They did a c-section without anesthesia

Specialties Ob/Gyn

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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 needed out, so...they just did it without him. no local or anything. I wasn't there but it sounds like it was a horrific case.

have you seen anything like this, and if so, what were the repercussions if any?

Specializes in Maternal - Child Health.

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.

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Specializes in Med/Surg Renal.

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.

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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.

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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).

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Specializes in Maternal - Child Health.
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.

To an extent, I understand and agree with what you are saying, but these MDAs were notorious for practicing obstetrical anesthesia at their convenience. This was a small hospital with a relatively low-risk population, and the MDAs were not required to be in house with active labor patients. They would drag their heels coming in when a mom requested an epidural and were similarly slow about returning to re-dose existing epidurals. The OBs were not enhancing their revenues by placing epidurals, they were simply trying to offer their patients timely pain relief.

Also, although the MDAs claimed liability issues in dosing epidurals they had not personally placed, they re-dosed each-other's epidurals all the time, so that argument lost a bit of its believability. And think about it, we utilize existing IV and art lines all the time. We don't start a new IV simply because we think there is too great of a liability in infusing meds thru a line started by someone else. We assess the patency and appropriate placement of the line first, which is exactly what I would have expected the MDAs to do with the epidurals.

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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).

What a jerk! I worked w/ a nurse who took demerol out of the narc box for an MDA to push postpartum for his soon to be ex-wife. (he had been kind enough to transmit HSV to her during the pregnancy). They were separated and he was not on duty at the time. There is no way I would have done this. Why did he have stuff for the epidural at home??? Maybe he can get together w/ the guy down in FL who was doing plastic surgeries at his patients homes. Unbelievable.

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Specializes in postpartum, nursery, high risk L&D.
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.

This is how it is where I work too. I had no idea OB docs did stuff with epidurals at other places. THAT would be handy!

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Specializes in Psych Charge RN/ Med Surg/Float Nurse.
This is how it is where I work too. I had no idea OB docs did stuff with epidurals at other places. THAT would be handy!

Yeah, I thought it was weird too after watching all those baby shows that always show an anesthesiologist, but apparantly it's the norm there for the docs (at least the ones in that practice) to do their own.

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What a jerk! I worked w/ a nurse who took demerol out of the narc box for an MDA to push postpartum for his soon to be ex-wife. (he had been kind enough to transmit HSV to her during the pregnancy). They were separated and he was not on duty at the time. There is no way I would have done this. Why did he have stuff for the epidural at home??? Maybe he can get together w/ the guy down in FL who was doing plastic surgeries at his patients homes. Unbelievable.
He stole the epidural tray, just like he stole the drugs.
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To an extent, I understand and agree with what you are saying, but these MDAs were notorious for practicing obstetrical anesthesia at their convenience. This was a small hospital with a relatively low-risk population, and the MDAs were not required to be in house with active labor patients. They would drag their heels coming in when a mom requested an epidural and were similarly slow about returning to re-dose existing epidurals. The OBs were not enhancing their revenues by placing epidurals, they were simply trying to offer their patients timely pain relief.

Also, although the MDAs claimed liability issues in dosing epidurals they had not personally placed, they re-dosed each-other's epidurals all the time, so that argument lost a bit of its believability. And think about it, we utilize existing IV and art lines all the time. We don't start a new IV simply because we think there is too great of a liability in infusing meds thru a line started by someone else. We assess the patency and appropriate placement of the line first, which is exactly what I would have expected the MDAs to do with the epidurals.

An epidural is NOT anywhere close to being as innocuous as an IV or an art line. There's a lot of difference between a little phlebitis from poor sterile technique with an IV and poor technique with an epidural that can result in an epidural abscess that can turn someone into a paraplegic. Who gets blamed if there's a complication? Both if they both managed it.

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He stole the epidural tray, just like he stole the drugs.

I realized how dumb my question was later. What a doof and thought he could get away w/ it too. GEEZ!

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Specializes in trauma, critial care, ob, transplant.

in an obstetrical emergeny where there the fetal heart rate is low you don't have 20 minutes to wait for anesthesia, you don't have five minutes if you expect a reasonable outcome. i agree...i wouldn't work in an obstetrical unit that doesn't have in house anesthesia coverage...but the OB should have used a local. i work in a hospital with in house anesthesia coverage and have had situations where they just couldn't get here fast enough because they can't leave their patients on the table...never seen a case where the OB didn't give local...and if I'm the mom, I want them to do whatever is needed to get that baby out so it has a reasonable chance for a good outcome....but some local would be nice. Hopefully, the outcome was good, so that the mother can be thankful that the OB had the guts to go ahead and cut ....she has a healthy baby and the pain is over.

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