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Caesarean section may be a planned procedure for you or it may be necessary in an emergency situation. If your obstetrician arranges for you to have an elective Caesarean section, you will have time to discuss the type of anaesthetic most appropriate for you with your Anaesthetist.

The decision will be between having your operation done using a regional anaesthetic (Epidural or Spinal or combined) with you awake, or a general anaesthetic. There are advantages and disadvantages for each technique but it is generally considered that the outcome for the baby does not depend on the type of anaesthesia used. Many mothers choose a regional anaesthetic so that they and their partner can participate in and witness the birth process.

Regardless of which technique is used, special precautions will be taken to protect you against the risks of aspiration of stomach contents during the procedure. Your stomach does not empty normally during the last weeks of pregnancy, so although you will be fasted, you will almost certainly have acid contents in the stomach. Different approaches may be taken, but the most popular technique at present is to give you a liquid antacid immediately before coming to the operating theatre.

An intravenous line is always inserted and a “drip” is commenced before performing major regional anaesthetic. The choice of epidural, spinal or combined spinal/epidural will be decided by your anaesthetist and explained to you. This will be inserted with you lying on your side curled up, or sitting up in your bed in the operating theatre or adjacent anaesthetic room.

Like all procedures there are complications (see Epidurals in Labour). A common complication is a drop in blood pressure which may require the administration of intravenous fluids and drugs which your anaesthetist has close at hand. Because all sedative drugs given to you will also sedate your baby, as a general rule these drugs, if given at all, will be withheld until after the baby is delivered. It is common to feel some pulling and pushing sensations during the operation, but you should not feel any cutting.

If you have a general anaesthetic further precautions are taken against aspiration. As you are going off to sleep an assistant will push on a specific area of the front of your throat (called “cricoid pressure”), which blocks the top of the oesophagus to prevent aspiration of stomach contents. With both methods a wedge will be put under your hip so you are not lying flat on the bed which could cause a major drop in your blood pressure.

In an emergency situation there may not be time to use a regional anaesthetic technique and in the interest of the best outcome for your baby, a general anaesthetic may be used to expedite rapid birth of your baby.

After the birth of your baby, your anaesthetist will administer further drugs to assist in contracting your uterus, and possibly antibiotics. Your anaesthetist will also arrange your pain relief after your operation which may be given intravenously or via your epidural (if present). These will usually be commenced after you are transferred to the Recovery Ward at the end of the procedure.

Your anaesthetist may also be called upon to attend to your newborn baby to administer oxygen, clear the baby’s airway or do other things to help your baby get over the stress of birth. This is quite common and you should not be concerned if this occurs.

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