At 22:00 it is reported that dilation was 4.0, effacement 50 and station -2. At 23:01 contraction frequency was 3 and contraction duration 60-90. At 23:53 contraction frequency was 3-4 and duration 40-100. At 23:55 the patient requested an epidural. At 00:08 the patient was positioned on the side of the bed for the epidural which was placed at 00:23. The patient was instructed to lie back down as soon as the contraction stopped. The patient was moaning and pursuant to the nursing notes asked “Is it time?” The patient reports that she said, “It is getting ready to come.” The patient was encouraged to lie down in the bed for SVE and the obstetrical teaching service was called for delivery. Within a minute the baby literally fell out onto the floor sustaining a hematoma and skull fracture. The nurse’s note indicates that the patient did not push. Issue: Should the patient have been monitored more closely to prevent this injury?

Unless the hospital policy prevents the attending obs nurse from performing vaginal exams and emergency deliveries, the baby should not have suffered the injuries.

The delivery was managed in a negligent fashion. If Mom is lying down in bed how does the baby fall to the floor? Even if Mom was sitting up for the epidural someone should have been at her side and in front of her to hold the neonate as it was being expelled by Mom. Allowing the newborn to fall onto the floor is negligence.