C section with a general - any experiences?

[civilfawlty]

Hi all. Due to a combination of circumstances (raised amniotic fluid levels and a terrible needle phobia which rules out an epidural ands breech baby) it appears that a c section with a general is my most likely delivery method. I am finding it very hard to access a realistic nuts and bolts summary of what will happen - has anyone any experience of this they would be willing to share please?

I am keen to find out what the pre-prep is like (invasive?); whether there is a way of being calmed before they administer the general; who is in the room; how long it takes; when my husband can have the baby; recovery times; when I can do skin to skin; length of hosp stay; pain; when I can shower; if it has any implications for breast feeding; and most importantly outcome for my baby. And I'll bet there are a million other things I've not thought of. (I know-I have catheter anxiety-can they do that once I am out? I dont think I can cope with being touched when I'm awake.)

Thank you for any input. Appreciated

Why are you having a caesarian. Have you considered having a breech birth? Read up on it.

Basically, you will be given pre meds on the ward and asked to change into a gown. You will walk down to the operating theatre where they will put a cannula into the back of your hand. You will sit on the side of the couch and a spinal will be put in your back, this generally takes about mins. Its a bit of prodding and poking but not too bad. You will then feel your legs go numb and the anaesthestist will spray some very cold fluid on your legs and abdomen to assess how numb you are.

A Catheter will be inserted into your urethra by the midwife, then the screens will be put up and the operation will start. It generally takes about 5 mins to get through the different layers to the baby. Sometimes breech babies can be difficult to get out and forceps may be applied.

The baby will be taken to the rescusitaire to check it is breathing will and then you will have your baby in your arms. Whilst the doctors spend about half an hour or so stitching you back up. The baby will be weighed and checked over and after that you will go out to recovery for about 1/2 and hour.

Hope that helps!

I had to have an emergency general CS with DS I def would not advise it at all - no rush of feelings - I actually woke up and didn't feel like i had a baby - was a very odd feeling - ok so it didnt help that DS had to go to special care - although i did see him before he went, he just didn't feel like mine at all - with DD I was awake and the experience was 100 x better - surely for a generally you will still ahve canulas etc put in before you are asleep!

The theatre team normally consists of an anaesthestist who will become your best friend, he will talk you through what is happening. The e Registrar who will perform the operation, the SHO who will assist. A Theatre nurse, an Operating Department Practitioner and a runner (someone who runs to get things that are needed) and a midwife. The midwife will stay with you throughout the procedure and advocate for you.

If you want to do skin to skin in theatre, then ask. I generally encourage mums to do skin to skin when they get to recovery. It is a bit more relaxed and the baby is more likely to latch and feed then.

The catheter will stay in for at least 12 hours (to prevent urinary retention) and you will be bed bound until the catheter is out. But don't worry the midwives are used to assisting mothers who have had caesareans, to do things like change pads. You will have a bed bath when you get back to the ward. You will be able to eat and drink small amounts too. Most women stay in hospital for a minimum of 48hours. However, if you are well enough, you may be able to go home sooner.

Re the GA. Anaesthethest are reluctant to give General Anaesthetics without a good reason as they compromise the baby.

It really is better to have a spinal if at all possible.

This is what the consultant anaesthiatist told me when CS under GA was a possbility for me:

A CS under GA needs to be done very fast because GAs aren't really that good for babies or pregnant women, it can pass to the baby and because you're flat and intubated there's a risk of vomit aspiration
You're more likely to have bruising and a longer recovery period because they aren't as careful when they cut due to the time pressure
Recovery time depends how long you're under, skin to skin and BFing depends how well you recover
My DH wouldn't have been allowed in the room so up to 30 mins, depending on the health of the baby, before the baby is allowed out of the OR.

You will need canulas etc before you go under so needles are involved in any case. Eventually I came round to the idea that I'd agree to relatively heavy sedation and a spinal and I HATE the idea of needles.

Thank you for your replies. Unfortunately I can't have a spinal because of a severe needle phobia. The consultants and co agree that a general is the best option if I have to have a c section (versus spontaneous vaginal delivery-induction is out of the question). The breech isn't the only issue, the amniotic fluid levels are wry high.

Anyway-just hoping to hear about the practicalities of a c section with a general. Unfortunately, I don't have many choices. Thanks

So how will you cope with the cannula before? Not judgy/combative btw, a genuine question.

It can be done but anyone who says its a pleasant option is lying through their teeth and a lot of what you ask will vary depending on how well it goes. Your consultant is probably better placed to comment on your specific case. A CS under general is like a CS under spinal but very fast and with added complications.

Once you're awake you'll be able to have skin to skin and BF (the reasoning being that if the drugs in your system are at a low enough level that you're awake they'll be low enough not to pass to the baby) but how long that will be is impossible to say. You're looking at an hour plus rather than minutes though.

How will I cope? Badly. I will have a panic attack I imagine. I understand I can have a sedative first. I'm terrified of all the options, but the spinal is the top of the hierarchy.

Have you tried G&A? Might that be a way of coping with the epidural (or the cannula of course) I personally would recommend Valium for temporary relief of phobia, but I have no idea whether that's an option - I assume it's contraindicated in pg - but if it's a choice between a contraindicated drug and a GA the balance may be tilted.

Hi civilfawlty I had an emergency c section under GA just over two weeks ago. I already had an epidural and catheter in but the epidural didn't work properly hence GA. I was anxious about it because didn't like the idea of not being conscious when my baby arrived and dh wasn't there either. Took me a while to come to terms with but feel fine about it now. Son was with dh fr first two hours of his life but when I saw him, I absolutely felt bonded with him straightaway it was so emotional. He latched on to breast feed almost immediately. Recovery is no picnic as lost alt of blood and have been in pain but I am slowly getting there. I'm sure it will be fine...good luck x

How have you coped having bloods taken during pregnancy?

I had a cs under ga 8 weeks ago tonight. It was very emergency (dd's heart stopped) so I can only answer some Qs as I was knocked out very quickly.

I already had a canula in my hand.
There were about 4 people apart from me and dh in prep room. Then 10-12 in surgery (obviously I don't remember this, but I had a cs with spinal block for ds),
DH was not allowed in theatre.
Mw brought dd to dh less than ten mins after I was taken off. He cuddled her skin to skin until I came round.
I came round 2 hours later and bf dd straight away.
I was in for 4 days same as with ds)
Pain was bareable with painkillers, which I took for about ten days.

I've had 3 c- sections under GA (cant have a spinal or epidural). Ask for the cannula to be placed once you'd are under. I had 2 cannulas with my first section but woke up with them in place, my second two sections I was awake for them and it was unpleasant.

Also ask for catheter to be put in while under. My first two sections they waited until I'd had the GA but were going to put one in while I was awake for my third section. I was about to shriek my disapproval when a midwife suggested they do it later. Love that woman.

There are lots of people in the room but are prepping stuff and you don't even see them. You are flat on your back and then tilted to the side a bit with the dr and anaesthetist looking down at you. They chat away and keep you calm and tell you what's going on.

My DH was allowed in for my second and third sections. Do push for this if it's what you'd both like. My DH had to wait outside while all the prep was going on, and while they put the tube down my throat etc but was brought in to see everything else.

I didn't wake up for about an hour after my DC were born. My DH was with them while I was out of it. I held them soon after I woke but needed major supervision as I was so groggy I felt like I would drop them!

Breastfeeding was a group affair at first! I couldn't hold to feed so someone had to do that and place nipple in my DS's mouth. I also had a midwife express milk into a syringe thingy to give to my DC so they were still getting milk. At the time it didn't feel at all weird to have someone else manually express me!

I was up and in the shower the next morning. It's sore to laugh, cough and sneeze and don't even ask about going for a poo! But I've found it's two days of ow ow ooooowwwww then it's fine, you just need to take it easy.

Can you not have the same sedative for a spinal block as you would have for the GA? You will not see the needle at all for the spinal?

I have had sections under GA and spinal and the spinal was infinitely preferable because I felt I was actually present for the birth of my baby, whereas for the GA birth I was totally absent (as was dh, who was not allowed in the room) and it still bothers me to this day. Honestly, if there is a time to tackle this phobia then perhaps seize it now so you don't miss the birth of your baby?

I had an emergency CS with a GA so can't help you with the 'before' questions but DH was allowed to hold our baby almost immediately - I was knocked out for a while, in fact when I came round I was on my own in the room with another patient recovering from an operation - my DH had asked to be with me to 'break the news' but he was elsewhere (with our baby) so the surgeon told me I had a DS - to be honest I was still 'out of it' so I wasn't disappointed that DH and DS weren't there.

I had absolutely no problems with the cathetar but I was incredibly 'numb' down below and one of the worse things was knowing I was bleeding heavily and asking for STs but the nurse didn't even put them within reach .

Establishing breast feeding was quite hard and I have since read that it can be due to the GA - no one had told me this before hand and if I had known it would have made life a lot easier - as soon as I got home I could BF easily.

No scar , no pain afterwards - overall I was pretty happy with the experience. I was up and about as soon as I get home (it is an urban myth that you can't drive after a CS - but check with your own insurer - I had no difficulty).

You will have medicines on the ward to reduce the risk of damage to your lungs should any of your stomach contents come up then go into your lungs.
It is unlikely that your partner will be allowed to stay with you in theatre for GA, but fairly routine for spinal.
If you are having a GA you will need a cannula in your hand first. The anaesthetist will probably use a tiny injection of local anaesthetic under the skin before putting in the cannula.
They will prepare everything for surgery before they put you to sleep- paint your belly with disinfectant, put up drapes, catheterise you etc so they can operate the second the tube is in your trachea.
You will be given oxygen to breathe, then as you are going off to sleep you will feel pressure on the front of your neck (to reduce the risk if stomach contents soiling your lungs).
Afterwards you may feel sleepy & nauseated for a while, and can expect a bit of a scratchy sore throat. Your baby may be sleepy initially.
Generally for most women a spinal is the better option, but not for everyone. Your consultant will help you figure out what's best for you.
You will be hooked up to various monitors to record your heart rare, oxygen levels etc.

I had a slightly different experience to what you're expecting so can only tell you my experience for after a GA (I had an emcs with a topped up epidural but after my son was born the anaesthetic from the epidural had got into my spinal cord and I stopped breathing so had a GA so they could breathe for me)

I woke up I think about an hour after ds was born in the recovery room where ds was with my DH mum and dad already dressed. This was very disorientating. I felt very shakey and couldnt hold him for long as it felt as if i would drop him plus i kept falling asleep.

I did BF my ds for 11 months, and didnt find the GA affected this- the nurses were very good at helping me, showing me how to lie on my side to feed him so it was easy for him and no pressure on my scar and my milk came in as normal at 3 days.

The only things that bother me still, ds is 2, is that i didnt get to dress him for the first time and I dont really remember his first day as I was so groggy with the after effects of the GA and kept falling asleep.

I wish you all the best, its not an easy option

Thanks for all the helpful advice.

Not going to engage with the more judgemental posts. I have not coped with bloods and have had several panic attacks and now have to be sedated though not completely obviously. And-I am trying to deal with the phobia but referral was quite late and agreement is that I am unlikely to be over it before I am due

Judgemental posts.

Where would they be then?

I had an EmCS with GA with my first child, EMCS with spinal for DC2. The first had to be done very quickly and I remember very little about the blur before the delivery or the 10 hrs post delivery. I wasn't able to breastfeed as my milk did not come in.

My DH was not allowed in and could not hold our DS for approx 40 mins. I have been told though that if it had been a planned section under GA they may have let him in, not sure if that holds up anywhere else though.

It was the most harrowing feeling waking up on my own on a ward after it (don't remember coming to in recovery but I must have) and being totally unaware of the actual birth- I didn't know what sex child I had nor whether the baby was alive (they were uncertain it would go well before I went under). I found out my childs sex by reading my name bracelet- not pleasant, I hate that everyone in my family knew I had a boy before me. I felt my son had been given to me from a cupboard, I had no maternal feelings or bond with him at all- he could have been anyones (5 years on I still feel really guilty about this).

The tube from the ventilator scratched my throat and made me cough- something which is very painful after a section. The catheter and saline drip via cannula were removed after approx 12 hrs. I was in hospital for 3 days, up walking and showering as soon as catheter/drips were removed. I had to have injections of anti-coagulant into my tummy each day and for a couple of days at home after via the midwife.

My DS is absolutely fine, no ill effects from the section but he was very drowsy for the first day.

Different perceptions of birth experiences always fascinate me.

A c section under GA would be my dream birth, even though some women here dislike the idea so much. I don't really care to be the first one to see the baby etc- it's my baby, I have my whole life to enjoy him/her. What's a couple of hours?

I also don't care to be wake during the who,e chikdbirth process. Knock me out and wake me up with a baby. Sounds perfect to me.

Unfortunately GA comes with a set of risks and a longer recovery. So while I'd definitely opt for a c section, I'd skip the GA unless it was required.

I've had two.

My first was a crash at 31 weeks as they realised I had delivered a foot. At 6:45pm the doctor said we needed her out, at 7:15pm she was born and I woke at 7:45pm. Apparently I was hard to wake, there were problems getting her out and things were a little difficult.

Because of the speed of everything, my baby was already in NNU when I woke, I was left with Birth Trauma (PTSD after the birth of a baby) as my brain could not bridge that 45min gap where I was asleep. It left me in a mess, I didn't accept she was mine and my day threes were so bad they had to call the M&B doctor to come and assess me. Fortunately for me breastfeeding was something we were successful at as it helped the "baby sitting" feeling as I was the only one that could do it and I'd sit there reminding myself that only her mummy can breastfeed her (don't get technical on me lol)

My second one was a planned crash. They knew I would have her early as I'd already been having contractions (not BH) for 11 weeks so there was no way to have an elective section and they didn't want me to deliver naturally as I have a special scar. Basically I was left to labour until they thought it was far enough then rushed me into theatre. When they painted my back for the spinal they were concerned about the pain it was causing me (it's very cold!) then when he did the thing where they count down and then push between the vertebra I gasped and was off the bed pulling away from him. He did it again and they decided this wasn't viable and gave me a GA. It was a little easier this time as I had more time to get used to it and I actually saw the inside of the theatre!

Third time I planned to VBA2C but because of the issues with my back and knowing I would only ever have a crash section, they got an anaesthetist to assess me for an epidural. He did the same thing as they had done at the last section and couldn't stop apologising, he went and got me some tissue as my eyes were streaming in pain, so it was decided I would not be eligible for an epidural and would always need a GA. Fortunately it wasn't needed in the end.

My tips:

1. Go into labour. Firstly, something about labour helps a baby, even if they are born prematurely or by section they will do better statistically than if it was planned. Secondly it gives baby chance to turn and babies will turn even in labour.

1. Visit theatre. Ask someone (your cons or a SOM) to take you there and explain what everything is and what it does. This is not just any operation this is the birth of your baby and not being there as a mum when your baby is born can be rather disconcerting at the least, so if you can prepare yourself mentally for it by understanding the process so when you go down and wake up you can tell yourself "this is what happened" you will do a lot better.

1. Always remember your TBRAINS. Always talk to them, this is your body, your birth, your baby - never be afraid to ask them anything. TBRAINS is

Time/ Talk - do we have time to talk about this? If they say no, nothing else matters, this is serious do what they want! If they say no because they're brushing you off too busy then push them. Benefits - what are the benefits to doing this? Risks - what are the risks of doing this? Alternatives - what alternatives do I have, what are my options? Instinct - what's it telling you? Usually mums know what's going on better than they think. Nothing - what would happen if we do nothing? Wait and see? Delay things? Smile - it makes you feel better and can diffuse a tense situation.

Dancelikethewind I have a friend who said similar to me after my EMCS under GA. I remember her comments went like a sword through me.

I think there might be a (good) difference between a planned CS under GA and an emergency under a GA, where the GA is thrust upon you and is a shock. Knowing you're going to miss the birth of your baby perhaps allows you to come to terms with this in advance. Certainly, you can put elements in place (skin to skin with husband/husband to tell you the sex of the baby/consultant to give you a debrief of what happened in theatre, etc.,etc.) that can give you feelings of control and understanding - sadly lacking when you have a GA caesarean in my experience.

It wouldn't be my choice. I had one when my epidural and spinals failed during my EMCS for the delivery of my twins. I was knocked out with a GA whilst someone pressed violently on my throat (I understand that this was something to do with anti-nausea medication they had just given me - it's not typical I don't think). It literally felt like being suffocated. I then woke up in agonising pain (no epidural or spinal for pain relief and they hadn't got the morphine sorted) and was completely disorientated. They handed me two strange and tiny, tiny babies who could have belonged to anyone. I felt nothing - nothing apart from pain. The day got worse as I vomited from the morphine and coughed endlessly - not great on a newly operated stomach. It's my great sadness that I missed the birth of my babies.

However, because I believe that God laughs whilst we make plans, I had a list drawn up this time around in case my VBAC plans exploded and I ended up with another EMCS under GA. I decided that if I was going to miss out then I'd like the following to be in place: -

1. My husband to be told immediately and given the baby for skin to skin. They are not allowed in the theatre for the birth and I understand this is non negotiable. We certainly pleaded and pleaded for my husband to be allowed to stay first time around and it fell on deaf ears.

1. Provide your own CD. They often have the radio on but this way you can pretty much determine the sounds that your baby comes out to. It doesn't get to hear you say "hello baby" first of all but the idea of it hearing your favourite music seemed pretty nice to me. Your baby could grow up knowing that was his/her song, which I think is lovely.

1. My husband to tell me the details of the birth of my baby. I didn't want some random midwife bellowing "congratulations, you hadda boy" as I came round.

1. Consultant and/or midwife to give me a full debrief of what went on in theatre. Did the baby cry when he/she came out. Was oxygen required, etc. What were the APGAR scores. Was there any bloodloss with me, etc. It may seem irrelevant and mudane but it still paints a picture. I can never tell my daughters if they cried at birth or what they looked like when they came out.

1. My husband and I are to be the first to dress the baby. This time around, although I had an EMCS and the baby ended up in NICU due to complications at delivery, the THRILL of being the first to dress him and touch his new skin was wonderful.

1. Adequate post-surgical pain medication in place. Honestly, if you don't have a spinal or epidural the pain can be quite intense, especially if the drugs they give you are 'chasing it' i.e. the pain is already there. Make sure they are on this. They'll usually give you a voltarol suppository in theatre which acts fast. And also, get your husband to put a 3 1/2 hourly alarm on his phone so that you can chase your drugs in time. They're issued every 4 hours and if you're on top of this and getting them on time then it can make a big difference. I got a few drug rounds late due to midwives forgetting and honestly it was a rough few hours. I was much more capable when I was fully loaded. Also, if paracetamol isn't cutting it then ask for stronger stuff. They'll give it to you. It's much easier to care for a baby if you're pain free. In a gung-ho 'pain-off' with hardcore new mothers it would be nice to beat everyone by declining all pain relief but seriously, your baby won't give a sh!t if you've taken everything going.

I hope this helps. I think there are many types of 'good birth' and I wish you a really positive one. This time around I swerved a GA, although I did have a EMCS again. It was an amazing birth for me as so many wonderful things happened that I had lost first time. However, I hand on heart know that had this baby been born under GA I would have been prepared and ready and there would have been none of the shock and dislocation and fear of the first time. And that would have been a good birth for me.