Page 50 - OB Risks - Delivering the Goods (Part One)

SVMIC Obstetrics Risks: Delivering the Goods

well as an abnormally thin perineum during the patient’s
prenatal care. The physician also documented estimates

for fetal growth during the prenatal visits which indicated
another large baby was likely.

According to the physician, he had a discussion with the

patient wherein he explained the only way to avoid another
fourth-degree laceration was to have a C-section, but this

discussion and the key elements of the potential risk of a
vaginal delivery were not documented. Finally, in addition

to the absence of documentation about the risks of the
vaginal delivery, there was no documentation about the

recommendation that the patient have a C-section and
that she declined this option during this discussion

(informed refusal). The failure to document this discussion
and the patient’s refusal resulted in an indefensible claim.

You may be asking, how can these experienced physicians make
such seemingly elementary mistakes? Quite simply, the doctors

were busy; documentation was prepared well after the visit
which led to mistakes and omissions; and the physicians felt

like they had a really good rapport with their patients and that
everyone at the time was on the same page with the plan, and

as such, there was no need to document everything.

As we pointed out at the beginning of this course, an injury to
or loss of a child is a highly emotional event that can create

anger, pain, despair, and strong feelings which can destroy even
the best relationships. Parents are often looking for someone to

blame because these types of outcomes are “not supposed to

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