What to expect for a caesarean
Anaesthetic options
Anaesthesia options (pain relief during the procedure)
An anaesthetist will come to speak to you before your caesarean birth. They will be able to advise you about the two different kinds of anaesthesia:
Regional anaesthesia: an injection into the back to numb from the chest down
General anaesthetic: being put to sleep for the operation
Regional anaesthesia
There are three types of regional anaesthesia: spinal, epidural and combined spinal-epidural. For all three of these, local anaesthetic is given into your back to numb your abdomen and lower body. This means that you can remain awake and should be comfortable during your birth.
Spinal anaesthesia is commonly used in caesarean birth. Epidural analgesia is commonly used during vaginal birth. If you were planning a vaginal birth, are in labour, and have an epidural in already this may sometimes be used during an emergency caesarean birth. Your anaesthetist will discuss which of the three types of regional anaesthesia is most appropriate for your caesarean birth.
Spinal anaesthetic is most commonly used during planned caesarean births.
The nerves that carry feeling from your lower body are contained in a sack of fluid inside your back. The anaesthetist injects local anaesthetic into this fluid, using a very fine needle.
Epidural anaesthetic is when a thin tube is placed near the nerves in your back. This tube is used to deliver local anaesthetic. It is used during labour to numb the contraction pain but stronger local anaesthetic can be given for an unplanned or emergency caesarean birth
At the start of your caesarean the theatre team will place monitors for your blood pressure, heart rate, and oxygen level. The anesthetist will prepare the equipment for your anesthetic. You will be asked to either sit up or lie on your side. They will feel the spaces in your back with their hands, then put some local anaesthetic in your lower back to numb the skin. The procedure usually only takes a few minutes, but may take longer if it is difficult to find the small space in your back.
When the injection is finished, you will lie on your back, with a tilt on the bed. The anaesthetic begins to take effect within a few minutes. Once the anaesthetic is starting to work, you will have a catheter (plastic tube) inserted to keep your bladder empty during the operation. This stays in until the heaviness in your legs wears off to protect your bladder and it means you don’t need to worry about getting to the toilet.
The anaesthetist will do some simple tests to check that the anaesthetic is working properly, such as asking you to lift your legs and touching your skin with something soft, sharp or cold. You shouldn’t be able to feel anything. The anaesthetist will only tell the obstetrician to start the caesarean birth when they are satisfied that the anaesthetic is fully working. You shouldn’t feel any pain during the operation but it is normal to feel pressure and pulling. Sometimes you may be given extra pain relief. Occasionally, the anaesthetist may recommend changing to a general anaesthetic.
The advantages of spinal analgesia, over other kinds are that they are usually safer for you and your baby; your partner can be present so you can experience the birth together; you will feel less sleepy and have less chance of feeling or being sick afterwards; your baby will usually be more alert when it is born and you may be more comfortable afterwards.
You may experience some side effects, which your anaesthetist will manage. These include low blood pressure (which might make you feel dizzy or sick), itching or shivering. Other complications of regional anaesthetic include headaches and inadequate pain relief. Temporary nerve damage is a rare complication. Permanent nerve damage is very rare (approximately 1 in 50,000).
General anaesthetic
A general anaesthetic is where you are asleep and do not feel anything during the procedure.
These are some of the reasons why you may need a general anaesthetic rather than a spinal or epidural:
If you need a caesarean very urgently, there may not be enough time for a spinal or epidural anaesthetic to work
If you have certain medical conditions such as a bleeding tendency or abnormalities of your back
Occasionally, a spinal or epidural anaesthetic may be unsuccessful or inadequate for surgery
Your birth partner will not usually be able to come into the operating theatre with you if you have a general anaesthetic. They will be able to stay nearby and kept updated until they can see you after the operation.
The anaesthetist’s assistant will attach equipment to measure your blood pressure, heart rate, and the amount of oxygen in your blood. You may be asked to drink an antacid medicine to reduce the acid in your stomach. You will be given oxygen to breathe through a facemask for a few minutes. The obstetrician may clean your tummy and insert a catheter (plastic tube) into your bladder so that they are ready to deliver your baby once you are safely asleep. Once the team are ready, the anaesthetist will give the anaesthetic into your drip. As you go off to sleep, the anaesthetic assistant may apply some pressure to your neck. This is to prevent any stomach fluid getting into your lungs. You will have a breathing tube placed into your throat.
The anaesthetist will keep you asleep and monitor you closely while the obstetrician delivers your baby. When your baby is born they will be cared for by a neonatal nurse or doctor at first. If your baby does not need any specialist care, the midwife will then look after your baby until you are out of theatre. After your baby is delivered, the obstetrician will close your tummy. Some local anaesthetic may be given into your tummy at the end and you may be given a suppository (tablet) into your bottom to help relieve pain when you wake up.
Once the surgery is complete you will gradually wake up and the breathing tube will be removed. You will then be transferred from theatre into the recovery area. You may feel sleepy for a while until the anaesthetic wears off.
Your birth partner and baby will usually be able to join you in the recovery area. If your baby needed assistance at delivery, they might be receiving further care on the neonatal unit. You will be able to visit them on the neonatal unit as soon as you feel well enough.
Common problems: feeling sick and vomiting, a sore throat, shivering or itching.
Uncommon complications: breathing difficulties after the anaesthetic, damage to lips or teeth, and accidental awareness during anaesthesia. Accidental awareness is when a patient may have memories of events in the operating theatre. The majority of patients who become accidentally aware do not feel pain.
Rare complications: severe allergic reaction, most commonly to medicines.
Very rare complications: brain damage or death caused directly by anaesthesia is extremely rare.
References
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Jenkins JG. Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a prospective study of 145,550 epidurals. International Journal of Obstetric Anesthesia 2005 – chapter 14, pages 37–42.
Reynolds F. Infection a complication of neuraxial blockade. International Journal of Obstetric Anesthesia 2005 – chapter 14, pages 183-188.
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