Cesarean Section Anesthesia Options at Mercy Hospital St. Louis

In general, there are two types of anesthesia available for Cesarean Section (CS) – regional anesthesia (numbing of the body from the chest down) or general anesthesia (going to sleep). General anesthesia is usually only used if a mother’s medical condition requires it or in the case of an emergency where there is not time to perform a block. In all cases, a member of the anesthesia team is with you from the start of your anesthesia, throughout your surgery, until you are taken to the recovery room where a nurse will continue your care.

Facts About Regional Anesthesia

Regional anesthesia involves putting medications into various spaces surrounding your spinal cord to make you numb and control pain. This can be done with an epidural, a spinal, or a combined spinal-epidural (CSE). These procedures differ a little bit in how they are done and how quickly you get numb but they are very similar. In all instances, your back will be cleansed with a disinfectant to reduce the risk of infection, your skin and deeper tissues will be numbed with an injection of numbing medicine, and the appropriate space will be identified. If an epidural or CSE is being done, an epidural catheter will be placed. If a spinal is being done, the medication is injected and nothing is left in your back. The end result of any of these techniques is a block that makes you numb from your breastbone to the tips of your toes and unable to move your legs for 90 minutes or longer. Your block will be checked to make sure it is adequate before surgery starts. You can expect to feel some tugging and pulling during your surgery but you should not feel pain. If you are having pain, the anesthesia provider may give additional medications or even general anesthesia if necessary. Medications will be put in your spinal area to provide pain relief for the first day or two after surgery.

Benefits:

  • You are awake for the birth of your baby and your support person can be with you the entire time.
  • Virtually no medication goes to your baby.
  • It is generally considered safer than general anesthesia.

Risks

  • Side effects such as shivering, itching, a drop in blood pressure, nausea/vomiting, and a sensation of difficulty breathing due to your chest being numb may happen.
  • About 1 in 100 times (1%) the procedure can result in a severe headache afterwards that may require a procedure to treat it. This is called a spinal headache.
  • Temporary injury to a nerve that lasts days to weeks and may cause pain, numbness, or weakness in that area happens about 1 or 2 in 10,000.
  • An excessively high block, a high spinal, happens 1 in 15,000 times and can cause loss of consciousness, extreme low blood pressure, difficulty breathing and require immediate delivery of your baby.
  • Very rarely (about 1 in 100,000 times) a block can cause permanent nerve damage, seizures from toxicity of medications, infection, or bleeding.
  • Cardiac arrest and extreme allergic reaction (anaphylaxis) occur at a rate of 1 in 500,000.

Facts About General Anesthesia

General anesthesia is required in some cases when the surgery is an emergency or when a mother’s medical condition makes it dangerous to perform regional anesthesia. For general anesthesia, you are given oxygen to breathe through a mask while the surgeons prepare to operate on you. Right before the start of surgery, medication will be given through an intravenous catheter (IV) to make you lose consciousness and a breathing tube will be inserted. You will remain unconscious throughout your surgery and will awaken at the end and the breathing tube will be removed. Your pain will be controlled with IV pain medications. If you are stable, your partner will usually be allowed into the operating room (usually after delivery of the infant) to see the baby, take pictures, etc.

Benefits:

There aren’t really any benefits to general anesthesia as opposed to regional anesthesia except that it can be faster in an emergency and some medical conditions may make it unsafe for a mother to have regional anesthesia.

Risks

  • Your partner does not get to be with you and the infant the entire time.
  • You will not remember the birth of your baby.
  • You may have a sore throat and there is the possibility of damage to your teeth or your lips.
  • The medication that we give you to make you unconscious does transfer to your baby. Your baby may be sleepy when it is born. This is temporary. The effect of anesthesia on infants and children is a topic of research and it is not currently known what the long-term effects are.
  • There is still a risk, although very rare, of cardiac arrest and severe allergic reaction with general anesthesia.

We’re excited that you chose Mercy, and we look forward to being part of this remarkable experience with you.