• Sweden edition

Mum endures c-section without anaesthetic

Published: 10 Feb 10 08:45 CET | Double click on a word to get a translation
Online: http://www.thelocal.se/24896/20100210/

A woman has reported Lund University Hospital to Sweden's Medical Responsibility Board (HSAN) after being subjected to a caesarian section without the benefit of an anaesthetic.

The incident was never followed up by the hospital and no report was made of the extraordinary nature of the woman's ordeal, according to local newspaper Sydsvenskan.

"I heard later that they had thrown the report away," the woman told the newspaper.

The hospital has conceded that several mistakes were made during the operation as it became clear that the anaesthetic administered to the woman was not working.

During the procedure, the woman complained to the surgeon that she could still feel as layer upon layer of her abdomen was being cut through, but was told that it was too late to put her to sleep. She instead worked hard to try to stay calm.

The incident occurred at the maternity clinic, which told the newspaper that the circumstances would be reviewed and admitted that mistakes were made.

Päivi Kannisto, deputy head at the clinic, explained that the first mistake occurred when the anaesthetist expressed concern that the anaesthetic had not worked. But this was not perceived by the doctor conducting the operation.

The task of formulating a report over the incident was given to a trainee doctor - a further error, Kannisto conceded. The incident was never reported as the senior physician never saw the report.

The woman was furthermore denied the right to access her medical journal on request.

"We can only apologize that it turned out this way," Kannisto told Sydsvenskan.

The woman and the child have now fully recovered from their ordeal.

TT/The Local (news@thelocal.se/08 656 6518)

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10:58 February 10, 2010 by peropaco
Why am i not surprised about this report?
11:21 February 10, 2010 by sagar
again ... the law of torts needs a major upgrade ... this is not setting a good precedence for a modern society
12:08 February 10, 2010 by krrodman
May sound crazy but this situation is not as rare as one might think. Been there during 30 year career. Occurs maybe 1% of cases, maybe less. A spinal or epidural is placed for a cesarian section. It works partially(it would be impossible to perform surgery on a wide awake patient with no anesthesia). Some areas are well anesthetized, some are not. Often times there is just a single small area that is not well anesthetized.

Here is the tough part..... General anesthesia is riskier for both the mother and baby so there is a sound reason not to add a general anesthetic in addition to the spinal anesthetic unless absolutely necessary. Even a sedative to calm the mother will sedate the baby as well as the mother. Needless to say, rarely it is necessary to administer a general anesthetic when the spinal/epidural has completely failed.

Here is the key point: Once the baby is delivered - should be less than 5 minutes after the start of surgery - the mother can be heavily sedated or, if necessary, a general anesthetic can be given without any risk to the baby. The risk of general anesthesia remains for the mother but sometimes it is necessary to take the risk. In any case, the mother should not be in pain for more than 5 minutes before aggressive intervention.
12:53 February 10, 2010 by Skallywag
@Krrodman

Hats off and well said Kroddman. If you are right (as your comment does sound extremely convincing). It is really good to see someone really trying to explain why this happens and putting across the facts, instead of the usual comments e.g "well why am I never failed to be surprised by these reports" (Sorry peropaco not picking on you I promise) as one does see many similar comments from other people who simply say the same as in "why am I never surprised blah blah blah....
14:01 February 10, 2010 by calebian22
"She instead worked hard to try to stay calm"

Holy crap! Hari Kari without the kaishakunin. Tough Lady.
14:45 February 10, 2010 by StockholmSam
It is a good thing humans have had anasthesia for the past 5 million years...otherwise, I don't see how our species would have survived the ordeal of giving birth. We would have died out eons ago.
14:51 February 10, 2010 by LailaC1
Wow Stockholm Sam that's harsh. Alot of women don't elect to have a caesarean but have to have the procedure done in order to deliver a baby safely due to complications. I am in awe of this poor woman and the trauma she went through.
15:20 February 10, 2010 by sissygirl
@Stockholm Sam I gave birth twice with no meds, all natural. I thought I was gonna die. But I was perfectly fine once that little darlin' was out.

I have heard of epidurals not working. But never heard such a story like this. 5 minutes is a long time to be in her kind of pain.
15:35 February 10, 2010 by krrodman
I do not know the particulars of this case.

I don't know if the baby was in distress making delivery of the baby an urgent matter. I don't know if the mother had risk factors for general anesthesia(obesity/ recent meal/diabetes/ high blood pressure etc) All of these factors would be critical to the actions of the anesthesiologist.

I do know that in medicine we are often forced to make a decision between two less than perfect alternatives. For the purposes of this discussion I am going to assume that the anesthesiologist was concerned and well trained and diligent. In a situation like this, the anesthesiologist was forced to choose between the patient having pain for a short period of time, or putting the patient at risk by administering a general anesthetic. In the high risk the potential complications from general anesthesia are real and potentially life-threatening. So, the decision is not always an easy one.

We do not have enough information to decide if the doctor acted in the best interests of the patient or not.
15:40 February 10, 2010 by Puffin
This is not an uncommon situation - I've read about many cases in many different countries where there is no time to wait for the anaesthetic to take effect and they operate without. There was one in the UK were the woman was paralysed but not put to sleep.

The weakness of the situation in Sweden is that the whole system relies on the clinic reporting itself to the national board of health and welfare for investigation. some are more inclined to do this than others
18:45 February 10, 2010 by kenny8076
LailaC1 i think what stockholm was trying to say is that women have been giving birth both normal and c-section since the first humans millions of years ago...... and probably even harsher ways, anaestesia i guess is a bonus now a days not a must have to give birth..... convenience...... it sucks, but so does life sometimes, i wish i could have a baby so my girlfriend wouldnt have to go through the pain but it is what it is
20:12 February 10, 2010 by Twiceshy
Stockholm Sam I suppose you're being facetious so I will not honor that stupid argument with a real reply.
06:54 February 11, 2010 by HarryBosch
Oh my goodness. I'm speechless. How could this happen in Europe?
07:20 February 11, 2010 by alison36
i totally believe it, i had a spinal block 3 months ago and i felt most of it, i felt pain, no one would listen to me, it was hideous and that was in australia!
12:43 February 11, 2010 by Sam1
IDIOT, i swear to God 50% of Swedish doctor are dumb asses and I say it to their face, when they do an operation they shiver and freak, the should Go to India or some country and learn as a practicant. Poor women.

EVERY ONE SUFFERS FROM THE MEDICAL CARE IN SWEDEN. their rule is like communist you cant change your doctors, they are pack of DOGS in a hälsocentral mafia they support each other. No specialist all are general medicine.

If they dont know what is a disk? or IBS, or some new disease this means you are okay to them. I luckily met a german doctor in Stockholm who helped me and thank God. i meet some foriegn docs here once a while. better than nothing.
21:07 February 11, 2010 by SouthAfrican_in_Sweden
@ Sam1.

Still can't belief how well the social system (including medical care) work here in Sweden. I have sympathy with any individual who has a bad experience and of course think the responsible caregiver should be investigated and reprimanded if proves to be human error BUT compared to many other countries people living in Sweden have a lot to be thankful for.

I continue pay my tax with a smile.
09:53 February 12, 2010 by karex
@kenny8076

Have you stopped to read what you wrote? ...Women have been giving birth by c-section for millions of years...? Do you know what a c-section is? It involves CUTTING someone open with a knife. Millions of years ago, indeed even as recently as a century or so women either gave birth naturally or died in the process.
20:40 February 12, 2010 by Curt Cornella-Carlson
Usually the level of anesthesia is checked before beginning the operation . In an emergency, the doctor can also inject the layers of the abdomen with a local anesthetic - like Lidocaine. It does take a couple of minutes before it begins to work. Maybe there was fetal distress - baby with an abnormal heart beat and they could not wait?
08:40 February 24, 2010 by aglaria
more cases of the same problem pop up now in Swedish media.

The reasons for a doctor to make a decision to go forward with an big operation like that is one thing.But that after such a major incident the complete medical staff passively agrees not to report the incident ,be quite about it and hide it by throwing away the report..........

In my eyes it shows a common problem in Swedish society, nobody takes responsibility for his actions and the laws and rules are bend when you might get in trouble .

I bet you that this is going to end up in the same way as a million times before and a million times after.

There´s going to be an investigation into the case of a group heavily over paid people, its going to take as much time as it takes to let everybody forget what it was all about.

The conclusion will be vague recommendations , no disciplinary actions will be taken to anybody.

Then everything can go back to normal
22:17 March 7, 2010 by tenorlove
It can happen anywhere -- When I was 10, I had to have stitches after I cracked my head open in a bicycle accident. The local anesthesia did not take, and they kept on stitching, even though I was screaming. The doctors at first told me I was lying about being in pain, then told me I deserved it for being careless on my bike. When my own child had to have stitches in his head (he climbed the deck rail & fell off), I insisted that he be put out, and stayed with him until he was under. He was released about 2 hours after he woke up, and as soon as he got home, he ran straight for the deck rail & started to climb it again. He's 15 now, and will still climb anything that doesn't climb him first, and that's the only time he's ever gotten hurt. I feel for this woman, I'm incensed that the hospital tried to cover it up, and I hope she sues the pants off the hospital and wins.
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