A recent obstetrical case got me thinking about posttraumatic stress disorder (PTSD) after childbirth.
As an OB hospitalist, I had assumed care at 5:00 pm of a private OB patient who had been laboring all day.
Her progress began to slow, so I started a conversation with her about the possibility of a cesarean section.
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After 2 more hours of labor, another 2 hours of pushing, an epidural that was not working well, and exhaustion, we all finally agreed to deliver the baby via cesarean section.
Unfortunately, surgery was delayed, as I had to do an emergency cesarean on another patient. While trying to manage two patients at the same time, communication was limited. So it wasn’t until just before beginning my first patient’s cesarean section that the anesthesiologist told me that she had been acting “strange” and might be having a reaction to the epidural bolus.
I am not exactly sure what actually happened, but in retrospect, my best guess is that the patient might have had an acute stress reaction. Due to this, and the fact that her epidural had been bolused many times throughout the day, general anesthesia was administered.
Several days later, after my patient had a chance to rest and gain some distance from the event, I was able to round on her. I found her to be teary and she even suggested that she might not have more children. I tried to “debrief” her in a nonrushed fashion, doing my best to remember all the rules — sit down, don’t answer your pager, and take your time.
I explained and reassured as best I could, cautioning her about posttraumatic stress disorder (PTSD), acute stress, and postpartum depression. I also relayed everything we discussed to her regular healthcare providers, knowing that they would follow her closely, as I doubt that I will have the opportunity to see her again.
Although I tried to do what I could, it’s a situation that worries me. Technically, I did nothing wrong. But as a hospitalist, I am often called into stressful situations and treat people who have never met me and have no reason to trust me. My actions — or lack thereof — can have long-lasting consequences for them. How would this patient fare?
