* Author Topic: Cesarean and a choice of anesthesia  (Read 880 times)

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Offline Minou

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Cesarean and a choice of anesthesia
« on: 13/11/19, 16:49 »
Hello ladies.

I am now 28 weeks pregnant and started to plan the delivery.  It has been preliminary agreed to go for an elective cesarean at 38 weeks.

I've had a meeting with an anesthetist last week and they are really pushing for a spinal (possibly with epidural) anesthesia. 

It is really freaking me out due to the risks of nerve damage and I'd rather go for general anesthesia. But then, of course,  they were saying that it's not as safe.

Then I thought that local anesthesia is probably the best option, but don't know if they use it on cesarean these days. I got so stressed out during the meeting that forgot to ask about it.

Most of my friends had an epidural during delivery, and think that I am overthinking and panicking unnecessarily...

Did any of you, ladies, have anesthesia other than spinal/epidural? Was it your choice?

Does anyone else feel the same about spinals/epidurals?

Many thanks


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    Offline StrawberrySundae

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    Cesarean and a choice of anesthesia
    « Reply #1 on: 13/11/19, 18:12 »
    Hi Minou,

    Congrats on your pregnancy!

    I had an elective c section at 38 weeks last month via spinal anaesthetic. I was freaked out by the risks described to me too and despite not having a great start to the drugs at the beginning, overall it was fantastic and Iím really glad I opted for this. My scar is really neat too which is better than I was expecting (apart from a slight wobble with the end couple of stitches thanks to a community midwife insisting on snipping off the dissolvable knot unnecessarily just cos it was a bit red).

    Anyway the delivery was brilliant and so much better than an emergency c section. In the past Iíd have opted for a natural birth, but after my rocky journey the past few years and being now 45, I decided this would be the safest option, plus my consultant who I trust and is really experienced, recommended this to me too.

    Lastly I feel no guilt or disappointment whatsoever about not having delivered vaginally, but I know each case is different. It felt the safest option for my baby, which was the most important thing to me.

    Any questions just ask and good luck whatever you decide  :)

    Offline Emily Swift

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    Cesarean and a choice of anesthesia
    « Reply #2 on: 13/11/19, 20:18 »
    Hiya, Iíve had a general anaesthetic for my 1st c-section, then a spinal for my second. The GA was an emergency so I had no choice. Whilst I am so grateful that everything turned out fine afterwards I really felt like i has missed seeing my LO come in to the world so next time I planned a c-section with a spinal, i was soooo nervous but I shouldnít have been, it was great & amazing to see the consultant holding up the babies and having that first cuddle.
    Scar & recovery have all been fine.
    But everyone is different and u should do whatís best for u and your LO.
    All the best xx

    Offline Saltysea

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    Cesarean and a choice of anesthesia
    « Reply #3 on: 13/11/19, 20:45 »
    I am an anaesthetist. There are risks with everything you do in a hospital. Local anaesthetic is not possible for a cesarean unless you are in a very very resource poor environment.
    The risks with a general anaesthetic are substantially higher for you and the baby than a spinal. A spinal is a super safe procedure unless you are on blood thinners. The important nerves are all higher up in your back and swim away from the needle in the fluid surrounding them. The recommendation from the doctors has already weighed up all the risks and benefits and the balance is strongly in favour of the spinal, which is why they recommended it to you. Try and relax and focus on the fact you are one of the lucky ones that get to have a spinal and be there for the birth.

    Offline Tigs33

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    Cesarean and a choice of anesthesia
    « Reply #4 on: 13/11/19, 21:48 »
    I had a spinal block when I had my little boy, it was great, was awake at his birth and I recovered very quickly with little pain.

    Offline K jade

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    Cesarean and a choice of anesthesia
    « Reply #5 on: 13/11/19, 21:48 »
    I had emergency c-sec with epidural (as was originally being induced but it failed) then spinal as well when they decided I would need a cesearean.
    Was a great experience and completely pain free.
    Recovery has been brilliant.
    Understand your concerns, but thumbs up all round from me.

    I do kno a lady who sadly suffered nerve damage during epidural. Unfortunately she now has chronic life long back pain with mobility issues.
    I believe this is extremely rare however.
    X


    Offline Minou

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    Cesarean and a choice of anesthesia
    « Reply #6 on: 13/11/19, 23:09 »
    Thanks everyone for your replies!
    Congratulations, Strawberry on your baby and glad it all went well for you.
    I have no problems with a c-section and not concerned about the scarring either. It's really the complications from the spinal/epidural that scare me. I nearly fainted during the consultation  :o and I am normally not worried about surgeries or pain. Over the years I've had so many surgeries that I've lost count.

    Emily,how soon after the surgery did you get to see the baby? As soon as you "came around"? Would you say there was any difference in babies? Apgar score, or difficulties with breastfeeding or anything else? How far apart were the 2 births? Sorry, you don't have to answer all the questions if you think they are too personal.

    Thanks a lot, Sally for your reply. It helps to get an independent professional opinion. I appreciate that there are always risks in hospital or outside.  I am just trying to get as clear picture as possible about the risks involved, as unfortunately, quite often,  we, as patients, don't get to know enough to make an informative decision.
    I do feel that the risks of spinal/epidural are often minimised for some unknown reason.. even if I look at the official numbers - the risk of paraplegia is between 1 in 50,000 to 1 in 140,000. To me that's not so small. And these are the most severe officially reported cases at the time of discharge. There are many, many lesser complications that are either never reported, or manifest themseleves some time later or dismissed by the doctors all together.
    And the most disconcerting thing, is when you ask questions,  most of the time you get something similar to your reply "it's super safe... stop worrying and count yourself lucky". That's why we are left with no choice,  but to trawl forums and other resources on the internet.
    Sally, why is spinal considered safer than general anesthesia? What risks are compared? Mortality? Are there any risks associated with general anesthesia that can be avoided by spinal (apart from aspiration) ? I could never get an answer, beyond "safer and better" and it would help to know what risks I am avoiding by subjecting myself to a possible severe nerve damage. Sorry a bit long and hope it doesn't sound too harsh.

    Offline Minou

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    Cesarean and a choice of anesthesia
    « Reply #7 on: 14/11/19, 07:53 »
    A quick edit: apologies Saltysea, I misread your nick last night and referred to you as Sally. Sorry!

    Also, Emily, I looked at your signature this morning and saw the birth years for your babies, so one of the questions is irrelevant.

    Tigs and Jade  thanks for your input. Much appreciated.

    Offline jdm4tth3ws

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    Cesarean and a choice of anesthesia
    « Reply #8 on: 14/11/19, 08:35 »

    I had general anaesthetic planned c section. Consultant wasnt happy but I stuck to my guns as I have crumbling discs in my back. So in my mind, spinal or epidural was simply not an option. If he had been head down, section wouldn't have been an option either.

    The preparations weren't explained fully beforehand and I found that part traumatic. However, I had made out a section birth plan just in case and although I missed out on the first 30-60 minutes of babys life, my husband didnt. He got all that extra skin to skin and bonding with our little boy. I had also wrote in the plan, if j wasnt physically capable to breast feed and he was hungry, the nurse had my permission to latch him on. No formula to be given.  My husband assures me the nurse did do this. Missing 9ut on the first hour of his life did affect bonding slightly for a couple.of weeks, but 9 month on, km as close to him as I am/was my other kids when they were babies.

    I think you have to weigh up the pros and cons for you personally. For me an epidural was a.step too far. I didn't want to run the risk of further back pain and problems. So they were told in no uncertain terms it was GA or no way, I would take my changes and birth him vaginally even though he was breech.

    I hope you make the decision that is right for you. X

    Offline Saltysea

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    Cesarean and a choice of anesthesia
    « Reply #9 on: 16/11/19, 18:11 »
    Hi Minou - I totally understand your need to understand the reasoning behind the recommendations and often there simply isn't the time to explain this to the extent that each person actually deserves. This definitely leaves patients hanging. Maybe some of the reason though is also the more we know what to worry about, the more we worry and this actually doesn't protect us. Some doctors may be trying to protect you from that. I definitely can relate to your anxieties though, it's a completely normal reaction and unfortunately made worse when we research things ourselves  - I really can relate because I did this and made myself a nervous wreck when it comes to fertility.

    I am going to answer your questions as best I can and I really hope it ends up helping you. It is so important you realise the most important bit of all. Complications are rare! Complications of a spinal in a planned C-Section are exceedingly rare. You will be fine. There are other situations where complications are not rare in hospital but it doesn't sound like you have any of these risk factors (although I don't know your medical history, I am sure your doctors would have explained these if they were relevant). 

    Firstly, the risks of a spinal and epidural are quite different. An epidural is quite a bit more complex and carries higher risks. I can not imagine why they recommend an epidural in your case for an elective (planned) C-Section. Looking at the numbers can be disconcerting, especially if you don't work in the field. Just as in IVF one woman may have an 80% chance of success (eg. egg donor) and another 1% (eg. late 40's with low AMH), these numbers vary for risks with the spinal/epidural as well. Some patients get epidurals high up in their backs for rib fractures that are taking aspirin and cortisone therefore increasing their chances of bleeding and a suppressed immune system and this epidural is often left in for 1 to 2 weeks. These patients are the ones where the risks are no longer insignificant. These are the patients where a paraplegia can rarely happen. Often also any complication is documented and 'counted' - many women have epidurals during labour and some women complain of pain in one of their legs the next day. Many women don't have epidurals and also have pain in one of their legs the next day. The pain could be from the pregnancy, the labour, the delivery or the epidural. In the vast majority of the cases, the pain also goes away after a few days.

    Most of all though, labour and birth, be it natural or C-Section both carry risks. The riskiest of all is a C-Section under General Anaesthesia, yes mortality but also other risks and for both mom and baby.  Aspiration is one of them, that can be a very serious one, in the worst case scenario (rare, yes, but not less rare than paraplegia from a spinal), it can mean an ICU stay and even death from pneumonia. Other risks include difficulty in securing the airway of the mother (in pregnant women this is a significant risk), this can cause chipped teeth on a good day but far worse on a bad day. Babies are far more likely to be born 'flat' and need help to start breathing with ICU care afterwards. The medication we give for a general anaesthetic also increase the chance of a hypotonic uterus that bleeds more. This on a bad day can be very serious. Issues with bonding is also worthy to be mentioned.

    To finish off, for you and to any one else reading this. The vast majority of the time even a general anaesthetic for a C-Section is uneventful. And if there is a problem, that is what all the doctors and nurses standing around you on the day are trained to act on so the minimum damage possible results. Usually it all ends well. BUT if you weigh up the risks and benefits there are few areas in medicine where it is so clear and definite - the spinal for an elective C-Section (non-emergency) in an average patient is a very safe procedure and far safer than a general. This is the reason we as doctors barely give you the choice, it would just be wrong to do a general if you can do a spinal.