Don’t get sick/deliver in July! You’ve all heard it. The good thing for ob/gyn departments is that they seem to be immune to the “July Phenomenon”—when residency programs begin and greenhorns make enough errors to increase hospital morbidity and mortality rates. Luckily for Ob/Gyns, there is no good evidence showing these increases, presumably because Ob/Gyn residents receive a significant amount of oversight. No one wants any medicolegal situations to arise, and experienced Ob/Gyn nurses don’t want new doctors to “mess up” their patients.
So the great news for women is that July is as good a time as any to deliver or have a gyn-related hospital procedure. Some may even argue that this is the safest time because of the extra oversight. But even with this extra vigilance among the Ob/Gyn department staff, your patients may not be safe from the errors of new, eager, and inexperienced residents of other specialties?
Consider this scenario:
It’s mid-July, and a 32-year-old woman who is 38 weeks pregnant has been admitted after going into labor spontaneously at home. It’s about 1:00AM, a full moon, and L&D is slammed. The patient knows she wants an epidural but has been very specific and vocal about wanting the procedure performed by someone experienced—she knows she’s delivering at a teaching hospital, but for the epidural, she doesn’t want anyone to “practice” on her.
Around 3:30AM, she is briefly seen by the on-call doc from her 6-physician Ob/Gyn practice; he apologizes for not checking on her sooner, explaining he just finished an emergency surgery, is about to perform another emergency surgery, and that his replacement, who is known to the patient, will be in shortly after change of shift at 7:00AM to check on her. He reassures the patient that she’s in good hands with the nurses and that he’s requested her epidural.
The anesthesiologist, however, is really backed up due to several emergency C-sections and doesn’t make it down. Then change of shift happens. Luckily for the patient, the anesthesiologist showed up around 7:30AM. The patient greets him and reiterates that she only wants an experienced anesthesiologist to place the epidural. He said he understands, excuses himself to step out of the room, consults someone in the hallway near the door, and comes back in and begins to prep for the epidural. By this time, the patient has been experiencing piggy-back contractions for hours, is miserable and desperate for pain relief, and is relieved that her epidural is imminent.
It took 3 sticks and 45 minutes to place the epidural; to the patient, it felt like forever. She was helped to lie back down on her back; her bed was slightly elevated. A minute or so later, she becomes hypotensive; the baby’s heart rate drops as well. The patient loses consciousness, ephedrine is administered, and just as the patient is coming to, the anesthesiologist shows up.