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

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]

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.

[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?

[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]

Thanks.

[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!

[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]

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.

[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.

[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

[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]

RedToothBrush thank you!