They did a c-section without anesthesia - page 4

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 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.
    People die in all types hospitals period every year that shouldn't. That is a whole other story. We can't have level one trauma and level three NICU capabilities at every facility or in-house everything. There aren't enough resources for that. To take services like OB away from small hospitals would create more problems than it would solve. Then you would have people delivering in the ED w/ no OB doc. What if someone like that needs a C/S? What you need is a plan. Most places do have a plan, procedure, etc. for what happens when a pretermer, etc. comes in and is active. We have had 24 weekers come in and pop that child out in a matter of minutes. Once they hit the door NICU is being at our referral facility and are on their way. We transfer people who are stable enough so they can deliver somewhere else if they are preterm or very high risk. As for anesthesia and ob being in house 24/7. They wouldn't. That is their call, to a large extent, and if the hospital mandated them being there all of the time, then we wouldn't have them. They would just move away to a facility which has house staff. Again, patients should talk to their doc. If you want them there, the whole time in labour, then say it. I don't know that they will agree to it. It is not just a matter of greed on the facilites' part. There really is a shortage of certain providers for a variety of reasons. I don't know your situation w/ a 29 weeker. We have flown and ambo'd many a preterm mom away w/ good results. We have also delivered many a pretermer w/ good results. We would much rather send them prior to delivery. Thankfully, you had a good outcome. We have also had moms who were to deliver at our referral hospital come in w/ a terrible strip or bleeding and they had a good outcome because we were there and able to get a team in within a few minutes because they didn't have the time to drive to that facilty.
  2. by   Jolie
    Quote from nuberianne

    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.
    I was present in a C-section where the patient initially had good epidural pain relief, but cried out in pain when the OB began to cut thru deeper tissues. This was a planned surgery, with no urgency for the baby to be delivered, so the OB stopped and allowed the MDA time to re-dose the epidural more than once. It was not effective. They finally agreed that the best course of action would be for the OB to inject a local, which provided sufficient pain relief for the case to be completed. The physicians theorized that the epidural had not effectively numbed certain nerve branches, while providing sufficient pain relief to others.

    I wonder if this is what happened in the OP's case. I agree that it is unconscionable that the OB continued surgery AFTER the baby's delivery without sufficient anesthesia, and agree with the suggestion of referring this to an ethics committee, as well as the hospital's morbidity and mortality review. I suspect that the patient was given an amnesic drug such as Versed, which would prevent her from remembering the horrific pain she felt. That, of course, does not justify subjecting her to the pain in the first place, once the baby was safely delivered.
  3. by   BSNtobe2009
    Quote from 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.
    I don't think having an CRNA in-house 24/7 makes a facility a Level I trauma center.

    The fact is, we aren't talking about some things that can be done TEMPORARILY by another doctor or nurse...Anesthesia is Anesthesia. If you don't have at minimum a CRNA there, then someone shouldn't have to choose between getting a surgery without property pain control and dying when immediate transport is not possible, and more is required to stablize a patient.

    I'm not saying that rural hospitals should be able to do everything and every hour....anesthesia is just something that I cannot believe hospitals "skimp" on. It's just too important.
  4. by   Jolie
    Quote from BSNtobe2009
    I don't think having an CRNA in-house 24/7 makes a facility a Level I trauma center.

    The fact is, we aren't talking about some things that can be done TEMPORARILY by another doctor or nurse...Anesthesia is Anesthesia. If you don't have at minimum a CRNA there, then someone shouldn't have to choose between getting a surgery without property pain control and dying when immediate transport is not possible, and more is required to stablize a patient.

    I'm not saying that rural hospitals should be able to do everything and every hour....anesthesia is just something that I cannot believe hospitals "skimp" on. It's just too important.
    Then get ready to pay double, triple or more for your health care. You make a very impassioned argument for the 24 hour availability of anesthesia, and the next person in line can (and will) make an equally eloquent plea for another vital service like MRI, which is critical to the well-being of a trauma patient. At any given time in any given hospital the immediate needs are different. It is simply not possible to provide all desirable services at all times at all places, especially within a system in such precarious financial straits as ours.

    Decisions on what services to provide are made on a cost-effectiveness basis. None of us like to consider that, but it is true.
  5. by   merrick
    That sounds like a horrific experience.

    Are only anesthesiologists and CRNAs allowed to give epidurals? Because with my first child, my OB did the epi. From what I understand all the docs in the practice did the epidurals.
  6. by   BSNtobe2009
    Quote from merrick
    That sounds like a horrific experience.

    Are only anesthesiologists and CRNAs allowed to give epidurals? Because with my first child, my OB did the epi. From what I understand all the docs in the practice did the epidurals.
    That is a very good question, and I wondered that. I fully undersand the economic issues regarding having an in-house CRNA. Maybe this is something that the medical schools should be addressing in training doctors in basic anesthesia in the event of a catastrophic emergency.
  7. by   mom23RN
    Quote from BSNtobe2009
    I don't think having an CRNA in-house 24/7 makes a facility a Level I trauma center.

    The fact is, we aren't talking about some things that can be done TEMPORARILY by another doctor or nurse...Anesthesia is Anesthesia. If you don't have at minimum a CRNA there, then someone shouldn't have to choose between getting a surgery without property pain control and dying when immediate transport is not possible, and more is required to stablize a patient.

    I'm not saying that rural hospitals should be able to do everything and every hour....anesthesia is just something that I cannot believe hospitals "skimp" on. It's just too important.
    There are hospitals in the UP of Michigan that don't even have a DOCTOR on staff - not even in the ER. If they get something they can't handle they call him in! Most of their stuff is stablize and ship. In reality some of these hospitals probably can hardly afford the few staff members they already have working.
  8. by   Spidey's mom
    Quote from mom23RN
    There are hospitals in the UP of Michigan that don't even have a DOCTOR on staff - not even in the ER. If they get something they can't handle they call him in! Most of their stuff is stablize and ship. In reality some of these hospitals probably can hardly afford the few staff members they already have working.
    This is true - some hospital have docs on-call for the ER.

    Our docs stay in the clinic when it is their turn to staff the ER - there is a room in the back with a bed, bathroom, tv. So we always have a doc available.

    As I mentioned, our OB docs redose epidurals but don't place them.

    steph
  9. by   SmilingBluEyes
    We have but one OB doc who will even touch an epidural and that is to turn it off, if needed. Other than that, nobody touches them except to discontinue at MDA order. We call the MDA in if the patients need re-bolusing or if a c/section is called. That is how it works at my smallish community hospital anyhow.
  10. by   Jolie
    I worked in one facility where there was a HUGE turf war between the OBs and MDAs regarding epidural placement. The OBs wanted to do them themselves for labor patients, for timeliness, and patient convenience. The MDAs were not happy about the lost revenue, and refused to work with any epidural that had been placed by an OB. So if a patient had a labor epidural placed by her OB, then needed a C-section, the MDAs would DC it and reinsert a new one.

    The OBs finally gave up and handed all epidurals off to the MDAs, which was a terrible shame, because the OBs did not charge, nor were they reimbursed extra for epidural placement. It was included in their flat fee for prenatal, delivery and post-partum care. So patients began to be billed for a significant added expense.
  11. by   SportyNurse
    My friends Aunt had to have a C-Section without anesthesia. Long story short, they were life-flighting her with a doctor on board, things went south really fast, and they had to get the baby out. (Both mom and baby in bad shape) They did give her a massive dose of Versed though, and it really wiped out most of her memory about it happening. She only has a vague recollection of the actual event.

    That sounds horrible though. I can't imagine going through something like that, because I am a big baby.
  12. by   imenid37
    Quote from merrick
    That sounds like a horrific experience.

    Are only anesthesiologists and CRNAs allowed to give epidurals? Because with my first child, my OB did the epi. From what I understand all the docs in the practice did the epidurals.
    Our two older ob docs, both in their early 50's used to do their own epidurals. Health insurance won't pay for the same person to be both anesthesia and ob provider. Malpractice says you are insured as an OB doc, not an anesthesiologist. This is what they have told us anyway.
  13. by   jwk
    Quote from Jolie
    I worked in one facility where there was a HUGE turf war between the OBs and MDAs regarding epidural placement. The OBs wanted to do them themselves for labor patients, for timeliness, and patient convenience. The MDAs were not happy about the lost revenue, and refused to work with any epidural that had been placed by an OB. So if a patient had a labor epidural placed by her OB, then needed a C-section, the MDAs would DC it and reinsert a new one.
    If you place it, you manage it. Finish what you start. It has nothing to do with revenue. What happens when there is a complication? You think the anesthesia provider wants to manage problems with an epidural placed by an OB doc? Not a chance.

    We had one OB doc years ago that did epidurals on his PAYING patients, but tried calling us in for a Medicaid patient he picked up on call. We told him either you do them all or you don't do any of them.

    We also had an idiot anesthesia doc from another hospital place his wife's epidural AT HOME when she first went into labor, and then came to our hospital demanding that we use it and manage it. We told him we wouldn't. The OB nurses caught him dosing it when he thought they weren't looking, using drugs he had taken from his hospital. Not a smart move on his part, as he found out when he returned to work (for a very short time).

close