Cesarean sections (c-sections) comprise around 30 percent of births in the United States, the Nemours Foundation reports. All cesarean sections, like any other major surgery, are done under anesthesia. Anesthesia for cesareans falls into two categories: regional and general. Around 95 percent of cesareans in the United States are done under regional anesthesia, Gilbert Grant, M.D., states in the article, "Anesthesia for Cesarean Delivery" on UpToDate.com.
Spinal Anesthesia
Many cesarean sections are done under spinal anesthesia, a regional anesthesia that numbs from the middle of the chest down. Spinals work quickly, which makes them a good choice for cesarean deliveries where time is of the essence, such as those done for fetal distress or complications. One possible complication is placental abruption, where the placenta separates from the wall of the uterus, causing hemorrhaging and decreasing fetal blood supply. Spinal anesthesia is somewhat easier to do technically than epidural anesthesia and is effective almost immediately.
Spinal anesthesia has minimal effect on the baby and, generally, lasts for several hours. Since the average cesarean takes between 30 minutes to an hour, this gives plenty of time for surgeons to work. However, the spinal needle is removed right after the drugs are injected, so there is no way to increase the amount of drug given for an exceptionally long surgery, such as a cesarean section complicated by hysterectomy. Morphine is often injected with the spinal anesthesia, which lasts 12 to 24 hours, anesthesiologist Gareth Kantor, M.D., of Case Western Reserve University states on NetWellness.com. This helps with postoperative pain. Regional anesthesia can also cause maternal hypotension, which can affect blood flow to the baby, so adequate fluid must be given intravenously. Spinal headache can also occur if spinal fluid leaks out at the injection site; however, with today's smaller needles, this is uncommon.
Epidural
Cesarean sections are often done under epidural anesthesia, a regional anesthesia, especially if the cesarean was not planned and is being done for nonemergent, but necessary, reasons during labor. In epidural anesthesia, a catheter is left in place, so medication can be given as needed during labor. If the cesarean is being done for mild fetal distress or failure of labor to progress and an epidural catheter is already in place and working well, it may be used for the surgery. One benefit of the epidural catheter is that the drugs can be given continuously during the surgery or re-administered as necessary. Epidural anesthesia can also be given for a planned cesarean. Some hospitals leave epidural catheters in place for a day or so and administer pain medication through them, according to Dr. Kantor.
General Anesthesia
General anesthesia is usually used for cesarean sections done as emergencies, because it is faster to put a woman to sleep under general anesthesia than to place a spinal or epidural needle. In severe fetal distress or a true obstetric emergency, general anesthesia is the fastest option. However, general anesthesia may cause respiratory depression in newborns, the American Pregnancy Association states, so the surgery must be done soon after anesthesia is given. Because general anesthesia is given in emergency situations, there is a good possibility that the mother has had something to eat or drink in the last eight hours, which increases her chance of aspiration pneumonia, explains Brigham and Women's Hospital. And, since she is asleep, she cannot participate in her baby's first moments on earth. Pain immediately after surgery is usually greater after general than with regional anesthesia, because pain relief is usually still present for several hours after regional anesthesia. This can interfere with bonding right after birth.
References
- UpToDate: Anesthesia for Cesarean Delivery; Gilbert Grant, M.D.
- Brigham and Women's Hospital: General Anesthesia for Cesarean Delivery
- Nemours Foundation: KidsHealth: Cesarean Section
- NetWellness: Spinal Vs. Epidural for C-Section; Gareth Kantor, M.D.
- American Pregnancy Association: General Anesthesia
