Why its good to see your anaesthetist before giving birth?
Your are entering the great unknown and whilst you are an expert in your own field, you may not know as much about your options when giving birth. We always recommend where possible to educate yourself and understand your options as much as possible.
In the video below, Donna (our midwife) and Dr. Nathan Judd (Anaesthetist at Adelaide Anaesthetic Service) discuss this very fact at length. Have a listen to get some great insights into certain risk factors which may further drive your decision
This is also relevant if you think there is a chance you may have a caesarean birth or an induced labour.
Donna: Why would someone maybe need to see an Anaesthetist before birth? What would you say before birth?
Nathan: We do see quite a lot of ladies nowadays just to talk about their options for labour analgesia so either epidurals or anesthetics for cesareans, so spinal or general anesthetics.
We don’t see all ladies, but there are some that we’re particularly keen to see. And there are some people who perhaps can’t have an epidural for their labour, we do like to sit down and talk to them about what their options might be. And that would include people who have had previous back surgery. Or people whose blood doesn’t clot properly, for example – with very low platelets. Happy to talk to anybody who’s had a previous unsatisfactory experience with an epidural or a caesarean. Or is just worried about what might go on during labour or cesarean. We’re increasingly wanting to talk to bigger girls, so obese girls. And it’s just practical implications of getting a spinal or an epidural in for labor or cesarean, just it’s just harder.
And so to be able to plan that a little bit more and talk about the options, getting a timeline in place is particularly useful. And so if your obstetrician or midwife thinks you should see an anesthetist make an appointment, we’re happy to talk to you about it.
You get the bill from them, but what does the anaesthetist do for you during birth?
You listened to Dr. Nathan and when and spoke to an anaesthetist. And they spoke to you all about the risks and considerations with the painkillers and procedures you may need during birth.
But don’t be put off, be rest assured, it is still all your decision about how all these things happen. Watch Donna and Nathan speak about consent and how you are very much in control of your own destiny.
Dr Nathan also speaks about some great strategies to over come anxiety or hesitation about medication during childbirth. It is your body and your care, make sure they care caring for your health – whether that is emotional, physical or mental health. You aren’t putting them out, that is their job.
There’s a bit more to anaesthesiology than I thought, even the sneaky photographer role:)
Donna: So you always need, in say something like a caesarean, you always need an anesthetist and obviously surgeons. As well as all of the other support groups. And so the anesthetist’s role in something like that is to offer pain relief?
Nathan: So during a cesarean, our role is to make the procedure comfortable and tolerable for you. And there are only really three ways we can do that. The other thing that we do is sort out your pain relief afterwards. So for the first two hours, days, weeks. We’ll chart all that.
Donna: So you’re in charge of that as well?
Nathan: We’re in charge of starting the ball rolling, talking to you about it, and having a plan. And often if there are problems later on with pain relief, you guys might give us a call at home and sort something out for you.
Donna: OK. And you obviously make sure that the bloods are OK as well? So the doctor might have done the bloods, but it’s your role to interpret that in terms of the medications.
Nathan: Yes, yes. So whoever requested it should be following up as well, but we’ll be having a look at those. And making sure that it was safe to go ahead with your procedure and safe to have whatever pain relief afterward you need.
Donna: And I guess also for mums to know that before they have any procedure, they always have to sign a consent. So sometimes the mum’s a bit nervous about a spinal anesthetic, for example, for a cesarean, then maybe they see the anesthetist beforehand. So they get all that information. And there is this part that they sign, that they understand what you said.
Nathan: Yeah, that’s right. So we’ll certainly talk about the pros and the cons and make a suggestion about what anesthetics are best for you and then ultimately the choice is yours. And as a patient, you can choose to accept or choose an alternative. And then we’ll normally get you to sign to say that we’ve talked about it and are happy to go ahead.
Donna: So it’s always completely your choice and a great discussion to have with your care provider, whether it’s the midwife or the doctor. There are some people, I find that are very anxious about anesthetics and maybe they don’t like needles or they’ve had a bad experience before. And having a chat with you on a nice bright sunny day and not stressed and anxious, they can get lots of good information so that it doesn’t seem as scary.
Nathan: I think so. I think importantly as well, if you have a chat early on, you can put in place some other plans if you are needle phobic, hypnotherapy might just be magic for you. So go and see a hypnotherapist early on and spend some time with them. You’re not going to lose anything and it may well make a massive difference to the rest of your life, not just your labour and delivery. We can also do things like numbing cream if we plan ahead long enough to get you more comfortable with needles. And just to inform you about what’s going on so you can be relaxed.
Donna: Nathen had got lots of chit-chat to get you through a cesarean no problem, so you can talk about anything.
Nathan: I love taking photos of your baby as well once it’s done.
Donna: Yeah, he gets quite particularly with the angles, actually.
Before we go to much further, we need to talk risks. What are they?
It is important to have a really good understanding of the risks associated with taking medications during labour, birth and beyond.
We have all heard of the horror stories about permanent nerve damage or persistent numbness Dr Nathan helps put that in perspective. He also details some of the lesser know side effects and their potential impact on your life style.
Epidurals are not bad, they are one of the safer forms of anaesthetic but every medication comes with risks and side effect’s – be informed but not alarmed.
Some great insights into safe medication use and storage – worth taking note of. Not just with regards to pregnancy medication, but all medication that we might have in the house.
Donna: And to demystify some of the information that comes out there, like one bad, terrible outcome can make media all around the world. And the percentage of that can be incredibly small like something like permanent nerve damage.
Nathan: Yeah, so that’s fabulously rare. As far as permanent nerve damage goes to put it into context, there is a chance with an epidural in particular, also with a spinal, but less so. But your chance is something akin to your chance of dying in a car crash in Adelaide every year, right? So amazing low, if you’re getting into your car to drive around, you’re not petrified about that.
Your anesthetic, your spinal, or your epidural is essentially safer to manage from a permanent nerve damage point of view. So we’re talking 1:50,000 to maybe 1:100,000, something like that. So amazingly rare but it does happen.
Donna: And that’s the part of that information. Sharing them so that they understand a lot of medicine especially is just treating one bit and then going away. At least this one you can see it from the start to the end.
Nathan: That’s right. Do one job, do nothing else. Until that’s finished, do it properly, move on to the next job. It works for me.
So one in 200 ladies will get a bad headache, like a migraine after an epidural and sometimes that will need to be fixed with another epidural in a couple of days. Blood patch, that’s about one in 200 and that’s really just an irritation for those 1:200 because it will lay you flat for two days to a week even. But once again. 199 out of 200 won’t get that.
Donna: And if you think about that in a normal-sized maternity unit that’s about one a month, if that.
Nathan: Yeah, 1:1000 ladies will have a temporary irritation of the nerve in their back-
Donna: Like a back ache?
Nathan: No, causing some numbness or weakness in the legs for example. Or a tiny little patch in your legs perhaps.
Donna: Ohh like there are some people that go, this bits numb.
Nathan: Yes, that’s right. So 1:1,000 will have that. That gets better, but it takes days and weeks to get better. So it’s 1:1,000, as I said before, no significant damage it’s only going to some numbness and weakness. Thats fabulously rare, but not impossible.
Donna: And it’s not like the risk of having a car accident once a year in Adelaide doesn’t stop you from driving around?
Nathan: Absolutely not, no.
Donna: So you’d have to really put that in perspective as well. And reactions to epidurals and spinals, are there very many?
Nathan: Well, with regards to epidurals, most work really well. As far as reactions go, both an epidural and a spinal will cause your blood pressure to go down, to a certain extent. So we’ll measure your blood pressure often after they both go in. And if you don’t feel fabulous, just yell out. It’s usually quicker for you to tell you’re anesthetist or midwife you’re feeling a little bit lightheaded than it is for a blood pressure cuff to think about it and tell us the same.
And that’s easily fixed. You’ve always got a drip in a vein with some fluids or some medicine going in. And you’ll feel better straight away. So that’s common, it’s temporary, you know it’s not the end of the world,
Donna: And we’ve kind of already had a bit of a chat about the postnatal medications and the fact that you might start off stronger. And then certainly when you go home you get some education and some awareness about how to wean down on those things.
But it’s not like maybe when a doctor prescribes you a course of antibiotics and you think I better take them all. Certainly, postnatal medications and inflammatories have certainly got side effects. Paracetamol was fairly safe, but you’re stronger painkillers if you don’t need them, you don’t keep taking them because they got prescribed to you. You just wean them down.
Nathan: You take them when you need them, and if you don’t need them, don’t take them. That’s quite right because they do have their side effects. You’ve got no real chance of getting hooked on them if you’re using them as suggested, and stop using them when you don’t need them, they’ll disappear from your system pretty quickly.
Donna: And if you feel uncomfortable having some of those, more narcotic-based medications at home and you’ve still got some left. You can always take them back to your local pharmacy and they’ll dispose of them safely. Certainly the strong painkillers, we don’t encourage you just to put in the bin because you don’t want someone to come across them. So, you know, safe disposal of your medications.
Nathan: Yeah, you don’t want to leave things like that laying around in a cupboard for a kid to find them. So once you’re finished with them, take them back to your pharmacist to get disposed of properly.
Donna: And they’ll do it properly. Or even think, ‘Ohh, I remember those drugs I had when I had a baby. Four years later I’ve got a sore neck. I might take some endone’. It’s probably good to go back to the doctor and get that checked up and don’t share them as well. I do find that there’s a bit of a climate of medication sharing amongst some friends that is quite worrisome. Actually, because what did I have the other day, someone said ‘Ohh was feeling a bit anxious’ so my friend gave me her antidepressants and I’m like, Oh my God don’t. Just don’t.
Nathan: That’s not safe. It’s not sensible. It’s probably not legal either. So just don’t do it, just go to the GP,
Donna: Yeah, absolutely. And get that advice just for you, especially with the pain relief medication postnatal.
How are epidurals given?
We have given consent and now are at the stage of getting an epidural. But where is it given, what is the process and how does it work?
Donna and Dr Nathan go into some depth about how long an epidural can take and why we always talk about, if you want an epidural – you need to go early. They also discuss how it is inserted and can you lay on it.
The epidural works by injecting the aesthetic into the epidural space around the nerves in your spine. The anaesthetic acts like an inhibitor on the pain receptors to block the pain signals going to your brain.
Due to the localised nature of the epidural injection the impacts on the baby are minimal.
Donna: Epidurals. So lots of people think. Let’s see how I go. Or some people like no, I’m not going to see how I go. I’m going to have one straight up. So it’s still you we would call?
Nathan: Yes, an anesthetist will always put an epidural in and then write up the orders for it. And then midwives are trained to carry on with those orders and assess the effectiveness of an epidural and manage it in conjunction with the patient and call the anesthetist or get him to come back if there’s a problem.
Donna: OK. And you explained that with the spinal you curl up and then have a little bit of numbing and then the needle, is it very much like that?
Nathan: Very similar. So it does take a bit of time. Firstly, from the time you call for an anesthetist, that is if you’re in a public hospital, there’s one there waiting for you. Presuming we’re not doing anything else, they’ll be there straight away. In a private hospital, they’re probably going to have to come in from home – 20 minutes, half an hour maybe. And then it’s going to take at least 20 minutes, maybe 30 or 40 minutes for that epidural to be in and starting to work.
So the early message is, if you really want an epidural, talk to your midwife about it. Talk to your obstetrician about it, if you think you want one call for it as early as you can because it’s going to take, let’s say an hour or so until you’re comfortable from that time.
And they are really pretty simple to get in most of the time. There are some practical challenges and in all honesty, the bigger the ladies are, the harder they are to get in. Its just a bigger back to deal with, and it can take a bit longer to get it in and get it working.
Donna: Because it’s not like you’re putting a drip in because you can’t really see the spot. It’s a kind of a blind procedure.
Nathan: It’s all about feel, that’s right. So we look at a place to aim for, gently creep forward until we found the perfect spot thread a tiny little flexible catheter in there, and then stick it all down and put some medicine down.
You’re OK to lay on that afterwards. There’ll be sticky tape all over your back because we don’t want it to fall out. But there’s no harm laying down.
Donna: And moving around. And there’s that much tape. It’s not going anywhere. I find anesthetists are quite particular with how they like things to be taped down.
Nathan: Yep. And taking the epidural out when you are done though, it’s entirely different. It’s just a huge Band-Aid coming off your back. Piff and it’s out. It’s nothing like putting it in, its so quick and easy.
Ok, so we know know epidurals are given for pain relief during labour, but are there any other reasons?
I found this section fascinating. I didn’t realise the many other reasons of why the clinical team might consider giving an epidural. I thought it was all just about pain relief – turns out that’s not the case.
Nathan: And another thing about epidurals, there are times when an epidural is recommended to you by an obstetrician or midwife. So they have other uses than just making you comfortable.
So they’ll control the big blood pressure surges that you get with your contraction. So if you’ve got a problem with blood pressure like significant preeclampsia, for example, your obstetrician might say you need an epidural. And have a conversation with them about that about why it’s useful. But take their advice on board, we’re happy to come along and pop one in if it’s medically indicated.
Also for some people, if your obstetrician or midwife just knows you aren’t going to cope well with the labour. They might suggest you have one early on. They’ve seen a lot of people out there and they know often who’s going to cope well and who’s not.
Donna: Yeah, and there’s also in some cases with a difficult birth or twins birth, that the doctor will want some sort of an epidural on board, ready to use.
Nathan: And for significantly obese ladies we more and more are putting in early epidurals. Because it’s just so much harder when they’re rolling around in labour. It’s a challenging procedure anyway, just to find the perfect spot in a larger girl. They are more likely to have a cesarean also. So to have that in and ready to go in case they have a cesarean to provide great comfort for their labour is often the plan nowadays. Not always but increasingly so.
Donna: Absolutely. And you would generally have had that chat with the anesthetist before the birth anyway.
Nathant: Yes, that can all be planned.
Donna: So you’re well aware of it.
Phew, its over! Now for recovery and loving this baby.
Finally after 9 long months, it is over! Congratulation’s and great work mum.
Now for the recovery side of things. Often this is missed and all the focus goes to the baby. But a healthy, well mum makes for a health and well baby. This recovery stage is every bit as important as the 9 months you have spent growing this baby.
Take careful note of what Dr Nathan speaks about of particular note, make sure you are feeling pain free enough to get up and about. I found particularly interesting the conversation about pain medications and the impact of that on your ability to function and breastfeed. Well worth a watch.
Nathan: Your spinal anesthetic will start to wear off in about 1.5-2.5 hours. It will just drift away.
Donna: Goes downwards.
Nathan: Yeah, it’ll just drift down. So you’ll get your feeling back. Eventually, your leg strength will come back. That’s probably 6-12 hours until it’s fully gone.
So enjoy the first day after your cesarean and rest in bed. Put your feet up and then the next day you have to be up and about, out of bed. Enough pain relief to be comfortable to move. And get moving. Get out of bed. Otherwise, you’ll potentially run into some risks if you don’t get moving.
Donna: Yeah, yeah. It’s quite important to keep all that blood moving and deep breaths.
Nathan: And be comfortable doing that. So take some pain relief for the first couple of days at least and get moving.
Donna: And I guess, thinking about what your body does, if you accidentally got your foot stuck under a chair leg, you would get this instant message to your brain saying, ‘Your foot’s stuck, get it out’. And so that doesn’t alter the pain message when you’ve had a caesarean because your body’s like, excuse me?
Nathan: Yeah, that’s right. So you will have some discomfort afterwards. That’s just a fact and everybody responds to that differently and the amount of pain relief will vary depending on what you need. What your experience is and how you’re coping.
There’ll be options out there, but you just got to take something for the first few days at least. Certainly, Panadol four times a day. Plus some anti-inflammatories. These are the bare minimum. On top of that there will be some stronger options just ask your midwife for them if they are available.
Donna: There’s always good and bad with all of our stuff. It’s always a balance, sometimes really strong narcotics can make you feel really sleepy. And some people don’t like that feeling. Or some people really love it, a little bit too much and we’re like, you can’t be on them forever. But it’s about knowing that it’s more important that you’re moving about and you can’t expect to do that without some sort of medication.
Nathan: That’s right, for at least the first couple of days, you really need to be taking something decent to get up and get moving. And after that, you can start winding back a bit. And the stronger stuff has the potential to come out in your breast milk a little bit. But really the amount in your mind or in your brain is similar to the amount in your breast milk. So if you’re taking it and you’re not drowsy and semi-conscious, then there’s not enough in your breast to affect your baby. So if you’re taking sensible amounts of pain relief such that you’re comfortable but not sedated, you’re OK to breastfeed.
Donna: Perfect. And knowing that at that stage you’ve actually got very small amounts of colostrum or breast milk as well. So then you think of the relative percentage to that as well, it’s really risk-benefit, but the amounts are very, very small and you know if you weren’t moving because you weren’t taking pain relief, the risk to you for that. Is actually worse. So we’re always balancing.
And people explain that to you because you spend the whole pregnancy avoiding medication. All of a sudden we’re saying ‘here, you go’, But in that cesarean situation, there is a reason why we need to tell that message that your body is saying ‘this is really sore,’ to just calm down a bit.
Which is why we use that combination of paracetamol, which is going to make everything last longer, and anti-inflammatories we can’t use in pregnancy because it can affect that little hole in the baby’s heart that we want to keep open. But once the baby’s out, we don’t worry about that anymore. So unless you’ve got a medical condition where you can’t take an anti-inflammatory, we would use it certainly post birth.
Nathan: As a matter of routine, in fact, it’s one of the best pain reliefs.
Donna: Because there’s lots of muscles involved, so you want to just calm them down a bit and then maybe some sort of a stronger painkiller to balance everything up. Which is great.
And some people, even after a normal birth, use a combination of those painkillers. Because there’s lots of soft tissue e.g. the perineum, that can be quite tender and so and in terms of postnatal medications that’s kind of the three types that we tend to look at using.
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Disclaimer: This article is for general information only and not intended as a substitute for medical advice. All information provided on this website is not intended to diagnose or prescribe. In all health-related matters we recommend consulting with your local healthcare professional
