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Butter Torts: A Truly Canadian Legal Podcast

Jun 11, 2021

Brenda Agnew and Charles Gluckstein, your hosts are welcoming Richard Halpern to today’s episode. This episode is dedicated to having a discussion about the critique Richard Halpern recently did about the 2020 Clinical Practice Guidelines number 396 by the Society of Obstetrician and Gynecologists of Canada and the impact it has on legal cases.


The SOGC is one of Canada’s oldest national specialty organizations. Established in 1944, the Society’s mission is to promote excellence in the practice of obstetrics and gynecology and to advance the health of women through leadership, advocacy, collaboration, and education.


The SOGC has over 4,000 members, comprised of obstetricians, gynecologists, family physicians, nurses, midwives, and allied health professionals working in the field of sexual reproductive health.


Key Takeaways:

[2:08] Gluckstein has always shown interest and represented victims of birth injury cases.

[3:55] Why the SOGC group set guidelines and why they are relative to legal cases.

[5:38] Is the SOGC 396 guideline updating a previous one?

[6:55] Why is the SOGC doing this review?

[8:30] How should this guideline be used by lawyers?

[10:41] Richard explains the process it took for him to write the critique.

[12:13] Richard talks about the difference between the American and Canadian Guidelines.

[13:47] What is fetal health surveillance?

[16:54] Richard talks about the limited amount of data about the fetal heart rate that can be registered.

[20:50] This guideline perpetuates the misunderstanding about the data that doctors are relying on.

[22:18] Richard provides an example.

[25:27] Every guideline says that with augmentation or reduction of oxytocin you must have continuous EFM, but why is it this way? What is the logic behind it?

[26:14] EFM markers determine the baby’s stress and then something needs to be done about it.

[26:55] How does the guideline update the uterine activity?

[30:05] The guideline captures too many things under one definition in regards to uterine contractions.

[32:54] What is the motivation to be so imprecise in this guideline?

[33:35] What does the guideline say to do in the event that it is tachysystole?

[36:53] How do you resuscitate if there is no oxytocin in the picture?

[38:27] Does this guideline update the issues of dealing with tachysystole and resuscitation?

[38:47] Richard explains some of the fetal heart rate baseline terminology.

[42:07] Richard talks about the subtle change between the old and the new guideline.

[44:50] Richard shares his two major critiques on the guideline.

[48:33] Richard gives an example of how a lawyer’s case could be affected by the guideline’s way of understanding causation.

[51:46] The SOGC guideline on causation is incorrect.

[52:49] The impact of this guideline on babies and mothers.


Mentioned in this episode:

To learn more about the work we do at Gluckstein Lawyers, please visit Gluckstein Lawyers.

Learn more about Richard Halpern


Learn more about The Society of Obstetrician and Gynecologists of Canada

No. 396-Fetal Health Surveillance: Intrapartum Consensus Guideline


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