C-section and GA

[thistlemuncher]

OK, I know labour is a long way away, but I'm thinking through scenarios! all the info I read about C-sections assumes that you have an epidural unless it's a real emergency. Is it not possible to have an elective c-section under GA? If not, why not?

There was only one thing I put in my birth plan last time and that was no epidural under any circumstances and I mean to do the same this time (although to be honest I just assumed that I wouldn't need a c-section). But what if baby is in the wrong position or something happens that means I need a non-emergency c-section? Can I insist on a GA? Did anyone else choose this?

Sorry have you already had one vaginal delivery?

Why would you want to insist on a GA?
Its only used as a last resort really, i even had emergency surgery under spinal because it was a short operation.
The risks of a GA are small but ignificant. I doubt you would be able to persuade an anaesthetist to perform a GA for an elective without very good reason

i assume they do an epidural/spinal as standard because the risks of GA are higher (presume somebody medical can confirm that)

however, having had a section under GA, for placental abruption, i can't imagine why you'd want one... it was truly horrible not seeing ds1 born, and it took ages to come round from it so it was hours and hours before i saw/held him.

Yes, already one. I'm planning on another.

Just that a friend of mine is planning her c-section (her first was breech) and it made me think about it as it wasn't something I'd really considered before. But I am adamant that I'm not having an epidural. I'm not willing to take the risk. I have a friend who had one a little over 2 yrs ago and she's still in a wheelchair and was unable to lift her child for most of the first year of its life. Last time I had an operation (ovary removal) I was given the choice and I took GA. DH is in agreement with me, he also chose GA when he had to have his foot repaired.

If e.g. the baby is breech and I'm not allowed to have a vaginal delivery can they force me to have an epidural? Can they actually impose that without my or DH's consent?

No they cannot force you or perform an epidural without your consent, however they can also refuse to perform an unecessary procedure.

Im sorry about your friend, but you could equally find horror stories about GAs or about CS (mine).

Evidence states that a spinal or epidural is safer. Its not anecdotal its a fact and a decent anaesthetist would try and explain that to you

safer for what? When I had my operation before I was just asked which I wanted. There was no question of one being safer than the other. Why would it be different for childbirth?

The only info I have seen re childbirth and anaesthesia is the booklet from the royal college of anaesthetists and it even says that there are no accurate figures available from literature re risks and figures vary from hospital to hospital.

Pregnancy increases your risk of complications with a general anaesthetic. So the mother is at increase risk.
The general anaesthetic drugs can also affect the baby, so they prefer to give the mother the minimum amount, this means there is a small risk awareness.
If you have a general anaesthetic you miss the initial bonding and can feel a bit shit for a few hours as the anaesthetic wears off.
Your partner cannot be present if you are asleep for CS.
Under some circumstances it is safer to have a general anaesthetic, but usually not.
They will probably not refuse you a general anaesthetic, but will certainly make you aware of what is safest for you and your baby.

Hi

The risk of GA in pregnancy is twofold, involving mum and baby. The main concern for mum is airway management (would be good if any lurking anaesthesitists come forward to explain it better and in more detail). There can be increased swelling and odema in pregnancy which may make intubation difficult, for starters, and there is a risk of aspirating stomach acid too through soemthing called mendelsons' syndrome if you fancy a google. From a neonatal perspective, the baby will also be affected by the GA which can make it difficult for it to make the necessary adaptations from uterine exisitance and complicate resuscitation.

What you have will depend on the operation, the anaesthetist, your health, your risk factors (BMI, smoker etc), your anatomy etc.
I have had all 3, all for different ops.
Generally an epidural or spinal carries less risk than a GA, the drugs used in general anaesthesia carry a risk of their own, without any other factors, you risk damage to your teeth, allergic reactions, risk of aspiration, Unintended intraoperative awareness, slow recovery compared to spinal or epidural.

Apart from your friends story you dont seem to be backing up your decision with any real evidence.

Why on Earth would you subject yourself and your baby to a GA if it was unnecessary? Frankly. it seems a bit of an over reaction on your part to one unfortunate event. I wouldn't do it because I would miss the birth of my child and not be able to hold them for several hours - this is madness and I think you need to get a bit of a grip to be honest

Research strongly indicates that the rate of maternal death due to general anesthesia may be at least double the rate of deaths due to regional anesthesia. The primary cause of maternal death due to general anesthesia is difficulty with airway management. The greatest concern for the baby is the decrease in uterine blood flow and neonatal depression.

From Danforth's Obstetrics and Gynecology bible 'the prolonged neonatal effects have led to the virtual elimination of general anesthesia?s use during labor and birth'

I've had 3 sections under GA as I can't have a spinal/epidural due to medical reasons. My DH was allowed in with me for 2 of them.

But I wouldn't choose GA I'd had a choice. My DS1 was born with an apgar of 2 and had to be resuscitated.

Recovery from the GA is horrible. I couldn't even hold my baby safely as was so woozy.

Don't have references to hand, but based on what I've read in the past, mosschops is correct - it's not the same as your DH choosing GA for his operation, as the risks are higher for a pregnant woman, and there are the effects on the baby to consider as well. That's why it's normally used only if spinal/epidural isn't possible for some reason, or if it's a real emergency and there's no time.

If you absolutely can't consider an epidural than I think that should be your choice. No one can or should force you to have any intervention without your consent. But I would strongly suggest you talk it through with a medical professional, and tell them about your concerns, before you get into the mindset of 'refusing' and 'insisting'.

Thanks mosschops and laluna. I'm going to be searching the literature for these things when I get back to the office next week and have access to some medical journals.

On the info sheet for anaesthesia and childbirth there's no mention of there being increased risks for pregnant women. They say that side effects of regional anaesthetic e.g. low blood pressure can be countered easily by drugs - but presumably the baby then gets these drugs too. And that 1 in 20 epidurals don't work well enough and end up in a GA

Maybe it is an overreaction. I'm well aware that it's probably not rational. My mum and gran both have back problems that have been attributed to epidurals (although, with the number that my granny's had it's probably unsurprising). Just the idea of someone coming near my back with a needle when I'm having contractions freaks me out. The idea of missing the birth and not being able to hold the baby for a few hours worries me much less than the idea of an epidural/spinal. They can give the baby to DH, it's his child too.

There are increased risks to mum and baby with GA rather than spinal/epidural. Also highly unlikely that your DH will be allowed into theatre if GA used

I have had a VB with a retained placenta and a spinal to remove that. My 2nd was born via EMCS due to being brow, this was started as a spinal but the spinal failed and I felt the cut so was quickly knocked out.

My main fear with my 3rd was the spinal failing, so I asked this and was told they will only do a CS under GA if there is a real emergency, I was given a plan of action should I need a ELCS, which involved both a spinal and an epidural combined. I went into labour early and had a VBAC but did need a epidural due to scar pain thankfully it worked.
I know how you feel in the worry sense, I spent my whole pregnancy worried about this, in the end it was all pointless worry but of course I didn't know that at the time.

Speak to the midwife about your fears.

Should say you shouldn't be having contractions if you are talking about and ELCS. The reasons given for mine not working during the EMCS was due to the rush to get my son out as he was distressed, my spinal with my 1st was perfectly fine.

You can ask for a meeting with an anaethatist, I had one with my last pregnancy due to my concerns and I found it really really helpful.

Not read all the comments, but a GA carries far great risks to both mother and baby. Spinal anaesthetics are much safer and offer much better pain relief for the few hours afterwards.

I had an EMCS with GA. It was all a massive panic as DD was distressed after attempted forceps. I had already had an epidural so asked for it to be topped up rather than being knocked out. They did that but, like nunnie, I felt the cut so they knocked me out.

Had it not been such a rush, and the anaesthetist could have spent a bit more time getting the dosage right, I would have much preferred not to have GA. Not only did both DH and I miss the birth and I missed the first hour with DD, but also I am convinced that the GA affected both DD and I so we were both much too sleepy at a time when we should have been establishing feeding. When other women on the ward spent the nights pacing with their babies to stop them crying, I spent my nights trying to wake DD to feed her. In the end, after a few days of everybody thinking feeding was going ok (probably because I didn't know enough to realise it wasn't) she turned out to be seriously dehydrated and we ended up on bottles. After a long stay in hospital, I ended up back there with a chest infection they thought was something worse without DD for 3 nights.

I don't know exactly how much of this would have been prevented if the C-section had been by epidural but I am fairly sure some of it would have been.

BTW, I was terrified by the idea of an epidural like you, but in the end, it was really not bad at all, and I had no problem sitting still during my contraction (I imagine the anaesthetists try to time it so you are not in the middle of one when they put the needle in.) I am not suggesting anyone should have one in labour if they don't want one - it is definitely the case that they make other interventions more likely - but if you had to have one to have a CS, it honestly is not that bad.

Why would you be contracting during ELCS?

A possible alternative is a spinal block but one of the issues with that and a GA is that you can't be topped up with pain meds via the epidural tube, so you'd be on heavy duty painkillers which can leave you feeling groggy.

FWIW I requested a spinal for my second CS as I'd had one with my first and had a really good experience. The anaesthetist insisted on an epidural and I'm glad he did as I had a huge severe PPH and they had to do bi-manual compression to stop the bleeding. If you're feeling string google this and you'll see why I was VERY glad they could numb me up straightaway!

You have to remember that around 25% of deliveries are CS and the VAST majority use spinal anaesthesia. Then add in all the women who have it with difficult/instrumental deliveries and the vast majority have a positive and trouble free experience. It's a shame to let your friend's single poor experience cloud your judgement.

I had a spinal 6 weeks ago for cs to deliver breech twins - was great. The worst part was dtd1 was rushed to SCBU so I didn't see her for 6 hours - it would have been longer if I'd had GA. Also, I know my mum had a bad reaction to GA and felt terribly ill for days after so I wouldn't have wanted that while caring for my babies. There are always horror stories but my experience was so much better than my VB which left me pretty traumatised.

I image you can have GA if you want it, but not sure why you would. Each to their own.

I had a GA for my ELCS after an anaesthetic trauma with my vb. The GA itself was fine, worst bit was the 3 mins of oxygen you have to take. Also, you have no pain relief when you come around, they need to wake you before giving you morphine, and of course there is no residual spinal taking the edge off.
DD had very low agpars at birth and had to have the crash teams in. Consultant couldn't even tell my dh whether we'd had a boy or a girl because it was, she said, 'pandemonium'. From that point of view I was glad I was out of it.
I think though that they will not offer GA lightly, and there'd have to be a good reason.

What happened to your friend is probably very rare compared to all the successful epidurals going on every day. Perhaps try to look up some stats and definitely speak to the hospital when the time comes.

I would be far more nervous of a GA to be honest, for equivalent horror stories. GAs carry their own horror stories too. You are apparently knocked out and can't indicate if something is amiss.

I have had an epidural and a spinal. Both were painless, from the local anaesthetic, to wearing off. Not even a dull ache in the back area to say I had had a spinal. 100% fine. I am aware that everyone's experience is different but I do think your friend's is very uncommon and she was very unlucky. As for doing epidurals while you are contracting, trust me, if you are writhing in agony and cannot sit still they would just not perform an epidural as it would be too risky. That's why they say some women ask for them "too late" because contractions are thick and fast and you need to be able to sit still.