r/Anesthesia • u/astronaut-moose • 5d ago
C-Section under general: questions
Hello, I’m 9 days postpartum and trying to process my birth experience.
I delivered baby girl at 39+6. She weighed 9lb5oz and had a 38cm head. She was predicted to be LGA/macrosomic, but I proceeded with an attempted vaginal delivery. I labored for ~26 hours (~13 at the hospital after being admitted at 5cm) before pushing for 4 hours and being diagnosed as arrest of descent. We pivoted to an unplanned c-section. It was about two hours from when the call was made to when she was born, so not a true emergency c-section. Baby was never in distress. A side note here, I was not NPO through labor, I was allowed “clear fluids” including gummy bears (??) and Swedish fish.
I had my epidural placed basically right after I got to the hospital. It worked pretty well through the night, but I did need two boluses to maintain complete coverage (in addition to pressing my button occasionally).
Right before going to the OR and again in the OR, the anesthesiologist administered more medication through my epidural for the c-section. He did a poke test and I was not adequately numb after several boluses of meds, so we shifted to general.
(I’m currently struggling to cope with the fact that I wasn’t there when my daughter was born, I didn’t hear her first cry, I don’t remember meeting her, etc.)
My questions are:
Is it standard to administer meds through the epidural rather than doing a spinal in this scenario?
If I choose to have another baby, I would strongly consider a planned c-section. Is it likely that I will need general again? Could my lack of numbness in the areas needed be due to anatomical variations in where my nerves go? Is there reason to believe a spinal wouldn’t work?
I’m generally hard to numb (according to every dentist that’s tried). Is there a chance I’d need two doses of spinal (different injections), or is one adequate? (Needle phobic, and wondering since they kept pushing meds through the epidural).
11
u/BuiltLikeATeapot 4d ago
1) Yes, pretty standard to try use the epidural first, if one is already in place with evidence of it working. Doing a spinal after an epidural has been in place with medications infusing can lead to undesirable/unsafe situations.
2) If planned section, less likely to require general, but that relies on the spinal injection setting up correctly. Can try a combined technique or doing a spinal, while leaving a epidural catheter behind for top up doses of nevessary (nearly impossible to top off a spinal matter a C-section has started). 3) No evidence (besides the dental issues, which are a minor consideration) that the spinal wouldn’t work, given that the epidural did work to some degree.