epidural issue…

I had a client in 2008 who desired a natural birth but after several hours without any change in dilation, interventions were begun and she ended up with a cesarean birth. She was my only doula client who ended up with a primary cesarean last year. She had stayed at 8 cm for several hours and then received an epidural. The effects of the epidural dropped her blood pressure causing the baby to go into distress and her cesarean was immediate. I hate that it happened. I am not sure we could have done any more than we did. Perhaps if she had been able to relax more- given more time before getting the epidural… I don’t know. But the thing that caused me the real problem with this birth was not the outcome per se.

This hospital, Emory Crawford Long, does not allow a laboring woman to have anyone stay with her if she chooses to get an epidural. NO ONE- as in not her husband or her doula or her friend or her mom… only medical staff. Why?

Let’s hear from the nurses…on allnurses.com the forum had these comments:
“I have heard of a case where the husband was holding his wife during the procedure, fainted and hit his head and died!! (i believe this was a Kaiser case in california, dont know the exact details but this is the base of the story).The family then sued (GO FIGURE!) the hospital for negligence in using him as staff in supporting his wife during the procedure. As a CRNA, im very concerned about this as my new job allows the husband to hold the wife, and of course my last job did not!”
“If the laboring mom wishes to have her partner present during epidural placement, and he is able to be of comfort to her without getting in the way or compromising the sterile field, then I think that is fine. But to have him physically hold her is not safe, in my opinion.”
“I think it’s a shame we’re unable to trust our patients anymore. We can’t let dad hug mom or hold her hand because he might pass out and sue? If that’s the case we better start banning dads from the delivery room altogether lest they pass out at the birth.”
“They aren’t doing anything to ensure proper positioning. They are there for emotional support. Even as the nurse “holding” the mom, I wasn’t holding her to ensure she stayed in position. I was just supporting her. Me being there wasn’t going to stop her from moving. She was the one who had to listen to us and respond when we said “Bend your back out like a cat”, I couldn’t make her do it. We also let dads hold moms’ legs up when they were pushing. It doesn’t require an RN license. ”

I could not find an article regarding protocol for anesthesiologists. The articles are all membership only access articles. But several hospitals had protocols and it would state that it was up to the anesthesiologist at the time of placement as to who would be allowed to be support for the laboring mom.

So, is it they don’t want to possibly have someone get in the sterile field? Hmmm then why are dads allowed in for a cesarean birth? Is it because if they make a mistake they don’t want a witness? Is it because having a person there makes them nervous? Is it because they do not see any value to having a support person be with the mom? I do not do well by hearing, “it is our policy.” What does that mean?

So… back to why this birth outcome made me upset. The anesthesiologist arrived and explained that it would take about 45 minutes to get the mom anesthetized with her epidural and we would not be allowed to stay during the placement. It was not my battle to fight- and the dad looked at me. I just shook my head and asked again why and was told it was policy of this particular anesthesiologist. Since we had been without a break for over 12 hours, the nurse suggested we step downstairs and get something to eat. So, we did.

We returned to the lock down unit and picked up the phone to be allowed back in after only 40 minutes. There seemed to be some hesitation on the part of the staff to allow us back in. But when they did I could see the client’s room. The door was open and the cleaning staff was cleaning the room. I thought- oh no!

I asked where the mom was, although I kinda already knew. They said that after the epidural placement, there had been a reaction that caused the baby to “crash” so there had been an emergency cesarean. I asked had they thought to call the dad to alert him? They said they did not have his number and do not page overhead for such things. I was so upset. This mom had been wide awake- frightened- and alone during the surgical birth of her baby. The dad had not been included at all.

The dad was dressed in scrubs and led to the OR to meet up with his wife and baby. They were both doing good. Seems the mom’s drop in blood pressure as a result of the epidural had caused the baby to have a sudden drop in blood pressure as well- therefore causing the “sudden crash.”

What would I do differently? Well one thing is I tell all moms and dads that they can insist on a support person staying or ask for an anesthesiologist who does allow it to replace the one who will not. I suggest that if it is hospital protocol to write letters questioning the policy. I ask dads to stay close by- only as far as the waiting room at most. I suggest taking out a pen and writing the cell number of the dad really large on the sheet or white board for all to have access to.

The dad had been so relieved that everyone was okay that he stated he guessed that it was okay- healthy mom and healthy baby. I encouraged him to remember that it was also about her experience and he needed to acknowledge his disappointment of not being present with her during the birth as well as hear her disappointments before being dismissive of those feelings. I also encouraged him to write a letter to the administrator and anesthesiology department.

I still feel sad about this birth. Not that she had to have an epidural that caused the sudden emergency- because this mom and I both know she worked long and hard and was at the point where an epidural could have proven helpful… but because instead of birthing with her partner by her side, she experienced this alone with mostly strangers around her. This is not ever ideal.