Choosing GA for elcs

[wingingit33]

I spent today on the antenatal ward due to start/stop tightenings (I'm 37+3). I'm having a section due to previous 3rd degree tear. My elcs is booked for next week but today I was prepped for theatre just in case it needed to be today which included meeting the anaesthetist. It all sounds terrifying. The chance of anti emetic drugs causing visual disturbances, the chance of dizziness from low bp, the paralysing feeling of the numbness which can go too high. I know he had to explain all the risks but Jesus Christ I've gone from anxious to full blown panic. I asked for a GA and he said it is always an option/my choice but that only 2% take it up. My anxiety is honestly through the roof. The thought of lying on that table totally out of control of my own body and unable to run away from it all is just utterly petrifying. I now feel confident I want my section under GA - all the problems I'll sleep through and be none the wiser. Has anyone else had one and can share experiences?

Once baby was sorted out I was awake and aware and able to hold him, that should of said.

I haven't had a spinal block for giving birth but did for placenta removal straight after and had GA a few years ago for a tonsilectomy. I'd pick the spinal block everytime. The GA took hours to come round from, I was weak, dizzy, had awful trapped wind pains and constipation afterwards (side effects, didn't know about them beforehand!) The SB was odd, not being able to feel the lower half of my body was not nice but a couple of hours later I was walking around.

I had 3 failed spinals due to the anaesthetist not putting it in the right place on my emergency csection, on the 4th attempt he said "I've guessed the others, that's why they hurt so much. If this doesn't work I'm putting you under" I was terrified at that point, I would have pushed for him to keep attempting (if that was an option) because the thought of missing my baby being born, not being able to hold immediately (not that I did in the end until after I was all stitched up and transferred out of theatre where DP and baby were waiting) but I'm so so glad I got to witness them holding him up. I would also be worried about how out of it I might be after GA. Obviously, you know what's best for you but if you can ease your anxiety I'd definitely recommend spinal, even after my less than perfect experience.
Whatever you choose will be right for you OP.

@Morechocmorechoc it's not an option to have a vaginal birth. I had a third degree tear and then had prolapse repair three months later.

I’ve had both.

Elective section under GA for my first as I had placenta praevia so there was no choice in the matter. Everyone met dc before I did when I woke up an hour or so later & in extreme pain but thankful that we were both alive.

Second was emergency with a spinal block. Even though it was an emergency it was a much nicer experience & I got to see dc being born.

No contest imo but only you can make that decision

Had both, GA (EMCS, platelets too low for a spinal) was horrid. Was awful coming to and I was woozy.

Spinal for 2 & 3 was much easier than I'd feared. Yes I was 'dead' from chest down but otherwise felt fine. I felt a teeny, teeny bit of tugging. But I was alert and got the baby straightaway. I was so nervous about being able to be still for the injection but it was all right. The anaesthetist talked me through it. A straight spinal is much easier to do than combined spinal-epidural.

If you’re reaction would be to get up & run half way though your section, then having numb legs is probably the best thing!

Seriously, you are unlikely to notice any of the risks he mentioned. I’ve had a emergency & a planned section & they were both fine. Have a Google about birth plans for CS, for my second they put the baby straight on my chest for skin to skin.

On a practical note, perhaps have another chat with the anaesthetist and ask if there are any other drugs they can give you (eg like Valium) to take the edge off your anxiety. You won’t be the first to feel like this so they must have some kind of compromise.

Like PP I have seen one elective GA section in a decade on labour ward. The obstetric and anaesthetic teams will will want to avoid this and will work with you to find a solution, take you to to theatre to have a look, give you a sedative etc. Did you have your tear repaired under spinal?

Decided on GA. Thanks for all input.

I had two deliveries with GA and one with a spinal block and I would recommend the spinal. For the GAs my husband wasn't allowed to be in the room so neither of us were present for the birth of those two of our children. The first GA was an emergency because I had an abruption and they couldn't get me numbed fast enough. I was so confused and angry when I woke up and saw my husband standing next to me holding a baby. I couldn't understand what was happening or where the baby had come from. If it wasn't for the fact that DS1 looks so like me I think I might have rejected him. The second delivery by GA wasn't as bad because the drugs meant DS3 had to be in an incubator at first as he couldn't breathe on his own so I didn't have the same disconnect; I had woken up properly from the confusion of the GA before I could hold him. With the spinal it was a completely different situation even though it was still an emergency due to an abrupting placenta praevia. I walked into the operating theatre and sat on the bed. The anaesthetist and his assistant talked me through everything that was happening - it certainly didn't feel out of control. While they obstetric team were performing the c-section I could listen to what was happening, talk to people, hear my baby's first cry and as soon as they could they brought him around the screen for me to see and touch. The two GA deliveries weren't births for me, they were operations. With the spinal it was still a birth and I was able to be present. It doesn't feel out of control when your legs are numbed. It really isn't as distressing as you're imagining. And it doesn't take long before you can get up and walk around again. Indeed they want you to get up as soon as possible to speed your recovery. I can understand how distressed you feel about the thought of the section. I never imagined I would need one and I ended up having three. In my opinion your awareness and presence at the birth of your child will far outweigh your fear over the procedure.

I've had both and much preferred the spinal. It meant DH could be with me and I was awake to see DD born and have that first cuddle with her.

I understand its the spinal you are anxious about but honestly I didn't even feel it go in! I thought it was absolutely amazing what they could do and how easy it was, the anaesthetist looking after me was fabulous too.

When DS was born (under GA) I was pretty out of it for a while after. It was a few hours before I could hold him. His birth really traumatised me actually.

I operate for conditions where people can generally choose a spinal, GA or a peripheral nerve block.

Almost everyone expresses some anxiety about a spinal before the surgery, and almost nobody mentions and adverse experiences afterwards. In my experience, very well tolerated.

I also echo what people say about GA, I see loads of people who are pretty incoherent for 30—60 minutes afterward, and look dazed / drunk for at least a couple of hours.

DO NOT get a GA, it's my biggest regret. My DH wasn't allowed in the operating theatre because it's a GA (not sure if different in the UK) so my DS was born with not myself or my husband present. I didn't get to meet him for an hour or so as it took that long to come around from the GA and even then I was completely out of it and couldn't care for him by myself until the next day.
Had an elective section for the second with a spinal block and it was the most amazing experience seeing him come out and being able to hold him straight away.

They have to tell you the potential side effects but if you read the side of a paracetamol packet in detail you'd never take one of those too. Same with driving a car. You will be fine

I take it they have been through the risks of having a GA?

I do hope everything goes okay and you are able to come back and tell you whether you feel you made the right choice.

I had my first emcs under GA and couldn’t recommend it. It was horrible for me and horrible for DH who couldn’t come into theatre and was just handed a baby and left to it. My first day of his life is a confused blank.

Second & third babies were also emcs (failed vbsc & premature delivery) but under spinal. They were fine. I know the idea of it is horrible but honestly there’s so much going on it does take your mind off it. Good luck

Interesting that not one person has recommended GA but you have still gone for that option

The GA hurts so much more then a spinal

I have a very real fear of feeling out of control. It affects most things that I do. I haven't had a GA so I can't comment on that (except the thought of falling asleep with a GA makes me think I'd feel massively out of control), but honestly I didn't feel out of control with any of my spinal a. I've had three. I didn't feel amazing obviously, but not out of control. Plus there was the anaesthetist, my partner and a nurse right by my head so if I needed talking through anything they were right there. I can't imagine that a GA would be easier

@toomuchlaundry personal choice. I don't want the panic of the feeling of paralysis, feeling/being sick during, hearing people saying what's happening, the list goes on. I'm prepared for feeling "out of it" after and my husband is supportive of my body, my decision.

I've had two ELCS under GA and can most definitely recommend it.

I have severe tokophobia and didn't want to be awake when having my sections. Was also a bit nervous over the (admittedly tiny) risks of a spinal block.

I recovered quickly, not too many ill effects from the GA- remember feeling a bit out of breath stood in the shower when my DD was a few days old- midwife told me this was a common effect of GA.

Didn't affect my bonding with either of my babies. I was able to breastfeed both times til they were toddlers. All was good.

I can't really remember any real negatives for me- I definitely had good experiences of ELCS under GA.

Honestly the spinal block is absolutely fine. I've had an emergency section and an elective and both times the spinal was fine. Gas and air made me throw up but none of the drugs administered during the sections did. I was terrified of the elective section as I was going in "sober" rather than pumped full of pethidine but it was honestly absolutely fine! And I'm a big old wimp. Best of luck!

I have been terribly nauseous after my GA’s and not really felt myself for a while. I had an ELCS with spinal for my last baby following a 3rd degree tear previously and it was such a wonderful experience.
Despite the heavy feeling in my legs I felt in control of the situation at all times. I was talked through everything (at my request) and felt ‘heard’ throughout, unlike a GA where you are unable to participate in the birth at all. The team in theatre were respectful and reassuring and I was able to have lots of lovely cuddles with new baby before the sensation (and pain) returned so really treasure those moments in recovery. Had I had a GA I would have missed that.
Also, complications from GA are much more common than a spinal and recovery is slower. I’ve never heard anyone say they regret a spinal but have heard it said about a GA.
Ultimately, it is of course your choice. But make it based on fact rather than fear. Don’t rush the decision and know that you are able to ask for reassurance or to change your plan if you wish at any time.
Not long until you’re having lovely new baby cuddles either way

I felt dizzy and sick during my cs with a spinal block but the anaesthestist gave me drugs straight away. I was aware of everything, no pain, got to have skin to skin in recovery and dd bf then too.

You couldn't do any of that with a GA. The risks and recovery from a GA are much higher.

I have had an EMCS and an ELCS under spinal. I was terrified both times, and the anaesthetist pre-op briefing for the second one had me in tears.

Personally I would recommend you go with the spinal - although I recognise it’s your choice - and make it clear to the staff how scared you are, and exactly what you’re worried about. The midwife for my ELCS was amazing - completely understood tokophobia and anxiety (and mine was extreme). She was able to rationalise everything, eg “yes, that is a risk but in the two years I’ve worked on this ward I’ve only seen it happen twice”.

There are some things they can’t guarantee - your blood pressure could drop, and it’s as well you know what to expect, but they can give you drugs/cold flannel on your forehead, etc. But there are other things they can be more mindful of, eg that you don’t want a running commentary, and you could choose music to distract yourself in most hospitals - would thinking of a playlist help at all? I found that if I had my partner by my head, with music playing, and very soon after they started, a noisy baby, I couldn’t really hear muttering about anything that was going on over the screen.

The numbing isn’t as heavy as you might expect - with my ELCS, I panicked because I could not only feel my legs, I could wiggle my toes. The midwife took time to show me it had worked as I would have felt the water spray they use to test numbness as being icy rather than warm. I can assure you I felt no pain during the op!

Whatever you choose, I really would encourage you to be as open as possible with the staff about your fears.

I would strongly recommend a spinal. I have lost count, but must be hundreds of times I (anaesthetist) have had conversations with people for procedures which could be done under spinal or GA. Generally people know absolutely nothing of what either entails but say things like “I just don’t want to know what’s going on” etc. The terminology around spinals makes it sound much more scary than it is. When people have wanted a GA but a spinal is definitely better for them and they get a spinal- I can say 100% of them say it was “totally fine”, “way better than they thought”, “wasn’t bad” etc.
It’s an injection no worse than a vaccination, if your BP drops it will be sorted in less than 30 seconds. Yes, you can’t move your legs and people get a weird feeling in their tummy but that’ll be just like having felt the baby move for the last few months. Your partner can be their with you and with all the chat from the theatre staff, music in the background it’s actually quite nice. Someone will take pictures after etc and let you know the babies weight etc, you can see the baby and hold them. You’ll be back in recovery within 1.5hrs and be totally with it. Your legs will be fine again in 2-3hrs. Nausea much less likely and can eat etc straight away. The other thing is pain control much better with spinal as they put a strong pain killer in with the local anaesthetic.
Anaesthesia is very safe these days and I am sure you’d be fine having a GA, but a GA for a full term woman has a slightly higher risk profile. I would say that is a small consideration though as you’d likely be fine. I think the main things is that a spinal is a very safe, quick, simple injection, with excellent people around you and after 5 minutes it will be done. It’s a vastly better idea for many reasons. As a (currently pregnant) anaesthetist a GA section would be an absolute last resort. I would put money in the fact you’d manage a spinal and afterwards you would say it was fine