Women in Labor Denied Epidural Due to Lack of Anesthesiologists

Doctors are frequently unable to provide epidural anesthetic for birthing women due to a lack of hospital human resources, according to a new study.

Ichilov Dan Keinan
Dan Keinan

According to figures presented by the Israeli Society of Maternal-Fetal Medicine for 2007, half the women giving birth in Israel use an epidural in vaginal births. This figure is considered high in comparison to most Western countries, but the actual figures vary from 16 percent to 90 percent, depending on the hospital.

The study on epidural use was the first extensive research of its kind in Israel, with figures coming from hospitals all over the country.

Another survey, from 2005, showed that only 11 of the 25 obstetrics units studied had an anesthesiologist available 24 hours a day for birthing mothers who requested an epidural, and these units performed a large number of epidurals. Three other hospitals had anesthesiologists available in delivery rooms only on day shifts. However, in 11 other hospitals there were no anesthesiologists on duty in delivery rooms, and they had to be called from the general surgery department or other departments if an epidural was required.

Dr. Yehuda Ginosar, director of the Mother and Child Anesthesia Center at Hadassah University Hospital, Ein Karem and former chairman of the Israel Association of Obstetric Anesthesia, says that hospitals that do not have an anesthesiologist on duty in the delivery room mean women may have to wait for an epidural or may not get one at all if the anesthesiologists are busy with other surgery.

Only in three of the six biggest hospitals in Israel that have between 5,000 and 7,500 births a year was an anesthesiologist available 24 hours a day.

Ginosar says not only does the birthing mother suffer and the quality of her treatment is impaired when no anesthesiologist is available to administer an epidural, but also: "If a birthing mother has received an epidural and suddenly needs a Caesarean section, the dose can be changed and the operation performed with local anesthetic. But if she has not had an epidural because of the wait for an anesthesiologist, and is suddenly taken for a Caesarean, we have to use general anesthetic, which raises the risk of complications for the mother and fetus," Ginosar said.

The shortage of anesthesiologists in Israel has been discussed in recent years in various forums of the healthcare system, and is likely to be raised again in discussions between the Finance Ministry and the Israel Medical Association, slated for after the holidays, of doctors' wages in the public sector.

The Israel Society of Anesthesiologists has been working recently to improve conditions for anesthesiology residents to encourage young doctors to specialize in the field.

According to Health Ministry figures, 44 new anesthesiologists are needed every year for the next five years to counteract the shortage of anesthesiologists in Israel - 76 percent more than the number now entering the system annually.