They did a c-section without anesthesia - page 3

The pt had an epidural, but it didn't do the trick. We don't have in-house anesthesia, and it took 20 minutes to get to the hospital. meanwhile there were heart tones in the toilet and the baby... Read More

  1. by   imenid37
    Quote from nuberianne
    If anyone has to cut me wide open while I am fully awake because there is no doctor or CRNA available, I will sue the pants off of everyone I saw from the minute I walked in the hospital up until the minute I left. Maybe my comments sound ignorant, but I am only in my first semester of my adn program so I have not had any OR or L&D training yet. I am just commenting from a layperson's point of view.
    I think you do not understand how things are in rural hospitals. There is not normally anesthesia onsite at all times. Heck, your ob might not even be there. The "I will sue everyone" attitude is really killing us. One day you will be the healthcare provider, God willing, and see that in the real world isn't always predictable or ideal. When you are on the recieving end of the "suing" threat, you might feel differently. I don't mean to be nasty to you. I really do think that you don't understand how things work in some places. In a larger, metropolitan hospital, there is 24/7 onsite everything. There are not enough resources to do that at every facility. I do think your comments bring forth a good point. Patients should understand that this is the case. We get folks who move to our area from a metro area and they don't realize that they ask for an epidural and they may have to wait 20-30 min. for anesthesia to come in. This can happen w/ 24/7 in house people too if they are tied up w/ another patient. I have also had patients think their ob is going to come in from home at night to dc them when they come in w/ r/o labour or r/o srom.
    The physician is called and the patient is sent home after a telephone report from the nursing staff if nothing is going on. I think in terms of negligence in a rural facility, this would be the case if you did not try to assemble the team in a timely manner or have plans on what you will do when you have only 5 min. rather than 20-30. Having to do something really drastic to save a life, is something that is in the realm of distant possibility in rural healthcare. If you want a NICU and 24/7 ob, anesthesia, and peds when you deliver then you should not come to this type of facilty. I think that patients should have this fully explained to them so they know what to expect. You may also have to drive a distance for the more advanced services if you desire them. This, also presents another set of risks if you live in a rural area. The trade-off is that for a healthy pregnancy, you will get a lot more , usually, care and personal attention in the smaller facilty.
    Last edit by imenid37 on Dec 5, '06
  2. by   GardenDove
    Quote from imenid37
    I think you do not understand how things are in rural hospitals. There is not normally anesthesia onsite at all times. Heck, your ob might not even be there. The "I will sue everyone" attitude is really killing us. One day you will be the healthcare provider, God willing, and see that in the real world isn't always predictable or ideal. When you are on the recieving end of the "suing" threat, you might feel differently. I don't mean to be nasty to you. I really do think that you don't understand how things work in some places. In a larger, metropolitan hospital, there is 24/7 onsite everything. There are not enough resources to do that at every facility..
    Amen to that. I work in a rural hospital, this is the way it is. We are what is termed a 'critical access hospital'. We don't have pharmacy or anesthesia at night. We transfer extremely critical pts.

    We give excellent care for what we offer, including OB. When people move to rural areas they need to understand that life is a trade off. Many people are retiring here from Western Washington, building their dream houses. They come without a physician and they think they are going to drive to Seattle for all their healthcare needs. But, when they call the ambulance for chest pain, they'd better realize that the closest cath lab is an hour away.

    If you sue because anesthesia is on call, you will lose. You have no grounds, this is the standard of care in rural areas.
  3. by   Mrs.S
    Well, I think I addressed most of these questions in my earlier posts, but I will try to clear things up.
    The pt had an labor epidural which was working fine, strip looked good, but she suddenly progressed very quickly from 5 to 9 cm and the heart tones went into the toilet and stayed there. The anesthesiologist who placed the epidural had indeed gone home and there was no one in-house as it was a Saturday night. Oftentimes after they have placed an epidural they will voluntarily sleep at the hospital, or be at home a few minutes away, but this particular MDA, who is newer to this hospital, took 20 minutes to get to the hospital and therefore her epidural was not bolused prior to the section. The baby was out within 15 minutes and is doing well in NICU.
    I was not in the OR that night but appparently the pt was comfortable until they opened the peritoneum, which is when she went through the roof. The OB did not attempt to use a local (which I'm not really sure would have helped?), and after the baby was out, the staff asked her repeatedly to wait for anesthesia before finishing the case but she ignored them, and so we are not sure what her rationale was for continuing when the pt's pain was clearly not controlled. This is when there were three RN's holding the pt down as the OB was closing her back up. Post-op, the 18-yr-old primip pt did fine, didn't seem traumatized or even seem to realize that what happened was not normal, from what I heard (I have not taken care of the patient).
    Thanks to those who answered my original questions re have you seen this happen and what, if any, were the consequences. I really appreciate it. Also if anyone has any insight as to what could have been done differently by the OB doc or nursing staff, I'd love to hear it.
  4. by   PMFB-RN
    [quote=jwk;1953679

    The better question is "Why should a hospital that only delivers a few babies a week or even a month be allowed to offer OB services at all?"[/quote]

    *** Youre kidding, right? In many rural areas it either the baby is delivered in a small rural hospital with a CNMW or FP doc or at home. My own children were born in a small rural hospital (12 beds) with a FP doc attending.
    There was no other option except home birth or taking the chance on the 3 hour drive to a larger hospital.
  5. by   CritterLover
    Quote from nuberianne
    i am a nursing student so i am not comprehending this at all. if someone shows up at this hospital conscious but with a massive bleed somewhere who is going to administer the anesthesia to that pt? another question, if the pt had an epidural that had not been effective who administered it? i guess i don't understand how hospitals operate without someone in house to be available for emergency surgery.

    if anyone has to cut me wide open while i am fully awake because there is no doctor or crna available, i will sue the pants off of everyone i saw from the minute i walked in the hospital up until the minute i left. maybe my comments sound ignorant, but i am only in my first semester of my adn program so i have not had any or or l&d training yet. i am just commenting from a layperson's point of view.


    many hosptials do not have 24 hr on site anesthesia, not just rural hospitals. i work in a failry small, inner-city hospital. while we do have 24 hr crna coverage (due to the ob unit), we do not have 24 hr on-site surgery coverage. on the occasions where someone has shown up needing emergent surgery in the middle of the night (like a walk-in gunshot wound), we do one of two things: fly them to the level 1 trauma center twelve miles away or call in the or. our or staff has 30 min to respond.

    it would be completely impractical for all hospitals to have a surgeon/anesthesia provider in-house 24/7. ambulances know not to bring emergent trauma patients to us. it is part of their job to know where to take a patient.
  6. by   GardenDove
    Speaking of pain, unmedicated natural childbirth is extremely painful, take it from me I had 6 unmedicated home deliveries, and the pain lasts more than 15 minutes. Call me an old hippy, but people nowadays expect a pain free existance. My friends in OB say that no one goes Lamaze anymore, everyone gets an epidural, no wonder the C-section rate is going through the roof. I'm not saying that C-sections should goes without pain relief, but an emergency is an emergency and I'm sure that she was glad to get a healthy baby. Life is messy and we're lucky we don't live in the third world.
  7. by   cozmo_blozmo
    First off we are getting the information 2nd hand which bothers me. secondly, alot of these patient's her age are very immature and complain of pain even under a good spinal. If they baby was out why didn't she get IV narcotics for pain control when they were stitching her up?






    Quote from Mrs.S
    Well, I think I addressed most of these questions in my earlier posts, but I will try to clear things up.
    The pt had an labor epidural which was working fine, strip looked good, but she suddenly progressed very quickly from 5 to 9 cm and the heart tones went into the toilet and stayed there. The anesthesiologist who placed the epidural had indeed gone home and there was no one in-house as it was a Saturday night. Oftentimes after they have placed an epidural they will voluntarily sleep at the hospital, or be at home a few minutes away, but this particular MDA, who is newer to this hospital, took 20 minutes to get to the hospital and therefore her epidural was not bolused prior to the section. The baby was out within 15 minutes and is doing well in NICU.
    I was not in the OR that night but appparently the pt was comfortable until they opened the peritoneum, which is when she went through the roof. The OB did not attempt to use a local (which I'm not really sure would have helped?), and after the baby was out, the staff asked her repeatedly to wait for anesthesia before finishing the case but she ignored them, and so we are not sure what her rationale was for continuing when the pt's pain was clearly not controlled. This is when there were three RN's holding the pt down as the OB was closing her back up. Post-op, the 18-yr-old primip pt did fine, didn't seem traumatized or even seem to realize that what happened was not normal, from what I heard (I have not taken care of the patient).
    Thanks to those who answered my original questions re have you seen this happen and what, if any, were the consequences. I really appreciate it. Also if anyone has any insight as to what could have been done differently by the OB doc or nursing staff, I'd love to hear it.
  8. by   nuberianne_RN
    I too have experienced childbirth without meds, twice in fact. Both of my children were born without even an IV in my arm so I am not scared of some pain. What I am terrified of is being cut open without anesthesia. That pain is not the same as childbirth.

    As to the fact that this is a rural hospital, ok I get it. I too live in a small town. It still sounds to me like this situation could have been handled differently. I believe some of you indicated that your MDA or CRNA stays in house or is able to get to the hospital once an epidural is placed. The OP said that the MDA was new and instead of staying at the hospital, he left and took 20 minutes to get back to the hospital. This seems to indicate that was not normal procedure. Therefore, policy was not followed properly somewhere.

    Another thing, how could they not know until crunch time that the epidural was not effective? Did she have pain relief and then all of a sudden the epidural stopped working and baby hit bottom and mom was taken to OR and cut open all in less time than it took for the MDA to get there?

    I know as healthcare providers we do not want to hear of any threats of a lawsuit especially after giving your all to care for the patients. I'm just saying to look at this situation from the patient's point of view who went through a horrific experience. I did not mean to imply that I would sue the nurses involved, but policy should be reviewed to prevent something like this from happening again. I am sure there are many of hospitals that use on call anesthesia service but I don't think it is normal for a pt to have to go through a c-section like that especially since she did not arrive at the hospital in distress.
  9. by   BSNtobe2009
    Quote from mom23RN
    Boy, in this case it sounds like surgery without anestesia = live baby.

    Wait for anesthesiologist to get there = dead baby.

    I think almost any mother you talk to (even if the delivery/c-sect was horrible and you felt everything) would make the first choice. I'm sure it's barbaric and sounds horrible, but I don't know what other choice there was?
    If I was that mother, I have to admit, I would want an ethical committee to review that case.

    Even in sue happy America (yet I still beleive that doctor's are not God's and even if someone dies doesn't men the doctor did anything wrong)....in order for me to have peace of mind, I would need to KNOW that the doctor didn't have a choice.

    For me the c-section was painful enough with the epidural, so I cannot imagine it, but I would have done anything for a healthy baby.
  10. by   BSNtobe2009
    Quote from nuberianne
    I am a nursing student so I am not comprehending this at all. If someone shows up at this hospital conscious but with a massive bleed somewhere who is going to administer the anesthesia to that pt? Another question, if the pt had an epidural that had not been effective who administered it? I guess I don't understand how hospitals operate without someone in house to be available for emergency surgery.

    If anyone has to cut me wide open while I am fully awake because there is no doctor or CRNA available, I will sue the pants off of everyone I saw from the minute I walked in the hospital up until the minute I left. Maybe my comments sound ignorant, but I am only in my first semester of my adn program so I have not had any OR or L&D training yet. I am just commenting from a layperson's point of view.
    Now you know why people die in rural hospitals...it's not that the staff isn't competent, it's just that the population doesn't allow for the funding of certain professions to be there 24/7.

    I agree with you, it should be illegal...hospital systems should have to buffer the cost, because I guarantee it costs lives every year.

    The year I had my daughter @ 29 1/2 weeks old, I was planning to visit my father that weekend, but decided at the last minute not to...the next day, I was in the hospital.

    After she came home two months later and everything was fine, I got a call from my Uncle who is a PCP (my Dad is a Neuro)...and they both agreed..if I had come home to the very, very rural area of VA that weekend....they said that things for my daughter would have turned out different...ALOT different.

    He didn't mean that in a good way either.

    By the time I had her and they transported her an hour away, there is no question in my mind that my daughter would not have made it.
  11. by   cozmo_blozmo
    Those are the risks associated with living in a rural area. Just like their are risks in living in a crack neighborhood in the big cities. It should not be illegal because every hospital in America is not a level one trauma center. That is ridiculous.




    Quote from BSNtobe2009
    Now you know why people die in rural hospitals...it's not that the staff isn't competent, it's just that the population doesn't allow for the funding of certain professions to be there 24/7.

    I agree with you, it should be illegal...hospital systems should have to buffer the cost, because I guarantee it costs lives every year.

    The year I had my daughter @ 29 1/2 weeks old, I was planning to visit my father that weekend, but decided at the last minute not to...the next day, I was in the hospital.

    After she came home two months later and everything was fine, I got a call from my Uncle who is a PCP (my Dad is a Neuro)...and they both agreed..if I had come home to the very, very rural area of VA that weekend....they said that things for my daughter would have turned out different...ALOT different.

    He didn't mean that in a good way either.

    By the time I had her and they transported her an hour away, there is no question in my mind that my daughter would not have made it.
  12. by   jwk
    Doing a C-Section without any type of anesthesia is barbaric. Period.

    The fact that this patient didn't jump off the table with the skin incision indicates that the epidural probably was working to a certain extent. A patient will not just lie still and let you slice open their abdomen if there is no anesthesia of some sort on board regardless of whether "it's for the baby" or any other reason. Get real.
  13. by   chadash
    Actually, had a similar experience with an epidural. Second birth, my previous c section was emergency, this one scheduled because of a really really contracted pelvis(I would have chosen natural, I am no hollywood type}. Yep, the epidural did not take. At the time the reasoning was to do anything more would have impacted the baby negatively. She was a bit bluish at first, but warmed up nicely. She is a wonderful young lady now. The epidural apparently took enough that I would not have rated it as a pain over 5...went through long labor with my first to no avail, and felt that that was worse.
    Now if the epidural did not take at all.....I am a little surprised at that.

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