how to find out if the hosp/anesthesiologist will give pre-op calmative before C/S

[skeetaboat]

Hi everyone,

Just wondering if anyone knows how I could find out if the anesthesiologist will give me something to minimise anxiety during the c section - either a pre-op calmative or gas, OR, if neither of those are an option, something in the IV to calm me down once the baby is out.

I asked the midwife when I went to the birth preparation appointment but she didn't know. She said you get a consult with the anesthesiologist an hour or two before the C/S and you can ask him them. However, I'd like to know NOW if it is an option or not - if it's absolutely out of the question I don't know what I'll do.... but I need time to prepare...

Does anyone know how I would find this out? The staff at the hospital won't put me through to the midwifery department, and refer me to the booking-in department, who are never there and never answer the phone. I can't ask the OB because the OB I'm seeing isn't the OB who will be doing the c-section (I'm going to a public hospital so have no idea who will perform the c/s). The OB i'm seeing has said that I might be able to ask for a pre-op calmative, but he doesn't know what the hospital's policy is or if it really is an option or not.

I know there are other ways to manage anxiety: the staff will be lovely; everyone will talk to me and distract me; hubby will be there to distract and reassure me (at least until the baby is out and then he'll take the baby to the maternity ward and leave me all alone lying on the table while they've still got 40 mins of stitching up to do (hospital policy)!!!!!!!!!!!!!!!!!!!!!!!!); i can bring an IPOD with relaxing music, seeing the baby will distract me, etc, etc. I also know that many people have good c/section experiences without much trauma...... BUT, I'm not looking for advice on how to deal with the anxiety or reassurance that it won't be as bad as I think (I have heard all that, and thanks to everyone who is kind enough to offer their kind words and experiences)... but to be really honest I really just want to know how to find out anti-anxiety drugs are available or not, if anyone has asked for and received them, or if anyone was given a calmative/sedative after the baby was out.

I'm going to a public hospital in south east Melbourne.

Thanks in advance to anyone who replies.

[Phteven]

I've yet to encounter an anesthesiologist who doesn't hand out drugs like they're lollies. They always look so cheerful when they dose you up or hand you a script for some insanely powerful pain killer.

[Ryatha]

Yep - I was in contact with the mental health team for the maternity ward at my hossy, as I also have a history of anxiety. It was put in my case notes that I was able to have a short acting anti-anxiety shot in my IV if I freaked out. I luckily didn't have to use it but knowing it was there really helped me know that I would be ok. I was a public patient at a hospital in Adelaide, do you have a similar team you are able to get in touch with?

[skeetaboat]

Yep - I was in contact with the mental health team for the maternity ward at my hossy, as I also have a history of anxiety. It was put in my case notes that I was able to have a short acting anti-anxiety shot in my IV if I freaked out. I luckily didn't have to use it but knowing it was there really helped me know that I would be ok. I was a public patient at a hospital in Adelaide, do you have a similar team you are able to get in touch with?

Hi Ryatha, wow, I've never heard of a mental health team attached to a maternity ward. How did you find out about them? It doesn't seem like my hossy has one.. I think the midwife would probably have mentioned it to me when I asked about the possibility of anti-anxiety meds. She did follow up with someone on the midwifery ward but all they were able to tell her is 'she can ask the anesthesiologist an hour before the operation' . I too think that knowing it is available will help me (both during the operation and to stop me stressing out for the month I have left).

It does help knowing that it was an option for you, and from what I can gather it's routine in the US to offer a pre-op calmative to all c/s patients... so I know it's not totally out of the question medically.... but the fact that two midwives at my hospital have no idea if it's allowed at this hospital or not isn't very reassuring...surely if it was common or at least occasional, they would know about it???

Thanks for your reply

[Ryatha]

I found out about them by asking... I had bad PND with DD1 and when I recognised the warning signs when I was 6 months pregnant I told my middy that I needed help and she got in contact with them. It made a huge difference and so far, fingers crossed I haven't got PND.

I guess if the midwives don't work in delivery often they may not know about the options available. I spoke to the head of the delivery ward about my options. I was really really proactive due to my first birth experience and I think they appreciated me asking lots of questions and making sure I got help when I needed it. Keep asking, it doesn't hurt and it may make all the difference when you go in to have your baby.

Feel free to PM me if you want to know more or just want a chat!

[Mother Goose]

Largely it is going to depend on the anethetist on the day and also how you yourself are coping. You can ask for one when you see them (or if you're on the ward, start asking the nurses/midwives). You can also start talking about it with your caregivers now and gt them to make a notation in your history about your concerns and needs.

The problem with asking which anethetist will be on duty for then now is that rosters change, anethetists get moved from list to list depending on complexity of patients and surgeries happening in other theatres, also on sick leave. So it is very variable. But, like Bron said, anethetists do tend to be happy to dish out drugs

[AnyDream]

You should have a pre-surgical appt several days before your CS is booked. On that day you should expect to see someone from the obstetric team (probably a registrar) AND someone from the anaesthetists team. Ask them about it then (you can ask to see the consultant - who is the head anaesthetist doctor) and use this opportunity to discuss your fears as well as a plan on what can be done. They may also schedule you earlier on the list so you don't have to wait as long on the day. Good luck.

[skeetaboat]

Hi Marydean, my hospy doesn't do a consult days before the c-section, but you do see the anaesthetist an hour or two before going in for the actual c/s.

I really want to find out before the actual day.. rather than stressing about it for the next month or finding out at the last minute that there's no possible option for anxiety relief and having a panic attack or freaking out. I don't have any further consults with anyone who is actually connected to the hospital, so I'm going to get in contact with the hospital advocate or social worker to see how I can find out what the hospital policy is or who I should ask.

Thanks for your advice

[Schmickers]

Maybe try asking if you can see the registrar / consultant at your next antenatal appointment, and discuss it with them? If they order it, the anaesthetist (or the midwives if it is ordered preop) will give it.

[HotI]

I had an appointment with one of the anaesthetists prior to getting pregnant to assess my medications, medical history and how this would affect pregnancy and birth (either labour or CS). The person i spoke to was prob not the dude i will see on the day, but the plan talked about went in my file.

This was at a public hospital in Melbourne.

Is it possible to get an anaesthetic assessment at your hospital? A patient advocate or social worker may be able to help you get the info.

take care

[skeetaboat]

Hi everyone, I just spoke to a middy from the birth unit, and she called theatre and spoke to an anaesthetist, and he said there is definitely an option for a pre-op calmative before the c/s, I just have to ask for it when I first arrive. Thanks everyone for your advice.

[synergygirl]

Hi Skeetaboat
Sorry to hear that you have been so stressed. Although I havent had a CS I recently had surgery (in a private hospital) but fortunately managed to have a phone call consult with the anaesthetist and alerted him to my fears and he assured me of a calmative being administered. I was given an oral dose of valium and it was just truly amazing the difference it made to my demeanor. No stress and no anxiety AT ALL. My recovery was easy also.
This is NOT to say that this would be in any way similar to a CS but just the assurance of the treatment being available and then it actually being instigated made my 'process' a simple journey. No panic attack nor feelings that I may 'lose it' just prior to my procedure. I do suffer anxiety even under normal life situations but I did not want to be frightened in this situation.
Do you perhaps have a close friend or relative who has been through something similar that could perhaps be a mentor for you? Nothing worse also than feeling alone even if you have your husband nearby. They are a great support emotionally but sometimes they dont really understand those feelings of sheer panic and/or anxiety
Thinking of you ..

[Me+him+bub]

i would say 99% yes, im an RN and have worked as an anaesthetic nurse, just last week to be exact! and where i work its routine to give everyone a calming agent before any operation big or small, sedated or epi. there are quite a few different drugs but they all have the same effect.

[Tecopa]

I too am thinking about the same thing. I really am not sure I'd cope if I need a C-section. I'd love to know if anyone has had any luck in being asked to be put under for the entire thing?

My sister had a C-section and it was okay until the baby was out but she hated some of the sensations afterwards and started to freak out. They offered to put her under then, but I'd prefer to just miss the whole experience. To me the option of seeing the baby first pulled out isn't enough for me to be able to stay awake for it! I'm terrified.

[skeetaboat]

Hi all,

I just thought I'd come back and share how it went for me.

I months before my c-section, I did some research to find out if there are calmatives/sedatives that are safe to give the mother in small doses. I found several randomised controlled trials and research studies in peer reviewed journals on various substances used to calm the mother while a c-section was performed on her under a spinal or epidural anaesthetic. I found out that there are several substances which can be offered in small enough doses that they have negligable effect on the infant's APGAR or respiration, but still provide enough anxiolosis (anxiety relief) to make the c-section less traumatic for the mother.

I rang the hospital about 3 weeks prior to my scheduled c-section to ask if I could have one of these as a pre-op calmative before the c-section. The midwife I spoke to called theatre to speak to one of the anaethetists. Whoever she spoke to said that it would be no problem, I would just have to organise it with the anaethetist when they came to see me about an hour or two before the c-section.

When I got to the hospital on the morning of my c-section, I asked the midwife who was assigned to me about a pre-op calmative/sedative. At first she tried to talk me out of it (gave the the 'anything we give to you affects the baby' spiel). I told her that from my research there were a number of safe substances they can give, and that I had already called 3 weeks ago and was told that it wouldn't be a problem. She then she said she would speak to the anaethetist.

The anaethetist came around and I explained yet again that I was scared sh*tless and wanted a mild sedative or calmative before they began cutting me so that I didn't freak out and have a panic attack on the table. He also tried to talk me out of it ('anything we give to you affects the baby' spiel again.. I was getting very sick of being treated like an uniformed dummy at this point). I then started freaking out a little thinking that a pre-op calmative was not going to be an option. My hubby piped up at this point and basically said 'she needs it and wont go through with the c-section without it'. At this point he said 'Ok. We'll organise something'.

I felt a bit better, but just couldn't totally relax because I had a feeling that they would reneg at the very last minute.

My time came and they wheeled me down to the operating theatre waiting bay. I stayed there for another hour getting progressively more anxious. A second (and seemingly more senior) anaethetist came out to speak to me and explained that they would give me something after the baby was out but not before. At this point I burst into tears and decided that I couldn't go through with it. Hubby once again came to the rescue and said something like 'she really doesn't want to be talked out of this, she can't cope with the idea of being cut open while wide awake, even if she can't feel it, she can't mentally cope with it. She's not asking to be knocked out completely, she just needs something mild to make her less aware of what is happening so she doesn't freak out'. The anaethetist did a backflip at this point and said 'of course, this is your day, we don't want it to be traumatic for you, we can give you the spinal and a mild sedative which I will top up until you're at the point that you feel like you can cope with the operation going ahead'.

Turns out that the fist little bit they gave me was enough to calm me down and they were able to go ahead straight away. I believe it was propofol (diprivan) that they gave me. My son let out a cry as he was born, had no respiratory problems, and scored a 9 and 9 in APGARS.

I was awake and talked to my husband throughout the procedure. I was barely aware of what they were doing to me and when I was aware, it didn't bother me. Occasionally I felt pulling and tugging but it didn't freak me out.

So I just wanted to share my experience just in case anyone else with high anxiety about surgery whilst awake visits this thread. In my experience, it was very difficult to get a pre-op calmative and the whole experience leading up to the operation was really stressful. In hindsight I wish I'd made an appointment with someone from the hospital so that it could have been pre-approved. Having to explain myself and battle with 3 different people on the day when my anxiety was already high and my ability to reason and argue was low, made me even more stressed out and anxious leading up to it.

[skeetaboat]

Tecopa, I believe that if you don't consent to the spinal or epidural, they have to put you under. There are risks that your bub will need resuccitating if you have a general, which is why they don't advertise general as an option. What I had (small amount of sedative and a spinal - see previous post) worked out really well for me with much less risk to baby. I wasn't freaked out at all and coped really well during the op. HTH.

[Lulu]

Skeeta - whilst I'm glad it worked out well for you, I can't help be slightly PEEVED that they only listened to your DH. Sheesh!

[HotI]

Congratulations on your little boy, and its great that you got what you wanted (needed) in the end.

(I agree with Lulu, too!)