Delivery record key after shoulder dystocia: consider dictating notes.(Obstetrics)

MAUI, HAWAII -- Put plenty of details in the delivery record of a baby injured due to shoulder dystocia to avoid a lawsuit, two attorneys advised at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

"Even if you do everything right, if you do not have a detailed delivery record, you'll be lost when you get to court," said Norman D. Tucker, J.D., a plaintiff's lawyer in Southfield, Mich.

Approximately 5% of suits against obstetricians involve shoulder dystocia. Mr. Tucker, who has been in practice for 20 years, said he has never seen a legal case involving shoulder dystocia that included a detailed delivery note. "So either the physicians are not doing them, or the ones who do never get to litigation," he said.

The unreliability of the mother's recall of labor events highlights the importance of the medical documentation, added Robert R Roth, J.D., a defense lawyer in Bloomfield Hills, Mich. A recent study of 277 women who were interviewed a median of 10 weeks after delivery found that 60% could not recall accurately at least one of the major management events (such as use of forceps) in their labor); only 40% answered all questions correctly (Am. J. Obstet. Gynecol. 189111:195-200, 2003).

Most physicians sense within minutes of delivering an injured child that a lawsuit is probable Documentation is the key to defense, Mr. Roth said at the meeting, sponsored by Boston University and the Center for Human Genetics.

Be prepared in advance for shoulder dystocia (through practice drills, having enough help in the delivery room, and keeping backup help ready) but don't neglect making a detailed record afterward.

If you feel compelled to make a correction in the record later, follow the accepted protocol of crossing out the portion to be changed, writing the new portion, and signing your initials with the date and time, he added. If a lawsuit is filed, avoid further changes but consider creating a memo of additional recollections.