Nature of the Case
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Facts
In 1996, Taft was pregnant with P, her second child. P began her prenatal care at the Lynn Community Health Center and provided a medical history, including the fact that her first child, due to her large size of 9 pounds and 3 ounces, suffered an injury during vaginal birth that resulted in Erb's Palsy. Taft first met with Dr. Laz, a Board-certified obstetrician, and gynecologist, at the Lynn CHC. Taft informed Laz that her first child suffers from Erb's Palsy. At the time, Laz's general practice with patients who had had a prior large baby was to determine the estimated fetal weight by ultrasound at about 37 weeks' gestation. If the estimated weight was 4500 grams or more, Laz would offer the patient an elective Cesarean section. If the estimated weight was under this threshold, Laz would recommend inducing labor at 37 or 38 weeks' gestation. As for probability of something wrong happening the following were the risk factors, it is well known that second children are usually larger than first, that the fetus was male, and males are generally larger, and Taft was an obese woman at the time of her pregnancy. Taft experienced excessive weight gain during the pregnancy; and her prior delivery resulted in an Erb's Palsy injury. Laz recognized these risk factors, he considered them to be normal birth risks and therefore did not discuss them. Laz obtained the delivery record for the first child, and it was marked 'without any complications.' Laz now believed that the Erb's Palsy developed spontaneously, rather than as a result of a shoulder dystocia. The weight at 37 weeks was well under 4500 grams, and Laz determined a vaginal delivery was proper. Laz recommended that labor be induced, but he did not discuss with her either the risks of vaginal birth or the possibility of a C-section. At birth, P weighed 4508 grams (9 pounds and 15 ounces) and had a weakness of the right arm and hand, which was subsequently diagnosed as Erb's Palsy. The delivery was difficult, and P was injured in delivery. P sued D claiming Laz failed to meet the standard of care by not originally offering an elective C-section and by not performing a C-section during labor based on fetal heart monitoring; and (2) Laz failed to obtain informed consent by not discussing the risks of vaginal birth and disclosing the alternative of a C-section. The court found for D in that balancing the risks of vaginal birth for the baby were 'something more than negligible,' when these risks were balanced against the risks to the mother from a C-section, 'a cesarean section to avoid brachial plexus injury was not a reasonable medical judgment.' P appealed.
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