Elective cesarean - options about anaesthetic

[LashesandLipstick]

I'm requesting an elective cesarean due to a combination of reasons, mainly severe anxiety. I have PTSD and GAD with panic disorder thrown in, the traumatising event that happened was several medical procedures when I was a child. I had very little control over what happened to me, was prodded and poked, and have very vivid flashbacks to being held down, stuck with drips and screaming. I feel that an ELC would be better for me because it's planned, it's calm, although I have to have a procedure I know what's going on vs the unpredictable nature of a VB where they could tell me I need an EMC or forceps and I'd have no time to mentally prepare and the loss of control would come back. I'm also scared I wouldn't be able to cope with it.

On top of that, my mum had a horrible experience with me. Very slow labour, she had a 3rd degree tear and a retained placenta that no one noticed, hemorrhaged several days later and had to be rushed back into hospital, emergency D&C that tore through her stitches and made her tear worse, developed PND had to have a hysterectomy a few years later due to the damage caused.

I have had panic attacks where I think I'm going to die in labour or my son will, I sometimes can't eat or sleep because of it and I struggle to enjoy my pregnancy.

I mentioned to my doctor at 20 weeks I would like an ELC and she said "that's an option" and I have an appointment to discuss it. I've also been advised by my psychologist that she thinks I'd cope better with the ELC than natural birth.

However I am still terrified. I feel better about having the ELC rather than a natural birth, but the spinal is frightening. I still have to have blood tests with emla cream, a butterfly needle, and it can take an hour to get it because I usually have an anxiety attack when I walk in the room. I'm tempted to ask for a general anaesthetic but I'm scared that I won't "know" he's my baby and it will affect bonding :(

So my questions are

1. Spinal anaesthesia - what does it feel like? I know the local anaesthetic goes in first, can I have emla cream on my back so I don't feel it? Can I take a sedative? Can I have gas and air? ANYTHING? I really want to be awake for his birth but I am literally terrified of this
   
   
2. Anyone out there with similar experiences, did you have a cesarean and how was it?
   
   
   Thanks for reading

[VivaLeBeaver]

I've had one epidural and about five spinals. It's not really any worse than an ordinary injection. That bad bit is the local anaesthetic, so normal type injection. After that it is numb enough that you just feel pressure and pushing, not pain when they actually site the spinal.

I am a bit needle phobic and sobbed and sobbed before my first spinal and then wondered what the fuss was about!

For me the worst bit is the cannula in the hand which they'd have to do whether it was a GA or spinal.

[Lovingtheseagulls]

I had a spinal and it was fine. I hardly noticed the local going in and the spinal didn't hurt either. It just get's to a point where you think ooh I'm not sure I like this and it stops. It kind of felt like brain freeze in my back, then your feet go lovely and warm and it feels lovely! You have to kind of perch on the edge of the bed and bend over I thjnk.
It really was fine, I have no idea of general anaesthetic so can't comment on that.

[LashesandLipstick]

VivaLeBeaver - Thanks! So it's only the local that feels like an injection? I've been thinking I'll feel the needle for the whole time it's in (which isn't THAT long but it feels like it is when it's happening)

The cannula worries me as well but I know I can have emla cream for that so not as worried as the spinal

[LashesandLipstick]

Lovingtheseagulls - Thank you :) That's very reassuring

[VivaLeBeaver]

Honestly if I had to have either a spinal or a blood test tomorrow Id have the spinal!

[lunalovegood84]

I had emcs at fully dilated so I was in the thick of labour but I felt absolutely nothing at all when the spinal was put in. You go numb from the chest down so you are not aware of anything your body is doing, never mind a needle. When it wore off I was a bit shaky which is apparently a common side effect but it was really fine. (So was the whole cs and recovery).

[LooksLikeImStuckHere]

I had an epidural and a spinal with DS as they prepared for EMCS but ended up with forceps.

The spinal was like getting into a warm bath. The only bit of the whole birth process I remember with any fondness

[trilbydoll]

They spray your back with freezing stuff, that's the worst bit! And the local anaesthetic for the cannula stings a bit. But the actual spinal needle was a non event.

They're very chilled out with an elcs, loads of time to explain everything, tbh I was a bit "get on with it" but hopefully you would find it quite reassuring?

[TheAuthoress]

I had an elective after an emergency section first time. I was originally going to try for a VBAC but had extreme anxiety (not just about the baby but lots of other stressy things going on) and like you was very worried that me or my baby were going to die.

I had a general with my emergency section and wouldn't really recommend it, i was very out of it for a while afterwards, though I had been through labour before that.

Getting the local anaesthetic injection was fine, just like a sharp scratch. Then I didn't feel the spinal going in at all. They talk to you so you don't really notice what is going on, I don't even remember getting the canula in. Plus you'll be very excited to meet your baby so will be focusing on that.

[lunalovegood84]

LooksLikeImStuckHere - getting that spinal was one of the best moments of my life. Probably second only to seeing DS.

[BreeVDKamp]

I can't advise much but just want to add my positive experience :) I had a spinal 2 weeks ago post delivery (for stitching up 3rd degree tear) and it was amazing! I too was so scared about an injection in my back, but there was no other option really. I was shaking so much with adrenaline/shock after delivery but it was a piece of cake, the anaesthetist was so lovely and the pain relief was complete and immediate and absolutely amazing. Plus it made my body itch for ages afterwards, the scratching was so satisfying!
Reading your back story it definitely sounds like a good plan for you to schedule a section and not allow for an emergency situation, but just to reassure you my 3rd degree tear is causing me no problems 2 weeks on, I'm able to get down on the floor with my baby and walk round the park and stuff now no probs, and have no bleeding now :) Also I had emergency forceps which was another big fear of mine and it was fine!
You can do it! Good luck! Wishing you a lovely calm, empowering, controlled birth and gorgeous little baby :)

[OhMittens]

I was very anxious too but they do the tiny local anaesthetic first which really is just a pin-prick (not even a scratch) and then absolutely nothing. I agree with the person who said they'd rather have a spinal than a blood test! So would I!! Having blood taken is more painful, for comparison. I've had an EMCS and two ELCS and they were all fab - calm and peaceful.

All my CS were fantastic experiences. I recovered pretty quickly and none of the CSs gave me any bother afterwards. I am very pleased that I feel exactly the same down below. My DCs were all born pink and screaming and I was also pleased that they didn't have to go through any traumatic birth experience. All in all 10/10 :-)

[OhMittens]

then felt absolutely nothing.

[theaveragebear1983]

I had a general anaesthetic for my c-section after a failed induction, not because I'm scared of the injection, but because I'm terrified of the paralysis. It didn't seem to affect the baby too much, and I didn't seem to have any worse after effects than other people who had a spinal. In comparison with my 'normal' delivery, the c-section was considerably harder in the few days post birth, much more painful than I had anticipated. I'm having a section again this time around, as I have placenta praevia, and will definitely be asking for a general again.

[ThatBloodyWoman]

I have had a cs under spinal,and one under ga.
Both were dealt with calmly (even though the one under ga was an emergency) and I felt I was given full knowledge of what was going on.

The injection thingy in the back really honestly was fine -all done at a steady pace,with great care.You will feel sensations during the procedure,so be prepared for that -but not pain.
The ga left me out of it for a few hours,but I really don't think it affected bonding at all.

Good luck with whatever you decide

[ChickenLaVidaLoca]

I didn't feel the spinal for my EMCS go in as they numb you up first. What I do remember is the delicious sensation of the numbness hitting. I'd never had a spinal before and found it very interesting! It didn't hurt at all.

[ThePhoenixRising]

I had a topped up epidural for my EMCS and a spinal for my ELCS and also for a MC surgery. Much preferred the spinal and felt less rummaging than during the EMCS.

My ELCS and, considering the circumstances, the surgery for the MMC were positive experiences.

I know someone who had GAs for both her sections and it made no difference to the bonding etc. it was the choice she made and she was happy with it. I was given the option but was terrrified of GA.

When you have your appontment just talk over the options for anaesthetic. I hate needles but like a PP would have a spinal over a blood test any day. I felt a sharp pain when the needle went in, but it lasted about a second, was over before I could even react, and from then on it was just loveliness.

Should also add that for my ELCS, as am quite an anxious person (understatement) I was admitted the night before, given a light sedative and a good meal to help me sleep (best night's sleep ever) then in the morning given another sedative before being wheeled down to surgery. I felt slightly stoned but lighthearted about the whole thing. It was a fabulous birth, I remember every second. There are things like that that you can ask for and have, safely. It is in no-one's interest that it be a stressful time for you.

[smogsville]

Had two planned sections, generals both times. No problems bonding with either baby, EBF my daughter for nearly a year and DS is currently 8 wks and we're all happily bumbling along together. Feeding going well with him too.

Best of luck whatever you decide.

[Tranquilitybaby]

I found the spinal to be absolutely fine both times, just a scratch then v quickly felt warm like I was laying in a bath.

My c sections were calm and positive and I'm hoping my third one in TUESDAY will be the same x

[RedToothBrush]

I had an ELCS for anxiety.

I had the choice of spinal or GA. I went for the spinal.

I was offered the option of staying in hospital the night before to get used to things and to help if I was getting very anxious but I didn't do this as I thought I would be worse.

The theatre staff all knew my issues and were fantastic in explaining things throughout even though there was a screen up. They had a plan in case I didn't cope so well (I don't know what that was as I was told but the impression I got was the possibility of a sedative for the spinal) They broke with normal procedure to allow DH to be there for the spinal which helped a lot. They used a local before giving the spinal - I didn't find it as bad as I feared in the end (I didn't feel pain just a force of it). I had to have a drip in my hand which I personally found worse as that did hurt.

The injection wasn't as bad as I'd feared. The paralysis was weird but not awful. The thing I didn't like and wasn't prepared for was about half way through starting to feel mildly faint and as if I wanted to fall asleep which gave them all a fright however everything was text book and I didn't suffer much blood loss.

I felt 'out of it' for a couple of hours after, so I'm very glad I didn't go for the GA as I suspect I'd have been a lot worse and would have worried about what happened in theatre.

I personally think the key, is not so much the actual day, its more about the stuff before, having discussed a robust birth plan that suits your needs which in turn helps your anxiety because you have more trust in those treating you.

In terms of 'knowing' it was my baby. I didn't see DS born. I heard him cry and they brought him around a few minutes later. He could have been snuck in when I wasn't looking in theory. It was 'oh hello then' and I couldn't really equate him with being mine straight away. So I'm not terribly sure it would be hugely different for a GA.

All in all, I could not have been treated better and it does sound like you are at a good hospital who are being supportive. I found it better than all my expectations overall. The post natal stay was hard, but again I was well looked after in a private room - you should also give some thought to options post natally as you may find some bits hard if you suffer anxiety. It doesn't just stop with the birth.

[LashesandLipstick]

Thank you these are reassuring

RedToothBrush, what would you advise for the post natal stay? I haven't thought much about it

[Athenaviolet]

Before I had dc1 I said to the MW that if I did need a c section I wanted to have ga over a spinal. (The thought of being awake during surgery is utterly horrific to me)

She laughed at me!

[LashesandLipstick]

Athena so did you have the spinal?

[Athenaviolet]

I had a natural birth. It was to put in my birth plan.

[RedToothBrush]

Post natal may depend on the hospital as to what your options are. DH was allowed to stay with me in a private as I have fears about medical procedures. However I know this isn't possible everywhere.

Also off the top of my head:

Pain relief - its normal to have a suppository during a CS for pain relief. I declined this and had pain relief with tablets instead which is slightly less effective but suited me better.
Catheter - You'll need one for the operation. I had mine after the spinal so I didn't feel it going in, but you also need it removed so have a think about how you'll feel about it.
Feeding - I found this awful. I had no preference for what I wanted to do until DS was born. It hit me like a ton of bricks. I genuinely don't think there is a lot you can do to prepare yourself for it.
Risk of admission to SCBU - there is a slightly higher risk of the baby needing to go to SCBU. DS didn't need to and everything was completely fine, however you probably want to give some thought to it and how you would cope should you not be quite so lucky. The whole point of the ELCS is to try and help you keep control of the situation, so if there is a problem, then it could really foil you, unless you are prepared for the small possibility. Its the most likely complication (and the only increase risk that NICE highlight for first time mothers having an ELCS) but it is still uncommon.

Just generally, I found it difficult in hospital to ask for help as I thought I was being a pain and my anxiety played up as I was scared to ask for help. Even when they said to! Had DH not been there I really would have struggled as I couldn't even reach DS in his crib never mind pick him up. If you think you might lack confidence in asking for help, I'd mention it as you discuss your birth plan because they are more likely to keep an eye on you.

It sounds like stating the obvious to a degree but in hindsight asking if x, y or z was possible rather than worrying about if I was being a pain helped both before and after as I was able to mental prepare myself better. Remember that if your anxiety makes it difficult for you to cope, its a legitimate medical reason to be a pain in the arse making special requests. They can only refuse.

I'm sure there are other things but you've actually got loads of time to think about and plan with the hospital.