Opinion ID: 2687597
Heading Depth: 2
Heading Rank: 1

Heading: In failing to document the progress of descent

Text: during the second stage of Larysa Asher’s labor; B. Using a [vacuum extractor] to assist in the delivery of [the baby]; C. In failing to perform a cesarean section on Larysa Asher for the purpose of delivering [the baby]; D. In failing to recognize and diagnose [the baby’s] shoulder dystocia; E. In failing to perform proper maneuvers to deliver [the baby] after she developed shoulder dystocia; F. By applying excessive lateral and/or rotational traction to [the baby’s] head in an effort to deliver her. Instruction No. 12 further informed the jury it could award damages only if it found Onuigbo’s negligence was a proximate cause of the damage. Onuigbo objected to the instruction, arguing Asher failed to present substantial evidence of a causal link between any failure to document and the alleged harm or the use of the vacuum extractor and the alleged harm. The district court also instructed the parties on causation. Instruction No. 13 instructed the jury as follows: The conduct of a party is a proximate cause of damage when it is a substantial factor in producing damages and when the damage would not have happened except for the conduct. “Substantial” means the party’s conduct has such an effect in producing damage as to lead a reasonable person to regard it as a cause. 4 Onuigbo objected to Instruction No. 13 on the ground that while it would have been proper in the past, Thompson substantially altered the law of causation and the instruction did not reflect the current state of the law. The jury found in favor of Asher and awarded substantial damages. After the district court denied Onuigbo’s posttrial motions, he appealed. On appeal, Onuigbo claims Instruction No. 13 inaccurately reflected the current state of the law in light of Thompson and, as a result, the judgment must be vacated and the case remanded for a new trial. Onuigbo also claims there was insufficient evidence to support a finding of negligence based upon the failure to document the progress of the fetus’s descent through the birth canal during the second stage of labor or the use of the vacuum extractor to assist in the delivery. Onuigbo argues that because the jury returned a general verdict and it is not possible to determine whether the verdict was based upon a valid theory of negligence, the verdict cannot stand. B. Overview of Trial Record. Because we are reviewing whether substantial evidence supported submission of certain instructions to the jury, we view the evidence in the light most favorable to the party advocating submission of the instructions. See Hoekstra v. Farm Bureau Mut. Ins. Co., 382 N.W.2d 100, 107–08 (Iowa 1986). Viewing the facts in the light most favorable to Asher, a reasonable jury could have found the facts as follows. Larysa began experiencing contractions on the morning of November 7, 2006. Her husband drove her to Covenant, where they arrived at approximately 7:05 a.m. At 10:00 p.m., Larysa’s medical chart indicates she was completely dilated, meaning the first stage of her labor was complete. Though there had been some documentation of the fetus’s station, or position, in the birth canal prior to this time, as recently as 5 8:00 p.m., there was no documentation of the fetus’s station at 10:00 p.m. From this point until the birth of the baby at 2:26 a.m., there was no further documentation of the fetus’s station, although either Onuigbo or another member of the medical team performed vaginal exams at 11:54 p.m. and 1:47 a.m. Larysa experienced a protraction disorder during the first and second stages of labor. A protraction disorder occurs when the fetus’s descent through the birth canal proceeds at an unusually slow rate. The severe protraction of the second stage of labor indicated the fetus was having trouble moving past the pelvic bone. During the second stage of labor, Onuigbo breached the standard of care by not performing enough vaginal examinations and by not documenting the progress of the labor and the station of the fetus in the birth canal. The protracted labor and lack of adequate progress posed a risk of harm to the baby. Onuigbo did not discuss the risk of harm with his patient. Onuigbo then used a vacuum extractor to help draw the baby into position for delivery. The baby’s shoulder became lodged against Larysa’s pubic bone, a condition known as shoulder dystocia. Instead of performing maneuvers to free the lodged shoulder, Onuigbo applied lateral traction, causing injury to the baby’s brachial plexus nerves.