Comments on: Disclosing Medical Errors to Patients

By: Melissa Maimann

Melissa Maimann — Tue, 02 Jun 2009 12:52:14 +0000

Ive often considered reporting unsafe practices such as unnecessary induction if it leads to other complications. I remember caring for a woman who was having her third baby and had had 2 previous vaginal births. She was being induced because this was a big baby. The induction didn’t work and she had a caesarean for failed induction and the baby was about 3.5 Kg. Not big compared to her other children, and not big by any standards. By day 3 she had worsening abdo pain and distention and no cause could be found. Things worsened and the following day she was taken back to theatre for a laparotomy. no cause was found and she recovered (physically). The baby was not breastfed beyond a few days and she now has 2 scars. All for a “huge” 3.5Kg baby!!!

Should we report caesareans for fetal distress if the baby comes out pink and crying, with apgars of 9 and 9?

By: Marge

Marge — Tue, 02 Jun 2009 06:39:35 +0000

In a case I have come across lately, a woman was sectioned for a long labor (12+ hours) and FTP. In her clinical notes her labor (active) was only 10 hours. Her baby had non-reassuring tones for 13, yes that’s 13, hours, while synto. was administered and CX were 5:10 (app. 4 hours); facts which were kept from the mother at the time but are in the chart. The baby was 9/9 merc. free. This was an induction for post-dates at 39+ weeks.

She has put in a complaint but has little faith in establishing anything other than a paper trail. The hospital staff and on-call OB have denied any wrong doing. For the life of me I can’t figure out why the c/s was for FTP and not fetal distress, why the synto. was not discontinued for non-reassuring tones, and how people with L&D backgrounds could let 13 hours go by with out “doing something”.

By: Joy Johnston

Joy Johnston — Mon, 01 Jun 2009 09:53:33 +0000

It’s interesting to ponder these questions, Melissa. For example, I wonder how many midwives would be prepared to report their hospital or an obstetrician for social inductions. We have access to a lot of that data already, but I haven’t seen evidence of any action.

I raise my eyebrows when words like ‘evidence based’ are applied to maternity care. The most basic and do-able evidence based practice is to provide midwives as primary carers, taking caseloads. Yet how hard is that? How many of the women who experience the cascade of interventions and have low levels of satisfaction with their care will be counselled that the service failed to provide a known midwife who would work alongside that woman in promoting physiologically normal birth???