CS under General Anaesthetic - Is it safe.

[flopsy1974]

Had my previous child 4 years ago. He was born with forceps and shoulder dystocia. The only way they could get him out was by internal manoevres. Not good. All was well in the end thank goodness.

I have a growth scan at 38 weeks (two weeks time)and if another big baby (last one was 9lb 1oz)my consultant may recommend an ELCS. He is worried about the shoulder dystocia.

In labour last time I had an epidural but it didn't work properly (it only numbed one side of my body). If it doesn't work again and they did it under a GA is it safe - is there anymore risk to me or the baby. I am overweight which also makes me higher risk.

Any experiences or ideas would be gratefully received. I don't particularly want to go under the knife, but the shoulder dystocia really frighteded me and with just under 4 weeks to go till my due date I am starting to worry.

Sorry about the long post.

Hi flopsy, hopefully everything will go well for you. I may be wrong but I thought they only used GA for absolute emergencies - life and death situations... Just because your epidural didn't work last time, that's not to say that it wouldn't be successful this time round. I had 2 epidurals when I was having DS - the first one just didn't work (not sure of reasons and never enquired). Did the docs give any reason for the epidural not working last time?

Sorry, just realised I haven't answered any part of your question....

I should add that DS was born by EMCS - hence the need to have the epidural working!

No reason as to why it only numbed one side. Just one of those things they said.

Hi flopsy I have recently had an EMCS under epidural, followed by an emergency op with a spinal. I also used to work in anaesthetics.
Like gwennie says there is no reason why an epidural wont work for you this time, but if your CS is planned then most anaesthetists prefer to do a spinal, which wears off quicker and is usually easier to place.
There are risks with a GA, but none that wouldnt be there if you werent pg, its the same risk, although these days the risks of GA are small.

they will try to give you an epidural this time, but if it doesn't work they will give you GA.
I had planned a section, and had 5 attempts at the epi ( my back looked like a well used pin cushion after ), until the consultant told me it wasn't going to work and i had to go under properly.

So if your overweight ( like i was ) i would prepare for it not to work again just in case.

my consultant told me for next time try some yoga during pregnancy to stretch my back etc, as they couldn't find the space to put it in.

I had GA for crash section with first baby as the epidural didn't work (epi was being sited before we knew it was going to be a CS), and spinal for 'routine'EMCS with second.

AFAIK it will be easier/less rushed to put a spinal/epidural in for a planned section, as they will have plenty of time (no distressed baby to get out quickly), you will not be having contractions, and there is always the back up plan of GA if unavoidable.

Having had both, I would try to avoid GA if possible but it was ok. The drama was the rushing for a crash section rather than the GA itself, for me.

Meant to add, bear in mind that late scans for size can be very unreliable, and a lot depends on the position of the baby/being able to get in good position, it would be quite unlikely for SD to recur- and many SD babies are average size.

But a previous biggish baby and being overweight are risk factors, and after a traumatic first delivery a planned CS, if you are happy, may be a decent option.

All general anasthetics carry a risk (extremely tiny) of coma and death. This is why local anasthetics are used as much as possible.

Have you ever had a GA before? If so, there is less likely to be a problem.

The risk is mostly to you. The baby can be affected if there is a delay so these c-sections are usually carried out very quickly. Also, as you will be unconscious for a while after the delivery the baby will miss out on skin-to-skin contact and immediate breastfeeding.

There is also a small risk of chocking if you have eaten recently so you will have to go the 24 hours before the op without food.

Despite these risks I'd personally opt for a GA over a spinal/epi despite thatnot being a very 'rational' choice.

Bilmey forever a pregnant woman would starve to death after 24 hours I would have done at least

The fasting period before a planned GA is usually from 12 midnight for a morning op, from 6am after a light breakfast for an afternoon slot. Although 4-6 hours is usually enough, they tend to add a bit of extra time to make sure.

I think they want a longer fast for a c-section GA because being heavily pregnant increases the risk of choking because of physical and hormonal differences and that the action of doing the c-section also increases the risk.

Flopsy, just wanted to say that I had an em c-s under GA with DD1, as my epidural had not worked (just one of those things). However, I have had 2 subsequent (vaginal) births, with which I have had epidurals which worked just fine.

I had an emergency c-section under general as my epidural and a spinal didn't work with DS1. I could feel them cutting into me. I had a panic attack, and then they knocked meout.

Then I had a vbac with DD1 and had this enforced natural labour as the epidural didn't work then either (they tried 3 times). Also worked just on one side. I had stitches and the lot all done without pain relief as the local didn't work either (even though they waited 6 hours to sew me up !). That was worse than the birth and I just had to scream through the pain.
The recovery and trauma was worse than my c-section !

Now I am due with DC3 in 4 weeks and I think I want to push for a c-section, but I don't want to have an epidural or spinal - i just want to be knocked out. I don't want to have to go through them testing me to see if it had worked and then cutting into me again even though I kept on saying it hasn't worked.

I don't think they'll let me though.

I have a growth scan on Thursday - let's see what they say !

I suppose whenever anyone goes under GA there are risks, and obviously they would prefer to have you awake, but like you - Idon't want to have to go through that again.

Thanks for the advice so far. 36 weeks + 3 and starting to panic.

I would avoid a GA if I possibly could. They can literally kill you! Obviously that is highly unlikely to happen, but really why risk it if you don't absolutely have to? If you have a planned CS then they will not be in a rush and I am sure they will be able to get a proper epidural/spinal block in before they have to start.

I had a similar problem with my section with DS, the epidural was far too high, so I was numb from my shoulders down to my tummy, but where they were cutting I felt absolutely everything, it was horrendous. At the time the anaesthetist kept asking if I wanted to be put to sleep instead, but after 24 hours of labour, being terrified and in pain, I had no idea why he thought I would want to! I didn't know sections weren't supposed to hurt like that, it was only afterwards I found out what had happened.

I'm having a CS for this one next month, and I'm having a spinal instead of an epidural. The consultant (the same who delivered DS) has said if I feel a thing they will put me straight under, but chances are everything will go smoothly.

I'm happy with that plan, I'm really scared of the thought of being put under and don't want it to go like that, would rather try with the spinal first. But if the same happens again I would rather take a risk than go through that agony again!

Urm. Not sure about some of the information on this thread....

I am an anaesthetist (hence imaginiative username).

Firstly - there is every likelihood that a spinal anaesthetic (+/- epidural) inserted in a calm and controlled manner before an elective c-section will work. The actual choice depends on the anaesthetist on the day and regional preferences - some areas use lots of CSEs (combined spinal epidurals) and others tend to just use spinals on their own for planned sections.

Secondly - yes a GA does carry slightly more risk than a regional anaesthetic for a c-section which is why anaesthetists tend towards regionals (spinal/epidural) if we can. The main problems to the Mother are with airway management (being pregnant makes things more tricky, the rate of failed intubation (ie how often the breathing tube doesn't go into your lungs is about 10x greater in the pregnant population) and being overweight won't make it any easier). Having said all that it is still rare for things to go wrong.

There are also problems for the baby in that some of the anaesthetic drug will get transferred to them - this isn't a long term problem (after all babies at 24 weeks + sometimes get anaesthetics using the same drugs) it just means that sometimes they are a bit sleepy and need some help with their breathing initially. Worse case scenario would be a SCBU admission for ventilation.

Thirdly - fasting. Current rules in the UK are 6hrs for food, 2hrs for clear fluids (water/cordial/ basically anything you can read newprint through. Notable things you can't have are tea/ coffee with milk, or carbonated drinks). Babies only need to fast for 4hrs from a breast milk feed.

Hope this answers your questions.

I had a planned GA for a planned CS with DD. The idea of an epidural scared the shit out of me following a hideous lumbar puncture 13 years ago. DH was waiting to get DD and had skin to skin contact until I woke up. I am hugely overweight and a smoker.

Have had 2 great cs's. ds2 was a calm emcs, under ga. my blood sugars plummeted, my diabetes was just going mad, they lost the trace, and had concerns about his breathing. awoke, felt fine. recovered fine. dh held him and had loads of loving, telling him about football !!!!
hope yours goes and smoothly and happily as mine. not everyone has awful birth experiences just because they've had cs's or under ga.

Thanks for the information and advice everyone. It's nice to hear about other experiences and advice from people who know what they are talking about.

DefNotYummyMummy - you're not hypermobile are you?

I have hypermobility syndrome and a complication in about 60% of people with it is that local anaesthetics are largely ineffective. I don't think anyone really knows why.

I'll definitely be having this in big bold letters on my birth plan for if I need to go into hospital. If they give me about 5x the usual amount of local it takes the edge of a bit, but locals never provide complete pain relief for me - I used to think this was normal. I'm concerned that an epidural or spinal is less likely to be effective for me because of this (it's another "no one seems to know" thing!). If it came to an EMCS situation, I'd let them try a regional anaesthetic as long as they realised that it's quite possible it won't work so GA will be needed (at least I know they work!).

Also means that any stitching needed will have to be done with no analgesia (gulp!).

Japhrimel - never heard of that, but will research it. Saw consultant and have my ELCS. BUT she said they will absolutely have to try epidural and spinal before resorting to GA. She did ask me if I go to the dentist, do the needles work for pain relief ? I said yes.

Your experience does sound like mine though. They said after a spinal there is enough to knock out a horse and I am a petite 5ft 2 woman (although about 2 stone overweight now !). But it still hurt. I had to cry uncontrollably before they would believe me.

Thanks for the info and good luck !