Lack of informed consent alleged after elective induction of labor

February 1, 2012

The parents alleged that there was no medical indication for induction of labor and that informed consent had not been obtained; specifically, that they were not informed tht induced labor increases the risk of tachysystole, failure to progress, and the risk of caesarean delivery.

The parents chose to have the induction and went to the hospital that afternoon. They alleged that the induction was hyperaggressive, with use of misoprostol followed by high-dose oxytocin, that the oxytocin was increased to extremely high doses in the face of hyperstimulation, and that when the fetal heart pattern became abnormal, the dosage was increased still more. The child suffered hypoxia, which caused hypoxic-ischemic encephalopathy (HIE), cerebral palsy, and spastic quadriparesis. He will require 24-hour care.

LEGAL PERSPECTIVE

The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 107 addresses counseling for induction of labor and specifically addresses elective induction in nulliparous women with unfavorable cervices as to the 2-fold increase in risk of cesarean delivery, length of labor, and the need for a readily available physician capable of performing a cesarean delivery. ACOG also offers a Patient Safety Checklist for induction of labor that includes documentation that risks and benefits were discussed with the patient.

In this case, a settlement was reached with the hospital and doctor for a total of $5 million. The hospital also agreed to implement new policies on induction and augmentation of labor, including a requirement for an informed consent that includes the risks of elective induction.