Three questions you should ask your anaesthetist before a C-section.Apr 19, 2023
- What will you do if I say I can feel the surgery?
- Will you believe me?
- Will you take action to stop me feeling the pain?
In 2016 Dr David Bogod, reported in the British Journal of Obstetricians and Gynaecologists, that approximately 92% of all C- sections in the UK were carried out under regional (spinal, epidural or combined spinal-epidural) anaesthesia. This he said, has helped reduce the risks associated with a general anaesthetic, which in the past had been one of the top causes of maternal death.
In place of that risk, there has been an increase in cases of pain being felt during caesarean delivery. This had become almost certainly the most commonest reason for successful negligence claims against anaesthetists.
Dr Bogod said,
“Complete comfort cannot be guaranteed for patients being delivered surgically when awake because, although the level of block required for a caesarean section extends to the upper thoracic dermatomes, sometimes this is not enough. We know that a small proportion of patients will feel pain and that in some cases this will warrant intra- operative conversion to general anaesthesia. The Royal College of Anaesthetists sets an audit standard that fewer than 5% of elective patients should feel pain and that fewer than 1% should require conversion to general anaesthesia; these ﬁgures rise to 20 and 15% respectively, for Category 1 procedures i.e. for emergency reasons.
This means that between 5% and 20% may feel a spectre of pain during surgery, of that less than 1% should require conversion to a general anaesthetic. I was one of the 5% of elective caesarean cases who felt the scalpel cutting through the layers, stretching the uterus open to birth the baby, followed by the stitching; only I was not offered a general anaesthetic. Women and birthing people must be informed that it can and does happen on rare occasions. You must have this conversation with your anaesthetist. The accepted standard is that only 1% of the 5% -20 % of women who experience pain in surgery, will need to have their anaesthetic converted to a general anaesthetic and be asleep for the rest of the surgery. Who makes that decision? Conversion to a general anaesthetic is not always offered by anaesthetists, as was the case for me. It seems women and birthing people are sometimes not believed and consequently have no action taken, therefore being left with no choice, but to endure the raw pain of the surgery.
The aftereffects of birth trauma can be devastating and lifelong if not identified and treated with effective trauma therapy. I was one of the 1% who should have had a conversion to a general anaesthetic. I know from personal experience, the lifelong fallout, the PTSD symptoms have been often triggered over the last three decades. Don’t risk it. Get your anaesthetist and OBGYN to assure you that if you feel sharp raw pain he will halt the surgery and either treat the pain or allow time for conversion to a general anaesthetic.
If you are not believed and not put to sleep, the aftershock may take weeks or months to emerge and morph into symptoms of PTSD. This can impact the persons bonding with their baby, their general well-being, and their capacity for quality sleep, irritability, flashbacks, hypervigilance, fear and anger.
The terminology commonly used today for such mistreatment is obstetric violence. Obstetric violence occurs when a woman or birthing person is not listened to by any member of the obstetric team, and they feel powerless and violated in some way.
Be loud, be strong call it out. It must not happen with today’s modern medicine. No woman or birthing person should lay powerless, feeling themselves being cut open, whilst wide awake.
Dr David Bogod spoke of his experience giving his opinion in medicolegal cases while a consultant anaesthetist at Nottingham University Hospitals NHS Trust in 2015. He said that in 74% of the 76 claims he was called for an opinion on, problems seemed to arise in four main areas.
- “During the consent process. It is mandatory to warn patients that they may feel pain which might be severe enough to need converting to general anaesthesia. Without this important information, patients are not able to make a fully informed decision about what anaesthetic technique they prefer During. The burden upon doctors in the UK to ensure that patients are provided with sufficient information has been highlighted by the recent Supreme Court verdict in Montgomery: Montgomery v Lanarkshire Health Board(2015]) UKSC 11, (2015)All ER(D) 113 (Mar).
- It is essential to test the block carefully, especially the upper level, and ensure that it is high enough before allowing surgery to begin. Cold stimuli such as ethyl chloride are almost universally employed for this purpose, and the patient should not feel this as cold until the fourth thoracic dermatome (T4) is reached, represented by the middle of the breasts. Ideally, even the sensation of touch should be abolished below the T5 level.
- When the patient complains of pain, it is important to(1) believe her, and (2) take action. This often means temporarily halting surgery (unless the uterus has been incised prior to delivery or haemorrhage control is necessary), giving fast-acting and hopefully effective intravenous analgesia, and ensuring she is comfortable before cautiously continuing.
- Failure to control pain should lead to an early offer of conversion to general anaesthesia, repeated if initially declined. “
SUBSCRIBE FOR OUR CAESARCARE UPDATES
...AND GET ACCESS TO DISCOUNT CODES AND REWARDS
We hate SPAM. We will never sell your information, for any reason.