This is a case about a child who suffered a significant brain
injury during his mother's (Kim) labor with him just prior to birth. This
was mom's second child. Her first was a scheduled c-section because of
breech presentation.
Mom was followed throughout her pregnancy by a nurse midwife
with a goal of vaginal delivery. This made mom a VBAC (vaginal birth after
cesarean), not an essential normal candidate for vaginal delivery because of
certain risks, but it is medically accepted and even encouraged today.
A week before she is due, mom has a sudden gush of bleeding at home.
Her husband drives her to ER where she is met by nurse midwife and is
admitted by MD (who doesn't come to hospital). She is admitted and labor is
induced next morning by the midwife. Labor progresses and by mid-afternoon
the baby shows signs of distress. Midwife doesn't call doctor and doesn't
communicate any concern to mom. After a few more hours with rather
persistent problematic signs on the fetal monitor, nurse midwife calls the
doctor who comes to the hospital.
Here's the issue:
Doctor looks at fetal heart tracings on monitor and says to mom and midwife
"You need to deliver this baby. If you don't deliver in the next 15
minutes, we will need to proceed to operative delivery." Mom, now in
hospital for over 18 hours and in labor for approx 7hours, says "You're not
sectioning me. I have come too far. I want to have this baby vaginally."
Doctor leaves room without saying anything (He goes to call team for OR).
Midwife coaching to push, push, push. No delivery. In 15 minutes, doctor
comes back and says, "You're baby is in trouble. You need to have a
c-section." Mom immediately consents.
What impact does Mom's initial reaction to mention of c-section have on your decision regarding cause of brain injury?