Can a healthy baby be born from an unconscious mother?

April 18, 2006 4:07 PM

Must a woman be conscious during childbirth?

According to Wikipedia, during C-sections minimal anesthesia is used. Is this due to general risks of anesthesia or is the woman being unconscious a health risk for the child?

Basically, I need a scenario during which a woman DOES become unconscious during delivery but where both her and the baby are fine afterwards. That said, the *greater* the risk that the child not be fine (but the child still being fine within the realm of possibility) is the best scenario for my purposes. (This is for a fiction piece.)

Suggestions on what process/procedures would take place to arrive at my ideal scenario?

posted by dobbs to health & fitness (31 comments total)

Up until the 50s at least it was common (though far from universal) practice to give a woman in labor a combination of drugs to induce a state called "twilight sleep", which I've seen referred to as zombie-like or trance-like. It left the mother with no memory of the birthing experince....
posted by mr_roboto at 4:16 PM on April 18, 2006

I was born through c-section and my mother was under full anesthesia. She woke up a few hours later. Now they don't usually do that anymore as anesthetic techniques are more sophisticated, I guess, so epidurals are the default. So it might be depending on which time/place you're setting the story.
posted by funambulist at 4:19 PM on April 18, 2006

Thanks, mr_roboto and funambulist, but I need something that can plausibly be done today. I read the entry there and it sounds like it wouldn't be.

Is it possible to get someone to that state (or some other similar state) with just "too much" or whatever the standard anesthesia is for childbirth today?
posted by dobbs at 4:21 PM on April 18, 2006

btw, I'm talking late 70's/early 80's, full anesthesia was still used for c-sections, don't know about the US specifically, I imagine there it was already more advanced?
posted by funambulist at 4:22 PM on April 18, 2006

One major issue with giving the mother anaesthesia is that it passes to the child. If the baby comes out heavily sedated, it may interfere with the natural process of such key things as starting to breathe.
posted by AmbroseChapel at 4:24 PM on April 18, 2006

Does it have to be obvious at the time it happens that both are going to be fine? Does it have to be something done on purpose? If not, perhaps some unexpected situation makes an epidural impractical and an inhaled or injected general anesthetic is administered in excess of what it should be and total unconsciousness results.

Alternately, some drug interactions cause medications to have a greater impact than they should; perhaps your character can fall victim to that and end up in a twilight despite that not being the intention.

Anesthesiologists make mistakes; it's not implausable. my grandfather was accidentally killed (temporarily, thankfully) when an injection went into a vein rather than an artery and his heart stopped.
posted by phearlez at 4:33 PM on April 18, 2006

dobbs, I don't think that "too much" would happen accidentally, but for emergency reasons I think general anesthesia is still used even when it's no longer the default.

Or it could be even a choice.
posted by funambulist at 4:36 PM on April 18, 2006

If the C-section is an emergency due to some severe complication and the woman didn't already have an epidural in place - my understanding is that the practice is to do general anesthesia since an epidural takes some time to install and take effect. This would also cover your need to have things maybe not be ok. I am not a doctor only a pregnant woman who has read too many books...
posted by Wolfie at 4:37 PM on April 18, 2006

dobbs ol' pal, here's one from my life: When my wife was in labor with our first kid, her epidural was put in by a resident, who fucked it up and missed the sweet spot in the spine where the anaesthetic should be injected for an epidural (i.e. one that would numb just the lower body). He compounded his mistake by injecting the full dose and not a test dose. As a result, my wife got not an epidural but a spinal, which is a much more major act of anaesthesia that crept so far up her body that it inhibited her ability to swallow. Her blood pressure dipped to 20/0 and her ability to breathe under her own power would have been the next thing to go. And my wife did briefly lose consciousness.

Less specifically, an emergency c-section where the baby is in trouble will usually involve sufficient general anaesthesia that the mom gets ko'd.
posted by blueshammer at 4:49 PM on April 18, 2006

hmm. Thanks for the answers so far. I'll flesh out my question a bit more:

Essentially, I need a pregnant woman to be told her baby didn't survive due to X and I need her to have no memory of the birthing. What is X?

The woman begins to suspect a plot that the child truly survived and that she was lied to.

What's the shortest, most believable route to this scenario in contemporary times?

SPOILER FOR ROSEMARY'S BABY BELOW

Essentially, think Rosemary's Baby in contemporary times: in that book/film, Rosemary comes to and the baby's not around and she's told it didn't survive. However, in those days the twilight sleep was normal so it's plausible she doesn't remember a thing.

Pretend RB was being done today...

END OF SPOILER

... how could such a scenario take place that

a. is believable the woman has no memory of the birth
b. is believable the child died and believable that it survived
c. the total sedation is planned by either the woman or the medical pros (ie, it cannot happen as a result of something going wrong during normal birthing, unless that something going wrong could also be realistically blamed on the medical pros)

On preview, it looks like blueshammer's scenario is possible as a planned fuckup by med pros (thanks bh!)... any others anyone can propose?
posted by dobbs at 4:54 PM on April 18, 2006

And blueshammer, creepy story. Hopefully it all worked out in the end.
posted by dobbs at 4:56 PM on April 18, 2006

Well, my daughter is making her younger brother scream bloody murder right now, so I guess it depends on how to define "worked out." But generally speaking, yeah.
posted by blueshammer at 5:11 PM on April 18, 2006

Pretend RB was being done today...

ok then it's basically the same, the only assumption that needs to change is that the general anesthetic has to be an exception, so you could have a situation where no c-section was planned, but because labour started earlier and the baby was not properly positioned, there's no time to prep for an epidural so you have to to have an emergency c-section. This still happens all the time.

This could also be combined with the baby being premature and with related complications so that the mother is told it didn't survive and believes it (of course you have to make it believable that she doesn't even get to see it), but not too premature, so that when she finds out it was alive it's also believable. I'm sure there's more original scenarios than this, this is the most obvious one I can think of.
posted by funambulist at 5:14 PM on April 18, 2006

but because labour started earlier and the baby was not properly positioned,

But funambulist, both of these things are outside of the control of the medical pros, no?

It has to be something planned in advance.
posted by dobbs at 6:25 PM on April 18, 2006

But the doctors could be lying about the baby's position, no? You go into labor, doctors are flying about telling you you need X or Y, most people don't question it.
posted by occhiblu at 6:30 PM on April 18, 2006

OB nurse here-

there are 2 ways this could happen, but both would require a c/section birth.

A- baby takes a sudden turn for the worse during labor (this is most commonly diagnosed due to "late decels" where the baby's heart rate drops after the peak of each contraction), after a few of these you begin to talk c/section and after one or 2 dips where the heart rate stops altogether or slows down into the 20s or 30s you're rushed (actually we shove you on a gurney and literally run full speed into the OR) to have an emergency section. If you didn't already have an epidural, you would have a general anesthesia since there's no time to set up the sterile field for the epidural nor to wait for the total effect to set in.

B- this happened to me in 2002 when I had my last child. A scheduled c/section and I had a drastic and unexpected reaction to morphine. Since there had been almost 13 years since my last surgery before this, and anesthesia having advanced so much, none of us expected me to react badly. I was given DuraMorf, which is a sustained release form of morphine which is, to my knowledge, the current standard among c/section pain relief. Unfortunately I lost consciousness immediately after it was given to me (right after they pulled my son out), and I couldn't be revived for many hours. Then I was in and out of it until the next day. To this day I don't remember anything from just shortly after my epidural was given to me in the OR until the next day. I don't remember the birth, his first bath and weighing, my husband's reaction to seeing his only child being born or anything great like that. I remember feeling like I was dying and then waking up the next day with my family all in my room talking to me. Very scary stuff.
posted by hollygoheavy at 6:32 PM on April 18, 2006

Why not an emergency scenario? Mother has placenta previa (which covers the cervix, and in some cases can cause heavy bleeding.) Most of the time, mothers and doctors are careful and it's not a huge deal. Mom is admitted for the C-section that a placenta previa requires, and boom, she wakes up, un-pregnant and scarred.

The doctors or devils or whatever you have- they can tell her that she passed out from blood loss and the baby died from lack of oxygen because her previa was more serious than originally suspected (placenta accreta, making the C-section that much more difficult.) Whatever actually happened, massive blood loss, unconsciousness and emergency C-section should more than cover for it.

Your problem is getting around letting her see the body, because most hospitals apply grief counselling to parents who lose neonates. An infant, even a grievously deformed one, will still be cleaned, dressed and swaddled so the parents can hold him/her and make their peace. Of course, your story sounds pretty ghoulish already, so giving Rosemary somebody else's dead baby to hold... *shudder*

Good luck!
posted by headspace at 6:32 PM on April 18, 2006

Your problem is getting around letting her see the body, because most hospitals apply grief counselling to parents who lose neonates. An infant, even a grievously deformed one, will still be cleaned, dressed and swaddled so the parents can hold him/her and make their peace.

But not everyone knows that it works that way. If your Rosemary isn't familiar with hospitals, she might not know to expect that sort of grief counseling — in which case, it wouldn't set off any alarm bells when she didn't get it.
posted by nebulawindphone at 6:47 PM on April 18, 2006

True, nebulawindphone. Dobbs, of course, can say she had no idea it should happen, but the body is still an issue. Hospitals don't throw away dead, full-term infants, and North American families traditionally have services for stillbirths. (Which is not to say families in other regions don't; I just don't know.)
posted by headspace at 6:56 PM on April 18, 2006

I think the story works better if we find out that they had a dead baby on ice, either literally or figuratively, just so they could trick her into believing hers had died.

When I say "better" of course, I mean "more evil".
posted by AmbroseChapel at 6:58 PM on April 18, 2006

In the US, most educated pregnant women would know that you could ask to see a baby who has died during birth. The typical pregnant American woman tends to be obsessive about getting as much information as possible.

A more plausible situation might be a language barrier or cultural gap preventing adequate communication. If you could work in either or those, you could do all sorts of evil things under the guise of medicine, and you wouldn't have to worry so much about the mother being unconscious and unaware of her surroundings.

Re cultural gap - the patient is from a culture that reveres doctors and medicine; and does not question authority. The only example of this I can give is anecdotal, so I can't say if it can be applied more generally, but fwiw - my sister-in-law is an L&D nurse in an inner-city hospital that serves a mostly Spanish- and Tagalog-speaking population. She has noticed how much more compliant, respectful and obedient her patients are, versus the patients in the more expensive hospital out in the 'burbs where she used to work.

Also, there have been situations where a woman with some kind of disability has been raped and her doctors didn't realize she was pregnant until it was too late. Lots of hits for "rape comatose birth" at Google. Now I have to go wash out my brain with soap. Eww!
posted by SuperSquirrel at 7:25 PM on April 18, 2006

Twilight sleep was treated somewhere in the popular literature somewhere, specifically wrt its amnesiac effects. Even if you don't use it as a plot device, you might find it helpful reading if I could think of where it came from.

I remember doctors using the phrase "scope 'em," a sort of heavyhanded condemnation of the rich (who used drugged labor) and praise of the poor (who were forced to give natural childbirth), kind of hamfisted oversimplification of characters, but the science being pretty OK. Maybe Michael Crichton, Travels.
posted by oxonium at 7:34 PM on April 18, 2006

Yeah, I had the dead baby covered by Dead Baby Storage so that wasn't an issue.

Thanks all for your excellent answers...

I think I can now proceed!
posted by dobbs at 7:52 PM on April 18, 2006

I was conscious but exhausted and doped up after labor, then c-section. For the surgery, I was draped, and couldn't see much. The doctor had to lift him up high for me to see him. In a diabolical scenario, the baby could have been taken out of the delivery room and I could have been told he died. Babies don't necessarily cry when born. With of anesthesia and sedative, I was pretty groggy. I thought I had hallucinated some of the details, but my doctor confirmed otherwise.
posted by theora55 at 8:19 PM on April 18, 2006

Considering your previous question, dobbs, looks like it's going to be an interesting script!
posted by greatgefilte at 8:25 PM on April 18, 2006

greatgefilte, two diff scripts (and 13 days to get them both done), but thanks for the encouragement!

And thanks for your answer, too, theora55.
posted by dobbs at 8:31 PM on April 18, 2006

"Kill Bill" spoiler follows.

The Bride gave birth while unconscious in the Kill Bill duology. Not exactly a direct answer, but presumably they thought it possible.
posted by WCityMike at 9:00 PM on April 18, 2006

FWIW, hollygoheavy's A scenario happened with both of my babies' births. Both had a sudden and unexpected heartrate dip after contractions during pushing, and on quick investigation it was found that they were positioned badly and would have to be born via c-section in any case, so I was rushed (no kidding) into theatre, given an epidural with the first, a spinal with the second, and awake for both births.
posted by tracicle at 10:46 PM on April 18, 2006

have had two c -sections. one with epidural, one with full sedation due to a someone who apparently had no idea how to do an epidural. they knocked me out at the last minute because only the right side of my body was numb.

my last memory pre birth was feeling my doctor poke me with something sharp. my first memory post birth was insisting i was now cross eyed. i was slurring my words as though i had downed 20 shots of tequila. at that point i could have been told anything and shown anything and not been able to argue a logical point.
posted by domino at 6:32 AM on April 19, 2006

I have a real world solution to your problem. The drug Versed can be used to induce amnesia without a person being fully 'under'.

There was an actual case where an emergency C-section was needed and the anesthesiologist was not able to get to the hospital fast enough. The c-section was performed without anesthesia but instead with a combo of morphine, other pain killers, and Versad. The woman was in great pain and had to be physically restrained but remembered NOTHING of the whole ordeal.
posted by killThisKid at 8:12 AM on April 19, 2006

Excellent. Thanks, all!
posted by dobbs at 8:44 AM on April 19, 2006