c/s with ONLY local

DebblesRN, ASN, BSN, RN · Feb 19, 2012

One hospital I worked for did not have anesthesia in house 24/7. They would come in, put in an epideural, then leave. When we had a C/S at 2 AM, you had to argue with one of them to come in for it. They wanted to know dilation, effacement, station, reason for C/S, then why does C/S have to be NOW, is doctor there, blah blah blah, all while we're trying to get an unstable mom and baby ready for the OR. There were four C/S I remember there where we had to do C/S under local anesthesia because anesthesia took an hour to get there and the baby was DYING. MD injected lidocaine, cut the baby out, threw a wet lap over mom's gaping belly, and waited til anesthesia came to close up.

I have NEVER seen a C/S done without anesthesia unless the baby was in danger of dying, and as soon as the baby was out, the surgeon stopped as long as the bleeding was under control. That anesthesia group got dropped eventually thank God.

I think ANYONE who is willing to do a C/S with only local anesthesia for the sake of not waking a doctor up should have to suffer the same treatment. Unreal.

morte, LPN, LVN · Feb 19, 2012

But this means you would have to have an OB that is OK with it. ????

One of our l&d RNs (I work pp) left us to become a director at another hospital. After just a few months she came back. Apparently, while she was at that hospital there were 4 c/s in which they did not get anaesthesia & only gave her a local injection.....4 rns were required to hold these pts down during the procedure. Does this really happen anywhere else????!!!!! Apparently, only one case was emergent. During the other 3 that occurred while she was there, the staff just didn't want to wake the anaesthiologist (sp?). This sounds completely crazy to me! Those poor pts!!!!

MandaRN94 · Feb 19, 2012

I also worked in a hospital that did not have anest 24/7. we had a prolapsed cord and the doc had to do a c/s with local until the anest arrived -it was horrible. one of the reasons I left that hospital -the liability of of no in house anesth is not worth my license.

MomBabyUnitRN · Feb 19, 2012

We don't have anesthesia at our hospital 24/7 either, but their response time is amazing. They respond PDQ when we need them for emergent C/S's. I have to admit that most stay in house during their call time since we often call them anyway, but they're under no obligation to stay. On the rare occasion they do go home, they're there within 10 minutes when we need them. I have never cared if I had to wake one. That's what they're there for.

klone, MSN, RN · Feb 20, 2012

Did not want to wake the anesthesiologist? That is farking insane! I've personally seen it twice, and both times were what we call "splash and slash" - highly emergent "get this baby out now or mom and/or baby will die in the next three minutes" kind of thing where we didn't have an anesthesiologist in house and it was 2am. Both times were highly traumatic for everyone involved and required extensive debriefing for staff afterwards. For what you describe in the OP, I would call that malpractice.

caregiver1977 · Feb 20, 2012

Did not want to wake the anesthesiologist? That is farking insane! I've personally seen it twice, and both times were what we call "splash and slash" - highly emergent "get this baby out now or mom and/or baby will die in the next three minutes" kind of thing where we didn't have an anesthesiologist in house and it was 2am. Both times were highly traumatic for everyone involved and required extensive debriefing for staff afterwards. For what you describe in the OP, I would call that malpractice.

I can only imagine the kind of debriefing these patients needed. WHAT A NIGHTMARE!! Fear of c/s is one of the reasons why I refuse to have another child. I am approaching 35 and have past pre enclampsia issues, so I am too afraid I would be "forced" into a c-section.

shortstuff31117 · Feb 22, 2012

That's truly disgusting. Those poor moms...I can't even imagine!

We don't have 24/7 in house anesthesia, but in the 5yrs I've done OB, we've had only one c-section under a local. She did have an epidural, but the baby crumped, and needed to be delivered NOW. Luckily 2 OBs were in house but yeah..scary. My coworkers said the look on the anesthesiologist's face when he walked into the OR and saw the baby already delivered was priceless. He did give Mom some Versed so she didn't really remember anything, thank goodness.

crazylilkelly · Feb 22, 2012

Thanks for all of your responses. If it's an emergent case & anaesthesia can't get there in time definitely makes the situation more understandable. But to hear that only 1 of the 4 were emergent is very disheartening. I am very thankful I work at a hospital in which we have anaesthesia & obs in-house 24/7!

beachyfe · Feb 27, 2012

I work at a hospital that has in-house anesthesia, but one night we couldn't find him when we needed to do a stat section. We paged, called, went to call room, etc. but no luck. Doc had to start using a local and it was terrifying for everyone. The patient was screaming and we had to hold her down. Finally the CRNA arrived and quickly put her to sleep. I hope I never have to see that again.

Rfuel · Mar 8, 2013

I am a new nurse and I have no L&D experience so I need to ask if what happened to me was normal. I was 37 weeks pregnant, I had been diagnosed with polyhydraminous (sp?) and my baby's head was not engaged in my pelvis. I was displayed 4 cm when contractions stopped. MD knew that my baby's arm and cord were lined up with my cervix and that a prolapse was expected if my water were to break. Md decided to break my water and see if the cord would prolapse or if I could have a natural lady partsl delivery. I was given an epidural for labor just incase I had to go to surgery quickly. Md broke my water and the cord did indeed prolapse. I was rushed to the OR. The anesthesiologist bolused my epidural and they started prepping my abdomen. I told them " I can fell that, I can feel the coldness". No body said anything to me. Next thing I know, the md cut me! I screamed "I can feel that! I can feel everything you're doing!" They didn't stop. They gave me morphine and fentanyl but I still felt the entire surgery. They did not even attempt general anesthesia. Why could someone not have held the baby's presenting part (arm) off of the cord until the epidural kicked in? Why could they not have put me in trendèlenberg until it kicked in? Was there anything else that could have been done to help me?

klone, MSN, RN · Mar 8, 2013

I'm sorry that happened to you. We cannot give medical advice here.