A Special Patient

Dr. Brian Launius MD, Diplomate, The American Board of Anesthesiology describes the merits of Accuro

I got a call from our midwife early one afternoon concerning a special patient. Because of a very traumatic experience with her first delivery, a woman, due to deliver her ninth child in the coming month, had decided she would never have another baby in a hospital: until now.  

Before continuing, let me provide a little background. I am an employed anesthesiologist working in a rural, sole-community-provider hospital along with four other anesthesiologists. We have a small labor and delivery floor with five LD&Rs and deliver around 500 babies each year. Our CRNAs are fantastic, but due to our small care team, the anesthesiologists predominantly cover labor and delivery, especially at night and on the weekends. A year or so before my story takes place, I acquired an Accuro spinal navigation device to use on our patients with challenging anatomy.  

The midwife arranged for the patient to visit me and discuss her history, including concerns regarding a hospital birth. When we finally met, I understood why this woman, who was in her mid-30s with eight children, was special. As we sat down, she could barely contain her nervousness at simply setting foot in the hospital. 

Glancing at her chart, I saw 160 kg and BMI = 60.

She explained how she and her husband went to a University hospital, full of anticipation and excitement, to have their first child. As she continued, tears began to well up in her eyes, and her voice quivered. She described her excruciating labor pain when it was time for an epidural and the increasing panic she and her husband experienced as provider after provider attempted multiple epidurals without success. 

Ultimately, the providers “Gave up on me,” she said. 

She received an IV, but that did little to abate the pain or her anxiety. Later that evening, the OB told her the baby was in trouble, and she needed to have a C-section as soon as possible. “The doctors repeatedly tried to give me a spinal, but they couldn’t get it in,” she continued. She was informed she’d have to be put to sleep. Then, she recalled nothing.  

She awoke to confusion, pain, and the cries of her first child. For days, even after returning home, she and her husband could barely speak of her experience.

By the time she was pregnant again, they had decided they would prefer to have their baby at home with a midwife and doula rather than ever return to a hospital. 

Babies number two through eight were born at home. “While the pain was terrible,” she recalled. “I felt safer at home.” It was only because she was having problems with her blood pressure and gestational diabetes that her midwife insisted on delivery in our hospital.

Delicately, I told her that I understood her trauma and asked if I could explain how her birthing experience might look this time. She let me examine her back during our consult, and I was not at all surprised why her anesthesia providers had experienced such difficulty. I could hardly appreciate any bony landmarks with her extreme obesity. I showed her our Accuro device, and she allowed me to examine her back once more. What I saw with the Accuro gave me the confidence to tell her that not only could I offer an epidural for her comfort and aid in reducing her hypertension, but I believed that I might be able to do it in one attempt. Quite a bold statement, but I had confidence and felt it important to gain her trust.

Several weeks later, she arrived with her husband for induction of labor. Thankfully, I was able to be present and, with the data from Accuro indicating her interlaminar depth was approximately 12 cm, I was confident that we had an adequate needle length to reach her epidural space successfully. 

The Accuro device provided me critical data to augment my decision to proceed with confidence; I quickly obtained loss-of-resistance and placed her epidural catheter on the first attempt. 

My sigh of relief was as palpable as that of my patient and her husband.

Later that evening, she had a comfortable, uneventful labor and delivered a healthy baby girl. To this day, this remains one of the most gratifying moments I’ve had as an anesthesiologist and a story I like to share when discussing the merits of our Accuro.