Most women hope for, and have, a "normal" delivery with minimal medical intervention. However, some need anesthesia to allow for procedures which are painful (e.g. forceps delivery, a Cesarian section, the removal of all or part of the afterbirth, or the suture of a tear). In some cases the anesthetic can be planned weeks in advance (e.g. a scheduled Cesarian section). In others it is done as an emergency (e.g. where the baby needs urgent delivery).
If an anesthetic is necessary, it will be provided by an anesthetist - a medical doctor with special training in providing safe anesthesia and who can treat any complications quickly and effectively. An anesthetist will remain with you during any anesthetic, (but not during labour with an epidural).
General anesthesia is not usually the best choice for childbirth. It is used only when there is no alternative, because the woman is unsuitable for other types of anesthetics, because a very quick anesthetic is needed, or because the mother insists on being asleep.
Common side-effects:
Some people suffer nausea and vomiting after general anesthesia. The tube may cause a sore throat.
Serious problems:
These are mainly related to difficulty inserting the breathing tube after the sleep drugs have been given. This can lead to lack of oxygen to the brain or to the spilling of stomach contents into the lungs. Both of these complications could cause death. Pregnant women are at increased risk of these problems as they have smaller lungs, use up oxygen faster, and often have full stomachs.
Effect on baby:
Some of the anesthetic drugs enter the baby's blood stream. This does not usually cause problems.
Effectiveness:
Because the anesthetist tries to give the smallest amount of anesthetic possible, to avoid risks to the baby, it is possible, but rare, for the mother to be awake but unable to move during surgery.
Most pregnant women who have needed a general anesthetic have not had any complications and have not felt any pain.
Spinal anesthesia is given nearer the spinal cord than an epidural, so it works quicker and produces a strong block with a smaller dose of freezing. One injection produces numbness of the lower half of the body for about three hours and by adding morphine pain relief can last up to 24 hours after surgery. This is the anesthetic we recommend for Cesarian section.
Epidural anesthesia is usually used if there is already an epidural in place for pain relief in labour (see handout entitled Epidural Pain Relief in Labour). An extra top-up of stronger medicine can be used to provide the pain relief needed for surgery.
Common side-effects:
Some people experience a fall in blood pressure, which may cause nausea and vomiting. This is watched for and treated with intravenous fluids and medication.
The pain killers may cause itching, especially of the face. This itchiness can be treated with medication.
Possible problems:
About 1% of people get a "spinal headache." If this bad headache does not go away with bed rest and tylenol, another treatment called a "blood patch" usually cures this headache.
Serious complications:
These include getting infection, a blood clot, or the wrong drug in the back, all of which could cause paralysis. Injecting a large dose of local anesthetic into a vein can cause convulsions or cardiac arrest.
Effect on baby:
Epidurals or spinals have little or no effect on the baby.
Effectiveness:
Expect to feel touch and probably some pushing and pulling, but no pain during surgery. Sometimes additional medicine has to be given to help the freezing work. Very rarely, a general anaesthetic is needed because the block has not worked well enough.
Spinal and epidural anesthesia are usually very safe and work very well.