What do you mean NO theatre?

I previously worked in a hospital in east malaysia where there isn't any dedicated obstetric theatre (am talking about a tertiary hospital). When there is a need for an emergency c-section, we simply call up the theatre, booked the case and several minutes later send the patient for the operation. There are times when we couldn't get a theatre because the two theatres are both occupied with other emergencies. And many times we manage to open the 3rd theatre just in the neck of time to prevent potentially fatal outcome. You can just imagine the adrenaline rush when situation as such arises.

Having worked in the UK for the last two years (well, almost), i came to realised the importance of not only having a theatre specifically tailored for obstetric patients but also an anaesthetist working full time for the delivery unit.

Why? Firstly, when any patient is to have an emergency section this can be done without any delay. If a trial of instrumental delivery (i.e. potentially ending up with a c-section) is needed, this can be carried out in the theatre. This won't be possible where i was working before. I remembered that whenever i had to carry out a ventouse delivery, i had to inform the GA MO that i may come to the theatre for a 'crash section' if i fail to deliver the baby. At this point, there will be two midwifes with a trolley bed all gear up for transfer and another with a shaver in hand. Sounds scary? You bet.

Epidural services in labour? Utmost important to help labouring women to control the pain. Would you be able to get this there? Never... unless you are a specialist labouring away perhaps. Or an anaesthetist. Reason? No one is able to monitor the patient if she is to have an epidural (or rather no one WANTS to monitor). No anaesthetist is in charge of the delivery unit to perform the procedure. Sad right? I had once felt so disgusted with myself as an obstetrician telling the patient that she can't have the Entonox as it ran out and she can't have another dose of pethidine as it was too soon after a preceeding dose an hour ago. Its practically asking the woman to bite on to her 'baju' and carry on with the labour pain.

I was hoping things would be better in the years to come. Alas...how wrong was i. JL in the last week had emailed me and told me that he was put on the 'center stage' and had some 'grilling' as there was a delay in a c-section for 3 hours. This was a case where a women had meconium (unborn baby's pooh) stained liquor and not in labour requiring immediate delivery. Reason for delay? you guessed it... theatre busy with other cases... This would not have happen had there been an obstetric theatre right? I strongly believe its the system at fault. Unless there is commitment of the anaesthetic team to provide the service of epidurals, an obstetric theatre and delivery unit oncall anaesthetist, there would not be an improvement in provision of care.

(me talking to my gwai lo anaesthetic colleague)

me: know what... the last hospital i worked in do not have a theatre like here... and erm..(malu look) no epidural as well...

gwai lo: What do you mean NO theatre? This is so @£$%! ridiculous.