OB/GYN Expert Witness Opines on Delivery Resulting in Bladder Necrosis

This case involves a thirty-four-year-old female who delivered her child at thirty-eight weeks gestation. The woman was in active labor for sixteen hours. Her OB/GYN was concerned because the baby descended into the pelvis but the head appeared to be stuck. The woman told her physician that she experienced extreme pain below her umbilicus localized to a bone above her vagina. The OB/GYN recommended that she have a Caesarean section. The woman was against having a C-section because that was not part of her birth plan. The OB/GYN told her that she must have a C-section and she would be making a terrible decision by not doing so. The woman still refused to have a C-section. The physician became visibly upset and angry towards the patient. He threw his hands up in the air and said, “…do what you want, see what I care.” He then stormed out of the room and told the nurse to call him when the baby’s head was visible. The woman was in active labor for another eight hours until the baby was finally delivered. Shortly after giving birth, the woman had difficulties urinating, noticed blood in her urine, and had severe suprapubic pain. Imaging of her pelvis revealed that the patient had extensive necrosis of the bladder requiring surgery. The woman developed numerous complications while being hospitalized for one month.

Question(s) For Expert Witness

1. Did this physician practice the standard of care when treating this patient and her child, and what should have been done differently to prevent harm in this patient?

Expert Witness Response

This physician let his emotions get to him when treating this patient. Although the woman refused a C-section, the physician should have still practiced proper medical protocols. Firstly, the physician could have explained more about the patient’s labor and what could be done to alleviate the situation. If the woman still refused, the physician could have continued to attempt vaginal delivery instead of walking away. The delay in delivery caused the baby’s head to keep pressing on the pubic symphysis where a portion of the bladder exists. This continued pressure eventually led to the development of bladder necrosis.