December 12, 2002

Those anaesthetists again!

I’ve been off the air for a couple of days, while my trusty laptop has an upgrade. It is like trying to survive without one’s umbilical cord - I am gasping for a “fix”!

The debate about the anaesthetists and the epidurals is going strong at one hospital in Australia. I have been corresponding with two of the educators about this issue and will post here some of that conversation - perhaps some of you are in the same boat in your area. I am sure these tactics are nothing new. I will put their email message italics for clarity:

Had our meeting at the hospital today - mind you, not one anaesthetist turned up! For now, Preparing for Birth has been withdrawn from CBE classes - but we are working on it.
Typical of the anaesthetists not to turn up -probably too busy putting in the epidurals and making money to be bothered! If parents still want the books, you can give them the web site address and we can send them from here....
Anyway, we presented all your references..... however some of them are from 1981, so they could be questioned. However, my colleague and I argued that if no further research has been done since then, are these references then not accurate???
Yes, the point is that no other research has been done - the date doesn't make research any less valid, in fact the Sepkoski paper was done ten years after the Rosenblatt paper to replicate and check the results and they were the same.
There seems to be a view that if there is no research, there is no problem. Two problems with this (for starters) often research with poor results or unexpectedly negative findings doesn't get published because people only want to good news, and research on the effects of drugs on newborns is expensive and time consuming to do - therefore it is often avoided. Doesn't mean that there is no problem, just that it hasn't been found or else written up. Parents have a right to know when there is no research - this also means that a treatment/drug etc can't be shown to be safe, either. A good strategy for parents to use is for them to ask the doctor if they are prepared to give them a signed statement that the treatment being offered is "safe". When this is refused, as it will be, this gives the parents a lot to think about.....
We are also going to spend a day perusing the drug book at the hospital, in an effort to find a correlation between different types of drugs used in epidurals, and the subsequent birth outcomes for the last 2 years. Apparently there is one drug, which gives a great epidural block, but "seems" to lead to fetal distress and emergency caesar. We are going to find out!
Epidurals typically are a mixture of an anaesthetic (usually bupivacaine) and an opiate (Fentanyl or pethidine or some others). It will be interesting to see what you turn up. See if you can get a copy of the package insert for the drugs check what it says about contraindications/side effects. Ask the anaesthetists how they feel about using a drug with these listed side effects and check if they are giving this information to the parents as part of the informed consent process. Management might like to know this too - the drug companies list this information to protect themselves in case of litigation, and the info is supposed to be taken on board by the doctors too. In the event of a case, there is little likelihood that a drug company will be effectively sued if they can show that the side effects and contraindications were made available for the doctors' benefit so they could act appropriately regarding the use of the drug.....
The unit manager will meet with the doctors next week. She will present our findings and explain that your book cannot be touched. She will also lay down the law about their "guest speaking" and will let us know how she goes. She will also ask that they withdraw their comments about ambulent epidurals being the norm -what a complete lie!!! Nobody in this hospital has ever walked after an epidural!
These days most anaesthetists are now recommending against walking around with a "mobile" epidural because of the risk that the woman might fall over due to the woozy head (opiate drug effect) and loss of sensory nerve feedback from her legs -numb feet make it hard to walk confidently). She might then sue them and hospitals are not willing to take this risk (risk management is all the go these days). Your guys have obviously not caught up with this latest advice! How are they going to "sell" mobile epidurals in light of these new recommendations, I wonder?
Interestingly, an obstetrician in this town is advising his clients not to attend our CBE classes.... says he has all the current research in his rooms and there's no need to do classes elsewhere.... and his wife, his receptionist, talks to the clients about parenting! We will tackle him also!!!! Part of his CBE includes "I break the ladies' waters for her at 4cm", etc.... the list goes on. Surely he cannot understand anything about social networking, adult learning principles, informed choice and so much more.
This kind of behaviour could be construed as a "restrictive trade practice" ! Might be worth dropping that into the conversation!

This is not the end of this story.... it will have more chapters, for sure!

Posted by andrea at December 12, 2002 08:11 AM