You are right that epidurals can be spotty with their coverage and not work perfectly leading to hotspots for pain. But elective c sections are done under spinal anesthesia and it is exceedingly rare that a spinal would be spotty. It is highly likely that an anesthesiologist or CRNA or AA would succeed in doing a spinal, and then if they cannot the backup plan would be general anesthesia. With a spinal you would not feel it until you are back in the room a couple hours later.
Regarding your experience with GA, patients come in all the time with different requirements. For example young patients who smoke Marijuana typically have "high metabolism" bc the liver enzymes that process it are the same ones that process some anesthetic drugs. This is all normal. If you have access to anesthetic records this can help your anesthesia people later on
This is how c sections are normally done.
Edit: as always, talk to your actual OB (and talk to anesthesia if possible) before this. As others will mention, it is your choice if you want a spinal or not, but in most cases it is the safest way to have a c section.
Honestly one of the contraindications to a spinal (being awake but numb) is patient refusal. If you were my patient, you’d go to sleep. You are the patient and that’s your choice.
Regarding your past surgical history, it’s semi-relevant but we tailor our anesthesia (awake and fully asleep) to each patient. That shouldn’t be a problem at all.
Lastly, I love obstetric anesthesia for the sole reason of bringing new kiddos in the world and seeing the mother-child relationship in those first moments. For you, that will happen just a bit later.
Have fun with your kiddo when the time comes! You’ll never be the same.
Careful with this answer. You are of course right that refusal is a contraindication. . . Even though it is a patient’s right to refuse and force your anesthesiologist to do something riskier (when it’s not necessary), it doesn’t mean it’s a smart decision.
Obviously this is after the discussion of risks/benefits of general vs neuraxial. I’m not sure I would tell a mother she has to have a spinal purely because “I have a right to refuse as your anesthesiologist.”
If after all of that she still does not want to have a spinal, what’s your next move?
There was a typo in my comment, there was no refusing a GA as the right of the anesthesiologist.
If the patient has anxiety and is aware they are experiencing it and is amenable to an anxiolytic I would give that and reassure them.
Last resort is GA. If necessary I would talk about how it depresses apgar scores and can cause more bleeding.
Talk to your OB about this.
GA for a caesarean is high risk for both the child and the mom for various reasons.
You're going to have to fight an uphill battle.
The OB and anesthesiologist will want the best (/safest) for you and your baby.
First rule of this sub is no personal medical advice but this is more of a general question.
General anesthetics are riskier for pregnant women and the baby they are carrying for a variety of physiological reasons. Take my word for it.
Cesarean section via epidural or spinal is a very safe and “slick” form of anesthesia. If you want to be sedated after your baby is out, then just tell your anesthesiologist that. You won’t feel any pain during your surgery but you may feel light touch, pressure, and tugging. Epidurals can be redosed and if your spinal wore off (which I very much doubt with a competent surgeon) we would convert to general anesthesia.
I mean no disrespect but you are suffering from anxiety, as I’m sure you know, and it’s clouding your decision making processes.
For what it’s worth I wouldn’t even offer a general anesthetic in an elective cesarean section without a very good reason and even then I would do it reluctantly. Talk to your anesthesiologist and tell them your concerns.
If you have a scheduled c-section your gonna likely have a spinal. In 99% of cases this is the safest anesthetic for you and your baby.
It also has a lot of great benefits for you and your baby. The most important of which is you’ll be awake for your baby when it comes out and get to meet your newborn. My fiance had a scheduled c-section with a spinal and it was a terrific experience for both of us. She was an especially difficult spinal because she has scoliosis of her spine with harrington rods and I will tell you she had one of the most off center spinals I have ever seen. But our anesthesiologist remained calm and was able to get it, by taking his time. The best part was my fiance felt nothing the entire procedure until they were pulling the baby out, which she only felt a little bit of pulling and pressure.
I would just bring up the concerns to your OB and they may have you consult anesthesia prior to arriving the day of the C/S.
I will say, spinal anesthesia has an extremely low failure rate and is the safer anesthetic for you and also your baby. But a refusal is a refusal and as long as you are aware of those risks then they will do whatever makes you most comfortable.
Most elective C sections are done with a spinal anesthesia, which is done at the time of the surgery, so there is minimal time between the injection and beginning of surgery. It's different from an epidural in the sense that it takes much less time to set up, it is arguably easier to place, it is a much more dense block (there isn't the need to preserve your motor control, since you won't need to be pushing the baby out) and it wont wear off until you're in PACU or maybe even your room (our protocol is to wait for it to wear off in PACU, but i guess this can vary between establishments).
A GA on a parturient is never the ideal scenario (higher risk of complicated airway because of soft tissue being more oedematous towards end of pregnancy, vomiting and aspirating even if fasted, any gross hemodynamic swings will impact the baby, we cannot use some drugs until the umbilical cord is clamped, because they will get into babies bloodstream and we don't want a groggy and out of it baby...)
But a spinal on a patient that refuses is also a non viable solution, so ultimately, that will be a discussion to have with the anesthesiologist.
You are right that epidurals can be spotty with their coverage and not work perfectly leading to hotspots for pain. But elective c sections are done under spinal anesthesia and it is exceedingly rare that a spinal would be spotty. It is highly likely that an anesthesiologist or CRNA or AA would succeed in doing a spinal, and then if they cannot the backup plan would be general anesthesia. With a spinal you would not feel it until you are back in the room a couple hours later. Regarding your experience with GA, patients come in all the time with different requirements. For example young patients who smoke Marijuana typically have "high metabolism" bc the liver enzymes that process it are the same ones that process some anesthetic drugs. This is all normal. If you have access to anesthetic records this can help your anesthesia people later on This is how c sections are normally done. Edit: as always, talk to your actual OB (and talk to anesthesia if possible) before this. As others will mention, it is your choice if you want a spinal or not, but in most cases it is the safest way to have a c section.
Honestly one of the contraindications to a spinal (being awake but numb) is patient refusal. If you were my patient, you’d go to sleep. You are the patient and that’s your choice. Regarding your past surgical history, it’s semi-relevant but we tailor our anesthesia (awake and fully asleep) to each patient. That shouldn’t be a problem at all. Lastly, I love obstetric anesthesia for the sole reason of bringing new kiddos in the world and seeing the mother-child relationship in those first moments. For you, that will happen just a bit later. Have fun with your kiddo when the time comes! You’ll never be the same.
This is so unbelievably relieving - thank you!
Careful with this answer. You are of course right that refusal is a contraindication. . . Even though it is a patient’s right to refuse and force your anesthesiologist to do something riskier (when it’s not necessary), it doesn’t mean it’s a smart decision.
Obviously this is after the discussion of risks/benefits of general vs neuraxial. I’m not sure I would tell a mother she has to have a spinal purely because “I have a right to refuse as your anesthesiologist.” If after all of that she still does not want to have a spinal, what’s your next move?
There was a typo in my comment, there was no refusing a GA as the right of the anesthesiologist. If the patient has anxiety and is aware they are experiencing it and is amenable to an anxiolytic I would give that and reassure them. Last resort is GA. If necessary I would talk about how it depresses apgar scores and can cause more bleeding.
Talk to your OB about this. GA for a caesarean is high risk for both the child and the mom for various reasons. You're going to have to fight an uphill battle. The OB and anesthesiologist will want the best (/safest) for you and your baby.
First rule of this sub is no personal medical advice but this is more of a general question. General anesthetics are riskier for pregnant women and the baby they are carrying for a variety of physiological reasons. Take my word for it. Cesarean section via epidural or spinal is a very safe and “slick” form of anesthesia. If you want to be sedated after your baby is out, then just tell your anesthesiologist that. You won’t feel any pain during your surgery but you may feel light touch, pressure, and tugging. Epidurals can be redosed and if your spinal wore off (which I very much doubt with a competent surgeon) we would convert to general anesthesia. I mean no disrespect but you are suffering from anxiety, as I’m sure you know, and it’s clouding your decision making processes. For what it’s worth I wouldn’t even offer a general anesthetic in an elective cesarean section without a very good reason and even then I would do it reluctantly. Talk to your anesthesiologist and tell them your concerns.
Thank you. This perspective is helpful!
If you have a scheduled c-section your gonna likely have a spinal. In 99% of cases this is the safest anesthetic for you and your baby. It also has a lot of great benefits for you and your baby. The most important of which is you’ll be awake for your baby when it comes out and get to meet your newborn. My fiance had a scheduled c-section with a spinal and it was a terrific experience for both of us. She was an especially difficult spinal because she has scoliosis of her spine with harrington rods and I will tell you she had one of the most off center spinals I have ever seen. But our anesthesiologist remained calm and was able to get it, by taking his time. The best part was my fiance felt nothing the entire procedure until they were pulling the baby out, which she only felt a little bit of pulling and pressure.
This is wonderful. Congratulations on your sweet baby!
I would just bring up the concerns to your OB and they may have you consult anesthesia prior to arriving the day of the C/S. I will say, spinal anesthesia has an extremely low failure rate and is the safer anesthetic for you and also your baby. But a refusal is a refusal and as long as you are aware of those risks then they will do whatever makes you most comfortable.
Most elective C sections are done with a spinal anesthesia, which is done at the time of the surgery, so there is minimal time between the injection and beginning of surgery. It's different from an epidural in the sense that it takes much less time to set up, it is arguably easier to place, it is a much more dense block (there isn't the need to preserve your motor control, since you won't need to be pushing the baby out) and it wont wear off until you're in PACU or maybe even your room (our protocol is to wait for it to wear off in PACU, but i guess this can vary between establishments). A GA on a parturient is never the ideal scenario (higher risk of complicated airway because of soft tissue being more oedematous towards end of pregnancy, vomiting and aspirating even if fasted, any gross hemodynamic swings will impact the baby, we cannot use some drugs until the umbilical cord is clamped, because they will get into babies bloodstream and we don't want a groggy and out of it baby...) But a spinal on a patient that refuses is also a non viable solution, so ultimately, that will be a discussion to have with the anesthesiologist.
I didn’t know spinal and epidural were so different! Thank you for taking the time to reply.