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#1 of 51 Old 06-05-2006, 12:35 AM - Thread Starter
 
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Not sure where to put this but...I want to have a homebirth (when I get pregnant anyway) more than ever now. Very sad


A routine epidural turns deadly

Julie and Chris LeMoult were excited parents-to-be. Did a hospital infection turn the happiest day of their lives into a nightmare?

There is a national effort underway to try to get hospitals to report their infection rate. Seven states have now adopted legislation to require it, and 33 states have legislation pending. Click here to find out where your state stands.

mod edited due to copyright concerns

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#2 of 51 Old 06-05-2006, 12:53 AM
 
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To me, this is an excellent example of why we need nurse staffing ratios in hospitals. Studies have repeatedly shown that the risk of death increases with each patient a nurse carries above six in a low acuity-setting and one in a high-acuity setting (which labor and immediate postpartum are considered to be). recognizing the signs of infection and what is and is not normal following an epidural is a nursing assessment. Giving ordered antibiotics is a nursing role. If the hospital had been appropriately staffed, it's very possible that could have made the difference despite what may have been substandard medical care. Good and adequately staffed nursing care can and does make up for a host of medical errors.

It may not have made a difference, and infection is one of the known risks of an epidural. But the timely recognition and treatment of infection could have made a difference, and staffing makes a difference in how well nurses can function.

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#3 of 51 Old 06-05-2006, 12:56 AM - Thread Starter
 
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Luckily CA already has a law for safe ratios and MA is basically there too. Now we just need the rest of the states to follow.

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#4 of 51 Old 06-05-2006, 02:23 AM
 
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This is such a sad story. It really highlights the necessity for INFORMED consent to epidurals. The docs/hospitals and our society see this as a routine part of hospital care and people are pushed to have the epidural, many of whom do not have the faintest clue what the risks are. Just as there are risks to homebirth, which are spouted by many people when they find out someone is going to have (or has had) a homebirth, there are also very serious risks and complications from medical intervention too!

I consented to the epidural with my first, after knowing the risk and wanting with everything I had not to chance it, so i find it horribly sad to read,

"...one needle down, one big one to go! And it will all be worth it!"

It definitely wasn't worth it this time. Thankfully, most experiences aren't like this, but everytime there is one, it needs to be brought to the foreground, so that people can start becoming aware of the associated risks of medical interventions.

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#5 of 51 Old 06-05-2006, 02:41 AM
 
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Originally Posted by Keshia
Not sure where to put this but...I want to have a homebirth (when I get pregnant anyway) more than ever now. Very sad

While I absolutely agree that this is incredibly sad and frightening, I wonder what the risk of maternal death is during a routine, uncomplicated homebirth?

I know the risk of overall maternal death during vaginal delivery is 1 in 10,000. Is the risk roughly the same, better, or worse during homebirth?

I ask because the risk of maternal death due to epidural is 1 in 200,000.

So while I can see where this article is sad and frightening, when you look at the FACTS, you are WAY more likely to die during an uncomplicated, unmedicated, routine vaginal delivery than you are to die from placement of an epidural.

Now, that doesn't mean the risk is a good one for every woman to take, as there are other very real risks besides death from getting an epidural. But to think that homebirth is somehow safer based on this article alone is a bit unrealistic IMO.
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#6 of 51 Old 06-05-2006, 03:07 AM - Thread Starter
 
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Originally Posted by wifeandmom
But to think that homebirth is somehow safer based on this article alone is a bit unrealistic IMO.
Yes that's obvious. I didn't always want a hospital birth, then read this article and think "OMG! No more hospital for me!". I'm sorry I made it seem that way.

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#7 of 51 Old 06-05-2006, 03:16 AM
 
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Originally Posted by Keshia
Yes that's obvious. I didn't always want a hospital birth, then read this article and think "OMG! No more hospital for me!". I'm sorry I made it seem that way.
No need to apologize!

Research is definitely on the side of midwife attended homebirth for a woman who is low risk. Of course, there are still risks that go along with that choice, but choosing a hospital birth doesn't make the process risk free. It presents DIFFERENT risks.

An epidural has its own set of risks, however maternal death is NOT one that I'd spend a great deal of time fretting over, as it literally is what I posted earlier. One in 200,000 women will die as a result of epidural placement during labor. There are a *whole lot* of other potential deadly complications us women can focus our worries on that are much more likely that dying from an epidural.

Wouldn't it be nice if there was an option that truly WAS risk free? What would we worry about then?
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#8 of 51 Old 06-05-2006, 03:27 AM
 
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i know i just saw this on dateline tonight!

so sad i posted in homebirth because this really makes me want one i was 99.9% sure but now i think im 100% sure for a homebirth!

because stuff like this happens more then we think. imho

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#9 of 51 Old 06-05-2006, 09:48 AM
 
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I think the hospital was not concerned because the symptoms of her infection are also commonside effects of an epidural. They probably see it all the time and just thought she was a whiney patient. When the symptoms went beyond that they took her to ICU.

This and other stories like it definitely influence my desire to have a homebirth. Hospitals are full of germs, full of sick people. Infections can be spread.
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#10 of 51 Old 06-05-2006, 10:00 AM
 
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God how heartbreaking for that poor motherless little boy and his family.
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#11 of 51 Old 06-05-2006, 10:19 AM
 
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I only read 1/2 of that but I do want to say that I have a friend who's wife got menengits from her epidural as well, she's fine now. Personally, I am afraid of anyone putting anything sharp anywhere near my spine, but this makes it worse. Poor family.

Heather
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#12 of 51 Old 06-05-2006, 10:34 AM
 
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Am I the only one who noticed that she was induced? Come on, ladies. Let's go get a pit induction! Then we can get an epidural 'cause the pit cxt are evil. It's just so much more conVIEnient to choose your baby's birth day with an induction...

Sorry but they don't DO that at home, and yes, homebirths are statistically as safe or safer for normal healthy moms. As a matter of fact, studies have shown that, for most HIGH risk births, home birth is as safe as hospital birth, because interventions aren't there to put the baby at further risk.

I'm sorry, though. This was a well educated couple. I put SOME of the blame on them. I don't want to sound hard hearted, because it's an awful tragedy. However, you are going to have needles and major MAJOR drugs put into your body, and you DON'T KNOW OR CARE ABOUT the RISKS? I'm sorry, but there's a reason that the page you sign when you give consent is so full of very fine print. THere's a reason the line you sign says that you've asked all the questions you have and that those questions have been answered to your satisfaction. Because you have a responsibility to KNOW the risks, and to weigh them versus the benefits. She was a normal, healthy, low risk mom. Why was she being induced? It was an unnecessary induction, an unnecessary epidural. Yes, the hospital should have been more careful about the sterile field. But if she hadn't been administered the pit, would she have needed the epidural? If she hadn't chosen the epidural, would she have gotten meningitis?

I'm sorry, but my husband had major abdominal surgery and his wound was infected by a hospital strain strep. Having surgery in a major hospital brings that risk. You can get it from the sheets, from a bandage...even bleach and antimicrobal cleaners don't kill these bugs. It's a risk you take with surgery. My husband had another surgery in his abdomen where we asked over and over and OVER again whether it would affect his fertility, as we would have saved sperm if it would. We were told no, that it wouldn't affect his fertility. So, we felt fine reading all the risks on the paper, not finding fertility, and signing the informed consent feeling like we were informed (it was a life saving surgery, so the risks listed were definately worth the benefit of his survival. However, the docs lied to us about the risk of infertility, as they really believed that he was going to die anyway, and it wouldn't be an issue. Well, he lived. We were as informed as we could be, and very unhappy about the results. However, this was a life or death procedure. Julies was NOT. Her's was a convenience procedure.

Sorry mamas. I really agree with homebirth, too, and this is just one more reason. I mean, in general, homebirth midwives just don't advocate convenience inductions or running away from the work of childbirth, so this wouldn't have happened at home. But, they were obviously too mainstream to be using a homebirth midwife. So, where do we go from here? Education. The hospitals ARE NOT going to give full education about inductions, epidurals, and c-sections. They are what make the hospitals and the doctors the big bucks. And they ARE in existance to make money. We really need to have more NON hospital birthing classes around. We need to make them commonplace, with all the real info about all the interventions that take place in hospitals. We need to challenge the status quo, and make mainstream women question interventions too.

I see this a less of a homebirth issue and more of an education towards evidence based medicine issue. And the only way we'll get more education is if we call for it. So, are we going to see this as a call to action? I hope so. I really do. SOrry to be so intense...can you tell I'm passionate about this?...

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#13 of 51 Old 06-05-2006, 10:34 AM
 
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Just saw that on Dateline. I was blown away by the stats they gave: More Americans die from hospital aquired infections each year than AIDS, breast cancer, and auto accidents combined!!! : 1 out of every 20 hospital patients will develop a hospital aquired infection!

And to think of all the comments I got about how I really shouldn't give birth at home because "hospitals have a sterile environment."

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#14 of 51 Old 06-05-2006, 10:59 AM
 
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I know the risk of overall maternal death during vaginal delivery is 1 in 10,000. Is the risk roughly the same, better, or worse during homebirth?

I ask because the risk of maternal death due to epidural is 1 in 200,000.

So while I can see where this article is sad and frightening, when you look at the FACTS, you are WAY more likely to die during an uncomplicated, unmedicated, routine vaginal delivery than you are to die from placement of an epidural.
I find this hard to believe. I have to wonder what the circumstances surrounded those maternal deaths during birth have been?
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#15 of 51 Old 06-05-2006, 11:00 AM
 
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More Americans die from hospital aquired infections each year than AIDS, breast cancer, and auto accidents combined!!!
Anybody have sources for this?
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#16 of 51 Old 06-05-2006, 11:04 AM
 
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http://www.timesonline.co.uk/article...204359,00.html

This was a story in the UK last week highlighting the effects of human error when administering any drugs in hospital.Apparently most lines on epidural bags are tagged or a different colour to prevent this occuring but human error is another risk factor that mothers should consider when choosing treatment.
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#17 of 51 Old 06-05-2006, 11:16 AM
 
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Originally Posted by fourlittlebirds
I find this hard to believe. I have to wonder what the circumstances surrounded those maternal deaths during birth have been?
I would guess the hospital. I know they don't give you any risk/benefit ratio when they give you epidural. no "this is what will happen if you get the epidural, this is what MIGHT happen, this is what COULD happen...do you still want it" just "oh you want an epidural? GREAT lets get someone in here ASAP."

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#18 of 51 Old 06-05-2006, 11:39 AM
 
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I had an emergency c-section and had to be rehospitalized shortly after returning home due to a massive infection in the incision (it was caught just as it was hitting my uterus, luckily).

Considering the severity of the infection and the fact that the incision had been constantly covered from the time I left the hospital until I went to the OB's for the pain, I had to have gotten the infection at the hospital. I only required 24 hours of IV antibiotics and went home with my babe a second time (I demanded he come with me), thankfully. Luckily.
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#19 of 51 Old 06-05-2006, 11:44 AM
 
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Originally Posted by wifeandmom
While I absolutely agree that this is incredibly sad and frightening, I wonder what the risk of maternal death is during a routine, uncomplicated homebirth?

I know the risk of overall maternal death during vaginal delivery is 1 in 10,000. Is the risk roughly the same, better, or worse during homebirth?

I ask because the risk of maternal death due to epidural is 1 in 200,000.
Do you think the two can be teased apart, though? In other words, are some reported maternal deaths during delivery due to epidural and are reported as resulting from the delivery? Or are some epidural deaths due to pregnancy complications are are put down as being caused by epdural?

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#20 of 51 Old 06-05-2006, 01:50 PM
 
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Originally Posted by fourlittlebirds
I find this hard to believe. I have to wonder what the circumstances surrounded those maternal deaths during birth have been?
You find what hard to believe?

The stats that 1 in 10,000 women die during vaginal delivery?

The stats that 1 in 200,000 women will die as a result of epidural placement during labor?

Not sure what to tell you, except these are the numbers. For vaginal delivery, think PPH that cannot be controlled so mom bleeds to death, amniotic embolisim, infection due to retained placenta that leads to septic shock and death, etc etc etc.

It's rare, 1 in 10,000 certainly isn't a huge number, but I personally know of two women who have died after vaginal deliveries. If I count the ones that DH is aware of through working on L&D for the past 3 years, that number goes to 5. It happens. It's well documented. I know you can find the 1 in 10,000 number on almost any website dealing with vaginal delivery vs. c-section (which carries a 1 in 2500 risk of death or 1 in 5000 risk of death if it is a scheduled section with no labor).

As for the epidural risks, that number comes from research as well. DH gets all the anesthesia publications, and I've never seen the number any HIGHER than 1 in 200,000 for laboring women, although I have seen it LOWER in some studies. I figured I'd go with worst case scenerio since it's still such an incredibly low risk.
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#21 of 51 Old 06-05-2006, 01:51 PM
 
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Originally Posted by fourlittlebirds
I find this hard to believe. I have to wonder what the circumstances surrounded those maternal deaths during birth have been?
You find what hard to believe?

The stats that 1 in 10,000 women die during vaginal delivery?

The stats that 1 in 200,000 women will die as a result of epidural placement during labor?

Not sure what to tell you, except these are the numbers. For vaginal delivery, think PPH that cannot be controlled so mom bleeds to death, amniotic embolisim, infection due to retained placenta that leads to septic shock and death, etc etc etc.

It's rare, 1 in 10,000 certainly isn't a huge number, but I personally know of two women who have died after vaginal deliveries. If I count the ones that DH is aware of through working on L&D for the past 3 years, that number goes to 5. It happens. It's well documented. I know you can find the 1 in 10,000 number on almost any website dealing with vaginal delivery vs. c-section (which carries a 1 in 2500 risk of death or 1 in 5000 risk of death if it is a scheduled section with no labor).

As for the epidural risks, that number comes from research as well. DH gets all the anesthesia publications, and I've never seen the number any HIGHER than 1 in 200,000 for laboring women, although I have seen it LOWER in some studies. I figured I'd go with worst case scenerio since it's still such an incredibly low risk.
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#22 of 51 Old 06-05-2006, 01:55 PM
 
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Originally Posted by savithny
Do you think the two can be teased apart, though? In other words, are some reported maternal deaths during delivery due to epidural and are reported as resulting from the delivery? Or are some epidural deaths due to pregnancy complications are are put down as being caused by epdural?
Could this ever possibly happen? Sure, researchers are human and make mistakes. However, over time, the numbers are what they are. When you come up with approximately the same numbers time and again with a well controlled study, I figure they are fairly accurate.

I know when it comes to anesthesia complications, these things are reported separately from birth complications. If there is ANY doubt as to what caused the problem, it is recorded and looked at extensively during a research study. Of course, they may mistakenly attribute a maternal death to vaginal delivery when the reality is it was the epidural, but like I've said, time and again the risks for vaginal delivery and epidural placement have come out to be what I originally posted.
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#23 of 51 Old 06-05-2006, 02:00 PM
 
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Originally Posted by courtenay_e
Am I the only one who noticed that she was induced? It's just so much more conVIEnient to choose your baby's birth day with an induction...


Why was she being induced? It was an unnecessary induction, an unnecessary epidural.

Julies was NOT. Her's was a convenience procedure.

Did you read a part of the article that I somehow missed? Cause nowhere in that article did I see any mention of WHY she was being induced. It *is* possible for women to be induced for a valid medical reason, you do realize that, don't you?

Unless I missed something, and please correct me if I did, I simply do not see how you are determining that her being induced was for convenience or that it was unnecessary. The article I read simply did not specify WHY she was being induced.

Again, if I missed something, please point it out for me.
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#24 of 51 Old 06-05-2006, 02:05 PM
 
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Originally Posted by wifeandmom
Did you read a part of the article that I somehow missed? Cause nowhere in that article did I see any mention of WHY she was being induced. It *is* possible for women to be induced for a valid medical reason, you do realize that, don't you?

Unless I missed something, and please correct me if I did, I simply do not see how you are determining that her being induced was for convenience or that it was unnecessary. The article I read simply did not specify WHY she was being induced.

Again, if I missed something, please point it out for me.
Well, they mentioned that she was happy, healthy, and smiling, and all her labs were normal. In general one doesn't have normal labs when one is being induced for PIH, pre-elampsia, HELLP, whatever. I'm a doula. I understand that there are inductions that are really for the health of mom and baby. THis did not sound like one of those. Otherwise, trust me, the hospital would have used that reason as a reason for possible "complications" in their reason behind the possible infection. I've dealt with hospital lawyers. It's their job to save the docs from malpractice insurance hikes. The fact that she was being induced for a "valid" reason would not have been "missed" in their statement.

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#25 of 51 Old 06-05-2006, 02:09 PM
 
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This is very scary and sad, the doctors need to use more common sense and not ignore the signs of an emergency.
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#26 of 51 Old 06-05-2006, 02:09 PM
 
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Originally Posted by courtenay_e
Well, they mentioned that she was happy, healthy, and smiling, and all her labs were normal. In general one doesn't have normal labs when one is being induced for PIH, pre-elampsia, HELLP, whatever. I'm a doula. I understand that there are inductions that are really for the health of mom and baby. THis did not sound like one of those. Otherwise, trust me, the hospital would have used that reason as a reason for possible "complications" in their reason behind the possible infection. I've dealt with hospital lawyers. It's their job to save the docs from malpractice insurance hikes. The fact that she was being induced for a "valid" reason would not have been "missed" in their statement.

Hmmm, when it came time to have my twins, it was because twin A had NO measurable amniotic fluid pockets left in her amniotic sac and twin B had a severely calcified placenta. Neither of those would have shown up in maternal blood work or in my vital signs, yet both warranted intervention if we actually desired to have two live babies at the end of the pregnancy.

Perhaps she was induced for no other reason than she was tired of being pg. Perhaps she had a tennis match in 3 weeks and wanted to be recovered enough to play. Perhaps she had theater tickets for the following weekend.

Fact is, we DO NOT KNOW, and I find it awfully arrogant to ASSUME it was for no other reason than convenience unless the reason is specified.
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#27 of 51 Old 06-05-2006, 02:15 PM
 
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According to Julie’s hospital records, she was admitted at 7:05 a.m., and a half hour later, her vital signs are taken. Temperature, pulse and white blood count were all normal. Julie appears the picture of health.

The excited parents-to-be decide to make a home movie for their new baby.

Chris teases her about her hospital gown. An intravenous line is inserted into her arm, and Julie is given the drug that will induce labor. The business of having this baby begins.
Well, here's what the article says....doesn't appear anything was wrong if she "appears the picture of health. The thing is, many, many women are induced as a matter of convenience. It is so commonplace. If there was anything wrong, wouldn't they have mentioned in the article?
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#28 of 51 Old 06-05-2006, 02:17 PM
 
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Originally Posted by wifeandmom
I ask because the risk of maternal death due to epidural is 1 in 200,000.
However, the RID site says that one in 20 hospital patients contracts an infection. Yikes!!

Considering how nasty and drug resistant those infections can be, a risk of infection that high seems like an adequately good reason to stay out of the hospital entirely if you are healthy.

Remember that an epidural needle isn't the only childbirth-related thing that could cause a a deadly infection. The RID site says it could be any other needle, a catheter, a ceasarean surgery incision or just unwashed hands.

--AmyB
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#29 of 51 Old 06-05-2006, 02:18 PM
 
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This article is tragic... but I see other things that could have prevented her death besides simply refusing an epidural. The article says no nurses checked on her in the 5-6 hours after delivery. I mean, isn't that odd? When I was in the hospital, after an epidural I felt was truly lifesaving, I was checked probably every couple of hours by a nurse, also had multiple visits from the OB and anthesthesioligist, too. I feel if those follow-up visits had been done this woman could have been saved.

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#30 of 51 Old 06-05-2006, 02:30 PM
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Originally Posted by courtenay_e
Am I the only one who noticed that she was induced?

I put SOME of the blame on them. I don't want to sound hard hearted, because it's an awful tragedy. However, you are going to have needles and major MAJOR drugs put into your body, and you DON'T KNOW OR CARE ABOUT the RISKS?

But if she hadn't been administered the pit, would she have needed the epidural? If she hadn't chosen the epidural, would she have gotten meningitis?
It is a little bit mean to draw these conclusions. I am sure they knew about the risks but like most people in a hospital they were focusing more on the positive effects - they were going to have a baby. Having had a medically necessary (like my baby would have died without it) induction, I can tell you that there are times that they are necessary. The induction and the pitocin and the epidural were not the problem - the lack of basic sanitation was the problem. This woman was basically killed by a stupid anesthesiologist who did not follow hygiene standards and her death was furthered by the nursing staff who did not follow up with her care.
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