Caesarean Section

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 with you awake, using a regional anaesthetic (Epidural or Spinal or combined), 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.

Caesarean section is more commonly performed today under spinal or epidural anaesthetic. In this situation the mother remains awake and aware of what is going on, sees their baby being born, but should not feel significant pain. Also the baby's father can be present in the operating theatre to witness the birth. You should discuss the relative value of general anaesthesia and epidural anaesthesia with your anaesthetist. The details can be quite involved and your choice is an individual one. The choice (all other things being equal) is one for yourself, your anaesthetist and your obstetrician to resolve in your best interests.

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 any type of anaesthetic.

Like all procedures there are possible 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 which may be slightly uncomfortable, but you should not feel any pain.

Induction of general anaesthesia for a Caesarean section however is not usually preceded by sedation because the agents can cross the placenta and depress the baby's ability to respond and breath when born. Oxygen is usually given to patients before induction, the bed tilted to the left and light pressure applied to the front of the neck to minimize the chance of stomach contents entering the lungs. In addition and antacid may be given before entering the theatre.

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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