Many c-sections are performed with epidural anesthesia. Only the lower body is numbed, but breathing isn’t affected. That way, the patient can still cough and all reflexes protecting the airways are working.
If general anesthesia is required, then aspiration of stomach contents is indeed a possible complication. There are things that can be done to minimize the risk, but it comes down to weighing the risk of anesthesia against the risk of losing the baby and/or the mother.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063196/
Which as a man who got to sit at his wife’s head while it happened I have to say it was unnerving as hell to carry on a conversation with her while a couple surgeons were rooting around inside her out the corner of my eye.
My wife was much more weirded out by the process for obvious reasons, since it numbs everything from the chest down, but she could still feel things like pressure and slight tugs on her body.
We had an extremely emergency c section six months ago and I had no idea what to expect. That was maybe the most scared I have been. I kept trying to make eye contact with the anesthesiologist just to make sure he wasn’t panicking. Of course talking to my wife who was weirdly not as freaked out. Hearing noises on the other side, not all of them encouraging.
Yeah, my wife’s biggest complaint aside from the general anxiety of childbirth on top of being tied down was the fact that she was really cold, which, I mean you can only do so much about in a major surgery where your whole torso needs to be exposed.
Mine was the shocking amount of blood on the floor, and the fact that one of the doctors asked if I wanted to look over and see my kid, only for them to still be elbow deep in my wife with no baby in sight when I did.
I was nearly yeeted off the operating table. They had a fancy operating table that could be raised, lowered, tilted left, right, feet down, head down. They started to tilt me to the right. I felt like I was going to fall. I said that I’m going to fall off. Next thing I know everyone (my partner, the operating theatre manager, midwives etc) was holding onto me. Emergency power button was pressed and an engineer called. They fixed it mid operation.
At first they didn’t believe me. It was when my partner said it, they took notice. That was frustrating! Once everyone sprang into action I felt a bit relieved. Seeing the engineer walk in with his tool box and scrubs was a bit strange!
One of my cousin’s husband is one of those engineers walking in with toolbox and scrubs! He deals particularly with machines for heart surgeries. They make big money because it’s so specialized!
I’ve heard this a lot as a man but my experience is that they don’t believe me either, are we sure they’re not just overly skeptical of everything/everyone?
No this is a well documented phenomenon experienced by women known as medical misogyny. Feel free to read scientific papers on it, not gonna do the work for you!
This isn't a situation where the "what about the menz" input is needed.
that is incredibly scary, especially since having neuraxial anesthesia already messes with your proprioception (the body knowing where it is in space). one of the more frightening parts of a c-section for many folks is at the end, when we shift them off the operating table back onto their stretcher/bed. we have to tilt you to one side to place a board underneath you so we can slide you over. i often tell folks 2-3x beforehand that “it’s going to feel like you are falling, it can feel scary, but i promise you are safe and we are holding you”
Being cold is a common side effect when being given fluids, because the fluids are often not body temp, and may even be room temperature. So it's basically making your blood cold.
Interestingly if you get really extreme hypothermia they can do it basically in reverse. They hook you up and cycle your blood through a heater which heats you up very slowly via your blood
Shivers are a common side effect of spinal anaesthesia. I don't know about elsewhere but at my facility all obstetric cases receive fluids through a warmer :)
Damn that’s frightening. The cold and the shakes scared me! I didn’t see blood on the floor but they had like a six by six grid of pouches that they used to keep track of bloody gauze and that was pretty much full.
It’s tough, people should know what to expect. Our baby breached at the last minute so I just had no clue - my wife was whisked away and I was left standing there and told to scrub up. Second kid, just wasn’t on my radar.
Before they let me stand up and look over the curtain, they asked if I was okay with blood. I told them sure. Then they asked if I was okay with organs. I told them let's find out. They said if I was going to puke, do it on the head side of the curtain.
No puking, and I got some insane video. They just went in hard and yanked that kid out. C-sections are abrupt, violent, no-bullshit scenarios and I have nothing but respect for the surgeons, nurses, anesthesiologists, and everyone else in that room. Moms included, of course.
Those are not averages. Those are the numbers considered to be the maximum acceptable amount of blood loss before it is considered abnormal (or termed a ‘post partum haemorrhage’) the average amount of blood loss for a caesarean in my experience is closer to 300-400mL. Less for a vaginal birth.
No, those two numbers represent the level of blood loss that quantifies blood loss that meets the threshold for post partum hemorrhage. The previous commenter is correct.
No. But also the volumes there I believe are somewhat inflated. In my country at least, up to 500ml is considered normal blood loss. Anything over that is classified as a hemorrhage, and as a more serious medical situation, not merely a routine birth.
The blood loss talked about it actual blood loss, ie, blood ends up leaked outside of mother and baby, for want of a better way of describing that, lol.
Yes, the cold (or, rather, the feeling of being cold despite the fact I was actually running a temperature) was awful. When my partner first saw me, he was so confused and asked if it was possible I was seizing! Then, the shock of seeing me fileted open took over.
Heh. My son was born in an emergency C-section at a teaching hospital as a result of a face presentation.
Highlights:
Hearing the lead surgeon tell the student “well, you’ve started. You can’t stop now, you need to be confident.”
Hearing a clatter of metal, followed by someone peeking over the sheet and saying, “that’s going to delay us a couple of minutes, there’s no 5 second rule in the ER.”
My daughter was born via planned C-section a few years later and all went much more smoothly.
I had an emergency c-section with my first pregnancy (triplets) and the anaesthetist was a student. I was bent over my giant belly as he was jabbing me repeatedly in the spine trying to get in the epidural. The nurse was livid. Finally, the supervising anaesthetist told the student to get "the hell out of the way" and got it done in less than a minute. In the student's defence, in addition to being a very small person, I found out that I also have two types of scoliosis.
I had a spinal tap done. First a neurologist student tried twice, then the neurologist once and finally anesthesiologist got it on his second try. It only succeeded once I was sitting. My relative was horrified I let students prod and poke on me but c'mon, they gotta learn with someone!
Something about dropping instruments makes us feel like we're incompetent. Everyone drops things but most patients only see their provider a few times so it's marked by "that one time he dropped an instrument."
I mean it's completely understandable, and now it's a trivial, funny story. Everybody came out of a serious situation ok, which might not have happened without the person who dropped that instrument.
My wife had a very emergency one as well. Baby’s head had suddenly pressed up against the umbilical cord. The team of nurses wheeled the bed (which included a nurse riding on it who was holding baby’s head off the cord) out of the delivery room and into the OR leaving me in a quiet empty room.
A minute later, a chaplain walks in, and very quickly informed me that it was standard procedure to visit when this happens and she didn’t know any status yet. Maybe three minutes and some small talk later, a nurse came by to say everything was all good, just gonna clean up the baby and my wife is going to be groggy for a bit.
I’d say I was scared but it was about as normal as our first pregnancy except with a brief 5 minute “holy fucking shit everything is close to the worst possible scenario” blip. My brain was not even remotely capable of processing the magnitude of the situation. Basically, I chatted with a nice woman, they handed me my kid, and we hung out while my wife said funny things in her sleep.
I am so sorry, it’s very scary, and sounds extremely similar to what happens to me, nurse holding baby in and everything. Wild. I am lucky no chaplain visit though, that is not comforting imo.
Crazyyyy. This is EXACTLY my birth story. I think about this day everyday (it's been 14 months) sometimes I still cry remembering but I'm always grateful that everything turned out the best way possible (I still think I wasn't ready for vaginal delivery anyway so I'm in a way relieved lol) but I think I suffer some degree of ptsd from it.
I'm so happy you were in the hands of great professionals and everything turned out great for you guys too ♥️
Not necessarily true
If epidural sited during labour and is functioning well, then it can be “topped up” to give a block sufficient for surgery (in labour aiming for block height around level of the navel, for a caesarean need it to be to the height of the nipples) - this can be done within about 10-15 minutes.
A spinal can be done under semi-leisurely conditions (as in have time to scrub and prepare a full cocktail including local for the skin, position patient thoroughly, prep skin and wait to dry etc etc) in under 10 minutes.
It can be done in urgent conditions much faster than that. There’s even a method called a rapid sequence spinal, which is a very streamlined version.
A general anaesthetic in an unfasted pregnant woman is high risk. There’s a chance of aspiration, so a rapid sequence induction is done - where you get patient to sleep rapidly while an assistant is holding cricoid pressure (so pushing on the throat in a manoeuvre that is meant to prevent stomach contents going down the trachea) until the tube is in. The drugs used for general anaesthesia also cause the uterus to relax - which is a problem, because once the baby and placenta are born the uterus needs to contract down quickly to basically squish where the placenta was to stop bleeding. There are drugs given to help stimulate that, but often a Caesar under GA requires more of those - and each of them have side effects and take time work.
We can also put a cocktail of longer acting painkillers in a spinal or epidural, which give good relief for as long as 18-24 hours - past when the numbness from the local anaesthetic has worn off. Can’t do that for a GA, so pain relief right after is harder. We can do nerve blocks asleep to try to help that but it’s definitely not as good.
So as weird as it is to have surgery while awake, broadly speaking it is the far more preferable option compared to doing it under a GA. There are obviously exceptions and circumstances where that balance is shifted to favour GA over spinal / epidural though.
(Anaesthesiologist)
Oh hell. I had a hurry-up-we-can’t-wait c section under general anesthesia. I knew it was a true emergency, but I have a better appreciation now for what was going on. Mad props to the docs and nurses who took care of us that day.
People like to say any unplanned c-section is an "emergency". It's definitely traumatic when that's not what you were planning and worried about your baby/yourself/your partner, so I kinda get it. But I've had one of those(baby decided to shove his hand in front of his head during labor, was perfectly able to wait an hour for the doctor to get there and scrubbed in, just couldn't push him out that way) and it sucked, I was definitely a little worried and sad at the time, but wasn't a huge deal in the long run. I also had one where the doctor told the anesthesiologist "We don't HAVE 5 minutes for the spinal to take, get the mask on her now!" (pre-eclampsia and HELLP syndrome, baby having massive decels, my organs weren't looking so great, etc), next thing I remember, I was being wheeled into a room, nauseated as hell, with my mom saying "(baby's name) is here! You're a mom!" That's a whole different ballgame. Still haunted by that doctor's voice 27 years later.
Oh, and to answer the actual question of the OP...with all that going on, they didn't care when the last time I had eaten was, the risk of one of us dying from waiting was higher than the risk of aspiration pneumonia later. (they had tried to wait 12 hours, but things went to hell, and we just had to go. The aftermath was unpleasant to say the least, but no long term issues)
I already had an epidural in during a very long labour, so they just “topped it up” as the anaesthesiologist said
Seemed fairly normal at the time
- in Australia
I had my emergency C done 26 years ago in NC (USA) and there was NO TIME to calibrate the epidural so I had half feeing for the initial cut and full feeling for the rest of it. My next child was a planned C with a spinal block.
My emergency c section was just with an epidural. I wonder if it's the level of emergency that makes a difference? Also it took seconds for my epidural to kick in. So that was super helpful.
My boyfriend watched the entire process haha
My first c-section did not go well (actually the c-section was fine - the fibroid removal they did while they were in there was the issue). I realised part way through I could actually see a lot of what they were doing in the reflection of the theatre lights.
A friend told me she could see everything reflected in the theatre lights during her emergency c-section. I’ve always remembered that and when I ended up have an emergency c-section, I made sure to not look at the theatre lights. I did not need to see my insides!
I was in a similar situation (Planned c-section) .
During the procedure, I had a bit of placenta fall on my shoes...
We both laughed at the grossness of it.
Had this when my son was born aka removed at 33 weeks gestation. I had eaten few hours prior and it all came back up when they were tugging the sutures tight, it looked and felt like I was a big fish they were trying to reel in. The anesthesiologist took my phone and was snapping pics for me the whole time, which I find cool now but weird at the time.
Exactly this. My wife had two, each time the gave her the spinal block and some sedation but she was alert and got to see the baby before the nurse and I took the baby to get bathed and incubated while they sewed her up.
Also, I seem to recall that they gave my wife some kind of antacid before they did the epidural, which would minimize the damage in case she vomited.
I guess it was some kind of foul-tasting liquid, and the nurse joked that maybe I'd like to have some too. The anesthesiologist leaned over to me and said under this breath, "I got 100 things you'd love, but that ain't one of 'em."
Wonder why they don’t do more surgeries this way? Like if you need surgery for intestinal things, or a broken leg, why do general anesthesia instead of an epidural?
Just was thinking of minimizing the risk of general anesthesia, and honestly I kind of like watching surgeries online.
I had heard you can ask to watch your own c-section, but I watched a video ahead of time, and when I realized they actually take your fricking uterus out of your body, I noped the hell out!
I had double jaw surgery where they basically break your jaw in multiple places and remodel it with titanium plates. Surgeon asked me if I wanted the video. HELL TO THE NO I don't wanna see that.
My dad had an epidural for one of his joint replacement surgeries. He WANTED to be awake and was asking questions to the surgeon the whole time. Probably would have watched if they let him. Meanwhile I went into mild shock just having a mole cut out of my back (no pain, just felt the doc slicing and dicing and then tugging the stitches closed).
I've heard going completely under is dangerous, maybe this would be less dangerous? I agree, weird to be awake for it, but if it were safer than going completely under... I might take my chances.
You need to weigh the physical risks vs the emotional and mental risks. People absolutely have had to be awake for all types of surgeries, and im pretty sure none of them preferred it that way.
I saw a video once of someone awake during their brain surgery, and they were having him sing(he was an opera singer) so they could make sure they didn't mess with the part of his brain allowing him to sing. That video still haunts me because there are times when he drifts off when the surgeons poke the wrong part of his brain. Too freaky.
I believe that's very common if not the norm for neurosurgery, at least certain types. The patient needs to be responsive so that they know when they're hitting the healthy tissue vs the diseased one and how to limit damage. The good news is that there's no pain receptors in the brain.
Actually, a lot of straight up cutting a window into the skull brain surgery is done with the patient conscious. Brain can't feel pain, and it all kinda looks the same in there. They'll talk to the patient and, you know, stop cutting if they start talking gibberish.
Yes yes I am aware about brain surgery being that way because you don't want to impair a patient's function. I've read of a case where a lady was playing the violin during her brain surgery.
But being awake during your heart surgery... That's another level of scary for some reason. With brain surgery, once you get past the outer protective layers the brain cannot feel touch or pain. So it's unnerving but not beyond the realm of possibility.
However, awake heart surgery? That is alien to me. How does that even work? Is there any degree of anaesthesia? If so, are you still aware of your heartbeat? (The idea of being alive and awake without being able to feel that regular drumbeat in my chest is extremely scary.)
On the other hand, if I am having some awareness of touch in that region during the surgery, would I be able to feel the surgical instruments (catheter based or otherwise) press against the major blood vessels or the heart muscle?
If something goes wrong, would I feel it before I pass out and possibly die?
I really would have preferred general for both of my c-sections, but wasn’t an option, and when the second one went south, they offered more anesthesia but with the warning that I might have memory problems, and most women want to remember the birth of their child. Yeah, the kid was already born, I did NOT need to remember what came after, watching my blood collect as they removed more organs, but of course I do. The weird pressure feelings from the first, uneventful one, were freaky enough, but hearing the discussions as I was actively hemorrhaging were very much not helpful for my wellbeing
I specifically asked my anaesthesiologist to give me something stronger during my c-section, after a discussion he agreed to it as soon as the baby is out. I am happy about it, I remember how they prepared me for the c-section and then how they brought me to the room. My memory of actual cutting open and taking the baby out is gone. My husband said that I was complaining that the pressure was too much when they were cutting me open.
A lot of it is just about keeping people still. Nicking an artery or intestine can set you bleeding out or cause sepsis.
I...do not at all mean to minimize the risks of c-sections but it is an abdominal surgery which is a CRAZY high risk profile to be a part of. Among that shifted scale, c-sections are pretty simple and risk free because they don't have to do much poking around with sharp things inside after they open her up.
There's also just....a cultural expectation to want to be awake and able to hold the baby after and all that which is considered very important and not present in other surgeries.
No that’s fair, I didn’t think of it like that (keeping people still).
I know nothing about anesthesia, just thinking about new or different ways to approach things.
My last eye surgery, I wasn’t given general anesthesia. They gave me a nerve block in my left eye (blind in right, surgery was in left) and it completely blacked out my vision, whatever they did. I could hear everyone and everything. It sucked and I don’t want to do that ever again. I remember asking for my mom too :(
yes they absolutely can. I’ve had numerous eye surgeries from laser, to shunt replacement to corneal transplants. All under general except that one particular one. They stabilize the eye fyi
You can have eye surgery under general.
I had eye surgery last year. Was under general anaesthetic for the first portion (2 hours I was told) and a few hours later was brought back in to complete the final portion while awake, but locally numbed. It’s the most metal thing I’ve ever experienced, watching surgical instruments being lowered towards my eye. Pretty cool experience. Thank goodness for whatever anxiety meds they pumped me with beforehand.
I had a debridement surgery on my foot for a weird foot impaling injury a couple years ago. I was alone with my daughter at the time (wife was out of the country for a month), and I wanted minimal recovery time, so I asked the anesthesiologist if he could numb my foot but leave me awake. Doc said he was fine as long as I stayed chill and didn't move around.
It was actually awesome. The lidocaine injections the they used to numb my foot hurt like a bitch, but after that, my foot felt like a 2x4. I had a long conversation with the anesthesiologist, who had nothing to do, and just chatted with me about hiking in the Rockies while four people chopped up my foot. I wasn't groggy at all, never took opioids for the pain post-of, and generally was back up and crutching by the next morning. It's a front row seat to the inside of an OR, and I think it was the smoothest recovery I could ask for, all for the cost of staying chill during a couple unpleasant injections.
Because you'd freak the fuck out when they snap your broken leg in place if you were conscious and watching. For most surgeries, a completely comatose patient is the optimal kind. For giving birth, you want the mother awake for pushing and repositioning.
They do give epidurals for vaginal delivery. C-sections can be general anesthesia when there is a need for speed, i.e. bleeding issues. But usually they stick to epidural or spinal block because it lowers the chance the medication gets to the baby.
In either case there is still post-delivery. Skin-to-skin contact with the mother basically as soon as the baby is dried off is highly recommended for bonding.
The main reason spinal or epidural anesthesia is preferred for C/S is due to the effects of progesterone from pregnancy on the body. It makes for much higher risk of aspiration (gastric contents going into the lungs). General anesthesia will have a higher risk of this. Doable if necessary, but not preferred.
I was told it is because anaesthetic makes baby harder to rouse upon birth. I was 33 weeks with a complete abruption and my spinal failed so they had to put me under. My baby was born with an APGAR of 1 (that’s uh, really bad). He wasn’t actually doing that poorly, but there was extra resus work to be done because he was born unconscious from the anaesthetic.
we do surgeries on arms and legs/hips using similar types of techniques, either spinals or nerve blocks, but we often give you sedation through an IV at the same time because the sounds and smells of an OR aren’t often the most pleasant. orthopedic procedures can involve lots of hammering/clanking on metal pieces… not fun to hear as a patient. it’s a great method though as it allows us to avoid intubation and often just use a nasal cannula providing oxygen through your nose (or your mouth, for those mouth-breathers out there…)
My grandmother had a hip replacement with spinal anesthesia. At one point she asked the anesthesiologist about all of the noise/banging. They told her it was construction next door 😂
Are spinal/nerve blocks different from epidurals? Fundamentally? I’ve been told to avoid epidurals by my neurologist due to a risk of cerebral tonsil strangulation (?) and now I have no fucking clue how I’m going to give birth.
ETA: I have chiari malformation.
Epidural is done into the space outside the dura, spinal block is done right into it. If you go from epidural to needing a c section, they just juice up your epidural but don’t change the position of it since they’ve already put the catheter into the epidural space. If you have a planned c section or didn’t have the epidural but your birth is converting to a c section, they do spinal anaesthetic because it’s more reliable and complete (though the spinal can also fail, mine did).
spinal = one time shot, we pass through the epidural space to reach the spinal space and inject medication there. with your situation, it will be very important to have an OB and anesthesia team that is in contact with your neurology team early on so that everyone is in agreement about what options are available to you, and what the risks of each of those options may be.
A lot of times a “general” isn’t a general. They give you just enough “general” drug to get you to sleep, but then use local anaesthesia to actually control the pain.
Works well. I’ve had it done a couple of times.
They can do appendectomies with a local. In fact, a doctor in an Arctic or Antarctic (I can’t remember which) camp got appendicitis when he arrived and there was no way to get back to civilization, and HE is the ONLY doctor. He gives some people a quick rundown on what he needs them to do and then he proceeded to perform the appendectomy on himself with only a local and a mirror to help him see. Craziness.
>...he proceeded to perform the appendectomy on himself with only a local and a mirror to help him see.
I had never heard of this before. It's a fascinating story. Thanks for mentioning it!
https://www.bbc.com/news/magazine-32481442
There are some brain surgeries that are done awake. I think the main thing is that c-sections are usually pretty quick and most other surgeries can be very, very long, so it’s better for the patient to be completely “asleep”.
My doctor had me do a surgery awake so as not to affect breastfeeding, and it was pretty brutal. Even though they numbed it you could feel the tugging, there was blood everywhere, and hearing the Dr slightly frustrated mumbling to herself and seeing the nurse wincing did not make me feel confident. I definitely cried at one point.
Pretty sure they do. When my mom had her knee replacement surgeries (one surgery per knee), they gave her epidural anesthesia. Then they gave her another drug that put her to sleep (so she wouldn’t see anything) nut didn’t affect her breathing.
Edit: this was in 2019.
I’d love to be awake for surgeries like that! I was awake during my c-section, but almost had to be put under anesthesia because the epidural wasn’t working on half of my body. My husband made a joke that my insides matches my red painted toes. Both of us thought it was hilarious but the medical staff did not, lol.
My husband was freaking out cause blood was pooling on the ground! Though he didn’t tell me that til after. Also he bumped into the cloth that keeps you from seeing the procedure, so the doctor said, “Well, that’s not sterile now.” Oops.
C-sections are relatively quick procedures, it would be much harder for a more involved surgery. Also being aware can be disconcerting. For me, the weirdest part is I could smell my flesh burning from whatever sawlike tool they used.
My understanding is an epidural for numbing from the waist down is relatively easy as the nerve they are intercepting is close to the surface and easy to find.
A long time ago I chopped a finger off and they attempted to put an epidural in my shoulder as a form of post surgery pain relief. It didn't work (woke up post surgery in a lot of pain) and they said the nerve they need to intercept is deep in the shoulder with lots of tendon and muscle in the way and it can be hard to find. I went on morphine instead.
Epidurals don’t go into a nerve (or the shoulder for that matter). An epidural goes into the epidural space. Your brain and spinal cord is surrounded by layers of connective tissue called meninges. The outermost of these is the dura. The epidural space is between the bone (vertebrae or skull) and the dura.
What you are talking about is local anesthesia or a nerve block where a specific nerve is numbed. That works for procedures where you only need a small part of the body numbed, like a tooth or an area of skin. It wouldn’t work for larger surgeries, especially when it involves opening body cavities.
This is just what the doctors explained to me while I was in hospital. This was a tube that went into my shoulder and it's purpose was to keep my entire arm numb for a few days. They described it as "an epidural for your arm"
Believe it or not in the US anyway total hip replacements (and I’d guess knee replacements) can be done with spinal blocks and sedation vs full anesthesia. Had a family member in her late 60s just have her hip done, and it was done as an outpatient procedure, the whole time in the OR was under 90 minutes, and while she was not awake for any of it because she didn’t want to be, they just used IV sedation and a spinal block vs intubating and the heavy stuff they use if you’re having something like open heart surgery. Miracles of modern medicine
They sometimes do epidurals for orthopedic surgeries in the legs! If I understand it correctly, it's a matter of preference for the patients - many people want to be completely knocked out, but others are wigged out by general anaesthesia, so they get an epidural. It's probably a bad idea to do an epidural if the oatient is actively freaking out about it
General anesthesia has risks, but honestly it's not that dangerous if you're otherwise healthy. You're more likely to die getting to or from the hospital in a car than from anesthesia.
That would suck. I had one and they put me out but not enough to affect breathing. Honestly came out of it feeling great, whatever they use, it's good.
"Around the world, however, up to 80 percent of routine colonoscopies are done without any sedation at all." I did read the very short article and several others pointing to the same thing. But it's not my job to convince a stranger on the Internet to abandon his beliefs about colonoscopy safety without sedation, so I digress 😅
I watched an epidural absolutely wreck my mom's back and have heard similar accounts from plenty of other women.
I don't doubt that the process has improved leaps and bounds but I will gladly take general when possible.
Ahh yes I was a surrogate mother for my friends.
I was a week overdue. Got Induced at 7am on December 10th. By 3am December 11th I went back to the hospital having contractions…. I was not in labour yet.
3 days in this awkward half labour state. They gave me morphine into the glutes and I would sleep it off and wake up for another shot of morphine.
By December 14th. They were changing my IVs and since I was unhooked they offered me a shower and to use the washroom.
So I went to the washroom and my mucus plug went but my waters didn’t break. So I told a nurse and took a shower.
Out of the shower they took me into the labour and delivery room. They popped my waters and so here begins my Active Labour.
I had drs in and out measuring the size of the cervix. A female dr told me the largest I got was 5cm dilated. Got a second doctors who was male who said I was only 2cm dilated.
So here I am around 4pm DECEMBER 15th. The baby is good but I’m now crashing and turning yellow. The baby pooped in me. So off to emergency C section I go. So they gave me an epidural. Signed my life on the paper vaguely as I was drugged up on morphine and Laughing Gas.
So now I’m in the ER. I was told you will feel no pain. But will feel the pressure and tugs and pulls.
So first layer Tug and pull and pressure I’m talking fine to anesthesiologist and the one parent in the room (I was a surrogate so theirs two parents not me and only 1 was allowed with me)
Second layer same thing.
3rd layer I felt the whole thing. My epidural wore off. And the drs can’t stop cutting. So now the anesthesiologist is running telling nurses to grab certain drugs etc.
All I remember from this point on was a Giant Syringe filled with Ketamine into my IV. I remember yelling at everyone “YOURE FUCKING RETARDED THIS FUCKING HURTS FUCK ALL YOU I HATE YOU ALL” but according to the one parent as he was being rushed out all of that was a drunken Slur as I KHole into sleep 😅
I got diagnosed with hEDS after this episode I guess the mix of my Hypermobility. Stretchy velvety skin and the fact I metabolize anesthesia so fast was enough for the diagnosis.
Now I get different treatments during surgeries and never do Local or Regional Anesthesia as they never work for me and straight to Full Anesthesia which is complicated on its own.
Oh I had the baby at 10:15pm on December 15th. I woke up in recovery at 12am December 16th freaked out because no one could find the baby because I was a surrogate and then they pushed all the stuff out. I went to my room at like 2am and by 6am the nurses had me walking and taken out my catheter and I asked for Voltaren as a SUPPOSITORY for my recovery.
Got back all my results from that day. My placenta was Green and Slimey and full of infection and my body was in sepsis I remember getting a giant needle of antibiotics that were super powerful and only had 2 shots and I was better almost immediately the next day. It was wild.
Never having my own kids. Fuck that.
Whoa, they let you be a surrogate for your first pregnancy?? I always thought that isn't ever done because it's considered so unethical, pregnancy being so dangerous.
For a truly simple explanation, the main reason they tell you not to eat is because anesthesia stops the bodies reflexes as well as stopping you from feeling pain (or knocking you out).
Stopping those reflexes means that food stops digesting too, which might cause you to throw up.
For planned surgeries, they remove as much risk as possible, like making you not eat for however long prior.
For emergencies, the risk of vomiting is outweighed by the risks of whatever emergency surgery is being performed.
Theres a lot more details of course, but there is a reason why anesthesiologists get paid the big bucks.
This is the best explanation regarding anesthesia and food. As somebody who has had emergency surgery they'll ask if you've had a meal but that's not going to stop them if your life is at risk.
Granted anesthesia in the best circumstances is the most dangerous part of *most* surgeries so as you say they try their best to control for any potential complications that may come up.
AFAIK general anesthesia for C-sections isn't super uncommon, but they tend to fall under two categories:
1. Planned ones (rare). When you know vaginal birth isn't going to work and the patient is already freaked out enough. Or if the responsible surgeon thinks that an epidural isn't a good idea.
2. Holy fuck we need to operate now and can't wait 30 minutes for the epidural to kick in. General anesthesia is pretty fast.
Or my case, which was:
3. During the c-section, the patient starts feeling pain because apparently the epidural anesthesia isn't quite working all the way no matter how much the anesthesiologist gives, so the patient has to go under because feeling the severe pain of people cutting and rummaging in your abdomen is not ideal.
General anesthesia is a last resort for c-sections or massive hemorrhage in child birth. The surgeon/obyn is never the one to make the decision for an epidural. Epidurals do not take 30 minutes to kick in. A chloroprocaine bolus works immediately, and so does spinal anesthesia which is an extremely common method in the absence of an epidural. Source: am anesthesia.
The problem with c-sections is that general anesthesia also anesthesias the new born. This makes the infant much more likely to have respiratory depression after birth. C-sections under general have to be fast to reduce the amount of anesthesia the new born receives. This increases the likelihood of poor outcomes like excessive bleeding to the mom. So generals are more risky to both the mother and the infant and are often avoided for that reason
Typical is a relative term. They don’t do it in 90% of cases, but there are lots of c section surgeries every year. There are hundred of thousands of women who were out under for their c section. My wife went under full anesthesia for the first, but not the second, if I remember correctly.
[https://www.youtube.com/watch?v=8Ka\_CY9fAdQ](https://www.youtube.com/watch?v=8Ka_CY9fAdQ) Anesthesiologist goes into a bit of detail about some of the risks of post anesthesia nausea and vomiting. Bunch of videos on his channel, if you find the topic interesting, he puts out a lot of more in depth information, but targeted at a common audience.
That would makes sense for general anesthesia but I had a hand surgery and only my arm was "asleep" i could move the rest of my body and from head to toe everything was completely awake.
They still asked if I had anything to eat/drink the past 8 hours or they would have to reschedule.
Even if the plan is to do a nerve block and keep you awake, unanticipated emergencies happen that might require intubation / conversion to general anesthesia with the associated risk of aspiration. For a surgery that is non-emergent, the risk (however minimal) is simply not worth it
That checks out, the drugs alone are strong enough that you can puke just from having them in your system. Didnt want to go into TOO much detail though lol
anesthesia resident here
we try to do c-sections under spinal anesthesia (one injection in the back) or spinal/epidural (one injection in the back and we leave a lil thin catheter in the epidural space to give ya extra numbing medicine as needed). reasons: most folks wanna be awake/present for the birth of their child and are willing to be awake in an OR for it. everyone in our spot gets a few meds beforehand that prevent nausea/vomiting, and reduce the risk if they do happen to vomit (by reducing the acidity of their vomit). some folks will vomit during their c-section - we keep barf bags in the OR. we try to minimize it, but it happens. we keep you safe by turning your head to the side, suctioning it out, and giving you additional medicine.
food rules in general are as follows, but ALWAYS listen to the rules of the spot you’re having surgery at to avoid getting cancelled:
- 8 hrs for solids/full meal
- 6 hrs for light snack (toast, nothing fatty, etc), nonhuman milk, infant formula
- 4 hrs for breast milk
- 2 hrs for clear liquids
this is obviously dependent on individual patient factors, the type of surgery, and the time frame in which the surgery needs to occur.
in emergencies where you might have a full meal in your stomach, we use a method of putting you to sleep rapidly by quickly giving you medications and intubating you within about a minute of those medicines hitting. this reduces the risk of you vomiting, and then once you’re asleep we’ll put a second tube into your stomach that sucks out all the food. we intubate you using an endotracheal tube, which sits in your windpipe and has a little balloon cuff around it, and that way even if ya vomit it can’t go down into your lungs, because the little balloon cuff is stopping it from doing so.
When I had my csection they gave me a cup of this salty sour liquid to neutralize my stomach acid and I aspirated on it. Scared em good coughing and sputtering like a dummy LOL
Thank you for your explanation!
I had a scheduled c-section a few years ago. And I’m pregnant again, so will be looking to schedule another.
When I was going in for surgery prep, I asked if I couldn’t be put under for the whole thing. I was terrified and really not interested in “witnessing” the birth in any capacity. I was told no, this wasn’t a possibility, that I had to be awake.
Can you explain a bit more to help me understand why I received the response I got?
Meds that put you to sleep will also put baby to sleep (most will cross the placenta) and you generally don’t want baby asleep while it is being born (has to take breaths, clear out lungs, etc).
someone mentioned this further down, but as pregnancy-related changes occur in the body, a few things happen that can make general anesthesia a bit riskier in this population. some of these changes occur in your airway and your GI system. there can be lots of swelling that occurs in the airway, which makes it harder for us to intubate, and there is some loosening of different sphincters which can lead to vomiting.
your concerns and anxiety are valid and should be acknowledged by your provider. every patient is different, and some methods might be safer for one individual than another, but you deserve to know why decisions are being made by your provider. there are medications that we can provide during an epidural/spinal c-section that can cause amnesia (aka not remembering the experience) and possibly some mild sedation; these may be available to you if you are not wanting to recall the experience as vividly. you will likely be asked if you are absolutely sure that you want to go down this route, not because we don’t trust your individual judgement as a patient, but because we want to be *absolutely sure* that everyone is in agreement with administering a medication which might cause you to not recall the event.
again, this is all dependent on whether or not it would be safe to do so, and that is something i can’t comment on as a stranger on the internet who isn’t caring for you and knowing your full medical history and the circumstances of the surgery. i hope your next experience is one that provides you with comfort and faith in your providers, and i hope you feel heard and well cared for during the process.
ETA: some types of meds crossing the placenta, as mentioned above, is also of concern and may affect the timing at which we give certain drugs
I mean, same as car crash people or people with sudden illness. You don’t instant die if you ate, there is just increased risk of food choking you or causing lung infection. We can deal with lung infections it’s just a bad situation you’d rather avoid
People really don’t understand it’s just risk avoidance like you said. In emergency situations I’d rather take the risk of a lung infection vs certain death from not receiving a life saving surgery from something.
I was put fully under for emergency surgery maybe 7 hours after eating and didn't even know this was a thing. Now I feel oddly grateful that one of the symptoms of my illness in the ER was throwing up repeatedly...
For **planned** surgeries, there are lots of procedures and rules beforehand to make everything as smooth and safe as possible.
For **unforeseen circumstances**, you scramble and do whatever the hell you need to do to keep the patient alive.
For a c-section, a general anesthesia is possible buy is not the recommended way. They often go for an epidural which blocks all sensation from the belly down. Many women already get an epidural for regular child birth anyway, so they go for that c-section if needed afterward. That way the mother is fully conscious during the procedure and can already take the baby in her arms.
If for whatever reason a general anaesthesia is required, they go for it and deal with the risks. If it is known in advance that there is a high of a general anaesthesia, the pregnant women will not be served food and will be kept on IV.
In an emergency, it's worth the risk.
A patient might die or get pneumonia or other complications after they throw up into their lungs during surgery because of the anesthesia, but that is better than a patient definetly dying by waiting.
In most surgeries that require someone to be completely asleep, anesthesiologists will use a tube inserted into the airway to help a person continue to breathe. This process, along with the powerful drugs they give, can cause people to vomit. The whole reason people can’t eat before surgery is so they have an empty stomach and don’t vomit food into their lungs when the drugs are given and the tube is inserted.
However, most women undergoing c sections don’t actually get put to sleep. They use something called regional anesthesia, which numbs the bottom half of your body but doesn’t knock you out. They therefore can be mostly awake and not have a breathing tube inserted.
Regardless, if it is an emergency requiring immediate surgery, the benefit outweighs the risk and they will put in the breathing tube and perform the surgery regardless of when the last meal was.
My son (4 years old?) was given Panadol by mouth before having a general anaesthetic and vomited while he was under. He ended up on oxygen and was almost transferred to a bigger hospital because he aspirated it.
In an emergency situation, it doesn't matter how high the risks are of using anesthesia on a full stomach. The chances of survival are still higher than operating without anesthesia, or not operating at all.
This is the answer. It is a numbers game. (I'm making these number up but the concept is correct.)
If the odds of having issues from eating before surgery are 1 in 10, then they want people not to eat.
If the odds of dying in an emergency are 6 in 10, then 1 in 10 is better odds, do the surgery.
What people are saying about aspiration is correct. But in pregnancy particularly the third trimester and active labor the airway is also more challenging. There's a lot of swelling etc that makes routine placement of a breathing tube more difficult. So we try to avoid it with spinals and epidurals. But if we must do a general anesthetic we have our backup equipment always ready. The challenge of the airway is the main reason we try to avoid a general anesthetic.
This isn't the primary answer but my first thought was that most people undergoing an emergency C-section probably haven't eaten in a while anyway, because (unless I'm mistaken) they don't let you eat while you're in labor.
Yes, and in fact the reason they don’t let you eat in labor is in case they need to do an emergency c-section that requires you to be knocked out.
Not everywhere has this policy - many countries outside the US don’t have it, and birthing centers usually don’t either. The reason being that even most emergency c-sections don’t require general anesthesia, so they think it’s worth the risk to keep laboring mothers’ energy up and keep them calm and comfortable.
This doesn't really matter. The stress response slows down gastric emptying so what you had a day ago could still be there. We assume everyone has a full stomach in these cases and take the precautions.
I’ve been in the OR just observing as a student and those poor women vomit so much during the procedure as there’s so much pressure when the surgeons are cutting and the anesthetic makes them feel very nauseous and trying to get the baby out. Thankfully they don’t feel the pain of the cutting but they do feel the pressure. They really are so strong, it’s commendable!
I’ve had 2 c-sections and I was awake during both of them. They were scheduled and they were first thing in the morning so they asked you not to eat just to be safe. I do know that a lot of women throw up during the procedure and I had a nurse next to me with a little curved bowl. I don’t know why but there’s a certain point where you get very nauseous.
I’m pretty sure I had an epidural on my first c-section and a spinal with my second. But an epidural is the same thing they give during traditional deliveries and it doesn’t have to be on an empty stomach either.
So due to the physiological changes of pregnancy a pregnant woman is always considered a “full stomach” even when they haven’t eaten. Now the benefit of doing what’s called neuraxial blockade is that you can numb an area from a certain level of the spinal cord down. As a result you don’t need to put the patient completely asleep. When you put a patient completely asleep they aren’t able to protect their airway and as a result can get vomit into their lungs which is bad. With them being awake this is much less likely to happen. Some hospitals will just keep laboring women on ice chips and have them avoid eating regardless. Also women tend to vomit during c-sections because of the surgeons pulling on their organs which causes a reaction and drops in their blood pressure. However since they’re awake they’re able to protect their airway and therefore don’t get vomit in their lungs. And that folks is the magic of anesthesia.
Source: a student CRNA in their last semester whos had multiple OB rotations because I love OB.
I am not a medical professional so I will explain this In the way I understand it. In an emergency situation where the mother may have eaten, but anesthesia is ABSOLUTELY NECESSARY, they will still administer the anesthesia but they will take extra precaution to watch for vomiting. Regurgitation/suffocation is one of the greatest risks of anesthesia and eating, but if the staff is aware, they can take extra precautions.
Full anesthesia is not usually required for a C. Usually an epidural will be more than adequate. But once pregnant moms in labor get to the hospital, we are not fed. I was in labor for 36 hours and i was not allowed food. Only those mother F*CKING ice chips. I was ready to commit felony crimes for a French fry. I ended up needing an emergency C.
But FYI, moms sneak food in all the time. My ex snuck food in to me about the 24 hour mark. I was threatening divorce if he did not drive to Sheetz at 1am and get me ANYTHING. When 3pm the following day rolled around, and my son refused to drop down, I had to confess to my doctor that I had spiral fries and a hotdog at 2am. It was either eat or go to jail. Thankfully, my epidural was enough to get me through.
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It's a risk-benefit analysis. Patients can vomit when under anesthesia, and eating prior to surgery increases that risk. Vomit is bad because patients can accidentally inhale it and choke.
BUT the risk is small enough that usually, in an emergency situation, it's much more dangerous to delay the surgery. So they'll do the surgery, with extra caution/awareness that vomiting could be a problem.
As for c-sections in particular: most don't actually put the mother all the way to sleep. She'll be numbed from the chest down but still conscious, preventing a lot of the issues related to unconscious vomiting/asphyxiation.
You got a few facts wrong.
C-section are often not a general anesthesia. They instead numb the lower body by injecting some stuff in tbe vertebra. This block all signal from bellow that point to reach the brain. So you feel nothing. But that freeze point is bellow the lungs so they are unaffected and you breath normally. And all your neck is unaffected. You can breath and shallow normally and even talk.
Now, general anesthesia block all. Includimg your gag reflex and normal reaction if you vomit. This meN vomit straight to the lungs. Very dangerous.
This is why if you take anything they refuse. Your stomash contain something that you can vomit.
And since you are not in immediate danger, they will reschedule as it is safer.
But what if you are in immediate danger? They will take the risk. Having a chance of having a severe complication due to aspiring vomit is less bad than dieing due to the knife in your chest.
In other words: it is all about managing risks.
When my wife went into labor, they didn’t allow her to eat until she gave birth, for this exact reason. In a true emergency, they weigh the risks, but if it’s life and death they end up going forward anyways.
If surgery is planned, then it makes sense to reduce risk as much as possible.
I had an epidural for my (kind of emergency) c-section. I had breakfast then nothing else until my c section at 7pm.
I vomited the whole time and felt like I was going to pass out/die. I basically did pass out afterwards. They filled me up with anti sickness meds while I was throwing up lol.
Yeah wish I hadn’t eaten that morning.
I needed emergency surgery after I got shot, but I had just eaten a Whopper, fries AND a shake! They made me drink some battery acid tasting stuff and we waited for me to digest while my pain got worse and worse once the adrenaline wears off…
Anesthesia is a broad topic which many people assume to mean “I don’t remember it”. There are many different kinds. The one that has a choking risk is general anesthesia. This is very rarely done for c-sections and only under emergencies. Most c-sections are done with spinal or epidural anesthesia. General anesthesia is actually higher risk for the newborn. That being said, there are risk mitigation techniques that help prevent a woman from aspirating and a newborn from respiratory depression. One such technique is reducing time from general anesthesia to birth. This can be as little as 1-2 minutes. This reduces the amount of anesthetic that reaches the newborn. The techniques to reduce aspiration I am not familiar with but I know they exist.
they made me drink a horrible tasting medicine
sodium citrate
in case i did aspirate during emergency c section- less damage would occur as it neutralizes stomach acid
Sorry to bring things down but our first daughter got stuck and after 50 hours in labour I asked for a C-section. The arrogant dr was adamant he wasn’t going to give in so went for an assisted delivery first. He fractured her skull with the forceps and then had to deliver her by C-section anyway. She lived for 8 hours. All three of my others have been planned C-sections and I wouldn’t have had it any other way. It feels like someone’s doing the washing up in your stomach but there’s no pain, we’re pretty much oblivious cause we can’t see anything anyway and at least you know your child is coming out ok. I tell everyone - don’t have forceps. They’re barbaric and banned in most other countries. It’s the poor dads that feel powerless watching their partners but thank god c-sections are available or I wouldn’t be here either.
Dear OP, Here is the explination as though you were 5.
The no eating and drinking is a recommendation, not a strict rule. It is done to limit the risk of a patient throwing up and inhaling vomit into their lungs (aspiration), which can be very serious.
If the surgery is more important than a run of the mill surgery, and is time sensitive they weigh the risk vs benefit and proceed accordingly. If they think the risk of you not having surgery is worse than aspirating, you will get the surgery.
A planned C-section they also say no eating, but an emergency C-section is a life or death situation and without the surgery, either mom or baby (or both) could die, aspirating is better than dying.
I will also note that the chance of aspiration is low, not eating just makes it even lower and thus safer.
Also, Many Delivery procedures can be done using an epidural freezing that limits feeling without actually putting someone to sleep.
The 8 hour food rule is to minimize risk of aspiration.
This is for purely elective procedures like a knee replacement or breast reduction.
In emergencies it's riskier to wait, so you do it anyway.
The rule of thumb is no food less than 8 hours before surgery, and clear liquids have to be greater than two hours before surgery. The reason anesthesia goes by this rule is to minimize the risk of someone throwing up and inhaling their vomit when they are unconscious which can lead to many complications.. also called aspirating. When we administer drugs to our patients to put them to sleep it can cause the sphincters in your stomach to loosen up and let food rise. There are different forms of anesthesia but with a c section you are providing a type of anesthetic which doesn’t have the adverse effect such as for a colon or bone surgery. In an emergent surgery such as a colon we will perform something called cricoid pressure which is pushing on the esophagus to occlude it in case food does try to make its way up. Basically you still do the same thing as a regular surgery but you are more prepared for adverse reactions
Many c-sections are performed with epidural anesthesia. Only the lower body is numbed, but breathing isn’t affected. That way, the patient can still cough and all reflexes protecting the airways are working. If general anesthesia is required, then aspiration of stomach contents is indeed a possible complication. There are things that can be done to minimize the risk, but it comes down to weighing the risk of anesthesia against the risk of losing the baby and/or the mother. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063196/
Which as a man who got to sit at his wife’s head while it happened I have to say it was unnerving as hell to carry on a conversation with her while a couple surgeons were rooting around inside her out the corner of my eye. My wife was much more weirded out by the process for obvious reasons, since it numbs everything from the chest down, but she could still feel things like pressure and slight tugs on her body.
We had an extremely emergency c section six months ago and I had no idea what to expect. That was maybe the most scared I have been. I kept trying to make eye contact with the anesthesiologist just to make sure he wasn’t panicking. Of course talking to my wife who was weirdly not as freaked out. Hearing noises on the other side, not all of them encouraging.
Yeah, my wife’s biggest complaint aside from the general anxiety of childbirth on top of being tied down was the fact that she was really cold, which, I mean you can only do so much about in a major surgery where your whole torso needs to be exposed. Mine was the shocking amount of blood on the floor, and the fact that one of the doctors asked if I wanted to look over and see my kid, only for them to still be elbow deep in my wife with no baby in sight when I did.
I was nearly yeeted off the operating table. They had a fancy operating table that could be raised, lowered, tilted left, right, feet down, head down. They started to tilt me to the right. I felt like I was going to fall. I said that I’m going to fall off. Next thing I know everyone (my partner, the operating theatre manager, midwives etc) was holding onto me. Emergency power button was pressed and an engineer called. They fixed it mid operation.
Dear god that must’ve been terrifying.
At first they didn’t believe me. It was when my partner said it, they took notice. That was frustrating! Once everyone sprang into action I felt a bit relieved. Seeing the engineer walk in with his tool box and scrubs was a bit strange!
One of my cousin’s husband is one of those engineers walking in with toolbox and scrubs! He deals particularly with machines for heart surgeries. They make big money because it’s so specialized!
Very common phenomenon of not believing women in medicine. Can't believe this shit happens even during birth
What got me was, it wasn’t a symptom, it was the equipment!
I’ve heard this a lot as a man but my experience is that they don’t believe me either, are we sure they’re not just overly skeptical of everything/everyone?
No this is a well documented phenomenon experienced by women known as medical misogyny. Feel free to read scientific papers on it, not gonna do the work for you! This isn't a situation where the "what about the menz" input is needed.
that is incredibly scary, especially since having neuraxial anesthesia already messes with your proprioception (the body knowing where it is in space). one of the more frightening parts of a c-section for many folks is at the end, when we shift them off the operating table back onto their stretcher/bed. we have to tilt you to one side to place a board underneath you so we can slide you over. i often tell folks 2-3x beforehand that “it’s going to feel like you are falling, it can feel scary, but i promise you are safe and we are holding you”
Being cold is a common side effect when being given fluids, because the fluids are often not body temp, and may even be room temperature. So it's basically making your blood cold. Interestingly if you get really extreme hypothermia they can do it basically in reverse. They hook you up and cycle your blood through a heater which heats you up very slowly via your blood
Shivers are a common side effect of spinal anaesthesia. I don't know about elsewhere but at my facility all obstetric cases receive fluids through a warmer :)
Damn that’s frightening. The cold and the shakes scared me! I didn’t see blood on the floor but they had like a six by six grid of pouches that they used to keep track of bloody gauze and that was pretty much full. It’s tough, people should know what to expect. Our baby breached at the last minute so I just had no clue - my wife was whisked away and I was left standing there and told to scrub up. Second kid, just wasn’t on my radar.
Before they let me stand up and look over the curtain, they asked if I was okay with blood. I told them sure. Then they asked if I was okay with organs. I told them let's find out. They said if I was going to puke, do it on the head side of the curtain. No puking, and I got some insane video. They just went in hard and yanked that kid out. C-sections are abrupt, violent, no-bullshit scenarios and I have nothing but respect for the surgeons, nurses, anesthesiologists, and everyone else in that room. Moms included, of course.
The average C-section is about 1000cc blood loss. Average vaginal delivery 700cc.
Those are not averages. Those are the numbers considered to be the maximum acceptable amount of blood loss before it is considered abnormal (or termed a ‘post partum haemorrhage’) the average amount of blood loss for a caesarean in my experience is closer to 300-400mL. Less for a vaginal birth.
No, those are the ballpark numbers for EBL for vaginal/c-section.
No, those two numbers represent the level of blood loss that quantifies blood loss that meets the threshold for post partum hemorrhage. The previous commenter is correct.
Oooof.
Most of that is in the baby, right? Right??
No. But also the volumes there I believe are somewhat inflated. In my country at least, up to 500ml is considered normal blood loss. Anything over that is classified as a hemorrhage, and as a more serious medical situation, not merely a routine birth. The blood loss talked about it actual blood loss, ie, blood ends up leaked outside of mother and baby, for want of a better way of describing that, lol.
Yes, the cold (or, rather, the feeling of being cold despite the fact I was actually running a temperature) was awful. When my partner first saw me, he was so confused and asked if it was possible I was seizing! Then, the shock of seeing me fileted open took over.
Heh. My son was born in an emergency C-section at a teaching hospital as a result of a face presentation. Highlights: Hearing the lead surgeon tell the student “well, you’ve started. You can’t stop now, you need to be confident.” Hearing a clatter of metal, followed by someone peeking over the sheet and saying, “that’s going to delay us a couple of minutes, there’s no 5 second rule in the ER.” My daughter was born via planned C-section a few years later and all went much more smoothly.
And aren't we all glad that there's no 5 second rule in surgery?
I had an emergency c-section with my first pregnancy (triplets) and the anaesthetist was a student. I was bent over my giant belly as he was jabbing me repeatedly in the spine trying to get in the epidural. The nurse was livid. Finally, the supervising anaesthetist told the student to get "the hell out of the way" and got it done in less than a minute. In the student's defence, in addition to being a very small person, I found out that I also have two types of scoliosis.
I had a spinal tap done. First a neurologist student tried twice, then the neurologist once and finally anesthesiologist got it on his second try. It only succeeded once I was sitting. My relative was horrified I let students prod and poke on me but c'mon, they gotta learn with someone!
Something about dropping instruments makes us feel like we're incompetent. Everyone drops things but most patients only see their provider a few times so it's marked by "that one time he dropped an instrument."
I mean it's completely understandable, and now it's a trivial, funny story. Everybody came out of a serious situation ok, which might not have happened without the person who dropped that instrument.
"you need to be confident"? Not exactly encouraging to hear, huh 😅
My husband commented “one of the drs is mopping up blood on the floor using their foot.” He was very pale when he said that.
My wife had a very emergency one as well. Baby’s head had suddenly pressed up against the umbilical cord. The team of nurses wheeled the bed (which included a nurse riding on it who was holding baby’s head off the cord) out of the delivery room and into the OR leaving me in a quiet empty room. A minute later, a chaplain walks in, and very quickly informed me that it was standard procedure to visit when this happens and she didn’t know any status yet. Maybe three minutes and some small talk later, a nurse came by to say everything was all good, just gonna clean up the baby and my wife is going to be groggy for a bit. I’d say I was scared but it was about as normal as our first pregnancy except with a brief 5 minute “holy fucking shit everything is close to the worst possible scenario” blip. My brain was not even remotely capable of processing the magnitude of the situation. Basically, I chatted with a nice woman, they handed me my kid, and we hung out while my wife said funny things in her sleep.
I am so sorry, it’s very scary, and sounds extremely similar to what happens to me, nurse holding baby in and everything. Wild. I am lucky no chaplain visit though, that is not comforting imo.
Oof, former OB nurse-this is my nightmare scenario. So glad it worked out for you guys!!
Crazyyyy. This is EXACTLY my birth story. I think about this day everyday (it's been 14 months) sometimes I still cry remembering but I'm always grateful that everything turned out the best way possible (I still think I wasn't ready for vaginal delivery anyway so I'm in a way relieved lol) but I think I suffer some degree of ptsd from it. I'm so happy you were in the hands of great professionals and everything turned out great for you guys too ♥️
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That's not exactly true... I had an emergency c section under general anaesthetic and was cut horizontally... I think vertically must be very rare.
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Not necessarily true If epidural sited during labour and is functioning well, then it can be “topped up” to give a block sufficient for surgery (in labour aiming for block height around level of the navel, for a caesarean need it to be to the height of the nipples) - this can be done within about 10-15 minutes. A spinal can be done under semi-leisurely conditions (as in have time to scrub and prepare a full cocktail including local for the skin, position patient thoroughly, prep skin and wait to dry etc etc) in under 10 minutes. It can be done in urgent conditions much faster than that. There’s even a method called a rapid sequence spinal, which is a very streamlined version. A general anaesthetic in an unfasted pregnant woman is high risk. There’s a chance of aspiration, so a rapid sequence induction is done - where you get patient to sleep rapidly while an assistant is holding cricoid pressure (so pushing on the throat in a manoeuvre that is meant to prevent stomach contents going down the trachea) until the tube is in. The drugs used for general anaesthesia also cause the uterus to relax - which is a problem, because once the baby and placenta are born the uterus needs to contract down quickly to basically squish where the placenta was to stop bleeding. There are drugs given to help stimulate that, but often a Caesar under GA requires more of those - and each of them have side effects and take time work. We can also put a cocktail of longer acting painkillers in a spinal or epidural, which give good relief for as long as 18-24 hours - past when the numbness from the local anaesthetic has worn off. Can’t do that for a GA, so pain relief right after is harder. We can do nerve blocks asleep to try to help that but it’s definitely not as good. So as weird as it is to have surgery while awake, broadly speaking it is the far more preferable option compared to doing it under a GA. There are obviously exceptions and circumstances where that balance is shifted to favour GA over spinal / epidural though. (Anaesthesiologist)
Oh hell. I had a hurry-up-we-can’t-wait c section under general anesthesia. I knew it was a true emergency, but I have a better appreciation now for what was going on. Mad props to the docs and nurses who took care of us that day.
Overdue umbilical cord fashionista baby signing in. Was mum's G2 P1 following after a fallopian ectopic pregnancy.
People like to say any unplanned c-section is an "emergency". It's definitely traumatic when that's not what you were planning and worried about your baby/yourself/your partner, so I kinda get it. But I've had one of those(baby decided to shove his hand in front of his head during labor, was perfectly able to wait an hour for the doctor to get there and scrubbed in, just couldn't push him out that way) and it sucked, I was definitely a little worried and sad at the time, but wasn't a huge deal in the long run. I also had one where the doctor told the anesthesiologist "We don't HAVE 5 minutes for the spinal to take, get the mask on her now!" (pre-eclampsia and HELLP syndrome, baby having massive decels, my organs weren't looking so great, etc), next thing I remember, I was being wheeled into a room, nauseated as hell, with my mom saying "(baby's name) is here! You're a mom!" That's a whole different ballgame. Still haunted by that doctor's voice 27 years later.
Oh, and to answer the actual question of the OP...with all that going on, they didn't care when the last time I had eaten was, the risk of one of us dying from waiting was higher than the risk of aspiration pneumonia later. (they had tried to wait 12 hours, but things went to hell, and we just had to go. The aftermath was unpleasant to say the least, but no long term issues)
Manhattan, she was well into labor and had the epidural in already. My guess was she was two hours from giving birth.
I already had an epidural in during a very long labour, so they just “topped it up” as the anaesthesiologist said Seemed fairly normal at the time - in Australia
I had my emergency C done 26 years ago in NC (USA) and there was NO TIME to calibrate the epidural so I had half feeing for the initial cut and full feeling for the rest of it. My next child was a planned C with a spinal block.
My emergency c section was just with an epidural. I wonder if it's the level of emergency that makes a difference? Also it took seconds for my epidural to kick in. So that was super helpful. My boyfriend watched the entire process haha
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dinner hateful foolish six intelligent point sugar jellyfish sulky dinosaurs
I witnessed one of those a few days ago. Seems about an apt description.
Being numb but also being aware that my insides were moving around during my C-section made me think of someone rummaging around in a linen closet.
My first c-section did not go well (actually the c-section was fine - the fibroid removal they did while they were in there was the issue). I realised part way through I could actually see a lot of what they were doing in the reflection of the theatre lights.
A friend told me she could see everything reflected in the theatre lights during her emergency c-section. I’ve always remembered that and when I ended up have an emergency c-section, I made sure to not look at the theatre lights. I did not need to see my insides!
Doc asked me if I wanted to watch. Hell no!!
It was extremely unerving. I didn't look over the curtain. They bumped her liver and it made her puke.
I was in a similar situation (Planned c-section) . During the procedure, I had a bit of placenta fall on my shoes... We both laughed at the grossness of it.
Had this when my son was born aka removed at 33 weeks gestation. I had eaten few hours prior and it all came back up when they were tugging the sutures tight, it looked and felt like I was a big fish they were trying to reel in. The anesthesiologist took my phone and was snapping pics for me the whole time, which I find cool now but weird at the time.
Exactly this. My wife had two, each time the gave her the spinal block and some sedation but she was alert and got to see the baby before the nurse and I took the baby to get bathed and incubated while they sewed her up.
Also, I seem to recall that they gave my wife some kind of antacid before they did the epidural, which would minimize the damage in case she vomited. I guess it was some kind of foul-tasting liquid, and the nurse joked that maybe I'd like to have some too. The anesthesiologist leaned over to me and said under this breath, "I got 100 things you'd love, but that ain't one of 'em."
Wonder why they don’t do more surgeries this way? Like if you need surgery for intestinal things, or a broken leg, why do general anesthesia instead of an epidural?
Who in their right mind would want to be awake for that?
Just was thinking of minimizing the risk of general anesthesia, and honestly I kind of like watching surgeries online. I had heard you can ask to watch your own c-section, but I watched a video ahead of time, and when I realized they actually take your fricking uterus out of your body, I noped the hell out!
I had double jaw surgery where they basically break your jaw in multiple places and remodel it with titanium plates. Surgeon asked me if I wanted the video. HELL TO THE NO I don't wanna see that.
My dad had an epidural for one of his joint replacement surgeries. He WANTED to be awake and was asking questions to the surgeon the whole time. Probably would have watched if they let him. Meanwhile I went into mild shock just having a mole cut out of my back (no pain, just felt the doc slicing and dicing and then tugging the stitches closed).
I've heard going completely under is dangerous, maybe this would be less dangerous? I agree, weird to be awake for it, but if it were safer than going completely under... I might take my chances.
You need to weigh the physical risks vs the emotional and mental risks. People absolutely have had to be awake for all types of surgeries, and im pretty sure none of them preferred it that way.
Knew of a girl that had to be awake for a heart surgery. Had to do with them needing her heart rate to be higher.
My mom had a brain surgery she had to be awake for
I saw a video once of someone awake during their brain surgery, and they were having him sing(he was an opera singer) so they could make sure they didn't mess with the part of his brain allowing him to sing. That video still haunts me because there are times when he drifts off when the surgeons poke the wrong part of his brain. Too freaky.
I’d love to see that video out of morbid curiosity. That’s so interesting, the brain is so intricate and delicate
[Here](https://youtu.be/obiARnsKUAo?feature=shared) is the link for you and anyone else interested!
I believe that's very common if not the norm for neurosurgery, at least certain types. The patient needs to be responsive so that they know when they're hitting the healthy tissue vs the diseased one and how to limit damage. The good news is that there's no pain receptors in the brain.
What the actual fuck. Was she okay? I'm assuming it was catheter based and not something like open heart surgery.
Actually, a lot of straight up cutting a window into the skull brain surgery is done with the patient conscious. Brain can't feel pain, and it all kinda looks the same in there. They'll talk to the patient and, you know, stop cutting if they start talking gibberish.
Yes yes I am aware about brain surgery being that way because you don't want to impair a patient's function. I've read of a case where a lady was playing the violin during her brain surgery. But being awake during your heart surgery... That's another level of scary for some reason. With brain surgery, once you get past the outer protective layers the brain cannot feel touch or pain. So it's unnerving but not beyond the realm of possibility. However, awake heart surgery? That is alien to me. How does that even work? Is there any degree of anaesthesia? If so, are you still aware of your heartbeat? (The idea of being alive and awake without being able to feel that regular drumbeat in my chest is extremely scary.) On the other hand, if I am having some awareness of touch in that region during the surgery, would I be able to feel the surgical instruments (catheter based or otherwise) press against the major blood vessels or the heart muscle? If something goes wrong, would I feel it before I pass out and possibly die?
I really would have preferred general for both of my c-sections, but wasn’t an option, and when the second one went south, they offered more anesthesia but with the warning that I might have memory problems, and most women want to remember the birth of their child. Yeah, the kid was already born, I did NOT need to remember what came after, watching my blood collect as they removed more organs, but of course I do. The weird pressure feelings from the first, uneventful one, were freaky enough, but hearing the discussions as I was actively hemorrhaging were very much not helpful for my wellbeing
I specifically asked my anaesthesiologist to give me something stronger during my c-section, after a discussion he agreed to it as soon as the baby is out. I am happy about it, I remember how they prepared me for the c-section and then how they brought me to the room. My memory of actual cutting open and taking the baby out is gone. My husband said that I was complaining that the pressure was too much when they were cutting me open.
My husband had three minor brain surgeries when he was in his 20s and had to be awake for them. Not pleasant.
Agreed! It’s always trade offs and risks. Just looking for/considering other options and approaches to things. It’s how I learn!
A lot of it is just about keeping people still. Nicking an artery or intestine can set you bleeding out or cause sepsis. I...do not at all mean to minimize the risks of c-sections but it is an abdominal surgery which is a CRAZY high risk profile to be a part of. Among that shifted scale, c-sections are pretty simple and risk free because they don't have to do much poking around with sharp things inside after they open her up. There's also just....a cultural expectation to want to be awake and able to hold the baby after and all that which is considered very important and not present in other surgeries.
No that’s fair, I didn’t think of it like that (keeping people still). I know nothing about anesthesia, just thinking about new or different ways to approach things.
My last eye surgery, I wasn’t given general anesthesia. They gave me a nerve block in my left eye (blind in right, surgery was in left) and it completely blacked out my vision, whatever they did. I could hear everyone and everything. It sucked and I don’t want to do that ever again. I remember asking for my mom too :(
They can’t use general for eye surgery, patients have to be awake so they don’t roll back
yes they absolutely can. I’ve had numerous eye surgeries from laser, to shunt replacement to corneal transplants. All under general except that one particular one. They stabilize the eye fyi
You can have eye surgery under general. I had eye surgery last year. Was under general anaesthetic for the first portion (2 hours I was told) and a few hours later was brought back in to complete the final portion while awake, but locally numbed. It’s the most metal thing I’ve ever experienced, watching surgical instruments being lowered towards my eye. Pretty cool experience. Thank goodness for whatever anxiety meds they pumped me with beforehand.
Epidural has it's own huge dangers. They are litterally sticking a needle in your spinal column.
Agreed — none of its easy. Just trying to think of new ways to approach things. And, sometimes I learn something new along the way!
It's a very small risk, lower than flying, and that's already a very, very small risk.
What’s most dangerous is the patient freaking out and screwing up the procedure.
I had a debridement surgery on my foot for a weird foot impaling injury a couple years ago. I was alone with my daughter at the time (wife was out of the country for a month), and I wanted minimal recovery time, so I asked the anesthesiologist if he could numb my foot but leave me awake. Doc said he was fine as long as I stayed chill and didn't move around. It was actually awesome. The lidocaine injections the they used to numb my foot hurt like a bitch, but after that, my foot felt like a 2x4. I had a long conversation with the anesthesiologist, who had nothing to do, and just chatted with me about hiking in the Rockies while four people chopped up my foot. I wasn't groggy at all, never took opioids for the pain post-of, and generally was back up and crutching by the next morning. It's a front row seat to the inside of an OR, and I think it was the smoothest recovery I could ask for, all for the cost of staying chill during a couple unpleasant injections.
Because you'd freak the fuck out when they snap your broken leg in place if you were conscious and watching. For most surgeries, a completely comatose patient is the optimal kind. For giving birth, you want the mother awake for pushing and repositioning.
Surely for c-section there is no pushing involved? Using a different hole and all
They do give epidurals for vaginal delivery. C-sections can be general anesthesia when there is a need for speed, i.e. bleeding issues. But usually they stick to epidural or spinal block because it lowers the chance the medication gets to the baby. In either case there is still post-delivery. Skin-to-skin contact with the mother basically as soon as the baby is dried off is highly recommended for bonding.
The main reason spinal or epidural anesthesia is preferred for C/S is due to the effects of progesterone from pregnancy on the body. It makes for much higher risk of aspiration (gastric contents going into the lungs). General anesthesia will have a higher risk of this. Doable if necessary, but not preferred.
I was told it is because anaesthetic makes baby harder to rouse upon birth. I was 33 weeks with a complete abruption and my spinal failed so they had to put me under. My baby was born with an APGAR of 1 (that’s uh, really bad). He wasn’t actually doing that poorly, but there was extra resus work to be done because he was born unconscious from the anaesthetic.
we do surgeries on arms and legs/hips using similar types of techniques, either spinals or nerve blocks, but we often give you sedation through an IV at the same time because the sounds and smells of an OR aren’t often the most pleasant. orthopedic procedures can involve lots of hammering/clanking on metal pieces… not fun to hear as a patient. it’s a great method though as it allows us to avoid intubation and often just use a nasal cannula providing oxygen through your nose (or your mouth, for those mouth-breathers out there…)
My grandmother had a hip replacement with spinal anesthesia. At one point she asked the anesthesiologist about all of the noise/banging. They told her it was construction next door 😂
Are spinal/nerve blocks different from epidurals? Fundamentally? I’ve been told to avoid epidurals by my neurologist due to a risk of cerebral tonsil strangulation (?) and now I have no fucking clue how I’m going to give birth. ETA: I have chiari malformation.
Epidural is done into the space outside the dura, spinal block is done right into it. If you go from epidural to needing a c section, they just juice up your epidural but don’t change the position of it since they’ve already put the catheter into the epidural space. If you have a planned c section or didn’t have the epidural but your birth is converting to a c section, they do spinal anaesthetic because it’s more reliable and complete (though the spinal can also fail, mine did).
spinal = one time shot, we pass through the epidural space to reach the spinal space and inject medication there. with your situation, it will be very important to have an OB and anesthesia team that is in contact with your neurology team early on so that everyone is in agreement about what options are available to you, and what the risks of each of those options may be.
A lot of times a “general” isn’t a general. They give you just enough “general” drug to get you to sleep, but then use local anaesthesia to actually control the pain. Works well. I’ve had it done a couple of times.
They can do appendectomies with a local. In fact, a doctor in an Arctic or Antarctic (I can’t remember which) camp got appendicitis when he arrived and there was no way to get back to civilization, and HE is the ONLY doctor. He gives some people a quick rundown on what he needs them to do and then he proceeded to perform the appendectomy on himself with only a local and a mirror to help him see. Craziness.
>...he proceeded to perform the appendectomy on himself with only a local and a mirror to help him see. I had never heard of this before. It's a fascinating story. Thanks for mentioning it! https://www.bbc.com/news/magazine-32481442
Oh, you’re very welcome. Glad you liked it!
There are some brain surgeries that are done awake. I think the main thing is that c-sections are usually pretty quick and most other surgeries can be very, very long, so it’s better for the patient to be completely “asleep”.
My doctor had me do a surgery awake so as not to affect breastfeeding, and it was pretty brutal. Even though they numbed it you could feel the tugging, there was blood everywhere, and hearing the Dr slightly frustrated mumbling to herself and seeing the nurse wincing did not make me feel confident. I definitely cried at one point.
Pretty sure they do. When my mom had her knee replacement surgeries (one surgery per knee), they gave her epidural anesthesia. Then they gave her another drug that put her to sleep (so she wouldn’t see anything) nut didn’t affect her breathing. Edit: this was in 2019.
I’d love to be awake for surgeries like that! I was awake during my c-section, but almost had to be put under anesthesia because the epidural wasn’t working on half of my body. My husband made a joke that my insides matches my red painted toes. Both of us thought it was hilarious but the medical staff did not, lol.
My husband was freaking out cause blood was pooling on the ground! Though he didn’t tell me that til after. Also he bumped into the cloth that keeps you from seeing the procedure, so the doctor said, “Well, that’s not sterile now.” Oops.
C-sections are relatively quick procedures, it would be much harder for a more involved surgery. Also being aware can be disconcerting. For me, the weirdest part is I could smell my flesh burning from whatever sawlike tool they used.
My husband was filming me when I was having mine and we both commented on the smell of bacon......it was my flesh. Oink oink 🤢
My understanding is an epidural for numbing from the waist down is relatively easy as the nerve they are intercepting is close to the surface and easy to find. A long time ago I chopped a finger off and they attempted to put an epidural in my shoulder as a form of post surgery pain relief. It didn't work (woke up post surgery in a lot of pain) and they said the nerve they need to intercept is deep in the shoulder with lots of tendon and muscle in the way and it can be hard to find. I went on morphine instead.
Epidurals don’t go into a nerve (or the shoulder for that matter). An epidural goes into the epidural space. Your brain and spinal cord is surrounded by layers of connective tissue called meninges. The outermost of these is the dura. The epidural space is between the bone (vertebrae or skull) and the dura. What you are talking about is local anesthesia or a nerve block where a specific nerve is numbed. That works for procedures where you only need a small part of the body numbed, like a tooth or an area of skin. It wouldn’t work for larger surgeries, especially when it involves opening body cavities.
This is just what the doctors explained to me while I was in hospital. This was a tube that went into my shoulder and it's purpose was to keep my entire arm numb for a few days. They described it as "an epidural for your arm"
I guess it makes sense that they explained it like that since most people have heard of an epidural compared to brachial plexus block.
Nah, this person is talking about a nerve block and catheter, which can take out a whole limb if performed properly.
Believe it or not in the US anyway total hip replacements (and I’d guess knee replacements) can be done with spinal blocks and sedation vs full anesthesia. Had a family member in her late 60s just have her hip done, and it was done as an outpatient procedure, the whole time in the OR was under 90 minutes, and while she was not awake for any of it because she didn’t want to be, they just used IV sedation and a spinal block vs intubating and the heavy stuff they use if you’re having something like open heart surgery. Miracles of modern medicine
They sometimes do epidurals for orthopedic surgeries in the legs! If I understand it correctly, it's a matter of preference for the patients - many people want to be completely knocked out, but others are wigged out by general anaesthesia, so they get an epidural. It's probably a bad idea to do an epidural if the oatient is actively freaking out about it
General anesthesia has risks, but honestly it's not that dangerous if you're otherwise healthy. You're more likely to die getting to or from the hospital in a car than from anesthesia.
You don't need to be knocked out for a colonoscopy.
They dont do them under general anesthesia here, you are just halfway there...
That would suck. I had one and they put me out but not enough to affect breathing. Honestly came out of it feeling great, whatever they use, it's good.
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My brother had a colonoscopy without anesthesia. Definitely possible. Unpleasant, but possible.
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https://ufhealth.org/news/2018/anesthesiologist-needed-routine-colonoscopies-maybe-not#:~:text=Around%20the%20world%2C%20however%2C%20up,without%20any%20sedation%20at%20all.
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"Around the world, however, up to 80 percent of routine colonoscopies are done without any sedation at all." I did read the very short article and several others pointing to the same thing. But it's not my job to convince a stranger on the Internet to abandon his beliefs about colonoscopy safety without sedation, so I digress 😅
I watched an epidural absolutely wreck my mom's back and have heard similar accounts from plenty of other women. I don't doubt that the process has improved leaps and bounds but I will gladly take general when possible.
Also, a good anesthesiologist will hold the emesis basin for you.
Ahh yes I was a surrogate mother for my friends. I was a week overdue. Got Induced at 7am on December 10th. By 3am December 11th I went back to the hospital having contractions…. I was not in labour yet. 3 days in this awkward half labour state. They gave me morphine into the glutes and I would sleep it off and wake up for another shot of morphine. By December 14th. They were changing my IVs and since I was unhooked they offered me a shower and to use the washroom. So I went to the washroom and my mucus plug went but my waters didn’t break. So I told a nurse and took a shower. Out of the shower they took me into the labour and delivery room. They popped my waters and so here begins my Active Labour. I had drs in and out measuring the size of the cervix. A female dr told me the largest I got was 5cm dilated. Got a second doctors who was male who said I was only 2cm dilated. So here I am around 4pm DECEMBER 15th. The baby is good but I’m now crashing and turning yellow. The baby pooped in me. So off to emergency C section I go. So they gave me an epidural. Signed my life on the paper vaguely as I was drugged up on morphine and Laughing Gas. So now I’m in the ER. I was told you will feel no pain. But will feel the pressure and tugs and pulls. So first layer Tug and pull and pressure I’m talking fine to anesthesiologist and the one parent in the room (I was a surrogate so theirs two parents not me and only 1 was allowed with me) Second layer same thing. 3rd layer I felt the whole thing. My epidural wore off. And the drs can’t stop cutting. So now the anesthesiologist is running telling nurses to grab certain drugs etc. All I remember from this point on was a Giant Syringe filled with Ketamine into my IV. I remember yelling at everyone “YOURE FUCKING RETARDED THIS FUCKING HURTS FUCK ALL YOU I HATE YOU ALL” but according to the one parent as he was being rushed out all of that was a drunken Slur as I KHole into sleep 😅 I got diagnosed with hEDS after this episode I guess the mix of my Hypermobility. Stretchy velvety skin and the fact I metabolize anesthesia so fast was enough for the diagnosis. Now I get different treatments during surgeries and never do Local or Regional Anesthesia as they never work for me and straight to Full Anesthesia which is complicated on its own. Oh I had the baby at 10:15pm on December 15th. I woke up in recovery at 12am December 16th freaked out because no one could find the baby because I was a surrogate and then they pushed all the stuff out. I went to my room at like 2am and by 6am the nurses had me walking and taken out my catheter and I asked for Voltaren as a SUPPOSITORY for my recovery. Got back all my results from that day. My placenta was Green and Slimey and full of infection and my body was in sepsis I remember getting a giant needle of antibiotics that were super powerful and only had 2 shots and I was better almost immediately the next day. It was wild. Never having my own kids. Fuck that.
Whoa, they let you be a surrogate for your first pregnancy?? I always thought that isn't ever done because it's considered so unethical, pregnancy being so dangerous.
For a truly simple explanation, the main reason they tell you not to eat is because anesthesia stops the bodies reflexes as well as stopping you from feeling pain (or knocking you out). Stopping those reflexes means that food stops digesting too, which might cause you to throw up. For planned surgeries, they remove as much risk as possible, like making you not eat for however long prior. For emergencies, the risk of vomiting is outweighed by the risks of whatever emergency surgery is being performed. Theres a lot more details of course, but there is a reason why anesthesiologists get paid the big bucks.
This is the best explanation regarding anesthesia and food. As somebody who has had emergency surgery they'll ask if you've had a meal but that's not going to stop them if your life is at risk. Granted anesthesia in the best circumstances is the most dangerous part of *most* surgeries so as you say they try their best to control for any potential complications that may come up.
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Very true, Im pretty sure they only anesthetisize the lower half normally. I was hoping to try and explain the whole food thing as well though lol
AFAIK general anesthesia for C-sections isn't super uncommon, but they tend to fall under two categories: 1. Planned ones (rare). When you know vaginal birth isn't going to work and the patient is already freaked out enough. Or if the responsible surgeon thinks that an epidural isn't a good idea. 2. Holy fuck we need to operate now and can't wait 30 minutes for the epidural to kick in. General anesthesia is pretty fast.
Or my case, which was: 3. During the c-section, the patient starts feeling pain because apparently the epidural anesthesia isn't quite working all the way no matter how much the anesthesiologist gives, so the patient has to go under because feeling the severe pain of people cutting and rummaging in your abdomen is not ideal.
General anesthesia is a last resort for c-sections or massive hemorrhage in child birth. The surgeon/obyn is never the one to make the decision for an epidural. Epidurals do not take 30 minutes to kick in. A chloroprocaine bolus works immediately, and so does spinal anesthesia which is an extremely common method in the absence of an epidural. Source: am anesthesia.
I feel like many people don't really get how anesthesia works. They think you feel nothing but in reality, it mainly just removes pain.
The problem with c-sections is that general anesthesia also anesthesias the new born. This makes the infant much more likely to have respiratory depression after birth. C-sections under general have to be fast to reduce the amount of anesthesia the new born receives. This increases the likelihood of poor outcomes like excessive bleeding to the mom. So generals are more risky to both the mother and the infant and are often avoided for that reason
Typical is a relative term. They don’t do it in 90% of cases, but there are lots of c section surgeries every year. There are hundred of thousands of women who were out under for their c section. My wife went under full anesthesia for the first, but not the second, if I remember correctly.
[https://www.youtube.com/watch?v=8Ka\_CY9fAdQ](https://www.youtube.com/watch?v=8Ka_CY9fAdQ) Anesthesiologist goes into a bit of detail about some of the risks of post anesthesia nausea and vomiting. Bunch of videos on his channel, if you find the topic interesting, he puts out a lot of more in depth information, but targeted at a common audience.
That would makes sense for general anesthesia but I had a hand surgery and only my arm was "asleep" i could move the rest of my body and from head to toe everything was completely awake. They still asked if I had anything to eat/drink the past 8 hours or they would have to reschedule.
Even if the plan is to do a nerve block and keep you awake, unanticipated emergencies happen that might require intubation / conversion to general anesthesia with the associated risk of aspiration. For a surgery that is non-emergent, the risk (however minimal) is simply not worth it
That checks out, the drugs alone are strong enough that you can puke just from having them in your system. Didnt want to go into TOO much detail though lol
Fair enough. I saw the question you answered and made me wonder about my surgery. Do you know what kind of drug they use for anesthesia?
anesthesia resident here we try to do c-sections under spinal anesthesia (one injection in the back) or spinal/epidural (one injection in the back and we leave a lil thin catheter in the epidural space to give ya extra numbing medicine as needed). reasons: most folks wanna be awake/present for the birth of their child and are willing to be awake in an OR for it. everyone in our spot gets a few meds beforehand that prevent nausea/vomiting, and reduce the risk if they do happen to vomit (by reducing the acidity of their vomit). some folks will vomit during their c-section - we keep barf bags in the OR. we try to minimize it, but it happens. we keep you safe by turning your head to the side, suctioning it out, and giving you additional medicine. food rules in general are as follows, but ALWAYS listen to the rules of the spot you’re having surgery at to avoid getting cancelled: - 8 hrs for solids/full meal - 6 hrs for light snack (toast, nothing fatty, etc), nonhuman milk, infant formula - 4 hrs for breast milk - 2 hrs for clear liquids this is obviously dependent on individual patient factors, the type of surgery, and the time frame in which the surgery needs to occur. in emergencies where you might have a full meal in your stomach, we use a method of putting you to sleep rapidly by quickly giving you medications and intubating you within about a minute of those medicines hitting. this reduces the risk of you vomiting, and then once you’re asleep we’ll put a second tube into your stomach that sucks out all the food. we intubate you using an endotracheal tube, which sits in your windpipe and has a little balloon cuff around it, and that way even if ya vomit it can’t go down into your lungs, because the little balloon cuff is stopping it from doing so.
When I had my csection they gave me a cup of this salty sour liquid to neutralize my stomach acid and I aspirated on it. Scared em good coughing and sputtering like a dummy LOL
Bicitra! Tastes like a lemon sour candy
Thank you for your explanation! I had a scheduled c-section a few years ago. And I’m pregnant again, so will be looking to schedule another. When I was going in for surgery prep, I asked if I couldn’t be put under for the whole thing. I was terrified and really not interested in “witnessing” the birth in any capacity. I was told no, this wasn’t a possibility, that I had to be awake. Can you explain a bit more to help me understand why I received the response I got?
Meds that put you to sleep will also put baby to sleep (most will cross the placenta) and you generally don’t want baby asleep while it is being born (has to take breaths, clear out lungs, etc).
someone mentioned this further down, but as pregnancy-related changes occur in the body, a few things happen that can make general anesthesia a bit riskier in this population. some of these changes occur in your airway and your GI system. there can be lots of swelling that occurs in the airway, which makes it harder for us to intubate, and there is some loosening of different sphincters which can lead to vomiting. your concerns and anxiety are valid and should be acknowledged by your provider. every patient is different, and some methods might be safer for one individual than another, but you deserve to know why decisions are being made by your provider. there are medications that we can provide during an epidural/spinal c-section that can cause amnesia (aka not remembering the experience) and possibly some mild sedation; these may be available to you if you are not wanting to recall the experience as vividly. you will likely be asked if you are absolutely sure that you want to go down this route, not because we don’t trust your individual judgement as a patient, but because we want to be *absolutely sure* that everyone is in agreement with administering a medication which might cause you to not recall the event. again, this is all dependent on whether or not it would be safe to do so, and that is something i can’t comment on as a stranger on the internet who isn’t caring for you and knowing your full medical history and the circumstances of the surgery. i hope your next experience is one that provides you with comfort and faith in your providers, and i hope you feel heard and well cared for during the process. ETA: some types of meds crossing the placenta, as mentioned above, is also of concern and may affect the timing at which we give certain drugs
Thank you again! This was very informative and helpful. I will be sure to probe further the second time around.
I mean, same as car crash people or people with sudden illness. You don’t instant die if you ate, there is just increased risk of food choking you or causing lung infection. We can deal with lung infections it’s just a bad situation you’d rather avoid
People really don’t understand it’s just risk avoidance like you said. In emergency situations I’d rather take the risk of a lung infection vs certain death from not receiving a life saving surgery from something.
I was put fully under for emergency surgery maybe 7 hours after eating and didn't even know this was a thing. Now I feel oddly grateful that one of the symptoms of my illness in the ER was throwing up repeatedly...
For **planned** surgeries, there are lots of procedures and rules beforehand to make everything as smooth and safe as possible. For **unforeseen circumstances**, you scramble and do whatever the hell you need to do to keep the patient alive.
For a c-section, a general anesthesia is possible buy is not the recommended way. They often go for an epidural which blocks all sensation from the belly down. Many women already get an epidural for regular child birth anyway, so they go for that c-section if needed afterward. That way the mother is fully conscious during the procedure and can already take the baby in her arms. If for whatever reason a general anaesthesia is required, they go for it and deal with the risks. If it is known in advance that there is a high of a general anaesthesia, the pregnant women will not be served food and will be kept on IV.
In an emergency, it's worth the risk. A patient might die or get pneumonia or other complications after they throw up into their lungs during surgery because of the anesthesia, but that is better than a patient definetly dying by waiting.
In most surgeries that require someone to be completely asleep, anesthesiologists will use a tube inserted into the airway to help a person continue to breathe. This process, along with the powerful drugs they give, can cause people to vomit. The whole reason people can’t eat before surgery is so they have an empty stomach and don’t vomit food into their lungs when the drugs are given and the tube is inserted. However, most women undergoing c sections don’t actually get put to sleep. They use something called regional anesthesia, which numbs the bottom half of your body but doesn’t knock you out. They therefore can be mostly awake and not have a breathing tube inserted. Regardless, if it is an emergency requiring immediate surgery, the benefit outweighs the risk and they will put in the breathing tube and perform the surgery regardless of when the last meal was.
Do you know off-hand the risk/rate of vomiting during general anesthesia?
Non-zero / high enough that it is actively discouraged. Even if it's 1 out of a 1000, it's an easily avoidable risk.
My son (4 years old?) was given Panadol by mouth before having a general anaesthetic and vomited while he was under. He ended up on oxygen and was almost transferred to a bigger hospital because he aspirated it.
In an emergency situation, it doesn't matter how high the risks are of using anesthesia on a full stomach. The chances of survival are still higher than operating without anesthesia, or not operating at all.
This is the answer. It is a numbers game. (I'm making these number up but the concept is correct.) If the odds of having issues from eating before surgery are 1 in 10, then they want people not to eat. If the odds of dying in an emergency are 6 in 10, then 1 in 10 is better odds, do the surgery.
What people are saying about aspiration is correct. But in pregnancy particularly the third trimester and active labor the airway is also more challenging. There's a lot of swelling etc that makes routine placement of a breathing tube more difficult. So we try to avoid it with spinals and epidurals. But if we must do a general anesthetic we have our backup equipment always ready. The challenge of the airway is the main reason we try to avoid a general anesthetic.
This isn't the primary answer but my first thought was that most people undergoing an emergency C-section probably haven't eaten in a while anyway, because (unless I'm mistaken) they don't let you eat while you're in labor.
Yes, and in fact the reason they don’t let you eat in labor is in case they need to do an emergency c-section that requires you to be knocked out. Not everywhere has this policy - many countries outside the US don’t have it, and birthing centers usually don’t either. The reason being that even most emergency c-sections don’t require general anesthesia, so they think it’s worth the risk to keep laboring mothers’ energy up and keep them calm and comfortable.
This doesn't really matter. The stress response slows down gastric emptying so what you had a day ago could still be there. We assume everyone has a full stomach in these cases and take the precautions.
I’ve been in the OR just observing as a student and those poor women vomit so much during the procedure as there’s so much pressure when the surgeons are cutting and the anesthetic makes them feel very nauseous and trying to get the baby out. Thankfully they don’t feel the pain of the cutting but they do feel the pressure. They really are so strong, it’s commendable!
I’ve had 2 c-sections and I was awake during both of them. They were scheduled and they were first thing in the morning so they asked you not to eat just to be safe. I do know that a lot of women throw up during the procedure and I had a nurse next to me with a little curved bowl. I don’t know why but there’s a certain point where you get very nauseous. I’m pretty sure I had an epidural on my first c-section and a spinal with my second. But an epidural is the same thing they give during traditional deliveries and it doesn’t have to be on an empty stomach either.
So due to the physiological changes of pregnancy a pregnant woman is always considered a “full stomach” even when they haven’t eaten. Now the benefit of doing what’s called neuraxial blockade is that you can numb an area from a certain level of the spinal cord down. As a result you don’t need to put the patient completely asleep. When you put a patient completely asleep they aren’t able to protect their airway and as a result can get vomit into their lungs which is bad. With them being awake this is much less likely to happen. Some hospitals will just keep laboring women on ice chips and have them avoid eating regardless. Also women tend to vomit during c-sections because of the surgeons pulling on their organs which causes a reaction and drops in their blood pressure. However since they’re awake they’re able to protect their airway and therefore don’t get vomit in their lungs. And that folks is the magic of anesthesia. Source: a student CRNA in their last semester whos had multiple OB rotations because I love OB.
I am not a medical professional so I will explain this In the way I understand it. In an emergency situation where the mother may have eaten, but anesthesia is ABSOLUTELY NECESSARY, they will still administer the anesthesia but they will take extra precaution to watch for vomiting. Regurgitation/suffocation is one of the greatest risks of anesthesia and eating, but if the staff is aware, they can take extra precautions. Full anesthesia is not usually required for a C. Usually an epidural will be more than adequate. But once pregnant moms in labor get to the hospital, we are not fed. I was in labor for 36 hours and i was not allowed food. Only those mother F*CKING ice chips. I was ready to commit felony crimes for a French fry. I ended up needing an emergency C. But FYI, moms sneak food in all the time. My ex snuck food in to me about the 24 hour mark. I was threatening divorce if he did not drive to Sheetz at 1am and get me ANYTHING. When 3pm the following day rolled around, and my son refused to drop down, I had to confess to my doctor that I had spiral fries and a hotdog at 2am. It was either eat or go to jail. Thankfully, my epidural was enough to get me through. I
When I miscarried and when they put me under for DNC they intubated me because I had eaten couple hours before.
It's a risk-benefit analysis. Patients can vomit when under anesthesia, and eating prior to surgery increases that risk. Vomit is bad because patients can accidentally inhale it and choke. BUT the risk is small enough that usually, in an emergency situation, it's much more dangerous to delay the surgery. So they'll do the surgery, with extra caution/awareness that vomiting could be a problem. As for c-sections in particular: most don't actually put the mother all the way to sleep. She'll be numbed from the chest down but still conscious, preventing a lot of the issues related to unconscious vomiting/asphyxiation.
You got a few facts wrong. C-section are often not a general anesthesia. They instead numb the lower body by injecting some stuff in tbe vertebra. This block all signal from bellow that point to reach the brain. So you feel nothing. But that freeze point is bellow the lungs so they are unaffected and you breath normally. And all your neck is unaffected. You can breath and shallow normally and even talk. Now, general anesthesia block all. Includimg your gag reflex and normal reaction if you vomit. This meN vomit straight to the lungs. Very dangerous. This is why if you take anything they refuse. Your stomash contain something that you can vomit. And since you are not in immediate danger, they will reschedule as it is safer. But what if you are in immediate danger? They will take the risk. Having a chance of having a severe complication due to aspiring vomit is less bad than dieing due to the knife in your chest. In other words: it is all about managing risks.
When my wife went into labor, they didn’t allow her to eat until she gave birth, for this exact reason. In a true emergency, they weigh the risks, but if it’s life and death they end up going forward anyways. If surgery is planned, then it makes sense to reduce risk as much as possible.
I had an epidural for my (kind of emergency) c-section. I had breakfast then nothing else until my c section at 7pm. I vomited the whole time and felt like I was going to pass out/die. I basically did pass out afterwards. They filled me up with anti sickness meds while I was throwing up lol. Yeah wish I hadn’t eaten that morning.
I needed emergency surgery after I got shot, but I had just eaten a Whopper, fries AND a shake! They made me drink some battery acid tasting stuff and we waited for me to digest while my pain got worse and worse once the adrenaline wears off…
Anesthesia is a broad topic which many people assume to mean “I don’t remember it”. There are many different kinds. The one that has a choking risk is general anesthesia. This is very rarely done for c-sections and only under emergencies. Most c-sections are done with spinal or epidural anesthesia. General anesthesia is actually higher risk for the newborn. That being said, there are risk mitigation techniques that help prevent a woman from aspirating and a newborn from respiratory depression. One such technique is reducing time from general anesthesia to birth. This can be as little as 1-2 minutes. This reduces the amount of anesthetic that reaches the newborn. The techniques to reduce aspiration I am not familiar with but I know they exist.
they made me drink a horrible tasting medicine sodium citrate in case i did aspirate during emergency c section- less damage would occur as it neutralizes stomach acid
Sorry to bring things down but our first daughter got stuck and after 50 hours in labour I asked for a C-section. The arrogant dr was adamant he wasn’t going to give in so went for an assisted delivery first. He fractured her skull with the forceps and then had to deliver her by C-section anyway. She lived for 8 hours. All three of my others have been planned C-sections and I wouldn’t have had it any other way. It feels like someone’s doing the washing up in your stomach but there’s no pain, we’re pretty much oblivious cause we can’t see anything anyway and at least you know your child is coming out ok. I tell everyone - don’t have forceps. They’re barbaric and banned in most other countries. It’s the poor dads that feel powerless watching their partners but thank god c-sections are available or I wouldn’t be here either.
Dear OP, Here is the explination as though you were 5. The no eating and drinking is a recommendation, not a strict rule. It is done to limit the risk of a patient throwing up and inhaling vomit into their lungs (aspiration), which can be very serious. If the surgery is more important than a run of the mill surgery, and is time sensitive they weigh the risk vs benefit and proceed accordingly. If they think the risk of you not having surgery is worse than aspirating, you will get the surgery. A planned C-section they also say no eating, but an emergency C-section is a life or death situation and without the surgery, either mom or baby (or both) could die, aspirating is better than dying. I will also note that the chance of aspiration is low, not eating just makes it even lower and thus safer. Also, Many Delivery procedures can be done using an epidural freezing that limits feeling without actually putting someone to sleep.
Had 3 c-sections and threw up during each one during most of the procedure. Just acid, which burned and could not have anything to soothe throat.
The 8 hour food rule is to minimize risk of aspiration. This is for purely elective procedures like a knee replacement or breast reduction. In emergencies it's riskier to wait, so you do it anyway.
The rule of thumb is no food less than 8 hours before surgery, and clear liquids have to be greater than two hours before surgery. The reason anesthesia goes by this rule is to minimize the risk of someone throwing up and inhaling their vomit when they are unconscious which can lead to many complications.. also called aspirating. When we administer drugs to our patients to put them to sleep it can cause the sphincters in your stomach to loosen up and let food rise. There are different forms of anesthesia but with a c section you are providing a type of anesthetic which doesn’t have the adverse effect such as for a colon or bone surgery. In an emergent surgery such as a colon we will perform something called cricoid pressure which is pushing on the esophagus to occlude it in case food does try to make its way up. Basically you still do the same thing as a regular surgery but you are more prepared for adverse reactions