talk to me about spinal/ epidural meds and options.... - Mothering Forums
Forum Jump: 
Reply
 
Thread Tools
#1 of 33 Old 07-20-2011, 12:12 PM - Thread Starter
 
hildare's Avatar
 
Join Date: Jul 2009
Location: in-the-sticks-off-a-dirt-road, GA
Posts: 2,692
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I am hoping to try for a VBAC this time, but if it doesn't work out, then I'll have another c-birth.  I'm hoping to have a better experience this time if that's the case, though, and i know part of my problem last time was whatever they gave me made me totally geeked up and out.  i even refused pain meds, ALL of them, except torridol, so i know it wasn't that. 

 

my questions are:  what do they put in the spinal?  (i know it was some sort of opiate they gave me, and i told them i was ALLERGIC.  i guess they didn't believe me?)

 

are there drugs for a spinal that are less "druggy?"   Do they give other meds that can be refused? 

 

I guess I need to know options and what to do for a minimally drugged c birth.


Is it getting lonely in the echo chamber yet?

hildare is offline  
#2 of 33 Old 07-20-2011, 03:20 PM
 
AlexisT's Avatar
 
Join Date: May 2007
Location: Central PA
Posts: 2,265
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

You really need to speak to an anesthesiologist to find appropriate meds. Tell your OB you have allergies and need a consult. Every anesthesiologist has his own quirks. Mine just loved combined spinal-epidural, whereas an American anesthesiologist would probably have done a straight spinal in my situation (emergent C with no labor, so no epi placed).

 

There are different mixes, but they usually include an anesthetic and a painkiller. They also typically put in a long-lasting narcotic such as Duramorph for postoperative relief, though if they use an epidural they may use PCEA for post-op. IIRC there was a study showing that a narcotic in the spinal was preferable to IV PCA. IIRC, the mobile epidural mix is typically bupivicaine + fentanyl.

 

If you felt drugged, it may not have been the spinal/epidural. They may have given you IV tranquilizers which are routine in some hospitals (eg Valium, Ativan). Tell them you don't want them.


DD 01/2007, DS 09/2011

AlexisT is offline  
#3 of 33 Old 07-21-2011, 07:13 AM
 
kltroy's Avatar
 
Join Date: Sep 2006
Location: Chicago
Posts: 2,151
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

^ what she said - get a consult with an anaesthesiologist on this.  That said, I'd also fill your mental "toolbox" with everything that you can in terms of natural pain relief.  This would include thinking about heat and cold, water, having good labor support, and also simple things like guided visualization, self-hypnosis, and just plain counting your breaths or rocking.  The Birth Partner by Penny Simkin has lots of great suggestions on these, and she talks about the "3 Rs:  Rhythm, Ritual, Relaxation" (I think that's them?) that seem to work for people.  For me, sighing and counting my breaths, and focusing on my mom's mouth was enough to get me through labor.

 

Even if you opt for an epidural, spinal, or end up with a repeat cesarean, these techniques can help the situation to be less stressful. FYI when I had my first birth (c-section) I don't know what they put in the spinal, but once the duramorph wore off I was able to cope with just a large dose of ibuprofen (like 800 mg every 4 hours).  I don't like narcotics and I didn't want to feel loopy, plus my sense was that most of these don't function to reduce the pain, just to reduce the degree to which you care about it, if that makes any sense.  


Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

kltroy is offline  
#4 of 33 Old 07-21-2011, 11:29 AM - Thread Starter
 
hildare's Avatar
 
Join Date: Jul 2009
Location: in-the-sticks-off-a-dirt-road, GA
Posts: 2,692
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

clarifying.. i wouldn't get any drugs whatsoever unless i have another c-birth.  then there's no choice but to have a spinal or epidural. 

 

i was hoping there would be some medical field mamas who know what the commonly used drugs are so i can try to sound like i know what i'm talking about to the doc..??

 

do they always put the duramorph in?  that sounds like what would have made me feel so horrible.  i was told at the time of my last c birth that they did NOT use opiods (lie) and that they couldn't give me valium or something to calm me down. 

 

do they put the complete list of drugs in your ob chart?  or will i have any way to find out what they used? 

 

:( i guess i just want somebody to tell me they had a spinal or whatever with a c birth that DIDN'T make them drugged up or have opiates.  (come OOOOOOOON VBAC!)


Is it getting lonely in the echo chamber yet?

hildare is offline  
#5 of 33 Old 07-21-2011, 03:39 PM
 
mambera's Avatar
 
Join Date: Sep 2009
Posts: 1,308
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)

That is very weird.  The whole point of the spinal or epidural is that the medication stays around your lower spinal column and doesn't get into your bloodstream, hence should not get to your brain at all.  (Nor to your placenta, and nor to your baby, despite widespread misconceptions on this site to the contrary.)  No matter what they put in it.

 

Are you sure you did not get anything at all orally, IV, or IM?  (I see you say you got Toradol but that is an NSAID and should not have affected your mentation either.) 

 

 


Me, DH, DD1 (5/2009) and DD2 (10/2011).
I'm not crunchy. I'm evidence-based.

Vaccines save lives.

mambera is offline  
#6 of 33 Old 07-21-2011, 04:58 PM
 
AlexisT's Avatar
 
Join Date: May 2007
Location: Central PA
Posts: 2,265
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Duramorph isn't universal, but it's extremely common. I cannot imagine that they would do it with no painkillers at all. You'd be in excruciating pain as soon as the anesthetic wore off.

 

I had opiates, but I did not feel drugged. They used diamorphine in my epi, which is pharmaceutical grade heroin. (Not legal in the USA, you definitely didn't get that.) If you're going to get drugged off anything, that would be it.

 

Can you get your records? They would show what was used.


DD 01/2007, DS 09/2011

AlexisT is offline  
#7 of 33 Old 07-22-2011, 05:40 AM - Thread Starter
 
hildare's Avatar
 
Join Date: Jul 2009
Location: in-the-sticks-off-a-dirt-road, GA
Posts: 2,692
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

you know, this totally makes me angry.  i knew what i was choosing when i elected to take the Toridol, but i absolutely did NOT give any sort of informed consent about the drugs they used in the spinal.  i was pretty specific about my reaction to opiates and that i did not want them. 

it was difficult for me to process what was happening and i had tremendous difficulty getting breastfeeding going. 

do they not have to tell you what is in the medication with the spinal?  i'm not sure how informed consent is supposed to work but i think in my situation it pretty much went wrong. 

i guess opiates affect everyone differently, but if i said i didn't want narcotics, i don't think the anesthesia doc should have just ignored what i said without explaining that it wasn't possible to do without or whatever.  i'm definitely going to be more vocal and proactive if this happens again. 


Is it getting lonely in the echo chamber yet?

hildare is offline  
#8 of 33 Old 07-22-2011, 11:05 AM
 
AlexisT's Avatar
 
Join Date: May 2007
Location: Central PA
Posts: 2,265
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

This may have been a miscommunication, too. They may have thought you meant postoperative narcotics such as additional morphine or Percocet. I don't know what else they could use in the epi, or if they could have picked an alternate med that wouldn't trigger your allergies. But again, I would really suspect that the culprit was something in your IV, not in the spinal/epidural. Either they did give you a tranquilizer, or they gave you additional painkillers IV. The usual reaction to Duramorph is not feeling drugged, but nausea (especially for epidural administration) or itching. Meds are frequently given to counteract these effects (Zofran and/or Benadryl). You're not supposed to feel drugged from an epi; that's the point, and one of its big advantages over IV meds in labor.


DD 01/2007, DS 09/2011

AlexisT is offline  
#9 of 33 Old 08-03-2011, 04:20 PM
 
brovie's Avatar
 
Join Date: Aug 2011
Location: Vancouver, BC
Posts: 5
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Drugs that typically go into a spinal or epidural for C/S:

 

local anesthetic (usually bupivacaine or ropivacaine) - causes the numb sensation, heavy/ weak legs

narcotics:

short acting typically fentanyl or sufentanil - acts synergistically with the local anesthetic (smaller doses of both drugs cause greater effect than either alone).  Usually peaks around 20 minutes, lasts about an hour or so.  Small amounts of fentanyl or suf will leak out of the spinal or epidural space into the blood stream and can cause some sedation effects.  the epidural dose is higher than the spinal dose which makes this more likely.  However, the actual doses for either route are very small.  Typically for fentanyl, 20 micrograms in a spinal, a dose that if you were given IV you probably wouldn't even notice.  This short acting narcotic really helps to numb the peritoneum (the membrane of your abdominal cavity NOT to be confused witht the perineum)...without it there can be uncomfortable sensations that local anesthetic alone can't get rid of.

long acting: typically morphine or duramorph.  provides analgesia for a day or so after.  onset is typically an hour or so...which means that it starts to work as the fentanyl or sufentanil is coming off.  cuts down on the requirements for opioids/ narcotics via oral or IV after the operation and their associated side effects.  sedation is rare.

 

You could ask not to get any long acting narcotic if you end up needing a c/s again...but I would recommend sticking with the short acting fentanyl or sufentanil for the operation itself.

 

Its not uncommon to feel really tired and sleepy after getting a spinal or epidural...especially if you've been in labour for a while and are already sleep deprived/ flying on endorphins and catecholamines (fight or flight).  Once an absence of pain occurs and you crash off those endorphins sleep is nearly inevitable.

 

i'm a health care professional and I've seen lots of women fall asleep in the OR or shortly thereafter when they have been given NO sedation. 

brovie is offline  
#10 of 33 Old 08-03-2011, 04:41 PM
 
APToddlerMama's Avatar
 
Join Date: Oct 2009
Posts: 2,172
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by hildare View Post

 

my questions are:  what do they put in the spinal?  (i know it was some sort of opiate they gave me, and i told them i was ALLERGIC.  i guess they didn't believe me?)

What?!?!  You should definitely consult with an anesthesiologist  before                 be  beforehand.  I hope you're not planning on going back to the same place with this baby...  I don't know the answers about meds but I am shocked that they wouldn't take your allergy very very seriously.  When my son had to be sedated, the medication they wanted to use had some sort of reaction for people with soy allergies so they of course didn't use it even though he has tested positive, then negative to soy.  That is really shocking....  Anyhow, you can find out what they used last time by getting your medical records.  That was how I found out a year after the fact that I had been given pitocin in my IV without consent. 
 

 

APToddlerMama is offline  
#11 of 33 Old 08-03-2011, 04:42 PM
 
APToddlerMama's Avatar
 
Join Date: Oct 2009
Posts: 2,172
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

excuse my typos... mdc won't let me edit and the computer is being wonky

APToddlerMama is offline  
#12 of 33 Old 08-04-2011, 10:11 AM
 
EdzMommy's Avatar
 
Join Date: Aug 2011
Posts: 4
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Agreeing with Brovie...

 

I'm an American anesthesiologist and a mom.  When I obtain informed consent from a patient for a spinal/epidural/combined spinal-epidural, I do explain which meds I will be using.  I don't like to refer to opiates and benzos as narcotics...that's a police term and the meds are very different classes.  In general, I usually avoid benzodiazapines because they prevent moms from remembering the baby's birth...although I have used them if medically indicated.  Valium is long-acting, and it can't be given through the IV.

 

The dose of opiates in a spinal is on the order of 1/10th to 1/20th of what is given IV.  It should not cause drowsiness.  What can happen is that by blocking pain receptors in the spinal column, the amount of stress hormones released by the adrenal glands drops...and the amount of adrenaline in the blood stream drops.  The majority of women fall asleep or feel sleepy after the baby is born via c-section.

 

Toradol is a great anti-pain med, but it can affect the way blood clots.  If a c-section is complicated & there's a lot of bleeding, many OBs request that the anesthesiologist not give toradol.  It just depends on the situation.  Once the numbing medicine in the spinal/epidural wears off, there is nothing other than tylenol or opiates for pain control if we can't give toradol.  IV opiates (morphine, fentanyl) have more systemic effects than a single dose given through a spinal or epidural.  Opiates have a lot of bad side effects like itching, constipation, decreased bowel motility, sedation, etc.  But, major abdominal surgery (c-section) is painful, and we know that pain and stress hormones aren't good for moms or babies.  We have to find a balance.

 

While I never give a patient a medication that they're allergic to, I will sometimes give a medication if the patient describes a common side effect and not an allergy.  For example, itching and nausea are side-effects of opiates, not true allergies. 

 

Finally, I'd like to say that it seems like a lot of patients are anti-physician these days.  I went into medicine to help people...I've missed out on a decade of family holidays, weddings, birthdays, family vacations, funerals because of my training.  I get to work at 6am and leave around 6pm M-F, and I work at least one full weekend a month.  I'm not complaining, it was part of the training, and I love my job.  But, it's hard to read comments insinuating that my fellow anesthesiologists are untruthful or deceiving.  If the baby is in trouble (ie-the heart rate is dropping and the baby will soon die), we don't have time to discuss the cocktail put in a spinal.  We are trained to stay calm during true emergencies and take care of the mom and her baby to the best of our ability.  I'm a huge advocate of birth plans and empowering moms to make informed decisions.  But situations can arise that require flexibility of plans.  If moms have questions about pain-control options, its best to make an appt to talk to an anesthesiologist before heading to the hospital in labor.  Its hard to have an indepth conversation between contractions or as we're rolling back to the OR for a crash c-section.  

EdzMommy is offline  
#13 of 33 Old 08-04-2011, 10:31 AM - Thread Starter
 
hildare's Avatar
 
Join Date: Jul 2009
Location: in-the-sticks-off-a-dirt-road, GA
Posts: 2,692
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

brovie and edzmommy:  i really thank you for your input.  your information was very helpful. 

edzmommy, i am not anti-physician and i thank you for what you do.  i know you save lives and keep people from experiencing horrible pain.  i think some of the problem stems from me being the kind of person who wants to know EVERYTHING.  that might be an anomoly for the average anasthesiologist-patient interaction...

 

i know that i am not really allergic to opiates, but i really experience wretched side effects... so when i say i don't want them, i mean that i don't want them.  perhaps the anesthesiologist in my case felt that we were having an emergency c-birth?  so he didn't elaborate when i would have wanted to know more.  it wasn't a heart decel situation or anything like that... my waters had been broken for 48 hrs with no effacement or dialation and maximum pitocin.  baby was fine. 

 

brovie, if you're still around, do you mind one more question?  if i ask that i not receive duramorph or morphine, is it likely that i would then have to request an opiate later?  or (since i could tolerate the toridaol last time) could i manage without opiates completely?  i don't want to walk into a situation with unbearable pain but at the same time, i was pretty high and had a hard time with breastfeeding, etc.  and i can stand a little pain rather than the drugged effect.  your descriptions were really helpful. 

 

aptoddlermama -  i think what happened was what edz mammy says-- that lots of people report an allergy to opiates that isn't really.  i knew that, but try to say that anyway.  the hospital where i birthed otherwise was pretty fantastic, and i do think that several things were going on:

they don't believe what i had was a true allergy

possibly thought that it was an emergency emergency. 

felt they were doing what was good/right/necessary or what my ob had instructed? 

 

 

 

 

 


Is it getting lonely in the echo chamber yet?

hildare is offline  
#14 of 33 Old 08-04-2011, 11:11 AM
 
Storm Bride's Avatar
 
Join Date: Mar 2005
Location: Vancouver, BC
Posts: 27,300
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Brief thread hijack here...

 

Quote:
Originally Posted by EdzMommy View Post

Opiates have a lot of bad side effects like itching, constipation, decreased bowel motility, sedation, etc.  But, major abdominal surgery (c-section) is painful, and we know that pain and stress hormones aren't good for moms or babies.  We have to find a balance.

 

Who finds the balance? The anesthesiologist? This is one of the things that drives me nuts about doctors. The anesthesiologist "finds the balance". But, I'd rather be in pain than itching, and constipated (esp. post c-section!!). It's easier for me to tolerate pain, psychologically, than the other effects. This is the kind of decision that doctors routinely make for patients, and it drives me around the bend. I almost went out of my mind with the itching when I had dd1, and had planned to refuse the...think it was duramorph?...with ds2...only that anesthesiologist didn't bother to ask - he just added it without my consent.

 

While I never give a patient a medication that they're allergic to, I will sometimes give a medication if the patient describes a common side effect and not an allergy.  For example, itching and nausea are side-effects of opiates, not true allergies. 

 

And, again - once they describe the side effect, do you just administer it, or do you check with the patient?

 

Finally, I'd like to say that it seems like a lot of patients are anti-physician these days.  I went into medicine to help people...I've missed out on a decade of family holidays, weddings, birthdays, family vacations, funerals because of my training.  I get to work at 6am and leave around 6pm M-F, and I work at least one full weekend a month.  I'm not complaining, it was part of the training, and I love my job.  But, it's hard to read comments insinuating that my fellow anesthesiologists are untruthful or deceiving.  If the baby is in trouble (ie-the heart rate is dropping and the baby will soon die), we don't have time to discuss the cocktail put in a spinal.  

 

FWIW, only one of my sections was under those conditions (my son didn't survive), but I've never had an anesthesiologist discuss these things with me - not even once. (Actually, that occasion was the closest I came to it - the anesthesiologist had a discussion with me about my options while I was in labour...it didn't cover all the details, but it was an actual discussion, which I appreciated.) I wouldn't say those doctors were untruthful or deceptive. I would say they were making decisions on my behalf, and that doesn't sit well with me. The net result is that I would choose a lifetime of ill health over a doctor's visit at this point in my life. I don't trust medical professionals - not because I necessarily think they'll lie to me, but because I do think they'll do what they think is best, whether or not I agree. It's paternalistic, condescending and has cost me a lot in my life.

 

We are trained to stay calm during true emergencies and take care of the mom and her baby to the best of our ability.  I'm a huge advocate of birth plans and empowering moms to make informed decisions.  But situations can arise that require flexibility of plans.  If moms have questions about pain-control options, its best to make an appt to talk to an anesthesiologist before heading to the hospital in labor.

 

I actually did one consultation, before going in for a scheduled c-section. It was a complete waste of my time. I was there for a very specific reason, and it wasn't even addressed. I went through an emotionally traumatic experience (was instructed to watch a video in the waiting room and it was a "what to expect from your surgery" thing, and I was only getting through the days by not focusing on the upcoming visit to OR - I was shaking and almost crying by the time the video ended), in order to ask a very specific question, and then they couldn't answer it, anyway.


Brief hijack is over. I just rarely have a chance to talk to a medpro in an environment where I think there's a snowball's chance in hell that they'll actually listen to me, so I thought I'd grab it when it came along.

 

 

OP: Last time around, I refused any painkillers in the spinal. I was given a patient controlled pump, instead, so I gave myself a whack of...think it was Demerol...before I got up for the first time, and at bedtime. I went without anything, except a couple of Tylenol, for the rest of the visit. I hate having my pain "managed" to the point where it doesn't exist.

 


Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

Storm Bride is offline  
#15 of 33 Old 08-04-2011, 12:33 PM
 
EdzMommy's Avatar
 
Join Date: Aug 2011
Posts: 4
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Dear Storm Bride:

 

I'm sorry that you had such horrible experiences with your anesthetic care.  It's not fair to group all medical professionals into the "paternalistic, selfish" category.  There are certain standards of care that I must maintain.  They are established by the American Board of Anesthesiology, the American Society of Anesthesiologists, and Society for OB Anesthesia.  These guidelines and standards are based on decades of scientific research and observation.  And when patients sue, these are the standards that care is compared to in court.  Its not fair to ask me to compromise quality of care and put me in an uneasy situation that could possibly compromise your and your baby's health.

 

I find it frustrating that you'd rather get IV pain meds in multiple doses that are systemically absorbed and get into breast milk, but you have such an issue with the neuraxial opiates that are given in such small doses.  But, its your decision.  Informed consent is a two-way street...patients need to ask questions and be honest when giving the docs information.  Lying about drug reactions could jeopardize your health and your unborn baby's health.  Demerol has a ton of bad side effects, and most hospitals don't even have it on formulary anymore because of those side effects.  

 

I respect your autonomy and ability to make decisions for yourself.  However, you seem very angry and argumentative and are more interested in your own agenda than having a true conversation with your anesthesiologist.  We're not just epidural jockeys or techs or bartenders.  After 13 years of education post-high school, I consider myself an expert on anesthesiology.  Do you scrutinize your car mechanic like this?  Do you ask about which types of oil, coolant, hydraulic fluid that go into your car when you take it for an oil change?  I  have been a patient before and I understand the vulnerability that one feels when you have to relinquish control.  Maybe the folks you interacted with were really old school...but its not fair to dictate the terms of your anesthesia.  It bothers me that patients never seem to question the need to go for c-section, but want to tell me exactly how to do their anesthetic.  You've painted me and my fellow anesthesiologists as drug pushing monsters looking to get our patients wasted.  And it is far from the truth.

 

We anesthesiologists have a huge responsibility to get our patients through surgery safely...and sometimes in emergencies we can't do a la carte care if it could injure you.  Primum non nocere...first do no harm.  It's part of the Hippocratic Oath.

 

 

Honey693 and Kelly1101 like this.
EdzMommy is offline  
#16 of 33 Old 08-04-2011, 01:05 PM
 
Storm Bride's Avatar
 
Join Date: Mar 2005
Location: Vancouver, BC
Posts: 27,300
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by EdzMommy View Post

Dear Storm Bride:

 

I'm sorry that you had such horrible experiences with your anesthetic care.  It's not fair to group all medical professionals into the "paternalistic, selfish" category.  There are certain standards of care that I must maintain.  They are established by the American Board of Anesthesiology, the American Society of Anesthesiologists, and Society for OB Anesthesia.  These guidelines and standards are based on decades of scientific research and observation.  And when patients sue, these are the standards that care is compared to in court.  Its not fair to ask me to compromise quality of care and put me in an uneasy situation that could possibly compromise your and your baby's health.

 

I never said medpros are selfish. I said they're paternalistic. Whether or not what I said applies to all of you, at least get what I said right if you want to argue the point. I also wouldn't sue a doctor, except in circumstances of extreme negligence (eg. showing up in OR drunk). I think it's insane to expect doctors to be perfect at all times, because you're human, just like the rest of us.

 

I find it frustrating that you'd rather get IV pain meds in multiple doses that are systemically absorbed and get into breast milk, but you have such an issue with the neuraxial opiates that are given in such small doses.  But, its your decision.

 

Frustrating? Why is it frustrating? You're frustrated that I want care that works for me?

 

ETA: The IV pain meds that I self-administered were taken later. By the time I was getting them, the stuff in the spinal would have already worn off, anyway. BTDT. So, I'd have been taking something else at that point, regardless of whethe or not I'd been through the post-op itching hell.

 

Informed consent is a two-way street...patients need to ask questions and be honest when giving the docs information.  Lying about drug reactions could jeopardize your health and your unborn baby's health.  Demerol has a ton of bad side effects, and most hospitals don't even have it on formulary anymore because of those side effects.  

 

What are you talking about? I've never lied to a doctor about a drug reaction and I never would. I have no known drug allergies of any kind, and I've always said so. This has nothing to do with what I'm talking about. I'm not sure that it was Demerol - can't remember for sure, as it was two years ago, and I had a lot of other things on my mind.

 

I respect your autonomy and ability to make decisions for yourself.  However, you seem very angry and argumentative and are more interested in your own agenda than having a true conversation with your anesthesiologist.  


And, what do you base this on? Have you ever been there when I was talking to any of them? Holy crap. I post something on a message board, after my experiences with multiple anesthesiologists, and you decide how I've talked to said anesthesiologist based on it? My only "agenda", as you put it, is getting care that works for me. If that's imcompatible with your job, then I'm not the one who has the issue.

 

We're not just epidural jockeys or techs or bartenders.  After 13 years of education post-high school, I consider myself an expert on anesthesiology.  Do you scrutinize your car mechanic like this?  Do you ask about which types of oil, coolant, hydraulic fluid that go into your car when you take it for an oil change?  I  have been a patient before and I understand the vulnerability that one feels when you have to relinquish control.  Maybe the folks you interacted with were really old school...but its not fair to dictate the terms of your anesthesia.  It bothers me that patients never seem to question the need to go for c-section, but want to tell me exactly how to do their anesthetic.  You've painted me and my fellow anesthesiologists as drug pushing monsters looking to get our patients wasted.  And it is far from the truth.

 

Never seem to question the need for a c-section?? Maybe you should find out who you're talking to before you spout off. I've been to hell and back trying to avoid c-sections. I don't believe any of mine were needed, except the one that didn't ultimately succeed. Spare me your assumptions.

 

"Scrutinize" my car mechanic? Ask what types of fluid? What are you talking about?? If a mechanic puts something in my car that makes the engine seize, does it again, and then tells me I need that again, then, yes - I'm going to "scrutiinze" him. You are completely missing the point. I trust my mechanic to do an oil change, if that's what I asked him to do. But, if I take my car in for an oil change, he's bloody well better ask me before he does any other work. The fact that I have no choice but to have anesthesia for surgery doesn't mean I have to accept pain killers, as well. I'm not talking about the anesthesia. I don't even ask any questions about what goes into that stuff, because I need to have the spinal for surgery, and I have no known drug reactions, so it's not relevant to me. I've even accepted that I can't request general, although I'd prefer it, because of the effects on me and the baby. I'm talking about post-op pain management, not anesthesia. And, yes - I have the right to "dictate" whether or not I want it!

 

I'm not painting anyone as a "drug pushing monster" and I've love to know where you get that.

 

We anesthesiologists have a huge responsibility to get our patients through surgery safely...and sometimes in emergencies we can't do a la carte care if it could injure you.  Primum non nocere...first do no harm.  It's part of the Hippocratic Oath.

 

Okay. So, what does geting me through surgery safely have to do with post-op pain relief, which is the only thing I'm addressing in my post? Your response comes across as though you haven't even read what I wrote, and you seem to have some really bizarre preconceived notions about what I was saying (ie. your simultaneously hysterically funny, yet infuriating comment about "patients never seem to question the need to go for c-section").

 

My c-sections, except the first one, and the fourth one (where my son died) were not emergencies. ANd, the two emergency ones were both done under general anesthesia. I realize that an emergency situation has special circumstances around it, but the "sometimes in emergencies" aspect of this doesn't apply to me at all. I had grotesque, show up at the hospital as if I'm getting my hair done, "births" with my 2nd, 3rd and 5th. There was lots of time to talk to the anesthesiologist, if they'd wanted to talk to me.  (And, the guy who gave me the morphine stuff during my second one did tell me he was going to - but I didn't know about the side effects, and I was also not in very good shape to think, as I was just barely suppressing absolute panic. The next guy didn't ask - he just gave it to me. And, I didn't get it the last time, because I addressed that ahead of time.)

 

Your profession (and I don't just mean anesthesiology) has decided that pain=bad, so anything that takes away pain=good, whether the patient (ie. the person actually experiencing all this) agrees with you or not. I've had to accept spinal anesthesia, three times, as part of the hurdle of having children. It's been hellish. It's roughly as awful an experience as the surgery itself. And, that has NOTHING to do with what I was talking about - which is giving me post-op pain relief (NOT surgical anesthesia) that I don't want, without my knowledge or consent.

 

I don't really have a big beef with anesthesiologists. As far as medical professionals go, your specialty is better than average, imo (although I understand you're the ones ultimately responsible for the insane "nothing by mouth" labour guidelines).


Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

Storm Bride is offline  
#17 of 33 Old 08-05-2011, 11:25 AM - Thread Starter
 
hildare's Avatar
 
Join Date: Jul 2009
Location: in-the-sticks-off-a-dirt-road, GA
Posts: 2,692
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by EdzMommy View Post

Dear Storm Bride:

...

I respect your autonomy and ability to make decisions for yourself.  However, you seem very angry and argumentative and are more interested in your own agenda than having a true conversation with your anesthesiologist.  We're not just epidural jockeys or techs or bartenders.  After 13 years of education post-high school, I consider myself an expert on anesthesiology.  Do you scrutinize your car mechanic like this?  Do you ask about which types of oil, coolant, hydraulic fluid that go into your car when you take it for an oil change?  I  have been a patient before and I understand the vulnerability that one feels when you have to relinquish control.  Maybe the folks you interacted with were really old school...but its not fair to dictate the terms of your anesthesia.  It bothers me that patients never seem to question the need to go for c-section, but want to tell me exactly how to do their anesthetic.  You've painted me and my fellow anesthesiologists as drug pushing monsters looking to get our patients wasted.  And it is far from the truth.

 


and i know this wasn't addressed to me, but i do feel compelled to answer to some of this. 

i DO scrutinize my mechanic this way; in fact, i drive a hybrid car and was able to keep my car from being damaged by double checking the kind of oil that was used in a recent oil change with a new mechanic.  but, again, i'm just that kind of human.  and fwiw, i too have more than 13 years of education post high school, though i'm not in your line of work. 

in fact, i like to have pride in my own profession, but i realize that there are people in every profession who aren't "people persons" or have poor communication skills, or who just aren't nice, too.  it's sad because those folks reflect badly on the rest of us, but i acknowledge that they're out there. 

i'm not going to take it personally if someone strikes up a conversation about a jerky member of my profession, but i'll probably do what you did and try to address it as best i can. 

and for some people, medical professionals do tend to represent a point of view or a perspective that differs from one's own.  your interactions with patients are probably never in a happy place; few people are glad to be getting surgery.  or even if they are, there are other mixed emotions, such as fear, involved. 

i think you'll find in this particular online community, there does exist a strong sense of questioning caesarian birth's necessity.  most of us are very well informed here, or else we're seeking to learn more, which is why mdc exists.  in my own case, i cannot say whether my c-birth was absolutely necessary but i do know that with such a long length of time for my waters to be broken, no progress having been made, having declined the strep b test, and having had multiple vaginal examinations, i had crossed a line in terms of risk that i wasn't willing to continue following. 

personally, i am glad for your input, as i was hoping to have some questions answered about the medication that i received.  i feel like in my own case, i wasn't fully informed, for whatever reason, but you can bet that i do have probing questions for most people whether they be my mechanic or my ob or the anesthesiologist.  i assume that's rare for you?  but, may i suggest that you not take offense at the questioning... it seemed to me that you were offended.  if you are a person in a position of the holder of knowledge, you shouldn't be too surprised when people do ask!

 


Is it getting lonely in the echo chamber yet?

hildare is offline  
#18 of 33 Old 08-06-2011, 07:57 AM
 
by-the-lake's Avatar
 
Join Date: Jul 2008
Location: Northern Wisconsin
Posts: 1,135
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Waaaaaiiiiittt a minute.... Hildaire posts a questions regarding regarding anesthesia drugs. No problem. Then a real anesthesiologist answers, great! A very thorough, respectful answer. Then another poster applies that post to her experience. Derailing here..... then the anesthesiologist defends herself. OK. Of course she was a bit offended. I am confused why you posted a specific medical question, received a medical answer, and then say

 

"i think you'll find in this particular on line community, there does exist a strong sense of questioning caesarian birth's necessity.  most of us are very well informed here, or else we're seeking to learn more, which is why mdc exists".

 

and

 

"but you can bet that i do have probing questions for most people whether they be my mechanic or my ob or the anesthesiologist.  i assume that's rare for you?  but, may i suggest that you not take offense at the questioning... it seemed to me that you were offended.  if you are a person in a position of the holder of knowledge, you shouldn't be too surprised when people do ask!"

 

Were you looking for answers? Or an argument?

 

 

 


Wife to DHluxlove.gif DS 98thumb.gif DD 03flower.gif DS 09 babyf.gifwinner.jpgcd.gifnovaxnocirc.gif

She is here!!! Oct 5th!!!joy.gif

 

by-the-lake is offline  
#19 of 33 Old 08-06-2011, 09:33 AM
 
AlexisT's Avatar
 
Join Date: May 2007
Location: Central PA
Posts: 2,265
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:

Originally Posted by hildare View Post

 

i know that i am not really allergic to opiates, but i really experience wretched side effects... so when i say i don't want them, i mean that i don't want them.  perhaps the anesthesiologist in my case felt that we were having an emergency c-birth?  so he didn't elaborate when i would have wanted to know more.  it wasn't a heart decel situation or anything like that... my waters had been broken for 48 hrs with no effacement or dialation and maximum pitocin.  baby was fine. 

 

If you know you are not allergic to something, you shouldn't use the term allergy, which has a specific medical meaning.

 

In this case, you sabotaged yourself. I did some reading on this yesterday. True allergy is rare, and doctors know this; they also know many patients mistakenly believe they had an allergy when what they had was a histamine related reaction. So, they're trained to ask you about your reaction to the drug. By your description, they'll suspect you didn't have a true allergic reaction, and therefore, all opiates are not contraindicated. They might give you a different one, or give an antihistamine. But you will have made them simply dismiss your reaction, instead of take it seriously. They'll think "Oh! I can do this better." They don't have a full picture of exactly what side effects bothered you and how you wanted to manage pain this time. Keep in mind that good pain control is a priority for physicians because it's been shown to have an effect on healing, and what they will remember are the horror stories of patients who were traumatized by inadequate anesthesia or analgesia. Their goal is also to provide the best pain relief with the smallest amount of medication (and consequently the fewest side effects). So, from what I read when I was looking at this for my upcoming RCS, IV PCA requires more meds than Duramorph in the spinal to achieve the same level of relief.

 

Next time, be honest with your anesthesiologist about exactly what effects you experienced and want to avoid. You are not helping yourself by withholding information from your physicians. They can only do their job with complete information.

Alenushka and by-the-lake like this.

DD 01/2007, DS 09/2011

AlexisT is offline  
#20 of 33 Old 08-06-2011, 11:33 AM
 
Storm Bride's Avatar
 
Join Date: Mar 2005
Location: Vancouver, BC
Posts: 27,300
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by AlexisT View Post



 

If you know you are not allergic to something, you shouldn't use the term allergy, which has a specific medical meaning.

 

In this case, you sabotaged yourself. I did some reading on this yesterday. True allergy is rare, and doctors know this; they also know many patients mistakenly believe they had an allergy when what they had was a histamine related reaction. So, they're trained to ask you about your reaction to the drug. By your description, they'll suspect you didn't have a true allergic reaction, and therefore, all opiates are not contraindicated. They might give you a different one, or give an antihistamine. But you will have made them simply dismiss your reaction, instead of take it seriously. They'll think "Oh! I can do this better." They don't have a full picture of exactly what side effects bothered you and how you wanted to manage pain this time. Keep in mind that good pain control is a priority for physicians because it's been shown to have an effect on healing, and what they will remember are the horror stories of patients who were traumatized by inadequate anesthesia or analgesia. Their goal is also to provide the best pain relief with the smallest amount of medication (and consequently the fewest side effects). So, from what I read when I was looking at this for my upcoming RCS, IV PCA requires more meds than Duramorph in the spinal to achieve the same level of relief.

 

Next time, be honest with your anesthesiologist about exactly what effects you experienced and want to avoid. You are not helping yourself by withholding information from your physicians. They can only do their job with complete information.


While this is all true, I'd like to point out that not all patients do know the difference between a true allergy and other reactions. So, it's not unlikely that a patient could tell a doctor (anesthesiologist or otherwise) that they're allergic to a certain drug/class of drugs, even though they're not...and still not be lying. (I know OP said she knows she's not allergic, so she did knowingly use the wrong term, and this doesn't apply here.)

 


Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

Storm Bride is offline  
#21 of 33 Old 08-06-2011, 12:35 PM
 
AlexisT's Avatar
 
Join Date: May 2007
Location: Central PA
Posts: 2,265
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Well, yes--in fact, patients were even told they were allergic, when they're not. It's been perpetuated by doctors as well as a misunderstanding of the difference between "side effect" and "allergy." But that's why docs are trained to ask about the specifics, so they can try to tell what it was. Big difference between "the Duramorph made me really itchy" and "my throat swelled and I couldn't breathe." Two different complications, two different approaches will be needed for the patient.

 

Side effects are very real and need to be taken seriously--I don't mean they're irrelevant. But by painting it as an allergy, you may lead the anesthesiologist to take an approach that won't meet your needs. S/he will base decisions on the "allergy" rather than the true problem. Simply saying "I don't want opiates" may not help because the anesthesiologist is going to be extraordinarily reluctant to leave you without a pain management option after major abdominal surgery. By planning ahead and consulting with an anesthesiologist, you can have a much more satisfying plan of care and a much, much better experience. I know someone who had to have a planned C. She was so scared of spinal anesthesia that she thought they would have to do a general. By working with her doctors, she was able to have spinal anesthesia, see her baby be born, and have a really positive experience.


DD 01/2007, DS 09/2011

AlexisT is offline  
#22 of 33 Old 08-06-2011, 04:56 PM
 
katelove's Avatar
 
Join Date: Apr 2009
Location: Australia
Posts: 3,756
Mentioned: 1 Post(s)
Tagged: 0 Thread(s)
Quoted: 8 Post(s)


Quote:
Originally Posted by EdzMommy View Post

 Valium is long-acting, and it can't be given through the IV.


Just curious to know what you mean by the bolded. Is diazepam not given IV in the US?


Mother of two spectacular girls, born mid-2010 and late 2012  mdcblog5.gif

katelove is online now  
#23 of 33 Old 08-06-2011, 11:17 PM
 
Devaskyla's Avatar
 
Join Date: Oct 2003
Location: in my great new home
Posts: 4,693
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Hildare, have you gotten your medical records to see exactly what you were given? That might help you make a more informed decision.


 

Quote:

Originally Posted by EdzMommy View Post

 

While I never give a patient a medication that they're allergic to, I will sometimes give a medication if the patient describes a common side effect and not an allergy.  For example, itching and nausea are side-effects of opiates, not true allergies. 

 


How does this not violate the patient's right to informed consent/refusal? This kind of thinking makes me really angry. The anesthesiologist for the cesarean I had with my oldest obviously had the same thinking, because he gave me morphine, despite me saying I didn't want it because it caused extreme nausea. He blew me off with 'that's a normal reaction' and gave it to me anyway. Fast forward 16+ hours to several panicked nurses freaking out because I couldn't even keep water down. If I hadn't had morphine before and known what it did to me, I dread to think what would have happened. And all because someone decided to give me something I specifically said I didn't want because they decided that my reaction was common, without ever finding out details. That is the trouble with ignoring patients who ask to avoid something because of something you consider "common". Not to mention, unless there are no other options, no one else should decide for someone what they should put up with in the way of side effects.

 

Unfortunately, due to this experience, if I ever have to have surgery again, I know I won't be able to trust that my wishes will be respected. Hopefully it's a moot point & I'll never have another surgery, but if I have to, I will likely be extremely vocal about not getting morphine.

 

 


mom to all boys B: 08/01ribboncesarean.gif,  C: 07/05 uc.jpg, N: 03/09 uc.jpg, M: 01/12 uc.jpg and far too many lost onesintactlact.gifsaynovax.gif

Devaskyla is offline  
#24 of 33 Old 08-07-2011, 11:08 AM
 
Storm Bride's Avatar
 
Join Date: Mar 2005
Location: Vancouver, BC
Posts: 27,300
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by AlexisT View Post

 

Side effects are very real and need to be taken seriously--I don't mean they're irrelevant. But by painting it as an allergy, you may lead the anesthesiologist to take an approach that won't meet your needs. S/he will base decisions on the "allergy" rather than the true problem. Simply saying "I don't want opiates" may not help because the anesthesiologist is going to be extraordinarily reluctant to leave you without a pain management option after major abdominal surgery.

 

The bolded is where my personal issues come in. Why is it the anesthesiologist's decision as to whether or not I get pain management "options"? How are they "options", if I'm getting them when I don't want them? What does being reluctant to leave me without those "options" after surgery have to do with meeting my needs, if I don't have a need for said "options"?

 

By planning ahead and consulting with an anesthesiologist, you can have a much more satisfying plan of care and a much, much better experience. I know someone who had to have a planned C. She was so scared of spinal anesthesia that she thought they would have to do a general. By working with her doctors, she was able to have spinal anesthesia, see her baby be born, and have a really positive experience.

 

 

I'm glad for your friend, but it doesn't always work that way. I've had three planned c-sections. I was terrified of the spinal when I went for the first of those three. I was more terrified by the second one...and I only got through the third one without a complete breakdown, because the anesthesiologist allowed dh to come into OR while she administered the spinal. They don't normally allow that, but she was a wonderful doctor, and I have that "mother of a stillborn baby" note in my file that makes most care providers actually pay attention to what I say (finally - I'm appalled at the difference in the care I received after going through a personal tragedy, not because there was anything wrong with it, but because there's no reason why every patient on L&D/maternity shouldn't get the same level of consideration). I was scared of spinal anesthesia initially, because it was an unknown. I was far more scared of it once I knew what it was going to be like. There's not a single aspect of spinal anesthesia that doesn't cause me fear...I hate the needle being in my spine. I hate the pain of the needle. (Needles generally don't even make me blink...I can have IVs, innoculations, blood draws, including donation, etc. without batting an eyelash.) And, most of all...I hate the anesthesia itself - the numbness. I was conscious for the "births" of three of my children, and as happy as I was to see them so soon...being unconscious was a much, much, much better experience. For some women, being there for the "birth" trumps being awake for surgery, but it doesn't work that way for me. I can't opt out of the spinal, because general anesthesia confers additional risks to me, which I'd risk in a heartbeat, and my baby, which I wouldn't risk, and don't have the option to risk, anyway. If I could, I would. Being unaware was a much, much better way to have surgery.

 

Receiving spinal anesthesia is a grotesque, surreal, traumatic experience for me. It's about on a par with the surgery itself. Just thinking about getting the needle makes me twitch. After I typed "I hate the anesthesia itself - the numbness" in the above paragraph, I started to describe what it was like...and had to leave the keyboard twice, started feeling queasy, and had to take multiple deep breaths just to get under control, and had to delete the sentences in question. There is no way to make spinal anesthesia (or a c-section, for that matter) a positive experience for me, because the experience is inherently negative, in every respect, except that I ended up with a baby at the end of it. I summarize my last c-section - the only one I initiated, planned, and went into something resembling willingly, and the one where everybody bent over backwards to make it "positive" for me - as a "less sucky" c-section, because that's as good as a c-section, especially under spinal, is ever going to get.

 

Anyway...this post was much longer than I intended. Spinal anesthesia has caused me a lot of psychological trauma, and once I get talking about it, I lose my train of thought very easily.

 



 

 

 


Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

Storm Bride is offline  
#25 of 33 Old 08-07-2011, 06:30 PM
 
AlexisT's Avatar
 
Join Date: May 2007
Location: Central PA
Posts: 2,265
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

How can you possibly know in advance of surgery how you will feel? How can you possibly know there will be no complications, that you will NOT be in extraordinary pain that is beyond what you have planned for? If you exclude all opioids and refuse to discuss them at all, and then you have that one in a thousand horrific surgery, and you've bled too much for Toradol... you've just forced yourself to suffer and have removed your doctors' ability to deal with the problem. This isn't just "Do I get Duramorph in my spinal?" It is not just "this is my pain and I get to decide how to cope with it." With any surgery, you're running the risk of complications. You could be half conscious and unable to make a rational decision. You could have a level of pain that your providers judge to be potentially harmful to you. It is very much the anesthesiologist's job to make sure you have options. Whether or not you have an option available to you is not the same as whether or not you have the right to say yes or no. You can say no to an option.

 

That is aside from the medical and ethical challenges of doing the surgery itself without opioids in the spinal. Yes, leaving patients in horrible pain is considered unethical for an anesthesiologist. Pain control is considered a right.

Alenushka likes this.

DD 01/2007, DS 09/2011

AlexisT is offline  
#26 of 33 Old 08-07-2011, 07:45 PM
 
brovie's Avatar
 
Join Date: Aug 2011
Location: Vancouver, BC
Posts: 5
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Hildare:

 

to answer your question (finally! :))

 

"brovie, if you're still around, do you mind one more question? if i ask that i not receive duramorph or morphine, is it likely that i would then have to request an opiate later? or (since i could tolerate the toridaol last time) could i manage without opiates completely? i don't want to walk into a situation with unbearable pain but at the same time, i was pretty high and had a hard time with breastfeeding, etc. and i can stand a little pain rather than the drugged effect. your descriptions were really helpful."

 

whether or not you decide to refuse having duramorph or spinal/epidural morphine, after a C/S (which is a major abdo surgery as you know) you are likely to need something for pain relief.  Most people need opioids.  Studies show that oral and IV or subcutaneous or intramuscular opioid use is cut down by spinal or epidural morphine.  Studies DON'T show that pain control is worse....but the effect of having to take more opioids by other routes is generally that women experience more side effects like nausea and constipation. 

 

That being said, the same opioid by different routes (spinal vs IV vs oral morphine) can have a different side effect profile in any given patient.  For example, through experience you might find that spinal morph makes you itch like mad for two days whereas oral morph makes you constipated whereas IV morph does both (note, I'm just giving reactions here to try to make a point, I'm not trying to suggest that that this is what actually happens).  You might find that morphine loops you out but hydromorphone or oxycodone doesn't.  So even if you need opioids after the surgery, being able to decide when and how much to take for yourself will probably sit better with you than having someone put a 48 hour dose in your spinal or epidural space.  For example, you take a small dose of hydromorphone orally, it loops you out but it wears off in 4 -6 hours....so next time you take a smaller dose...or you ask to try oxycodone...or you take some extrastrength tylenol and some toradol and tough it out because that's your preference.  Retaining more control over what is going into your body generally results in great satisfaction...that's the whole premise behind IV patient controlled analgesia, patient controlled epidural analgesia etc etc.  Moms at the maternity hospital I trained at where given a "box of goodies" after their delivery (vaginal or C/S) that contained a whole wack of oral medications with instructions...including tylenol, anti-inflammatories, and a few different kinds of narcotics.  Sure the nurses and docs would answer their questions and help them if asked, but they really were totally in control of their own pain management.

 

I think its important FOR EVERYONE ON THIS BOARD to remember that you and the anesthesiologist actually have the same goals and I don't see why we can't approach each other with a little less baggage and a little more respect (a little less paternalism on the doctor's side and a little more open-mindedness and trust on the mom's side): 

- freedom from UNwanted pain (note: not ALL pain.  this is patient determined...pain vs pain meds and side effects and is a different threshold for every person)

- the ability to mobilize (get out of bed, lift your infant and take care of your infant, walk to the washroom, etc) after surgery

- the ability to breastfeed if desired (requires both pain control and breastfeeding compatible meds)

 

A helpful way for you to frame the discussion, Hildare, if you have to have a c-section again would be something like this:

- I had a horrible reaction to what I think was the morphine/ duramorph in my spinal last time and I would like to avoid this medication.  Then describe the reaction...then ask if they have your anesthetic record from your last C/S and what they think may have caused it...

- in general I hate how opioids make me feel.  Is there a way we can minimize my need for them?  Can I try other opioids than morphine to begin with because morphine makes me feel ____________?

- what are the options if I have a bad reaction/ side effect again?

 

But I wish you a successful and fulfilling VBAC! :)  I'm so pro-VBAC is hurts and I can't believe that the american posters on these boards so often can't find someone who will let them VBAC.  That's a travesty!

brovie is offline  
#27 of 33 Old 08-07-2011, 08:04 PM
 
Storm Bride's Avatar
 
Join Date: Mar 2005
Location: Vancouver, BC
Posts: 27,300
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by brovie View Post


I think its important FOR EVERYONE ON THIS BOARD to remember that you and the anesthesiologist actually have the same goals and I don't see why we can't approach each other with a little less baggage and a little more respect (a little less paternalism on the doctor's side and a little more open-mindedness and trust on the mom's side): 

- freedom from UNwanted pain (note: not ALL pain.  this is patient determined...pain vs pain meds and side effects and is a different threshold for every person)

- the ability to mobilize (get out of bed, lift your infant and take care of your infant, walk to the washroom, etc) after surgery

- the ability to breastfeed if desired (requires both pain control and breastfeeding compatible meds)


I have my baggage, because of my experiences. Sorry if that doesn't suit you, but it's the way life works. It would make no sense at all for me to continue to trust doctors, as they have, by and large, repeatedly shown themselves to be undeserving of said trust. I had a good feeling about my last OB, and I'd trust her if I ever needed an OB again...but that doesn't mean that I'm just going to say "oh, okay - that one was good, so the various crap I've had from every other doctor I've seen in the course of my reproductive life doesn't count - doctors are obviously going to look out for me". Quite honestly, it would be completely illogical for me to do so.

 

My anesthesiologists (at least two of them) did not have the same goals as me. They didn't even know what my goals were. They assumed that I wanted the same things they did, and proceeded accordingly. The fact that they may have been right, if they'd made the same assumptions about most patients, doesn't mean they were right about me, or that we wanted the same thing. This kind of blanket "you and the doctor have the same goals" statement is one of the things that drives me batcrap crazy about the medical profession, as a whole.

 

Interestingly enough, my ability to mobilize after surgery was best with my last c-section (the one where I put "my agenda" ahead of the anesthesiologist's experise -  apparently - by refusing any post-op pain meds, excpet those I dispensed for myself). And, increased mobility, because you can't feel pain, isn't all it's cracked up to be. While I've had pain after all my surgeries, even with the duramorph, the "pain management" did work reasonably well after I had ds2, which is how I ended up tearing a staple out of my incision, which then got infected, and didn't fully close for almost two months. I'd have done a lot better with less pain management, and a little less mobility, in that particular situation.


Why does breastfeeding post-op "require" pain meds? I've never needed meds for that.

 

And, re: "unwanted pain" being patient determined. I've never had a doctor (including an anesthesiologist), nurse or any other kind of care provider express any interest whatsoever in what level of pain was acceptable to me. They decided what was okay, and proceeded to attempt to "manage" my pain according to their own bias.

 

 

 

ETA: Before I leave, I wanted to add something about the mobilization thing. After my first, "emergency" c-section, I was badgered endlessly by doctors and nurses telling me to get up and walk, that they "know it hurts, dear, but you have to walk". Not one of them (there at least 10-15 medpros who talked to me about this in the three days it took me to be able to leave my bed for more than an assisted trip across the room to the bathroom) listened to a word I said. I repeatedly explained that the problem wasn't pain. It was weakness.

 

I hadn't eaten much while in labour, and nothing at all for at least 6-8 hours before I went to the hospital. I'd vomited when labour started, shortly after dinner. So, I had a c-section on Friday evening, and the last real meal I'd eaten was lunch on Thursday, with a small snack that afternoon, and then maybe a cup of fruit/veggies over the course of my 21 hour labour. Then, I'd been given all kinds of drugs in my IV (general anesthesia). Then, I was given morphine in post-op. Then, I was given a sleeping pill (which I'd have refused, but I was still too out of it from all the other drugs). Then, I wasn't allowed any solid food for another 3.5 days, while recovering from surgery, "childbirth", and all those medications. I simply couldn't walk. I could barely stand up (not long enough to change a diaper, for instance, even though I was clinging to the cart the bassinet was on). I was too weak. Not a single person I talked to believed me, and I was repeatedly castigated for, basically, caving to the pain. "I know it hurts, dear, but it's important." "It's going to hurt, but you have to do it." "I'm sorry it hurts, but walking is essential to your recovery." "You have to get moving, no matter how much it hurts." "You're still not walking? You're going to have to ignore the pain." Over and over and over and over for more than three days. And, the pain wasn't the problem, and I told every single one of them that. I can walk if it hurts. I can't walk if I'm physically not strong enough to stand on my own two feet.


Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

Storm Bride is offline  
#28 of 33 Old 08-07-2011, 08:19 PM
 
Storm Bride's Avatar
 
Join Date: Mar 2005
Location: Vancouver, BC
Posts: 27,300
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by AlexisT View Post

How can you possibly know in advance of surgery how you will feel? How can you possibly know there will be no complications, that you will NOT be in extraordinary pain that is beyond what you have planned for?


What on earth does any of that have to do with what pain control meds are automatically given to me, simply because I'm not allergic to them? What does it have to do with giving me the meds, before there's any reason to suspect complications or an unusually high level of pain?

 

If you exclude all opioids and refuse to discuss them at all, and then you have that one in a thousand horrific surgery, and you've bled too much for Toradol... you've just forced yourself to suffer and have removed your doctors' ability to deal with the problem. This isn't just "Do I get Duramorph in my spinal?" It is not just "this is my pain and I get to decide how to cope with it."

 

So, once I refuse any opioids before my surgery, I can't request them later, if I happen to have unusually horrific levels of pain? That seems...very strange to me.

 

With any surgery, you're running the risk of complications. You could be half conscious and unable to make a rational decision. You could have a level of pain that your providers judge to be potentially harmful to you.

 

Ugh. Just..ugh. My providers, as far as my personal history shows, have long since decided that any level of pain is potentially harmful to me, and they'll do anything to avoid it. It doesn't matter if I've made it clear that what they want is harmful to me, because I'm not a doctor, and can't possibly know what's in my own best interests. If I'm screaming "make it stop", then it's probably pretty obvious that the pain is too much. If I'm not doing so, or otherwise demonstrating that I can't/don't want to handle that level of pain, then why is someone else making that call for me?

 

It is very much the anesthesiologist's job to make sure you have options. Whether or not you have an option available to you is not the same as whether or not you have the right to say yes or no. You can say no to an option.

 

If I can say, "no", then what's the point of your above example of being half-conscious and unable to make a rational decision? In that scenario, does that mean I can say "no"? Or does it mean that I can say "no", but that "no" will be ignored if my "providers" feel that ignoring it is in my own best interests?

 

That is aside from the medical and ethical challenges of doing the surgery itself without opioids in the spinal. Yes, leaving patients in horrible pain is considered unethical for an anesthesiologist. Pain control is considered a right.

 

I have no idea what was in my spinal. I wasn't in pain during the surgery, so I have to assume they used opioids, if that's the only way to numb the pain. I'm sure the pain is horrific. What I was addressing in previous posts was post-op pain management. I've been pretty clear about that, I think. And, I don't want it. I don't want anything for pain after a c-section (ie. once I can feel my feet and wiggle my toes again), unless and until I decide the pain is bad enough to require it. Nobody else can make that call for me, whether they're an OB, a nurse, or an anesthesiologist. If I have the right to have pain control, then I have the right to refuse pain control, too. If I can't refuse it, it's not a right - it's a requirement.

 

 


OP: Sorry for the total derailment. I've read one too many posts in this thread that have brought back all my anxiety about dealing with the medical profession ever again, and it's triggered me. I'm going to try to ignore this one when it comes up in my inbox (have hit "don't subscribe", but I don't know how that works in the new format), as the entire topic is upsetting on multiple levels.

 


Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

Storm Bride is offline  
#29 of 33 Old 08-07-2011, 09:48 PM
 
katelove's Avatar
 
Join Date: Apr 2009
Location: Australia
Posts: 3,756
Mentioned: 1 Post(s)
Tagged: 0 Thread(s)
Quoted: 8 Post(s)

This is what is commonly offered in Australia; in OT the woman is given a PR NSAID (usually diclofenac or ibuprofen). Once they return to the ward and are able to eat and drink ( usually within a few hours) they are encouraged to have *regular* paracetamol and an NSAID. Depending which one is used, the NSAID is a twice daily dose and the paracetamol is every 6 hours. Research has found that women using this regime require fewer opiates and report better pain control**.

 

Something else to consider when deciding on how much pain relief you require - in order to reduce your risk of the post-op complications of pneumonia or DVT/PE you need to be able to take deep breaths (almost fully inflating your lungs), cough and move your legs in bed or walk (slow walking is fine) about once every hour or so. Even if you're wearing anti-embolism stockings.

 

Also, someone mentioned the ethics of pain management. It is absolutely unethical to leave someone in pain *if* they want treatment. But a legally capable adult has the right to choose to decline all forms of treatment, including pain relief. In that case, our ethical obligation is to ensure that it is an informed choice and to make sure the patient is aware that they can change their mind at any time.

 

 

 

 

**NB. We also usually leave them with a patient-controlled analgesia device (either IV or epidural) which has an opiate (IV) or opiate/local anaesthetic mix (epidural) for the first 12-24hours. There is also research which shows that patients who have PCAs require less opiates than patients who receive intermittent doses which they have to request from the nursing staff each time.

Alenushka likes this.

Mother of two spectacular girls, born mid-2010 and late 2012  mdcblog5.gif

katelove is online now  
#30 of 33 Old 08-08-2011, 06:43 AM - Thread Starter
 
hildare's Avatar
 
Join Date: Jul 2009
Location: in-the-sticks-off-a-dirt-road, GA
Posts: 2,692
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)


Quote:
Originally Posted by by-the-lake View Post

Waaaaaiiiiittt a minute.... Hildaire posts a questions regarding regarding anesthesia drugs. No problem. Then a real anesthesiologist answers, great! A very thorough, respectful answer. Then another poster applies that post to her experience. Derailing here..... then the anesthesiologist defends herself. OK. Of course she was a bit offended. I am confused why you posted a specific medical question, received a medical answer, and then say

 

"i think you'll find in this particular on line community, there does exist a strong sense of questioning caesarian birth's necessity.  most of us are very well informed here, or else we're seeking to learn more, which is why mdc exists".

 

and

 

"but you can bet that i do have probing questions for most people whether they be my mechanic or my ob or the anesthesiologist.  i assume that's rare for you?  but, may i suggest that you not take offense at the questioning... it seemed to me that you were offended.  if you are a person in a position of the holder of knowledge, you shouldn't be too surprised when people do ask!"

 

Were you looking for answers? Or an argument?

 

 

 

nope; i wasn't looking for an argument and indeed posted seeking answers.  however, i did thank that poster for input but felt the need to address a statement she made, " It bothers me that patients never seem to question the need to go for c-section, but want to tell me exactly how to do their anesthetic. "  i really feel as though that's a very inaccurate statement for most folks here at mdc.  she also DID seem offended that people were asking questions, which i was attempting to point out, is not really something to be offended by.  i understand that it's not fair to lump people of the same profession into one category if they (like stormbride) are bitter about a past experience.  but at the same time, if you have knowledge and other people are interested in or ask questions about it, that's not really something to take affront with, in my opinion. 

i don't think i was disrespectful at any rate, and did thank that poster several times for the input.

 

 


Is it getting lonely in the echo chamber yet?

hildare is offline  
Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off