r/AskDocs Layperson/not verified as healthcare professional May 28 '22

I was administered IV Narcan at the beginning of my c-section earlier this year - why did it happen? Physician Responded

For context, 22F with an unremarkable full-term singleton pregnancy, also my first pregnancy. At time of labor, fetal position was occiput anterior, dilated to 6cm with extremely minimal cervical effacement over the course of 15~ hours. OB decided that the size (?) of my pelvis was limiting labor progression (I broke my tailbone as a child, I tend to believe that this played a role in my body’s presumed inability to delivery vaginally) and I was offered/advised to move forward with an emergent cesarean section as there was fetal distress. Now onto the traumatic delivery that I’m still processing nearly 4 months later. I was given an epidural roughly 10 hours into labor, controlled my own medication intake via the button on the epidural line, my vitals stayed in a good range from the time the epidural was placed to the time of the surgery. I experienced vomiting during the time in between, but no other notable side effects. Just before the procedure, I remember overhearing the surgeon order 3 (units? bags?) of the epidural medication to be pushed through the line. Shortly after the initial incision, I began shaking violently, then my pulse & BP plummeted. I faded in and out of consciousness, then I was administered narcan. The sudden clarity and agony was mind-boggling. The procedure was extremely fast (low traverse incision) lasting less than 10 minutes from start to finish, but due to the amount of pain I experienced throughout, I don’t believe that I received any additional pain relief until after the procedure was completed. My questions are, why did I respond so poorly to the higher dose of a medication that was previously treating me well? Is it standard procedure to carry on with the surgery as opposed to administering general anesthesia/a spinal block, when extreme fetal distress is present & surgery has already begun? Seeing as this was my first surgery of any kind, is this event something notable if I should require surgery again at any point? And lastly, for my fellow humans, medically trained or not - is it rational that this was traumatic enough for me to consider counseling? I’m healthily attached to my child and being treated for PPD, but this event comes to mind on a daily basis, and puts my stomach in knots. Giving birth is no walk in the park for anyone, so I feel a bit silly for still working myself up over something that has come and gone with no poor outcome for myself or my child. I know many others aren’t so lucky. TIA.

66 Upvotes

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u/WreckedEmKilledEm MD - Peds GI | Top Contributor May 28 '22

Yes it’s normal and rational to be traumatized by this experience. Childbirth is awful enough. Yes you should feel totally justified seeking counseling.

However, it sounds like they were concerned that intrathecal narcotics were affecting your hemodynamic stability and they were trying to save your life. You had heart rate and blood pressure drops and seems they were concerned it was due to systemic effects of your epidural.

Narcan is extremely unpleasant, but not dangerous, and if given at the right time, lifesaving. I don’t think anyone here can tell you if it was truly necessary in your case. But if it was, it might have saved your life and the life of your baby.

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u/Downtown_Asparagus14 Layperson/not verified as healthcare professional May 28 '22

I do have inherent trust in medical professionals, honestly - I believe that the vast majority are in their respective fields for the right reasons, and that they make medical decisions with the best outcome in mind. I’m almost certain that it was necessary, I’m just more curious as to why it became necessary. Like you said, I’m sure no one here could give me the one definitive answer to that question, or any question about my specific case. I’m more just looking for possible reasons that this was how my body responded (medication allergies? dosage ratio?) because I think it’ll help me to wrap my mind around the event just a bit better. However, I think you’re absolutely right, counseling would be a rational next step in comprehending/coping with the feelings that surround the subject for me. I don’t necessarily have to know the why behind the narcan, there might not be one singular reason that it became suddenly necessary. I’m contemplating writing a letter to my surgical team to ask for a bit of explanation, if they’d be able to provide it. They were all phenomenal, and very reassuring throughout the procedure, from what I recall. I just think too much time may have elapsed by now for them to remember exactly how my surgery went down. Thank you for responding!

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u/WreckedEmKilledEm MD - Peds GI | Top Contributor May 28 '22

I think your plan is great. You have the right to answers. You’d be surprised what people remember, especially in unusual situations like yours.

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u/Little_Conflict_6489 Layperson/not verified as healthcare professional May 28 '22

If you're anywhere like Canada, we can always get the surgical notes from the hospital when we request them. Might be something to look into.

3

u/castaspellx Layperson/not verified as healthcare professional. 29d ago

There are likely some detailed notes on your surgery in your chart, which you should be able to access (or request access to). These will possibly help answer the why about giving the narcan (the doctor you responded to is almost certainly correct about the hemodynamic stability reason, but you may feel reassured seeing that documented), but they may not answer why the increased pain meds did it to you in the first place. I'm glad you and baby are doing well now and hope you are able to get answers, or at least peace with not having firm answers.

41

u/aenaesthaesia Physician - Anesthesiology May 28 '22

I would definitely speak to your OBgyn (and if possible, the anesthesiologist) about this and get some clarity. I have done many many csections and your unique case seems like a complex and urgent situation that’s hard to understand without having been in the OR or at least, reviewed the anesthetic and surgical records. There are some confusing and unusual points/clinical decisions in your story but again, it’s hard to know what happened as an outsider.

Im sorry you went through this - definitely a very traumatic event and counseling actually sounds like it could help. Are you already seeing a family doctor or psychiatrist for your PPD? Best of luck!

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u/Downtown_Asparagus14 Layperson/not verified as healthcare professional May 28 '22

I saw my OB for my PPD, but I moved states in April & unfortunately need to find a new provider. My case seemed unusual to me, but my sister had a VERY similar experience in her delivery which was also a cesarean section - I’m wondering if there may be a genetic component to my/her reaction to the medication. Our mom & maternal grandma delivered unmedicated and vaginally, so I can’t really gather more clues from their deliveries. Stranger things have happened! I know the world of medicine is complex and anesthesia is an especially delicate practice, so with that stated, I’m positive that they did what they thought to be the best things for me as each new situation arose. It certainly wasn’t a typical delivery, but everyone involved acted like they’d seen it a billion times, which blows my mind looking back on it lol. I’ll definitely write them and ask for a review of records/explanation of events, just for the sake of clarity.

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u/Puzzleworth Layperson/not verified as healthcare professional 29d ago

It might be a good idea to get your sister's and your own medical documents together and see a genetic counselor. There are several known genes that affect anesthesia resistance.

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u/warkwarkwarkwark Physician May 28 '22

Your story honestly sounds so far outside of normal practice that it's difficult to comment on the actual events around your ceasar. Narcan is really the least of it - by itself it shouldn't significantly affect your experience of the operation.

It definitely sounds like you have some PTSD surrounding the events with or without the PPD. I'm not at all surprised - I think anyone would be having difficulty after that experience. It would be wise to seek help for that.

I am extremely doubtful this is all the result of a genetic condition you have, at least directly. I don't think it should affect you should you require further operations, but the only way to be certain would be to acquire all the notes surrounding the event, and I would be most interested in the anaesthetic record.

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u/fabs1171 RN May 28 '22

OP I am not a doctor nor well versed in obstetrics or surgical services, what I’d like to tell you that you can’t compare your need/desire for therapy based upon how others have reacted in the same or a similar situation. No one should compare traumas in order to decide to have therapy. Your experience sounds terrible, but even if it wasn’t terrible, if you felt you wanted therapy - just do it. I’m a huge advocate for talking it out with professionals