Friday, 10 June 2011

“Take the easy way”–no option apparently!

That seems the motto of my body as it seems. Given the length of time it took us to actually GET to be pregnant plus the amount of operations I had in between and injections and all that … After my first 2 laparoscopies I met Dr Ros Burns (anaesthetist at RIE) who diagnosed me with a “Grade 3 Throat, difficult intubation” – or in her own words: Nearly impossible to intubate. I believe they always had to use EVERYTHING in the book for the General Anaesthetics for the following 2 laparoscopies (ovarian cysts due to very severe endometriosis)!!

Today I had an appointment with the anaesthetist regarding my options when it comes to labour, and while I knew that Ros was one of the anaesthetists for Simpsons (Centre for Reproductive Health at RIE), I was happy that I actually had my appointment with her. I think she was close to (happy) tears when she saw me, given that she’s been quite involved on our path through infertility.

But back to my body … remember that “Grade 3” bit in the first paragraph?? Weeeelll… apparently during pregnancy (hormones, swollen glands etc.) this increases by 1 Grade – so right now I am a blimming Grade 4!!! DEFINITELY IMPOSSIBLE TO INTUBATE with normal metal laryngoscope.

Wanna know what that means??

Well, they won’t have as much time for intubation as they usually have for GA for scheduled operations if I’m coming to the labour ward and insist on having the wee ones naturally. A emergency C-section would pose some problems as well. Just because they can’t sedate me to do the intubation with the normal gear.

Nooooo … what I need IF I need GA is a so called “awake fibre optic intubation”. A fancy intubation with camera with lots of local anaesthetics down my throat – while I’m awake. Just so it’s in place. 
To add to that I would need a dual epidural. Sounds fancy, but means only to numb the normal area like other pregnant women get, plus I get the added “bonus” of numbing of the tummy section where they’re likely to cut me for a c-section.

DH and I are open when it comes to birth plan (which means so far we didn’t really HAVE one, we just agreed we’re open for everything that ensures the health of the babies (and of me)). Which means we KNEW there was the possibility of a c-section anyway, with us having twins and one of the placentas still lying low (was told today it’s on the back low which doesn’t cause problems for a section). We were even considering an elective c-section, although I was hoping for a try at natural birth – until today that is.

There are apparently lots of women (increasing number) who are “too posh to push” and book their sections, and yes, not that many may have GA for it. And I am aware that you have to be told about the risks for OPs etc, but sitting there by myself, being all reasonable and agreeing with the doctor from the twin clinic and the anaesthetist that a planned c-section is best for us and less risky STILL is not that easy to take in. Specially being told that maternal health goes over foetal health. Scary thought, which really never occurred to me until today. We always were still aware that one or both of the twins might not make it (hey, there’s ALWAYS that possibility!), but so far I never thought really that it would affect MY LIFE.

So … we will have another appointment with the anaesthetist (at which we will meet one of the 3 “awake fibre optic intubation specialists” as well – only 3 out of 10 anaesthetists can do that at the RIE, would you believe), so DH can get the full layout and ask any questions, too. But our birth plan is now around a planned c-section including that intubation and the dual epidural. Which is ok, given the fact it’s less risks involved than emergency section etc. All will be in my notes and with the doctors.

Who’d thought the little sticker to have the anaesthetist informed when I report to the labour ward or the triage when in labour would mean so much!! I’m just glad we’re aware of my intubation problem, just imagine what would have happened if I’d NOT been diagnosed in the past as a difficult intubation! And I rather have that all planned than having trouble in the future. Currently waiting for my mum’s e-mail with the details of the anaesthesia  components she was diagnosed as allergic to (which resulted in her tracheotomy – i.e. cut through the windpipe) so we can get them noted in my medical notes, but I had spoken to Ros before the last laparoscopy about that and I am sure she said that the components were used in previous GA for me and I didn’t react to them.

And there was me wondering if there was any reason of me dreaming of a tracheotomy on myself last night?! Signs of the info above??

Will keep you up-to-date on the whole thing, but right now we’re opting for C-section. I was told that I still might go into labour and get both twins naturally etc. You never know.

And if anyone has any experience in c-section or an awake fibre optic intubation or dual epidural – please let me know! Would be much appreciated.

Just realised - having the anatomy knowledge etc I have is both a curse and a blessing... :o 

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