There are three options for anaesthesia. All of them are given by the anaesthetist and an anaesthetic nurse working as a team. A midwife will also be present, as will the obstetric operative team. There is a minimum of seven members of staff present in theatre during most obstetric operations.
Before we start
You will need a working ‘drip’ before the anaesthetic is started. We monitor your heart beat through sticky dots applied to your chest, use an automatic blood pressure cuff and a pulse oximeter to measure oxygen in the blood through a clip on your finger. We usually tilt the bed so your left side is downwards, to keep the weight of your baby off the middle of your back, until the baby is born. You will be offered a dose of antibiotics given through your drip before a Caesarean section. This may be delayed in extremely urgent cases but is usually given before the operation starts.
A fine needle is used to place local anaesthetic (bupivacaine), usually mixed with pain killer (diamorphine) for pain relief after the operation, into the spinal fluid at the bottom of the spine. You need to sit up, with your back curled outwards. You are awake during the operation, which means that you and your birth partner can be present when your baby is born.
Cold antiseptic spray is used to clean your back first, then your lower back is covered with a plastic sheet. The needle is fine, and the procedure is not usually painful. The anaesthetic works quickly, usually within 15 minutes. You will be very numb from about the level of the armpit to the toes, and your legs will be heavy and difficult to move.
The anaesthetic is very effective, but does not always get rid of all feeling – you may be aware of movement during the operation. The numbness is checked carefully before we start the operation.
The anaesthetist and other team members, together with your birth partner, are with you throughout the operation, and we can explain things and offer other help if you need it during the operation. The numbness lasts for at least a couple of hours, then wears off gradually. It is common to feel pins and needles as it wears off.
Your legs should be able to take your weight after about six hours although this can vary. Please be careful and don’t try and get out of bed after the operation without someone else to help.
It is common for your blood pressure to fall as the spinal anaesthetic takes effect. To try and avoid this, we give medicine to raise the blood pressure through the drip. Sometimes, blood pressure falls a lot despite this medicine, and you can feel ill or sick until your blood pressure return to normal. Tell the anaesthetist straight away if you aren’t feeling well; he or she will be able to help.
Avoids the risks of general anaesthesia. Compared with a general anaesthetic caesarean section you usually have less pain afterwards.
Two or three in every 1000 women develop a particular type of headache following a spinal anaesthetic, related to a continuing leak of spinal fluid. This can be severe and require treatment with an epidural injection.
Three in every 1,000 women are unable to have a spinal anaesthetic because it cannot be placed easily or it is not effective enough for the operation to be started. You may need a general anaesthetic if that happens. Rarely (about 1 in every 10,000 cases) the anaesthetic has much more effect than intended. If this happens you will need a general anaesthetic until the effects wear off.
Very rarely (about 1 in every 100,000 cases) nerves are damaged during a spinal injection or as a result of complications such as an infection or blood clot in the spine. The effects vary, but are potentially serious.
Epidural top up
If you already have a working epidural, this can be rapidly topped up in about 10 minutes.
Rapid anaesthesia without needing any extra procedures. For pain relief after the operation, longer acting pain killer can be given down the epidural tube.
Epidurals do not always provide enough numbness for an operation; if your epidural has not worked well for labour, we will not top it up for a Caesarean. We recommend a spinal anaesthetic (or a general anaesthetic) instead.
We ask everybody to read about this option before labour, because one of the commonest reasons for choosing this type of anaesthesia is that the situation is such an emergency that there is no time for any of the other options. In an emergency, there may not be much time to explain what is happening, and it is very helpful if you have already read about it.
Unfortunately birth partners cannot accompany you to theatre during general anaesthesia. This is for safety reasons as the team cannot attend to a partner if they have questions or are unwell during critical phases of the anaesthetic or operation, especially in an emergency.
About 1 in every 100 women having a planned caesarean section and 10 in every 100 women having an emergency caesarean section at the RVI has a general anaesthetic. The anaesthetic is given into a drip in your hand or arm, following which you rapidly lose consciousness and ‘go to sleep’ – though it is deeper than sleep.
You will be given a small dose of antacid medicine (sodium citrate) to drink . The anaesthetist needs to check your mouth and neck, looking for loose, capped or crowned front teeth and to plan breathing assistance for you during the anaesthetic.
First you will be asked to breathe oxygen through a clear plastic face mask. It is extremely important for your safety and that of your baby that you do this. The mask needs to fit closely over your nose and mouth, so that you are not breathing air from the room at all. The purpose is to exchange the air in your lungs for oxygen, this usually takes one or two minutes.
As soon as the oxygen breathed out of your lungs reaches the correct level, the anaesthetist will give you some anaesthetic medication through the vein. As this is given, the anaesthetic assistant will start pressing on the front of your neck. This is necessary to prevent vomit going down the wrong way as you are going to sleep.
You will wake up shortly after the end of the operation. You may be aware of a tube in your mouth which is taken out as soon as you are awake. You may not remember much for a short time after your anaesthetic.
General anaesthesia can be given very quickly. General anaesthesia is the only option in circumstances where a spinal or epidural top up are not possible.
Your blood pressure can rise at the start of a general anaesthetic. If you have high blood pressure then you will be given extra medication to prevent this. A sore throat is common after a general anaesthetic.
Two or three in every 1,000 women who have a caesarean section under general anaesthetic are not as unconscious as intended during the operation, and can recall people talking or feel that they have been dreaming.
Four in every 1,000 general anaesthetics for caesarean section are complicated by unexpected difficulty in helping the mother with her breathing at the start of the anaesthetic. This is usually managed by following an emergency drill without the mother being aware of the difficulty, but on rare occasions can result in waking the mother up without doing the operation.
Very rarely, serious complications occur, and can lead to serious brain damage or death of the mother. The anaesthetic drugs cross the placenta and can make the baby sleepy or slow to take a first breath. It is unusual for the baby to be sleepy for longer than a few minutes. A paediatrician will come to help look after your baby immediately after birth if you have a general anaesthetic.
During your time in theatre and afterwards in the recovery area we ask that only one birth partner accompany you.