is labour analgesia service possible for all mumbai mothers ?? HOW DO WE DO IT ?

1. IS LABOUR ANALGESIA SERVICE
POSSIBLE FOR ALL MUMBAI
MOTHERS?
HOW DO WE DO IT?Dr. kalpesh shah
M.D.(Anaesthesia)
Consultant Anaesthesiologist, Mumbai

2. MANAGEMENT TALK
• So think like a Management people for
this problem of providing Labour Analgesia
to all mumbai mothers.

3. GROUND WORK
• Telephonic interview of 33 obstetrician,12
junior Anaesthesiologist & 10 consultant
Anaesthesiologist taken with my 17 yrs. of
work experience in private practice.

4. • Tried to understood every aspect of this .
• Every aspect has been given a complete
management angle to understand.

5. OBSTETRICIAN VIEW
• Most common comment is NON Availability
of Anaesthesiologist when needed
So NO planning from both the sides.
• 2nd most common comment
Fear of instrumental delivary and
complications of epidural.

6. CONSULTANT ANAESTHESIOLOGIST VIEW
• Unpredictable time and disturbance to
routine planned surgery

7. JUNIOR ANAESTHESIOLOGIST VIEW
• Very limited experience
• Seen around 4 or 5 cases in entire 3 yrs. of training.

8. DIFFERENT ISSUES AT DIFFERENT TYPE OF HOSPITALS

9. PRIVATE NURSING HOME
• Limitation of infrastructure
• Economics is very important
• Unorganized Anaesthesiologist network

10. CORPORATE HOSPITAL
• Sophisticated environment with need for communication and
documentation as maximum
• Patients are too sensitive ,for any complications and fear of
medico legal is very high

11. GOVERNMENT INSTITUTIONS
• Maximum management issues.
• Anaesthesiologist is understaffed and so
overworked, specifically in emergency.
• Less support from obstetrician.
• Patients are less demanding for such
procedures due to lack of awareness.

12. HOW TO IMPROVE ?
• Motivate Anaesthesiologist.
• Motivate Obstetrician.
• Improve awareness among patients.

13. SUPPLY AND DEMAND RATIO
Currently demand is more then supply

14. LOOK WITH IN OURSELVES FIRST
Number of Anaesthesiologist who
are willing to do LA is less then the
existing demand for the LA from
patient side

15. • Ask obstetrician about how do they manage for LA and
availability of anesthesiologist.
• Most of them first see the availability of anesthesiologist and
then try to convince pt., which is not true for any other
obstetric surgery (LSCS, D&C etc.)
• So WHY?

16. • Unpredictable time is it the only reason?
• Many of us are not trained and experienced of it specifically
seniors because this procedure is
relatively new for them.

17. • Level of confidence in out own colleague as a
Anaesthesiologist.
• Confidence in other unknown Anaesthesiologist

18. EXAMPLE
• Some unknown Anaesthesiologist has put epidural catheter about 6 hrs.
before ,he went to another case thinking there is enough time for the
delivery.
• After another 1 hr. , pt. needs emergency LSCS and now obstetrician is in
search of Anaesthesiologist.
• Every one is refusing since some one else is
involved and medico legal questions if something
goes wrong.

19. TEAM UP WITH OTHER ANAESTHESIOLOGIST
• TEAM WORK Is the answer to all the basic problems of Labour
Analgesia.
• TEAM WORK
• TEAM WORK
• TEAM WORK
We made it possible with our group practice only.

20. Do we need qualified Anaesthesiologist every time to be with
pt.?

21. Yes

22. NURSE ANAESTHESIOLOGIST
• Can we mobilize nurse anesthesiologist to help here ?
• Nurse Anaesthesiologist is widely used in all other developed
countries where training is good to reduce the cost as well as
fill the gap of shortfall in Anaesthesiologist.

23. Training of the existing nurses in small unit with written material
given to them.

24. Can we train our obstetrician minimally as per need ?

25. • Can we involve junior anesthesiologist and other consultants
and train them?
• Whoever is willing to learn and help with positive mind in LA
are all welcome.

26. TRAINING IN PARENT TEACHING INSTITUTIONS
• First lets learn it well before we actually
use the technique on patients.

27. • If our complications are less ,then acceptance will be more .
• Failure to put epidural catheter smoothly for multiple time ,
obstetrician has stopped motivating patients.

28. WHY DO WE HAVE LESS NUMBERS IN
TEACHING INSTITUTIONS?
Is lack of manpower is the only reason?
Or
lack of motivation from all the sides is responsible?

29. • In teaching hospitals ,Anaesthesia
department is always strong
So ,
• If they get motivated to do it, I am sure
nobody can stop them.

30. ECONOMICS AND DISTRIBUTION OF MONEY
• Be open to discuss about economics at
every level.
• All the failures are primarily due to not
handling economics in proper way.

31. IS PAIN RELIEF NECESSARY?
• Why do we charge premium for LA?
• Do we think that this is essential services
or it is a Luxury?
• If it is premium services then obviously it
can not have more customers..

32. DIFFERENT CHARGES PATTERN
• Fixed charges
• There are centers who pay some fix
amount of money for LA.
• For example average pay is Rs. 100 for
general ward , and Rs. 200 for deluxe
irrespective of time taken for delivery.

33. PAY PER TIME CONTRIBUTION
• Epidural charges is 3000,then every hr. is 1000 and if LSCS it
will be 50% of actual LSCS payment
• Average LA lasts for 4 to 5 hrs. if started at 3-4 cm of dilatation.

34. ECONOMICS IN THE MIND OF OBSTETRICIAN
• Average earning of obstetrician is 15-20000 per normal
delivery after taking care of patient for 9 months.
• If we go for 2 or 3 hrs. and ask for 10000, it is not acceptable to
their mind (it may be ok for the pt.),so they do not try to
convince pt.

35. SAFETY OF PATIENT

36. PROTOCOLS
• Use of standard protocols will
reduce the chances of error and
miscommunications.

37. DOCUMENTATION

38. SYSTEM TO GIVE OVER

39. HOW TO INCREASE DEMAND
Talk freely about economics with obstetrician.

40. Take lectures on 7 month
Printed material on the day of admission

41. MOTIVATE OBSTETRICIAN
• Make Obstetrician aware of common
problems of epidural
• Keep a plan for alternative to epidural
• Show your availability repeatedly.
• Stick to the protocols and discuss this
protocols with them often.

42. MOTIVATE PATIENTS
• Take videos of happy patients.

43. FOLLOW UP EPIDURAL PT. AND TELL THEM TO DISCUSS WITH
THEIR FRIENDS OPENLY

44. GIVE THEM A SENSE OF PRIDE OF HAVING EPIDURAL

45. USE OF SOCIAL MEDIA
ARTICLES
LECTURES
REVIEWS
VIDEOS
TESTIMONIALS