This case involves a thirty-year-old female who presented to the hospital while in labor. She told her obstetrician/gynecologist (OB/GYN) that she had regular contractions at home. Her OB/GYN examined her which showed that her cervix was fully dilated. The physician had the nursing staff set up the equipment for a vaginal delivery. A half hour later, the physician returned to have the woman start pushing. Although she used adequate effort when pushing, labor was not properly progressing. After a few hours, the baby began to progress down toward the pelvis. The woman was in a great deal of pain and explained that she felt like the baby’s head was stuck. She was instructed to still try and push until she no longer could. The woman explained that she was very tired and was unable to continue pushing. Her physician was concerned about the position of the baby and quickly grabbed a pair of forceps to deliver the child. Using the forceps, the child was delivered successfully. A few hours later, the child was examined by the pediatrician who noted that the child’s face seemed expressionless. When the baby cried, her lower right face would droop instead of wince. She also noticed that when the baby slept, her right eyelid did not close. The pediatrician told the mother that the child sustained a facial nerve injury secondary to forceps use.
Question(s) For Expert Witness
1. Did this OB/GYN practice the standard of care when delivering this child, and did the baby develop a facial nerve as a result of forceps use?
Expert Witness Response
This case involved a female patient who was not progressing through active labor. Usually, the patient will either have a vacuum delivery or Caesarean section if she is failing to progress through normal labor. Additionally, the OB/GYN probably used the forceps incorrectly resulting in facial nerve injury. The facial nerve runs down the side of the face, therefore it comes into contact with the forceps. If pressure is applied to the face with forceps for extended periods of time, the child can develop signs of facial nerve injury. Some of those signs and symptoms include failed eyelid closure on the affected side, uneven lower portion of the face during crying, inability of the mouth to move down while crying on the affected side, and full facial paralysis in extreme cases. Normally, the facial nerve will heal with time but can require surgical repair.
About the author
Jason Cohn
Jason is a 4th year medical student pursuing a career in Otolaryngology/Facial Plastic Surgery. His Interest include sports, fitness, chemistry, otolaryngology, plastic surgery, allergy/immunology, surgical oncology, human genetics, public health, preventative medicine, and rheumatology.
