Have you seen an anaesthetist/anesthesiologist during your pregnancy, or are you booked in?
A few facts about these specialists and what you might expect – and… what you might ask!!
So what or who is an anaesthetist (in the UK) or an anesthesiologist (in the US)? These are the same doctor under slightly different names….
Anaesthesia means ‘loss of sensation’ – and that’s basically what they do.
They are specialist doctors, who’ve done the long formal medical training, and then specialised, in techniques which numb sensations in certain parts of the body, or induce sleep. This is essential for many procedures and surgeries, to prevent pain or discomfort, and enables a wide range of procedures to be carried out.
There are four broad types of anaesthesia – general (inducing sleep) regional (numbing a large area, such as an epidural in labour and birth) sedation (sometimes used in fertility treatment) and local (an injection to numb a small area of tissue, perhaps before getting a drip put into your arm).
So, not only do some doctors specialise in anaesthetics, some specialise in women’s health (obs & gynae) anaesthetics, as there’s plenty to help with in women’s health alone.
Labour wards (or delivery suites) in hospitals are always staffed by anaesthetic doctors. They are primarily needed to provide epidurals for women in labour, and spinal anaesthetics (and occasionally general anaesthetics) during caesarean sections and other surgical procedures.
These are highly skilled professionals with a huge clinical responsibility.
But, here’s the thing about anaesthetists:
This is what they see, day in and day out: epidurals, caesareans, epidurals, caesareans. Repeat.
And because they have a high level of responsibility, they are, of course, committed to getting that right.
So – when it comes to your appointment with this specialist, here’s what they’ll be thinking:
‘How easy or difficult will it be for me to put an epidural into this patient’s back and effectively anaesthetise this patient in the event of an emergency
On a human level, they are, I’m sure, thinking ‘I hope you have a straightforward birth, no emergency, no difficult epidural…’
But from a professional standpoint, they’ll be planning for the most difficult scenario and working back.
They know from experience that getting an epidural in the right place in a patient’s back is easier when they are in early labour, more comfortable sitting still, rather than later on, when sitting still and in the right position through contractions can be challenging.
They are also wary of needing to quickly put in an epidural if one is needed fast for a caesarean.
And THIS is where I’ve seen some wonderful – and some awful – communication strategies happening during antenatal/prenatal consultations between anaesthetists and plus size women.
So during your conversation, you should expect – and you deserve – for your anaesthetist to ask you what you want for your birth – pain relief, place of birth, etc. They then should explain that if you want an epidural, or if you need one in the event you need a caesarean, this can be more easy, or difficult, depending on your individual anatomy (mostly the way your skeleton is shaped). And they should then offer/ask to examine the tissue over your spine, by gently pressing with their fingers, in order to individualise your consultation, check out your unique shape. Some doctors also use a small scanning machine as part of this. Sometimes being plus size can make it more difficult to feel, but this is by no means necessarily the case. Everyone is different.
You can then make a plan together for your birth – based on your preferences and your individual clinical circumstances.
What you shouldn’t expect is for your anaesthetist to tell you you are ‘high risk’, you should definitely have an epidural early in labour (unless you want one) and/or attempt to frighten you with talk of emergencies.
Anaesthetists have the skills we need to keep us safe, for pain relief and to literally keep us alive in the rare event a general anaesthetic is needed during birth.
But they can make all the difference to how you feel about your birth, the choices you perceive, the decisions you make, the experiences you have and how empowered and in control you feel.
Go to your appointment with questions, a notebook and a support person.
Let me know if you want to discuss your experiences or choices x