Emergency C/S with local anesthetic only

  1. Well, I think I've come up with a topic not seen here before. We recently had a woman come in via ambulance with a cord prolapse & the paramedics tried hard to do their best by keeping a hand in the vagina lifting the head off the cord, starting an IV & giving her oxygen as they raced to the hospital. They radioed in a precipitous delivery, but apparently not a prolapsed cord. She was immediately rushed from the ED to L&D when the situation was noted. The only OBs & the only anesthesiologist on L&D were in the midst of another C/S & could not leave immediately. A call went out to the OR, but all their anesthesiologists were also busy. Then one OB scrubbed out, assessed the situation (debate about whether there were FHTs or not) & tried to save the baby with an emergency C/S done under local anesthesia with the mother's consent. Fortunately, this OB had seen this done & done one before in the past. It was that or wait until an anesthesiologist became available. Those in the room had a difficult time with this equally difficult choice. The baby was resuscitated but expired a few days later. Has anyone out there seen an C/S done this way when anesthesiology was not available & it is a true emergency? If not, how do you always have the anesthesiology coverage you need 24/7? I feel badly for this OB who chose a difficult option to try & save a baby's life & is getting flack over that choice. Any experiences, thought or comments appreciated.
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  2. 22 Comments

  3. by   babynurselsa
    I have seen it done twice in my career. It was chilling to the mother and everyone involved at the time. We did have better outcomes for the babies that it appears but these were in house crashes with known down tome for the infant. If I remember correctly they did use versed.
    Maybe a pipe in from soem of our CRNA friends, how about etomidate in a situation like this???? would it be better than versed?
  4. by   TrudyRN
    Monday morning quarterbacking.

    Unfortunately, if policy is not to do what this doc did, he is probably in big trouble now, especially since the baby didn't make it.

    I wonder if the hospital or anesthesia department will be sued for being unprepared, the EMT's for not communicating the exact nature of the emergency, and so on.
  5. by   imenid37
    Never seen it done. We just ran a drill for this as we do not have 24 hr. in house coverage for anesthesia or OB. I hope I never see it. I think no one would undertake this lightly. I commend the doc for being brave enough to try this. I feel terrible for him/her and of course, the mom.
  6. by   kathiecnm
    There is no policy against doing an emergency C/S with local anesthesia, just the gut reaction by those involved & those hearing the story to the physical & emotional pain the mother experienced. What mother wouldn't risk that pain to try & save her baby however?
  7. by   mitchsmom
    Unfortunately, this has happened twice very recently on my unit. I was there both times. The babies still didn't make it. Even though it was the only option at the time, it is extremely upsetting for everyone, to say the very least.

    It's one of the reasons I was asking in another thread about in-house coverage.
    Last edit by mitchsmom on Nov 14, '06
  8. by   LizzyL&DRN
    I almost saw this done one time. The doc that almost did it tends to freak out a little quick. It was the pts 2nd baby, prev vaginal delivery and she was scheduled for c-section later in the week due to breech presentation for the entire pregnancy. The mom came in after laboring at home for several hours(don't know why she waited) at 8cm. Doc called a stat section. We got everything ready except anesthesia took an unusally long time to show up. She started talking about doing it under local, Thank God anesthesia showed up when he did.

    For the nurses that have seen this....How much pain relief does mom get? I would imagine it would be torture for her especially when the baby is actually being delivered. What is the circulating nurses role during a hell procedure like this?
  9. by   mitchsmom
    -After experiencing this, I find it unimaginable to think that we really haven't had the availablity of anesthesia for that long relative to our history as humans. This used to be a regular event. Thank goodness that we have anesthesia that is available and adequate for the vast majority in this age.
    Last edit by mitchsmom on Jul 12, '07
  10. by   sirI
    Have been involved with this type of C-section a few times many years ago. Fast and effective at the time with favorable outcomes for the majority. Was some of THE most interesting OB cases I've ever had the pleasure on which to work.
  11. by   jemommyRN
    I am still in nursing school and I have a question. Why is this procedure so risky for the babies? What is the difference (to the baby) whether or not the mom has the proper anesthesia? Does local anesthesia slow the heart rate, whereas general or epidural won't? just curious.
  12. by   mitchsmom
    Quote from jemommy
    I am still in nursing school and I have a question. Why is this procedure so risky for the babies? What is the difference (to the baby) whether or not the mom has the proper anesthesia? Does local anesthesia slow the heart rate, whereas general or epidural won't? just curious.
    I'm not sure that the procedure is more risky for baby in itself; it's just that the baby is most likely already compromised in the first place if you are doing a truly emergent c-section. We wouldn't be doing it if we thought the baby was doing ok or even stable enough to wait a few minutes for OR staff. Is that what you were asking?
  13. by   tinyscrafts
    Sometimes anesthesia fails too. Here are the stories of two women- not easy reading...Emotional Recovery From a Cesarean
  14. by   33-weeker
    Quote from LizzyL&DRN
    I almost saw this done one time. The doc that almost did it tends to freak out a little quick. It was the pts 2nd baby, prev vaginal delivery and she was scheduled for c-section later in the week due to breech presentation for the entire pregnancy. The mom came in after laboring at home for several hours(don't know why she waited) at 8cm. Doc called a stat section. We got everything ready except anesthesia took an unusally long time to show up. She started talking about doing it under local, Thank God anesthesia showed up when he did.
    I can't imagine even THINKING about doing this for a simple breech - esp. for a mom with a previous successful vag. delivery. Up until the not too distant past, 80% of breeches were delivered vaginally - most successfully.

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