When an Informed Consent for Induction of Labor Becomes a Story Told Backwards
Induction is common. Litigation often begins when there is a problem and when no one explains the pathway before it starts.
A healthy 29-year-old woman at 40 weeks is admitted for induction because the pregnancy is “going long.” Her cervix is closed. She receives misoprostol. Then a second dose. Then a third. Overnight her contractions become nearly continuous. She gets an epidural. There are many contractions. The fetal heart tracing deteriorates. Staff rush into the room. An emergency cesarean is performed. The baby is born with a low Apgar score and requires resuscitation. At two years of age the child is not developing normally. The mother eventually sits in a lawyer’s office. The lawyer does not begin with accusations.
He begins with a reconstruction. What happened?
What exactly were you told before the first dose?
Where Cases Actually Begin
Many obstetric cases do not begin in the operating room. They begin in the admission conversation. Induction of labor is often described to patients as a single intervention. Medically it is a sequence. Cervical ripening leads to contractions. Contractions require continuous monitoring. Monitoring produces decision thresholds. Crossing those thresholds leads to operative delivery.
Clinicians recognize this pathway intuitively. Patients usually do not. When the downstream events occur, they appear sudden and unexpected, even though they are foreseeable within the physiology of induction.
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