This description of anaesthesia for Caesarean Section is for general information only.
Your Anaesthetist will assess your specific circumstances prior to your operation and discuss your anaesthetic with you. You can obtain more information from your Obstetrician, Midwife or antenatal classes.
You may wish to see your Anaesthetist in the weeks beforehand, especially if your Obstetrician has concerns, or you have had previous anaesthetic problems, have medical problems or if you have specific issues you would like to discuss. You can arrange this by asking your Obstetrician who your Anaesthetist will be and by contacting Specialist Anaesthetic Services at 8273 5666.
Who Administers Anaesthesia for Caesarean Sections?
Your Anaesthetist is a specialist medical practitioner who has:
- completed a medical degree,
- completed hospital training,
- completed a minimum of 5 years further specialist training in anaesthesia, pain management and intensive care,
- extensive clinical experience, and
- participates in ongoing continuing medical education.
Types of Anaesthesia for Caesarean Section
Anaesthesia for Caesarean Section can be:
- Spinal Anaesthesia,
- Epidural Anaesthesia,
- Combined Spinal and Epidural Anaesthesia, or
- General Anaesthesia.
Spinal Anaesthesia is a single lower spine injection into the spinal fluid, whereas an epidural is an injection into the lower spine and insertion of a small plastic tube into the epidural space. Often the epidural has been inserted during labour for pain relief and is then topped up with stronger drugs if a Caesarean Section is required. Sometimes these two techniques are used in combination.
Spinal or epidural anaesthesia result in loss of pain sensation up to the level of the breasts and loss of movement in the legs during the Caesarean Section. Some sensation to touch and pressure often persists.
Most women and Anaesthetists choose this form of anaesthesia. Spinal and epidural anaesthesia both allow the mother to be awake during the delivery of the baby by Caesarean section. Your partner or support person can usually be present at the delivery. The baby is usually more alert at delivery after this form of anaesthesia and it may avoid some of the risks associated with general anaesthesia in the pregnant women (see below for more information about risks).
General Anaesthesia is occasionally used for a Caesarean Section, often in emergency situations or if spinal and epidural techniques are inappropriate or have failed. There are some medical or obstetric conditions where general anaesthesia is preferable. You are kept “asleep” with a combination of anaesthetic gases and intravenous drugs whilst the baby is delivered and the operation is completed. The support person or partner is usually not present in theatre if a General Anaesthetic is used.
Risks and Side Effects of Anaesthesia for Caesarean Section
Many women having spinal or epidural anaesthesia for Caesarean Section will feel some touch, movement, tugging and pulling. For most women there will not be discomfort associated with these sensations. It is important to be aware that these sensations do not mean you will feel pain.
Your blood pressure may drop soon after a spinal is inserted, or an epidural is topped up, and you may feel faint or nauseous. The Anaesthetist expects this and manages it with medication and intravenous fluid.
Discomfort or Pain during Surgery
Some women may feel discomfort or pain and may need intravenous medication. Rarely, conversion to general anaesthesia may be needed if discomfort cannot be controlled. It is important to advise your Anaesthetist if there is any discomfort. They will assess you and the stage of the operation, and decide how best to manage this.
Post Dural Puncture Headache
Spinal, and especially epidural, anaesthesia for Caesarean Section may result in post dural puncture headache. This is usually due to spinal fluid leaking from an accidental puncture of the dura (spinal membranes) with an epidural needle. This is thought to occur in about 1:200 or 0.5% of Epidurals. Sometimes a procedure, like an epidural, called an ‘epidural blood patch’ is required to try to settle the headache. Headache after spinal anaesthesia is usually less of a problem and usually settles on its own.
Rare and serious complications
Thankfully, rare and serious complications from spinal and epidural anaesthesia, including nerve injury, are extremely unlikely and rare. Please discuss your concerns with your Anaesthetist.
Risks and Side Effects of General Anaesthesia
Common Side Effects
Many common side effects of General Anaesthesia are the same for Caesarean Section as for other operations. These include nausea, drowsiness, sore throat and dry mouth. Dental damage is possible, but is unlikely.
Rare Side Effects
General anaesthesia has an extremely rare risk of severe allergic or unusual reactions. Please discuss your concerns with your Anaesthetist.
Side Effects that are more common with General Anaesthesia
Regurgitation and Inhalation of Gastric Contents
Pregnant women are more prone to gastric reflux. This means women having Caesarean Section require techniques to minimise the risk of inhaling gastric contents with general anaesthesia. These include antacid medication given before the operation and protecting the airway with a tube in the trachea during the anaesthetic. The universal use of these preventive measures, and increased use of spinal and epidural techniques, have markedly reduced the incidence of this serious problem.
Pregnancy can cause difficulties in managing the airway in women. Your Anaesthetist will assess your airway prior to anaesthesia. Anaesthetists are experts in airway management but may recommend spinal or epidural anaesthesia, if difficulty in managing the airway is anticipated, rather than general anaesthesia.
Awareness of Surgery
In the past, general anaesthesia for Caesarean Section was quite “light” because there was a fear that the baby would be sedated at birth. Current practice is to administer adequate doses of anaesthetic drugs to the mother making the risk of “awareness” very unlikely. Babies tolerate this process very well and any effect on the baby due to the anaesthetic given to the mother is easily managed by the Midwife and Paediatrician present at the birth.
Pain Relief following Anaesthesia
Techniques available for pain relief depend on the form of anaesthesia administered and are usually commenced in theatre. Options include a combination of:
- Regular paracetamol
- Regular anti-inflammatory medication
- Spinal or epidural opioids (often providing 8-12 hours of benefit)
- Opioid injections administered by nurses or patient controlled pump
- Strong oral pain medication such as oxycodone, tramadol or tapentadol
- Local anaesthetic nerve blocks such as TAP blocks are sometimes performed in theatre.
Side effects of the pain relief may include: nausea, vomiting, drowsiness, agitation or itchiness. These side effects will be treated if and when they occur.
Links to recommended sources of additional information
For more information you may wish to visit the following patient information sites where you can find:
- general information about Anaesthesia
- specific information about pain relief for Labour
- specific information about Anaesthesia for Caesarean Section.
- Australian and New Zealand College of Anaesthetists: http://www.anzca.edu.au/patients
- Australian Society of Anaesthetists Patient information: https://asa.org.au/patients/ and https://asa.org.au/anaesthesia-for-specific-operations/
- The Obstetric Anaesthetists Association (UK) patient information site: