OB present while placing labor epidural?

[chocomorsel]

Only an hour ago had similar case. Personally sited epidural. Feeling loads of pressure but couldn't feel cold. Face presentation.

Whipped out epi and gave sitting spinal. 2mls heavy with 15f 150m. No probs


If any doubt re epi when it comes to section time whip it out. I've even given full dose 2.4 mls post epi. Never had high spinal... Just hypotension. And I can fix that...

I never give cse on labor ward...

I totally don't understand his. 15f and 150m? It's like a different language. Personally sited epidural? Does that mean personally placed? Epi meaning epidural? Or epinephrine?
I am so lost.

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[chocomorsel]

Just wondering what everyone's hospital policy is. We are a small community hospital and take call from home. We currently require the OB (or their midwife) to be in the building when we place a labor epidural. Obviously, the OB department has an issue with this policy and wants it revoked.

Any thoughts? ASA says OB physician has to be readily available, but that is open to interpretation.

Ok, so let's assume the reason for this is in case the baby has some sustained decelerations, doesn't look good and needs to be emergently cut out, WTF is a midwife gonna do?

 

[IlDestriero]

Personally, I just want to know that you are familiar with the pt and abreast of her progress. If you have any concerns I would like to know what they are and that you are following them closely. I would also like to know the delivery plan if it isn't obvious. I really hate to get called to place an epidural in the middle of the night so that the OB can sleep. Then I get there and the pt isn't sure that they even want one. Do that to me once and I will ask that you see the pt before I place the epidural. Basically, you scratch my back and I'll scratch yours.

I've been there a few times. "Come in and place an epidural on this patient, 3cm, progressing, worsening pain, active labor, etc."
Sure, no problem... Get there and the patient doesn't even want one, has a 6 page birth plan, and is looking at me like I'm the devil. As if I wandered in on my own like the epidural fairy looking for business. I'm happy to not place an epidural in all the OB patients! Call me for your c/s.


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Il Destriero

 

[pgg]

I totally don't understand his. 15f and 150m? It's like a different language. Personally sited epidural? Does that mean personally placed? Epi meaning epidural? Or epinephrine?
I am so lost.

I plugged that mess into translate.google.com to convert it to Italian, then plugged that back in to convert it to German, then plugged that back in to convert it to English again, and here's what I got:

Just an hour ago I had a similar case. Personally I posed epidural. Hearing a lot of pressure but not cold. Presentation of the face.

He spat epi and put her back down. Heavy 2 ml 15f with 150m. no problem

If there is doubt about Epi when it comes to the time section, whip it. I also have the full dose of 2.4 ml post epi. Never had high spine ... just hypotension. And I can fix that ...

I have never CSE the Labor Office ...

Bottom line, when a problem comes along, you must whip it.



I think he meant he put in an epidural, seemed OK, got a sympathetic block, but patient felt a lot of pressure. Section called. He pulled the epidural and did a spinal with 2 ml hyperbaric 0.75% bupivacaine with 15 mcg of fentanyl and 150 mcg of morphine. It worked.

Then advised that you shouldn't take an imperfect epidural to section, just pull it and do a spinal. He's given a full 2.4 mg hyperbaric bupivacaine spinal after an epidural without ever encountring the book-predicted risk of a high spinal.

And he doesn't like CSEs for labor.

 

[facted]

Epidural topup is a million miles away in terms of analgesic effect compared to 2.4 heavy with f&m I'm

I know an obs anaestheist who had never give an epidural topup for section. Maybe a few times in his training. Spinal for everyone

I wouldn't do it... But I def prefer easy spinal to epi topup. Problem is of course, is it going to be easy?

Number one risk factor for a failed epidural during section is per the literature.....
Not comfortable during labor. They have a window, etc... Pull it out. Otherwise, I can't tell you the last time I had a failed epi for section when it was working during labor. Why put the patient through more procedures?

 

[Noyac]

Do you do this even if you had first loaded the epi? Is the dose the same regardless of the load?

Well, I do a CSE and I haven't had a CSE go bad, much less go to c/s. So usually there has been a enough time btw placement and the decision to cut. Now, if you painted me in a corner and said I had just placed a CSE and hr ETT needs an emergent c/s I would probably dose the epidural especially since she has an intrathecal dose also working.
If I had loaded the epidural and not have done a CSE which I do for early labor in primips then I would assess the airway and make up my mind. If a favorable airway then I'd probably do a spinal. If not favorable then I'd dose the epidural.
It's not a come one come all situation here. Judgement is key.

 

[Noyac]

Why do you pull a working epidural?

Sent from my SAMSUNG-SM-G920A using Tapatalk

Because they suck for surgery.

Seriously, I have very little tolerance for less than perfect anesthesia. I don't hold hands well and I'm not a person that enjoys sitting there telling everyone "it's ok, she's just a feeling it a bit, I'll give some ketamine." That's not good anesthesia in my book.

 

[Noyac]

I've been there a few times. "Come in and place an epidural on this patient, 3cm, progressing, worsening pain, active labor, etc."
Sure, no problem... Get there and the patient doesn't even want one, has a 6 page birth plan, and is looking at me like I'm the devil. As if I wandered in on my own like the epidural fairy looking for business. I'm happy to not place an epidural in all the OB patients! Call me for your c/s.


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Il Destriero

Hilarious. I chewed out a midwife for this and then got called to a meeting to discuss my behavior when dealing with said midwife. She brought her posse' of clueless midwives all with an axe to grind. 5 minutes into the meeting the OB said to the midwife, "you did what?" 10 minutes into the meeting the said midwife was crying. I promptly stood up and said, " this is supposed to be a professional discussion. I can't have a discussion with people who cry in the middle of our discussion. Call me when you can be professional." I never heard back from any of them.

 

[pgg]

posse' of ...

Ah, LOL.

 

[Noyac]

Ah, LOL.

I felt my term was inappropriate so I edited it. But I'm glad you enjoyed it.

 

[deleted697535]

I plugged that mess into translate.google.com to convert it to Italian, then plugged that back in to convert it to German, then plugged that back in to convert it to English again, and here's what I got:



Bottom line, when a problem comes along, you must whip it.



I think he meant he put in an epidural, seemed OK, got a sympathetic block, but patient felt a lot of pressure. Section called. He pulled the epidural and did a spinal with 2 ml hyperbaric 0.75% bupivacaine with 15 mcg of fentanyl and 150 mcg of morphine. It worked.

Then advised that you shouldn't take an imperfect epidural to section, just pull it and do a spinal. He's given a full 2.4 mg hyperbaric bupivacaine spinal after an epidural without ever encountring the book-predicted risk of a high spinal.

And he doesn't like CSEs for labor.

Yeah man. Basically that. Except I use 0.5 marcaine not 0.75.....


I didn't think it was very hard to understand. On an ob thread about epidurals how could you misconstrue epi as epinephrine? Anyway sorry for my rambling... I'm tired and grumpy lol

 

[GravelRider]

Hilarious. I chewed out a midwife for this and then got called to a meeting to discuss my behavior when dealing with said midwife. She brought her posse' of clueless midwives all with an axe to grind. 5 minutes into the meeting the OB said to the midwife, "you did what?" 10 minutes into the meeting the said midwife was crying. I promptly stood up and said, " this is supposed to be a professional discussion. I can't have a discussion with people who cry in the middle of our discussion. Call me when you can be professional." I never heard back from any of them.

Why do they always come in a posse' to these meetings? No profession "circles the wagons" as well as nurses and midlevels.

 

[deleted162650]

 

[chocomorsel]

I plugged that mess into translate.google.com to convert it to Italian, then plugged that back in to convert it to German, then plugged that back in to convert it to English again, and here's what I got:



Bottom line, when a problem comes along, you must whip it.



I think he meant he put in an epidural, seemed OK, got a sympathetic block, but patient felt a lot of pressure. Section called. He pulled the epidural and did a spinal with 2 ml hyperbaric 0.75% bupivacaine with 15 mcg of fentanyl and 150 mcg of morphine. It worked.

Then advised that you shouldn't take an imperfect epidural to section, just pull it and do a spinal. He's given a full 2.4 mg hyperbaric bupivacaine spinal after an epidural without ever encountring the book-predicted risk of a high spinal.

And he doesn't like CSEs for labor.

Hilarious PGG!!! That s hit was funny!! Thanks for translating.

 

[Twiggidy]

I've been there a few times. "Come in and place an epidural on this patient, 3cm, progressing, worsening pain, active labor, etc."
Sure, no problem... Get there and the patient doesn't even want one, has a 6 page birth plan, and is looking at me like I'm the devil. As if I wandered in on my own like the epidural fairy looking for business. I'm happy to not place an epidural in all the OB patients! Call me for your c/s.


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Il Destriero

As a matter of fact, I wish I could place the spinal and just leave the room

 

[Twiggidy]

Because they suck for surgery.

Seriously, I have very little tolerance for less than perfect anesthesia. I don't hold hands well and I'm not a person that enjoys sitting there telling everyone "it's ok, she's just a feeling it a bit, I'll give some ketamine." That's not good anesthesia in my book.

Speaking my language