Anesthesia and C-section?

[CartoBarto]

I've heard that during a C-section it's normal to be kept awake with an epidural for the safety of the mother and the child. Is this the case? If a mother wanted could she request to not have an epidural, and to be put under with anesthesia before the C-section was to take place? Does anyone know if this can be an acceptable birth plan?
Thank you all!

I have had 2 sections under general and I do not recommend.

I had general for my two and loved going to sleep and waking up with a baby each time!

@Forgetmenot123 What makes you say that? Were you able to choose that procedure or was it an emergency? Thanks so much for your response

@QueefQueen80s That's fantastic! I'm glad it was successful for you. Were you able to choose this procedure? In what country are you based? I rely on the UK's NHS so I'm wondering if they will let me choose something like that. Thanks for your reply

Hi @CartoBarto

C-section mamma, a few days post section and still in hospital recovering so do ask me anything.

@CartoBarto unfortunately generals anaesthetic isn’t available for maternal preference elective c-section.

The reason for this is that the drugs used for a general, cross over to the placenta and have risk factors for the baby. I asked the same thing myself and also aske
d if I could take an anti-anxiety drug, but that was a no too, for the same reason.
I suffer from terrible anxiety but although the procedure is scary, I was able to get though it and deliver my little baby safely.

An elective section under a ga is very rare and usually only preformed for medical reasons. I had one last year because of issues with locals not working

I had an EMCS and would not recommend GA. For one: you want to see your child being born and 2: you can wake up feeling sick, groggy and out of it if you have a GA.

The baby is out within minutes and there was no pain. Well, until afterwards that is. The most of the time you're on the operating table they're slowly stitching you back up again.

I asked for dc2's birth. The consultant OB said I'd have to discuss with an Anesthetist and referred me. I saw a Consultant who asked for my reasons and said in their opinion there was no reason why not. That there was no increased risk to the baby and a small increase to me but that had to be balanced against other factors like the reason for my request.

In the end they made two plans, one for a GA with a specific pain relief protocol and a spinal plan with skin to skin etc and said I didn't need to decide until one or the other needed administering.

That was on the NHS in 2018.

I believe the drugs can carry through to the baby.

Why are you thinking about it? Maybe people could help brainstorm if you're able to share

I'm in the UK. Both medical reasons. 1 emergency and 1 planned.
I don't mind general anesthetic but waking up woozy and unable to hold my babies was not pleasant. With a spinal/epidural you can hold baby while being stitched up. General you are in theatre unconscious for nearly an hour being stitched before being brought round. So you miss the so called golden hour skin on skin etc. It crosses the placenta so can effect babies. Mine did not breathe after birth which they think was due to the anesthetic.

I would have thought that there were more risks for the mother too under a GA not just the baby.

Are you worried about specifically to do with the staying awake option? I had an EMCS then an ELCS (emergency then elective) both times I had a spinal block not an epidural.

I've had 2 sections, awake both times with a spinal. Honestly, it's such a quick, calm, painless, exciting experience (if elective). I'd have another one tomorrow. Anesthetic wore off within 4-6hrs and I was up, walking around soon after.

As PP have said, GA is only for emergencies and can't be requested. GA comes with increased risks so won't be administered unless deemed medically necessary.

Also your husband/partner cannot be in theatre if you have a general. So they will miss the birth

I had an emcs with epidural. It was scary but it was fine really. You can feel a little pulling but you can’t feel pain. It was ok. I’m having an elective/epidural with my next. I don’t think it will be bad at all of elective. The worst part of my emcs was the shock of it, I’d been awake for days and I had bad sickness. I can’t see that happening again.

If it's anxiety worrying you they can help with that.
I started to freak out during my csection (baby couldn't breathe and dh passed out - it was all quite chaotic!) and the lovely anaesthetist gave me iv midazolam which took the edge off. Felt quite relaxed after that! And everything turned out fine with baby and dh too!

Hopefully @Greybeardy (hope you don't mind me tagging you) will be along soon with a UK anaesthetist's take on it.

IME, as others have said though, for electives, it's not really done. Only if the spinal has failed, or if there's a medical reason spinal anaesthesia is not a good option. Is there a reason you don't want to be awake? I definitely recommend talking it through with an anaesthetist sooner rather than later, so they can explain, and give options.

Having had general anaesthetics before (though not for a C-section) they are very unpleasant on the whole to wake up from. I certainly would not want to immediately have to try to care for a baby on top of it.

Your birth partner also cannot be in theatre while you are under, so will miss the birth. Baby is taken out of theatre once the paediatrician clears them, so they will get a cuddle before long.

Hope you find a solution.

Hi @CartoBarto i had a c section in October with an epidural, i didn't want the anaesthesia. I didn't feel a thing with the epidural and i as soon as my baby was taken out she was cleaned up and placed on my chest which i'm so glad i was awake for 🤗❤
All the best in your c section x

Hi CartoBravo, I’m a consultant anaesthetist who works a lot in maternity. There are 3 options for an anaesthetic for a section.

1. Spinal anaesthetic. This is by far the most common and the one that’s used almost exclusively in elective caesareans and all but the most urgent emergencies. A very small amount of local anaesthetic is injected into the spinal fluid via a very thin needle. This numbs you from around your boobs down. You can still feel some pushing and pulling but nothing painful. It’s a technique that’s been in use for a very long time and it’s extremely safe. The main side effect is a drop in blood pressure and some nausea but we give drugs to counteract this.
2. Epidural anaesthesia. This is usually for people who’ve received the epidural for labour pain who need an emergency section. We put a more concentrated drug in for the section to allow for a denser block. Epidurals are different to spinals. They go into the space outside the spinal fluid and are generally used for pain relief not anaesthesia but with the more concentrated drugs they work for performing surgery.
3. General anaesthetic. This is used in generally 3 circumstances. An emergency which can’t wait for a spinal to work (takes about 10 mins to work), a patient at bleeding risk usually due to a pregnancy related conduction once the platelets drop below a certain level or are rapidly dropping (eg pre-eclampsia)-this is because if their platelets are too low it can cause bleeding around the spinal cord. This complication is never seen in women without bleeding issues. Or 3rd reason is someone who has had a massive bleed before delivery and is too unstable for a spinal anaesthetic. As mentioned above general anaesthetics are not recommended as the baby can be drowsy when born and the mother is at risk of inhaling contents from her stomach or being difficult to ventilate. The chances of these are low but due to the big bump and some other changes much more common than the general population. The other advantages of avoiding a general anaesthetic (some mentioned already) are you don’t miss your baby’s delivery, your partner doesn’t miss your baby’s delivery (they’re not allowed in if the mother is asleep), a spinal or epidural are better for post op pain relief due to the drugs we give in it, less bleeding for the mother (the general anaesthetic causes the womb to be less contracted), and less drowsy after. I personally have never given a general anaesthetic for maternal preference but I’ve heard of it done. As I said general anaesthetic are extremely safe but their are better alternatives.

Hope this answers your questions

Forgot one other indication for a general anaesthetic. A failed spinal anaesthetic where we can’t put it in. Again not common

Anaesthetist - we do it for the safety of both mum and baby. Baby is exposed to the general anaesthesia drugs and sometimes needs NICU to recover. Anaesthetics for mums carry high risks at term due to risk of aspiration pneumonia and difficult airway related to pregnancy. I've not heard of us agreeing to do a general anaesthetic electively because a mum doesn't want a spinal anaesthetic (it's not an epidural you have for an elective section but a spinal, which is different) but I don't know your situation so can't give you specific advice. You need to speak to the midwife, obstetrician and obstetric anaesthetist in clinic for further info

I had two GA’s for my c-sections. During the first, my husband was made to wait outside the theatre all gowned up. He heard our baby’s first cry and had to wait for ten minutes or so before she was brought out to him, then another hour or so while I was in recovery then wheeled up to the room to be woken up. My next one was with twins. Because we knew the surgeon and he knew DH wasn’t a fainting risk, he allowed him into the theatre. DS was DT1 and he needed to spend 24hrs in NICU as his APGAR score was a bit low due to the anaesthetic. DD was DT2 and less crossed over to her. She came out like a shrieking harpy, so despite being a tiny, wee thing, her APGAR was the highest of the three of my babies. I had a uterine haemorrhage (it wasn’t unexpected) and that was resolved with DH holding DD at the time. (Uterus put in the bin a few months later.) It was weird when I woke up with only one baby beside me and I panicked. I can honestly say that I don’t really have any memory of first meeting of them. I do remember overwhelming protective animal-like instincts that I’d never felt before though.

I've had 3 c sections, 1 emergency and 2 elective. For all three I was told by the anaesthetist that once baby was out, if I was struggling they would put me under a general at my request. So this might be an option for you. Only stipulation was dh would have to leave the room. In my first (emergency) I had quite a bad panic attack after baby was out and the anaesthetist kept offering me a general, I think my panic attack was probably causing issues, but I refused as thought I'd never wake up (my panic attack was caused by being convinced I was dying). She eventually gave me a strong sedative to calm me down instead. Honestly having had a general for previous surgery I wouldn't want one for a c section if it could be avoided. You wake up so woozy and drowsy and I needed to sleep for hours and hours afterwards which is very impractical with a newborn to care for

Others have already mentioned the main points favouring regional (spinal or, less commonly, epidural) rather than general anaesthetic for elective section. An addition to the usual (physiological/anatomical) reasons for not doing a spinal/epidural would be maternal refusal, but usually that request comes from fear/misunderstanding and most women, once they do realise the benefits in terms of both safety and 'niceness', do decide to go with regional.

GA may also affect surgery to some extent as the drugs can impair uterine contraction once the baby's delivered, leading to higher blood loss and the use of more drugs to help the uterus contract (all of which have unpleasant side effects).

The normal physiology of pregnancy does make general anaesthetic higher risk than it would be in the same woman whilst not pregnant, even in the elective section scenario. The exact balance of risk and benefit for any of the techniques will be slightly different for every woman and their pregnancy, but a broad idea of the risks is given on the obs anaesthetics info leaflet on the labourpains.com website (Risk of regional anaesthesia (spinal/epidural) and general anaesthesia explained). A lot of hospitals have obstetric-anaesthetic clinics and this may be an option for getting a better idea of the specific pros/cons relating to you OP if this is something you're seriously thinking about.

A final bit of trivia related to anaesthetics is that the type of GA that is usually done for obstetrics (in order to reduce the risk as far as possible) is flipping terrible for the environment. While clearly this effect is never part of the clinical decision making, it's probably something that not a lot of people thin about, and may make a bit of a difference to how people feel about things.

HTH

This is not the case. I had a G/a elective section & partner only had to leave theatre for a few minutes after I was put under. He saw DD being born and held her while I was stitched back up. The theatre staff ensured baby had skin to skin contact with me and took a (slightly odd) photo.

Was definitely not an option for us. It must be very uncommon to allow a partner in theatre with a general as the anesthetist replying to this thread also said partners would miss the birth?
Was this in the UK and done recently out of interest?