In the mid – 1990’s, insurers and hospital groups began saving money by strongly encouraging obstetricians to perform fewer C-sections. Vaginal deliveries were thought to be less expensive than C-sections because vaginal deliveries resulted in fewer hospital days. It became routine for hospitals and insurers to track each OB’s “C-section rate.” OB’s became fearful of economic sanction if their C-section rate was too high. This pressure to perform fewer C-sections resulted in obstetricians’ failure to order needed C-sections to avoid a potential brain injury. This phenomenon became worse in the area of what is called a VBAC.
Traditionally, there was an obstetrical rule that said: “once a C-section, always a C-section.” This rule came from the understanding that once a woman had a C-section, she would thereafter be at risk for a uterine rupture if she attempted a vaginal delivery, due to the scarring left by the original C-section. However, in the era of “cost containment” and “managed healthcare,” providers thought they could save money by lowering C-section rates via the VBAC (Vaginal Birth After C-section). OBs were required to counsel their patients to “attempt” a VBAC. Theoretically, a VBAC could be safely converted to a C-section if the vaginal delivery became difficult or in the event of a uterine rupture. Tragically, it was often the case that the emergency C-section which became required during a failed VBAC could not be performed in time to save the baby or avoid a brain injury.
Kate Ranich was thirty-four (34) years old and became pregnant for the second time. Her prenatal care was normal and uneventful, with no problems reported. Four days short of her expected due date, her water broke at 5:00 a.m. She and her husband then drove to the hospital where they arrived at approximately 8:30 a.m. There they were met by Dr. Karns, who examined Mrs. Ranich at 10:00 a.m. He then decided to induce her labor with a stimulant, Pitocin. She was also placed on a fetal monitor, a machine to monitor the baby’s heart rate.
While she was in labor, her husband watched the electronic fetal monitoring device show that the baby’s heart rate dropped down into a measurement of approximately 50 beats per minute, but then after a few minutes, return to its baseline. Nurses came in, gave Mrs. Ranich some oxygen and turned her on her left side, around 4:30 – 5:00 p.m.
They continued to monitor Mrs. Ranich, and at approximately 7:00 p.m., Dr. Karns suggested a cesarean section. Mrs. Ranich was then given a shot of Stadol, a medicine to help the progress of delivery, and within ten minutes, she delivered vaginally.
When the baby was delivered, the umbilical cord was wrapped around the baby’s neck and the cord actually broke when the baby was delivered. The baby was born severely depressed, basically lifeless at birth, and then resuscitated. The baby had a collapsed lung, and remained in the hospital for two days before the baby died.
The Plaintiffs alleged that Dr. Karns, as well as the nurses at the hospital, failed to recognize that the baby was in distress and was being deprived of oxygen while in the mother’s womb, and that they should have noticed earlier and immediately gone to a cesarean section for delivery of the child.
The doctors and nurses defended the case by stating that the fetal monitoring strips did not show that the baby was in distress, and that they properly cared for the mother and baby before delivery.
A lawsuit was brought in the Court of Common Pleas of Allegheny County, Pennsylvania, and before the case was called for trial, the case settled for a substantial amount.