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Discussion (54 Comments)Read Original on HackerNews
I don't bring this up to say that actually Epidurals suck, just to bring attention to the fact that they can fail, and that the system has historically handled such failure really poorly, and that the system itself isn't very well aware of this issue. This isn't just opinion from some podcast, but also admitted by the professionals working within this field.
It's also something valuable to be aware of when you or your partner is planning to have an epidural, because there is real space (and even a need) for advocacy for the patient when an epidural fails and the woman giving birth is in excruciating pain.
> The result is unnecessary birth trauma.
Not trying to be snarky, but which is it? This is definitely a situation in which having a midwife there to advocate for you is an absolute plus.
The consensus seems to be shifting more towards converting to general anesthesia after epidural failure unless there are very clear reasons not to.
Will go for minimally invasive micro laminectomy next, tired of treating symptoms and not the root cause.
In that procedure surgeon will remove parts of lower vertebrae that is pinching the nerve bundle, nerves that progress down each leg.
Success rates of better than 70%, it's a gamble. But willing to accept that rather than end up on addictive pain pills for life.
3 to 6 months recovery period before active lifestyle again, cannot risk disturbing the "fix". Giving up flip turns in lap swimming for quite a while. Supplemental covers the other 20% that medicare won't pay.
Cash paying patients suffer $35k to $45 K for the procedure.
Medicare pony's up only about $6,500, which the surgeon must accept, no extra cash changes hands.
Supplemental covers the 20% that medicare will not pay.
Steve Kerr's advice after his own back surgery complications (albeit microdiscectomy, not a laminectomy) make me hesitant:
"If you're listening out there, if you have a back problem, stay away from surgery... Rehab, rehab, rehab. Don't let anybody get in there."
You acknowledge the parent commenter knows more than you, but you decide it's somehow helpful to post contradictory information anyway sourced from someone else who also likely knows more than you.
Don't get me wrong. I support state-sponsored health care, especially after moving from the US to Norway over a decade ago. Just the peace of mind not having to worry so much about financial ruin because of health issues relieves so much stress - even stress related to just keeping yourself healthy is less (If I get hurt while jogging, it isn't a big issue, for example) But fixing the US system is bigger than just payments or insurance for all. Gotta fix things like education costs, the burden of unpaid internships, and things like that, too. I wish it weren't such a complicated problem and I wish there were the political desire to do such a thing.
Don't completely trust any anesthesiologist (pain management) or neurosurgeon (for surgery) or chiropractor or random folks advice to do yoga/stretch. Spend quite a bit of time understanding the anatomy, read up on everything and maybe you will find the right set of exercises to help relieve pain. Troubleshooting disk/spine/nerve issues is very hard and most doctors don't have any time to investigate it deeply. They just look at MRI. There are lots of people with the same problems showing up on MRI, but they are pain free.
Sorry to hear about re-herniation. Thats what I am concerned about. I have multiple disc herniations, one with cauda equina. Multiple neurosurgeons have recommended surgery, but each is going to do a different procedure. I understood as they don't fully understand whats the root cause, everyone wants to do the procedure they are comfortable with and what they've been doing. One wants to cut the disc, another remove lamina, another fusion and something else. I decided its not worth taking the risk when they don't know what they are doing. There are so many reports of failed back syndrome, revision surgeries, cascading failures (because it increases pressure on adjacent discs).
> with the caveat that many physios don't seem to know what they're doing either
Yes, this is true of nearly any profession. We just have to spend significant time researching and troubleshooting with an engineering mindset.
disclaimer: I know nothing about this
[1] https://www.bbc.com/future/article/20260401-women-were-never...
The hospital only had two rooms suitably equipped for giving birth in a squatting position, so I was lucky to get one second time.
Note that per Wikipedia [0], death by abdominal surgery in general in High-HDI countries is on the order of 100-1000/100k.
[0] https://en.wikipedia.org/wiki/Perioperative_mortality
So it would be interesting to see the elective vs crash ceasarian rate.
Seems to depend a lot on the hospital. We (partner is pregnant with a high risk pregnancy) were at a level 1 prenatal care center in Germany a few weeks ago where they very much insisted that in her and the child's condition, a c-section is pretty much her only option.
We're now in a different, also level 1, prenatal care center, also in Germany (though a different state), where the prevailing medical opinion is "natural birth should work perfectly fine for you. We're not ruling out a c-section in case things go sideways, but natural birth is very much our preferred option in your case."
The first center seems to be quite keen on using as many cases as possible for training their staff in c-sections, even where it's not strictly necessary/beneficial. At least that's what we've heard from other parents in similar situations.
The first place might have a strong surgical team and might be inclined to solve everything via surgery?
Obviously, I'm only a spectator, but the overall experience seemed way less traumatic and stressful for her with the natural child birth, working with midwives and nurses rather than doctors.
It made it emotionally difficult to get surgery again.
Compare this to cows or horses - where the baby is of sizeable size, but goes statistically smoothly.