Spina bifida occulta and c-section

[speisaalmilk]

Are there any obstetric anaesthetists about, or anyone else with any experience of this?

I’m 34 weeks pregnant and booked in for an elective Caesarian at 39 + 5. It has just occurred to me that almost 20 years ago I was given a diagnosis of spina bifida occulta after scans carried out due to lower back pain. I was told at the time that it wasn’t related to the pain. I have no symptoms and apart from the very occasional flare up (3 or 4 times in fifteen years) which I manage with exercise, the lower back pain is gone.

There’s a note about the diagnosis in my medical records but no digitised back up as it was so long ago. I understand this is a super common and often undiagnosed condition. Is it something that is likely to impact the possibility of spinal anaesthesia for the section? Should I be flagging it with my midwife now?

TIA for any help possible!

Not an anesthetist but midwife and if you told me this at booking I would 100% be referring you to the anesthetist for an appointment. They need to assess you in pregnancy to ensure they can do an effective spinal. It can lead to incomplete block and increased risk of the known side effects like severe headaches. Even though mild it can make it difficult to place an effective spinal. Contact your midwife today an ask for an urgent appointment with the anesthetist as if you go into labour without this they may use general anesthetic if they haven't assessed you antenatally.

Thanks, this is really helpful - I can’t believe it never occurred to me before, it’s just not something I ever think about.

Obs anaesthetist - yes you need to see an obstetric anaesthetist as it does come with real anaesthetic implications.

Thank you - I will ask for an urgent referral. I know it’s probably case by case and you can’t tell me, but is it the sort of thing where I’m likely not to be able to have a spinal and would have to consider GA, or is it more likely that there will need to be extra steps taken e.g. scans etc to guide placement?

It will depend very much on the details, but generally it is one scenario where GA is more likely to be safer than spinal. If you have copies of any old scan reports/letters relating to it then show them to the anaesthetist when you see them. If you go into labour before seeing an anaesthetist then make sure you tell them as soon as you get to labour ward.

Absolutely flag it now. You will probably need to meet with the anaesthetist. I had metal rods put into my spine at 15 and we had a huge conversation around different possibilities and options for all birthing methods and pain relief. It also helped me feel secure, knowing the team were aware and had a plan for all options.

Our plan was to try a spinal injection at first and if the numbness didnt spread enough, to go straight to a GA, rather than multiple attempts as that was my preference.

Hi, just an update on how this worked out in case anyone has the same issue. I asked for an urgent referral to the anaesthetic team and in the meantime asked my GP to send over the original records relating to the diagnosis.

I spoke to the consultant anaesthetist on the phone. She was happy that due to the particular vertebra affected (S1) and because I’d had an MRI at the time which showed nothing else, it would be fine to go ahead. They placed the spinal first time with no issue, I had a very straightforward caesarean, and I now have a beautiful baby boy and am well on the way to recovery.

Thanks for your help!

Congratulations on your baby boy! Glad to hear you are recovering well x

Great news, congratulations!

Congratulations 💐