HOW TO USE THIS ANAESTHETIC ALERT PROFORMA
- Any Midwife or Obstetrician is asked to complete items A-F on one of these forms a) whenever they have noted one of the problems listed below (or something similar) or b) whenever the expectant mother wishes for more information or reassurance regarding anaesthetic involvement in labour or birth pain control e.g. morbid fear of labour, the use of an epidural after previous back surgery etc.
- Such a form may need to be completed at any time; for example at any ante-natal clinic, at a scan appointment, in the maternity ward or the late pregnancy assessment unit etc.
- Whenever appropriate, at the same time as this form is filled in, the informant should stick an “ANAESTHESIA ALERT” sticker in the “Special Features” section of the mother’s Pregnancy Health Record. These are available form the consultant ante-natal clinic staff.
- This proforma should be then sent to the Anaesthetic Secretary, where it will be filed temporarily in a special ring folder marked “MATERNITY ANAESTHESIA ALERT (Anaesthetic Department)”.
- On a weekly basis, all new alert proformas will be assessed by one of the Obstetric Anaesthetists who will decide on the appropriate management which may consist of one or more of the following:
a)An anaesthetic out-patients appointment with the expectant mother.
b)A letter may also (or sometimes instead) be required from the Obstetric Anaesthetist to the expectant mother herself and/or to the responsible obstetrician (to be read by him and then filed in the blue notes) and/or to the informant and/or to the relevant community midwife. It is almost always better to send too many copies of such letters than too few. If at all possible it always reduces the change of medical error if the mother herself has a copy of all correspondence.
c)Sections G and H of the proforma may need to be completed regarding the appropriate management at birth.
If this is so then the original of the proforma should be sent to the Delivery Suite. In the Delivery Suite the proforma then needs to be filed in a special yellow ring folder marked “ANAESTHESIA ALERT (Delivery Suite)”
For audit purposes it is useful to keep a photocopy of the proforma in the anaesthetic department.
- Whenever a mother with a ANAESTHESIA ALERT sticker is admitted to the Delivery Suite, the staff will need to check the ANAESTHESIA ALERT file.
- This original proforma should finally be filed in the Blue Hospital Maternity Record. (Birth Section).
SUGGESTIONS WHEN USING THIS PROFORMA MIGHT BE USEFUL
“If one calculates the number of expectant mothers who for one reason or another end up with either an epidural or general anaesthetic this includes a significant proportion of those having babies, and it is therefore helpful if the anaesthetic department has some forewarning, and is allowed the opportunity to arrange an appointment for discussion with the patient before she goes into labour” (Wendy Scott, Consultant Anaesthetist)
Past history of any difficulties with General Anaesthesia or an Epidural (e.g. known Difficult Intubation)
Needle Phobia
Serious Heart Disease
Serious Respiratory Disease (severe asthma previously requiring ventilation is relevant)
Bleeding Disorders (especially if the patient is on anti-coagulants)
Sickle Cell Disease
Family History of Malignant Hyper-pyrexia (or previous known incident of malignant hyper-pyrexia in patient)
Known Cholenesterase Deficiency
Family History of Cholinesterase Deficiency if the patient has not herself been tested
Neurological Diseases or Muscle Diseases
Cerebral Palsy
Autonomic Neuropathy for whatever reason
Laminectomy or Discectomy or Other Operations on Back
Note: None of the above are necessarily contra-indications for epidural anaesthesia.
If in doubt ask one of the obstetric anaesthetists, or fill in a form “just in case”
If the situation changes significantly, please complete a fresh form.