(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this birth injury/personal injury case and its proceedings.)
The nurse’s reference to “variables” means the variable decelerations of the fetus’s heart rate. There are many different types of decelerations of fetal heart rate. “Early decelerations” are decreases in the fetus’s heart rate that start at the beginning of a contraction and stop at the end of the contraction. “Late decelerations” are transient decreases in fetal heart rate that begin at the peak of the uterine contraction and do not return to baseline (the fetal heart rate over a period of time) until well after the contraction has ended. Late decelerations are indicative of utero placental dysfunction (insufficiency of the placenta to perform its function).
“Variables” (variable decelerations) are decelerations that are unrelated to the uterine contractions. They appear on a monitor strip as drops from the baseline heart rate and promptly return to baseline. Typically, this fetal heart pattern is the result of umbilical cord compression (the cord is compressed, which impairs the flow of blood and oxygen to the fetus) or maternal hypertension (which is part of pre-eclampsia). Variables that are persistent and continue to drop to very low heart rate levels, and that lengthen in duration, can indicate fetal distress. For more information about this topic, please visit http://www.sacramentopersonalinjurylawyerblog.com/.
According to the hospital’s Physician Order records, defendant Dr. Lee ordered 8 liters of oxygen by mask and ordered the nurse to turn off the epidural (but not the Pitocin). This is a substantial amount of oxygen delivered in a manner intended to oxygenate the blood immediately. By using a mask (as opposed to a nasal cannula, which blows oxygen into the nostrils), the patient gets oxygen regardless of whether she breathes through her nose or her mouth. The amount of oxygen and the manner in which defendant Lee ordered it delivered indicates a concern about the variable decelerations. The reason for ordering 8 liters of oxygen by mask is to try to increase immediately the oxygen in the mother’s blood, which in turn oxygenates the fetus’s blood.
The nurse did not tell defendant Lee, and defendant Lee failed to ask for, the objective data (not the nurse’s interpretation of it) concerning the variables, including (1) how long they were lasting (how long it would take to return to baseline); (2) how deep they were going; (3) how long they had been appearing and if they were deepening; (4) if the variables were repetitive, (5) the uterine contraction pattern; and (6) whether Ms. Jackson was still on Pitocin. The fetal variability and the baseline heart rate are also critical to determining the significance of the variables. (“Variability” (which is different from variables ) means short-term interval changes in the fetal heart rate around the baseline. Good variability means that there is an intact relationship between the brain and the heart. In the presence of acidosis or hypoxia, though, the variability diminishes or is lost entirely. In this case, the diminished variability would have alerted a reasonable physician in defendant Lee’s position that the fetus was becoming hypoxic.) (See Part 4 of 13.)
For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.