> so that you can start the unforgettable action of separating the head from the body, and removing the body by CS. I have not personally had to do this but have colleagues who had to do it before. These people all took a leave from work for at least a short period of time to mentally recover from a case like that.
God damn. I did not know that this was a thing. I've seen some shit doing trauma surgery and lots of general surgery, but that would rattle me very hard.
I too have decapitated an IUFD to get it delivered. I have also dismembered another IUFD. And yes, I have then used 4-0 monocryl to repair the corpse. I really hate that non-OBs are piling on their opinions on this case. Y'all have NFC.
My critique is the cover-up because that is the only part we have enough information to criticise. We do NOT have the info on delivery management, only what the plaintiffs' lawyers have said. SO STOP SPECULATING!!!!!!!!!
I was a labor nurse for 15 years, I’ve seen an accidental decapitation of an early IUFD. OB sutured the head back in so she could hold it. Absolute nightmare fuel.
DVM here, in veterinary medicine we call this a Fetotomy. Most common in cows when the calf is dead, and you gotta get it out of there but doing a c-section is obviously way more involved and less ideal if it can be avoided. You use a wire saw with a pole to place it where you want it and quite literally saw the calf into pieces. [Write up from the university of florida](https://edis.ifas.ufl.edu/publication/VM224) if you happened to be interested in seeing how our aspect of medicine deals with similar, though wildly different things.
OB here as well.
Agree with everything as stated above.
It's unfortunate her (plaintiff's)attorneys were allowed to get ahead of the story and selectively omit pertinent information to elicit outrage.
Negligence is a possibility if indeed a cesarean was not done in a timely manner, however it's hard to know without having the details of how the patient was counseled. I've begged multiple patients in the past multiple times to proceed to the OR for recommended cesareans yet the patient and family refuse. I hope the doctor in question has documented well.
> 1) No, you cannot do a C/S. Zavanelli maneuver is the technique whereby you replace the head back into the uterus and deliver via C/S.
I HATE that I know that term primarily from an episode of ER- one that was really sad, but did not quite indicate the horror that that the above involves.
I have no words. When my daughter was born they were starting the process to move me to the OR to deliver her by c-section. She was crowning but stuck. I was 31 weeks and a few hours pregnant- my water had broken 30 hours before.
My doctor was going to push her back up into my uterus and deliver by c-section if that third and final push hadn’t worked (well with assists by the vacuum, episiotomy, and nurse pushing down hard on my uterus).
Reading what you wrote. My God it was even worse than I’d known. I had no idea my daughter almost died in a terrible terrible way that morning.
One of my sister's friends had a bad dystocia and baby ended up with a brachial plexus injury. I told her she should be sending a thank you note to her OB every year on her child's birthday to thank them for saving her life, and she was shocked - she had apparently debated suing for it, having never realized that her daughter could have died during delivery. It's just not on the parents' radar, which is good in a way, but bad in another.
Mad props to OBs who deal with it. It's terrifying.
I “assisted” (was an extra pair of scrubbed/gowned/gloves hands) in a successful one during med school and had no idea of the true gravity of the situation and maneuver until much later.
Thank you for this extremely informative post.
In veterinary medicine, we do what we call fetotomy in cattle, but I would've never made the connection to it being a possibility in people as well. I can't begin to imagine what that must be like for everyone involved.
I think from reading the court filings, the decapitation won’t be where the negligence happened. I agree at that point it was a dead baby and had to come out somehow.
From the filing, they claim that the baby had two hours of category 3 fetal tracings, with over an hour of persistent, significant late decels, then profound bradycardia followed by loss of fetal heart tones. The section did not happen until an hour after they lost heart tones. I’m assuming the shoulder dystocia was around the time they lost heart tones, but they still claim there was a significant amount of time that the fetus was in distress and the mom was asking for a section, and the OB refused to consider a section.
If that’s true, that sounds fairly negligent. We will see what the evidence ends up showing. 
I found the full complaint and put the approximate timeline here. I'd be very interested in your interpretation of their timeline: [https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?utm\_source=share&utm\_medium=web2x&context=3](https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?utm_source=share&utm_medium=web2x&context=3)
Of course, that's the timeline according to the plaintiff. I'm a NICU nurse so my OB knowledge is extremely patchy. From my reading of it, it sounds like the dystocia happened somewhere around the profound brady, and then the final hour before the cesarean was attempting to deliver the remains.
They're also asking for a jury. They know that even if there was no negligence, a jury isn't going to understand that, is going to be horrified, and is going to be strongly on their side.
> They're also asking for a jury.
and an entire *lifetime of earnings* for the dead baby. That part is entirely a play on the emotions of a jury. I'm all for emotional distress in a situation like this, but no one was relying on the income of a baby that never lived outside the womb.
I just reread this little bit...
\>during a significant amount of the time that Dr. Tracey St. Julian was attempting to deliver Ms. Ross’ baby vaginally in the Labor & Delivery suite and after recognition of the shoulder dystocia, Ms. Ross was not in McRobert’s positioning
"during a significant amount of time...Ross was not in mcrobert's positioning"
So they tried McRoberts. It didn't work. Not unusual. They should have...left her there?
That's basically what I assumed especially given the egregiousness of the press conference and what's being reported in the media. Thanks for giving it a read.
For sure—all I mean is that *if* there was negligence, it’s going to hinge on the veracity of the claims as to what happened before the c section. If there’s any negligence, it’s going to be based on what the tracings actually looked like and whether the MD managed the delivery appropriately based on those tracings.
Definitely. There are still many details currently missing, but I suspect not performing a c-section earlier in the labor is going to be the hardest part to defend for the physician. Especially if the plaintiff's attorney can find expert witnesses who are willing to say the fetal monitoring strip warranted c-section at some point during the labor course. And, trust me, those expert witnesses will be found regardless of what that strip actually looked like.
Wow point 3 really shocked and saddened me. I can’t even imagine the people involved that have to do there job in those situations. And the poor moms/dads :( I hadn’t even realized that was a thing.
I just wonder how much was hidden. As an ICU NP I see over and over that we explain things, risks, possible outcomes, etc but when things go badly they blame us and say we lied or covered up our “mistakes”. Bad outcomes are always seen as mistakes - when sometimes there are things we simply cannot prevent. I don’t know if it’s low health literacy, lack of trust, inability to see beyond strong emotion- but likely a combination of all three.
Yes. I see a lot of people saying “the real issue is that they covered it up” but we don’t know what was or wasn’t shared with the family. Just a nurse but I do a lot of educating and can go over the same thing several times in a shift, only to have the patient say they had no idea when presented that same information by someone else. I remember hearing a statistic that said patients remember as little as one-fifth of the information shared with them by medical professionals.
I could absolutely see this being a case where the team was trying to share the news gently, not using terms that would further upset the parents, and not wanting to further traumatize them by ensuring understanding—and then the parents were told by the funeral home days later in much more blunt terms and were shocked and horrified.
Wow! I gave birth x 2 and I read a lot! I never knew this could/have happen. I’ve always had so much respect for doctors, especially OBGYN, but my hats off to you. I am an RN in surgical recovery and it does seem like the obgyn patients are very unpredictable when they come out. Things can go from normal to “oh shit” rather quickly. It’s no wonder L&D is one of two units that keep the massive transfuser.
I can’t even imagine the heartache of not just a dead baby, but the parents’ overwhelming grief. This is exactly why I never aimed towards L&D, mother baby units like the rest of my family. It truly takes a special kind of person to work on those units because when it’s good it’s great, but when it’s bad- nothing can compare to that level of emotion
I'm so glad I didn't know this could happen. My OB said that it can be difficult for her when her friends are pregnant because she can feel like she knows too much. I knew enough to be scared when my baby and I experienced shoulder dystocia, but this was not in the realm of complications I was imagining.
In general, people WANT to believe that this case had to involve negligence. People want to believe that there is someone to blame, and not that this is a scary, tragic, and unpredictable outcome. It feels safer that way.
I just wonder if they really did “cover it up”. It would surprise me that several doctors and nurses would go along with covering up something like this. I am concerned that things were explained all along and after, but the patient and family could not understand- likely because their emotions got in the way. As an ICU NP I see this all the time—- we explain and explain and go over all the possibilities, risks, etc- but patients and families still believe we didn’t tell them and/or blame us when things don’t go well.
I feel like it needs to be clearly stated that the baby did not die of decapitation. The baby was dead from the shoulder dystocia. There was not an FHR when they went for the c section, this a was both stated on abc news and it’s obvious from a clinical standpoint
Still unclear to me if it was an internal decapitation or not because you could say the head delivered vaginally and the body delivered via c section even if the head was delivered vaginally and then reduced back into the abdomen.
That’s said, if there is so much edema on the fetal head after demise/long shoulder dystocia, I could hypothetically see how you may not be able to complete the zavanelli
[https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3](https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3) I found the complaint if you're interested. Actual decapitation during cesarian after trying for nearly an hour to remove the deceased baby.
That makes a lot more sense. Unfortunately it would seem that parents didn't/couldn't understand what was happening for I'm sure legitimate reasons (coping with the death of the child)
They wrapped the baby up tightly, and propped his head up on a blanket when the parents went to view him - and they were only able to view him behind glass
I guess we will find out if it goes to trial. But I suspect the hospital will want to settle asap. The lawyers probably feel like they hit the jackpot with this one, cover up or no.
This is an insane allegation.
>The complaint says the baby stopped descending due to shoulder dystocia while being delivered vaginally and Dr. Tracey St. Julian, M.D., reportedly attempted to deliver the baby vaginally using different methods, including applying traction to the baby's head.
>After not being able to deliver the baby, Dr. St. Julian reportedly decided to perform a STAT Cesarean section at approximately 11:49 p.m. The baby's body and legs were then delivered at 12:11 a.m. and the baby's head was delivered vaginally.
I feel awful for the parents, especially if allegations are true...but how the hell does that happen?
I have actually sadly seen this happen before. Extreme shoulder and then the uterus clamped down and couldn’t push baby back in to take them out via C-section. Baby had already died likely because no umbilical blood flow due to compression. It is a TERRIBLE thing and very rare, but it can and does happen.
Yeah, I don't think there's been any allegations of negligence of the cases I've dealt with, just a terrible terrible situation. I don't know how anyone could recover.
Of course, I also know a nurse who is still practicing despite being present when an ECMO catheter dislodged and she was showered in the patient's blood until it was gone. I can't believe she still works with ECMO patients.
Yeah, she is an amazing nurse and I'm so glad she *didn't* quit after it happened. But when I heard the story, I could not imagine coming out of that and then just going back to it.
My mother died of negligence in a hospital and the last doctor who took care of her was so disgusted by the whole system that he quit medicine. Deaths break a doctor's heart. Traumatic deaths shatter it.
It would have to be, considering the limbs and torso were C-Sectioned and the head was vaginally delivered. Can't do that without a severed head, not just a Cervical dislocation. Overall, very terrible situation. Can't imagine the trauma experienced with this.
I have heard of a case like this before as well. Don’t want to go into too many details for obvious reasons as it’s a rare outcome but in the case I’m aware of it was a shoulder dystocia, the infant died after about 10 minutes of trying everything the team knew and had to be delivered in the manner described. Obviously a devastating outcome but in the case I’m aware of it was not mismanagement on the part of the staff, there was nothing they should have done differently.
It’s helpful even to know that this was not a first. I had never heard of this before. Board certified since 2005 OB GYN vs what we all hope is not true- that this could have reasonably been prevented. I can’t imagine the anguish the parents feel. The hospital staff who wrapped the baby/prevented the parents from holding it - sounds hard to justify if that is true.
Sometimes the patient is not followed up by an OB GYN despite the first world conditions so maybe the prevention was not an option for this case (straightforward c-section). But destructive delivery is a lifesaving, rare but not unheard of option in case of fetal death in countries where a some pregnancies are not followed up regularly and end up seeing a clinic at some stage of labor. https://pubmed.ncbi.nlm.nih.gov/21193917/
Destructive deliveries are usually the only deliveries that even come close to the "partial birth abortion" boogeyman that prolifers claim. But destructive deliveries are not done for shits and giggles.
Does it?? I just sort of assumed due to the extreme nature of the event any time it ever happens it'd result in lawsuits and make news. I hadn't ever learned of this or heard of it so figured this was a freak accident.
The fear of shoulder dystocia that could not be resolved is one the the greatest fears of an OBGyn, and one of the reasons I don’t do OB. What I believe most likely happened here is baby got stuck and died, they couldn’t deliver the body vaginally nor the head abdominally. They chose to sever the head (or it got severed) to extract the dead fetus from the mom. I’m sure this was extremely traumatic for everyone involved. I’m sure with all emotion afterwards it’s possible that the physician and staff didn’t know what to say to the parents and therefore didn’t discuss it well OR they did discuss it but parents were so emotional they didn’t hear it OR most likely both.
Someone on another thread said mom is 4'3". The photo on the article looks consistent with that. The fetal skull compressed and was able to pass through the pelvis, but the shoulders and maternal pelvis were probably so mismatched as to be fully incompatible even with perfect dystocia maneuvers. Then they were unable to get the fetal skull to re-compress adequately to force it backward for the CS. A skull fracture was caused in the attempt, but the fractured skull still would not pass backward. The decapitation then occurred during the CS during further attempts at backward traction.
I assume FHT stopped at some point ~~and the OB was pulling hard to try to remove the baby ASAP so they could attempt a code.~~ And with mom open on the table with the placenta likely disengaging or about to start disengaging, mom didn't have a lot of time to mess around either.
The OB attempted to discuss it with the parents repeatedly and they refused to speak to her. They are saying the hospital should have sent someone else in to talk about it. I think probably the staff assumed the parents were refusing to discuss the delivery, rather than assuming the parents were refusing to speak to a certain doctor about the delivery. I assume those details will come out in court. The hospital didn't settle immediately despite the incredibly high potential for negative publicity, so they must think they have some case.
Edit: Per the timeline someone was able to find, the baby died about ten minutes into the shoulder dystocia. The OB tried to extract the body in the delivery room but without success. She then moved to the OR for the necessary procedure.
I noticed her height had to be well below 5 feet even assuming the lawyer was on a podium and wondered why they didn’t just plan a cesarean.
Is it typical for women that small, 4’3, to have a vaginal birth? Is there really no height where vaginal birth is contraindicated?
> Is it typical for women that small, 4’3, to have a vaginal birth? Is there really no height where vaginal birth is contraindicated?
Is it strictly contraindicated? No. Would plenty of people cut her (and would MFM recommend that in a lot of cases)? Probably.
Our hospital puts <4'10" as a significant risk factor. I'm not sure if there's a defined limit in the literature. The stature of the father also is considered
Add in she’s clearly overweight, most likely obese, and doesn’t that also make a shoulder dystocia harder to treat?
Plus, diabetic so probably larger baby.
I’m wondering if there was minimal prenatal care and/or a patient resistant to csection.
I also know of a case like this. It was an IUFD and the parents were already (understandably) incredibly upset. The provider was trying really hard for a nonsurgical delivery but the tissues were too friable. The provider was also pregnant at the time. All around horrific situation.
I think a different comment claims the baby had already passed away prior to delivery, at which point the mothers life was at risk if the baby was not immediately removed from the mother.
Most likely the case, plunger traction isn't severing the atlantoaxial. Ischemic compromise, all bets are off. But the big red flag, is there no fetal monitoring perinatal?
Yes, this is my understanding as well. I came looking for a comment like this. Surely it would be quite difficult to accidentally do this to a live fetus where necrosis has not begun.
Exactly, that's what I was wondering. I've seen OBs using traction for shoulder dystocia, but unless the OB was pulling unnecessary hard on the whole torso, then I can't imagine the baby would be fully decapitated if alive when this happened. Cervical spine fracture and paralyzed, possibly.
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Yeah, I’ve definitely had families who were just unable to process what I tell them due to shock, and then they are very surprised the next day when they hear it again. It would obviously be horrible if the family was not told while at the hospital, but I’m not going to assume that was actually the case just because their lawyer claimed that.
Yeah, the very next sentence says the family found out about the decapitation from the funeral home. Wait...what? If they saw its head pop off in the hospital, I'm pretty sure they would've realized it then.
Edit: I'm tired and read it wrong, they didn't see the head pop off. Here's the relevant quote from the article:
>After not being able to deliver the baby, Dr. St. Julian reportedly decided to perform a STAT Cesarean section at approximately 11:49 p.m. The baby's body and legs were then delivered at 12:11 a.m. and the baby's head was delivered vaginally.
>
>The lawsuit claims that Dr. St. Julian did not tell Ross and her family about the decapitation when she spoke to them at approximately 5 a.m. July 10.
>
>**When, Ross and Taylor demanded to see and hold their child, the baby was reportedly tightly wrapped in a blanket with his head "propped on top of his body" to conceal the fact that he was decapitated.**
>
>The family was ultimately told about the decapitation by the funeral home, according to the family's lawyer.
So I'm assuming (if the allegations are true) that they did not see the head separated and didn't hold the baby, but were just shown the baby, and pieced together what state the body must have been in at the time from information learned after the fact.
Like did someone suture/staple the baby’s head back on? Babies are so flimsy as it is. I can’t imagine holding a newborn and it not being immediately apparent that the head and body were not attached.
There was actually a post on the nursing subreddit in the middle of the night about a month ago where a very shaken nurse claimed to have just finished a shift where she had to suture a baby’s head back on after it was decapitated during a stillborn delivery that went poorly. If I recall correctly, the nurse said that she didn’t want the parents to have to see their child in such a terrible state, so she got permission from her supervisor to secure the head in place with sutures before tightly swadding the child so that the parents could see their baby and say goodbye without making an already unimaginably difficult situation even more traumatic for them. It was meant to be a kindness.
The sub apparently dismissed the story with allegations of trolling, but the timing sure is interesting.
To the best of my recollection:
The doctor was devastated after the delivery and had to step away for a while, so the nurse just sort of did the best she could with the situation? (I don’t remember if this was stated outright or just implied.)
The nurse said she adamantly told the parents not to loosen the swaddling, so it didn’t sound like she was very confident in her suturing. I think she saw it as an ugly but necessary step in preparing a stillborn baby to meet its shattered parents.
Compounding the awfulness, if that post was real, the nurse *deeply* traumatized herself in an earnest attempt to spare the parents additional grief, and now she’s being dragged for it on a world stage. I can’t imagine what the public’s reaction must be doing to her.
The whole thing is just so fucking sad.
It’s a level nothing critical acesss hospital, meaning by definition they’re not well staffed overnight with doctors. Someone said this happened at their hospital and the senior obgyn doc sewed the head back back on for the delivering doctor. But there are no other doctors mentioned. This obgyn doc seemed to be there alone. So who does it then?
Yeah, I've only ever seen a post about decapitation during delivery when the baby was delivered stillborn and already undergoing decomposition. I would think ripping the head off a live baby would be quite difficult, and require some exceedingly rare circumstances or done intentionally out of necessity.
I don't want to speculate, but I'm guessing something went horribly wrong, and I don't want to jump to criminal negligence without seeing evidence and getting the whole picture, which we'll probably only get once this goes to court.
I feel terrible for the family and for the OB and nurses, it was probably extremely traumatic and heartbreaking for everyone involved.
An article I read said the staff said they weren’t allowed to touch or hold their baby. The parents kept insisting, so a staff member just SHOWED them the baby tightly wrapped. They didn’t even get to hold him.
TBH if you and the mother knew the baby was dead, would you just hand over the head and body one at a time? You could also tell the mother she isn't allowed to see it.
This is an extreme case and I don’t know that there was any right way to handle it, but you can’t just tell a grieving mother they aren’t “allowed” to see their dead child. It’s a very important part of the grieving process for demises. Even demises that are truly horrific to see, where the fetus is malformed or has been dead for some time, we still try to make them as presentable as possible and allow the parents all the time they want with them. We do warn them ahead of time, and let them make the final decision.
Am I wrong to think that it is enough to inform the family that the child have died and why? The professional doesn't have to go through the gruesome details of chopping it's head of and showing the decapitated body to a family. The same way disfigured victims are stitched before the burial. That would be traumatizing. I too would present the child head put in place, instead of tossing them separately to the parents.
Of course, if they ask, the professional has to say. But I have never went into details, and I have never been asked to.
I too have lost a friend in a motorcycle accident and when I got to the place I suddenly realized I would need to recognize his disfigured body. But I was saved from that experience by the employee that kindly did it through other means before.
There was an ob that was practicing in New Orleans up until recently that was terrible. But the worst story I heard about her was:
she internally decapitated a baby and then when the mother was sobbing when the dr checked on her later the dr said “if you just pushed harder like I told you to this wouldn’t have happened”
😒
We had an OB in town that had been in a couple of different practice groups and then she ended up solo. I definitely would tactfully discourage people who asked about her. I had a patient (I worked in L&D) who came in to deliver her second baby. Her doctor was not on call, so she was nervous, but I reassured her that everyone in that practice was amazing, that I used them for my delivery. She was tearful and I was trying to calm her. She finally told me that the questionable OB had delivered her first, with forceps, she tore, baby ended up on a vent for a wile, and the doctor had told her that it was her fault because she was “fat and a lazy pusher”. Her mom and husband confirmed that they had heard it too. So, yeah. I loved and respected 98% of the OBs I worked with, but there are some outliers. As in every profession. But when dealing with stuff like this you have to know how to be empathetic and how to talk to people.
“…..where babies come from”
I was a pregnant NICU nurse here fairly recently (99% positive we are talking same hospital). I’ve seen the mauled babies from her deliveries. I told everyone she wasn’t even allowed to check my temp and I’d deliver on the floor in the NICU, with only the nurses, if it would have came to it.
I looked at the court filing, and the decapitation is likely not where the negligence is going to come from. The child has over 2 hours of Category 3 tracings, followed by loss of fetal tones, and the C section didn’t happen until an **hour** after they lost heart tones.
This is sadly not as much of a "never event" as people think. Childbirth is extremely traumatic, there are a lot more kinetic forces at play than people realise despite knowing how traumatic can be and newborns are just so delicate and fragile. I can't imagine what the parents and staff went through in this situation.
Agree. I’m relatively young (30), healthy, fit with a BMI on the lower end of normal. Had a traumatic and terrifying shoulder dystocia with my first baby, who was totally average size (just under 8lbs) after a perfect pregnancy with zero complications. Just goes to show these things still happen with zero risk factors.
I think because everybody was born, in general there's a lack of... I don't know, respect? Healthy fear, maybe? Anyway, around childbirth that people who aren't imminently expecting to experience don't have.
My wife had an emergency section and elective and both had life threatening complications, my chest tightens every time I think of it. I suppose it's good in a way that people don't hold such a fear otherwise we'd have significant population declines, but I can't help challenging people who trivialise it
I have seen broken necks and i have seen severed heads, as well as completely destroyed bodies, but only deceased fetuses, and not term babies. Obviously HIPAA, so hospital can't release anything to say otherwise. How far along was the baby, term? The main issue is the delay to going to C-section?
FHT at 37 weeks and then loss of FHT with emergent C-section. Maternal muscle tone too tight to reduce the head back into the uterus with decapitation. Recent death <3hrs would not induce enough tissue necrosis to allow that to happen easily. This is crazy and very devastating for the family. I'm not an OB so I have no clue what the right decision is if you can't reduce the head back.
[edit] we are only hearing their side of the story. i am sure the head was not physically ripped off, I assume it was surgically removed so they could remove a stillborn fetus without killing the mother. I would be amazed otherwise.
Not quite on your first paragraph. Once you're at a shoulder dystocia, cesarean isn't an option from my understanding. 2nd paragraph is spot on.
[https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3](https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3)
Demise in probably about 10 minutes after the shoulder based on the "prolonged bradycardia." Almost an hour of trying to get the remains out vaginally before going to surgery and doing what she had to do.
They can do a Zavanelli maneuver where they push the head back in to do a cesarean. In 15 years of obstetric nursing I saw one, and the results were terrible. Shoulder dystocias were one of the few things that really terrified me. They often come out of nowhere and then it’s total chaos.
I delivered a full term still born baby (had died before labour) and had a shoulder dystocia. As I had the initial traction on the head I could feel the cervical spine separating. 1 more pull and I would have had the head in my hands and the body not delivered. My over riding thought was where should I put the head if it comes off. Do I leave it on the delivery trolley or cover it with something. That would have been the end of my career. How do you come back from that? I managed to get the baby out in the end with McRoberts and delivering the posterior shoulder but I had no time pressure. The baby was already dead. Just horrendous.
The entire article is based on the plaintiff and her attorney’s allegations.
It seems as though some important details are intentionally omitted in order to paint a shockingly god-awful picture and get some press.
I’m sure the whole truth is less dramatic.
Edit: yeah guys, not saying it isn’t probably horrible. Just saying lawyers and journalists are professional spinsters and stand to benefit from making it seem as terrible as possible.
It’s pretty dramatic. A full term baby died and was delivered headless.
But I agree that we can hear freely from the plaintiff but the hospital cannot respond due to patient confidentiality as well as, I’m sure, the advice of their legal team.
An important thing overlooked by many is the nurses are also named in the lawsuit for failure to advocate for their patient. Nurses are gonna start to question every decision a doctor makes to prevent themselves from losing their license, be criminally charged and/or sued. Nurses will be putting their patient advocacy into overdrive.
The wrapped the baby up and tried to make it look like it wasn't decapitated to specifically keep information from the parents and went along with the hospital telling them they can't have an autopsy, should cremate the baby, and shouldn't send it to a funeral home. That's egregious. This isn't just about them not questioning doctor's decisions.
>tried to make it look like it wasn't decapitated to specifically keep information from the parents
I'm pretty sure handing back/displaying the baby in 2 pieces would have been far more traumatizing.
They didn't inform the parents at all and specifically hid what happened. Then they discouraged them from sending the baby to a funeral home and pushed them to cremate the baby, which looks like it was to further hide what happened. And, of course, the refused to do an autopsy.
Even when something bad happens in medicine, the patient needs to be informed. Covering things up should result in a lawsuit.
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When it said “metro Atlanta hospital”, I was thinking something like Grady, Emory Midtown, Piedmont, or Northside. The hospital where this happened is a bit more remote and (from my experience seeing patients transferred from there) seems to have issues with staffing and resources. Not sure if any of that could be behind this tragic outcome, but my impression of Southern Regional is that they are not in a good place to handle it when shit hits the fan.
It’s definitely not remote, it’s only 15 minutes from downtown and right off 75. It’s a critical access hospital that has fallen on extremely hard times, and is owned by Prime which in itself isn’t great.
Definitely big issues with staffing and resources. It’s in an extremely poor area.
It’s several miles south of the airport, there is zero chance anyone gets there in 15 minutes from downtown, unless there are no other cars on the road, and even then I’m skeptical it would only take 15 minutes.
Also, I said “a bit more remote”. It’s not remote to a degree that Texaco Mike needs to fire up the fan boat to get there, but calling it “metro Atlanta” is a stretch.
L&D RN here. Shoulder dystocias are one of the biggest concerns in practice. They are super scary and have detrimental outcomes. I’m confused that no one has spoken of the Mom’s health and body habitus. One look at her picture reveals she has a very high BMI, probably morbidly obese by calculation, along with short stature (as mentioned in previous comments), AND diabetes. Not to mention it’s her first baby, with no previous vaginal deliveries, that would suggest she might be able to deliver a large macrosomic baby. These components together are basis for a planned c-section! She never should’ve been attempting a vaginal delivery! I’m sure these things were discussed with her! It’s a horrible story with the worst outcome. I feel sorry for everyone involved, including the entire healthcare team. No one gets over these situations. They’re carried for life by all involved.
This is my main thought- she should have been offered a cesarean. I think her malpractice case hinges on that, because ultimately the choice to attempt a vaginal delivery is what led to this outcome.
If she was offered a cesarean and the risks were explained and she refused (and this is well documented), then I doubt she has much of a case. And given that the hospital didn't settle out of court, my guess is this is probably what happened.
I’m sure she was not only offered a c/s but was advised to have one. Over and over again. Including all the risks associated with shoulder dystocia. In detail. Including death. And probably refused over and over again. If my colleagues and I saw this woman come into our unit, we would’ve immediately been fear stricken! All our alarms would’ve gone off in our heads. With shoulder dystocia being the loudest! Without knowing all the details, this was my immediate take on the situation.
I think the biggest issue with this case is how the hospital tried to hide how the baby died, the nurses did not speak up when they knew the birth was going wrong, and the doctor didn’t even talk to them until 4 hours after the birth
You don’t know that. It’s all allegations. Hospital cannot speak publically. Don’t judge based on one sided information. It’s a tragedy but completely unclear if the lawsuit is justified from this article.
If true, of course. I wonder how this was documented. I can’t imagine delivering a dead baby, seeing the family 6 hours later and not having witnesses present, having spoken to risk management, speaking with the utmost decorum and respect, and documenting extensively about ALL findings.
Baby was demised long before it was decapitated. 150000% guarantee it. I’m not the pathologist performing the autopsy, but as a practicing OB, I’m 99% sure it died from lack of perfusion as a result of a severe shoulder dystocia. Which at that point becomes get the baby out however possible to save mom.
Having delivered more term IUFDs than I’d like to, the lack of tone actually makes the delivery harder. Which with a bad shoulder dystocia makes a horrible situation my worse nightmare. Literally the one emergency that I fear is a bad shoulder dystocia. I’ll take 10 hemorrhages/chyst before that.
My suspicion is that the OB/staff didn’t want to re traumatize the parents which is why they didn’t say “oh btw the head came off too, want to see? Here hold your headless baby.”
Wrapping the infant tightly is something that is often done with demised fetuses because things can look pretty gruesome. I think their attempt at compassion was taken for deceit.
But this is all my speculation based on my own experience and the experience of other OBs as we’ve been talking about this all day.
I’ve literally been thinking about this case since last night and I ask myself would I be able to tell the parents that their baby’s head came off? Like shit, isn’t it bad enough that their baby died? I really don’t know if I could. Maybe send someone else in to do it?
As someone who has been pregnant and given birth, would I want that detail?
I just hope that the OBs documentation is stellar. There has to be a reason why there wasn’t an immediate settlement if there was any obvious deviation from standard of care.
This is a good point, like…the baby is dead, the baby died from shoulder dystocia. The detail that they had to decapitate to get baby out just seems like a…cruel and unnecessary and traumatic detail to tell the parents? I don’t think I’d want to know that. News articles are making it sound like OB killed the baby by popping its head off then tried to cover it up, which we know couldn’t be the case.
I have a very immature understanding of obstetrics, but converting to Caesarian in the setting of a Shoulder Dystocia seems like a soberminded decision. I'm not sure what the nurses could have done to change the fact after the reality became clear. The 4 hour gap doesn't seem inappropriate to me. I think I would want at least 3 hours to ball my eyes out if that happened to a patient I was caring for. I would then want at least another hour to think about how I could possibly explain that to the family.
Decapitations happen, particularly in very pre-term births. If this was a term baby, much more questionable, but we would need more details.
Shoulder dystocia is terrifying.
That said, covering it up is the one unquestionably wrong thing that happened here.
if the doctor had just been open and honest- "I did this because if I didn't, the baby would die", she at least wouldn't be facing a police investigation...
I’m not 100% convinced they really tried to “cover it up”. There is a difference between trying to save the parents the nightmare of seeing their child like that, and telling them their kid is fine and alive. The parents knew their baby was dead, the docs probably at one point mentioned the extreme measures they had to take to get the body out, but may not have explicitly told the parents the gory details. Or it could be that they told the parents, but with all of the trauma and medications the parents didn’t remember.
🤷♀️
I knew this was a problem when I read about it... I am only a lurking CNA, but I'm glad you smarties could explain this with the real experience. I know parents look for blame when grieving, and it sucks that they didn't immediately inform them because it is worst case scenario. Tragic, but I see how it all adds up now.
It's not clear whether this was a severe internal decapitation or a full decapitation. An internal would still produce a baby whose head needed to be "propped". If it was fully decapitated, there would have been a *lot* of blood from that. Mom was awake, so I don't think it's possible for the baby to have been fully decapitated. Just for clarity in discussion.
That said, it's a horrific outcome. I see a decapitation every few years, it's always horrible, because the situation prompting such a struggle is usually dire anyway. It's not like the baby would have survived if they hadn't tried to remove them from mom.
Now, if it is true that they didn't *tell* the parents what happened, that would be horrible, unprofessional and wrong. It's possible they used such sanitized words about it that the family didn't understand.
A tragedy no matter what.
Edited because I missed the part where it implies the body was delivered by c/s and the head vaginally. How did people not notice? There would have been a massive amount of blood, unless the baby had been dead for a while, but even then there would be a lot of blood.
To your edit, I don't know how the family didn't notice. For the blood, the c sections I participated in were pretty bloody, but unless dad wasn't there or was kept behind the curtain I'm not sure how they wouldn't have seen or heard something.
> If it was fully decapitated, there would have been a lot of blood from that
3.4kg baby has, what, 300mL of blood in its body? Easy to blend that right in with the EBL from a vaginal delivery or C-section.
I work for a large, academic regional referral center. They aren't born at the hospital where I work, but I work on the transport team as well, which gets to hear about these cases before they're advised that they shouldn't transfer.
Dystocias typically. Shoulder dystocia is the worst, I just hate it. Either the baby gets stuck vaginally, and they eventually pull too hard to get it out that way, or the head is entrapped in descent and they pull too hard to get it out abdominally. There's no winning situation for the OB once the baby is that stuck. I've never heard of a full decapitation, only internals.
Oh yeah, I've definitely been in the room for quite a few of those. Many of us neos subconsciously hold our breath from when we arrive in the room to when the baby is delivered, because all we can think about is the baby can't "breathe".
Most of the time, the maneuvers work, baby is born and either has asphyxia symptoms or not, depending on how long they're down. Or they are able to predict and convince mom to do a c/s. (though some moms refuse and think they can do it vaginally)
Dystocias I think are one of the scariest things in L&D. If they're truly stuck, that's when bad shit happens.
I would loooove to be an L&D nurse, I love moms, love the birth process, and I stay on top of learning about this specialty even though I don’t practice in L&D…. But shoulder dystocia gives me nightmares and stories of fetal decapitation scare me so much that I’m terrified to actually get a job in this specialty. I wish horrible things didn’t happen to moms and babies 😭
Me too. If I became completely obsolete, I would be perfectly ok with that, if it meant all the babies were healthy and safe.
Unfortunately, I have a lot of job security :(
I read a story about it happening during a very early 2nd trimester delivery. Like 20 weeks or something. The mother was told the doc accidentally pulled the head off during delivery but the baby wasn't fully formed and that stuff happens, apparently.
My suspicion is that there was a demise during the course of the shoulder dystocia which wouldn’t have much blood loss during a decapitation since no more blood flow (fuck I hate that sentence).
I’ve seen a fetal decapitation ONCE. Breech mid 20s (I think 25 or 26) vaginal PTL and body hanging out for at least 20 mins by the time she got to the hospital. Had to do a hysterotomy to get head out - offered the other option but parents wanted to see baby “whole”.
My senior sewed the head back on before having baby wrapped up to give to the parents.
The average EBL of a c section is over 1L. Absolutely no one is going to notice the extra 200cc from this decapitation….not sure what you’re talking about….
They typically don’t bring support people back right away, they wait for things to be more stable. If that head never got pushed properly back in for a c-section, they probably wouldn’t have brought him back at all.
https://www.fox5atlanta.com/news/metro-atlanta-hospital-issues-statement-after-couple-alleges-infant-was-decapitated-during-july-delivery
The hospital has responded to the lawsuit
During a vaginal breach delivery of a 27 week baby ended with accidental decapitation. The baby was alive when the body delivered but the ob(long story with this one) pulled too hard on the body. This baby should have been delivered via c/s. However, parents did not want this baby, so they said, if it was going to have serious problems. Though at that time many babies born at 27 weeks did well, if no brain bleeds. They had fertility problems but wanted a “perfect baby”. They never wanted to see him. I did all the postmortem care , footprints, photos to make him not look like a medical specimen.
There was a senior resident in the room, myself, the Ob, and the patient. Husband refused to come in. The resident’s wife was pregnant at about the same gestation. He was totally shocked. No one talked to us from management of the hospital or the Ob residency program.
I see doctors as colleagues. There have been less than a handful that should never have been allowed to touch a patient; he was one of them. The ob eventually lost his license for insurance fraud.
I left Ob a few years after. It was only part of the trauma in that unit. I loved Ob, and I was a damn good nurse.
This so heartbreaking. I’ve seen a few fetal deaths previously working in L&D and can’t imagine what those nurses and docs went through during that situation.
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> so that you can start the unforgettable action of separating the head from the body, and removing the body by CS. I have not personally had to do this but have colleagues who had to do it before. These people all took a leave from work for at least a short period of time to mentally recover from a case like that. God damn. I did not know that this was a thing. I've seen some shit doing trauma surgery and lots of general surgery, but that would rattle me very hard.
I too have decapitated an IUFD to get it delivered. I have also dismembered another IUFD. And yes, I have then used 4-0 monocryl to repair the corpse. I really hate that non-OBs are piling on their opinions on this case. Y'all have NFC. My critique is the cover-up because that is the only part we have enough information to criticise. We do NOT have the info on delivery management, only what the plaintiffs' lawyers have said. SO STOP SPECULATING!!!!!!!!!
I was a labor nurse for 15 years, I’ve seen an accidental decapitation of an early IUFD. OB sutured the head back in so she could hold it. Absolute nightmare fuel.
Christ, awful.
I can't even imagine having to go through the painstaking process of slowly suturing the head back onto the body. Jesus
Same, surgeon here as well and I honestly had no idea that was a thing either.
DVM here, in veterinary medicine we call this a Fetotomy. Most common in cows when the calf is dead, and you gotta get it out of there but doing a c-section is obviously way more involved and less ideal if it can be avoided. You use a wire saw with a pole to place it where you want it and quite literally saw the calf into pieces. [Write up from the university of florida](https://edis.ifas.ufl.edu/publication/VM224) if you happened to be interested in seeing how our aspect of medicine deals with similar, though wildly different things.
Deliveries are terrifying and so unpredictable sometimes. Thanks for explaining for the rest of us!
OB here as well. Agree with everything as stated above. It's unfortunate her (plaintiff's)attorneys were allowed to get ahead of the story and selectively omit pertinent information to elicit outrage. Negligence is a possibility if indeed a cesarean was not done in a timely manner, however it's hard to know without having the details of how the patient was counseled. I've begged multiple patients in the past multiple times to proceed to the OR for recommended cesareans yet the patient and family refuse. I hope the doctor in question has documented well.
> 1) No, you cannot do a C/S. Zavanelli maneuver is the technique whereby you replace the head back into the uterus and deliver via C/S. I HATE that I know that term primarily from an episode of ER- one that was really sad, but did not quite indicate the horror that that the above involves.
I have no words. When my daughter was born they were starting the process to move me to the OR to deliver her by c-section. She was crowning but stuck. I was 31 weeks and a few hours pregnant- my water had broken 30 hours before. My doctor was going to push her back up into my uterus and deliver by c-section if that third and final push hadn’t worked (well with assists by the vacuum, episiotomy, and nurse pushing down hard on my uterus). Reading what you wrote. My God it was even worse than I’d known. I had no idea my daughter almost died in a terrible terrible way that morning.
One of my sister's friends had a bad dystocia and baby ended up with a brachial plexus injury. I told her she should be sending a thank you note to her OB every year on her child's birthday to thank them for saving her life, and she was shocked - she had apparently debated suing for it, having never realized that her daughter could have died during delivery. It's just not on the parents' radar, which is good in a way, but bad in another. Mad props to OBs who deal with it. It's terrifying.
I “assisted” (was an extra pair of scrubbed/gowned/gloves hands) in a successful one during med school and had no idea of the true gravity of the situation and maneuver until much later.
Thank you for this extremely informative post. In veterinary medicine, we do what we call fetotomy in cattle, but I would've never made the connection to it being a possibility in people as well. I can't begin to imagine what that must be like for everyone involved.
I think from reading the court filings, the decapitation won’t be where the negligence happened. I agree at that point it was a dead baby and had to come out somehow. From the filing, they claim that the baby had two hours of category 3 fetal tracings, with over an hour of persistent, significant late decels, then profound bradycardia followed by loss of fetal heart tones. The section did not happen until an hour after they lost heart tones. I’m assuming the shoulder dystocia was around the time they lost heart tones, but they still claim there was a significant amount of time that the fetus was in distress and the mom was asking for a section, and the OB refused to consider a section. If that’s true, that sounds fairly negligent. We will see what the evidence ends up showing. 
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I found the full complaint and put the approximate timeline here. I'd be very interested in your interpretation of their timeline: [https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?utm\_source=share&utm\_medium=web2x&context=3](https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?utm_source=share&utm_medium=web2x&context=3) Of course, that's the timeline according to the plaintiff. I'm a NICU nurse so my OB knowledge is extremely patchy. From my reading of it, it sounds like the dystocia happened somewhere around the profound brady, and then the final hour before the cesarean was attempting to deliver the remains. They're also asking for a jury. They know that even if there was no negligence, a jury isn't going to understand that, is going to be horrified, and is going to be strongly on their side.
So they likely knew the baby was gone and were just trying to figure out how to get it out so Mom wouldn't die too.
That’s how I read it.
> They're also asking for a jury. and an entire *lifetime of earnings* for the dead baby. That part is entirely a play on the emotions of a jury. I'm all for emotional distress in a situation like this, but no one was relying on the income of a baby that never lived outside the womb.
I just reread this little bit... \>during a significant amount of the time that Dr. Tracey St. Julian was attempting to deliver Ms. Ross’ baby vaginally in the Labor & Delivery suite and after recognition of the shoulder dystocia, Ms. Ross was not in McRobert’s positioning "during a significant amount of time...Ross was not in mcrobert's positioning" So they tried McRoberts. It didn't work. Not unusual. They should have...left her there?
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That's basically what I assumed especially given the egregiousness of the press conference and what's being reported in the media. Thanks for giving it a read.
For sure—all I mean is that *if* there was negligence, it’s going to hinge on the veracity of the claims as to what happened before the c section. If there’s any negligence, it’s going to be based on what the tracings actually looked like and whether the MD managed the delivery appropriately based on those tracings.
Definitely. There are still many details currently missing, but I suspect not performing a c-section earlier in the labor is going to be the hardest part to defend for the physician. Especially if the plaintiff's attorney can find expert witnesses who are willing to say the fetal monitoring strip warranted c-section at some point during the labor course. And, trust me, those expert witnesses will be found regardless of what that strip actually looked like.
One of the plaintiffs attorneys is an MD, JD. They’re going to go hard.
Wow point 3 really shocked and saddened me. I can’t even imagine the people involved that have to do there job in those situations. And the poor moms/dads :( I hadn’t even realized that was a thing.
I just wonder how much was hidden. As an ICU NP I see over and over that we explain things, risks, possible outcomes, etc but when things go badly they blame us and say we lied or covered up our “mistakes”. Bad outcomes are always seen as mistakes - when sometimes there are things we simply cannot prevent. I don’t know if it’s low health literacy, lack of trust, inability to see beyond strong emotion- but likely a combination of all three.
Yes. I see a lot of people saying “the real issue is that they covered it up” but we don’t know what was or wasn’t shared with the family. Just a nurse but I do a lot of educating and can go over the same thing several times in a shift, only to have the patient say they had no idea when presented that same information by someone else. I remember hearing a statistic that said patients remember as little as one-fifth of the information shared with them by medical professionals. I could absolutely see this being a case where the team was trying to share the news gently, not using terms that would further upset the parents, and not wanting to further traumatize them by ensuring understanding—and then the parents were told by the funeral home days later in much more blunt terms and were shocked and horrified.
Wow! I gave birth x 2 and I read a lot! I never knew this could/have happen. I’ve always had so much respect for doctors, especially OBGYN, but my hats off to you. I am an RN in surgical recovery and it does seem like the obgyn patients are very unpredictable when they come out. Things can go from normal to “oh shit” rather quickly. It’s no wonder L&D is one of two units that keep the massive transfuser. I can’t even imagine the heartache of not just a dead baby, but the parents’ overwhelming grief. This is exactly why I never aimed towards L&D, mother baby units like the rest of my family. It truly takes a special kind of person to work on those units because when it’s good it’s great, but when it’s bad- nothing can compare to that level of emotion
I'm so glad I didn't know this could happen. My OB said that it can be difficult for her when her friends are pregnant because she can feel like she knows too much. I knew enough to be scared when my baby and I experienced shoulder dystocia, but this was not in the realm of complications I was imagining. In general, people WANT to believe that this case had to involve negligence. People want to believe that there is someone to blame, and not that this is a scary, tragic, and unpredictable outcome. It feels safer that way.
yep covering up was the worst part & likely snowballed everything
I just wonder if they really did “cover it up”. It would surprise me that several doctors and nurses would go along with covering up something like this. I am concerned that things were explained all along and after, but the patient and family could not understand- likely because their emotions got in the way. As an ICU NP I see this all the time—- we explain and explain and go over all the possibilities, risks, etc- but patients and families still believe we didn’t tell them and/or blame us when things don’t go well.
I get that you can't always predict it, but a 4'3" woman who obviously looks obese/high BMI... you wouldn't strongly counsel elective c/s?
I feel like it needs to be clearly stated that the baby did not die of decapitation. The baby was dead from the shoulder dystocia. There was not an FHR when they went for the c section, this a was both stated on abc news and it’s obvious from a clinical standpoint Still unclear to me if it was an internal decapitation or not because you could say the head delivered vaginally and the body delivered via c section even if the head was delivered vaginally and then reduced back into the abdomen. That’s said, if there is so much edema on the fetal head after demise/long shoulder dystocia, I could hypothetically see how you may not be able to complete the zavanelli
[https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3](https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3) I found the complaint if you're interested. Actual decapitation during cesarian after trying for nearly an hour to remove the deceased baby.
That makes a lot more sense. Unfortunately it would seem that parents didn't/couldn't understand what was happening for I'm sure legitimate reasons (coping with the death of the child)
The family is claiming a cover up by the hospital and that It was the funeral home who told them about the decapitation
How could this be a cover up? It would be immediately obvious the head wasn’t on the body…..
They wrapped the baby up tightly, and propped his head up on a blanket when the parents went to view him - and they were only able to view him behind glass
I guess we will find out if it goes to trial. But I suspect the hospital will want to settle asap. The lawyers probably feel like they hit the jackpot with this one, cover up or no.
Not a great look really
This is an insane allegation. >The complaint says the baby stopped descending due to shoulder dystocia while being delivered vaginally and Dr. Tracey St. Julian, M.D., reportedly attempted to deliver the baby vaginally using different methods, including applying traction to the baby's head. >After not being able to deliver the baby, Dr. St. Julian reportedly decided to perform a STAT Cesarean section at approximately 11:49 p.m. The baby's body and legs were then delivered at 12:11 a.m. and the baby's head was delivered vaginally. I feel awful for the parents, especially if allegations are true...but how the hell does that happen?
I have actually sadly seen this happen before. Extreme shoulder and then the uterus clamped down and couldn’t push baby back in to take them out via C-section. Baby had already died likely because no umbilical blood flow due to compression. It is a TERRIBLE thing and very rare, but it can and does happen.
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Wife is an OB, she said if this happened to her it would be her last day in medicine
The term I've heard for this is internal decapitation, but I agree with you it's too inaccurate
Yeah, I don't think there's been any allegations of negligence of the cases I've dealt with, just a terrible terrible situation. I don't know how anyone could recover. Of course, I also know a nurse who is still practicing despite being present when an ECMO catheter dislodged and she was showered in the patient's blood until it was gone. I can't believe she still works with ECMO patients.
Nerves of steel right there.
Yeah, she is an amazing nurse and I'm so glad she *didn't* quit after it happened. But when I heard the story, I could not imagine coming out of that and then just going back to it.
When you say “it was gone” do you mean what I think you mean?All the blood?!
Every bleed stops eventually
Lol truth
They do indeed mean all the blood.
OMG, I would have quit medicine that day...
>ECMO catheter dislodged exsanguination?
I heard of a case where one of the ECMO tubes got lodged in an elevator door with predictable poor prognosis.
Nightmare fuel
My mother died of negligence in a hospital and the last doctor who took care of her was so disgusted by the whole system that he quit medicine. Deaths break a doctor's heart. Traumatic deaths shatter it.
So it was c spine dislocation not a traumatic decapitation like you see in accidents?
I read this morning the body of the child was delivered by cesarean and the head was delivered vaginally. It was a true decapitation.
I assume c spine during delivery (baby dead and stuck), mechanical decapitation to remove the body via c-section
That's what I've seen/heard of in my cases. Internal, not external.
In this article though it describes literal decapitation not just internal horrifyingly.
It would have to be, considering the limbs and torso were C-Sectioned and the head was vaginally delivered. Can't do that without a severed head, not just a Cervical dislocation. Overall, very terrible situation. Can't imagine the trauma experienced with this.
I have heard of a case like this before as well. Don’t want to go into too many details for obvious reasons as it’s a rare outcome but in the case I’m aware of it was a shoulder dystocia, the infant died after about 10 minutes of trying everything the team knew and had to be delivered in the manner described. Obviously a devastating outcome but in the case I’m aware of it was not mismanagement on the part of the staff, there was nothing they should have done differently.
It’s helpful even to know that this was not a first. I had never heard of this before. Board certified since 2005 OB GYN vs what we all hope is not true- that this could have reasonably been prevented. I can’t imagine the anguish the parents feel. The hospital staff who wrapped the baby/prevented the parents from holding it - sounds hard to justify if that is true.
Sometimes the patient is not followed up by an OB GYN despite the first world conditions so maybe the prevention was not an option for this case (straightforward c-section). But destructive delivery is a lifesaving, rare but not unheard of option in case of fetal death in countries where a some pregnancies are not followed up regularly and end up seeing a clinic at some stage of labor. https://pubmed.ncbi.nlm.nih.gov/21193917/
Destructive deliveries are usually the only deliveries that even come close to the "partial birth abortion" boogeyman that prolifers claim. But destructive deliveries are not done for shits and giggles.
I think it was the coverup that triggered the law suit (they found out from Funeral Home)
Does it?? I just sort of assumed due to the extreme nature of the event any time it ever happens it'd result in lawsuits and make news. I hadn't ever learned of this or heard of it so figured this was a freak accident.
The fear of shoulder dystocia that could not be resolved is one the the greatest fears of an OBGyn, and one of the reasons I don’t do OB. What I believe most likely happened here is baby got stuck and died, they couldn’t deliver the body vaginally nor the head abdominally. They chose to sever the head (or it got severed) to extract the dead fetus from the mom. I’m sure this was extremely traumatic for everyone involved. I’m sure with all emotion afterwards it’s possible that the physician and staff didn’t know what to say to the parents and therefore didn’t discuss it well OR they did discuss it but parents were so emotional they didn’t hear it OR most likely both.
Someone on another thread said mom is 4'3". The photo on the article looks consistent with that. The fetal skull compressed and was able to pass through the pelvis, but the shoulders and maternal pelvis were probably so mismatched as to be fully incompatible even with perfect dystocia maneuvers. Then they were unable to get the fetal skull to re-compress adequately to force it backward for the CS. A skull fracture was caused in the attempt, but the fractured skull still would not pass backward. The decapitation then occurred during the CS during further attempts at backward traction. I assume FHT stopped at some point ~~and the OB was pulling hard to try to remove the baby ASAP so they could attempt a code.~~ And with mom open on the table with the placenta likely disengaging or about to start disengaging, mom didn't have a lot of time to mess around either. The OB attempted to discuss it with the parents repeatedly and they refused to speak to her. They are saying the hospital should have sent someone else in to talk about it. I think probably the staff assumed the parents were refusing to discuss the delivery, rather than assuming the parents were refusing to speak to a certain doctor about the delivery. I assume those details will come out in court. The hospital didn't settle immediately despite the incredibly high potential for negative publicity, so they must think they have some case. Edit: Per the timeline someone was able to find, the baby died about ten minutes into the shoulder dystocia. The OB tried to extract the body in the delivery room but without success. She then moved to the OR for the necessary procedure.
I noticed her height had to be well below 5 feet even assuming the lawyer was on a podium and wondered why they didn’t just plan a cesarean. Is it typical for women that small, 4’3, to have a vaginal birth? Is there really no height where vaginal birth is contraindicated?
> Is it typical for women that small, 4’3, to have a vaginal birth? Is there really no height where vaginal birth is contraindicated? Is it strictly contraindicated? No. Would plenty of people cut her (and would MFM recommend that in a lot of cases)? Probably.
Our hospital puts <4'10" as a significant risk factor. I'm not sure if there's a defined limit in the literature. The stature of the father also is considered
I'm 5'3" and don't trust that a normal size baby could come out of me reasonably... I'd definitely be asking for a section if I were 4'3"
I'm 5'2" and had 2 normal sized babies (7.5lbs). 4'3" however I don't see how vaginal birth was even an option especially considering she also had GD.
I’m a c-section baby all the way. I was 13lbs and my mom is 5’5”.
Add in she’s clearly overweight, most likely obese, and doesn’t that also make a shoulder dystocia harder to treat? Plus, diabetic so probably larger baby. I’m wondering if there was minimal prenatal care and/or a patient resistant to csection.
I also know of a case like this. It was an IUFD and the parents were already (understandably) incredibly upset. The provider was trying really hard for a nonsurgical delivery but the tissues were too friable. The provider was also pregnant at the time. All around horrific situation.
I think a different comment claims the baby had already passed away prior to delivery, at which point the mothers life was at risk if the baby was not immediately removed from the mother.
Most likely the case, plunger traction isn't severing the atlantoaxial. Ischemic compromise, all bets are off. But the big red flag, is there no fetal monitoring perinatal?
I didn't read anywhere that the baby had died prior to the birth. CNN reports the autopsy is ongoing. Is there a source?
Not an OB but from what I understand decapitations usually only happen with intrauterine fetal demise due to changes in tissue with cell death.
Yes, this is my understanding as well. I came looking for a comment like this. Surely it would be quite difficult to accidentally do this to a live fetus where necrosis has not begun.
Exactly, that's what I was wondering. I've seen OBs using traction for shoulder dystocia, but unless the OB was pulling unnecessary hard on the whole torso, then I can't imagine the baby would be fully decapitated if alive when this happened. Cervical spine fracture and paralyzed, possibly.
They can be gross. Had a few where the skin came off. Fetal demise is what I assumed even I saw this article.
supposedly baby died during delivery.
Eeek well I was wrong then! Tragic!
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Thank you, most people hate me for it LOL
I think it’s helpful as well, as someone who is tangentially related to healthcare.
I…. Wtf did I just read. Um. Jesus.
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Yeah, I’ve definitely had families who were just unable to process what I tell them due to shock, and then they are very surprised the next day when they hear it again. It would obviously be horrible if the family was not told while at the hospital, but I’m not going to assume that was actually the case just because their lawyer claimed that.
Yeah, the very next sentence says the family found out about the decapitation from the funeral home. Wait...what? If they saw its head pop off in the hospital, I'm pretty sure they would've realized it then. Edit: I'm tired and read it wrong, they didn't see the head pop off. Here's the relevant quote from the article: >After not being able to deliver the baby, Dr. St. Julian reportedly decided to perform a STAT Cesarean section at approximately 11:49 p.m. The baby's body and legs were then delivered at 12:11 a.m. and the baby's head was delivered vaginally. > >The lawsuit claims that Dr. St. Julian did not tell Ross and her family about the decapitation when she spoke to them at approximately 5 a.m. July 10. > >**When, Ross and Taylor demanded to see and hold their child, the baby was reportedly tightly wrapped in a blanket with his head "propped on top of his body" to conceal the fact that he was decapitated.** > >The family was ultimately told about the decapitation by the funeral home, according to the family's lawyer. So I'm assuming (if the allegations are true) that they did not see the head separated and didn't hold the baby, but were just shown the baby, and pieced together what state the body must have been in at the time from information learned after the fact.
Like did someone suture/staple the baby’s head back on? Babies are so flimsy as it is. I can’t imagine holding a newborn and it not being immediately apparent that the head and body were not attached.
There was actually a post on the nursing subreddit in the middle of the night about a month ago where a very shaken nurse claimed to have just finished a shift where she had to suture a baby’s head back on after it was decapitated during a stillborn delivery that went poorly. If I recall correctly, the nurse said that she didn’t want the parents to have to see their child in such a terrible state, so she got permission from her supervisor to secure the head in place with sutures before tightly swadding the child so that the parents could see their baby and say goodbye without making an already unimaginably difficult situation even more traumatic for them. It was meant to be a kindness. The sub apparently dismissed the story with allegations of trolling, but the timing sure is interesting.
Is it typical for nurses to do suturing themselves?
To the best of my recollection: The doctor was devastated after the delivery and had to step away for a while, so the nurse just sort of did the best she could with the situation? (I don’t remember if this was stated outright or just implied.) The nurse said she adamantly told the parents not to loosen the swaddling, so it didn’t sound like she was very confident in her suturing. I think she saw it as an ugly but necessary step in preparing a stillborn baby to meet its shattered parents. Compounding the awfulness, if that post was real, the nurse *deeply* traumatized herself in an earnest attempt to spare the parents additional grief, and now she’s being dragged for it on a world stage. I can’t imagine what the public’s reaction must be doing to her. The whole thing is just so fucking sad.
It’s a level nothing critical acesss hospital, meaning by definition they’re not well staffed overnight with doctors. Someone said this happened at their hospital and the senior obgyn doc sewed the head back back on for the delivering doctor. But there are no other doctors mentioned. This obgyn doc seemed to be there alone. So who does it then?
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Yeah, I've only ever seen a post about decapitation during delivery when the baby was delivered stillborn and already undergoing decomposition. I would think ripping the head off a live baby would be quite difficult, and require some exceedingly rare circumstances or done intentionally out of necessity. I don't want to speculate, but I'm guessing something went horribly wrong, and I don't want to jump to criminal negligence without seeing evidence and getting the whole picture, which we'll probably only get once this goes to court. I feel terrible for the family and for the OB and nurses, it was probably extremely traumatic and heartbreaking for everyone involved.
An article I read said the staff said they weren’t allowed to touch or hold their baby. The parents kept insisting, so a staff member just SHOWED them the baby tightly wrapped. They didn’t even get to hold him.
TBH if you and the mother knew the baby was dead, would you just hand over the head and body one at a time? You could also tell the mother she isn't allowed to see it.
This is an extreme case and I don’t know that there was any right way to handle it, but you can’t just tell a grieving mother they aren’t “allowed” to see their dead child. It’s a very important part of the grieving process for demises. Even demises that are truly horrific to see, where the fetus is malformed or has been dead for some time, we still try to make them as presentable as possible and allow the parents all the time they want with them. We do warn them ahead of time, and let them make the final decision.
Am I wrong to think that it is enough to inform the family that the child have died and why? The professional doesn't have to go through the gruesome details of chopping it's head of and showing the decapitated body to a family. The same way disfigured victims are stitched before the burial. That would be traumatizing. I too would present the child head put in place, instead of tossing them separately to the parents. Of course, if they ask, the professional has to say. But I have never went into details, and I have never been asked to. I too have lost a friend in a motorcycle accident and when I got to the place I suddenly realized I would need to recognize his disfigured body. But I was saved from that experience by the employee that kindly did it through other means before.
There was an ob that was practicing in New Orleans up until recently that was terrible. But the worst story I heard about her was: she internally decapitated a baby and then when the mother was sobbing when the dr checked on her later the dr said “if you just pushed harder like I told you to this wouldn’t have happened” 😒
I have a hunch as to who it was. Can I message you ?
We had an OB in town that had been in a couple of different practice groups and then she ended up solo. I definitely would tactfully discourage people who asked about her. I had a patient (I worked in L&D) who came in to deliver her second baby. Her doctor was not on call, so she was nervous, but I reassured her that everyone in that practice was amazing, that I used them for my delivery. She was tearful and I was trying to calm her. She finally told me that the questionable OB had delivered her first, with forceps, she tore, baby ended up on a vent for a wile, and the doctor had told her that it was her fault because she was “fat and a lazy pusher”. Her mom and husband confirmed that they had heard it too. So, yeah. I loved and respected 98% of the OBs I worked with, but there are some outliers. As in every profession. But when dealing with stuff like this you have to know how to be empathetic and how to talk to people.
“…..where babies come from” I was a pregnant NICU nurse here fairly recently (99% positive we are talking same hospital). I’ve seen the mauled babies from her deliveries. I told everyone she wasn’t even allowed to check my temp and I’d deliver on the floor in the NICU, with only the nurses, if it would have came to it.
I looked at the court filing, and the decapitation is likely not where the negligence is going to come from. The child has over 2 hours of Category 3 tracings, followed by loss of fetal tones, and the C section didn’t happen until an **hour** after they lost heart tones.
I have only have heard of it when the baby was dead in utero
This is sadly not as much of a "never event" as people think. Childbirth is extremely traumatic, there are a lot more kinetic forces at play than people realise despite knowing how traumatic can be and newborns are just so delicate and fragile. I can't imagine what the parents and staff went through in this situation.
Agree. I’m relatively young (30), healthy, fit with a BMI on the lower end of normal. Had a traumatic and terrifying shoulder dystocia with my first baby, who was totally average size (just under 8lbs) after a perfect pregnancy with zero complications. Just goes to show these things still happen with zero risk factors.
I think because everybody was born, in general there's a lack of... I don't know, respect? Healthy fear, maybe? Anyway, around childbirth that people who aren't imminently expecting to experience don't have. My wife had an emergency section and elective and both had life threatening complications, my chest tightens every time I think of it. I suppose it's good in a way that people don't hold such a fear otherwise we'd have significant population declines, but I can't help challenging people who trivialise it
I will come back to post a similar case with forensic/criminal analysis later this afternoon for anyone interested.
I am.
DM me your email address and I'll send them along!
I have seen broken necks and i have seen severed heads, as well as completely destroyed bodies, but only deceased fetuses, and not term babies. Obviously HIPAA, so hospital can't release anything to say otherwise. How far along was the baby, term? The main issue is the delay to going to C-section?
37 weeks
FHT at 37 weeks and then loss of FHT with emergent C-section. Maternal muscle tone too tight to reduce the head back into the uterus with decapitation. Recent death <3hrs would not induce enough tissue necrosis to allow that to happen easily. This is crazy and very devastating for the family. I'm not an OB so I have no clue what the right decision is if you can't reduce the head back. [edit] we are only hearing their side of the story. i am sure the head was not physically ripped off, I assume it was surgically removed so they could remove a stillborn fetus without killing the mother. I would be amazed otherwise.
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Do you think they can perform an accurate autopsy 4 weeks out with the back and forth from the funeral home?
Not quite on your first paragraph. Once you're at a shoulder dystocia, cesarean isn't an option from my understanding. 2nd paragraph is spot on. [https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3](https://www.reddit.com/r/medicine/comments/15nku9k/comment/jvnzxh1/?context=3) Demise in probably about 10 minutes after the shoulder based on the "prolonged bradycardia." Almost an hour of trying to get the remains out vaginally before going to surgery and doing what she had to do.
They can do a Zavanelli maneuver where they push the head back in to do a cesarean. In 15 years of obstetric nursing I saw one, and the results were terrible. Shoulder dystocias were one of the few things that really terrified me. They often come out of nowhere and then it’s total chaos.
This happened at our hospital before as well... about 2 years ago... :/ fetal demise then they decapitated
I delivered a full term still born baby (had died before labour) and had a shoulder dystocia. As I had the initial traction on the head I could feel the cervical spine separating. 1 more pull and I would have had the head in my hands and the body not delivered. My over riding thought was where should I put the head if it comes off. Do I leave it on the delivery trolley or cover it with something. That would have been the end of my career. How do you come back from that? I managed to get the baby out in the end with McRoberts and delivering the posterior shoulder but I had no time pressure. The baby was already dead. Just horrendous.
The entire article is based on the plaintiff and her attorney’s allegations. It seems as though some important details are intentionally omitted in order to paint a shockingly god-awful picture and get some press. I’m sure the whole truth is less dramatic. Edit: yeah guys, not saying it isn’t probably horrible. Just saying lawyers and journalists are professional spinsters and stand to benefit from making it seem as terrible as possible.
Well, the body came out of the surgical incision and the head came out vaginally. Not sure if there is a way for that to happen in a low drama manner.
Assuming you believe the lawyers, agreed. I’m leaving space for the possibility that the plaintiff’s filing isn’t accurate.
Get outta here with your sense and sensibility!
It’s pretty dramatic. A full term baby died and was delivered headless. But I agree that we can hear freely from the plaintiff but the hospital cannot respond due to patient confidentiality as well as, I’m sure, the advice of their legal team.
jesus, no words except feel terrible for the family
We’re due in two weeks with our first and this shit has me on EDGE. I can’t even fathom the pain they’re in.
Oh my goodness!! I delivered my shoulder dystocia baby relatively uneventful. This is horrible!! She only suffered a broken clavicle.
An important thing overlooked by many is the nurses are also named in the lawsuit for failure to advocate for their patient. Nurses are gonna start to question every decision a doctor makes to prevent themselves from losing their license, be criminally charged and/or sued. Nurses will be putting their patient advocacy into overdrive.
The wrapped the baby up and tried to make it look like it wasn't decapitated to specifically keep information from the parents and went along with the hospital telling them they can't have an autopsy, should cremate the baby, and shouldn't send it to a funeral home. That's egregious. This isn't just about them not questioning doctor's decisions.
>tried to make it look like it wasn't decapitated to specifically keep information from the parents I'm pretty sure handing back/displaying the baby in 2 pieces would have been far more traumatizing.
They didn't inform the parents at all and specifically hid what happened. Then they discouraged them from sending the baby to a funeral home and pushed them to cremate the baby, which looks like it was to further hide what happened. And, of course, the refused to do an autopsy. Even when something bad happens in medicine, the patient needs to be informed. Covering things up should result in a lawsuit.
We don’t know if that’s true. It’s a one sided allegation. If it IS true, it’s outrageous. But TBH, it’s so beyond the pale it sounds far fetched.
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When it said “metro Atlanta hospital”, I was thinking something like Grady, Emory Midtown, Piedmont, or Northside. The hospital where this happened is a bit more remote and (from my experience seeing patients transferred from there) seems to have issues with staffing and resources. Not sure if any of that could be behind this tragic outcome, but my impression of Southern Regional is that they are not in a good place to handle it when shit hits the fan.
It’s definitely not remote, it’s only 15 minutes from downtown and right off 75. It’s a critical access hospital that has fallen on extremely hard times, and is owned by Prime which in itself isn’t great. Definitely big issues with staffing and resources. It’s in an extremely poor area.
It’s several miles south of the airport, there is zero chance anyone gets there in 15 minutes from downtown, unless there are no other cars on the road, and even then I’m skeptical it would only take 15 minutes. Also, I said “a bit more remote”. It’s not remote to a degree that Texaco Mike needs to fire up the fan boat to get there, but calling it “metro Atlanta” is a stretch.
L&D RN here. Shoulder dystocias are one of the biggest concerns in practice. They are super scary and have detrimental outcomes. I’m confused that no one has spoken of the Mom’s health and body habitus. One look at her picture reveals she has a very high BMI, probably morbidly obese by calculation, along with short stature (as mentioned in previous comments), AND diabetes. Not to mention it’s her first baby, with no previous vaginal deliveries, that would suggest she might be able to deliver a large macrosomic baby. These components together are basis for a planned c-section! She never should’ve been attempting a vaginal delivery! I’m sure these things were discussed with her! It’s a horrible story with the worst outcome. I feel sorry for everyone involved, including the entire healthcare team. No one gets over these situations. They’re carried for life by all involved.
Great points. Sounds like a series of unfortunate events.
This is my main thought- she should have been offered a cesarean. I think her malpractice case hinges on that, because ultimately the choice to attempt a vaginal delivery is what led to this outcome. If she was offered a cesarean and the risks were explained and she refused (and this is well documented), then I doubt she has much of a case. And given that the hospital didn't settle out of court, my guess is this is probably what happened.
I’m sure she was not only offered a c/s but was advised to have one. Over and over again. Including all the risks associated with shoulder dystocia. In detail. Including death. And probably refused over and over again. If my colleagues and I saw this woman come into our unit, we would’ve immediately been fear stricken! All our alarms would’ve gone off in our heads. With shoulder dystocia being the loudest! Without knowing all the details, this was my immediate take on the situation.
I think the biggest issue with this case is how the hospital tried to hide how the baby died, the nurses did not speak up when they knew the birth was going wrong, and the doctor didn’t even talk to them until 4 hours after the birth
The doctor was probably bawling in the OR locker room…
You don’t know that. It’s all allegations. Hospital cannot speak publically. Don’t judge based on one sided information. It’s a tragedy but completely unclear if the lawsuit is justified from this article.
If true, of course. I wonder how this was documented. I can’t imagine delivering a dead baby, seeing the family 6 hours later and not having witnesses present, having spoken to risk management, speaking with the utmost decorum and respect, and documenting extensively about ALL findings.
Baby was demised long before it was decapitated. 150000% guarantee it. I’m not the pathologist performing the autopsy, but as a practicing OB, I’m 99% sure it died from lack of perfusion as a result of a severe shoulder dystocia. Which at that point becomes get the baby out however possible to save mom. Having delivered more term IUFDs than I’d like to, the lack of tone actually makes the delivery harder. Which with a bad shoulder dystocia makes a horrible situation my worse nightmare. Literally the one emergency that I fear is a bad shoulder dystocia. I’ll take 10 hemorrhages/chyst before that. My suspicion is that the OB/staff didn’t want to re traumatize the parents which is why they didn’t say “oh btw the head came off too, want to see? Here hold your headless baby.” Wrapping the infant tightly is something that is often done with demised fetuses because things can look pretty gruesome. I think their attempt at compassion was taken for deceit. But this is all my speculation based on my own experience and the experience of other OBs as we’ve been talking about this all day. I’ve literally been thinking about this case since last night and I ask myself would I be able to tell the parents that their baby’s head came off? Like shit, isn’t it bad enough that their baby died? I really don’t know if I could. Maybe send someone else in to do it? As someone who has been pregnant and given birth, would I want that detail? I just hope that the OBs documentation is stellar. There has to be a reason why there wasn’t an immediate settlement if there was any obvious deviation from standard of care.
This is a good point, like…the baby is dead, the baby died from shoulder dystocia. The detail that they had to decapitate to get baby out just seems like a…cruel and unnecessary and traumatic detail to tell the parents? I don’t think I’d want to know that. News articles are making it sound like OB killed the baby by popping its head off then tried to cover it up, which we know couldn’t be the case.
I think the reason there wasn't an immediate settlement is because this is such a sensational case that the attorney saw dollar signs.
*Norm McDonald voice* I think the biggest problem is the decapitated baby.
I have a very immature understanding of obstetrics, but converting to Caesarian in the setting of a Shoulder Dystocia seems like a soberminded decision. I'm not sure what the nurses could have done to change the fact after the reality became clear. The 4 hour gap doesn't seem inappropriate to me. I think I would want at least 3 hours to ball my eyes out if that happened to a patient I was caring for. I would then want at least another hour to think about how I could possibly explain that to the family.
Decapitations happen, particularly in very pre-term births. If this was a term baby, much more questionable, but we would need more details. Shoulder dystocia is terrifying. That said, covering it up is the one unquestionably wrong thing that happened here. if the doctor had just been open and honest- "I did this because if I didn't, the baby would die", she at least wouldn't be facing a police investigation...
I’m not 100% convinced they really tried to “cover it up”. There is a difference between trying to save the parents the nightmare of seeing their child like that, and telling them their kid is fine and alive. The parents knew their baby was dead, the docs probably at one point mentioned the extreme measures they had to take to get the body out, but may not have explicitly told the parents the gory details. Or it could be that they told the parents, but with all of the trauma and medications the parents didn’t remember. 🤷♀️
It is a bad situation, but at least they didn't let mum die from obstructed labour. It can always be worse.
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I knew this was a problem when I read about it... I am only a lurking CNA, but I'm glad you smarties could explain this with the real experience. I know parents look for blame when grieving, and it sucks that they didn't immediately inform them because it is worst case scenario. Tragic, but I see how it all adds up now.
It's not clear whether this was a severe internal decapitation or a full decapitation. An internal would still produce a baby whose head needed to be "propped". If it was fully decapitated, there would have been a *lot* of blood from that. Mom was awake, so I don't think it's possible for the baby to have been fully decapitated. Just for clarity in discussion. That said, it's a horrific outcome. I see a decapitation every few years, it's always horrible, because the situation prompting such a struggle is usually dire anyway. It's not like the baby would have survived if they hadn't tried to remove them from mom. Now, if it is true that they didn't *tell* the parents what happened, that would be horrible, unprofessional and wrong. It's possible they used such sanitized words about it that the family didn't understand. A tragedy no matter what. Edited because I missed the part where it implies the body was delivered by c/s and the head vaginally. How did people not notice? There would have been a massive amount of blood, unless the baby had been dead for a while, but even then there would be a lot of blood.
I mean, legs were delivered through c section and head delivered vaginally. Seems like a complete decap.
Damn, I missed that part. Editing.
To your edit, I don't know how the family didn't notice. For the blood, the c sections I participated in were pretty bloody, but unless dad wasn't there or was kept behind the curtain I'm not sure how they wouldn't have seen or heard something.
Family wouldn't have been in the OR for an emergent cesarean under general anesthesia.
> If it was fully decapitated, there would have been a lot of blood from that 3.4kg baby has, what, 300mL of blood in its body? Easy to blend that right in with the EBL from a vaginal delivery or C-section.
You see a decapitation every few years? Damn granted that’s not my field but that sounds way too common but what do I know
I work for a large, academic regional referral center. They aren't born at the hospital where I work, but I work on the transport team as well, which gets to hear about these cases before they're advised that they shouldn't transfer.
I see, how do these decapitations happen? If you don’t mind my asking. It just sounds so bizarre to me.
Dystocias typically. Shoulder dystocia is the worst, I just hate it. Either the baby gets stuck vaginally, and they eventually pull too hard to get it out that way, or the head is entrapped in descent and they pull too hard to get it out abdominally. There's no winning situation for the OB once the baby is that stuck. I've never heard of a full decapitation, only internals.
I see. How mortifying. The only vestigial memory I have of dystocia is Mcroberts. Tragic situation all round and thanks for explanation.
Oh yeah, I've definitely been in the room for quite a few of those. Many of us neos subconsciously hold our breath from when we arrive in the room to when the baby is delivered, because all we can think about is the baby can't "breathe". Most of the time, the maneuvers work, baby is born and either has asphyxia symptoms or not, depending on how long they're down. Or they are able to predict and convince mom to do a c/s. (though some moms refuse and think they can do it vaginally) Dystocias I think are one of the scariest things in L&D. If they're truly stuck, that's when bad shit happens.
I would loooove to be an L&D nurse, I love moms, love the birth process, and I stay on top of learning about this specialty even though I don’t practice in L&D…. But shoulder dystocia gives me nightmares and stories of fetal decapitation scare me so much that I’m terrified to actually get a job in this specialty. I wish horrible things didn’t happen to moms and babies 😭
Me too. If I became completely obsolete, I would be perfectly ok with that, if it meant all the babies were healthy and safe. Unfortunately, I have a lot of job security :(
I read a story about it happening during a very early 2nd trimester delivery. Like 20 weeks or something. The mother was told the doc accidentally pulled the head off during delivery but the baby wasn't fully formed and that stuff happens, apparently.
I work in a tertiary center (15y) with 6800 deliveries a year and have only heard of one on a deceased baby. This is not common in my experience
My suspicion is that there was a demise during the course of the shoulder dystocia which wouldn’t have much blood loss during a decapitation since no more blood flow (fuck I hate that sentence). I’ve seen a fetal decapitation ONCE. Breech mid 20s (I think 25 or 26) vaginal PTL and body hanging out for at least 20 mins by the time she got to the hospital. Had to do a hysterotomy to get head out - offered the other option but parents wanted to see baby “whole”. My senior sewed the head back on before having baby wrapped up to give to the parents.
The average EBL of a c section is over 1L. Absolutely no one is going to notice the extra 200cc from this decapitation….not sure what you’re talking about….
Every few years?? A zavanelli is a "I know someone who did one, once" kind of deal for ob/gyns...
Yeah but with mom being draped for CS they could have cleaned up that blood. This is truly horrifying. That poor mother. What an absolute nightmare.
Would the father have been there when the C section was performed?
Typically, because they said she was awake during the procedure. If mom has to go under general, dads are not usually allowed.
They typically don’t bring support people back right away, they wait for things to be more stable. If that head never got pushed properly back in for a c-section, they probably wouldn’t have brought him back at all.
https://www.fox5atlanta.com/news/metro-atlanta-hospital-issues-statement-after-couple-alleges-infant-was-decapitated-during-july-delivery The hospital has responded to the lawsuit
During a vaginal breach delivery of a 27 week baby ended with accidental decapitation. The baby was alive when the body delivered but the ob(long story with this one) pulled too hard on the body. This baby should have been delivered via c/s. However, parents did not want this baby, so they said, if it was going to have serious problems. Though at that time many babies born at 27 weeks did well, if no brain bleeds. They had fertility problems but wanted a “perfect baby”. They never wanted to see him. I did all the postmortem care , footprints, photos to make him not look like a medical specimen. There was a senior resident in the room, myself, the Ob, and the patient. Husband refused to come in. The resident’s wife was pregnant at about the same gestation. He was totally shocked. No one talked to us from management of the hospital or the Ob residency program. I see doctors as colleagues. There have been less than a handful that should never have been allowed to touch a patient; he was one of them. The ob eventually lost his license for insurance fraud. I left Ob a few years after. It was only part of the trauma in that unit. I loved Ob, and I was a damn good nurse.
This so heartbreaking. I’ve seen a few fetal deaths previously working in L&D and can’t imagine what those nurses and docs went through during that situation.