OB death

[anbuitachi]

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Back in the news for some reason... from a year ago

Dr. Dmitry Anatolevich Shelchkov, a former Woodhull Hospital anesthesiologist, has been suspended pending the probe by the state Department of Health into the 26-year-old’s death last July.

Dr. Dmitry Anatolevich Shelchkov, a former Woodhull Hospital anesthesiologist, has been suspended pending the probe by the state Department of Health into the 26-year-old’s death last July.

www.thecity.nyc

 

[deleted875186]

what happened with this? Not much medical information, sounds like arrest after a routine epidural?

presumable unintended spinal dose of a large amount of local?

 

[LineAndBerry]

Sounds like spinal dose which was not recognized promptly with intubation, etc.
Two points, setting aside any negligence or malpractice issues:
1. An epidural is not just a routine procedure without risk, as it is too often treated by patients and OB providers.
2. Childbirth is not a routine procedure without risk as any cursory historical review will reveal.

Again, this is not to take anything away from potential malpractice issues involved here.

 

[coffeebythelake]

Back in the news for some reason... from a year ago

Dr. Dmitry Anatolevich Shelchkov, a former Woodhull Hospital anesthesiologist, has been suspended pending the probe by the state Department of Health into the 26-year-old’s death last July.

Dr. Dmitry Anatolevich Shelchkov, a former Woodhull Hospital anesthesiologist, has been suspended pending the probe by the state Department of Health into the 26-year-old’s death last July.

www.thecity.nyc

Why did they quote a doula jn this article?

 

[deleted126335]

Why did they quote a doula jn this article?

Because they care so much.

 

[GassYous]

Sounds like woodhull could use a midlevel emergency response team

 

[dannyboy1]

This is ridiculous. All we know is that a patient had a cardiac arrest after an epidural. Can be many things (PE, AFE, LAST) ect. The article is throwing the doc under the bus and also making this unfortunate incident some sort of social justice issue.

 

[coffeebythelake]

This is ridiculous. All we know is that a patient had a cardiac arrest after an epidural. Can be many things (PE, AFE, LAST) ect. The article is throwing the doc under the bus and also making this unfortunate incident some sort of social justice issue.

Agree there is too little information available to figure out what happened. Patient coded shortly after epidural. It could have been directly related or maybe not.

 

[dabears505]

Epidurals are such a nightmare. I hate how we are now involved in 80% of births in this country. Is there any other natural process that has been so altered with?

 

[bikelady]

Epidurals are such a nightmare. I hate how we are now involved in 80% of births in this country. Is there any other natural process that has been so altered with?

Pretty much all of medicine? Isn't our entire field dedicated altering the "natural processes?" Do you tell the surgeons to let the "natural process" play out?

 

[jpgoodie]

This is ridiculous. All we know is that a patient had a cardiac arrest after an epidural. Can be many things (PE, AFE, LAST) ect. The article is throwing the doc under the bus and also making this unfortunate incident some sort of social justice issue.

Interesting this is re-surfacing now, given recent events. I'm sure we're going to see more and more of this, where complications related to minors or people of color are going to start being called race issues. I hope not, but I won't be surprised. Sad because we treat all patients the same, i.e. none of us want negative or adverse outcomes for any of our patients.

 

[dabears505]

Pretty much all of medicine? Isn't our entire field dedicated altering the "natural processes?" Do you tell the surgeons to let the "natural process" play out?

I don't think so. We usually treat pathology. Not a natural state.

 

[DocVapor]

I don't think so. We usually treat pathology. Not a natural state.

Outside of strict Amish communities and others like them, gestation and childbirth loses the naturalness factor long before we get involved.

 

[Southpaw]

I don't think so. We usually treat pathology. Not a natural state.

I don't feel I treat pathology most days. Most days I'm taking care of patients having surgery they wouldn't need if they took better care of themselves. I guess you could make the argument that it's still pathology, but I just don't feel that way.

 

[Southpaw]

The epidural certainly isn't treated like the invasive medical procedure that it is. It's treated by patients, nurses, and OBs as a woman's birthright. I certainly see no way to get this runaway train back to the station but I do wish there was more thought and consideration into the fact that not everyone needs an epidural and not everyone should get one. All that said, my wife had one with the birth of our children and I really don't believe she'd have made it without the epidural.

 

[anbuitachi]

The epidural certainly isn't treated like the invasive medical procedure that it is. It's treated by patients, nurses, and OBs as a woman's birthright. I certainly see no way to get this runaway train back to the station but I do wish there was more thought and consideration into the fact that not everyone needs an epidural and not everyone should get one. All that said, my wife had one with the birth of our children and I really don't believe she'd have made it without the epidural.

thats a huge issue too and can easily be made into a lawsuit.
'i requested epidural, but i didnt get one. i now suffer from emotional distress from the childbirth experience'

ive definitely had situations where i was too busy on LD with sections and epidurals get delayed. and since some patients ask for one when they are pretty dilated already, ive had patients deliver before we could get to them.

 

[coffeebythelake]

Epidurals are such a nightmare. I hate how we are now involved in 80% of births in this country. Is there any other natural process that has been so altered with?

That's called progress.

 

[coffeebythelake]

thats a huge issue too and can easily be made into a lawsuit.
'i requested epidural, but i didnt get one. i now suffer from emotional distress from the childbirth experience'

There are other ways to provide pain relief during childbirth. An epidural is a purely elective procedure. I seriously doubt this will ever get litigated the way you've described.

 

[chocomorsel]

Interesting this is re-surfacing now, given recent events. I'm sure we're going to see more and more of this, where complications related to minors or people of color are going to start being called race issues. I hope not, but I won't be surprised. Sad because we treat all patients the same, i.e. none of us want negative or adverse outcomes for any of our patients.

Although we think we treat all patients the same there is research that shows that minority patients are often ignored, are called dramatic, people think they can handle more pain than the Caucasian race and often times, their complaints aren’t taken seriously.
It’s called bias, based on stereotypes and old horrible research conducted on unsuspecting minorities; it does exist and leads to patients with the same problems being treated differently due to their race.
This story is not complete so who knows what happens. But there is truth to biased treatment in medicine.

 

[deleted162650]

Although we think we treat all patients the same there is research that shows that minority patients are often ignored, are called dramatic, people think they can handle more pain than the Caucasian race and often times, their complaints aren’t taken seriously.
It’s called bias, stereotypes and it does exists and leads to patients with the same problems being treated differently.
This story is not complete so who knows what happens. But there is truth to biased treatment in medicine.

Don’t take her seriously. She’s just being dramatic.

 

[GassYous]

Although we think we treat all patients the same there is research that shows that minority patients are often ignored, are called dramatic, people think they can handle more pain than the Caucasian race and often times, their complaints aren’t taken seriously.
It’s called bias, based on stereotypes and old horrible research conducted on unsuspecting minorities; it does exist and leads to patients with the same problems being treated differently due to their race.
This story is not complete so who knows what happens. But there is truth to biased treatment in medicine.

I can't take this seriously.

 

[chocomorsel]

I can't take this seriously.

I don’t give a damn what you take seriously or not.

Tuskegee happened, one of the founders of OB/Gyn experimented on black women where research was based. Hospitals were segregated in the past and blacks received inferior care.
So there’s that.

 

[dabears505]

That's called progress.

I'm not so sure about that

 

[coffeebythelake]

I don’t give a damn what you take seriously or not.

Tuskegee happened, one of the founders of OB/Gyn experimented on black women where research was based. Hospitals were segregated in the past and blacks received inferior care.
So there’s that.

while i don't think such explicit racism exists today like what happened with the tuskegee experiments etc, there are still implicit biases, stereotypes in healthcare.
can't just blame healthcare disparities on the broader socioeconomic inequalities that exist in our country.
report by Institute of Medicine: “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.”

 

[deleted697535]

I don’t give a damn what you take seriously or not.

Tuskegee happened, one of the founders of OB/Gyn experimented on black women where research was based. Hospitals were segregated in the past and blacks received inferior care.
So there’s that.

I think ppl were joking, not about the bias you describe!
Easy now

 

[Mman]

Epidurals are such a nightmare. I hate how we are now involved in 80% of births in this country. Is there any other natural process that has been so altered with?

pays the bills so I am not complaining

 

[coffeebythelake]

I'm not so sure about that

relieving pain in childbirth isn't a noble goal? it has dramatically improved the quality and experience of childbirth for millions of women. And it is a choice that women make which is empowering. If they want to do it without epidural that's perfectly fine as well.
here in America we've had epidurals for childbirth for decades and it is readily accessible so maybe you don't have much context.
look at the stories from UK
look at the data from China
then feel grateful we have the resources and personnel to allow this to happen.

i think you should hang your hat questioning why there are so many unnecessary c-sections, rather than lament on why so many women get epidurals.

 

[chocomorsel]

I think ppl were joking, not about the bias you describe!
Easy now

Not this dude. I think he is dead serious.

 

[deleted875186]

I also think it’s a plus that the United States can offer epidurals to most laboring women.

I agree epidurals are not risk free, but in a healthy patient, any serious complication should practically be a never event.

 

[deleted697535]

I mean i

relieving pain in childbirth isn't a noble goal? it has dramatically improved the quality and experience of childbirth for millions of women. And it is a choice that women make which is empowering. If they want to do it without epidural that's perfectly fine as well.
here in America we've had epidurals for childbirth for decades and it is readily accessible so maybe you don't have much context.
look at the stories from UK
look at the data from China
then feel grateful we have the resources and personnel to allow this to happen.

i think you should hang your hat questioning why there are so many unnecessary c-sections, rather than lament on why so many women get epidurals.

What stories from the uk?

 

[GassYous]

relieving pain in childbirth isn't a noble goal? it has dramatically improved the quality and experience of childbirth for millions of women. And it is a choice that women make which is empowering. If they want to do it without epidural that's perfectly fine as well.
here in America we've had epidurals for childbirth for decades and it is readily accessible so maybe you don't have much context.
look at the stories from UK
look at the data from China
then feel grateful we have the resources and personnel to allow this to happen.

i think you should hang your hat questioning why there are so many unnecessary c-sections, rather than lament on why so many women get epidurals.

I am also unfamiliar except that it seems that people in other countries deal with pain and discomfort much better than Americans.

 

[coffeebythelake]

I mean i

What stories from the uk?

Women asking for epidural and being told they cannot get one due to reining in costs.

Caesareans and pain relief for mothers giving birth 'should be cut to save the NHS money'

New guidelines drawn up for GPs urge them to encourage women to have natural labours with as little medical help as possible.

www.dailymail.co.uk

America vs. Britain: Which Country’s Better For Expectant Mothers? | BBC America

[caption id="attachment_1388" align="alignnone" width="460"] Which side of the pond is better for expecting mothers? (Press Association via AP Images)[/caption] Reassuringly, whichever country you pick...

www.bbcamerica.com

 

[coffeebythelake]

I am also unfamiliar except that it seems that people in other countries deal with pain and discomfort much better than Americans.

Probably a combination of expectations and access. I'm sure if given the option many more women in other countries will get an epidural during childbirth. I refer you to data from China. They had traditionally low epidural rates but increasingly rapidly (since 2000 onwards) as anesthesiologists begin to offer it to parturients and as the costs become less onerous. You can look up "no pain labor and delivery" program in China for more details.

No Pain Labor & Delivery – – Global Health Initiative (NPLD-GHI) by ApgarCARE® International Inc.

nopainld.org

 

[deleted697535]

Women asking for epidural and being told they cannot get one due to reining in costs.

Caesareans and pain relief for mothers giving birth 'should be cut to save the NHS money'

New guidelines drawn up for GPs urge them to encourage women to have natural labours with as little medical help as possible.

www.dailymail.co.uk

America vs. Britain: Which Country’s Better For Expectant Mothers? | BBC America

[caption id="attachment_1388" align="alignnone" width="460"] Which side of the pond is better for expecting mothers? (Press Association via AP Images)[/caption] Reassuringly, whichever country you pick...

www.bbcamerica.com

Thats wierd

Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study

Anna Seijmonsbergen-Schermers and co-authors report on use of childbirth interventions and associated outcomes in high-income countries.

journals.plos.org

epidural rates are around only 15% in uk versus 75% in us

 

[abolt18]

while i don't think such explicit racism exists today like what happened with the tuskegee experiments etc, there are still implicit biases, stereotypes in healthcare.
can't just blame healthcare disparities on the broader socioeconomic inequalities that exist in our country.
report by Institute of Medicine: “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.”

You mean like these "studies" where they let a NP learn how to do colonoscopies and majority of the patients HAPPEN to be black? Far less explicit.

 

[coffeebythelake]

Thats wierd

Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study

Anna Seijmonsbergen-Schermers and co-authors report on use of childbirth interventions and associated outcomes in high-income countries.

journals.plos.org

epidural rates are around only 15% in uk versus 75% in us

Unclear what you are trying to get at. Seems like the data while different in absolute % can be used to support the same conclusion. People tend to get epidurals a lot more in the United States than in the UK, and you cannot say it is because it is by choice or that the Brits "handle the pain better".

You mean like these "studies" where they let a NP learn how to do colonoscopies and majority of the patients HAPPEN to be black? Far less explicit.

You would need to see how these studies were designed and how they decided to choose particular sites for their design. Can I say that those studies are due to outright racist authors? Seriously doubtful. But that's the thing with implicit biases -- the people doing them might not even know they are doing them. For any single study, it can be difficult to tease out whether blacks are disproportionately affected due to their race vs. the social determinants of health. However when you look at studies at a whole it may point to an overall pattern of implicit biases that drives them.

https://email.nm.org/owa/auth/logon.aspx?replaceCurrent=1&url=https%3a%2f%2femail.nm.org%2fowa%2f

 

[anonperson]

The epidural certainly isn't treated like the invasive medical procedure that it is. It's treated by patients, nurses, and OBs as a woman's birthright. I certainly see no way to get this runaway train back to the station but I do wish there was more thought and consideration into the fact that not everyone needs an epidural and not everyone should get one. All that said, my wife had one with the birth of our children and I really don't believe she'd have made it without the epidural.

What's the thought and consideration exactly? Who shouldn't get one?

Seems simple enough, if having excruciating pain and coags/platelets are normal and patient can sit still, then patient should be able to get an epidural.

I tell my patients, no one technically needs an epidural but it makes a fairly unpleasant process more manageable.

Anecdotally, I have seen plenty of cases where a first time laboring mom is writhing around in pain at 3cm and is constantly contracting their pelvic floor. Get them an epidural and they sleep/relax and a few hours later they're ready to push out a baby.

 

[Southpaw]

What's the thought and consideration exactly? Who shouldn't get one?

Seems simple enough, if having excruciating pain and coags/platelets are normal and patient can sit still, then patient should be able to get an epidural.

I tell my patients, no one technically needs an epidural but it makes a fairly unpleasant process more manageable.

Anecdotally, I have seen plenty of cases where a first time laboring mom is writhing around in pain at 3cm and is constantly contracting their pelvic floor. Get them an epidural and they sleep/relax and a few hours later they're ready to push out a baby.

The G1 at 3cm isn't a good example. She may very well have a long road ahead of her and one could make the argument that she medically needs an epidural, but some still hold out forever for, well, reasons. Regardless, that's not what I had in mind when I posted. I'm more thinking of the countless number of times I've placed an epidural in a G4 with prior vaginal deliveries who comes in at 8-9cm screaming and demanding an epidural stating she can't push a baby out without it. She can. And she most likely will in minutes whether or not she gets an epidural. Guaranteed in minutes? No, but certainly most likely.

When I get called for an epidural, more often than not it's 'Ms. HavinABaby is ready for HER epidural' as if I have something of the patient's that she let me borrow and now I'm being called to go give it back. It's her possession, something she's taking home with her to keep forever.

We can go round and round about this forever, but my guess is we'd find more commonalities than differences on the issue.

 

[Aheadbyacentury]

There is so much to unpack here but what I know from the facts so far is that this is a medical complication. Period. Until proven otherwise and for the journalist to make it into more is just more Fake news. Complications, mistakes and death happen to ALL people of ALL colors and races..

 

[coffeebythelake]

The G1 at 3cm isn't a good example. She may very well have a long road ahead of her and one could make the argument that she medically needs an epidural, but some still hold out forever for, well, reasons. Regardless, that's not what I had in mind when I posted. I'm more thinking of the countless number of times I've placed an epidural in a G4 with prior vaginal deliveries who comes in at 8-9cm screaming and demanding an epidural stating she can't push a baby out without it. She can. And she most likely will in minutes whether or not she gets an epidural. Guaranteed in minutes? No, but certainly most likely.

When I get called for an epidural, more often than not it's 'Ms. HavinABaby is ready for HER epidural' as if I have something of the patient's that she let me borrow and now I'm being called to go give it back. It's her possession, something she's taking home with her to keep forever.

We can go round and round about this forever, but my guess is we'd find more commonalities than differences on the issue.

like so much of anesthesiology, in the operating rooms and outside of it, patients (and surgeons) expect it to be there whenever they want it.

 

[Aheadbyacentury]

When I get called for an epidural, more often than not it's 'Ms. HavinABaby is ready for HER epidural' as if I have something of the patient's that she let me borrow and now I'm being called to go give it back. It's her possession, something she's taking home with her to keep forever.

Its truly awful how cavalier everyone treats an epidural. While Im discussing complications with the parturient she is not even listening when I mention bleeding etc etc.. She just signs away... Even the nurses give me the stink eye when Im telling them about complications.

 

[coffeebythelake]

Its truly awful how cavalier everyone treats an epidural. While Im discussing complications with the parturient she is not even listening when I mention bleeding etc etc.. She just signs away... Even the nurses give me the stink eye when Im telling them about complications.

You think its because they are in a ton of pain? A mentor of mine, one of the biggest names in obstetric anesthesiology, once said that you can argue laboring patients are making their decisions under duress. They come in labor, can barely hold still, screaming and hyperventilating, and they really just want something to help take away the pain. When I come in the room with all the epidural supplies, you can bet the patient has already made up their mind they want the epidural. That's why it makes more sense to see them early on and consent them when they have the mind to think clearly and understand your explanations regarding complications.

As for the OB nurses giving you the "stink eye", that's just how OB nurses are like. They can be a special breed of crazy.

 

[Aheadbyacentury]

Hving read this thread, do you think busy OB anesthesiologists should be paid a lot more then someone who says does the same amount of Cardiac? Since I would argue doing OB anesthesia carries a lot more risk and in a riskier population and your intervention can be more easily be pointed to as the cause of whatever untoward outcome there is. Whether it is neonatal death, Maternal death, fetal asphyxia, back pain, post epidural spinal headaches, backpain, Persistent paresthesias.

 

[anonperson]

The G1 at 3cm isn't a good example. She may very well have a long road ahead of her and one could make the argument that she medically needs an epidural, but some still hold out forever for, well, reasons. Regardless, that's not what I had in mind when I posted. I'm more thinking of the countless number of times I've placed an epidural in a G4 with prior vaginal deliveries who comes in at 8-9cm screaming and demanding an epidural stating she can't push a baby out without it. She can. And she most likely will in minutes whether or not she gets an epidural. Guaranteed in minutes? No, but certainly most likely.

When I get called for an epidural, more often than not it's 'Ms. HavinABaby is ready for HER epidural' as if I have something of the patient's that she let me borrow and now I'm being called to go give it back. It's her possession, something she's taking home with her to keep forever.

We can go round and round about this forever, but my guess is we'd find more commonalities than differences on the issue.

The G1 could technically have her baby without an epidural as well. Patients in resource poor countries do it all the time. It's just a miserable process.

Same for the multips. I don't begrudge them for wanting to push with some pain relief. Pushing out a baby even if one has done it before doesn't seem pleasant.

I'm not an anesthesiologist but I still get amazed at the night and day difference with patients pre/post epidural. It's a testament to modern medicine/anesthesia.

 

[chocomorsel]

You think its because they are in a ton of pain? A mentor of mine, one of the biggest names in obstetric anesthesiology, once said that you can argue laboring patients are making their decisions under duress. They come in labor, can barely hold still, screaming and hyperventilating, and they really just want something to help take away the pain. When I come in the room with all the epidural supplies, you can bet the patient has already made up their mind they want the epidural. That's why it makes more sense to see them early on and consent them when they have the mind to think clearly and understand your explanations regarding complications.

As for the OB nurses giving you the "stink eye", that's just how OB nurses are like. They can be a special breed of crazy.

Except in many places, when you try to go in early and talk to the patient about an epidural, OB nurses won’t allow you, or will give you the worst “stank eye” ever for trying to push them into an epidural they don’t want. Only to call you a few hours later, almost always at 1 AM, because now she’s an agonizing pain and wants to push 7 cm.
I hate OB.
I had the same discussion with my cousin one time while she was pregnant, and she acted like it was her right to demand an epidural at any time. Even if she had declined it when offered prior.
Did I say how much I hate OB already?

 

[GassYous]

Its truly awful how cavalier everyone treats an epidural. While Im discussing complications with the parturient she is not even listening when I mention bleeding etc etc.. She just signs away... Even the nurses give me the stink eye when Im telling them about complications.

I couldn't give two ****s what the nurse thinks. Ob floors are ridiculously overstaffed and yet they are completely useless in an emergency.

 

[nimbus]

Hving read this thread, do you think busy OB anesthesiologists should be paid a lot more then someone who says does the same amount of Cardiac? Since I would argue doing OB anesthesia carries a lot more risk and in a riskier population and your intervention can be more easily be pointed to as the cause of whatever untoward outcome there is. Whether it is neonatal death, Maternal death, fetal asphyxia, back pain, post epidural spinal headaches, backpain, Persistent paresthesias.

At my practice, our busy OB folks do make more than anybody else including busy cardiac. OB is the only part of anesthesia where one anesthesiologist can simultaneously run multiple cases. On a very busy day, they can generate 2-3x units of someone in the OR. OTOH, a quiet L&D can be a money loser and stipend dependent.

 

[narcusprince]

There are levels to your practice.
Early on does plan A work? Switch to plan B? Does plan B work switch to plan C?

Very well that doc could have recognized that he indeed injected into the interthecal space.

Bradycardia Asystole start your ACLS management. Secure the airway. He may very well have done these things and met the standard of care.

With radical social reform we need to be cognizant that we can over correct. We can see racial bias when there is in fact not. I know our history and I know of the horrible things done in this country to people who look like me. But is it not equally horrible to pass judgment and say someone whom has worked their entire life to help those in need is commiting and act of malice?

 

[Aheadbyacentury]

I couldn't give two ****s what the nurse thinks. Ob floors are ridiculously overstaffed and yet they are completely useless in an emergency.

You will care when you are on the unemployment line what the L and D nurse thinks when she complains about your attitude at 2 am

 

[GassYous]

You will care when you are on the unemployment line what the L and D nurse thinks when she complains about your attitude at 2 am

You mean the jobs everywhere with signing bonuses line?