C-section - consultant wasn’t there

[Melonsoup]

I had my first ELCS a few years ago due to a breech baby and it was a really positive experience. I was extremely anxious before it and had watched and rewatched every possible thing about csections. From all my research it seemed that I’d go into theatre and everyone would introduce themselves, I’d get the spinal then the operation would start when they’d checked I was numb enough.

When it came to it though I went in, sat up on the table and got the spinal, lay back, they confirmed I was numb enough but then it seemed to escalate into a bit of a panic as they realised the second doctor wasn’t there. They started off quite casually looking for him, phoning round wards etc but I could hear the anaesthetist getting really quite concerned by the fact they couldn’t find him and I was already numb. The staff were lovely, they were making jokes etc but I could hear all this going on in the background. I heard the anaesthetist on the phone basically asking if anyone was available to come and do it as I’d already had the spinal 20/25 minutes before. I’m guessing they would have maybe needed to give me a GA if it had wore off too early.

The doctor they were looking for eventually arrived, he’d been out in his car on the phone. He washed his hands, the screen went up and it was all done very quickly. I was just so glad to have my baby in my arms I couldn’t have cared less about what happened before it but now I’m about to do it all again and keep thinking about this 🤔 Clearly this was a major mistake on their part not to have checked the doctor was there and ready before giving me the spinal? I’m not going to complain or anything, just slightly confused by the whole thing still and how it managed to happen. Has this ever happened to anyone else? Hoping this time everyone is there and ready 🤦🏻‍♀️

Not been through this but the benefit of this happening is you can quite literally ask is everyone here that needs to be. Don't be afraid to ask questions OP. I hope its much more how it should be this time for you

Very unlikely to happen for a planned caesarean as they should do the WHO checklist before they start and they won’t do that without everyone there.
I have experienced having to chase up the doctors once in theatre but they wouldn’t start the spinal til the surgeons were there.
sounds like you were unlucky but it doesn’t happen often

if there is fault, it is the surgeon's for wandering off and not telling anyone. However, we'd usually plan for a spinal to last significantly longer than the operation would normally last in case there are operative complications so it's not usually a problem if the surgeon's not there immediately. In the elective scenario, where there's no rush because of maternal/foetal distress the time taken to do an anaesthetic is essentially dead time for the surgeons and so they are often doing other jobs (albeit usually close by and having told someone where they are if they're not in the theatre suite!) while the spinal's being sited and checked. It would also be pretty unusual in a normal hospital for there to be no other surgeon at all who could come and take over if the surgeon has really gone awol. Bit weird that they didn't just phone his mobile though - he'd soon have realised what was going on! If there was panic, it may have been that they were concerned for his welfare if this was an out of character thing - were they worried he was unwell or had passed out somewhere (have had this scenario happen before too). Out of interest, this sort of thing is not a completely unheard of scenario on labour ward just because there are often multiple things going on at the same time - occasionally the surgeons have to deal with something more urgent before starting a theatre case (we do at least usually know where they are and what they're doing though!).

@Greybeardy thanks, I think they had tried his mobile but he seemed to be on his phone in the car so hadn’t answered it. It’s not a massive hospital but has two theatres so the electives aren’t usually impacted by emergencies. It was the last one of the day as well so whether that then made them more relaxed that they knew everyone was there I don’t know and he had been round and met me beforehand. It was just a bit of added anxiety that I could have done without but no harm done

@ChickpeaPie thats what I thought would automatically happen so out of all the awful scenarios running through my mind before it, that wasn’t one of them 😂 I will be able to tell them about it this time and laugh though

@Princesspeachee thank you, it wouldn’t have even crossed my mind the last time but I presume it was a one off or he had some sort of family emergency going on that he had to deal with. Fingers crossed there’s no dramas this time

I went into the theatre and had my spinal with the anaesthetist then everyone came in after and introduced themselves. Obviously the second doctor not being there was an error but maybe it’s not that unusual for them all to normally arrive as you’re having the spinal

Yes that what I would have assumed to tbf, I dont think it's the norm at all and normally you meet them before I'm sure

the spinal lasts way beyond the procedure and they’d just top it up if needed though

Spinal injections are single shots usually in this country so you can't just top them up (spinal catheters do exist, but aren't frequently used in the UK). Epidurals are different - the epidural catheter is left in so they can be topped-up. De novo epidurals aren't often used for elective sections. Combined spinal and epidurals are sometimes used and that gives the opportunity to use the epidural component if the spinal wears off.

I haven't been through it as a patient but I worked in surgery for 15+ years.
It's very common for a consultant not to be there at the start of an anaesthetic (it's far less common for them to be there at that point actually). It seems a lack of communication here between the theatre team and consultant when you were taken to theatre and when they started your anaesthetic.

We wouldn't start an anaesthetic, especially for a cs, without one of the team speaking to the consultant to let them know we were starting so they should make their way to the theatre.

Even if this does happen again, please don't worry. Theatre staff are very used to hunting down the doctors we need when we need them. It sometimes takes a while but we always get them where they need to be.

Nope! As has been said you can't top up a spinal. And I had sensation returning as I was being stitched up. And could start to move my legs as they were shifting me off the theatre table onto a trolley to take me to recovery. It took a look while for me to be numb at the beginning too - they kept testing and I could still feel it!