Teenage boys get anaesthetic for small op- why the bias against birth?.....

[kangers]

My friend told me about a teenager who had a VERY small nick in his foreskin to loosen it. He was allowed a general anaesthetic (at great expense to the NHS) and was under for less than 5 minutes (5+ staff involved, drugs, space etc). I think he has that right, but my friend pointed out that he would have had no pain with a local anaesthetic, and it seemed a little over the top. Plus the (male) surgeon was very sympathetic- far moe so we thought than many midwives/ anaesthetists can be to women giving birth. My friend and I compared this to the treatment of women who seem to have very few rights to pain relief in childbirth. We talked especially about the trouble getting epidurals in the night, and the numerous stitches we both endured with just gas and air. Not sure what the answer is, but is there sexism going on here or iis it me?

Most midwives/ anaesthetists are lovely. Childbirth and a medical circumiscim are totally different things. I expect the poor teenager was scared and embrassed. With that sort of op the patient needs to be still and GA is a good way to stop him from shaking with fear.

With childbirth pain relief can cause a casade of intervention. From a medical point of view it is better to avoid an epidural if you can. It lowers the risk of needing forceps, c section, if you don't have a c section if you can manage without an epidural. I think that there needs to be research to find ways of reducing the cascade of intervention with the mother have decent pain relief.

Having stitches without a proper pain relief is madness. I don't understand that. You get local anaesthetic if you need stitches with a homebirth.
That is appauling.

I agree with your comments reallytired, and yes I realise how epidural leads to other problems. But we all know the issues with childbirth, and it seems so very unfair that this huge event is NEGLECTED. Again- is it sexism?

Ths stitches issue is terible- my DH told me I had about 20 stitches with my first ( I didn't realise this and he is 15yrs old) with just gas and air. Plus it was the trainee/ new midwife's first time, so she was very slow and kept asking other to come and check her handywork. These were internal and external stitches and I had to keep VERY still- plus I had a new born!!!!

(I had to get the HV to cut them out as there were deforming my labia!)

I dont think its "sexist" at all

(though horrified at sound of those stitches... ouch)

It must be medically better for baby and mum for mum to not have GA if possible. The baby needs to be considered too.

Can imagine a teenager might really hate the idea of people doing stuff to his willy while he was awake. He can recover from GA in his own time, and not be needed to care for and breast feed a baby over the next few days.

My Dads male friend had a GA for an operation on his eye-ball. He just could not cope with idea of watching the Dr insert a needle into his eye-ball while he was awake. They suggested a local, so it was not been medically necessary to have a GA, but he was allowed. (not sure i could be still and not blink while someone poked a needle into my eye ball either, ewwwww).

I have had a fair few GA's in my time. They completley knock me out for a few days, and make me very sick. I now have learnt to always ask for anti sickness drugs before a GA, which stop me being sick, but no idea if thats safe for baby or for breast feeding,? and even if it is safe it must be better to not have if avoidable.

Even many big operations can be done under local aneasthetic.... think of elderly patients where a GA is likely to kill them but they need an operation. (my great uncle, who sadly passed away last year, had quite a few quite big operations with just local, before he died.... if thats possible then you can back track the arguement to "why do women who are just having a few stitches down there, need a general?"

Just to add, have not (yet) had any stitches down there, but am pg and i cant for a moment think that having stitches is nice at all. I cant yet imagine how horrid it must be, and while i really have no issues /fears about the giving birth, its the episiotomy / tearing / stitches part that freaks me out the most.

Yes nnayl- agree about GA no good for mums and babies. But I was thinking more about effective pain relief. Its going back to the old chestnut- if men gave birth they would have got it sorted out by now. The contrast between the 'nick' and the 20 stitches just got to me.

Have to say, after the intense pain of childbirth and much use of gas and air, the stitches were not too bad- the new baby is quite distracting!

Plus I am completely normal down there now, and had 2 further babies without stitches!

Its just such a shame that so many women feel there are different standards- and giving birth is definitely 'bottom of the heap' when it comes to attention from hospital managers, researchers etc.

I had an epi with my first after a painfully botched induction and the anaethatist was hideous saying things like "God, women have been doing this for years" and commenting on things that were on the tv in mock animation and horror, making out he'd done something wrong. Can't imagine him doing this to a non birthing patient.

Not many women would choose to gave a GA after a vaginal irth for stiches though. Would have to be separated from baby and feel like crap afterwards. They are supposed to give a local anyway not just gas and air.

If someone was going to slice my DS' penis, too right I'd want it numbed!

I don't think this is a terribly accurate comparison. The boy is having a planned surgical intervention - anaesthesia for planned C-sections is provided, and they are not done in the middle of the night.

They can give local and gas+air for post birth stitching. Putting stitches into a hugely distended area, especially if the tear is ragged, is not however the same as stitching up a previously intact area which has been surgically incised. There's no way of telling how it will subside, so I think the risk of stitches being too tight/loose is inherent in the condition.

This is not to say that lower skills are in any way acceptable (just that outcome is less predictable), and definitely not that ArRSe-brained comments by practitioners ever would be.

I think that it's right that the teenager had a GA - if I had been a terrified teenager needing a small op on my labia, I would have liked them to be that sympathetic to me too.

But I agree that childbirth seems a long way down on the list. I suppose that it's very difficult to test new pain relief methods on pregnant women - the potential risks are so high. And who among us would volunteer to be the ones to test it? It's more than that though. It seems as though because childbirth isn't actually an illness or an accident that we are supposed to suck it up and deal with it. It's "natural". And never mind the fact that thousands of women and babies have died over the years. And never mind the fact that evolution has given us a cobbled-together compromise between giving birth and standing on two legs, because it was only ever necessary to have enough women and babies survive to ensure that the population didn't die out.

I think that we have had a culture of misogyny for so long (and until so recently) that we are still living with the aftermath too. Personally I reckon that at least two OB/GYNs that I have had to deal with have enjoyed the power that it gives them over women. I've had more fantastic OB/GYNs, but the damage that the bad ones does is hard to erase (physically or mentally). :(

Big ops are not done under 'locals'. Those elderly patients have regional-block pain relief. My father had his prostate removed under epidural because he is elderly and has health problems such as hypertension and heart problems (heart attack, stent, some heart failure, etc).

Regional block pain relief carries risk as well.

And some people are not much affected by GA and recover very quickly.

vmonalogue- sounds awful- and you are so right- what other patient would be ridiculed for their pain or complaints?

Actually- can answer that myself- the elderly have quite a hard time too (you're old, what do you expect). But not the men who need GA for nick- would men get GA for smear- because that also ticks boxes for being embarrassing and keeping still!!

Think I need to go on the feminism thread. {Takes deep breath and yells!!!}

There are problems with the access a labouring woman has to appropriate pain relief and they need addressing. I know only too well the effects of these problems.

But comparing it to this boy's planned op is not helping the matter at all. DH had an op on his penis as a teenager (we were mere bf and gf back then) and had a local. The anaesthetic did NOT work and the doc said it was common for it not to as it wasn't an area you could easily numb as they don't inject it directly. He was held down by 4 doctors and screamed at one point. And he has a high pain threshold. So perhaps your point about 'no pain with a local' isn't quite right.

I agree 100%. My midwife advised me before I went into labour that if I decided I wanted an epidural, that I should INSIST it be brought the moment I wanted it....or they would delay and delay till' it was too late.

I did....and I did insist and they ordered me one and it still took ages to come.

Had I waited like they wanted then no way would I have got it.

Sounds unpleasant for your DH.
And valid point re comparison.

What research is there into labour/ pain relief etc. It seesm to the only figures that are bandied about are linked to the increases in Csections- and I can't say that I am surprised considering the variations of support and care in childbirth. Throw away pub comment- but don't you think that all men really would have Csection!!
My friend in NHS did say that the old adage about large/ strong men and pre-op fear is true (generally).

The risks of GA for pregnant women are hugely high - including stomach acid aspiration due to the hormonal changes relaxing the sphincter at the top of the stomach necessitating very swift intubation and drugs getting in breastmilk (my hospital has a no BFing policy for 6 hours after a GA). I have a 'potentially unsuitable spine' for an epidural/spinal block so I was told about the risks of a GA in great detail at my anaesthiatist consultation

Spinal blocks, for major operations, aren't the same as an epidual at all.

Stitches should really be done under local! Am absolutely shocked that yours weren't OP :(

I'm sure the anaesthetic was chosen taking the boy's risk factors into account as epidurals/spinal blocks are in no way risk free either - they just happen to be safer in pregnancy when many 'normal' things carry additional risk.

The problem is that science hasn't invented anything that's 100% effective and 100% safe yet and the precautionary principle is heavily applied during childbirth.

by the way- the teenager who had the GA on his nick was 19. And I think he should have that if he wants- we should get pain relief and care thats suited- but these principles seem less important in childbirth.

I don't think that anyone would advocate women having routine GA during childbirth. That isn't the point.

The point is that this 19-year old has had a lot of sensitivity and consideration shown to him to avoid pain. And quite right too. But there isn't always that consideration shown to women in childbirth. There are often not enough staff present to deal with the C-sections needed in a delivery unit (elective sections delayed due to emergency sections), let alone to give epidurals to all the women who need or want them.

Totally agree MTM and it makes me really

DH was 17 when he had the op. BIL had the same op a year later (must be a family problem with foreskins ) and had a local and was absolutely dandy.

I don't actually think that all men would have a cs actually, they're not a big homogoneous mass with one attitude between them. It's probably wise to be careful about how we deride one gender in the pursuit of bettering the experience of the other. DH says he finds that attitude offensive. He says if he were privileged enough to be able to be pregnant, give birth and bf, he'd want to experience it naturally. He says it's very rude to lump all men together. Same as with women. Some want an elcs, some want to give birth in a stream at midnight. Most fall somewhere inbetween. Why would individual men be different?

But he and I take your point about patriarchy and how decisions might be made in a male-dominated environment. There's a discussion in there but I think 'all men would have a cs' as a throwaway comment is as ridiculous as the problem of adequate care in labour in the first place.

I had a 2 day labour and had been fully dilated for 6hrs (dd was in dta and unbirthable). There was no anaesthetist available for the emcs and I had to wait nearly 2 hours with back to back contractions (so 8hrs fully dilated by that point) for an anaesthetist to be free to deliver dd. I have PTSD and the shame and horror of what happened will never leave me. In no other situation would a person be left in such pain for so long as it's labour and not illness/accident.

I dont understand the comparison.

LOL about giving birth in stream at midnight!
Yes- of course not all men would want cs- it IS a throwaway pub comment and offensive.
Your labour sounds horrific- and there is a two tier system here, with different standards of care allowable for this- 'non-surgical'? 'non-emergency' 'women's-troubles'? thing we call labour.
What to do, what to do??

I think the point is that many of us have experienced cavalier attitudes to pain management when on the labour ward, but such attitudes don't seem to extend outside the maternity ward. I do accept that some poeple think that the cascade of intervention is such a bad thing that it justifies discouraging or even restricting pain relief for a birthing mother (although I disagree with that view). However there is no medical justification whatsoever for doing perineal repair work with inadequate anaesthesia (which is something I have personal experience of). I am not aware of any other group of nhs patients that consistently report problems of inadequate pain relief (and/or judgmental attitudes of HCPs towards them taking pain relief). So I think the comparison is valid insomuch as it exposes what seems to be a significant attitude problem among some (alhtough by no means all) maternity hcps.

I think the problem which needs focussing on is the lack of availability of adequately trained staff to administer pain relief and anaethesia, which is particularly apparent in maternity care because most available methods aren't suitable for whatever reason. Many HCPs are very sympathetic but sympathy does bugger all if there honestly is no-one trained available!

Childbirth being a lower priority than other conditions does irk me though although I suppose in many situations it isn't life-or-death the way surgery on an RTA victim is.

Does anyone know statistics how many maternity units have at least one dedicated non OR anaesthatist available at all times?

And sadly there are many other situations where pain relief isn't given due consideration but those problems are relatively fixable by the siting of a PCA or similar/when all the patients on the ward are on the same schedule for prescribed pain relief.

Unfortunately maternity units just don't work like that.

Interesting question about available HCP/ anaesthetists at maternity units. Needs to be a MN campaign!!

Snap - I get what you're saying (and don't disagree that more trained pin relief adminstrators would be a good thing) but I do also think there's an attitude issue among some hcps.

From my personal experience, I can say that when I needed stitches in my leg (for a smallish cut sustained in a fall that wouldn't have healed by itself) I was given plenty of local and as soon as I said I could start to feel them stitching them they gave me a top up and checked it had taken effect before carrying on. In the maternity ward, when having repair work after an epi, when I expressed discomfort I was told that it "wouldn't be long" (in point of fact, she took another 15-20 mins to finish up, so it wasn't a case where there was only one stitch to go and the local itself would've hurt more than the stitch iyswim). It's clear that in both cases there was no issue with another case having higher priority, or with lack of availability of hcps trained to give pain relief (the person doing the stitching was the person giving the local, so was there anyway). So I can only assume that the difference in treatment came down to an attitude - when I was on the maternity ward it did not matter that I was in pain, whereas elsewhere in the (same) hospital, it did matter.