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

[Anonymous]

My friend recently had a baby in DC, and the anesthesiologist refuse to give her an epidural because of medical reasons that she feels were not adequate (I don't want to go into too much detail). She had epidurals for her previous births.

My friend's OB did not agree with the anesthesiologist, but the OB couldn't change his mind, so my friend labored and birthed with no pain medication. She was induced, which is apparently more painful that childbirth without induction.

I am angry on her behalf because I feel like if my friend and her husband (having heard about the concerns of the anesthesiologist) still wanted an epidural for her, they should have been allowed to make that choice.

How common is this refusal? I have heard about folks who waited too long to get an epidural, so they couldn't get one in time, but not about the anesthesiologist just refusing to give one.

[Anonymous]

The anesthesiologist is the one who decides, not the patient.

[Anonymous]

There are some conditions (I have a mild case of spinal bifida) that make anesthesiologists nervous. There is an increased risk for the patient and an increased risk for the anesthesiologist. The risk tolerance level of every doctor is different. Maybe she got a conservative doctor who wasn’t comfortable. You normally get the rotating anesthesiologist so not like they can go down to the OR and find some others.

[Anonymous]

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.

[Anonymous]

I should add (I'm 13:15) that her justification was that I take medication to control epilepsy and she had not "cleared" the epidural with my neurologist. I was never told, ever, during my pregnancy, hospital tour, etc. that it needed to be cleared.

[Anonymous]

It's the doctor's call. Not the patients. S/he is not going to undertake procedures that s/he feels are too risky. But, assuming they are at a large hospital, they could ask for a second opinion from a different anesthesiologist.

In terms of others though, this is very rare - that doesn't mean it's not warranted, just that it doesn't happen often. So I wouldn't worry about it happening to you if that is your concern.

[Anonymous]

The anesthesiologist is the expert in this situation. His call.

[Anonymous]

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

[Anonymous]

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.

[Anonymous]

I think that the answer is that people with complicated medical situations (e.g., epilepsy) may not be able to get epidurals from particular anesthesiologists. If that applies to you (i.e., you have a known medical condition that might complicate your labor and delivery in some way), and you know you want an epidural or the option of getting an epidural, work out with your OB (and potentially the hospital anesthesiologist/specialist who is treating your condition) in advance whether it will be possible for you in labor.

[Anonymous]

Anonymous wrote:My friend recently had a baby in DC, and the anesthesiologist refuse to give her an epidural because of medical reasons that she feels were not adequate (I don't want to go into too much detail). She had epidurals for her previous births.

My friend's OB did not agree with the anesthesiologist, but the OB couldn't change his mind, so my friend labored and birthed with no pain medication. She was induced, which is apparently more painful that childbirth without induction.

I am angry on her behalf because I feel like if my friend and her husband (having heard about the concerns of the anesthesiologist) still wanted an epidural for her, they should have been allowed to make that choice.

How common is this refusal? I have heard about folks who waited too long to get an epidural, so they couldn't get one in time, but not about the anesthesiologist just refusing to give one.

It’s up to the OB to birth the baby. It’s up to the anaesthesiologist to determine if the client (and their baby) are safe candidates for anaesthesia at that direct point in time.

Labouring and giving birth with no pain medication are not dangerous conditions, if uncomfortable ones. Giving someone an epidural under the wrong circumstances actually can be fatal and have lifelong consequence.

So no, unless your friend, her husband, and the OB had gone to school and done their internships related to anaesthesia, it really want their choice.

[Anonymous]

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.

[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.

+1

People want “the safest”

Until they don’t.

[Anonymous]

I used to listen to the Birth Hour and there would occasionally be someone on who would note they couldn't have an epidural, but they usually knew that in advance. Seems odd that this wasn't communicated to your friend until after the induction was started when they could have strategized to avoid her being in so much pain. That sounds like bad coordination/communication on the part of the medical team. Epidural analgesia can have serious side effects even among totally healthy people so I have to think it's not unheard of to risk someone out.

[Anonymous]

Anonymous wrote:My friend recently had a baby in DC, and the anesthesiologist refuse to give her an epidural because of medical reasons that she feels were not adequate (I don't want to go into too much detail). She had epidurals for her previous births.

My friend's OB did not agree with the anesthesiologist, but the OB couldn't change his mind, so my friend labored and birthed with no pain medication. She was induced, which is apparently more painful that childbirth without induction.

I am angry on her behalf because I feel like if my friend and her husband (having heard about the concerns of the anesthesiologist) still wanted an epidural for her, they should have been allowed to make that choice.

How common is this refusal? I have heard about folks who waited too long to get an epidural, so they couldn't get one in time, but not about the anesthesiologist just refusing to give one.

And would they agree not to sue the anesthesiologist if something went wrong? Even if they signed something, I bet they'd still try. Not to mention the anesthesiologist having to live with the guilt of injuring or filling a patient.

The medical reason matters, too. Just because she had epidurals before doesn't mean that there wasn't a reason not to administer one this time.