November 8, 2005

Epidurals: Needle In, Dad Out?

epidural_needle.jpgDanny Gregory got the automatic boot from the delivery room when his wife Patti was having her epidural. In our case, the topic never came up; I stayed through the whole thing, including the part where the hippie anesthesiologist stuck a Pulp Fiction-sized needle into the middle of my wife's spine. Other times, delivery room staff will ask a dad if he wants to stay or if he'd be better off waiting outside. Terrible story: one dad in California fainted while helping hold his wife for her epidural; he fell, hit his head, and died two days after the baby was born. [yes, there's a lawsuit.]

The result: there's no one way to approach the issue of spectators at an epidural. Policies are set by each hospital/birth center, so ask beforehand, and find out. Guys who get queasy around needles--especially large, curved needles, called Tuohy needles, for those playing at home--should pipe up about it in advance. And folks who want to stick together [no pun intended] through the whole thing should ask about it, too. There are surprises enough in the delivery room as it is.

Any insights on how or why these policies vary, or how to deal with it?


Thanks so much for the follow up, Greg! And, incidentally, all the friends whose husbands were asked to leave during the epidural were all in CA. Maybe the fainting dude started a policy trend there (especially considering Kaiser Permanente is one of the major insurers in So Cal)?

Fainting seems just as likely at any of the other shocking things that can happen at a birth. Or more so, actually. So if it's a policy thing, they ought to kick all spectators out for the duration. I don't see how falling and hitting your head is grounds for a lawsuit (it is a sad story though).

I think that the policy varies depending on the anesthesiologist - and not just for epidurals. My mother got the boot when they were threading an IV into my hand at my last surgery.

When my sister had her epidural, the doctor asked us all to stand with our backs to the wall. He did let our cousin, the med student, stand closer. When my sister started to bleed, cousin reached a hand out into the sterile feild. (An ungloved, unsterile hand.) The doctor flipped out on her (briefly, while still setting the epidural correctly!), then explained afterwards that couson's reaction is exactly why he asks people to stand back. Not becuase he's afraid they'll pass out and hurt themselves, but becuase they could contaminate the wound area while he's got the spine basically open. Instant meningitis!

They have to do what they have to do. I was in the room with my wife for both C-sections. I am very bad with this stuff. I almost fainted and I wouldn't have been bothere if they asked me to leave. She's (and the baby) more important than me. So at that moment the was more important than me since they had to take care of them.

They even began to make a little fun of me. They even put some music on to help me calm down while they joked around. It was quite an experience.

It's my understanding that one of the major Boston hospitals kicks the dads out because of the high fainting rates. The hospital has a policy that anyone who faints MUST go to the emergency room and basically the ER got sick of dealing with fainting almost-dads.

With the first one my husband was asked to leave, with the second one he wasn't. The births were in two different hospitals, but in the same state (about an hour away from each other) so I am guessing it depends on the hospital policy or maybe even just the anesthesiologist's personal policy or even liablity insurance?

It seems to vary by the individual practitioner's preference, or maybe some hospitals have a blanket policy about it. My husband was in the room for my epidural (but positioned so he was facing my front, and couldn't see what was going on). When my son was in the NICU, some nurses tried to make us leave when they had to shift his IV around or draw blood, and some didn't. We always refused to leave, and it was never a problem.

Our hospital had the policy that the nobody except hospital personnel could be in the room during the epidural.

I didn't really mind though. The thought of a shot in the spine kinda creeped me out.

It is amazing that the epidural would bother me. I dealt with 12 hours of unmedicated labor and 2 hours of pushing and a c-section.

Lenox Hill Hospital throws the dads out before the epidural--same reasoning as in Boston: too many fainting dads. Probably better I wasn't there, anyway. It seems that she jumped as they were putting the needle in and slammed into the jaw of the nurse holding her down.

Of course, my wife watched me get 2 epidural injections for a herniated disc, and she didn't faint, which still amazes me, as she's afraid of even the smallest of needles.

My husband was ordered to sit down during the CVS procedure when I was 11 weeks pregnant. Apparently a dad had fainted recently and hit his head. The CVS is essentially watching an ultrasound on a monitor. I hope the guy who fainted during that was far, far away when his partner was having an epidural!

If I recall correctly, he was allowed to stay during my epidural. I do not live in California (at the moment).

Chicago Prentice (Northwestern) Hospital kicks Dads out for this as well. Was about 40 minutes before I could return. Not a huge deal though.

At Kaiser West LA (CA) a nurse came running in panicked when the CRNA was going to let me stay for the epidural. She not only booted me out of the room, but banished me from the "birthing pavillion" all together. They wouldn't let me back in until the CRNA was gone and the nurse had cleaned up and tucked my drugged (and happy) wife back into bed. I work at a medical school, and have taught anatomy, so fainting wasn't an issue with me (and the CRNA didn't have a problem with me being there).

I was there for all (4) epidurals during the birth of our son. wife had to get (4). The first one didn't work and then the errors kept on piling on. Make sure that you don't have an overly tired fourth year resident who is NEVER going to work in maternity. (He took 40 minutes trying to put the first one in) and his attending was worse. For all the attempts I was holding my wifeís hand, trying not to flip out. She had been induced and was in full on labor,in excruciating pain, hunched over on the side of the bed while they tried to make it work. It was horrendous and finally our OB took charge and said enough and waited for the next team to come in. Apparently, my wife had weird physiology, which was compounding the problem, but it was a horrendous ordeal for all of us. I was staring at my wife and holding her hand and occasionally I looked at the nurses and the looks on their faces told me that it wasnít going well. I could tell they had 0 confidence in the first two docs and that is not a good feeling. Thankfully it did turn out all right becuase the relief team was awesome and just had twins himself so he knew what we were going through. The Chief of the department came by the next day to talk to us and he apologized for the terrible job the first two anesthesiologist did. Our OB had called him that morning and had a major meltdown (she is the attending physician and in charge of the OB residency program at UT-Houston at Herman HospitalÖit helped that she had some pull). Thank god our nurses rocked and our OB took charge and threw the first two out of the room. Later, my wife told me that she NEVER could have made it through the experience without me and I told her that seeing her in pain like that was the most difficult thing I have ever experienced. I canít imagine how hard it would have been if we werenít there for each other.

As a labor and delivery nurse, I've worked at a half-dozen hospitals on the west coast, and none of them have had a policy that support people had to leave while the epidural was administered.

I always cautioned the fathers (not just for the epidural, for the entire birth process) to make sure they kept a chair or stool near them in case they started feeling lightheaded. I said it was their responsibility to sit down at the first sign of faintness, stressing that there was ONE patient in the room and we didn't need any more.

This lawsuit is a crock. To term what we ask fathers to do in an epidural placement (stand/sit in front of the mother and provide support and reassurance) as "assisting" in the procedure is a bit of a stretch. The lesson of this sad case, as with a lot of medical malpracice suits, is "shit happens." Assigning blame isn't going to bring him back.

Guys, it's simple. Epidural - be in front of her. Delivery - be behind her (or on the side)

I was told quite simply, 'it is a sterile procedure, and we would like to minimize any non-sterile interferences'...

That being said, I stayed anyway. My guess is that the patient needs to be focused while insertion is taking place. Having a hovering husband probably doesn't help matters...

As an anesthesiologist and mother/epidural recipient, my solution to the (its more common than you'd think) fainting significant other is to have him/her sitting in front of my patient...this prevents him/her from seeing the needles piercing skin, protects him/her from a fall from standing, and gives her someone to concentrate upon during the procedure. It can be frustrating when administering an epidural anesthetic to answer intermittent questions or have someone near the sterile field. In addition, it is important to recognize that each person can present a technically "difficult back" which is often worsened by posture. Sometimes an epidural goes in in 2-3 minutes, sometimes it can take 1/2 an hour. Sometimes, they don't work and need to be replaced...I know as a recipient - and mine was placed by an experienced, fellowship trained anesthesiologist on one of the busiest maternity wards in NYC.

i was allowed to stay in the room but sit in chair 3 foot in front of my wife with the anesthesiologist behind her and hence all the needles out of site. I'm glad they did not send me out of the room.

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