Okay OB nurses All about a cesearean?

nurse_wannabe · Jan 17, 2005

Ohh gee thanks steph , fecal incontinence ?

:chuckle

I know how you feel! I am due in June and will be having my 2nd C-section.

As far as the fecal incontinence goes, for my 1st one I received a cleansing enema before the surgery. I'm sure it depends on your doctor's/midwife's preference, but that might be something you may want to check into. I would much rather have an enema than make a mess on the operating table! :imbar

The other recommendation I would make to you is to stay awake during the procedure. The first time, I opted to get "knocked out," (I'm still a student, ok? LOL). Waking up after surgery totally disoriented, in horrific pain, and scared to death was by far the worst part of the entire ordeal, and that includes all the pain afterward.

BUT, the morphine drip that followed was nice. :roll

LPNnurse · Jan 17, 2005

You will be fine! I recently had an emergency c-section after 35 hours of labor and I was SO HAPPY with the spinal! Surg. was fine as well. I didn't feel a thing and I had a happy healthy little boy. The recovery is not fun for a week but I have to say I would take the discomfort of the recovery for a year over 10 sec. of labor! Just relax! They had to try 3 times to get my spinal in the correct way but it really did not hurt. I sat on the side of the bed with my boyfriend standing in front of me and I just held on so he could support me. Try it that way and I think you will be okay! Good luck and just remember that the spinal will be a faint memory soon!

I was just told at my last check up that I will have to have a c-section . I have had three lady partsl births , with no drugs . I am terrrified of getting spinal anesthesia and the whole c-section . My midwives explination was too brief for me . Any advice ? What I need to know ? How long does it take ? The only knowledge I have is that from nursing school .And since I now work in LTC it really isn't much . Any words of wisdom greatly appreciated! :)

allnurses Guide · Jan 17, 2005

You will be fine! I recently had an emergency c-section after 35 hours of labor and I was SO HAPPY with the spinal! Surg. was fine as well. I didn't feel a thing and I had a happy healthy little boy. The recovery is not fun for a week but I have to say I would take the discomfort of the recovery for a year over 10 sec. of labor! Just relax! They had to try 3 times to get my spinal in the correct way but it really did not hurt. I sat on the side of the bed with my boyfriend standing in front of me and I just held on so he could support me. Try it that way and I think you will be okay! Good luck and just remember that the spinal will be a faint memory soon!

I have to agree with you about the pain . . . I hated labor pains. I secretly wished for a cesarean with my 4th. Didn't want an emergency one but everything worked out.

The incontinence was a side effect of the hemabate .. I must have been bleeding more than pitocin could handle - I don't remember the details. Hemabate is usually not the usual first choice after delivery of the placenta so don't worry about that.

There is a difference between a spinal and epidural . . Marie gave you some great advice about writing your questions down in a notebook and making an appt with the anesthesia person. We usually do epidurals and that doesn't go into the spinal column.

Normal lady partsl deliveries sometimes include a bowel movement. I have a friend who had all her kids at home and we had a discussion about it and I worried about the mess. Birth is messy, very messy. I mentioned the bm and she was shocked. "I didn't have a bowel movement when I gave birth". Well, you don't usually know that you do. :)

Anyway, you will do fine.

Are you getting your tubes tied at the same time by the way?? :)

steph

BETSRN · Jan 17, 2005

have to have a c-section because I have monsters that pose as babies ! LOL
My last child was delivered natural 11lbs4ozs and she suffered erbs palsy . I also hemmorahged and needed blood transfusions. My other children were around the 10lb mark and strangely I did not have gestational DM . I am apprehensive due to the location (spine) of needle! I have heard horror stories of complications after spinals , who knows if they are true ?

There is NO needle left in your spine at all. A needle is used to put in the medication, but nothing is left in your back with a spinal and with an epidural, a tiny flexible catheter is inserted into the epidural space through the needle and then that needle is also removed. I just wanted to make sure that you know that.

Burnt Out, ASN, RN · Jan 17, 2005

I had an emergency c-section almost 3 years ago. I had a spinal.

I was afraid of the spinal too, but the anesthesiologist and CRNA were great-they explained every little thing they did before they did it. About the only thing that really hurt was when they used the local to numb my skin-just felt like I was being stung by a bee and then they used the needle to inject the Duramorph and my legs felt warm and tingly. If you have a spinal, be prepared to loose feeling in your legs very quickly! :)

I did not feel any pain during my c-section: just pulling and tugging. Now that feels a little strange but it doesn't hurt. The only time I felt any discomfort was when the perinatologist was stitching all those muscles back together and my chest started hurting-the CRNA assured me I was fine-I think he gave me some Nubain (not sure) and told me they were pulling my muscles back together. And I also had uncontrollable shaking-they put more warm blankets on me but that didn't stop it, so they gave Versed for that.

When you are healing, don't be afraid to take your pain medication-remember, a c-section is major surgery. And another word of advice: Don't drink anything with a straw-I was allowed Sprite/7-Up, water and popscicles after I was good and alert and my post partum nurses wouldn't let me have straws at all because of gas (sucking in a lot of air). Thanks to that, I did not have horrible gas pain! :)

bam_bam · Jan 17, 2005

One thing I would like to add: When the doc is getting the baby out, they have to apply pressure to the fundus. This can be rather scary feeling if you aren't aware of it. It feels like an elephant is sitting on your chest and it is hard to breathe. This is only momentary and is very normal. Good luck!

kmchugh · Jan 17, 2005

Xmaxiex

This will be a long post, but I want to try to give you a lot of information. You have received a lot of good advice and support here. Lots of these folks have had c-sections, or been involved in a huge number of them. What I really want to do is try to alleviate your fears where the anesthetic is concerned, since that is what I do every day.

I am apprehensive due to the location (spine) of needle! I have heard horror stories of complications after spinals , who knows if they are true ?

The truth is that if one third of the stories we all hear about people dying, or being paralyzed, or turning into frogs from spinals and epidurals were true, we would have stopped doing them a long time ago. No anesthesia provider wants to do anything to you that has a high probability of causing you harm. In fact, where c-sections are concerned, spinal or epidural anesthesia is greatly safer than general anesthesia. Plus, it give you the advantage of being able to be awake when your baby is born, and no post-operative sluggishness or grogginess that goes wit the general anesthetics. I have enough confidence where these anesthetics are concerned that I plan (in a few years) to have my knee replaced under spinal/epidural anesthesia.

First, the difference between spinal and epidural anesthesia: With epidurals, we aim to stop the needle just outside of the dura, then place a small catheter (plastic) in the back. This catheter can be dosed as needed, and therefore is a great anesthetic for laboring women, as well as for post-operative pain management. With a spinal anesthetic, we use a smaller needle, and actually go through the dura. The gold standard of correct needle placement is a return of CSF. Through that needle, we inject a small amount of local anesthetic, usually bupivicaine, sometimes along with about 25 mcg of fentanyl into the spinal space. This medication blocks all nerve impulses from about T-6 down. Meaning you don't feel much at all below your nipple line. With either anesthetic, one thing many first timers find somewhat nerve wracking is that the patient is "paralyzed" below the level of the block. This isn't a complication, it's normal. When we block the nerves, we block all the nerves. The ones that transmit pain as well as the ones that carry movement commands. Depending on a number of factors, all the effects of the spinal will generally wear off in one to four hours.

The advantage of the spinal technique is that once you have a return of CSF, you are sure that you are going to obtain a good, dense block, with no "hot spots" or patchieness. The downside is that once it wears off (and it will last long enough to do a c-section, as well as give you some time numb after the operation), it's gone. It is a "one shot" deal. With the epidural, on the other hand, we leave a very small (20 gauge) flexible catheter in your back. We can intermittently dose this catheter, or even hook it up to an epidural pump to give you a constant infusion of medication to keep you comfortable. Epidural catheters can and often do stay in place for 48 to 72 hours. However, with epidurals, sometimes the block may not be quite as dense. Owing to the anatomy of the epidural space, it is possible to get a block on one side, and not the other, or to just have "hot spots," small areas that don't seem to be well numbed by the epidural. These are pretty rare problems, though, and all can be handled by your anesthetist.

Another technique many anesthesia providers (myself included) like to use for scheduled c-sections is a combined spinal-epidural technique. With this technique, an epidural needle is inserted and the epidural space is identified. Then, a spinal needle is inserted through the epidural needle to get the return of CSF. The patient is then given a spinal anesthetic dose, and the spinal needle is withdrawn. Then an epidural catheter is inserted, and the epidural needle is removed, leaving the epidural catheter in the back. So, for essentially one stick, you get the benefits of both anesthetics. We have the nice, dense block of the spinal for the c-section, and we leave the epidural catheter for 24 -48 hours for post-operative pain management. (This is currently how I plan to have my knee replacement done.)

I can't say what is best for you, but ask your OB to let you talk about it with the anesthesia folks at the hospital where you are having the c-section. Together with them, you can come up with an anesthetic plan you are both happy with.

So, the way all this is done is usually to have you sit up with your legs dangling over the side of the bed. We identify the anatomy, then paint your back with betadine. Then we use a small amount (about 3 cc's) of lidocaine to numb the skin and sub-q tissues. This burns a bit, kind of like a bee sting, but that is usually the worst of it. Then, the spinal/epidural is inserted. One note, particularly with epidurals, you may feel a kind of electric shock sensation down one leg or the other as the catheter is inserted, like hitting your funny bone. That is pretty normal, just tell your anesthesia provider about it. After the anesthetic is given, you will be put back in the prone position. You may be put in a little head down position (trendelenberg) to allow for good cephalad spread of the anesthetic. During the section, you will not feel sharp. You may feel something like a pulling sensation, and depending on a number of things, you may feel a crampy feeling, kind of like menstrual cramps, but you should not feel much worse than that. When the section is done, you will be moved back to your bed, and transported to your room.

Sorry, got to get ready for work now. Later today, or tomorrow morning, I will come back and write a bit about complications. If you have any questions before then, just post them, and I'll answer then to the best of my ability.

Kevin McHugh, CRNA

BETSRN · Jan 17, 2005

I was just told at my last check up that I will have to have a c-section . I have had three lady partsl births , with no drugs . I am terrrified of getting spinal anesthesia and the whole c-section . My midwives explination was too brief for me . Any advice ? What I need to know ? How long does it take ? The only knowledge I have is that from nursing school .And since I now work in LTC it really isn't much . Any words of wisdom greatly appreciated! :)

I see you have had a lot of good responses here. All I would add is that you should stay away from ANY carbonated drinks (soda) until you are passing gas (rectally that is). Gas build up is worse before your system really gets going again. We also use ginger tea to help pass gas.....

Ginger tea recipe. Just pour a glass of gingerale and try and stir as much of the carbonation out as you can. Then microwave it with a tea bag in it. The combination of the tea and ginger are a real help to get the gas passing!

xmaxiex · Jan 18, 2005

Awww you guys and gals are the BEST ! I feel so much better already ! Kevin you are great ! I guess now all I want to know is how long before you get sensation back ? You know reading all of your responses I realized I am a control freak ! I guess with natural labor I had some sense of control . (which is totally silly cuz we all know that baby comes when it wants to ! ) And yes steph I am getting my tubes tied . Does this make a difference ? In what way ? As always my friends at allnurses are the best .

allnurses Guide · Jan 18, 2005

Awww you guys and gals are the BEST ! I feel so much better already ! Kevin you are great ! I guess now all I want to know is how long before you get sensation back ? You know reading all of your responses I realized I am a control freak ! I guess with natural labor I had some sense of control . (which is totally silly cuz we all know that baby comes when it wants to ! ) And yes steph I am getting my tubes tied . Does this make a difference ? In what way ? As always my friends at allnurses are the best .

I didn't like natural labor because I felt I had NO control over what was happening to my body. It had a mind of its own. Funny how we each perceive things.

And I was just curious if you were finished having kids and who was getting "fixed" so to speak. It doesn't make a difference at all if you get your tubes tied after the baby comes out. Everything is right there.

Kevin - just what I was hoping for. Great explanation.

steph

Burnt Out, ASN, RN · Jan 18, 2005

I guess now all I want to know is how long before you get sensation back ?

If I remember right, it took about 2-2 1/2 hours for me to regain total feeling in my legs back. They took me to the NICU to see my son after I got out of recovery and I was still numb from the top of my thighs down-I was a sight moving from the stretcher to my bed! My nurse would ask me if I could feel her touching my toes or if I could wiggle them-eventually I could!

kmchugh · Jan 18, 2005

I guess now all I want to know is how long before you get sensation back ?

Well, it may seem like a cop out answer, but the real answer is "that depends." If this is done under a spinal, sensation will return somewhere between 45 minutes to four hours after the spinal is administered. Factors that affect this include your size (both height and weight); the medication chosen (lidocaine, not often used for spinals, lasts about an hour, whereas bupivicaine lasts anywhere from one and a half to three hours); the dose; speed of injection; your metabolism, and about ten thousand other factors. On the other hand, epidural catheters can and often are left in place 24 to 72 hours or more after a procedure is completed. You have great pain management for the duration of the epidural infusion, but reduced sensation goes along with that.

What I have found is that a bupivicaine spinal works very well for c-section. Generally, if we can interrupt and block the pain signals before they ever start, post-operative pain seems to be less severe than it is for patient's who receive a general anesthetic and simply sleep through the pain signals generated. In the past, after giving women a bupivicaine spinal for the section, I have found that many need only one or two doses of demerol that day, and by the next day are out of bed and using PO meds (ibuprofen and percocet or lortab) for pain management. Some women, however, seem to benefit from having the epidural for 24 hours post operatively. That's a decision to be made by you and your anesthesia provider.

Let me speak for just a second about potential complications. It seems as though almost everyone knows a spinal or epidural anesthetic story with a bad outcome. ("My aunt's fourth cousin's husband had an old girlfriend, and her sister's best friend's nephew's wife got an epidural and she was paralyzed from the eyebrows down forever!") As I said in my last post, if even a third of these were true, we would have stopped doing spinal and epidural anesthesia a loooooong time ago. However, like anything else in medicine, spinal and epidural anesthetics do carry some risk of complications.

Now, books have been written about these complications. That's not my intent here. Suffice it to say that the potential complications range from the relatively minor (drops in blood pressure related to vasodilation, that are easily corrected with fluid boluses and/or IV neosynepherine or ephedrine) up to the catastrophic, including paralysis and death. However, it is safe to say that the more severe the complication, the more rare it is. In my career, I have heard of one epidural related death, and that happened at a hospital ten years or more before I arrived there. Rather than write about it here ad nauseum, allow me to again suggest that you have your OB set up an appointment with your anesthesia provider. Discuss your concerns with him/her, and let them tell you about the anesthetic. The folks who are going to do it are your best resource for information.

Good luck, and let us know how everything goes.

Kevin McHugh, CRNA