appointment with anaesthetist, what to expect?

[wannabedomesticgoddess]

Just that really. Have an appointment tomorrow with the anaesthetist due to my BMI.

What will actually take place?

[rogersmellyonthetelly]

No idea but watching with interest as I have one next month due to my wanting an epidural and having a very arthritic back!

[BionicEmu]

I had an appt with an anaesthetist in my last pregnancy due to kyphoscoliosis and disc degeneration in my back. She talked to me about why I'd been referred to her, then examined my spine to see if she actually could site an epidural in there. We also talked about other pain relief options esp. diamorphine etc as she wanted me to be aware that due to taking opioids for years their effectiveness was probably reduced.

She ended up saying that she didn't think an epidural would be the best solution for me, so arranged that I would have a remifentanyl PCA pump. If it came to.a CS she would try and do a spinal block however. She gave me her bowel number and told me to get someone to bleep her as soon as I was admitted onto labour ward.

NB: that should read "bleep number, not bowel number, but stupid phone won't let me go back.

[wannabedomesticgoddess]

Did you have the remi? Was it any good?

So they just check the spine if there are no other health problems, seems straighforward.

[BionicEmu]

I just had gas & air in the end. I went into labour 6 weeks early and by the time anybody realised I was in labour (me included) I was 8cm dilated so there was no time to sort out the remi. On the plus side DS was born an hour later!

I don't know what they'll say if its due to bmi (although my bmi is 35 and it's never even been mentioned). But the appt pretty much seemed to be about whether they could physically site an epidural, and then about what forms of pain relief they think would be most suitable. It was very reassuring.

I'm now 26 weeks pregnant with DC2 and as I've chosen a different hospital this time I have to go see the anaesthetist again in a couple of weeks.

[rogersmellyonthetelly]

Ah that's good to know. Pethidine just makes me barf and sleep between contractions, no use to me, the bit between the contractions isn't a problem! I had an epi with ds which they sited in the usual spot and it only took on one side despite repeated retries. With dd they went one vertebra further up which worked brilliantly, but I had a car accident a couple of years ago and knackered that one aswell.

[BionicEmu]

Doesn't sound fun Pethidine had zero effect on me at all. Have you researched remi? I'm hoping to get the go-ahead for it this time as well. Have you had any recent x-rays or mri done on your spine? Luckily I had a fairly recent mri done which clearly showed the issues. Although my main worry this time is getting to the damn hospital in time as it's a good 40 minute drive away!

[wannabedomesticgoddess]

My hospital is over an hour away.

Iv heard that remi is good from some and others didnt like it at all.

I had pethedine with DD and it did nothing at all.

[BionicEmu]

wanna so you're in the "will I make it to hospital?" camp too then. Everyone keeps telling me second labours are faster too. Although with DS I'd already been in the hospital for a week due to pre-term labour, its just nobody realised that it had actually progressed that far all of a sudden.

I definitely want to give the remi a go if I can - I figure its worth a try and if it doesn't agree with me then at least I've tried it. Aside from transition "give me a damn epidural now", "you can't have an epidural", "well that's it, I'm going home, you have the damn baby" I coped ok with just g&a during labour, but good god I could've done with something more when the consultant took over an hour to stitch me up.afterwards.

[wannabedomesticgoddess]

I didnt feel them stitching me at all. They injected me with something. Its odd because people say it was really bad.

Yep, DP is panicking. We live in the middle of nowhere and the roads are terrible. Plus we will have to leave DD off at his mums on the way.

I think it will be ok. I was in labour for 15 hours with DD. I doubt it will be much faster.

I will have something more than G+A this time. I cant cope with the thought of it all again with nothing else :o

[NAR4]

My appointment with the aneth. was just to see if I could have an epidural or spinal tap if needed, (due to previous surgery on my spine). It was decided yes to an epidural, although scar tissue may stop it working effectively, but no to a spinal tap. I was told if a CS was needed I would need a general.

I imagine your appointment is just to cover all the bases and make sure its in your notes. Then everything is pre-decided, no matters what happens. That's what I was told.

[DolomitesDonkey]

Gosh you've just reminded me I had one before my elcs and I'd completely forgotten - gives you an idea of the impression it made!

Me: Hello
Him: hello, pop on the scales
Him: hmmn ok, allergic to anything? any problems last time? Nope OK, one of my colleagues will do the work on the day. Bye.

And that was it! This was for an elcs so a spinal.

[Marmiteisyummy]

They should do an assessment of your back to see if spinal feasible and also an assessment of your airway (neck movement, mouth opening etc). Also explain the process of anaesthesia should you require an lscs and answer any questions you have. Usually nothing more than that.
(Non-obstetric anaesthetist)

[rogersmellyonthetelly]

Oh I'm glad they will do an assessment of my mouth, with dd I bit down in the gas and air so hard I dislocated my jaw and was in agony for months and no one would listen. Apparently it's not possible, but I'm very hypermobile and it clearly is possible for me. I live in dread of having a general for an emergency cs and waking up to find my jaw has gone again, or possibly my hip, but that would be more obvious I think.

[utopian99]

Had an appointment today which got cancelled as I've been up with d&V all night and they said i can't come into the hospital to see the aneasthatist with d&v. Have been told they'll try to rearrange but not sure if they'll manage before my due date! So still no idea whether I'd be allowed an epi if i needed one, or if i need an emergency c-section if they'll have knock me fully unconscious to do it and might not be assessed till I'm in labour.
Reason for needing the appointment was that I have mild scoleosis - is it reasonable for them to put me off till i come in in labour?

[worldgonecrazy]

My appointment was for a similar reason go Nar4. Scar tissue can prevent epidurals being effective, and there's no way of knowing this until after the fact. Spinal anaesthesia can be given regardless of scar tissue and is effective almost immediately.

I ended up needing a spinal and was so glad I'd had the conversation as some stupid MW was trying to convince me to try an epidural when I kept telling her I'd had the conversation with the anaesthetist and needed a spinal. She didn't stop arguing with me until the consultant turned up.

[Marmiteisyummy]

Utopian, there will be an anaesthetist on labour ward every day so would be a bit rubbish if they can't reschedule.
Most minor scoliosis is not a problem for spirals and even epidurals. Depends a bit on where it is. It's the lower part of the back we use (the small of the back) so if that bit is ok then little to worry about.
Best of luck.