered via c/s for such a large baby!

I really do support a limit on the amount of money one can receive from law suits like these! I mean, this is CRAZY!!!

Hmm, does sound like a HUGE amount of info is missing or protected. This story as it is told is VERY fishy!

First off, I agree, how the heck would she have at least 12 hours to travel hospital to hospital looking for the care she wanted if she was in labor at G7P6?

Second off, isn't this an EMTALA violation???? Don't they have the right to care regardless of pay and desired care? And where the heck is the primary OB/CNM she was seeing, or wasn't she getting prenatal care??

Of course the OB on call has the right to be concerned, but as for EMTALA they do have the need to carry out proper and expectant care w/ regard to pt wishes, as long as she is given informed consent with all options, possible outcomes and alternatives discussed.

I really think that there is a lot more to this story and I really can't see them refusing to deliver the baby if the pt is active (8-9cm) and ready. She does have this right and the right to refuse.

However, alot of you are right in stating where do you draw the line? Where would the liability land if an adverse outcome? My guess is that if she sued and the case was documented in the medical records clearly stating her state of mind and that she refused treatment against medical advice then it should be clear that she went into this knowing the posibilities.

Like someone else said...WHAT A MESS!!!

Would really love to know the whole story, good thread!

Specializes in Case Mgmt; Mat/Child, Critical Care.

Actually, EMTLA violations occur if a pt is refused tx period....if a pt presents, she must be assessed/triaged and stabilized. EMTLA would occur if she showed up and was never triaged and just sent on her way. Sounds like she was actually a pt, and left AMA after being given medical advice from the healthcare professionals.

Also, she obviously wasn't in too active of labor if she had all night (12hrs or something like that) to run around to all these different hospitals.

If a pt. elects to leave AMA, there's not much you can do...

But, there is a lot to this story we're not getting...

Typical media...:rolleyes:

It is interesting to see that the couple is refusing to release the weight of the infant. Saying only that the baby weighs less than 13 pounds.

12 pounds 14 ounces is less than 13 pounds.

The probable reason that a G7 P6 was able to labor all night, then go to two different hospitals is because of insufficient pelvis size to deliver that big baby.

I would like to know other information: Mom's age (which the couple refuses to release) mom's blood pressures, how the fetal monitoring strip looked, and if mom had diabetes that resulted in large babies.

In the end, it matters most that mom and baby are healthy... but what if....?

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I just think this is yet another case of media irresponsiblity and not telling the whole story. It's about grabbing headlines and turning heads. I said before I and still believe we are NOT getting the whole story here and I don't buy it. I think it's a load of.......

poop.

I just read a good article on managing shoulder dystocia and thought I'd add it to this thread.

http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=11289

"A sudden call to a gentlewoman in labor. The child's head delivered for a long time, but even with hard pulling from the midwife, the remarkably large shoulder prevented delivery. I have been called by midwives to many cases of this kind, in which the child was frequently lost."

Smellie, 1730

Shoulder dystocia is an obstetric emergency defined as failure of the fetal shoulders to deliver despite routine obstetric maneuvers after the head is delivered.1 And the condition is not restricted to the large fetus.

Failure of the shoulders to deliver spontaneously places both the pregnant woman and the fetus at risk for injury. Reported incidence ranges from less than 1% to slightly more than 4% among lady partsl cephalic deliveries.2

Associated Trauma

Brachial plexus injuries and fractures of the clavicle and humerus are associated with shoulder dystocia. The most potentially serious-brachial plexus injuries-can be caused by extreme amounts of traction and flexion exerted on the infant's neck resulting in permanent disability. The reported incidence of this is 4%-40%, with 9%-25% not resolving.2

Maternal traumata during shoulder dystocia include bladder injury; cervical, lady partsl, or perineal lacerations requiring extensive repair; hematoma; spontaneous separation of the symphysis pubis; uterine rupture; postpartum hemorrhage; and endometritis.3

Many clinical factors have been statistically associated with shoulder dystocia through retrospective analysis. The strongest association is macrosomia at birth, which can be related to diabetes mellitus, maternal obesity, and prolonged gestation.4 The American College of Obstetricians and Gynecologists has defined the fetus with macrosomia as an estimated fetal weight greater than 4,500 grams.5

Handling the Danger

Having knowledge of the fetal weight before delivery is of great benefit to the provider. However, the likelihood of inaccurate prediction of fetal weight increases with the size of the fetus. Birthweight is underestimated by approximately 0.5 kilogram (1 pound) or more in 50% of cases where the fetus is larger than 4,000 grams and in as many as 80% of cases where the fetus is larger than 4,500 grams.5

A failed rotation of the fetal shoulder girdle within the maternal pelvis leading to impaction of the anterior shoulder behind the symphysis pubis can also be caused by a rapid or precipitous labor, nongynecoid maternal pelvic structure, and a fetus that is relatively large for the pelvis.4 A prolonged deceleration phase, prolonged second stage, or prolonged second stage and midpelvic delivery of the fetal head may also herald difficult shoulder delivery.6

Most cases of shoulder dystocia follow spontaneous delivery of the head and occur without warning. In shoulder dystocia, the fetal head retracts or coils against the maternal perineum and difficulty is encountered in accomplishing external rotation ("turtle sign").3

Should you encounter the threat of shoulder dystocia --

Stop maternal pushing and request assistance.

Avoid overzealous traction and pressure on the fundus, as this will only increase the impaction.

Employ suprapubic pressure, which can be helpful in dislodging the anterior shoulder.

Consider the McRoberts maneuver, which has proven successful in 91% of cases. The legs are flexed apart and knees drawn up to the abdomen, resulting in straightening of the lumbosacral angle.

Also consider the woods screw maneuver, which involves pushing the posterior shoulder backward through a 180-degree arc by applying pressure on the anterior surface of the posterior shoulder.

If rotational maneuvers fail to free the impacted shoulders, attempt the delivery of the posterior arm by passing a hand into the lady parts under the posterior shoulder and following the arm to the elbow. Pressure at the antecubital fossa will cause the forearm to flex so that it can be grasped and swept out over the chest.

If the fetus remains undelivered, the Zavanelli maneuver (pushing back the head) can be attempted and a cesarean delivery performed.4

Nursing Responsibilities

The nurse assists with the maneuvers during shoulder dystocia at the direction of the physician or midwife. Calmly assist the woman to the appropriate positions during the maneuvers to help her feel confident that necessary interventions are being done as quickly as possible by competent care providers.7

It is important to know whether the provider prefers pushing efforts by the mother be stopped while suprapubic pressure is being applied.8 Suprapubic pressure can be applied by either the Mazzanti technique (direct application of pressure posteriorly and laterally above the symphysis pubis) or the Rubin technique in which fingers, a palm, or fist are applied in an oblique manner posteriorly against the anterior shoulder (toward the direction of the face).9

Since shoulder dystocia can occur without warning, the intrapartal nurse must always be ready for such an emergency. Besides the routine checking of resuscitation equipment, practice sessions of applying suprapubic pressure, assisting with McRoberts maneuver and notifying staff when extra help is needed should be routine. A step stool, which is often needed for applying suprapubic pressure, should be part of the standard equipment in each labor room.10

It is critical to completely document the timing of events, maneuvers used, presence and care given by the neonatal team, Apgar scores, description of arm and hand movement, and any follow-up care the baby or mother might need should the event become a medicolegal matter later on.

For More Information

Listed below are some resources for more information about shoulder dystocia:

American College of Obstetricians and Gynecologists http://www.acog.org

American College of Nurse Midwives

http://www.acnm.org

Association of Women's Health, Obstetric, and Neonatal Nurses http://www.awhonn.org

World Health Organization http://www.who.int/en

Virtual Hospital: University of Iowa Family Practice http://www.vh.org/adult/provider/ familymedicine/FPHandbook/FPContents.html

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Patricia Connors, RNC, MS, is a perinatal clinical nurse specialist at Massachusetts General Hospital, Boston.

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References

1. Seeds JW. Malpresentations. In: Gabbe S, Niebyl J, Simpson J, eds. Obstetrics: Normal and Problem Pregnancies. New York: Churchill; 1991:539.

2. American College of Obstetricians and Gynecologists. Shoulder dystocia. ACOG Pract Patterns. 1997;7:1137-1143.

3. Bowes WA. Clinical aspects of normal and abnormal labor: Shoulder dystocia. In: RK Creasy, R. Resnik, Eds. Maternal-Fetal Medicine: Principles and Practice. Philadelphia: W.B. Saunders. 1994:532-533.

4. Naef R, Martin J. Mergent management of shoulder dystocia. Obstet Gynecol Clin North Am. 1995;22:247-259.

5. American College of Obstetricians and Gynecologists. Fetal macrosomia. Tech Bull No.159. 1991.

6. Kochenour NK, Clark SL. OB emergencies: shoulder dystocia. Contemp OB/GYN. 1994;39(1):9-12.

7. Simpson K. Shoulder dystocia: nursing interventions and risk-management strategies. MCN, Ameri J Maternal/Child Nurs. 1999;24(6):305-311.

8. Hall Sharon P. The nurse's role in the identification of risks and treatment of shoulder dystocia. J Obstet, Gynecol, Neonatal Nurs. 1997;26(1):25-32.

9. Naef RW, Morrison JC. Guidelines for management of shoulder dystocia. J Perinatol. 1994;14(6):435-441.

10. Connors P. High-risk perinatal issues: Delay in the diagnosis of fetal distress and insufficient documentation. J Nurs Law. 2003;9(1):19-26.

Thanks Dawngloves for the excellent information!!

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