Second, use oxytocin carefully, slowing or stopping it when required. While we do not have access to the fetal heart rate monitor strips in this case, we do know that the plaintiff met her burden of proof and persuaded the jurors that the midwife inappropriately increased the drug in the setting of uterine hyperstimulation, with evidence of fetal distress. It seems surprising that the allegedly “normal” pattern recorded at 1:26 am could have been the maternal heart rate—but apparently, the jurors were convinced of this.
Third, when a facility has a medication protocol, follow it unless there is good cause not to. Medication protocols can be useful to establish operating guidelines and reduce medication errors. But they can also shackle clinicians by substituting tables and algorithms for clinical judgment. Problems arise when a protocol is sidestepped, and the clinician is raked over the coals for failing to adhere. If your facility has protocols that are important to your practice, read the documentation. Learn it, know it, live it.
If you operate outside a protocol, and your case goes to trial, the expert witness defending your care will be forced to take on both the plaintiff’s allegations and your own facility’s recommendations. The plaintiff’s closing argument will include a variation of “Mr. A did not even bother to follow his hospital’s own rules.” This argument is easy for jurors to understand, and many will reach a finding of negligence based on this fact alone. If you disagree with the protocol, or it is not reflective of your actual practice, either clinician practice or the protocol must be changed. Do not routinely circumvent protocols without good reason.
Ideally, protocols should be constructed to give clinicians flexibility based on clinical judgment and patient response. If you have a role in forming a protocol, consider advocating for less rigidity and allowing for professional judgment. If the protocol is rigid, be sure that everyone understands it and that it can be strictly followed in a real world practice environment. Put plainly, don’t install a set of rules you can’t live with—it is professionally constraining and legally risky.
IN SUM
From a legal standpoint, it is not safe to completely discard surgical delivery; when needed, it is required. Patients given oxytocin must be monitored closely, and the drug should be discontinued in the setting of uterine hyperactivity with fetal distress. Follow medication protocols or change them—but whatever you do, don’t ignore them.