Electronic Fetal Monitoring: Management and Standard of Care Part 3
In 2013, a consensus of 18 authors (including a CNM,JD) came together and developed an algorithm for the management of Category II fetal heart tracings.
Electronic Fetal Monitoring:Management and Standard of Care Part 2
Electronic Fetal Monitoring: Management and Standard of Care Part 2
What Should We Do With Category 2?
For better or worse, electronic fetal monitoring has become a mainstay of fetal surveillance. Due to legal issues relating to failures in recognition and intervention with electronic fetal monitoring, several national associations have defined "graded categories" of tracing abnormalities, along with recommendations for interventions specific to the various categories. (Cat I,Cat II,Cat III.1
Electronic Fetal Monitoring: Management and Standard of Care Part 1
Electronic Fetal Monitoring: Management and Standard of Care (Part 1)
What Should We Do With Category II?
AFFIDAVIT OF EXPERT WITNESS
My name is John W. Jones, M.D. I am a physician in active practice in the area of Obstetrics and Gynecology. I am qualified as an expert by virtue of my knowledge, skill, experience, education, and training peritnent to the issues raised in this affidavit and I am
Shoulder Dystocia Maneuvers: The One Medicine Leaves Out
In the midst of a profusion of shoulder dystocia papers and publications, there is a notable absence of discussions regarding what is arguably the most effective, and least damaging, maneuver to relieve shoulder dystocia.
Common Legal Claims Against Midwives, cont.
During the course of a vaginal birth, a baby's shoulder can get caught on the mother's pubic bone, preventing the body of the baby to proceed down the birth canal for delivery. When this occurs, it is the result of shoulder dystocia.
Common Legal Claims Against Certified Nurse-Midwives and Certified Midwives
All events that are associated with a shoulder dystocia must be carefully recorded in the medical record. Appropriate documentation allows an accurate record of what happened during the delivery, especially for attorneys and experts to review retrospecitvely, but also for reviewing your own experience.
The AMA’s Creepy Response To “Non-Physician” Scope Of Practice Bills
The American Medical Association is having another moment, recently pushing back over proposed legislation which would expand the scope of practice for "non-physicians". When physicians' perch at the top of the vertical health care hierarchy began to wobble, the American Medical Association, in its physician advocacy role, went on the attack.
Obstetrics Consultations and Midwifery Liability
Campaigns against midwifery, starting at the beginning of the 19th century, set the table for strained relationships between physicians and midwives, which persist to the present time. Anti-midwifery sentiments, enhanced by the attitudes of J. Whitridge Williams and Joseph Bolivar DeLee*, ushered in the age of obstetrics and scientific medicine which were considered the only modern and realistic choice for safe and healthy childbirth in America.[1]
Myth of the Ordinary Midwife Part 1
Myth of the Ordinary Midwife Part 1
In deposition for a professional negligence lawsuit against a Certified Nurse-Midwife (CNM), the examining attorney’s opening question to the midwifery expert witness was this:
Attorney: Do you know what the learning and skill is expected of an ordinary midwife, yes or no?
Expert: Sir, I don’t know what an ordinary midwife is.
Glossary of Legal Terms Pertaining to Litigation
Legal Terms Pertaining to Litigation
Affidavit: A written statement made or taken under oath before an officer of the court (attorney) or a notary public or other individual authorized to act.
About the Website
These articles are intended to inform the best practices of certified nurse-midwives/certified midwives and the unique liability challenges that they face in clinical practice. The information provided will include, but is not limited to, standards of practice, midwifery liability challenges, hospital systems failures, professional conduct, avoiding litigation, cultures of care in corporate healthcare systems, and various legal considerations associated with safe practice.
Midwifery Profile and EMTALA - Part 4
Variations are appreciated and expected when encountering competing research findings. Women will always labor outside of research expectations, despite best practices and the predictions of labor models.
CNM/CM Legal Exposure in Triage - EMTALA Part 3
In the midst of enthusiasm and medical society endorsements for the data of Jun Zhang et al, the Friedman data do remain scientifically viable and legal for triage evaluation purposes. Admitting a patient at 4 cm is very unlikely to expose a triage midwife to an EMTALA violation, or even a civil claim for negligence, as long as a proper screening or labor evaluation is performed and documented.
Double Jeopardy in OB Triage - EMTALA Part 2
In American criminal law, Double Jeopardy protects a defendant from being punished twice for the same offense.1 In civil law, which governs malpractice in healthccare, defendant midwives can be punished twice for the same offense. Although the criminal version of Double Jeopardy does not apply in civil cases, the term is defined as “a risk or disadvantage incurred from two sources”
Emergency Medical Treatment and Active Labor Act - Part I
EMTALA is the Federal Statute, enacted in 1986, that eliminated the historic, common-law precept of “no duty to treat”
Independent Nurse-Midwifery Practice
Nurse-midwives may choose to have their own practice, independent physically and financially from a collaborating physician. A variety of arrangements can exist and the CNM actually is in complete control of her practice. This type of arrangement is increasingly rare, these days but the following descriptions may prove helpful.
Certified Nurse-Midwife/Certified Midwife Homebirth Practice
Currently, in the U.S., the majority of home-birth attendants are Certified Professional Midwives (CPMs). In nearly every State, Certified Nurse-Midwives (CNMs) are licensed to attend home deliveries, if that is their preference.
Federal Agencies and Defining CNM Practice
Fed Agencies and CNM Practice
Federal agencies such as Health and Human Services and the Centers for Disease Control and Prevention have played a role in defining certified nurse-midwifery practice, especially in the context of research, training programs and clinical care sites.
State Legislation of Midwifery Practice Environments
Professional associations with other healthcare providers, such as physicians, are varied among States in regard to mandatory written collaborative agreements. The legislative requirements among CNMs/CMs are somewhat different from State-to-State. This affects whether CNMs can provide reproductive care to the full extent of their education, training, and scope of practice.
Clinical Practice Guidelines vs. Standard of Care in Litigation
Clinical Practice Guidelines:
Nurse-midwifery guidelines, policies, procedures, and protocols are not rules or standards, per se, but they exist to support reasonable conduct and quality of care.