Does Failed Electronic Fetal Monitoring Fall under Malpractice?

Posted on

Electronic fetal monitoring (EFM) is commonly used by medical professionals to monitor a baby’s health during labor and is pretty much standard practice for most obstetricians. These machines continuously record fetal heart rate and other activities, and heart rate is critical because the patterns establish whether the fetus is getting enough oxygen throughout labor and delivery. Oxygen deprivation can lead to severe injuries, including brain damage; one example of this is cerebral palsy. When EFM fails, mothers and babies can suffer temporary or permanent consequences, including other kinds of disabilities and even fatalities.

Is EFM Safe?

EFM has been in use for decades, but there is some evidence suggesting that it is ineffectual. Other studies claim that it increases the chances for cesarean deliveries, does not produce better perinatal outcomes, has a 99 percent false-positive prediction rate for fetal distress, and is prone to interpretive errors. Still, it is the most common obstetrical procedure being used today; EFM is used by most physicians for their patients who are in labor.

EFM was first used clinically in the 1970s, and it is not surprising that there have been EFM lawsuits. Although experts agree and disagree about the advantages and disadvantages of EFM, there is no official statement such as a Practice Bulletin proclaiming that EFM is a helpful nursing labor-saving device or that it is the standard of care. Therefore, is EFM completely safe? The answer to that question is still up for debate.

What about EFM and Malpractice?

According to the National Library of Medicine, a doctor is deemed negligent, or guilty of malpractice, when she or he does not do the things that a prudent doctor would do, in similar or the same circumstances that were faced by that defendant provider. Negligence is directly linked to standard of care, and only physicians can testify as to what that is. This means that in medical malpractice cases, most states and countries require a physician witness to testify that the defendant was practicing below the accepted standard of care and was negligent, leading to patient personal injury or death.

It is important to keep in mind that an EFM also traces and monitors the mother’s uterine activity, showing how frequent, long-lasting, and strong contractions are. This is also important, as contractions can also interrupt blood flow to babies, which decreases oxygen. Medical providers are trusted to closely monitor fetal heart rates and contraction patterns, and when problems occur, they are supposed to provide medication or perform procedures for safe deliveries for mothers and their newborns.

With an obstetric malpractice case involving EFM failure to monitor, the main issue is whether the physician acted reasonably in the decisions made in response to the EFM strips that were printed out or displayed. Defense strategies can claim that the data did not indicate fetal distress or that by the time a problem was shown, it was too late to successfully intervene.

Types of Electronic Fetal Monitoring

External monitoring is performed using a special stethoscope or, more commonly, with two flat sensors attached to the expectant mother’s belly. The first sensor employs ultrasound technology to track the fetal heartbeat, and the second measures contractions. The sensors are connected to a machine that prints out the fetal monitor strips. External EFM is often used before labor, to check for stress; a lack of fetal movement; amniotic fluid; the placenta; and for mothers who have diabetes, high blood pressure, or are at risk for preterm labor. It is also used most often during labor and delivery.

Internal fetal monitoring can be used only during labor and delivery, and the woman’s cervix must be dilated to a minimum of two centimeters once the amniotic sac has ruptured (“water has broken”). These are used when problems are discovered in external monitoring. Internal EFM is more invasive but thought to be more reliable. With these, a sensor gets strapped onto the woman’s thigh and an electrode is placed in the uterus and onto the baby’s head; this allows for closer monitoring, and sometimes a small tube also gets placed in the uterus to monitor the contractions.

How Do Physicians Analyze EFM Strips?

For the most part, physicians rely on EFM printouts to ensure that the fetus is not having problems and do not have to take emergency steps; most of the time, the EFM simply shows a non-distressed fetus. If the strips do not appear as expected, it is likely that a problem is occurring. The strips have two graphs, and each one will be on a single row. The top part shows the fetal heartbeat, with normal being 120 to 160 beats per minute, and the bottom shows contractions. The heart normally drops a little bit during contractions but should then return to normal. If it does not, that should show up on the graph. However, some variability is normal. Problems can occur when providers see the following:

  • A decrease in fetal heart rate variability
  • An extended time for that heart rate to get back to normal
  • A decrease in the heart rate
  • A heart rate greater than 160 or less than 110 to 120 beats per minute

All of these are possible indicators that the fetus is not getting enough oxygen.  When this happens, practitioners can reposition the mother or give her or the baby supplemental oxygen. If the problem persists, an emergency delivery might be needed to prevent injury. Therefore, it is important for physicians and labor/delivery teams to closely monitor internal and/or external electrical fetal monitors continuously rather than intermittently.

Although the physician might not know the source of oxygen deprivation until the emergency delivery is performed, there are some common causes. These include a torn uterus, the baby being in a breech position, an umbilical cord wrapped around the baby’s neck, the placenta separating from the uterine wall, the baby being too large to exit through the birth canal, and amniotic fluid levels that are too low or too high. All these situations are dangerous, but quick and appropriate actions by the medical staff can ensure safe and healthy deliveries and babies.

Ignoring or misinterpreting EFM data can lead to very different and difficult outcomes such as cerebral palsy, brain injuries, brain swelling, broken bones, infections, and skin lacerations. Serious injuries can also happen when medical providers fail to monitor mothers and babies during postpartum delivery or fail to monitor infants who are in intensive care units.

Can I Sue for Failed Electronic Fetal Monitoring?

This may be an option if you or your baby experienced a birth injury because of medical malpractice. Depending on the circumstances, the doctor and delivery team could be held liable for the injury and the damages, including the costs of present and future medical care, lost time from work, pain, and suffering. If you believe that the EFM was not monitored properly during your pregnancy, labor, or delivery, you might want to speak with a medical malpractice lawyer who has experience with these kinds of cases.

With obstetric malpractice EFM claims, the court will need to know if the physician acted reasonably in the decisions made in response to the EFM printouts. There are often expert witnesses called in for both sides, and some will examine the strips to determine liability, whereas others will offer opinions as to how the obstetrician should have intervened, if at all; they might assert that the strips did not indicate fetal distress. The plaintiff will also have to prove that the physician’s or team member’s failure to respond or incorrect response led to the birth injuries. The stakes in malpractice cases are usually quite high, and defendants and plaintiffs usually rely on those printouts to build their cases.


Baltimore Medical Malpractice Lawyers at LeViness, Tolzman & Hamilton Treat Every Client with Care and Compassion

Birth injuries can be traumatic enough to change lives forever and can be especially devastating when negligence is involved. For a free consultation on any type of medical malpractice case, contact the caring, experienced Baltimore medical malpractice lawyers at LeViness, Tolzman & Hamilton. Call us today at 800-547-4LAW (4529) or contact us online to schedule a free consultation.

We have offices in Baltimore, Glen Burnie, and Prince George’s County, allowing us to represent clients in Maryland, including those in Anne Arundel CountyCarroll CountyHarford CountyHoward CountyMontgomery CountyPrince George’s CountyQueen Anne’s CountyMaryland’s Western CountiesSouthern Maryland and the Eastern Shore, as well as the communities of CatonsvilleEssexHalethorpeMiddle RiverRosedale, Gwynn OakBrooklandvilleDundalkPikesvilleParkvilleNottinghamWindsor MillLuthervilleTimoniumSparrows PointRidgewood, and Elkridge.