Free Born in the USA by Marsden Wagner Page B

in 1998. They were excited, as were their family and friends in the small community where they lived. There were two obstetricians practicing in their town, a partnership, and Mr. and Ms. M signed on with them.
    The pregnancy went smoothly, and when Ms. M was just about due, one of the obstetricians told her to come to the local hospital the following Monday evening. In the chart he wrote, “Cytotec induction,” though there was no medical indication for inducing labor.
    Ms. and Mr. M arrived at the hospital at 5 P.M. , and at 6 P.M. the obstetrician came in, examined Ms. M, and ordered the nurses to “follow the Cytotec protocol.” Neither the doctor nor the nurses told the parents what drug was being used and why, nor that the drug is not approved by the FDA, nor that serious risks were involved. In other words, there was no fully informed consent.
    Over the next several hours, nurses gave Ms. M three doses of Cytotec. The electronic fetal monitor began to show that her uterus was contracting too fast and the baby’s heartbeat was irregular, but the nurses continued “the protocol.” Although the nurses telephoned the obstetrician once at 11 P.M. because they were concerned about the baby’s irregular heartbeat, the doctor did not visit Ms. M again until the next morning, when he came in for his regular morning rounds. It had been twelve hours since he last saw her, and several hours since she had received an epidural block due to the pain of the extreme contractions.
    In the morning, the monitor was still showing uterine hyperstimulation, but the obstetrician ordered Pitocin to further stimulate labor—adding insult to injury. Though the monitor’s printout strip clearly shows many hours of uterine hyperstimulation, the condition was never recorded in the patient’s chart. Every time staff looked at the electronic fetal monitor strip, they recorded the baby’s heart rate, but never the other line on the strip, the uterine contractions.
    That evening, the obstetrician came in, cut Ms. M’s vagina open with anepisiotomy, put a vacuum cup on top of the baby’s head, and pulled the baby out. The baby came out completely floppy and didn’t breathe for the first five minutes. The staff put the baby on a breathing machine. In the first few hours after birth, the baby developed seizures and had to be transferred to a larger hospital with an intensive care unit for newborns. There, specialists diagnosed severe brain damage due to lack of oxygen during labor and birth.
    In spite of excellent care at the newborn intensive care unit and wonderful continuing care from a host of health care workers provided by the state of Idaho, the baby now has severe cerebral palsy and severe mental retardation. The family, with lots of support from the local community, provides loving care for this child, a twenty-four-hour-per-day effort. Because the family could not possibly pay for all the care required for this child, they sued the obstetrician and his partner. As is typical in Cytotec cases, they received a large settlement before the case ever came to trial. (See chapter 7 .) It is clear that a jury would not be sympathetic to the defense after hearing that Ms. M was given a drug that says on the label that it should never be given to pregnant women, and then was not adequately monitored after the drug was administered.
    This story has many elements that are common in Cytotec induction cases gone bad. The drug was used for convenience, not because of medical need. The parents were not adequately informed of the risks. The obstetrician was absent for many hours during the labor. The obstetrician and other staff failed to recognize when the uterus was hyperstimulated. The excessive painful contractions led to an epidural block. And then Pitocin was added to the mix. Finally, the baby was pulled out by vacuum extraction.
    Another undesirable consequence of drug-induced labor is a higher