So nervous about having the Spinal...

[Writerwannabe83]

I'm having a CS in a week and today I had my appointment with the anaesthetist for my pre-op chat. We spoke quite a bit about the spinal and he said that I'll feel numb from the chest downwards and although I knew this, it has suddenly really freaked me out.

I'm so scared I'm going to get myself into such an anxious state about the sensation of being paralysed. I'm panicking that something will go wrong and I'll never get my sensation back. I didn't think I'd be this nervous but I'm feeling really scared.

Can anyone reassure me that it's not actually that bad??

I had a spinal block but it was after 30 hours of labour so I was begging for it at that point and didn't care if it killed me

It was fine though, wore off fairly quickly afterwards and no negative side effects.

I was terrified of having a spinal. Had decided that if I needed ac section I'd have a ga. I'm sure you'll be fine but there are other options if you don't want a spinal block

It was fine for me but i had emcs so no time to give much thought to it beforehand. I think the thought of it is quite terrifying though, much like you.

It is a very strange sensation but i cant say that i gave much thought to it when the time came. I was much more concerned with making sure i couldnt feel anything rather than worrying about the fact i was momentarily paralysed or that i might not get any feeling back.

Once baby was out i honestly forgot anything was going on behind the sheet and just stared at my baby.

emcs with first baby and epidural. planned cs with second baby and spinal. Spinal was way nicer than epidural, hardly felt it - anaesthetist and rest of team were lovely, very calming, amusing, factual and reassuring - as well as competent. Best birth I've ever heard about! spinal wore off very quickly, no headaches, no concerns. Would do it again in a heartbeat.

I've had 2 ELCS and was nervous about the spinal for both.

Honestly they were fine. I asked the anaesthetist to ensure I had plenty of local before it went it, and despite my best efforts to prove otherwise I was definitely numb before they started anything

I felt slightly light headed with DC2 due to a drop in blood pressure, but I mentioned it to the theatre nurse & they sorted it straight away.

Good luck & congrats

Had 2 spinals here, and as the others have said it sounds scarier than it is. The sensation wears off quickly and you will be awake to hear your baby's first cry. I had both sections as emergencies and both were late at night, and I couldn't sleep until I felt sensation in my toes. There is no pain in the limbs, and when you start feeling sensation it happens very quickly. I didn't have a catheter so you need to be on your feet quite quickly to go to the loo. Once the sensation comes back, it happens suddenly it's not oh, I feel something in my toes and then 2 hours later I can walk. It happens sort of at once. I understand that you are anxious about it as it does feel strange thinking about the sensation, but you will do it and it will be over quickly.

This was my biggest fear for the exact reasons you describe. But it was absolutely fine. i wish i had known how fine it would be beforehand, I was an anxious wreck thinking about it. I wouldnt hesitate to have again.

Thanks everyone - I feel so much better now. The anaesthetist didn't mention the catheter now I think back, does every woman have one??

He also told me that if I'm having my CS on a Friday I could expect to be home by Saturday night!! I was gob smacked....I thought they'd at least keep me in for a few days??

Also, he said that my DH and baby will be taken through to Recovery before they start to "clean out my birth canal and give me a good clean up" and when the surgeons are all done I will then be wheeled into Recovery too. I was a bit surprised about this....why the need to remove DH and baby from the room beforehand?? I don't really want to be separated from them? Is this common too??

I had a spinal, after 24 hours of an induction with a back to back baby, was being prepped for an EMCS in case the ventouse didn't work, it was bliss. It wore off pretty quickly and I was fine.

The risks of a spinal are really very small. The obstetric anaesthetists' website has some good information (Google them, then on their home page there's a link on the left hand side called 'information for mothers'). A Caesarean section is one of the most commonly performed operations in this country and the vast majority of these are carried out under a spinal anaesthetic. Many other operations also involve a spinal, such as hip and knee replacements, prostate surgery and other foot/leg surgery. The advantages are that you're awake for your baby's birth and can usually have a cuddle and skin to skin pretty soon after, your partner can be there too (can't with a GA), you avoid the risks of a GA which although are small, are higher in the pregnant that the non pregnant woman and the baby avoids a general anaesthetic. The drugs cross the placenta and although little one is out as quickly as poss after they're given, they're usually a bit sleepy at least. With a spinal you get strong, long lasting painkillers given in the mix as well as local anaesthetic so post op pain relief tends to be better.
A spinal is not the same as an epidural. Similar but with fundamental differences (epidurals are also low risk in general).
The idea of a spinal is pretty scary in theory but it's actually a very safe technique. Yes of course there are risks and drawbacks but these tend to be pretty short lived and manageable. The serious long lasting ones (such as paralysis) are incredibly small. To try to put it in context, think of the journey you'll make to and from the hospital - what are the chances of being in a car accident that leave you with permanent injury? we take all sorts of risks every day (because life would be unutterably dull and difficult without them) without thinking about it because it's normal. A spinal really is very safe and the risk of badness is very very small.
As for dad and little one going into recovery for the end - it's pretty normal practice. Theatres aren't huge and you need to be got on to a largish bed once you've been cleaned up. Having that extra bed in theatre, plus everyone around it to move you across (you won't be able to yourself yet) makes things very squashed. The option is to have dad and LO pushed up into a corner somewhere (where you can't see them anyway!) or put them in recovery for the few minutes it takes to do it and wheel you out to join them. It's been done like that everywhere I've worked as far as I can remember. And catheters - most places do put a catheter in but I think a few don't. Local policy will alter a bit on that one, probably due to surgical preference.
I hope the anaesthetist can make you feel happier and more comfortable about what you decide and you have a lovely birth in the end.

Thanks for all that information jcb - it's really interesting.

The anaesthetist asked me if I wanted to be awake or asleep for the procedure and I was very surprised he asked this - I assumed a GA was only given in an emergency situation or because the spinal/epidural failed - I didn't realise it was something you could just opt for?!

Thanks for explaining about why dad and baby are moved into Recovery - it makes me feel much better about it all. Sometimes all a person needs to alleviate their fears/worries is a straight forward explanation

I've had two spinals and they're just weird, not scary. When they first put it in, it feels like they're pouring water over your legs. It's an odd sensation. After that you don't feel anything other than normal. You can't move which is odd but you also don't have to so it's not like you're paralysed and fighting against it iyswim. You lie there, you chat to the anaesthetist, your husband, theatre staff etc and you feel no different to you do lying in your bed at night. You can feel the op too. It takes away pain but you still have sensation. You will feel your baby being born which I quite enjoyed. Plus they allowed dh to stand and watch the op which meant he could describe it (my insides look like lasagne apparently). It's really, really not terrifying and by the time they're stitching you up, it will be wearing off anyway. I could move my legs/sit up etc as normal as soon as I was in recovery.

Here, the baby stays with you the entire time, as does your partner. They don't send them to recovery first.

And you can be discharged on day 2 with day 1 being the day of the surgery. I went home 12 hours after my first cs.

My DH asked the anaesthetist if he could observe the baby being removed and the response was, "I don't recommend it unless you want to see your wife looking like she's been attacked with a machete."

Just what I wanted to hear.....

That's amazing that you went home so quickly!!!!
I can't even imagine it - but I suppose if you make a good recovery there's no need to stay in hospital any longer than necessary.

DH was really curious and isn't bothered by blood. It was nice that he saw his son born. I felt quite robbed of a lot of elements of the birth experience and seeing my dc born was one of them but second time round, DH was privileged enough to witness it.

I had two emergency cs but recovered quickly. I think electives are even more likely to afford you a good recovery.

My second son was born at 3.30 in the afternoon. I had my catheter out at 6pm, went for a shower at 7pm and then had a cheese and onion sandwich and watched Saturday night television in my chair. I felt utterly fine, no need for painkillers at any point. You must listen to your body and take painkillers if you need them but a cs recovery isn't as terrible as you might currently be imagining.

And it's a lot nicer to get home than stay in the hospital any longer than you have to.

DH snuck a photo of DC4 half in half out, and of her out plus incision! They never said not to but I think they were surprised. The photos don't phase me in the slightest, in fact I love them! Perhaps because there's no context to it i.e. you can't see any part of me except the small part of skin around the incision site. No limbs etc.

I've had three c-sections and baby and DH have been with me the whole time whilst I'm being sewn up. In fact I've been allowed to have baby on my "chest" (more like my neck!) for the duration.

I went home 34 hours this time, could have been 30 if discharge had been quicker. Previous times it has been 72 hours and 48 hours. I was well enough to pick the DC up from school (5 minutes walk) the day after my EMCS this time, although I think the other mums thought I was trying to prove some point or other. But after four months of agonising SPD/lower back pain with crutches, a c-section with decent painkillers was nothing in comparison so long as I took it easy and carefully. The DC weren't expecting me to be home so soon, so I thought it would be a nice surprise for them!

Spinals just feel like lots of nice warmth spreading throughout your body, and any niggling aches and pains just evaporate! I do find spinals a bit weird if I think about moving my legs. Don't do this! If you find yourself doing it, you then can't stop doing it - ask to be distracted and then it's okay. Just imagine you are lying in bed with your legs all relaxed and straight out and then it's fine. I've had five of the things now (two were for stitch surgery/removal), that's my lot!

Some people do have a rough time of it for a c-section recovery, but generally not for an ELCS (or not a severe emergency EMCS). The vast majority of people are just fine very quickly and the pain soon fades to "discomfort" pretty quickly. Ten days out and I've been off the prescription pain medication for five days of that.

Arr thanks crispy - that's a very reassuring post.

My friend has had 2 CS - the first being an EMCS and the 2nd being an elective. She was in quite a bad way after her EMCS (probably not helped by the 24 hour horrendous labour she'd be in before having it) and her recovery was quite long and difficult.

She said her ELCS was a 100 miles away from that trauma and 3 days after having it she attended her routine dentist appointment

I think I'm probably imagining that the recovery will be worse than it'll be in reality - but that's human nature I guess.

I asked my anaesthetist if my DH could be with me when they give the Spinal and he said although they don't normally recommend it, it is completely my choice on the day. I don't know whether I'll feel more anxious or not if he's there....

Thanks miaow - my anaesthetist warned me about the itchiness but didn't say anything about the shakes - at least I know now that if it happens it's nothing to be too concerned about. That's brilliant your spinal wore off so quickly, I had visions of being numb for about 12 hours for some reason!!!

Yup - shakes very common but try do wear off. It's odd - some women get nothing, some get them really quite bad. No apparent rhyme or reason and no predicting who will/won't get them. Doesn't even seem to correlate particularly well with whether you have/haven't had them previously (but that's just an observation, not a study!).
The diamorphine in the spinal mix (which gives the best pain relief and is NICE standard) can make you itch. Again, it doesn't happen to everyone and if it does it can range from mildly irritating to absolutely maddening. Piroton can help some but so can naloxone (it reverses the effect of the drug at the receptor site). The disadvantage is that reversing the itch with naloxone also reverses some of the analgesic quality, so as with everything, it's a balance - itch vs pain relief. A little dose might make the itch tolerable without affecting pain relief too much. Either way, shakes and itch do go, they're not a given and some people ony get very mild effects that don't really bother them. Fingers crossed you're in the latter categories.
The time taken for a spinal to wear off varies too. Some people can wriggle their legs a little by the end of surgery, most get some movement back after a few hours. Full walking strength (which is what you're after really) often takes about 12 hours but can take longer (or a patch can take a bit longer still).

Thanks Jcb - do you work in anaesthetics??

The anaesthetist also went through all the pain relief I'd be given.....I assume it's all safe to take if breast feeding?? He didn't mention breast feeding you see and it only occurred to me this morning as to whether there were any issues??

The itch is definitely the diamorphine as opposed to the spinal itself. I had it very, very badly first time round and had it reversed with naloxone. DH was muttering to himself about how quickly it reverses the effects of heroin and had to explain himself after he saw the anaesthetist's funny look. DH is a copper and has seen it used a few times in overdose situations. I refused diamorphine second time round because it's hard to concentrate on bfing your new tiny baby when you want to tear your own face off to get rid of the itch. The drugs used are all bfing compatible btw. Here you are given diamorphine with the spinal and a suppository as they stitch you up. Drugs then become oral and you self-administer.

I didn't shake with my first spinal, but did with my second. It wasn't scary at all. I've seen people shake badly after a natural birth too due to the adrenalin. It soon wore off. It did cause my blood pressure to fluctuate a wee bit too so I had some meds to stabilise it but again, your anaesthetist stays with you until you're all stable and they spot these things happening before you do generally.

I was probably lucky in how quickly my spinal wore off. I had leg movement before I even left theatre and by the time I was back on the ward, I could stand up and move round.

Yes writer - am an anaesthetist. Although for the purposes of most of the threads I write on I'm just an anxious first time mum!
The painkillers you get put on post section vary somewhat trust to trust (local prescribing policy) but in general are: paracetamol - fine to breast feed with, ibuprofen or voltarol (which is what the suppository you get given at the end of surgery is) - also fine to breast feed - and some kind of opiate. This used to be codeine but there are several drawbacks. Codeine is metabolised to morphine in the body an it's the morphine that actually does the painkilling bit. The degree to which you metabolise it, which is determined genetically, determines how much morphine you get so how well it works as a painkiller. Some people get pretty much no effect, some can be pretty spacey on a fairly small dose. So that's one drawback. With breast feeding, the metabolizes are secreted in breast milk so some mothers end up giving their babies a big dose of morphine which can make them sleepy. There was a case not so long ago (in the states I think) where the baby died from effectively and overdose from opiate in breast milk. There were confounding factors though - from memory the baby had been noted to have been sleepy but nothing much had been done about it, and it's a pretty rare example. So again, we're back to the risk balance thing. For some people, codeine is a great pain killer and fine if you know to keep and eye on your baby and if it seems excessively sleepy then do something about it. For others, it little more than a pants painkiller with constipation side effects.
Oromorph (oral morphine) is usually given for the day or so after the section whilst you're in hospital. Again, can be passed to the baby but again, if it seems sleepy - people around to notice. And it's metabolised much more reliably than codeine. No reports (as far as I'm aware) of neonatal harm.
Naloxone reverses the effect of opioids (including morphine, diamorphine). Diamorphine is heroin, which is why you dh recognised its naloxone response Raxa, but we tend to give tiny doses, esp in a spinal, and not cut it with bleach and inject it with dirty needles!
Most drug manufacturers say avoid in breast feeding, not because they've tested it (ethical nightmare) but because they haven't tested it, don't know and can't afford the litigation if something went wrong. Most drugs used in obstetrics therefore are 'tried by time' i.e. Pregnant women have had them for years without notable consequence. And by the time your baby's born, if it needed a lot of the drugs itself, it'd get them anyway..... Including morphine.

Miaow that sounds awful and I'm sorry. You are of course right to bring it up. Your hospital needs to change. Have you given them feedback? I had PTSD after my first emcs and it was caused by some things not being explained adequately, resulting in terror and poor postnatal care. Thankfully, our hospital has fully retrained all staff.

While we are mentioning the unexpected you wish you'd known. I had really uncomfortable shoulder pain post op, like I'd slept funny. It was trapped wind and resolved completely by peppermint water. V sore and v v common and so easily resolved.