Shortage of anaesthesiologists hinder epidural services

Currently there are only two anaesthesiologists at the JDWNRH 

Health: Shortage of anaesthesiologists at the Thimphu referral hospital has hindered administration of epidural labour analgesia that was introduced free of cost since February last year.

As of last week, 56 women were administered epidural labour analgesia for painless childbirth. Last year, 52 women availed the service and four women this year.

On an average, in a month, four women availed the service.

However, with only two anaesthesiologists at the Thimphu referral hospital currently, officials said it is difficult to administer epidurals, as it requires constant monitoring.

Nine nurses from the birthing centre and two from the maternity ward are trained on administering epidural.

Medical superintendent Dr Gosar Pemba said the two anaesthesiologists were over burdened with work having to work in the operation theatre, Intensive Care Unit and in administering epidurals as well. “At times even when women demand the service, we aren’t able to provide it when doctors are not available especially when on leave,” he said.

Nurses at the birthing centre said that there has not been much demand for epidurals from pregnant women.

“Earlier some women used to demand for it but now even when we ask, they don’t want it,” a nurse on duty said.

Epidural analgesia is a medical technique of relieving pain administered to pregnant mothers during delivery. It is injected into the spine after placing a catheter into the epidural space before the woman goes into labour. Epidurals block the nerve impulses from the lower spinal segments resulting in decreased sensation in the lower half of the body.

The referral hospital alone requires more than four anaesthesiologists for efficient delivery of services.

Currently two doctors are specialising in anaesthesiology at the Khesar Gyalpo University of Medical Sciences of Bhutan. One is in the third year and the other in the first year.

Every year, there are two slots available at the university but there are hardly any takers.

Dr Gosar Pemba said as the job of anaesthesiologists is strenuous, not many opted for it. “Besides they are always on call,” he said, adding that it was normal for people to opt for jobs that are less hectic with less hours of work.

There are no anaesthesiologists in the regional hospitals. In some regional hospitals, nurse anaesthesiologists gave anaesthesia to patients but not in complicated cases as they usually work under a doctor’s supervision.

Meanwhile, records show that of the 56 women who were administered epidural, 10 delivered through emergency caesarean sections while one underwent a vacuum delivery.

There are certain criteria based on which a woman is given epidural. Women with deformity on the backbone, bleeding tendencies, low blood pressure and spinal abnormalities, among others, will not be eligible. A pregnant woman visiting the hospital fully dilated will also not be given epidural. Health officials said that pregnant women with rheumatic heart disease would be given preference, as it will reduce stress during labour without affecting her heart.

Complications during the process like post-dural puncture headaches, wrong placement of catheter, allergy and cardiac shock can occur.

Epidural analgesia is not a new concept in Bhutan. Health officials said that a few pregnant women were administered epidural based on request during which the process was found to be labour intensive.

While the cost implication would not be much, the workload on the hospital staff especially of the birthing centre increases when women are administered epidurals. Each dose of epidural analgesia costs about Nu 3,000 including the cost of the catheter set.

Currently, about 19 nurses are deployed at the Thimphu referral hospital’s birthing centre working on eight-hour shifts.

In 2015, 4,035 babies were born of which 27.7 percent were through caesarean sections. In 2014, 4,070 babies were born. Similarly, in 2013, about 25.9 percent of the 4,248 babies born were through caesarean section deliveries.

Kinga Dema

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