Labor and delivery malpractice: what the fetal monitoring strip and nursing notes show

In most labor and delivery cases, the physician or midwife is in and out; the labor nurse is at the bedside, watching the fetal monitor, adjusting medications and deciding when to call. That makes nursing records central to birth injury claims such as hypoxic-ischemic encephalopathy (HIE) and delayed C-section.

The records that matter

• The complete electronic fetal monitoring (EFM) strip, not a few printed segments. Ask for the native tracing.
• Nursing labor flowsheets: maternal vital signs, cervical checks, interpretations of the tracing, interventions.
• Oxytocin (Pitocin) records: start time, every rate change, and who ordered it.
• Notifications: when the nurse called the provider, what was said, and the response.
• Delivery record, neonatal resuscitation record and cord blood gases.
• Hospital policies on EFM interpretation, oxytocin titration and the chain of command.

Our medical record request checklist covers the general chart; the birth injury case page can email you an L&D-specific list.

How an L&D nurse reads the strip

Fetal heart rate tracings are commonly classified in three categories:

• Category I: normal; routine monitoring.
• Category II: indeterminate; needs evaluation, continued surveillance and often corrective measures.
• Category III: abnormal; requires prompt evaluation and action to resolve it, which may include expediting delivery.

The nursing questions are about time and response: when did the tracing change, did the nurse recognize it, what was done (repositioning, fluids, stopping oxytocin, oxygen as indicated), and when was the provider told? A gap between a worrying tracing and a documented response is often the core of the case.

Oxytocin: the most common nursing issue

Oxytocin strengthens contractions. Too much can cause excessive uterine activity (tachysystole) and reduce oxygen to the baby. A nurse consultant checks whether the dose was increased while the tracing or contraction pattern called for holding or reducing it, and whether that matched the hospital's protocol.

Chain of command

When a nurse is concerned and the provider doesn't respond or disagrees, hospital policy usually requires escalating to a charge nurse, supervisor or another physician. Missing escalation is a frequent deviation. Look for it in the notes, and for the policy itself.

Why you need an L&D nurse, not just any nurse

EFM interpretation is a specialty skill, and many L&D nurses hold specific fetal monitoring credentials. An opinion from a nurse without labor experience is easy to attack. Find one in the labor and delivery specialty; causation in birth injury cases usually also needs physician experts, which you can request from the same case (physician expert).

Next step

Post a birth injury case: L&D nurses review the strip and the nursing timeline and send proposals. Not sure yet? Try the birth injury case check.

General information for legal professionals, not legal advice. Rules and deadlines vary by state; check the statute and local rules that govern your case.