What if I were to tell you not every Legal Nurse Consultant is qualified to review your birth injury cases, would you be surprised? To properly analyze and provide a detailed evaluation of the medical records, the Birth Injury Legal Nurse Consultant must have many years of bedside experience and specialized skills. Med League’s Birth Injury Legal Nurse Consultant team collectively provides more than 400 years of bedside Labor & Delivery, NICU, OB/GYN experience. 

They hold credentials in Fetal Monitoring Strip annotations (C-EFM), Certified OB nurses (RNC-OB), Women’s Health Nurse Practitioner (WHNP) and Family Nurse Practitioner (FNP)

How Med League’s Birth Injury Legal Nurse Consultant can help to screen you Birth Injury case:

IDENTIFY BREACHES

• Failure to notify the doctor/midwife of maternal/fetal changes in a timely manner.
• Failure to administer Pitocin appropriately
• Failure to recognize/or intervene to the signs of fetal distress.
• Failure to timely recognize the risk for shoulder dystocia and implement the appropriate maneuvers.
• Improper usage of vacuum or forceps during delivery.
• Use of unnecessary force during delivery.
• Failure to appropriately monitor maternal and fetal infections.

SPECIFICS OF MEDICAL RECORDS THAT BIRTH INJURY LEGAL NURSE CONSULTANTs FOCUS:

• Prenatal records- ultrasounds, history
• What was the estimated fetal weight?
• Were there risks to indicate an alternative mode of delivery should have been offered?
• INFORMED CONSENT!
• Was labor spontaneous or induced?
• Pitocin initiation, rate adjustments, and discontinuation in response to signs of fetal distress.
• Identifying potential risks of hypoxia in the timeline.
• Was fetal resuscitation performed per NRP guidelines?
• Was a cord gas obtained in a timely manner?
• Was the provider notified in a timely manner?
• What was the providers location at the time of notification?
• Was the fetal monitoring tracing interpreted correctly?
• Were interventions indicated and performed in a timely manner?
• Was a shoulder dystocia called out?
• Was extra help called for?
• What positions were attempted to resolve the dystocia?
• • Are there any discrepancies in documentation?
  • Audit trails. Inconsistencies in documentation.
  • … and so much more 

Types of Cases Birth Injury Legal Nurse Consultant can assist

Hypoxic Ischemic Encephalopathy (HIE)

Perinatal Asphyxia/Hypoxia

Cerebral Palsy

Hypoxic Ischemic Encephalopathy and cerebral palsy cases are the most difficult to prove. Our legal nurse consultants are experienced with over 500 cases reviewed in just last year alone. They will be able to give you a thumbs up/down review so you can make an informed decision to take this case or not.

PRENATAL RECORD FOCUS

• Environmental
• Maternal Hx
• Placental Issues
• Medication
• Ultrasounds

LABOR RECORD FOCUS

FMS – Fetal Monitoring Strips 

• Pitocin – include times, rates, increase in presence of decels?
• Their narrative
• Intrauterine resuscitation? If none done, point it out

At Delivery

• Should NICU have been there? Were they not called with enough time to be present?
• Who was in the room?

Cord Gas

• What minute was it ran?
• Most places do allow for cord gases to be ran up to an hour after delivery.
• Still not standard every delivery but should be expected when NICU is needed at delivery or for fetal distress.
• Was it a “cord gas” or VBG/ABG? Differentiate if it was on the cord or delayed.

Seizure Activity

• When did it start?
  • Delayed – more likely to be stroke related
  • Immediate – HIE
  • Timeframes to focus on:
    • Seizure
    • Spasticity
    • Cooling
    • Indicated? Done/Not done? Delayed?
    • MRI – if looks like a stroke – include in the discussion/opinion section

Brachial Plexus Injury

FMS may or may not matter in these types of cases. Some of the things our nurses look for in these types of birth injury cases:

• What was happening with the Pitocin?
• Who was present?
• What were they doing?

Birth Injury Legal Nurse Consultant will focus their review on one of the two categories

Predictability

Our nurses will provide a graph of the EFW from the ultrasound reports

DATE	05.13.2020	06.08.2020	08.12.2020	08.31.2020	09.28.2020	10.12.2020
GA	16w4d	20w2d	29w4d	32w2d	36w2d	38w2d
EFW (%)	201 gm	415 gm	1808 gm 81%	2419 gm 85%	3618 gm >95%	4186 gm >95%

• Obesity
• Diabetic
• Hx of LGA babies

TRACTION

Failure to descend – in minutes

Shoulder called – in minutes

Maneuvers – specific types attempted – in minutes

• McRoberts
• Suprapubic Pressure
• Internal Maneuvers: Rubin & Woods Corkscrew
• Posterior Arm
• Gaskin
• Zavanelli

Credit for the content goes to one of our OB Nurse, Ashley Jefferson, BSN, RN, C-EFM, FNE. Our experienced nurses are ready to assist you with your next case and potentially reveal abnormalities when they assist the attorney with the work up on the case.  Contact Med League Support Services or call us at 908-788-8227 for a free consultation.  You can also fill out our web form with summary of your case and a team member will get back to you promptly after review.