OBSTETRIC ANAESTHETIST (OBS) 9120
Obstetric anaesthetist covers private birth suite epidurals from 0730 till 1730 weekdays.
1800-0800 1st or 2nd on call consultant may place epidurals if in hospital. Otherwise, covered by SR requested through 0400 page if urgent.
If pt refuses SR epidural out of hours 1st on Consultant can be called in but patient must be informed of 30 minute delay.
Requested via 0400 page, carried by registrar at all times. Between 0800-1300 there is a dedicated obstetric registrar (roving phone 5225, page 0799). At other times the obstetric cover is provided by the outside areas registrar that also coves pain and met calls.
Phone 9121 for any obstetric overnight handover.
Collect 9120 phone (charging base in office 6, please return at end of pm shift).
Obstetric Ward Round 0800
Attended by obstetric anaesthetic consultant and obstetric registrar, located at nursing station
Inpatient reviews 0830
This consists mostly of back checks, typically around 0830. There is a pain nurse available to assist with back checks. Private cases usually seen first but team may see public cases initially if consultant is held up.
Back check consists of checking for neuraxial complications, pain problems, examining back or previously reported neurology and explaining letters regarding complications and analgesia.
Neurology/back pain May take phone calls from discharged post neuraxial block patients. If minor can follow-up at next available SMAC appointment in antenatal clinic. If significant sensory/motor/bladder/bowel involvement/systemically unwell/fever arrange urgently to attend ED and assess. Where there are pain management concerns the pain team can follow up – please discuss with a pain consultant.
Afternoon obstetric consultant should take over phone between 1230-1300 hours, depending on morning workloads. When free from epidurals/back checks let DA know and help out with breaks and patient assessments. You may need to carry DA phone if DA especially busy with patient eg MET call/patient transfer
The afternoon cover for obstetrics is shared with pain and met call cover by the morning pain registrar. They carry the 5224 roving phone and the 0400 page.
Assist DA to enable evening staff to get dinner 1700-1730. May be required to stay till 1800 if clinical need. Usually second on carries 9120 so handover to them
Obstetric Anaesthesia Guidelines
The Guidelines for Obstetric Anaesthesia have been derived from the “Don’t Panic” guidelines in KEMH but have been adjusted to suit the JHC environment.
Public birth suite Epidurals Obs Consultant should be available to supervise juniors until they have their epidural ticket and to help with complicated epidurals. All registrars are required to get an ‘epidural ticket’ prior to solo insertions. This requires witnessing 5 epidural insertions (1 if signed off elsewhere).
Emergency Caesars DA and theatre coordinator should be phoned. DA will phone Obs Consultant and get them to assess patient/assist with transit unless DA closer to patient. Phone ahead to DA in theatre to communicate requirements.
These can be obstetric emergencies or neonatal emergencies on the ward. The registrar will get a call and the DA may ask you to attend these. The obs reg +/- consultant will be there. If neonatal, the neonatal CNC, paediatric registrar will attend +/- neonatologist/paeds consultant on call if able.
Post Dural Puncture Headaches
Blood patches If uncomplicated/obvious consent and book (use booking slip) to come to theatre. Can be done in empty theatre or anaesthetic room theatre 7. Use Obs Reg or other reg to assist. Check with anaesthetic coordinator (5065) for available assistance
If complicated/difficulty with diagnosis and need CT/ MRI, public patient will have to be readmitted to get MRI done without out of pocket expense.