Section under general

[Anonforthis2121]

I have just been told that baby will have to be born via a ga csection and I am really upset as I was not expecting it. Has anyone experienced one? What was your experience?

Is there a specific reason the doctors have told you this? Ie health concern with you or baby?

I was told I would have to have a c sec for my 1st born due to her being breech and expected to be 4lbs or under.
I refused and she came naturally a month later and healthy weight.

This is something that you have a right to say no to, but do have to consider all variables and health of baby and you.

I have to have it under general due to being diagnosed with a bleeding disorder of unknown (today at 33 weeks) cause so they do not want to do a spinal or epidural. I will also need many other bleeding precautions. This is after having 3 previous normal births with pph. I did have epidurals with them but we thought I just had lower platelets (mild itp) but as of today everything has changed.

I am left very nervous.

My close friend had a planned section under GA and she had a good experience and recovery.

Dad stayed with baby until she woke up and she was up and about the next day.

Sounds like they're advising sensible stuff & I'd ignore the rather unhelpful first reply.
We usually avoid GA where we can, but for some women it is the much safer option, and where clotting's a concern/undefined then that's a really good reason to do one. All being well, there's usually someone who can do photos and whatnot in theatre so you can see the very early baby shots even though you're anaesthetised (clearly not the same as being awake and seeing it, but hopefully makes up for that a little bit). A planned GA section is usually loads calmer than an emergency one (which is what most people who've had GA will have had). Pain can be a bit more difficult immediately post op, but there are lots of options for managing it and the anaesthetist will go through whatever the options are where you are.

Unhelpful by what, asking question and then giving an experience? Then suggesting with absolute limited knowledge of ops situation a suggestion.
Are you having a bad day?
Do you feel better now?

Anyway op, with a disorder that could potentially be a huge issue in labour, you have to listen to what is best for you and babe and reduce risks where you can.
My sister had ga and said it was surreal experience when coming back around, however she is somebody who doesn't react well yo ga, that being said, she bonded with baby just fine and recovered no worse than a regular csec. You got this! 💪

I did but was an emergency one. It was a bit strange not meeting baby straight away but it hasn't affected our bond (he's 9 months now). For me Id had a long labour and problems so by the time they'd put me to sleep I was kind of ready for it. You'll be fine. Your partner won't be allowed in, but I found out afterwards that apparently you can ask the doctors to take photos so that would be good

Pain. All encompassing pain. I woke in agony and was then asked to rank my pain on a scale! I couldn’t even think straight. I was unable to speak. They rolled their eyes. I couldn’t speak but was hyper aware.

The staff bustled on about my baby being a boy but at that point I didn’t care. I felt guilty for months/years.

Make sure you discuss pain relief before the event.

Don't mind her/him above. They love to come on threads telling Mums they're wrong and boasting about being an anaesthetist. They're purposefully argumentative and combative, and then disappear never to reply again once they've said their bit. (NC for this because a few months back so many comments I made were responded to in such a manner by above, and I don't want to get into it again.)
You didn't have the clotting issue info when you responded so weren't to know. We can all see that, don't worry 😊

perhaps I misinterpreted the OP - it read to me like a question about anaesthetics for a section so an example about deciding not to have a section didn't seem that useful.... apologies if I've missed the point completely.

I probably should have mentioned the reason why I was more just wanting people’s experience of being under general. I am now debating whether to ask to go for a vaginal birth as the cs was due to maternal request and also the fact I pushed for 2 hours with two of my children and I am not able to have a forceps or vaccuum birth but if they will now push csection more given I have been diagnosed with an unknown bleeding disorder. I am honestly terrified of being put under if I’m honest as I am worried about not waking up. I have trauma from my previous births and this news has just thrown me.

I didn’t have a general for c section but have had for multiple other ops.

main advice: it causes nausea in some people so ask for anti nausea drugs alongside.

i’ve had several ops.

while it is true that some people do not wake up this is mostly due to the nature of the operation being done and their previous condition.
if you are otherwise mostly well and it is a planned c section then the chances of you not waking up are very low.

it’s more due to my bleeding risk that I am so scared now. Before even though I knew I would bleed I never expected to be put under and that just feels scarier to me

I had an emergency under GA. So like @Greybeardy said I think it’s probably not helpful to compare as it’s not the same.

overall I don’t feel sad I missed out on the first moments baby was born. I still got lovely bonding moments later. The pain was pretty horrible when I woke up but I was soon given morphine. I felt confused when I woke up which I think is quite normal.

Overall I didn’t love it but the baby at the end made it all worth it

As an obstetric anaesthetist I can't think of a single baby reason why the section would be under GA (they're "worse" for baby)

Maternal reasons can be if mum has a bad heart condition, uncontrolled severe pre-eclampsia that was so bad their platelets were compromised (pretty rare), brain disorders meaning we can't do a spinal anaesthetic, spinal metal work (relative contraindication some will still do a spinal provided accept a metal work infection could be caterstrophic), rare bleeding disorders

From a ga perspective your birthing partner won't be allowed in but we will take you a ton of pics, bed is tilted to get bump off your tummy vessels, you'll be given an anti acid drink to minimise the risk. 3mins of oxygen which needs to be quite tightly on your face. They'll put the catheter in to drain your bladder before they start and put all the drapes and cleaning fluid on ur belly before we give the anaesthetic drugs, this is so there's the absolute minimum drug transfer to baby. Don't worry theyee not allowed to start till we give permission and you're totally asleep

The anaesthetic is cold as it goes up the arm, v normal..as you go to sleep our assistant presses on your neck to minimise regurgitation, most people won't remember that as its after we have started the drugs. We keep you asleep give you pain killers and antisickness before waking you up. Often have a sore throat for a few days, v small risk of damaging the lips or teeth with the tube.

All the drugs we give are breast feeding safe if you want to do so

GA sections are more painful to recover from so we often do nerve blocks to try to numb the abdo before you wake and you'll probably get a self administration click device to give yourself iv morphine

I've had both mine under emergency section with GA. My only advice is make sure someone is with you to be with baby before you wake up and then be prepared to be 'out of it' even once you've 'woken'.

With my first I went in for monitoring but didn't really expect to have my daughter that day so my Mum took me. My first memory of my daughter is of her being cuddled by my (special needs) brother and my Mum telling me I had a daughter and she was perfect. I will never forget the way my brother looked at her. She was shown love from the moment she was brought to the ward and although I will always be a bit sad that wasn't from me, I'm so grateful that she got that from someone.

For my second I declined a section because I didn't want the GA and I did get to labour but due to complications I ended up with a GA section anyway. Unfortunately I didn't have anyone who was able to stay with him until I woke up and I will always feel guilty for that, especially as it turned out he had an infection and was transferred to NICU at 8 hours old. I wish my Mum had been with him when I couldn't, but the important thing is we are all safe and well. I've not had any issues bonding with either of them.

Obviously I am gonna ask maternal medicine at next appointment (it was just haematology I had today) but in your opinion would you say vaginal birth or csection would be better for a bleeding disorder with a history of pph and long pushing stage.

We can't advise for you, if you ask your midwife they'll refer you to anaesthetic clinic and they'll have your notes and chat you through.

What was your reasoning for the maternal request?

I think I'd personally try for a normal delivery based on what you've said so far as you've clearly proven your body is capable of giving birth twice which is v reassuring

GA sections are often associated with increased bleeding as the gases we use make the uterus sometimes less able to contract back down again after baby is out

Normal straight forward deliveries have a lower blood loss than sections normally

You need an anaesthetic clinic referral from your midwife (maternal medicine is obstetrics/general medics with a special interest in pregnancy), although sometimes we do shared clinics).

They'll need access to your notes to advise you which is a better choice - as it depends on the cause of the pph as to how likely it is to reoccur (ie a chunk of placenta being stuck may not happen again, having a huge baby/induction of labour etc) as it maybe the pph was unique to that labour/baby etc

My friend had a breech baby and kept freaking out when they tried to put the epidural needle in so happily ended up with a GA section. Then another for her second child. She thought they were both great and has no regrets.

One was an assisted delivery which I would now not be allowed

my last labour was very long and involved me pushing for over two hours and him having decels, his head was measuring at 96th centile when he was born. He was very nearly an emergency csection. I then had another pph.

I had my DC under general; being put under was fine; they counted me down and while it was nerve wracking it was ok and I trusted the medical professionals.
It was painful when I woke up but pain relief was given quickly and I was very tired and needed a lot of help for the first 12 hours as I didn’t feel at all with it compared to my c section under local where apart from my legs I felt completely myself throughout

a few thoughts that spring to mind that it may be worth asking them to help with your decision making...

-if you do decide to try for a vaginal delivery, what pain relief options do they have if an epidural's off the cards again? (may be worth asking about remifentanil)
-what do they think caused the PPHs before? Was it the current clotting problem and it just hadn't been spotted/fully declared itself or was there something else/a combination of things?... in which case, would any of that make one way or other safer for this time?
-is there anything else about you that might make a GA more difficult (particularly, if it came to an emergency?)... this is one to ask an anaesthetist rather than a MW/obstetrician and might help you decide whether having a planned anaesthetic would feel safer/calmer than having an emergency one.

-is there anything about the baby that might make one route safer than the other (aside from not being able to do an instrumental delivery)...eg. if your expecting a whopper sized baby or there are concerns about how they might cope with labour then that may make a planned section seem more sensible for both of you, but if the baby's about the same size as your others and looking good then maybe vaginal would be straightforward. May also be worth asking whether they'd anticipate difficulty doing a section if you got as far as being fully and attempting to push given that forceps arent' an option.
-a GA really isn't usually anything to be wildly worried about. It is the safer anaesthetic option for women with clotting disorders because of the risk of bleeding in the back with spinal/epidural. But, for women who've delivered vaginally and had a big PPH it would usually be the first choice because it's usually safer than a spinal then too.

HTH

I had a planned c section under GA only 3 weeks ago, this was due to personal medical reasons. I went in for 8 in the morning and took omeprazole the night before and morning of. I was told I would be the first of the day, I got my gown and socks on and got out a nappy and hat for little one and then the anaesthetist came and went through the procedure with me again and answered any questions etc. I was taken down at 10.10am, walking into theatre is slightly daunting however all the staff were so lovely and it was really calm in there. I lay on the table and due to personal reasons I had the mask on to put me to sleep first and then they inserted the cannula and catheter when I was asleep, I don’t remember any of this (obviously) baby was born at 10.42 and was taken straight to dad who was waiting in the recovery room, my midwife took my phone into theatre and took pictures which was really lovely so definitely ask for that if you’d like.
I was in theatre for a bit longer as I lost blood due to being anemic but I was brought into the recovery room and came around, I remember waking up and I didn’t feel pain, only pressure. They gave me nerve blockers which definitely helped. You are slightly out of it due to the GA and painkillers and I was told recovery may be more painful as you don’t have the spinal and they have to work slightly quicker but I really didn’t think it was that bad, especially with the oramorph.
that evening they removed my catheter and got me up, which isn’t the nicest feeling however getting up after the first time gets easier. I was discharged the day after and took ibruprofen religiously which really did help. Remember to not lift anything heavier than your baby and moving really helped my recovery, I’m exactly 3 weeks post op and my scar has healed really well and I’m in no pain, my pain really started to go away just over a week post op.
Granted a GA section isn’t ideal for a lot of people, it wasn’t my ideal situation either, but it meant a safe delivery for us both and it ended up being a nice experience.

congratulations and I wish you the best with your delivery 🥰

This sounds stressful OP, it sounds like maybe a good talk through things with obstetrics, together with obstetric medicine if available where you are, and anaesthetics, should help sort things out. None of us here have exactly all the details to be able to inform your choice.

Mode of birth (vaginal via CS) - sounds like a good talk with obstetrician, maybe factoring in baby’s head size, detail of previous experiences, and also thinking about pain relief options in labour would be a good idea. You won’t be able to have an epidural by the sounds of it but could probably have a pain pump. Usually bleeding disorder itself doesn’t mean you need a CS but there are some exceptions to that. And the management to try and prevent or treat another PPH would need to be planned carefully with you - but that’s the same as with CS. Maybe you could consider a plan for vaginal birth but with an earlier recourse to CS if progress is slow.

GA - sounds like the haematologist/anaesthetist are worried about bleeding into the spine if they do a regional block, which can be pretty major - as others have said with GA you can be pretty sore afterward but any good obstetric anaesthetist should be able to factor that in, nerve blocks as mentioned above, also strong pain relief in the drip with a button you can control yourself (pCA).

In my unit we run big multidisciplinary meetings about cases like yours, so that obs/obs med/haem/anaes would all talk together and come up with recommended plan and alternatives so as to bring you a consistent and well informed opinion you can then work with. Hopefully you have similar in your location.

I hope everything goes well for you.