Caesareans and Pain Relief (Open thread)

[MandyG]

I hope it is ok that I post in this bit

my first baby was born by emergency section cause she was coming out wrong way andf got stuck - brow position. They only noticed this after 3 failed ventouse attempts - which have left her with a permanent scar on her forehead which almost goes onto her left eye

anyhoo - I was rushed into section only to have the epidural fail and I felt the whole op

for some reason I refused to let them knock me out til baby was out, then I had a major panick attack and thought they were trying to smother me, I honestly thought I had died - I was very ill after, and had to have blood transfusion cause I had a big PPH

I haven't been diagnosed with HMS yet but will be getting checked out after this baby is born.

I managed a VBAC with my second cause I refuise to go through a section again. still had problems with my placenta and needed it manually removed but they did this with nopain relief - had another big PPH and transfusion

I am due my third very soon and am worried if I have to end up with section again, at present baby is breech so it is a likely option

I dont ever want to go through what I went through

is this a common thing?

xx

[janey]

concerns re: breech babies are only raised if they are still breech at 37+ weeks. Currently the preferred method of delivery of a breech baby is by c/s but vaginal breech births are possible and do happen (though you do have to find out if there are any experienced practitioners at your local hospital).
There are ways of encouraging a baby to turn if they are still breech at 37+wks, frozen peas on the top of your bump (the idea is that the baby turns to get away from the cold sensation), moxibustion is also an effective way of turning a breech (most acupuncturists can do this). If a baby is still in a breech position at term then you should be offered an ECV (external cephalic version) which is a doc externally moving your baby into a head down position, different docs have different success rates so do feel free to ask.
Please feel free to PM me if you have any further questions and hope I have been a little helpful.
Best wishes
Jane
Midwife and mum to daughter with HMS

[MandyG]

hiya

thanks for that, I think I rambled on too much as usual lol

I was actually meaning how common is it for people to have their epidural fail? I was given extreme apologies from the hospital cause they had never had thathappen before

I am just worried about feeling it again if I did go for another section

xx

[janey]

I got the wrong end of the stick!! I would advise that if you have any concerns regarding epidurals then the best person to speak to would be the Consultant Anaesthetist. At our local unit they have a clinic run by anaesthetists who are on call to answer specific questions or deal with specific problems. You could either ask your midwife or approach via the anaesthetists secretaries to make an appointment to discuss your very valid concerns.
Good luck

[hannah]

There are some other threads on it somewhere, sorry I can't remember where, but problems with anasthetic being ineffective is common, and indeed frequently part of HMS/EDS. If you are a member of the HMSA you get a booklet called 'living with HMS' that has a good article on ineffective anasthetic that you could show to your Drs.

Try searching for anasthetic and you should find some relevant info. I'm not sure whether the epidural is of the same type of drug, or if it would be ineffective for different reasons, but maybe some of the info will be relevant for you.

[Finarda]

I had two cesaerians and EDS had quite an influence on both of them. With the first, the epidural didn't take during labour - it stopped working after about 20 mins. This is why I would differ in my opinion about taking all pain meds offered - I didn't have any options left and because I had been pain free for 20 mins it was harder to cope with the pain once it started again. During the c-section, which was abnormally long (45 mins) so not representative, I started to feel pain half way through. However, they upped the epidural and the morphine and I was fine.

I decided to try for a VBAC for the second (I still hadn't been diagnosed with EDS) which I would never recommend to anyone with EDS. After a long labour, one of the nurses felt my stomach and looked concerned. The OB didn't see any problem but offered me a c-section if I wanted it. I looked at the nurses face and knew that she was really worried about something so I agreed to the c-section. Once they opened me up my uterus was starting to rupture - they could see the baby clearly through the uterus it was so thin. After he was born they had difficulty stitching it up as it just tore as soon as the put a needle in it. I was advised to think carefully about having another child, and if so it would have to be by c-section around 36 weeks. I had had an epidural which didn't work, and because I had asked for a consult with an anaesthetist before hand, I ended up with most of the anaesthetist dept in my room! After trying the epidural again, they tried a spinal which for some reason didn't work properly either (although it gave me an instant headache and tinnitus which lasted 10 days!). However, again they were able to give me sufficient that I didn't feel any pain. It was the anaesthetist who asked me while I was lying on the table whether I was double jointed - he'd put 2+2 together (ruptured uterus plus anaesthetics) and correctly concluded it was EDS (he was even the one who first got me referred for testing).

All in all, I look back at the births with fond memories - the labour and delivery is such a short part that the pain is only there for such a short time. Definitely get a consult with an anaesthetist as they will take you much more seriously. They will give you a general in the rare chance that they can't get the epidural or spinal to work at all, so one way or another you'll be fine.

[annekh23]

I know this thread is old, but I just wanted to pop in and share my own experience. Basically I think it's an unknown area for each person, there are so many different ways of administering local anaesthesia and so many different theories as to why it sometimes doesn't work and how changing how it is administered might make it work. Some people have never had local anaesthics work, but a lot seem to be like me where sometimes it has, sometimes it hasn't and you don't have enough details to work out why it has worked sometimes and others not. I had a local anaesthetic administered whilst under a general for relief of post surgical shoulder pain, which worked so well it numbed the bottom of my mouth making eating diffcult, I've also had it for injecting die into my hip joint to get it imaged and felt everything!

I've not had a caesarean, but was anaesthetised for one whilst they figured out if they needed to get my daughter out quickly or not, they didn't, but I'm pretty confident I wasn't numb enough for a caesarean - I could walk, I could feel my skin, though it did still have some effect as I couldn't feel any uterine pain from contractions, shame it was hurting in my back and pelvis. This was having had a spinal, where they inject the drugs straight in, one layer deeper than where they would usually place an epidural catheter and then having the epidural catheter placed, given the standard dose and a few top ups.

I suspect that a knowledgeable anaethetist should have enough techniques up his sleeve to get most EDSers numbed up enough, but they need to be open minded, doses may need to be much higher and topped up sooner. I think what is more important than knowing your options is to know that the anaesthetist is on your side and will not let the surgeon touch you until you are numbed up enough and will intervene if the situation changes, anaesthetic issues don't happen because they can't get you numb or knock you out, but because they don't believe that you aren't. So it's important to understand what you are expected to feel, tugging, pulling pressure etc. and for the caregivers to know you understand that and you aren't describing these sensations as pain. Try to have a birth partner who is prepared to be an advocate for you, they need to know that if you say you are in pain, or your body language suggests pain that it means you are in pain and if no one is doing anything, they need to step in and say they need to sort that out.

If I have another baby, it will almost certainly be an elective caesarean, even though I know that on the basic dose I didn't get numbed up enough, I would definitely want to try for regional anaethesia, as well as allowing you to be there for the birth, it's better for the baby too, even the short time they are in you whilst you are out impacts slightly on outcomes. Key things will be making sure both anaesthetist and surgeon understand that this is a concern and that trusting they won't operate with me in pain is far more important than how they anaethetise me. Also, as most don't allow the father to be present if a GA is used, based on the belief that the father is there for the mother, not for the birth of the baby, that they know that having my husband witness the birth is very important to me to help minimise risk of disassociation that is common when mothers are knocked out and have the baby brought to them later.

Cheers
Anne

[bobbles]

Ladies

I'm 26 weeks pregnant, and have my appointment with the consultant anaesthetist next week to discuss my HMS and draw up a plan that will be attached to my notes "just in case".

This is baby no2 for me, but I didn't know I had HMS when I had baby no1, so this will be the first time I've had a chat about pain relief.

I have terrible problems at the dentist, and also felt all of my perinneal repair last time - my knees flinched with the pain every time the needle went in, I even got this rolled eyes "ohh give her entonox will you", like it was just me being "soft", and it wasn't, but I think that's what scares me, as I get the same attitude at the dentist too - I feel like nobody believes me.

All I keep thinking is that I managed a natural birth last time (as I do have a good pain threshold), and so hopefully I will just do the same this time, and not need to worry about anaesthetics....

...but the prospect of needing a c-section absolutely terrifies me - I'm scared that the anaesthetic won't work properly and that nobody will believe me, plus I'm a "big girl" too, so I don't even feel like a GA is an option either (that scares me too).

As it is, I'm planning a homebirth to try and ensure that my chances of needing any intervention are minimised, but you still never know what will happen on the day.

I really hope this appointment next week is a reassuring one!

Sharon xx

[Alison C]

Can you take along with you a copy of the HMSA Living with HMS booklet? Inside is a page on anaesthesia -also how about taking a copy of the pregnancy page to be found at the HMSA website? ie evidence to support you. I always found everyone to be keen to help. My spinal blocks (two caesars) worked - and I think they can be topped up if necc - before they operated on no 2 baby, they sprayed water on me to prove that I could not feel anything as I was worried whether it would work (I did not know about HMS with baby no 1). I did see the anaesthetist before the big day to go through everything alth saw someone different on the day - it did not matter. Second time around, I took all pain meds AFTERWARDS (someone earlier may have thought I meant during the op) as after baby 1 I was too much of a hero and coped with pain and walking etc and looking after my son - life was much easier with the pain meds (they were only needed for a little while - I cannot remember how long - at a guess a week).

Cheerio and good luck - you should see a difference in your care by professionals now you have a diagnosis.

Alison

[MandyG]

I just want to update - my first baby was emergency section which went wrong and I felt whole thing

2nd successful vbac and 3rd was elective

I was sooo nervous and made sure they knew what happened last time - they were soo nice and gave me extra spinal etc and made sure i couldn't feel it

it was my only positive birth experience - didn't feel a thing

xx

[hollilyric]

I have EDS 3 and had an elective section sue to this in August. I hada spinal and it worked brilliantly - i could feel the pushing and pulling as i expected but no pain at all.

following section i had a PCA (patient controlled analgesia with a morphine pump) as i had good experiences using this following my latest of 3 knee ops. again this worked very well to control the pain - i had tried oramorph before i resorted to the pump and it had no effect whatsoever.

the section and recovery went far better than i had imagined and is certainly NOTHING compared to knee re-alignment surgery!

[Natt]

Ive had 2 sections - one under spinal and one under epidural. Both were fine, though I dont recommened anyone having one under epidural as its a lot more traumatic to mum (though you still feel no pain)

After the first I had morphine - and regretted it. The 2nd I had minimal codeine and ongoing paracetemol. I had a lot of acupuncture leading up to the birth the 2nd time though, which I think helped the recovery.

x

[hollilyric]

i also took arnica up to and following my section. obviously i've only had 1 so not sure whether it made any difference but my recovery was great.

[emmajordan]

I have had the dental and the problem with stiches but I have found that the spinal block worked really well for me. They were so terrified that they completely aneathatised me so I literally could not feel a thing - but no pain what so ever. Recovery was easier than from a vaginal birth.

Research shows that women wiht EDS who have sections are much less likely to suffer from uterine or rectal prolapse. C-sections today are very safe.

[Angelwings]

HI, I have had 3 c sections now. 1st I was under GA as I had severe Pre Eclampsia, 2nd was under epidural and it was fine, 3rd was under epidural and was the worst experience in my life, my husband basically passed out because he could see how upset and in pain I was, so if I decided to have another child I will make sure I speak to my pregnancy consultant to ensure he doesn't let it happen again.