Having a planned general aneasthetic for a c/section - anyone have any experiences?

[Gillyan]

Hello

I'm booked in for a section on 2nd July. I am having one as had a 3rd degree tear last time that was very bed. I am having a lot of pain now from the scar tissue too. It5' staken me months to make the decision about the section.

I went to see the anaesthetist today as when they gave me a spinal for the repair job last time it took 9 attempts to get the needle in. It was very painful and I remember screaming for them to just knock me out. It did work eventually though.

I thought today was just to discuss it and get it in my notes so they would know I am difficult next time. He said that it would be better to knock me out completly though this time!!!! I am not too sure about this and said so and he said well they could try the spinal for as long as I could take it or they thought was reasonable. Needles don't bother me at all so I am more than willing to let them try. I think I only screamed to be knocked out last time as I had been in labour and was bleeding everywhere and totally fed up etc..

I feel really gutted as I missed the first 3 hrs of DD's life by being in theatre and I don't want to have to miss the first hour or so of this one's life.

Also he said the risk increases with a general and about 3/4 pregnant woman die each year from aneasthetic problems....starting to think ending up with a colostomy bag from giving birth may not be so bad now.

Any one had similar experience or know anyone who had to have a planned general??

Hi, I had a general with my first ds but it was not planned. Neither the epidural top up nor the spinal block worked so there really was no choice. I have to say that once I got over the shock of it all (which wont be an issue for you if you are planning it) it was fine. I had no real pain from the section itself, no problems with healing or scar or anything. Also, although I felt a little woozy the next day I was actually quite well as I had mentioned that anaesthetics make me vomit and I was given a super duper anti sickness drug!

I dont really know what to advise, obviously I wasnt completely aware of the risks as there was no choice for me (I was hoping for natural birth but things went horribly wrong), but all I can say is that my experience was quite a positive one. Obviously DH and I were sad not to see ds being born, but its not that big a deal in the scheme of things....he is healthy and we have had plenty of time to bond after the birth (he's 2 and a quarter now!).

I wish you all the best.

Not personal experience but as a Midwife in theatre. On occasion women chose a GA rather than Spinal, due to fear usually. If you did choose a GA I would expect a Consultant very experienced in maternity Anaesthetics to do it. As you have pointed out, there are risks involved for pregnant women, sorry don't have stats to hand.

I think what you already discussed is the best idea................attempt the spinal and have GA only as a last resort. Sounds like they are pretty flexible and as it will be documented in your notes they should have the appropriate Consultant there.

You may well find it's a lot easier as an elective procedure as you will not be in pain, tired, distressed but think about some coping mechanisms to stay calm and relaxed anyway. Best wishes for the birth!

Thanks for sharing your positive experience apprentice I agree in the grand scheme of things I don't suppose it matters how they come out as long as all is well in the end. Gllad you were ok.

trafficwarden thanks for your reply too. I just feel like I have no control over this birth at all. I am terrified of a bad tear again as worried about my pelvic floor in later life. MW told me after looking at my surgical notes that last time the tear was half a cm away from me needing a colostomy bag. I just can't get past this and I don't feel that there is anything I can do differently this times to avoid tearing. DD was 7.5lbs I was fully dilated, she came out the right way, she was breathed out etc so not obvious reason why I tore so badly and I had a big blled before her head crowned too. I am not even particularly happy about an elec/sec but just don't feel I could relax in labour as all I would be worrying about was my bum! I'm starting to think about just going for it though and hoping a pool is free at the hospital. Can I pick your brains? I have had conflicting info from MW and consultant...MW recommended I give birth naturally with an elective episotomy - consultant said thats a bad idea...and I asked MW about water birth and she said not a good idea as it can make your tisse more prone to tear - and consultant said he thought I should either have a water birth or a section? What would be your opinion?

Hmmm, it's such a personal thing Gillyan. Professionally speaking, there is no definitive research to suggest it will happen again. Elective episiotomy is NOT recommended though. Sounds like you did all the right stuff last time and it was just bad luck. That said, when I have looked after women with previous 3rd degree tears, it has never happened again. Since nobody can give you a definite answer and it sounds like you have problems with the scar tissue, I would be happy to support you in asking for a CS. But I would also support you through labour and birth and do my best for your perineum. Water can make the tissues much softer and stretchier so if you like the sound of that, great.
Sorry I can't be more definite, you need to do what feels right for you and your bum!

I know there is no definitive answer - it's so annoying isn't it becuase anything could happen and it's the not knowing! Thanks for your advice though, I keep hoping I might go into labour before my section date then I can ring labour ward, see what MW's are on and see if the pool room is free. I think I secretly want to give birth again...I am mental...I had a horrid time last time and really horrible MW's and I've since been told the ward was way way too busy and they should of called in extra staff. The MW's on my team are so so nice but you just don't know who you'll get. I keeping day dreaming about a fast delivery on the bathroom floor at home or something Just wish I didn't have all these choices.

It's really positive what you said about women having no tears after a 3rd degree, I am starting to swing towards just going for it again - I can't believe I'm changing my mind after deciding on the section all becuase they might have to put me to sleep..so silly. I think it will be a matter of deciding on the day. I wish it would jsut be out of my hands!!!

are you absolutely sure you need a general?

i appreciate it took nine attempts to site the spinal, but you were in the throes of labour ..

surely it is worth a try to get a spinal in , rather than a GA with the (small) but extra risks.

can you ask a second opinion from a different anesthatist?

I had a general for an emergency section with DD, and then had a planned section two years later for DS with a local. Before I had the local I met with the anaesthetist and I asked him about having a general again. He talked me out of it, and I'm glad he did. Recovery on the day from a local was much better. ANd, as you say, it meant I didn't miss those first few hours.

I didn't mind be knocked out the first time. In fact, by the time they were knocking me out I was quite happy about it. But, I really enjoyed "being there" for DS' birth.

And recovery from a general usually leaves me puking the rest of the day. Not really my idea of fun.

Better point out Gillyan that none of the women I looked after had 3rd degree tears again but a few did have some small tears. Nothing a bit of simple embroidery couldn't fix! Good luck with your decision x

lulumama No I'm not sure I need one thats why I'm not happy with what he has said. I have said to him that I would rather they try and get the spinal in, they did manage it last time so? I think he may of suggested a GA for next time as it took about an hour last time to get it in. Also he was suggesting it to save me the discomfort but I'm really not bothered about that. I just hope they don't give up trying becuase it's easier for them.

traffic Oh anything less than a 3rd degree will be a dream and I would welcome it! Not bothered about tearing again to a certain degree ( ha literally ) I'm only worried about the old bum going again.

Thanks for your replys guys xx

lulumama I had the spinal after I had the baby to be repaired so was not in the throes of labour, they just kept getting it wrong and the guy said he had never had so much trouble in his long career.

I had an emergency c-section with a general for DS and a planned c-section with a general for DD's birth. It took me a long time to waken up properly after DS - and when I did it was during the night and he was in Special Care, so it was a long time before I saw him. With DD I woke quickly and we were taken back to the ward straightaway. In both cases I insisted that I wanted DH to stay with the baby until I woke up - this was very important to me. Good luck with the birth whatever you decide to do.

I had 2 C-S with GA. Same experience as Riven. Went to sleep, woke up with baby ready to BF. No pain either time. I do feel a litle sad to have missed their first hour but when I look at some experiences around me, I don't have any regrets.

Not sure whether this is helpful or not, really not trying to be sensational or panic anyone but have you ever had a GA? I had my first and hopefully only, GA after miscarriage and I had a severe allergic reaction to it. I spent the next six months in bed with toxic hepatitis. To be honest I don't know the exact odds of that happening but it does happen and there was absolutely no way of predicting it. I only say it because I would advise anyone to remember that GA is a serious thing.

Your first experience sounds pretty awful, good luck with whatever you go with.

Hi chunglimum Unfortunately yes I have had several GA inclusing 2 just last year! I don't sem to suffer any side effects other than waking up crying. God your experience sounds terrible!

Thanks other guys too

Not an elective GA or an elective caesarean - I had an emergency section and, like TheApprentice both my epidural and spinal failed so a General Anaesthetic was the only option. Just one of the those things and really unlucky but I have to say I found it pretty devastating and wouldn't personally recommend it. I felt very ill after I woke up and spent all day on HDU dry vomiting - no fun after abdominal surgery. They gave me anti nausea drugs but these took a while to work. All in, I was knocked for six and struggled hugely with missing my daughters' birth (they were twins and it had been a really difficult end of pregnancy, with the last month in hospital). If I'm honest, it is the only real regret of my life.

In your situation (which is very difficult - so hard to guess how you'd do in natural childbirth with your previous tear) I'd elect for a caesarean. The chances are that they wouldn't struggle to site the epidural this time - it can be far more difficult to site in a labouring, restless woman, however hard she is trying to stay still. It might also be worth asking for a very experienced anaethetist to perform the epidural given your previous experience.

My advice would be to use the option of a General Anaesthetic as a last resort. Have it in your mind as a possibility and maybe plan accordingly. They won't allow your husband/partner/relative to be in theatre if you're having a general so neither of you will see the birth. You can ask someone in theatre to take photographs of the baby being born so you have some form of record. Also ask for your husband to have skin to skin immediately whilst you come round and then perhaps ask for it as soon as you're awake. I didn't have any of this as it was so sprung upon us and I really think it would have helped with the trauma of it all. Equally, have some snacks for post-op (dry crackers or bread or something) as if you do feel nauseaous post-op these can really help.

My final tip is to ask a midwife to debrief the birth to you afterwards - maybe the next day. Ask for this before you go into theatre (i.e. mention that you'd like it). It can really help to create a 'picture' of the moment of your baby's birth. It sounds prosaic but it helps to know the small details. I now know that my first twin didn't cry at birth and yet the second one did. That the second twin was given to my husband first. That the first twin was laid between my legs (so she WAS with me after all! I got to 'hold her' in a small way.) whilst I was being sorted out.

Hope this helps and best of luck with your decision and the birth.

K

Thank you so much for your message kitstwins

Thats really good advice. I think I am startuing to doubt my reasons for having the section in the first place now. It's like the goal posts have shifted from me being terrified of the same degree or worse tear and being left will continence problems v's the risks of a GA and missing the birth. If I was in labour and and something went wrong and I had to have a GA then at least that wouldn't be my decision. I'm alomst thinking if I make it to the section day and they can't get a spinal in I'll go home and wait for labour. I feel like my reasons wouldn't be good enough to put myself through a GA and a section recovery just in case I tear. Can't believe I may be changing my mind... I just have to hope any tearing is no worse than the last time.

Thanks for your advice though it is really useful and if I do end up having a GA I will keep it in mind. Mind you if I do have one it will have to be becuase of some emergency as I just can't see me choosing to have it. After finally deciding it would be best to have a scetion I'm not swinging violently the other wa y and thinking I just don't even want to go to hospital!

Hi Gillyan. Glad my post was helpful. I really feel for you as, essentially, you must feel as if you're in a no win situation. Without a crystal ball to hand you've absolutely no way of knowing how things would go and none of the options presented to you are either clear cut or without risks or downsides.

You could go for an elective and it could be very straightforward - easy epidural, good recovery, etc. Equally, you could go for a vaginal birth and not tear (or not tear badly). But both these options for you also come with history - the threat of awful tearing and incontinence and the threat of a failed epdidural. You've been unlucky in both respects in the past so it's not surprising that you have no faith in your options or things going to plan.

A girlfriend of mine tore very badly (a whisper away from a fourth degree tear - she tore into her rectum but not all the way through so some brilliant stitching and endless pelvic floor exercises has meant she has no continence issues). She has been told that a caesarean may be her safest option next time but that they will do a 'probe test' to guage the level of strength and, based on those findings, will advise her as to whether a vaginal delivery carries low or high risk of further tearing. Have you had this probe test? I'm not entirely sure what it's called but it might be worth asking for it if you haven't as they can assess the strength of the repair and give you a much better picture of your chances of tearing next time?

If you've torn badly before then the risk of tearing again is slightly higher but I don't think it's a foregone conclusion in all circumstances. I think you need a consultant or doctor to give you a clearer picture of the strength of your rectal tissue and repair. THere are lots of cases of people who have torn badly and then gone on to have a second vaginal delivery with less or no tearing. Positions can help, as can consistent midwife support during labour, a doula, etc. I've also heard that holding a warm cloth against the perineum during crowning/delivery of the head can minimise the risk of tearing.

Good luck and I hope this helps. Not an easy decision to make but at least you're thinking things through and weighing up all your options. There won't be a clear cut answer for you, but by thinking things through and weighing things up and changing your mind a few times, you'll eventually come to the right conclusion for you.

Really hope things go well for you.

Hi I have had 4 spinals and 3 GAs (all related to pg or m/c). 2 sections with spinal (1 planned) and 1 section with GA (emergency). I have a mild back deformity and it took 4 attempts to get the spinal in! I still preferred it to GA though as find recovery awful and missing the birth etc.