A patient requested an epidural during labour of a stillbirth. While siting the epidural, the anaesthetist was called away to an emergency c-section. An hour later, the anaesthetist was called to a second obstetric emergency c-section. The Senior midwife bleeped two other anaesthetists who were  unable to attend. A fourth anaesthetist was due to attend following a request to the anaesthetic office, however, baby was delivered before they arrived. The patient and her partner were very distressed during and after delivery.

Commentary

Delay in receiving epidural analgesia during labour is a common cause of complaint, particularly if there’s a failure to provide the woman with an epidural before birth.  National guidelines state that the anaesthetist should attend within 30 minutes, or exceptionally 1 hour, of a request for an epidural, where the preconditions for regional analgesia have been met.   There should be a robust escalation plan to ensure this timeframe is achieved.¹ In this case, if the anaesthetic office had been contacted earlier, the problem may have been avoided.

1. Guidelines for the Provision of Anaesthesia Services for an Obstetric Population 2025, Royal College of Anaesthetists