Anaesthetic used during a Caesarean?
The dose of anaesthetic used during a caesarean is very finely tuned. This is to reduce the amount of drug that may be passed, through the placenta, to the baby. So, although the Mother should feel no pain during the surgery, it is common to feel tugging, or pulling, sensations as your baby is being removed from your uterus.
The most common type of anaesthetic, used to control pain during a caesarean, is a spinal. This involves injecting an anaesthetic drug into the actual spinal fluid, which surrounds the spinal nerves and cord. This method of anaesthesia is faster acting than an epidural, and is given in a single injection, whereas an epidural dose can be adjusted.
The other type of anaesthetic commonly used during a caesarean birth is an epidural. In this case the local anaesthetic drug is injected into the epidural space, which contains the spinal nerves and their blood vessels.
Both a spinal and an epidural enable the Mother to remain awake during the surgery, and therefore be aware of the birth of her child, participating in this important life experience.
The epidural catheter, which is a fine plastic hollow tube through which the anaesthetic is administered, is often left in place for the first day after the c/section. This enables immediate pain relief to be given, directly into the epidural space, when requested by the Mother.
Some anaesthetists will use a spinal/epidural technique, which gives fast action and allows for postoperative pain relief.
Using one of these types of anaesthesia, rather than a general anaesthetic has other benefits than being awake to welcome your child. It also avoids the risk of vomiting under general anaesthesia and breathing this into your lungs.
The drugs used for epidurals/spinals also have the side-effect of relaxing the blood vessels in your lower body, below the spot on your spine that they were injected into, which may cause your blood pressure to drop, but it also contributes to less blood loss during the surgery.
Once the spinal/epidural has taken effect, then a urine catheter is inserted, and your bladder emptied. This reduces it in size and thus helps protect it during the surgery. This may remain in place until the morning after your caesarean, when you will be able to walk to the toilet and take care of this need yourself.
Spinals and epidurals do in themselves carry some risk. Between 1 to 10% of women experience fairly severe headaches after the spinal/epidural. Some women have suffered injury to the spinal cord and other severe effects but these are very rare (between 1 in 3000 and 1 in 2 million). Your anaesthetist can further discuss these risks with you.
General anaesthesia, where you are actually ‘put to sleep’ during the caesarean, is usually only used when an extreme emergency occurs (i.e., cord prolapse, uterine rupture). It’s avoided, where possible, due to the drug’s ability to pass through to the baby and make him/her drowsy.
If it should be necessary, this is what may happen. A drip is inserted in your arm, heart monitor dots are placed on your chest and you are tilted onto your left side to remove the weight of your uterus from your major blood vessels, which supply vital oxygen to your baby. Then a mask, flowing oxygen, is placed over your mouth and nose to boost your oxygen levels before proceeding with the surgery. A rapid-acting anaesthetic is injected via the drip, in your arm. You may get a metallic taste in your mouth depending on the drug used.
As you lose consciousness you may feel the nurse pressing on your neck, just below your Adam’s apple. This blocks your oesophagus, to prevent the risk of your vomiting. Another drug is then given to relax your muscles and a breathing-tube is placed in your throat, through which anaesthetic gases are given to keep you asleep. A longer-acting muscle relaxant is also administered.
After your baby has been born, a narcotic is often given to aid your after-surgery pain relief, and at the end of the operation a drug is given to reverse the muscle relaxation. The anaesthetic gases wear off quickly, and the tube is removed when you start to awaken, and begin to swallow or cough.
You may be given antibiotics, to avoid infections, and a drug that thins your blood, to help prevent the possibility of blood clots forming in your legs.
Even after a general anaesthetic your baby will often be able to stay with you and your partner in recovery with your midwife whilst you wake up fully. This may not always be possible, however, and if your little one does have to go to the nursery, you should be able to meet her/him very soon. Staff will make every effort to make sure of this, and you can remind them if they seem to have overlooked the importance of this monumental meeting!
Women have often told me of their concern, if they received a general anaesthetic, that their baby seems like a stranger. They have felt that they have missed out on witnessing the birth of their child. They search their children’s faces for ‘family features’ as they try to connect with their little ones. It’s sad that the natural bonding process has had such a big upheaval right at the beginning. Suggestions on how to recreate that bonding process are contained under the heading ‘Healing’ further on in this booklet.