how common is it for the anesthesiologist to refuse to give an epidural?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I don't disagree with what anyone is saying but no one is talking about the fact that giving birth is more than "uncomfortable." It's not like asking someone to just tolerate a headache without Advil. For many women, the pain is completely unbearable, hence why they want and get an epidural.

Being denied an epidural in the throes of labor if you are not prepared or planning on an unmedicated delivery I would imagine was probably very traumatizing for your friend. How is she handling her feelings? It is a real shame that her OB did not recognize this issue before so a plan could have been put into place in advance and that responsibility is really on the OB if he/she was aware of the condition of your friend.

The WHO recognizes that "Many women appreciate some form of pain relief in labour and would like a choice of options."

Was she given any other options for pain relief? The new WHO Intrapartum Guidelines state:

"Parenteral opioids, such as fentanyl, diamorphine and pethidine, are recommended options for
healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences."

Did they offer her anything like that?

http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1

I'm sorry but all women should be prepared with pain free birthing techniques. I know A LOT of women who were unable to get epidurals because their labor progressed too fast or they couldn't get to the hospital in time. You should be prepared for a worst case scenario.

It's not like they're performing a csection on you without pain medicine.

In most 1st world countries women labor with nitrous oxide instead of epidurals. Many hospitals around here are now offering that as an option.

As much as no one wants to hear it, Medication durin/ at birth is a comfort measure, not a medical necessity.

Depending on the medical reason for refusal of the epidural, opiates may also not have been an option OR the hospital may have no protocol for using them.

It goes against the grain to say so, but no woman should rely on the fact that she can and will get pain relief during labour. There are a lot of medical reasons not to.

Isn’t this the case for any and all medical procedure and surgeries? I mean if they amputate a limb is pain relief really medically necessary?

I suppose it depends if you consider an otherwise normal birth to be a "medical procedure."

[Anonymous]

Anonymous wrote:

Anonymous wrote:If something goes wrong with the epidural, the blame would be on the anesthesiologist and he/she would be sued. The patient cannot overrule the doctor’s decision on this.

This. I really wish people would realize this has nothing to do with your OB…he/she has no say in this matter. I am a CrNA and I see these situations often. The patient is mad that the OB "won't go to bat" for the patient but thats not how it works. Also our risk assessment is basically the most important part of our jobs please dont pressure me to lessen my standards.

I had a nurse CrNA trainee perform my epidural during labor, which was induced due to PROM. I was in unbelievable pain at the time and she did a beautiful job on the epidural. I'm so thankful to all of you who undergo this training to help women with the pain of childbirth.

I am also grateful to these doctors and nurses who make judgment calls for my safety. I would not feel comfortable with a doctor or nurse taking risks with my spine. I sincerely feel sorry for the woman who had to labor on Pitocin without an epidural; that is a special type of hell. But I hope she can be comfortable knowing her care provider made the best possible judgment call he could and that she and her baby are safe.

[Anonymous]

Anonymous wrote:
I suppose it depends if you consider an otherwise normal birth to be a "medical procedure."

Didn't OP say the mother was induced in this case? So it was, by definition, a medical procedure.

Regardless, though, I had epidurals for both my births. And I wouldn't challenge an anesthesiologist. Though if it's just a matter of feeling uncomfortable, I would hope they would suggest calling someone else (I actually think that might have happened with my first). For both of my pregnancies, I developed an immune response to my platelets, and it was a question whether my count would be high enough for an epidural. For my second, they actually had to run BW before they could do it.

I think it's a gray area the extent to which an epidural is a "medical necessity". Both of my labors were difficult, and both my kids got stuck in the birth canal leading to hours of "assisted" pushing. With my second, it was painful with an epidural, and I'm sure I would have fainted in pain had I done it unmedicated (I know, because I had to push for a little while before they got my BW back). I'm certain I would have needed a c-section without an epidural, which would also have been way riskier than a typical c-section due to the baby's positioning. But this is an extremely rare circumstance, and it's one where doctors would have made a judgment call between two different risky scenarios based on the situation.

[Anonymous]

Anonymous wrote:I was refused an epidural, but given a spinal.

I found the anesthesiologist at Sibley (Dr. Holley) very flighty and she has a bit of a reputation.

You do know there are multiple anesthesiologists at Sibley, right? I’ve given birth there three times and have met many anesthesiologists, and none of them were this doctor.

[Anonymous]

I was on lovenox during my pregnancies and no anesthesiologist would touch me with a 10 foot pole if I was within 24 hours of a shot. There is a risk of paralysis. There are also back injuries (or scoliosis) where the anesthesiologist has a right to say no especially if he doesn't have access to Xrays or an MRI or something.

[Anonymous]

Anonymous wrote:I was on lovenox during my pregnancies and no anesthesiologist would touch me with a 10 foot pole if I was within 24 hours of a shot. There is a risk of paralysis. There are also back injuries (or scoliosis) where the anesthesiologist has a right to say no especially if he doesn't have access to Xrays or an MRI or something.

You’re confused. The anaesthesiolgist always has the “right” to say no. They are not legally obligated to give you pain control if it is not medically safe or indicated.

Heck, if they are the only on-call and they have a patient that needs anaesthesia more than a woman in labor does, guess who gets their attention and expertise?

As has been said on this thread already, a medicated, pain free birth is not a given.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I had HELLP syndrome with #1 and got a range of 50K when anesthesiologists were asked what their absolute platelet cutoff for a spinal was. (I was going into an emergency c-section, so the alternative was GA not just unmedicated birth.) The hospital said the cutoff for residents/fellows to perform with assistance was 100K and that attendings had their own cutoffs between 50K and 100K. (The platelet test is performed up to an hour the c-section and in the case of HELLP, platelets often keep falling rapidly, so some wiggle room is built in. Apparently in a stable platelets scenario, some doctors will go as low as 25K.) Anyway, the on-call doc had a cut off of 75K and it was a hairsbreath from being an issue, because my platelets came back at 75K on the dot. If they'd come back at between 50K and 75K, we were going to try to make a stink, because GA is bad for the baby. In any case, luckily we didn't have to and the blood tests at delivery (about 35 minutes post-the original blood test in my case) later came back at 57K, so they were falling fast and I got really lucky to avoid a fight/GA.

Platelets can be a real issue. The risk of epidural with platelets too low is that you continue bleeding and put pressure on the spinal cord, causing potentially permanent paralysis.

I am 100% aware it’s a real issue, but the risks of GA are real too... especially for the baby. We weren’t going to try to get the anesthesiologist to do something s/he wasn’t comfortable with, we were going to try to insist on getting a doctor who was comfortable if at all possible.

[Anonymous]

Anonymous wrote:Their insurance and livelihood is on the line if something goes wrong. It's not common but it does happen (drug interactions, tattoos, etc)

Hold up - why would tattoos prevent you from getting an epidural? I haven’t got any, and I thought you couldn’t get an MRI with them? But an epidural?

Also, some of you are cold b’s. My induced for PROM VBAC was an insane nightmare until I got an epidural. That wasn’t discomfort, that was me wondering if I could bust through a window and leap to my death on 23rd St. I would have requested a c-section if I was epidural ineligible. And I get that there are medical conditions that prevent epidural - there are threads on here occasionally asking for moral support and suggestions how to get through without because x. (My second VBAC, also induced, was dealable without an epidural. Go figure.) I cannot believ I ever sided with the goofheads who pretend that just because childbirth is a natural process means it isn’t also medical procedure level pain.

[Anonymous]

Newsflash, birth is painful!

My epi failed. It hurt a lot. Of course you want to die for a few hours but it is just a few hours of your life.

I do think the natural birth people do everyone a disservice by pretending it doesn’t actually hurt and isn’t “pain.” Of course it is.

[Anonymous]

How did Aunt Lydia (multiple versions) get in DCUM??

[Anonymous]

Acute severe labor pain may induce many physical disorders on mothers and neonates such as maternal hyperventilation, respiratory alkalosis, increased cardiovascular load, fetal hypoxemia, and/or metabolic acidosis.[2] Furthermore, adverse psychological events such as poor maternal-neonatal bonding, traumatic stress disorder or even postpartum depression may also occur.[3]

Relief of labor pain has been considered one of the fundamental human rights issues addressed by some declaration such as “The Universal Declaration of Human Rights.”[4]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268526/#!po=19.2308

[Anonymous]

Anonymous wrote:Acute severe labor pain may induce many physical disorders on mothers and neonates such as maternal hyperventilation, respiratory alkalosis, increased cardiovascular load, fetal hypoxemia, and/or metabolic acidosis.[2] Furthermore, adverse psychological events such as poor maternal-neonatal bonding, traumatic stress disorder or even postpartum depression may also occur.[3]

Relief of labor pain has been considered one of the fundamental human rights issues addressed by some declaration such as “The Universal Declaration of Human Rights.”[4]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268526/#!po=19.2308

Quote that at the trial for the defense. That will make the case for you, huh?

[Anonymous]

Anonymous wrote:Acute severe labor pain may induce many physical disorders on mothers and neonates such as maternal hyperventilation, respiratory alkalosis, increased cardiovascular load, fetal hypoxemia, and/or metabolic acidosis.[2] Furthermore, adverse psychological events such as poor maternal-neonatal bonding, traumatic stress disorder or even postpartum depression may also occur.[3]

Relief of labor pain has been considered one of the fundamental human rights issues addressed by some declaration such as “The Universal Declaration of Human Rights.”[4]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268526/#!po=19.2308

You realize you are quoting a Saudi article directed towards " low-income countries owing to inadequate awareness, limited resources and insufficient financial support," where there is "limited knowledge of caregivers concerning the types, benefits, and adverse effects of various analgesic means."

That's a far cry from having analgesia and being willing to give it except for outweighing medical safety concerns.

That article even emphasizes that there is a broader range of analgesic options for a woman in labor: "In fact, more nonpharmacological interventions such as water immersion, relaxation, massage, and acupuncture as well as pharmacological ones like combined spinal epidural, nerve blocks or sole anesthetics have been demonstrated to be effective in relieving labor pain.[7] It is essential to note that the indications and contraindications, and the maternal and fetal benefits and risks for each method provided in labor pain control need to be fully explained to the parturient."

You seem to have googled to find something you could cut and paste to say what you wanted, without looking at whether the article was a) relevant, and b) actually supporting your position.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Their insurance and livelihood is on the line if something goes wrong. It's not common but it does happen (drug interactions, tattoos, etc)

Hold up - why would tattoos prevent you from getting an epidural? I haven’t got any, and I thought you couldn’t get an MRI with them? But an epidural?

I believe if the tattoo is where the epidural is to be placed, they often will not do it. A tattoo elsewhere would be a non-issue.

[Anonymous]

For the birth of DD, the anesthesiologist was too late to the hospital (our fault -- long story) and by the time he arrived DW was already in labor. He wouldn't give her an epidural because she was already having regular contractions.

It looked like it really hurt. Certainly hurt my ears.