Spinal or general anesthetic for C-section?

[ButterscotchBabe]

I'm having a C-section for twin pregnancy and need to decide whether to have a spinal or general anesthetic. I've spoken with an anaesthetist and gone through the pros and cons of both options but still struggling to decide.

Spinal
Pros - awake for the birth, calmer operation, doesn't affect the babies

Cons - risk of temp or perm nerve damage, risk of pain during the op if it doesn't work

General
Pros - no pain during the op (although they did say they use a lower dose for C-sections! 😬), no risk of nerve damage

Cons - neither myself or my husband can witness the birth, rushed operation to minimise anaesthetic effect on babies

If you've had a C-section could you share which option you chose and how you found it?

Are you in the UK OP? Very unusual to be offered a GA as standard.

I had a LSCS as a Cat 1, so probably not the story that you are looking for, but physically it was fine

Good luck.

Spinal. All day everyday.

Have you had general before OP? It makes me feel like shit for days, not how I'd choose to start with my babies.

Take the spinal, be awake and aware for your babies birth and let your husband see it too (although I didn't let the curtain come down - I did not want to see the actual birth).

In terms of cons. They test for numbness before they even let the surgeons close. My 2nd section it took an extra 10 minutes for the spinal to get where it needed to be, they gave that time to make sure I wouldn't feel anything. So i'd argue pain isn't really a con.
In terms of nerve damage. I have a spot on my back that hurts like fuckery if someone puts pressure on it. Its from my first section where they struggled with locating the right spot so I had a couple of attempts but it was an emergency and I was contracting every 30 seconds! But that's it and it's a very specific spot that doesn't in any impact everyday life.

I’ve had 2 c sections I had spinal for each. They tested to ensure you are completely numb before starting and was awake for the births and partner was allowed in and dealt with the baby afterwards while I was stitched back up etc

i know a lot of mums have issues /trauma about not seeing the baby’s being born or not seeing them afterwards so it’s honestly your own preference around that..

I had a GA for my first as an emergency so no one saw it coming and we couldn’t prepare for it. There were issues with the epidural and other things that were complicated. For my second I had a spinal and epidural as they knew it would be complicated and take longer than usual. I’ll be honest that we both struggled with neither of us being there for the first one, DH quickly kicked out of theatre and me out of it. The second one wasn’t easy but being aware of what was going on was much better and the recovery was complicated but quicker. That’s probably no help to you, sorry!

Spinal. No idea why you would opt for a GA unless an emergency. I've had a spinal c section, absolutely beautiful birth experience watching my baby come out and have skin to skin immediately.

Spinal. I think it’s really important for bonding to witness the birth and see your baby as soon as possible. Not sure why GA would even be a consideration unless there was a real medical need. I had a spinal and it was fine, couldn’t feel a thing and was magical seeing your baby being brought out. I wouldn’t want to feel woozy from GA first the meeting my baby if I could help it

Spinal all the way. I had it for both caesarians just over 30 years ago. No issues at all and it was lovely having everyone there for their birth.

Thanks for your responses, in answer to some of your questions -

> Yes I'm in the UK
> Spinal is the default but you do have the option of choosing general
> I've had general anesthetic numerous times for various operations, so not concerned about the after effects

I'm mostly considering general because of the concern around permanent damage to my spine and/or nerves. I'm 5'1ft and have a hyperlordosis (deep inwards curvature of spine), they don't think this is an issue as they can still feel the spinal bones they need to access. However, the doc did admit they essentially do it "blind" because they cannot see how far they are pushing the needle in, so there is room for errors.

Spinal. All day long. I say this as someone who has had a c section for twins and as someone who works in operating theatres (including maternity) and sees spinals and generals all the time.

All spinals are done blind, but the anaesthetist will keep checking they won’t push the needle in too far, until they get to the right space. There will likely be a few anaesthetists present too (or at least available) if your spinal is difficult someone else can scrub in for it.
I hate doing a GA section. Even the ones that are scheduled (not emergency), intubations feel rushed and riskier. Pregnant women more likely to aspirate gastric content under GA. Pregnant belly gets in the way. A spinal is usually so much nicer, calmer, happier. It’s always nice seeing a new family being made. Plus you’ll have the pain relief for after with the spinal. They usually infiltrate local anaesthetic with GA or spinal, but obviously with the spinal you’ll have that on board as well.
You can always ask for the spinal and give it a few tries. If they can’t get it in or you feel too uncomfortable you should be able to request a GA at the time.

I had GA with a cat 1 emergency and spinal with a failed vbac.
I probably would choose GA again as I was very shaky and nervous with the spinal.

Op, I had no problems with the spinal being done however, and I also have an unusual spine.

Spinal. No question. I have lordosis as well. I had two deliveries under general anaesthetic (one because they couldn’t numb me quickly and effectively enough with the spinal, and one because of the previous history - both were emergencies due to placental abruption.) I also had one successful VBAC and one delivery under a spinal with yet another abruption.

The spinal was a good experience for me, despite being another emergency section. I had a great anaesthetist team looking after me - a doctor and a nurse. They stayed up at my end of the operating table. The anaesthetist was able to explain what was happening while the surgeon and the rest of the team were busy working. The anaesthetic nurse was able to go look on the other side of the screen and tell me what was going on. As soon as the baby was delivered and resuscitated, he was brought straight to me. I wasn’t able to hold him straight away but as soon as I had been sewn up, I was able to breastfeed him.

The general anaesthetic deliveries were completely different. I wasn’t awake and my husband wasn’t allowed in so neither of us were “there” for the deliveries. You’ve had general anaesthetics before so you know how groggy you feel afterwards. When I came round from my first, I thought the baby had died and I was so angry at my husband for holding a baby. It took a while for me to work out that it was my baby. It made it difficult to bond with him. For my second GA delivery, I came round in a recovery room with my husband, a midwife and a nurse, again having missed the delivery. Honestly, it’s a completely different experience and not one I would recommend. Okay, the first one was an emergency and there was no choice but I definitely wouldn’t have opted for it either time if there had been an alternative. You also have more options for your birth plan with the spinal, for example if you choose delayed cord clamping.

Whatever you choose, good luck with the birth and enjoy your twin babies.

2 sections. 2 spinals. 0 issues with either. Am very grateful to have been conscious for the births too.

Spinal is generally safer for most women and babies unless there’s a real emergency that means cutting a few minutes off the anaesthetic time could make a difference to survival or there’s an unusual problem that makes spinal high risk (like bleeding problems/spinal cord problems). The reason it’s safer for mums relate to the changes in respiratory physiology that happen in pregnancy - it is not the same as having a GA when you’re not pregnant. Bleeding can be a bit trickier with a GA; pain can be a bit more difficult to manage initially; there’s a higher chance of accidental awareness in obstetric GA’s than other operations. The GA drugs for a section may well be different to the ones you’d have had for other operations so you can’t necessarily compare. For the baby, they get a dose of anaesthetic so are more likely to need paediatric support initially after a GA, whereas that’s not a problem with a spinal. The risk of nerve damage with a spinal (if that’s what you’re worried about) is in the order of 1:1000-1:250000.

none of that means that GAs are dangerous - they definitely have a role and if a spinal doesn’t work then the only option is a GA, but not many women chose to have a GA as their first choice because all other things being equal spinals are usually the better option. You are right in that you can decline a spinal, but unless there’s a particular reason for them advising that then you’ll be picking the higher risk of the two options for both of you.

spinals are done by feel - so while we can’t see where the needle is we can almost always tell what tissue it’s in so it’s not just stabbing about and hoping to hit the right spot! The needle also goes in way below the level at which the cord ends (which is further up the back than most people think).

iirc if you look on the labourpains.org website there’s a useful lot of info about anaesthesia for sections - might be worth reading (it’s run by the obstetric anaesthetists association).

I had a spinal and it was fine, no pain and no ongoing issues. Had skin to skin in the theatre and breastfed with no problems.

Wasn't offered GA as an option, didn't think it was the norm, but I might have considered it tbh. I never have bad effects after GA so that's not a problem for me and I don't think it was particularly important for me to see the baby be born and I'm sure I would have bonded fine either way (I didn't really see it as there is a curtain during the op and I didn't look).

I had both.

First GA for placenta praevia so no choice. It was fine but recovery was long and I’d been in hospital for a long time. In an out from 20 weeks and then properly from 28 weeks and on bedrest, due to bleeding and born at 36 weeks.

Everyone all my family and dhs met the baby before me, honestly I couldn’t have given a shit, was just so happy that we both had made it. GA didn’t really affect bonding tbh. We were in hospital for 10 days after birth, so maybe that’s why and as I knew staff so well, they really helped me with latching on and we were both a bit unwell and the staff were great.

Second was emergency and a spinal was offered or a GA and I took spinal. Bonding was no different. it was nice to see the baby being born though as obviously we hadn’t with the first dc. Some of the staff were the same and they made such a fuss of eldest which was nice.

Thank you for all your responses, I really appreciate you sharing your experiences and thoughts. I'm still not 100% decided but leaning more towards the spinal now

I had to have a CAT 1 emergency section under general when my baby was born at 33+1. I will never recover from the fact that neither me nor my husband got to see him born, hear his first cry, skin to skin, the lot. It was five hours before I even got to see my baby. He’d had his first feed, first nappy change, first all sorts by the time they took me to see him.

I’ve had a spinal previously for a cervical stitch to save his pregnancy, and can’t even imagine why anyone would think of choosing general anaesthetic as an alternative. GA is not good for baby - it crosses immediately the placenta. My son’s APGAR score at birth was only 3. He was blue, didn’t cry and needed to be resuscitated. It doesn’t make for happy first pictures. Someone in the theatre took some because neither me or husband were even able to witness it.

There’s risk in everything. We accept that the moment we start trying for a baby. You have to weigh up what matters to you more. My spinal was completely botched and that’s why I ended up with the GA, but I wish to God every single day the anaesthetist had just placed it correctly. I’d take a bruised spine and some temporary nerve pain to witness my baby’s birth.

I was offered either for my emergency CS (I know maybe that's different to elective), so maybe it's standard to allow a choice in most hospitals?
I wanted to be awake, OP, but I wouldn't really have minded, whichever was safest for her.

I wasn't given a choice as far as I recall, it was an emergency section however so perhaps there wasn't time or they automatically do spinal in my NHS trust.

I know there's risks etc but for my giant 10lber baby it was straightforward and recovered fine. Despite being at day 3 of botched induction, epidural failing back to back giant baby 8 hours to 3cm of labour I was still awake and aware enough to vividly remember meeting my son for the very first time, and can still feel that little face on my cheek. I was immediately flooded with an urge to protect and kept asking my husband to go be with the baby when he was being weighed etc.

If general is needed however for the health of mum and babies then that's the best option, I've known a few women who had general and they have a lovely normal bond with their babies.

I saw your update about your spine and wanted to pipe in. I had to have a c-section and I have scoliosis with half of my spine fused and metal rods in place. I was so anxious but my anaesthesia team were amazing! There was a risk of the spinal not working due to scar tissue, and the curvature of my spine. We agreed to do ONE attempt at a spinal only. If they were unable to gain access or if the anaesthesia didn't work properly, we would convert to a GA.

Luckily, the spinal worked! The team took their time with my spine and only proceeded once they felt they had proper access. The anaesthesia was slow to kick in so they tilted the bed so it would spread upwards and then they did so many checks that I was properly numb before proceeding.

It might help if you met with an anaesthetist and discussed all the options and come up with a plan you're both happy with.

For what it's worth, the spinal genuinely DID NOT HURT and I have an awful needle phobia!! So it was a huge decision for me but I really wanted to try and be awake and it was worth trying, I got to see my daughter straight away 🥰

I found the idea to be awake during my
operation quite scary and felt that I don’t really need to be there, I’d quite liked to have a GA. My mum had one with me, it was the done thing back then in my country of origin. However, after talking to the medical professionals, I came to the conclusion that there is a good reason why this is not the first choice anymore. It’s more risky for the baby, which leads to a more rushed operation and this increases risk for you. I also heard from an anaestheticist (I don’t know why) that recovery is more painful. It seems to not really be the same as other surgeries under GA. Make sure you get all the information from medical professionals.

I've had a GA C section, and it was devastating. I've never developed the same bond with the ga baby as I have with my other child. I have no photos of him being born, no birth story to tell him, his cord was cut by some random registrar doctor, and by the time he was brought to me he had been bathed and dressed. It was like being handed someone else's baby for a cuddle, who I had to then take home and care for, while it felt like the baby who was in my belly had just disappeared.

I've had a lot of therapy to get to the point where I accept that this is how things are just going to be for me after the ga section. It's tremendously shit, but it is what it is. If I could change one thing in my whole life, it would be to be awake when my baby was born.

I am quite surprised it's being offered as an option, I've only ever seen it for cases of pathological phobia at birth. Spinal risk of nerve damage is about 1 in 20,000, risk of paralysis is 1 in 500,000. Risk of death is double with GA because of the higher risk in pregnancy of failing to be able to intubate. Check out the RCOA infographics on obstetric anaesthesia choices.

I have had a general for both of my c-sections. I asked for a general when I was told I needed a c-section. My baby was breech and as they had estimated her weight to be low (it turned out my baby's weight was not as low as they estimated during the growth scan!) they refused to try and turn her manually and claimed she needed to come early due to the supposed low weight. Due to personal reasons, which are traumatic, I did not feel comfortable with being awake for a c-section. What really hurt me was being told by a nurse in the recovery bay that my baby was a girl. I had deliberately chosen to not find out during pregnancy and wanted to find out once my baby arrived. However, a general suited me better, without a doubt. My second c-section was an emergency section due to my c-section scar rupturing and a placental abruption (tried to deliver normally and staff did not monitor as they should have done hence this). They were truly wonderful with me and they instructed the nurses to not carelessly disclose the sex. If I was ever pregnant again and needed a c-section I would opt for a general. I did not have an option with the second as it was an emergency which is understandable. As the sex wasn't carelessly disclosed, I had no issues with that. It does hurt a bit as I did not have immediate contact with my baby (first c-section) however, I feel it would have been too traumatic for me to have had a c-section without a general. Please do what you feel is right for you but if you are not aware of the sex, then it would probably be wise to make sure they know to remind staff you do not wish to know until you see your baby (just to be on the safe side).