My co-collaborator Annie Tseng and I were tasked with creating medical legal visualizations intended for a Canadian courtroom, based on a settled case: Dow v. Miller. We were given the case file to determine the critical physiological sequence of events, and to demonstrate the plaintiff’s argument that Dr. Dow breached the standard of obstetric care. The case involved complications during the birth of Jordan Miller, son of the plaintiff Susan Miller. Upon delivery, Jordan Miller was found not breathing and required urgent resuscitation. Oxygen deprivation ultimately resulted in hypoxic ischemic encephalopathy, and ultimately, cerebral palsy. The plaintiff’s argument was that certain complications during labour should have prompted the obstetrician, Dr. Dow, to initiate internal fetal monitoring, and that doing so would have allowed proper monitoring of fetal oxygen supply.

This case presented a complex problem of how to show the importance of decisions not taken by a physician, and the result of that inaction. This led us to design the visualization with parallels in mind: on one track, the flow of complications resulting in Jordan’s cerebral palsy. On the other, the opportunity along that timeline for the use of fetal monitoring tools. We structured this parallel visualization along a timeline of labour, with a window into the crucial timepoint for fetal monitoring and a sample graph for what the readout might have shown.

The argument for using these tools is to get a better picture of what is happening within the uterus, and the relationship between uterine contractions and fetal oxygen supply. Therefore we used a second panel to make these intrauterine relationships clear. Making visible these processes, which are of course not visible to the obstetrician, further underlines that further monitoring is needed when it is unclear what the fetal oxygen supply is and when there are any indications of fetal distress.

3D ultrasounds, obstetrics textbooks and scholarly journals were used to create accurate visualizations of fetal-maternal blood-oxygen flow within the context of uterine contractions.