Spinal versus GA for elective section

[Dinosauratemydaffodils]

Due to existing mental health issues (primarily trauma based), I can pick whichever anesthetic I want for my upcoming c-section. The hospital are being hugely understanding and are not offering any opinions either way (which is both lovely and useless). However I have no clue how to choose as I can see positives and negatives of both. For a long time, I was sure I wanted the general but now I'm wavering yet the thought of being awake is utterly terrifying.

Any suggestions and thoughts welcome as I'm running out of time.

It depends on the previous trauma I suppose.

I've had both and I preferred the spinal.
I was much more tired and drowsy with the GA.

What are the specific thoughts that trouble you with a spinal?

Spinal.

babies generally don’t come out in as good condition when a GA is used. They often need a bit more resus. The drugs cross the placenta so the surgeon always wants to get the baby out ASAP once the woman is under as the clocks ticking.

Plus women afterwards tend to struggle with pain control more.

You should keep in mind that you may end up with a GA anyway.
They tried 5 times to place my first spinal and it wouldn't go in the right place so I ended up with the GA.

If you choose to have a GA you won't have anyone in there with you either, they don't allow it, only with spinal dare you allowed to have dad/ one person in with you and that's after they have placed the spinal in which can take some time.

@Takfujuimoto The being awake for surgery aspect. I had an emcs for ds but because of the state I was in, I hallucinated and thought I was back reliving the previous trauma. I'm terrified that I won't be able to control where my head goes and I'll end up in the same mess again. Our hospital allows "birth partners" in for the spinal with electives so that's not a huge issue and dh is okay with not being there as long as I'm happy with the choice I'm making. The consultant anesthetist I saw is confident that a spinal will work because I had an epidural at full dilation with ds (he was in an undeliverable position at that point) but I have considered it not working and feel that's an argument in favour of the GA.

@MNscum Thanks. The baby issue was one of the main factors swaying me but the consultant anesthetist didn't seem to see it as an issue.

I can only say from my own experience I have had both my DD is 2 and was an emergency section (due to undiagnosed breech) with spinal. Thy did have to do it twice but was painless and in general a very calm and pleasant experience considering was emergency, I saw my baby be born I heard her cry and found out she was a girl and that was lovely. She also came out in a good state.

I had my second baby 7 weeks ago it was a cat 1 crash section under GA there were a number of complications with me and baby came out in a bad way and needed some rescue breaths, we are both good and well now and was all fine. However I woke up in the general recovery suite with the hip ops and all sorts with no baby or husband, you are extremely groggy and I was for hours afterwards I was told what I had by a random nurse (a boy), they looked after me extremely well but it was so different and I missed the first three hours of my babies life. I must say I would choose a spinal hands down if you can.

I also don't react to well to medication and have quite vivid dreams and reactions (sometimes aggressive!) but I was fine with both. Obviously choose what's best for you but I must say if I could I would do spinal absolutely. Good luck!

I had to have a GA as my epidural only numbed me on one side, and they needed to get the baby out soonish. I woke up without my baby, without my partner and had to wait 45 to stop shaking before I could go up to the ward. I can't remember holding him for the first time either I struggled a bit afterwards with bonding as think it was a bit of a shock, I would chose a spinal next time for this reason. But everyone is different and the risk of feeling like that may be less than feeling out of control during a spinal?

Is your anxiety driven by how you were at your previous emcs? Because it should feel totally different, much more relaxed this time. And you won’t have been at your wits end from labouring for so long beforehand.

I’m a consultant anaesthetist who does a lot of obstetrics.

Drug transfer to baby does occur, however the effects are minimised by minimising the time between you going to sleep and the baby being born. This requires you to be anaesthetised in theatre (not in a separate anaesthetic room like most UK operations) with your tummy cleaned with antiseptic and draped and the team ready to start.

Also you’ll need to breath oxygen through a mask for a few minutes and as you go to sleep the anaesthetist’s assistant will press on the front of your neck.

I’ve given general anaesthetics for elective sections and the reality is that often these essential preparations can be quite anxiety inducing in themselves. However, if specifically being awake during the operation is what is worrying you than you might feel all of the above is worth it! Happy to answer any further questions you might have.

Because you had an awful experience last time you may go into that room and fight mode will kick in.

I had a horrible experience with DS1 emergency section hallucinations the whole lot they had to knock me out once I saw my baby and when I was being stitched back up I was so bad but when I went in with DS2 I cried and cried threw up everywhere. The room and the smell just took my head back but the team was amazing and if they know about your previous experience they help soooo much. Fight mode kicked in as I just didn't want to miss seeing my baby.

Whatever you decide everyone supports you just wanted to let you know I never thought I could go threw it again but I did and it wasn't half as bad so if I can anyone can

All the best xx

@Doccc The anxiety comes from the fact that I now associate the trauma I'm in treatment for PTSD (which has absolutely nothing to do with babies/surgery/hospitals/childbirth) with surgery in general, c-sections in particular because of an unfortunate set of circumstances last time around. I want it to be a positive experience but I'm afraid that I'll just lose the plot or that if I'm awake baby will end up needing NICU or something and I won't have the distraction. Both methods seem revolting, violating and repulsive but on the other hand baby can't stay put forever and given what happened with ds, I don't believe pursuing a vbac makes sense for us.

@katiehoffler They know and are being so supportive but they say only I can choose unless a medical reason presents itself as to why one or the other would be much safer. I know part of my issue is driven by a desire to punish myself (which to be fair I may have failed to mention to both Consultants). I don't remember seeing my son, didn't want to hold him, touch him or look at him because of the hallucinations so doing that with this baby seems wrong. Thanks, I'm glad you had a better experience the second time around.

Have you had a chance to talk with a consultant anaesthetist about this? They are likely to be the best placed to help you decide.

I had two EMCS, the second was GA (very quickly done at that), but the first was spinal/epidural (spinal didn't take quite well enough but the HR trace improved enough they could take the time to place an epidural as well). Definitely recommend the spinal/epidural if it is suitable - they did a top-up as they finished and, maybe I was lucky, but I didn't need pain killers for nearly 48 hours. After the GA I think I had a PCA and didn't quite realise how to work it and it was much more uncomfortable; pain relief is much more effective if you start "ahead" than if you get behind controlling it!

Under elective conditions, there is plenty of time for a spinal/epidural to be sited carefully and calmly, which helps enormously. If your anaesthetist has discussed things with you it is probably also possible to have a "bail out" plan to quickly recognise if you need to switch to GA.

For most people, unless there are physical issues with siting the spinal, that choice is obviously better. Yours is a special situation and it is good that your doctors are recognising that. Very best wishes!

@Pythonesque Yep, I saw a lovely consultant anesthetist a couple of weeks ago. Basically the same story as the consultant obstetrician, they won't offer an opinion, says it has to be my choice.

She checked my notes, had a look at my back and throat and said both methods should work no problem as I'm healthy etc.
Said that if I tried a spinal and couldn't cope, they would knock me out.

Made a plan for pain relief after a GA.

I have a weird relationship with pain and a hatred of pain killers. I tend not to take them at all. Certainly after my emcs, I didn't need anything. We still have all the stuff I was discharged with last time I think. Dh hid it so I couldn't overdose.

Thanks.

I had a GA and I wouldn't recommend it because I was quite woosy and out of it afterwards. I'd say a spinal is much preferable, but I've never had one to compare.

My baby was in great shape coming out though, no worries on that score.

Spinal for all of the reasons listed above. I would add that emergencies and electives are worlds apart. You can make your elective section everything you want it to be (depending on how accommodating the hospital is obviously!) most will allow you to play whatever music you wish in theatre, allow for skin to skin immediately after etc. You could try some hypnobirthing/breathing exercises and play relaxing music to keep you focussed throughout perhaps x

@Jellybean100 That's part of the problem, it's not the surgery in of itself which is the issue, it's entirely in my head but I can not separate what happened before from this. I don't want music (am pretty much tone deaf so it's just noise), I don't want skin to skin (that was the last thing ds had before he was whisked off to nicu) and I don't want to see the baby in an operating theater at all.

If I'm awake the plan would probably be no birth partner, baby to be checked over out of my sight and taken to dad outside theater assuming they were okay to limit risks of association but if I'm doing that, is there any point in being awake?

I’ve had both.

The GA was in the middle of the night and an emergency- my dc needed recusitating and from reading the notes it was a scary time. I am grateful I missed all of this.

Second was spinal block for same problem (pre eclampsia) I was terrified it would be like the first time and my child would be ill. It wasn’t and that was a positive. The hospital were good and scheduled delivery for first thing - I cried the whole time and was very very scared but I am glad retrospectively that I was awake and I feel it helped with dealing with ds’s delivery.

Practicals - the GA I was very woozy for a good day or so. Spinal could care from baby from birth - GA baby was in SCBU but if hadn’t I couldn’t have cared for him.

Long term recovery from surgery no different.

Bonding with baby no different.

Sorry pressed send too soon. Go with what feels best for you xx

I’ve had a spinal. It was wonderful to be able to hold baby while they were stitching me up. I did have a problem where it went ‘too high’ and restricted my breathing. It wasn’t too serious a complication and I felt safe but it could be scary in different circumstances.

I had a spinal for my emcs and for me it was very traumatic. I had planned an elcs due to previous trauma, but needed an emergency one sooner as one of my twins was really unwell.

It took 7 attempts (with corresponding locals) to get my spinal in. A couple of the attempts went wrong and it felt like my leg was being ripped from my body. They offered me a general after the third or fourth failed attempt, but I knew my husband would be heartbroken to miss it and I didn’t want to miss my babies being born. As it happened, I was so out of it on the drugs, and as soon as the babies were out they were immediately taken away to be resuscitated so I didn’t get to see them. I had to wait 7 hours until I was able to see them, and honestly I wish I’d been out of it and groggy for some of those hours!

On the plus side, I don’t know what would have happened to my smaller twin if I’d had a GA as he was seriously ill as it was. That was my other main concern at the time.

Having said all that, you’ve had an epidural before and had no issues with it, so that shouldn’t be a problem. I completely understand how some things can trigger past trauma and if you feel more comfortable being put under then I would do that. However, you could always opt for the spinal and ask them to put you under if you’re struggling during the procedure. I suspect you’ll find that an elective is so different to your first experience anyway and that may help.

Wishing you all the best with it - I can still remember exactly how I felt knowing I had to go through all this when it terrified me so much, so you have my sympathy