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(ii) During delivery Opposite Parties took the correct decision to opt for a normal delivery since there were no clinical or other medical conditions to indicate the necessity of a cesarean section e.g. suspected fetal compromise, placental disorder and maternal, medical and physiologic conditions (since the ante natal checks did not indicate any such abnormality). The progress of labour had been meticulously recorded on a half hourly basis by Opposite Party No.2 herself. A perusal of the same would confirm that everything was normal till the second stage of labour when the heartbeat of the baby dipped drastically indicating compression of the umbilical cord causing lack of supply of oxygen to the brain. Therefore, in the interest of saving the life of Complainant No.1, an outlet forceps delivery had to be performed and it was during this process that impaction of shoulder occurred leading to shoulder dystocia. In such cases what happens is that after the babys head has emerged, the neck suddenly retracts back against the mothers perineum causing the babys cheeks to puff out. Counsel for the OPs cited extensively from medical literature, including Williams*, to prove that in most of the cases shoulder dystocia cannot be predicted or prevented because there are no accurate methods and it can occur in both normal weight as also large weight babies. Further, a team of medical experts from Maulana Azad Medical College appointed on the directions of this Commission had opined that from a perusal of the records of the three ultrasound tests done on Complainant No.3 at 8th, 21st and 37th weeks of gestation there was normal progress of the pregnancy with no evidence of macrosomia.

Most importantly, the ultrasound results were not clinically correlated with other parameters, including proper abdominal examination/pelvic assessment of Complainant No.3. If this correlation had been done, the obvious error in the ultrasound findings would have been detected because by carefully examining the dimensions of the abdomen even a nurse/midwife can correctly assess whether the baby is large sized or normal and a more accurate weight of the fetus would have been known. If all the above ante natal tests had been conducted, any diligent medical professional would not have ruled out conducting the delivery through a cesarean section in fact it would have been the safest and, therefore, the only option.

After shoulder dystocia was noted, McRoberts maneuver was not used and, therefore, no mention of it had been made in the discharge certificate or in the notes purportedly recorded during delivery.

Complainant No.2 also produced medical literature to point out that shoulder dystocia can occur because of improper use of forceps during birth if the forceps are gripped too tightly and there is application of excessive lateral traction being applied to the babys neck so as to free the shoulder. In fact, lateral traction only serves to push the babys head towards either of his shoulder and these get stuck thereby causing shoulder dystocia instead of helping it along (reference http://EzineArticles.com/620664). It was obvious that following shoulder dystocia, the forceps were used with unnecessary excessive force because there is no other plausible explanation to explain the extensive brachial plexus injury, breaking all the five nerves of the upper right limb and damage to the face and head. It was also stated that when confronted with serious problems during delivery, an emergency cesarean section could not be conducted since the operation theater was not kept readily prepared for conducting surgeries, which is clearly a deficiency in service.

In the instant case, Complainant No.1 was only technically not macrosomic, being just 1 gram short of 4000 grams.

We also have no doubt in our minds that there was a clear nexus between the failure to conduct the required ante natal tests and the unfortunate repercussions which occurred subsequently. In this connection, it may be noted that Opposite Parties had stated that a cesarean section was not considered necessary because none of the conditions (including adverse maternal, physiological and clinical conditions) were present to warrant the same. However, if all the tests, including the test for gestational diabetes, and keeping a record of the weight gain etc. had been done and thereafter the ultrasound findings correlated with the maternal, clinical and physiological conditions, it is possible that conducting a cesarean section would not have been so categorically ruled out by Opposite Party No.2.