This case involves a 34-year-old overweight female with gestational diabetes. The patient was screened 10 weeks prior to delivery and it was discovered she had gestational diabetes. She was referred to a nutritionist and given a printout of a diet. The patient did not receive any additional follow-up to monitor her blood sugar levels following that visit. The patient went into labor at 34 weeks gestation. Prior to the delivery, the patient requested delivery by Cesarean section. She communicated this request to the nurse, but the nurse never communicated the request to the doctor because he felt it was not a necessary precaution. During delivery, the baby developed shoulder dystocia. The baby was delivered with a subgaleal hemorrhage and passed away a week later.
Question(s) For Expert Witness
- 1. Do you have experience treating patients with gestational diabetes?
- 2. Given this patient's risk profile, is it fair to assume that additional protocol should have been followed to ensure safe delivery of the baby?
- 3. What are the obligations of the nurse when a patient requests delivery by Cesarean section?
Expert Witness Response
I routinely treat patients with gestational diabetes as it is a fairly common pregnancy complication. When a patient has risk factors such as this Plaintiff, the nurse would need to have a heightened suspicion for the potential for a big baby (due to poorly controlled blood sugars) in this mom who was overweight. This could increase the risk for shoulder dystocia, even at 34 weeks gestation. It would be important to determine if appropriate nursing interventions were implemented once the shoulder dystocia was identified. It is the duty of the nurse to inform the physician of the patient’s desire. ACOG advises against routine C-section delivery for fetal macrosomia unless the fetus is estimated to weigh over 4500 grams in a diabetic patient. I have provided deposition testimony in several cases as a nursing expert witness involving shoulder dystocia. The babies in the cases I’ve been involved have had brachial plexus injuries and/or neurological injuries.