Posted by My OB said WHAT?!?.
Mar
24
Posted by My OB said WHAT?!?.
“That’s Okay, I Prefer Not To Do Them On Overweight Women Anyway.”
“That’s okay, I prefer not to do them on overweight women anyway.” -Anesthesiologist to mother who said she preferred not to have an epidural during an unplanned cesarean.
There are 29 comments to this post.
How rude! When they become doctors, do they plan on only treating the ones they like?
I thought it was about caring and helping all people.
And I agree with Jane, it’s like he’s *allowing* her to not submit to his ministrations. Thanks for the permission, doc.
Sheesh.
Micah, she may be scared enough of needles that general was a more attractive option to her. I could sympathize with that terror.
Wow, this one gets a prize for sheer rudeness and falls under the category of “If you have nothing nice to say…”
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It IS harder to get an epidural in.
My anesthesiologist tried TWICE before putting in a spinal block which was much easier and less painful than the other two.
He said overweight. Not fat, not huge; nothing derogatory. I’d rather hear overweight than obese any day.
Shoot me down if you want but as a woman who was in the same situation I wish they never would have tried the epidurals as it ended up being very traumatic for me.
I had to have a lumbar puncture 8 months ago and because of my experience with the epidurals I cried, shook and screamed the entire procedure.
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Heather Reply:
March 24th, 2010 at 8:54 am (Quote)
I had a spinal as an “overweight” woman and aside from breaking the equipment that had nothing to do with the actual puncture, the anesthesiologist had no problem at all. And with my VBAC, I had an epidural, again, overweight, only this one had even less problem than the first–as in, zero. Never commented on my weight, either. So, that’s a YMMV kind of thing.
It’s the way it was said that was rude and completely unnecessary, particularly to a woman about to undergo an unexpected cesarean. There was no reason at all for him to say anything except, “Okay, well, this is what we’re going to do…”
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Danielle Reply:
March 25th, 2010 at 5:23 am (Quote)
That doesn’t change the fact the clinically epidurals are more likely to fail in certain women and one of the groups associated with the risk is obesity.
While he or she didn’t have to mention it, they didn’t weren’t mean about it. Someone telling me I am overweight is like when I go in for an IV and they have trouble (even if I tell them they will) because I have fair skin and eyes which is clinically true. Hence my new portacath.
This is just my opinion based on medical fact.
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the Deranged Housewife had this to say,
Mar 24, 2010 @ 6:54 am (Quote)
Is it me or is this just a nice way of saying, “I don’t think fat women deserve pain relief”? WTF?!
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Jane Reply:
March 24th, 2010 at 7:02 am (Quote)
See, I could “get” if he meant “I find the epidural needle is more difficult to place on an overweight woman,” but it was a rude way of saying it. “I’d prefer a different form of anesthesia for you too because I’m not sure I’d do a good job, like the incompetent anesthesiologist in the previous MYOBSAIDWHAT post.”
But why tell her it’s okay that she make an informed medical decision? Isn’t that her right?
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Danielle Reply:
March 25th, 2010 at 5:28 am (Quote)
Clinically, overweight women are more likely to not get pain relief from them or a block failure. Also in that group are multiparity, of a previous failure of epidural anesthesia, cervical dilation of more than 7 cm at insertion, the use of air to find the epidural space while inserting the epidural instead of other things like N2O, saline or lidocaine and being a regular opiate user.
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Maybe this was a roundabout way of saying that he was not confident in his level of skill on larger women?
Either way, as an expression of prejudice or incompetence, the remark does not reflect well on the professionalism of the practitioner.
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We’re only getting a snippet of the conversation here. Of course, the mother found it offensive if she sent it in, and that is most important. Unless, as I have wondered, these quotes have been gleaned from various birth stories. Just wondering…..
At any rate, when I had my planned/unscheduled cesarean, the anesthesiologist made it very clear to me that she would do an epidurial “if I insisted,” but that she would much prefer to do a spinal. I later learned (from my OB, who among other things is a wonderful teacher), that some people can do epidurals well and some can’t. It’s a matter of being able to feel where the needle is, and some people just *are*not*good*at*it*. I would think that more tissue between the skin and the spinal membranes would increase the difficulty of feeling where the needle is. Perhaps the dr in the op was one of the ones who has diffiiculty to begin with, and really isn’t confident in his ability to do epidurals.
He should have stopped at “That’s ok,” though.
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Kat Reply:
March 24th, 2010 at 8:39 am (Quote)
teapot: He should have stopped at “That’s ok,” though.
And this is the whole point of mentioning it here. The remark about the woman’s weight was irrelevant, disrespectful, and rude.
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The Deranged Housewife Reply:
March 25th, 2010 at 7:56 am (Quote)
You’d think that with the high percentage of women who get epidurals in labor these days, no one would be bad at placing an one.
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Michelle Potter had this to say,
Mar 24, 2010 @ 2:12 pm (Quote)
Personally, what I took from this story is that this doctor has poor communication skills. He may well have been trying to say that due to the mom being overweight, and possibly also due to his skill level, administering an epidural would be more difficult and therefore riskier. (I don’t know whether that’s true, or if it is, whether it should even be an issue for a skilled anesthesiologist, but regardless it seems possible that it’s what he was trying, and failing, to get across.)
However:
* What’s the point of bringing it up? Mom doesn’t want an epidural, he doesn’t want to give her one, why does he need come up with reasons not to do it, especially dragging in an issue that may be sensitive for the mom? Just let it go.
* Telling the mom that he “prefers” not to do epidurals on overweight women does not give her any useful or medically relevant information. His “preference” is not really relevant, and bringing it up really just obfuscates the issue. If there’s a medical issue mom needs to know about, tell her. If not, leave it alone!
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first, let me say his comment was insensitive, un called for and he should have been reported. I read the remarks on this site to remind myself of the dumb things we say at the bedside and how it’s received by the public.
Most, if not all Anesthesiologist prefer regional anesthesia or epidural/spinal to general anesthesia or being put to sleep, because on the larger patient there is increased liklihood of difficulty intubating her due to short necks and increased tissue blocking the airway. Once the drugs for general anesthesia are given to mom, we have a small window to get the baby out before the drugs impact the baby. On the other hand, regional anesthesia allows the doctor to move at a steady pace because the drugs given to mom don’t pass into the bloodstream to affect baby. Remember, a prior C/S means more scar tissue he has to cut through. Sadly, when a woman goes to sleep, she doesn’t always get to see her baby before the baby goes to the nursery. Another point to remember is a patient that goes to sleep often wake up in pain, whereas with regional anesthesia and the addition of pain medicine into the catheter carrying the epidural or spinal meds has proven to decrease usage of pain medicine and earlier bonding. In a true emergency, the larger mom as the smaller one will be put to sleep unless she already has an epidural. Hope this helps.
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I’m not condoning his comment at all but, the expectation of perfection in any discipline is not realistic. In the facility I worked at, all patients that did not have an epidural already in place when a C/S was called received a spinal. In a true blue emergency the patient goes to sleep. I am curious as to what the woman received anesthesia wise for her C/S. Did she go to sleep or was a spinal placed. Epidurals can take up to 20 minutes to begin working whereas a spinal is immediate and almost always done during pregnancy prior to surgery. I suspect this was the reason he didn’t want to place one. The epidural space is not a true space so air is used to create a space for the medication to go in and bathe the nerves with pain and numbing medication. As to why normal saline or lidocaine is not used is a question I’ll ask anesthesia the next time I have an opportunity.
Placement of an epidural or spinal is dependent on many factors: The experience of the person placing it, if an average needle that comes in a pre-packaged kit to locate the space is used or if a longer one has to be called for. If the patient has had a prior bad experience or really frightened, which will make it difficult for her to sit still. She’ll jump everytime she is touched during placement. Honestly, it is near impossible to hit a moving target. Remember the anesthesiologist is trying to get between two bones that are packed one on top of the other. The only way to get into it is to have the woman bend over her abdoman opening the spaces. Some women especially if they are short have tighter spaces and the placement is all based on one sense of the body, touch; once in a great while the person placing the epidural can hear a small pop once the space is located. Another factor for an epidural not working is patient movement once it’s in place which can cause the catheter to move out of the space. One last thing to remember is that not all people are made the same. Have you ever noted that your hair is thicker or curls on one side versus the other or maybe one eye seems higher, maybe your breast are different. How many people have different shoe sizes? The human body comes together in the middle where the little brown line runs down from chest to pubic area. I’ve always found it utterly amazing that we are put together as well as we are. But, doesn’t it make sense that the back might be off center just a
little and this accounts for some women having coverage on one side versus another or maybe a hot spot? Yes, there are some that place epidurals and spinals better than others just like there are days I couldn’t hit a vein if my life depended on it and I’ve done IVs for 20+ years even going to other floors to start IVs. All this aside, it doesn’t excuse the anesthesiologist’s comment. Please always ask questions; in this case there may be some literature out there with a different take on this subject. If you ever have to have surgery again, explain to your anesthesiologist your fears and concerns in your pre-op visit.
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Sheva Reply:
March 26th, 2010 at 7:01 am (Quote)
None of us are complaining about his apparent lack of confidence, or even his possible lack of ability.
The only reason this was posted was because of his lack of TACT.
I don’t expect perfection from my caregiver, nor do I think s/he should be able to do everything. On the contrary, I commend and respect a caregiver who can say, “This is outside my area of expertise.”
But there is no reason to insert an insult into that sentence.
And this woman who said she didn’t want an epidural probably had either a medical reason or an emotional one, both of which should have been answered with a simple, “Ok, so let’s explore other options.”
And, most patients who have reasons for not wanting one form of treatment have already explored those other options and have come prepared with other ideas to discuss with their caregiver.
Also, you said that sometimes even skilled caregivers have their ‘off’ days.
True. But when you are finding it hard to place an IV, do you apologize for the extra prick, or do you tell the patient s/he has tiny veins?
As a caregiver, you can change the same uncomfortable/embarrassing/scary situation into a good one, just using your words. And the opposite is true, too, as evidenced by this post.
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Sheva,
You are 100% correct. There is absolutely no excuse for bad manners, and I have made this clear, more than once in the two post I’ve sent to this site on this subject.
I am a great proponent of Patient rights’ and Responsibilities’, Patient Satisfaction,and Patient Safety. Because I feel so strongly on these subjects, I have Chaired many committees pertaining to these subjects. Because I feel so strongly on these subjects, I teach not only patients but families, nurses, and residents many different subjects but, there is always a thread throughout the lecture with my passion for patient safety, satisfaction and rights throughout.
It doesn’t matter if the Anesthesiologist is having an off day or he is normally a jerk, unless he subscribes to this site, the unacceptable behavior continues because he has not been called to accountability. Patients’ have alot of power. The power to say: NO, or the power to say: WHAT DO YOU MEAN? and finally, the power to say: THAT WAS NOT OK, AND I WANT SOMEONE ELSE. A better venue to channel these grievences is on the Patient Satisfaction Survey, that every patient should receive a few weeks after a hospitalization. Fill the survey out and if the survey doesn’t directly address the area you have taken exception to, then use the comment section. These surveys get alot of attention and they don’t require a signature; however, names of people, signatures and telephone numbers are POWERFUL medicine. A pamphlet on Patient Rights and Responsibility is given to each patient on admission, read it. Take Childbirth Classes, empower yourselves.
Now, in terms of my IVs, well…no one has ever complained to my Manager or Administration through letters or surveys. Maybe they complained on this site….but, it never got back to me for accountability ;therefore, I can’t make changes in my words or technique to the detriment of other patients.
Childbirth should be a wonderful experience for parents, but it takes all parties working together to make it happen. Communication is a wonderful thing.
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Sheva Reply:
March 28th, 2010 at 6:21 am (Quote)
I’ve done that on many occasions and I’ve never received feedback about my experience. The one time that I actually made my complaint in person, where I incurred a lot of debt for tests I had to have run that weren’t covered by insurance because of this nurse’s incompetence, and a lifelong condition, I was basically told by the administrator of the hospital that it was my word against hers (even though I had the labs to prove it, and the backing of two other doctors not affiliated with that hospital). So, while in a perfect world what you are saying is amazing, it hasn’t worked for me, ever.
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Sheva,
If you have a life long illness as I do, then you have indeed encountered many situations along the way to influence your present and future experiences. From what I’m reading, it sounds like you have justifiable, unresolved anger from prior bad experiences and have developed a chip on your shoulder expecting the very worse from health care. Have you ever tried going through Patient Relations? If you haven’t then for future reference, it’s a good place to start. Patient Relations is a department that acts on the patient’s behalf. Now for me, there are two ways of looking at a situation: either the glass is half full or the glass is half empty. I have always chosen to see the glass as half full. I try to put a positive spin on everything life throws my way and as you’re aware this outlook is not always easy. My Grandmother would have said the Anesthesiologist was acting bad because he wasn’t getting any sex; she loved to embarass me. I apologize on behalf of those of us in health care that believe in the system for the wrongs done to you. You are very bright and possess a strong personality. I suspect you are quick to put people on the defensive. Put your facts and documentation together in order of importance; take your information to Patient Relations to garner their support, be congenial but firm. Finally, remember that nurses have a Nursing Board in every state they are accountable to; also, physicians have a Medical Board in every state and finally, administrators report to the hospital Board of Trustees. Very best to you and the plate you’ve been served.
TheaMarie
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Hi, I’m the submitter/Mom.
The comment was made by the anesthesiologist after my induction failed. This was in 1996 with my first son. I was absolutely terrified of the idea of a needle in my back, and requested general anesthesia. My problem with his comment was as many of you have pointed out – it just wasn’t necessary, and it did sting. Believe me, I am well aware that I am overweight. I am embarrassed about my body under the best of circumstances. In this instance I was in pain from the Pitocin contractions & back labor, and had been feeling awkward due to my size anyway. It just was a tack-on to the anesthesia discussion that wasn’t needed. IMO.
Fast-forward 4 years. I had a VBAC with our 2nd son (no epidural then either, I didn’t want one), and am in labor with our 3rd son. His cord prolapses and I find myself facing a repeat section. There was never any discussion – I was given a spinal (for which I was grateful, since I got to be awake for the birth of our baby!). I told the doctor what the other had said in 1996 before he started. After the spinal was done, he said to me: “You have a beautiful back for this type of thing.” How nice was that? I didn’t really think I needed healing from the first doctor’s comment — until it happened.
I had our 4th son 8 weeks ago today. I told *that* anesthesiologist what the second had said. Now he may have been humoring me, but after the procedure was done, he told me that the complimentary doctor had been right 
As it happened, there was a bit of trouble with the spinal in this instance, in that the first one didn’t fully take. I was tingly but could still feel touch and wiggle my toes. So, the spinal was re-done, and that second time it worked as it was supposed to. Whether the failed first dose had anything to do with my weight or not I don’t know; the doctor did not indicate that was the case.
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Serene Reply:
September 1st, 2010 at 8:10 am (Quote)
I am a very big girl (now… I didnt used to be! 
) but yes these comments sting. I can look at it and say to myself that yes its easier to give a spinal/epi in a small woman because there is less tissue to navigate, but the way he said it was just that little bit too senseless for me. Theres usually no need to even bother commenting on the weight issue. Most of us KNOW about it already!
I had a Nurse tell me once to get the next gauge needle for my insulin because “obese people have thicker skin to get through” and apparently my insulin could not have been working properly. OK. Fair enough. But could people not phrase these things better? Or how about “your recent medications have increased your weight so you might need a larger needle, would you like to try it?” BTW< my insulin was working fine and dandy… HbA1c of only 5.4!
Gah! We are human too!
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Em_Urgency Reply:
July 6th, 2011 at 3:30 am (Quote)
I see that many women come in with totally unrealistic birth plans, ideas of what the “just will not tolerate” and sometimes it’s frustrating to deal with.You must accept I want this and that, you may not do this or that…until they hurt.Then it hits the fan, get the doc in stat, I need medication, I don’t want to feel this any longer all the while they are jumping around in the bed.
Comes time to set-up, hurry up, no my baby daddy will not leave the room, no my camera people won’t give you any room, hey I’m on the phone right now can you wait. Yeah, I’m here all night ma’am.
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Every nurse that has worked OB has walked into a room full of drama. I have often found these women have either not educated themselves on the process or family/friends/doctor/ or hospital personnel have a different idea of what their labor and delivery experience should be. Twice in twenty years I’ve had to excuse myself from a bedside and trade assignments because I wasn’t the right nurse for the patient. These two women were drug addicts and we both wanted to be in charge. I traded assignments with a nurse who had practiced in New York. Good for the patient, good for the nurse. With the exception of these two women, I have found good manners, good listening skills and a willingness to work with women and their needs brings even the most chaotic of situations under control as you build trust. Remember, Nursing is a calling and if you have this much frustration, it may be time for a break.
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That’s okay–I’d rather not have medical procedures done by a blithering idiot.
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