At 5:00 pm, one of the nurses reported to the obstetrician that the plaintiff’s mother was fully dilated but was not experiencing an urge to push. There was no notation as to whether the fetus was OA or OT, nor whether the fetus had descended any more by that time.19
At 7:00 pm, the plaintiff’s mother was again assessed by the obstetrician, who noted that the fetus had not descended at all since her first assessment and that the fetus was OT. A lack of descent was established on the evidence “to be a sign of dystocia, which relates to a foreseeable risk of harm to both fetus and mother, including risk of fetal head impaction in the pelvis.”20
The decision was ultimately made to deliver the plaintiff by C-section, and this process began at 8:00 pm. By this point, the infant plaintiff’s head had become “tightly wedged” and “severely impacted” in her mother’s pelvis.21 One of the nurses was instructed by the obstetrician to try to elevate the fetal head by reaching her hand through the vaginal canal. When this was unsuccessful, the obstetrician herself reached her hand around the fetal head and delivered her. It was this latter process which caused the injury: in maneuvering her hand in between the mother’s pelvic bone and the plaintiff’s head, the obstetrician created three fractures in the plaintiff’s skull.22
At trial, the parties agreed that the applicable duties of care owed to the plaintiff and her mother included the duty to communicate, given the collaborative nature of the obstetrics team. The court found that “it is well-established that physicians and nurses have a duty to communicate as part of their duty of care” and that “when medical professionals (including both doctors and nurses) work as a team, they each have an obligation to communicate diligently with others.” Further, “the treatment team must take care in comparing notes and make certain that things do not slip through the cracks; elements of treatment or assessment should not be overlooked because each member of the team thinks the other has completed the task.”23 The obstetrician and the obstetrical nurses fell below the standard of care in this respect, and, in doing so, set in motion a series of events leading to the plaintiff’s catastrophic injury.
Doctor-Nurse Miscommunication
The first miscommunication occurred during the nurse’s assessment at 5:00 pm, at which time the fetal position had still not been ascertained. At trial, the obstetrician’s evidence was that she relied on the nurses to inform her if the plaintiff’s head was not OA at the time, or if she was not descending. The obstetrician further testified that if she had been informed that the plaintiff’s head was OT, she would have attended urgently to perform her own vaginal examination.24
One of the most interesting determinations in this case was the rejection of the obstetrician’s submission that, in the absence of a report from an obstetrical nurse, she could assume normalcy. Instead, the court found that, “where information is not relayed about the position and station of a fetus at full dilation … the standard of care of the primary care physician requires that she clearly ascertain this information, or for the obstetrician to personally examine the labouring patient, prior to authorizing pushing to start.”25
