A C-section, also known as a cesarean section, is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. It involves creating an opening in the mother’s abdomen and uterus to deliver the baby.
Many people wonder why doctors don’t routinely use general anesthesia to put mothers completely to sleep for C-sections. There are several important reasons why general anesthesia is not preferred for routine C-sections:
Safety of regional anesthesia
The most common method of anesthesia used for C-sections is regional anesthesia such as an epidural or spinal block. This numbs the lower half of the body while allowing the mother to remain awake. Regional anesthesia is safer than general anesthesia and avoids the risks of being put completely to sleep.
Awareness during surgery
Remaining awake allows mothers to be aware during the birth of their child and participate in the experience to an extent. This can help facilitate bonding between the mother and newborn.
Quick recovery
Regional anesthesia also enables a quicker recovery compared to general anesthesia. Mothers can usually begin breastfeeding and caring for their newborn sooner.
Why general anesthesia is avoided when possible
While regional anesthesia is preferred, general anesthesia is used in certain situations when required by medical necessity. However, there are risks associated with general anesthesia that doctors avoid if possible:
Breathing problems
General anesthesia involves giving medication that makes the patient completely unconscious and unable to breathe on their own. This requires the anesthesiologist to control the patient’s breathing with a machine. Sometimes complications can occur.
Drug reactions
Reactions or complications from medications used in general anesthesia can also sometimes occur. Adverse reactions are a risk any time someone is given general anesthesia drugs.
Increased recovery time
Waking up from general anesthesia usually takes longer than recovering from a regional block. There is also more postoperative grogginess, nausea, and vomiting.
Risks for the baby
General anesthesia drugs cross the placenta and reach the baby. While this is usually not a problem at delivery, it can sometimes affect the newborn. After birth the baby may have slightly depressed breathing, tone, and reflexes.
When general anesthesia is used
While doctors avoid general anesthesia when possible, it is required in certain situations:
Emergency C-sections
Emergency C-sections often require general anesthesia, especially if a regional block cannot be placed or takes effect quickly enough. Getting the baby delivered rapidly takes priority.
High risk pregnancies
Mothers with certain pre-existing conditions like heart or lung disease may require general anesthesia to avoid complications. The mother’s health must be stabilized as a priority.
Issues with regional anesthesia
If a regional block cannot be placed for some reason or does not provide adequate pain relief, converting to general anesthesia may be required. This is not common.
Patient choice
While not typical, a small number of patients may actually request general anesthesia if they have a strong preference to be completely asleep for the surgery. This is very uncommon.
Emergency situations
During surgery, general anesthesia may be required if certain emergency complications arise such as severe hemorrhage or the need for an emergency hysterectomy. The surgeons must be able to work as quickly as possible to resolve the emergency.
How general anesthesia is administered
When general anesthesia is used for a C-section, it involves giving medication through an IV line to quickly make the patient unconscious. An anesthesiologist or nurse anesthetist carefully monitors the mother. Common steps include:
Starting an IV
An intravenous (IV) catheter is placed in a vein, usually in the hand or arm. This provides a route to administer general anesthetic medication. Fluids and other medications can also be given through the IV if needed.
Pre-oxygenation
Before going unconscious, pure oxygen is breathed in through a mask. This fills the lungs with oxygen to help avoid low oxygen levels once anesthetized.
Administering anesthesia drugs
Anesthetic drugs are injected through the IV to rapidly induce general anesthesia. Common medications include propofol, etomidate, ketamine, and opioids like fentanyl. The drugs make the patient unconscious in less than a minute.
Inserting a breathing tube
Once unconscious, an endotracheal tube is inserted through the mouth into the windpipe. This protects the airway and allows the anesthesiologist to control breathing with a ventilator machine.
Maintaining anesthesia
Additional anesthesia medication is given through the IV to maintain general anesthesia for the duration of the surgery. The mother remains completely asleep and is also given pain medication.
Monitoring vitals
The anesthesiologist closely monitors oxygen levels, blood pressure, heart rate, and other vitals to ensure the mother’s health and safety while under general anesthesia.
The C-section procedure with general anesthesia
When a mother undergoes a C-section under general anesthesia, the overall surgical procedure remains largely the same, but the experience is different.
The mother is unconscious
Under general anesthesia, the mother is completely unconscious, unaware, and unable to feel pain. She does not experience the surgery or birth. A breathing tube is in place.
Support person may not be present
The mother’s support person is often not allowed to be present in the operating room when general anesthesia is used due to safety concerns and space issues.
The baby may require extra care
Since anesthesia drugs cross the placenta, the newborn may need some brief additional resuscitation measures after delivery until the medication wears off. This is usually temporary.
The mother awakens after surgery
After surgery the anesthesia drugs are stopped and the mother regains consciousness in a recovery room. She did not experience the actual delivery of her baby. She may feel groggy, nauseated, or confused as the anesthesia wears off.
Bonding and breastfeeding may be delayed
Since the mother was unconscious, the first bonding with her newborn will occur after she awakens in recovery. Initiating breastfeeding may also be delayed compared to regional anesthesia.
Recovery after general anesthesia
The recovery process after a C-section under general anesthesia involves:
Waking up in the recovery room
After surgery, the mother is monitored closely in a recovery room as she regains consciousness. Vital signs are monitored as anesthesia side effects wear off.
Relief of a sore throat
The breathing tube can cause throat discomfort. Ice chips, pain medication, and throat lozenges are often provided for relief.
Fatigue and grogginess
Mothers often feel tired, sluggish, dizzy, nauseated, chilled, and disoriented as they awaken. Medications can treat nausea and shivering.
Meeting the baby
Once the mother is alert, grogginess wears off, and vital signs have stabilized, the baby is brought to her if the newborn’s condition allows it. She is often eager to meet her baby and finally have the bonding experience.
Transfer to the maternity ward
Within a few hours, the mother is transferred to a regular hospital room on the maternity ward to continue recovering with her baby rooming in with her.
Getting up and walking
Unless complications occur, mothers are helped out of bed and assisted to walk short distances within 24 hours of surgery. This reduces the risk of blood clots in the legs.
Recovery timeline after general anesthesia
The recovery timeline after a C-section under general anesthesia may involve:
First 24 hours
– Waking up from anesthesia
– Meeting the baby
– Transfer to maternity room
– Drinking fluids and light foods provided
– Getting assistance to use bathroom
– Pain and nausea medication as needed
– Short walks around room
2-3 days after surgery
– Increase physical activity gradually
– Tolerating regular meals
– less IV fluids and medications
– Bonding, breastfeeding, caring for newborn
– Remove IV catheter when drinking well
4-5 days after surgery
– Moving around room and hallways easily
– Showering allowed (often sponge baths until then)
– Managing pain with oral medication
– Bowel movements returning to normal
– Incision healing well with minimal discharge
Discharge from hospital
– Usually after 4-6 days in hospital
– Tolerating diet and ambulating independently
– Caring for baby effectively
– Pain controlled with oral medications
– No signs of infection or excessive bleeding
– Bowel and bladder function normal
Pros and cons of general anesthesia
The main pros and cons associated with having a C-section under general anesthesia include:
Pros
| – Completely asleep and unaware during surgery |
| – Total pain relief during procedure |
| – May be only option in certain emergencies |
| – Preferred by a small number of patients |
Cons
| – More risks than regional anesthesia |
| – Greater chance of breathing problems |
| – Increased recovery time |
| – No chance to experience the birth |
| – Risk of drug reactions |
| – Higher costs |
Frequently asked questions
Is general anesthesia very painful for C-sections?
No, general anesthesia provides complete pain relief during the surgery because the mother is fully unconscious. No pain is felt during the procedure. Discomfort is only felt afterwards as the anesthesia wears off.
Can the mother choose general anesthesia for her C-section?
While very uncommon, a mother’s preference for general anesthesia may be accommodated unless there are specific medical reasons to avoid it. This should be discussed with the obstetrician and anesthesiologist during preoperative consultations.
How quickly does general anesthesia work during C-sections?
Intravenous induction anesthesia medications like propofol or etomidate will cause unconsciousness within 30-60 seconds after injection. The mother is asleep before the surgery even starts.
What type of anesthesia is right for me?
The ideal anesthesia technique is chosen based on your health history and surgical or pregnancy risk factors. Discuss options with your doctors, but regional anesthesia is recommended for most routine C-sections.
Can I still successfully breastfeed after general anesthesia?
Yes, general anesthesia does not preclude successful breastfeeding. However, you may need extra assistance initiating breastfeeding since you’ll be groggy after surgery. Regional anesthesia allows earlier breastfeeding.
Conclusion
While general anesthesia provides a pain-free surgical experience, obstetricians and anesthesiologists avoid using it for routine cesarean sections due to safety concerns and slower recovery times. Regional anesthesia allows the mother to remain awake and recover more quickly. However, general anesthesia may be required in certain situations when medically necessary for safe delivery of the baby. Close communication with your physicians can help determine the optimal anesthesia choice for your C-section.
