Elective cesarean - options about anaesthetic

[LashesandLipstick]

I'm requesting an elective cesarean due to a combination of reasons, mainly severe anxiety. I have PTSD and GAD with panic disorder thrown in, the traumatising event that happened was several medical procedures when I was a child. I had very little control over what happened to me, was prodded and poked, and have very vivid flashbacks to being held down, stuck with drips and screaming. I feel that an ELC would be better for me because it's planned, it's calm, although I have to have a procedure I know what's going on vs the unpredictable nature of a VB where they could tell me I need an EMC or forceps and I'd have no time to mentally prepare and the loss of control would come back. I'm also scared I wouldn't be able to cope with it.

On top of that, my mum had a horrible experience with me. Very slow labour, she had a 3rd degree tear and a retained placenta that no one noticed, hemorrhaged several days later and had to be rushed back into hospital, emergency D&C that tore through her stitches and made her tear worse, developed PND had to have a hysterectomy a few years later due to the damage caused.

I have had panic attacks where I think I'm going to die in labour or my son will, I sometimes can't eat or sleep because of it and I struggle to enjoy my pregnancy.

I mentioned to my doctor at 20 weeks I would like an ELC and she said "that's an option" and I have an appointment to discuss it. I've also been advised by my psychologist that she thinks I'd cope better with the ELC than natural birth.

However I am still terrified. I feel better about having the ELC rather than a natural birth, but the spinal is frightening. I still have to have blood tests with emla cream, a butterfly needle, and it can take an hour to get it because I usually have an anxiety attack when I walk in the room. I'm tempted to ask for a general anaesthetic but I'm scared that I won't "know" he's my baby and it will affect bonding :(

So my questions are

1. Spinal anaesthesia - what does it feel like? I know the local anaesthetic goes in first, can I have emla cream on my back so I don't feel it? Can I take a sedative? Can I have gas and air? ANYTHING? I really want to be awake for his birth but I am literally terrified of this
   
   
2. Anyone out there with similar experiences, did you have a cesarean and how was it?
   
   
   Thanks for reading

[LashesandLipstick]

RedToothBrush thank you!

[RedToothBrush]

DIY, I don't believe what you say to be true at all, and is a bit misleading.

Some of it is down to individual hospital policies. Some of it is standard procedure everywhere.

They will take a blood sample before any operation to establish your blood type and usually will test your blood for iron. But they may well do this for some women having a VB anyway, if they have had low iron during their pregnancy or there is some other reason to suggest that they may be at high risk of needing a blood transfusion or other complications.

Following my ELCS they took my blood during the operation (not by a needle) and my iron was ok, so I didn't have any further blood tests. If it had been low I'm sure they would have, but it didn't appear that it was necessary so they didn't. But as I say, that isn't something that's necessarily exclusive to having a CS.

I had a drip from the CS, so they were able to administer anti-biotics and pain relief intravenously without additional injections. I could have had morphine if I wanted - this would have been via IV so no need for another injection. (I didn't).

I did have anti-clotting injections as I am over 35, but at my hospital this was only standard for my age group or for women who had a medical history that suggested you needed this. It was the exception rather than the rule. This was once a day.

So blood test before the ELCS, spinal, drip and then a daily injection due to my age. That's 3 plus the daily anti-clotting for ten days. I personally don't think that's hugely excessive, especially if you are younger. It really is down to individual circumstances that dictate your individual need combined with hospital policy.

I was in hospital for 2 nights. Which is the hospital's standard for an ELCS without complications.

The thing I had found hardest in hospital post op was not the medical side of things, nor the pain or lack of mobility, but being constantly disturbed for various reasons even in a private room. The sleep deprivation was not exclusively down to DS. Being home in pain and struggling to move around was easier than being in hospital because of the relative peace and quiet - but that did rely on DH heavily looking after me.

Again, I do think that many of these things could have been issues regardless of the type of birth I'd had. You could attempt a VB and end up having more injections depending on how it panned out. Having a VB I may have been in hospital for a shorter time. But again you can be in labour for 3 days and then stay in for another 2 so there are swings and roundabouts there too. Regardless of what you do, you can only plan to a certain degree and you won't rule out all eventualities.

I remember, having got my head prepared for an ELCS, being terrified for the last week of the baby turning up before my planned date. I also had a big wobble a few weeks earlier too and had dashed to the hospital to get checked over because I was scared of reduced movements. So you need to have some sort of coping strategy in place for those sort of situations.

Ultimately, the issue for you is how you will cope with the unexpected, how likely that unexpected is and what the most likely unexpecteds are. Everyone is different and everyone has different things that they struggle to cope with, so that's what you need to assess more than anything.

As for anything being sprung, I was very well informed prior to having the ELCS. This was part of my treatment for the anxiety, and the hospital did everything they could to try and do this as they understood that this would help me with coping, because I could visualise things before the day. Visualising things won't be the right thing for everyone, but it was good for me. I was able to visit the waiting room, delivery ward, the theatre and the post-natal ward prior to the day. It meant that I wasn't just turning up with no idea of where I was going, what it would look like and who might be looking after me. They don't normally do this at the hospital I was at, but they were committed to individualised care plans and saw this as part of my care due to my anxiety. Like I say there were fantastic in recognising I had particular issues and tailored what they did to suit me, rather than just throwing me in and expecting me to deal with what was thrown at me. If they don't offer things like this, it may be worth asking if you think it might help.

[LashesandLipstick]

Cake as far as I'm aware not everyone gets jabs? Several people I know who've had cesareans haven't had them...I wonder if it depends on the hospital? Something to look into

[DIYandEatCake]

Oh and they take blood a few days before as well, if I remember right. I felt like a pincushion by the time I escaped (I was in for 4 days as my baby took a while to learn to breastfeed). They offered a morphine jab afterwards too, I declined that one. I guess either way it's a gamble isn't it - I was lucky with my birth, if I'd needed induction/ interventions I'd probably feel quite differently about it.

[DIYandEatCake]

Everyone gets anti-clotting jabs after a CS - the nurses do them in hospital, and if you go home early you normally have to do them yourself for a few days.
The blood tests just seemed to be standard, I had no medical conditions and no big blood loss or anything.

[LashesandLipstick]

Cake

Do you have a condition that meant you had to have blood tests and jabs? I cNt understand why they'd do those if not

You haven't caused more anxiety don't worry

[DIYandEatCake]

I've had an elcs (for a breech baby) and a vbac. I obviously don't know you or understand your issues, but would suggest taking time to look into your options. For me, personally, the thing I hated most about the elcs was the lack of control - of just lying there paralysed, and of medical staff being in control of the birth. And postnatally I hated having to rely on other people for everything until I was allowed out of bed. Also there were lots of needles in the days afterwards - blood tests, and the anti-clotting jabs. These were sprung on me - someone would just appear and say 'it's time for your jab'. The spinal was better than I expected, you feel a sting from the local and then I felt a lot of pressure, it felt like they were pushing hard, it was unpleasant but not painful at that stage.
I loved my vbac in contrast. My body kind of took over, I didn't have chance to worry, I found strength I didn't know I had and felt fantastic afterwards. Nobody did anything to me, I was lucky not to need stitches, and I could care for myself and the baby immediately. No needles, and I went home first thing the next morning (ds was born at night).
I hope I haven't caused more anxiety, just wanted to be honest and give a different viewpoint. Good luck whatever you decide, babies are so worth all the stress and pain!

[Athenaviolet]

Thanks.

[ChickenLaVidaLoca]

They put it in because you'll probably pass urine while you're unable to feel anything. It's not just that you couldn't move to get to the loo, you literally don't notice if you're peeing when you're fully under spinal or (obviously) general. So you might end up covered in pee otherwise, which is not what you want just after abdominal surgery as you need to keep the dressing dry. For that reason I don't think they could take it out while you're still under GA either, because you might need it.

When I had mine taken out, it didn't hurt at all and was just sort of a slight popping sensation. You could ask for gas and air I guess. I know they sometimes give it to women in early labour who find vaginal examination difficult to tolerate. Fear of catheter removal is arguably a similar principle. They don't routinely have it on the postnatal ward though, I don't think, so you might need to discuss this beforehand in order for it to be arranged.

[Athenaviolet]

Can I ask a question?

If I did have to have a c section this time one thing, sounds daft, I'm scared of is getting the catheter taken out. Do they give you pain relief/gas and air or something for it? Why do they put it in anyway? Can they not just take it out while you are still under ga?

[RedToothBrush]

Hospital policies on just about everything seem to differ so ask them about procedures rather than just asking on here as you'll tend to get a million and one answers that may contradict each other.

Also hospitals may be prepared to make exceptions to rules anyway if they think its in the best interests of patients, so the experience of one person at the same hospital might be different to what they may offer you. At my hospital they were allowing partners on the low dependency department over night, but not the high dependency one where I was and where they put all the CS patients. However again as I mentioned above they made arrangements so they could accommodate DH as they thought there was medical need to my mental health and it would help me greatly with my anxiety.

Which is why I stress to ask the question and see if things you feel may help are possible. You might not get a yes, but they may offer other options instead that you haven't thought of, if you do ask the question.

[LashesandLipstick]

RedToothBrush

This is really helpful! I'm not sure what my hospitals policy is with wether my partner can stay. The suppository thing doesn't bother me but I hadn't thought about the catheter - ill ask questions about this

I'd been told about the chance of him having fluid in the lungs but was assured it's not very common. Will research what happens if they happens

This is a very good post and I'm very greatful for you putting this

[RedToothBrush]

Post natal may depend on the hospital as to what your options are. DH was allowed to stay with me in a private as I have fears about medical procedures. However I know this isn't possible everywhere.

Also off the top of my head:

Pain relief - its normal to have a suppository during a CS for pain relief. I declined this and had pain relief with tablets instead which is slightly less effective but suited me better.
Catheter - You'll need one for the operation. I had mine after the spinal so I didn't feel it going in, but you also need it removed so have a think about how you'll feel about it.
Feeding - I found this awful. I had no preference for what I wanted to do until DS was born. It hit me like a ton of bricks. I genuinely don't think there is a lot you can do to prepare yourself for it.
Risk of admission to SCBU - there is a slightly higher risk of the baby needing to go to SCBU. DS didn't need to and everything was completely fine, however you probably want to give some thought to it and how you would cope should you not be quite so lucky. The whole point of the ELCS is to try and help you keep control of the situation, so if there is a problem, then it could really foil you, unless you are prepared for the small possibility. Its the most likely complication (and the only increase risk that NICE highlight for first time mothers having an ELCS) but it is still uncommon.

Just generally, I found it difficult in hospital to ask for help as I thought I was being a pain and my anxiety played up as I was scared to ask for help. Even when they said to! Had DH not been there I really would have struggled as I couldn't even reach DS in his crib never mind pick him up. If you think you might lack confidence in asking for help, I'd mention it as you discuss your birth plan because they are more likely to keep an eye on you.

It sounds like stating the obvious to a degree but in hindsight asking if x, y or z was possible rather than worrying about if I was being a pain helped both before and after as I was able to mental prepare myself better. Remember that if your anxiety makes it difficult for you to cope, its a legitimate medical reason to be a pain in the arse making special requests. They can only refuse.

I'm sure there are other things but you've actually got loads of time to think about and plan with the hospital.

[Athenaviolet]

I had a natural birth. It was to put in my birth plan.

[LashesandLipstick]

Athena so did you have the spinal?

[Athenaviolet]

Before I had dc1 I said to the MW that if I did need a c section I wanted to have ga over a spinal. (The thought of being awake during surgery is utterly horrific to me)

She laughed at me!

[LashesandLipstick]

Thank you these are reassuring

RedToothBrush, what would you advise for the post natal stay? I haven't thought much about it

[RedToothBrush]

I had an ELCS for anxiety.

I had the choice of spinal or GA. I went for the spinal.

I was offered the option of staying in hospital the night before to get used to things and to help if I was getting very anxious but I didn't do this as I thought I would be worse.

The theatre staff all knew my issues and were fantastic in explaining things throughout even though there was a screen up. They had a plan in case I didn't cope so well (I don't know what that was as I was told but the impression I got was the possibility of a sedative for the spinal) They broke with normal procedure to allow DH to be there for the spinal which helped a lot. They used a local before giving the spinal - I didn't find it as bad as I feared in the end (I didn't feel pain just a force of it). I had to have a drip in my hand which I personally found worse as that did hurt.

The injection wasn't as bad as I'd feared. The paralysis was weird but not awful. The thing I didn't like and wasn't prepared for was about half way through starting to feel mildly faint and as if I wanted to fall asleep which gave them all a fright however everything was text book and I didn't suffer much blood loss.

I felt 'out of it' for a couple of hours after, so I'm very glad I didn't go for the GA as I suspect I'd have been a lot worse and would have worried about what happened in theatre.

I personally think the key, is not so much the actual day, its more about the stuff before, having discussed a robust birth plan that suits your needs which in turn helps your anxiety because you have more trust in those treating you.

In terms of 'knowing' it was my baby. I didn't see DS born. I heard him cry and they brought him around a few minutes later. He could have been snuck in when I wasn't looking in theory. It was 'oh hello then' and I couldn't really equate him with being mine straight away. So I'm not terribly sure it would be hugely different for a GA.

All in all, I could not have been treated better and it does sound like you are at a good hospital who are being supportive. I found it better than all my expectations overall. The post natal stay was hard, but again I was well looked after in a private room - you should also give some thought to options post natally as you may find some bits hard if you suffer anxiety. It doesn't just stop with the birth.

[Tranquilitybaby]

I found the spinal to be absolutely fine both times, just a scratch then v quickly felt warm like I was laying in a bath.

My c sections were calm and positive and I'm hoping my third one in TUESDAY will be the same x

[smogsville]

Had two planned sections, generals both times. No problems bonding with either baby, EBF my daughter for nearly a year and DS is currently 8 wks and we're all happily bumbling along together. Feeding going well with him too.

Best of luck whatever you decide.

[ThePhoenixRising]

I had a topped up epidural for my EMCS and a spinal for my ELCS and also for a MC surgery. Much preferred the spinal and felt less rummaging than during the EMCS.

My ELCS and, considering the circumstances, the surgery for the MMC were positive experiences.

I know someone who had GAs for both her sections and it made no difference to the bonding etc. it was the choice she made and she was happy with it. I was given the option but was terrrified of GA.

When you have your appontment just talk over the options for anaesthetic. I hate needles but like a PP would have a spinal over a blood test any day. I felt a sharp pain when the needle went in, but it lasted about a second, was over before I could even react, and from then on it was just loveliness.

Should also add that for my ELCS, as am quite an anxious person (understatement) I was admitted the night before, given a light sedative and a good meal to help me sleep (best night's sleep ever) then in the morning given another sedative before being wheeled down to surgery. I felt slightly stoned but lighthearted about the whole thing. It was a fabulous birth, I remember every second. There are things like that that you can ask for and have, safely. It is in no-one's interest that it be a stressful time for you.

[ChickenLaVidaLoca]

I didn't feel the spinal for my EMCS go in as they numb you up first. What I do remember is the delicious sensation of the numbness hitting. I'd never had a spinal before and found it very interesting! It didn't hurt at all.

[ThatBloodyWoman]

I have had a cs under spinal,and one under ga.
Both were dealt with calmly (even though the one under ga was an emergency) and I felt I was given full knowledge of what was going on.

The injection thingy in the back really honestly was fine -all done at a steady pace,with great care.You will feel sensations during the procedure,so be prepared for that -but not pain.
The ga left me out of it for a few hours,but I really don't think it affected bonding at all.

Good luck with whatever you decide

[theaveragebear1983]

I had a general anaesthetic for my c-section after a failed induction, not because I'm scared of the injection, but because I'm terrified of the paralysis. It didn't seem to affect the baby too much, and I didn't seem to have any worse after effects than other people who had a spinal. In comparison with my 'normal' delivery, the c-section was considerably harder in the few days post birth, much more painful than I had anticipated. I'm having a section again this time around, as I have placenta praevia, and will definitely be asking for a general again.

[OhMittens]

then felt absolutely nothing.