Your Anaesthetist will meet you prior to your Caesarean Section and discuss your anaesthetic with you. The Anaesthetist will ask you about your general medical history and about any medications and allergies that you have. The Anaesthetist will also ask about your obstetric history and the progress of your pregnancy.
Types of Anaesthesia for Caesarean Section
There are four types of anaesthesia available for Caesarean section:
- Epidural Anaesthesia: Tends to only be used for those women who have already had an epidural inserted during labour. The strength of the epidural can be increased to allow for a pain free Caesarean section.
- Spinal Anaesthesia: Is where a single dose of local anaesthetic is injected at the level of the lower back into the fluid surrounding the spinal nerves, without the placement of a catheter.
- Combined Spinal/Epidural Anaesthesia: Spinal anaesthesia may be used for quick pain relief before proceeding to insert an epidural during labour. Both epidural and spinal anaesthesia allow the mother to be awake for the delivery. They cause a temporary loss of sensation up to the breasts and loss of movement in the legs during the Caesarean Section. The baby is usually more alert after this form of anaesthesia. The choice of anaesthesia follows a discussion between the mother and the Anaesthetist. The partner can also be present during the birth.
- General Anaesthesia (GA): May be used for Caesarean Section in an emergency. With a GA you have intravenous drugs to induce you to sleep and you are kept asleep with a combination of anaesthetic gases and intra-venous drugs. Unfortunately by its very nature, a GA prevents the mother from watching the birth of her child. It also prevents the father or partner from being present.
Frequently Asked Questions
“If I had an epidural put in for labour pain, and I require a caesarean section, what happens to the epidural?”
Provided that the epidural has been working effectively and provided you with adequate pain relief from contractions, it can be used to provide anaesthesia for the caesarean section. However, an epidural for labour pain may not be adequate to provide anaesthesia for surgery because the medications used for labour pain may not have spread far enough to provide pain relief for the surgery. The Anaesthetist will assess the adequacy of the epidural and, provided he or she is satisfied, may “top up” the epidural with more local anaesthetic with or without opioid drugs.
“How will the Anaesthetist make sure that I won’t feel pain during the caesarean section?”
There are several ways to test the effectiveness of the epidural or spinal block used to achieve anaesthesia for a caesarean section. Firstly, the Anaesthetist will ask you to raise your legs one at a time. Known as straight-leg raising, this involves lifting your leg up straight off the bed, keeping the knee straight. In almost all cases of effective block, you should have limited ability to do that. Your legs may feel incredibly heavy, “concrete” like, and you will experience pins and needles. This is all indicative of a successful block. Secondly, the Anaesthetist will test the level that the block extends up your body to determine its adequacy for surgery. This is done most commonly using ice. Temperature differentiation is controlled by the same types of nerves as pain transmission, so if you cannot feel the coldness of the ice then you will not experience pain.
Risks Of Spinal and Epidural Anaesthesia For Caesarean Section
Awareness of surgery: Both spinal and epidural anaesthesia numb the lower half of the mother’s body to pain sensation. Different nerves carry the sensation of touch and are often not completely blocked. Therefore, mothers will often experience a sensation of pulling or touching by the Surgeon but not any associated pain. This is normal and not an indication the anaesthetic is inadequate in any way. However, if you feel discomfort or pain it is important to advise your Anaesthetist so they can assess you and decide how best to manage this.
Headache: As with an epidural for childbirth, spinal and epidural anaesthesia for a Caesarean section may cause headaches.
Side Effects of General Anaesthesia For Caesarean Section.
Common side effects: General anaesthesia for caesarean sections can cause the same common side effects as for other types of surgery including, nausea, vomiting, sore throat, dry mouth and drowsiness. Bruising can also occur at the site of the intravenous injections but usually settles quickly.
Regurgitation and inhalation of gastric contents: Is where the stomach contents are brought up into the back of the throat and then inhaled into the lungs during the GA. It is important to fast for some time prior to your anaesthetic. There are many steps your anaesthetist can take to minimise this risk to you.
Awareness of surgery: Is where you can become conscious during the operation and remember things that happened during this time. This is most likely the result of receiving too little anaesthetic. With advances in monitoring and equipment, the risk of awareness has become extremely low.
Difficult Airway: Pregnancy can cause difficulties in managing the airway. Your Anaesthetist will assess this risk prior to your anaesthetic.
Rare Side Effects: General anaesthetic has a very small risk of severe allergic reactions. It is important to advise your Anaesthetist of any known allergies to medications or rubber (latex) products.