What anesthesia is better with cesarean section: types, indications, contraindications, reviews

Caesarean section is an surgical procedure in which a newborn is removed using an incision on the abdominal wall and uterus. Thanks to this procedure, thousands of children are born every year, so the question of how this operation is performed excites many future parents. In this case, one of the most important points that you should think about on the eve of childbirth is the type of anesthesia.

So, what kind of anesthesia is best for cesarean section? From the article you can find out basic information about the most commonly used types of anesthesia during this operation, their main advantages and disadvantages.

How is surgery performed?

Before figuring out which anesthesia is best for cesarean section, a few words about the essence of this surgical intervention should be said.

During a caesarean section, the newborn does not appear naturally (through the birth canal), but is removed through a small incision that the surgeon makes on the wall of the uterus. In modern maternity hospitals, an incision is made in the lower abdomen, so that the scar after surgery is almost invisible. A similar method of obstetric care is very common and widely used in practice: in some European countries, for example in Germany, up to 40% of babies are born in this way.

There are two types of surgical intervention: planned and emergency. The first is done if there is a risk of developing during the natural birth any complications that threaten the life and health of the woman in labor and the baby. The indications for this operation include too narrow a mother’s pelvis, the threat of hypoxia, premature birth, multiple pregnancy, etc. Naturally, planned surgical intervention is the more preferable option, since there is time to prepare a woman in labor for the upcoming operation.

An emergency operation is performed if any dangerous complications arise during the natural birth. In this case, emergency surgery in most cases is carried out using general anesthesia, one of the main advantages of which is the rapid onset of anesthetic effect: this is very important, because sometimes during complicated births the count goes on minutes.

Naturally, such a surgical operation is unthinkable without the use of anesthesia, otherwise the patient may not survive the pain shock.

What types of pain relief are used for caesarean section?

There are two main types of anesthesia that can be used in the process of cesarean section: regional and general anesthesia. The first completely deprives sensitivity of only the lower half of the body, while in general the patient’s consciousness is completely turned off, and all her muscles are relaxed. In this case, the choice of an adequate and most suitable method of anesthesia can only be done by a doctor, taking into account the characteristics of the course of pregnancy, the state of health of the mother, and many other factors.

Types of anesthesia for cesarean section:

• general anesthesia;
• spinal;
• epidural.

The main advantages and disadvantages of each of them are described below.

When can a choice be made in favor of general anesthesia?

The essence of general anesthesia is that due to the complex of drugs that are injected into the venous bloodstream or with the help of a tube inserted into the respiratory tract, the patient’s consciousness completely turns off and she no longer experiences pain. It is important to note that with general anesthesia muscle relaxation is observed, which allows you to create comfortable working conditions for the obstetrician surgeon.

This type of anesthesia for women who have a cesarean section is chosen relatively rarely. The need for general anesthesia may occur in the following cases:

• the presence of contraindications to other existing methods of pain relief;
• the presence of obesity in a woman in labor;
• the fetus is diagnosed with hypoxia;
• a woman's refusal from other types of pain relief;
• incorrect position of the fetus in the uterus, prolapse of the umbilical cord and other emergency obstetric situations.

Nowadays, general anesthesia for cesarean section is used if there is a need to perform it according to emergency indications, and surgical intervention must be started urgently in order to save the lives of the woman in labor and the child. This is due to the fact that general anesthesia has a number of significant disadvantages.

The disadvantages of general anesthesia

What anesthesia is better for cesarean section? Before answering this question, let's talk about its shortcomings. Doctors try to avoid this type of anesthesia with cesarean section, since anesthesia can give a much greater number of complications compared to other methods of pain relief. Among the most common it is worth highlighting:

• hypoxia of the woman in childbirth, which is caused by the fact that during anesthesia the volume of the lungs decreases and the body's need for oxygen increases;
• there is a high risk of aspiration, that is, ingestion of the contents of the stomach into the respiratory tract: if the anesthetist does not diagnose this condition in a timely manner, the consequences can be disastrous;
• in many women in labor during general anesthesia, pressure rises.

Anesthetic can lead to a violation of the respiratory activity of the newborn, as well as a depressing effect not on his nervous system due to the penetration of pain medications through the placenta. The latter is especially dangerous if general anesthesia is used in preterm labor. However, one should not be very afraid: modern drugs can reduce the risk of negative consequences for the child to a minimum, in addition, the newborn receives special medications that relieve the effects of general anesthesia.

Thus, it is better for you and your doctor to decide which anesthesia is best for Caesarean section, but remember that general anesthesia is far from the best way to anesthetize the operation, and you should resort to it only if there are no other options for one reason or another. stays. For example, if a woman in labor has an unstable psyche or suffers from any psychiatric diseases, the operation can only be performed under general anesthesia, because there is a risk that the woman will not be able to remain calm during the operation and will interfere with the surgeon's actions.

Much more often, epidural and spinal anesthesia are used in practice, that is, regional methods of anesthesia - these types are much safer, and also allow a woman to be in a state of clear consciousness during childbirth. This is important not only because she has the opportunity to immediately pick up a newborn. During caesarean section, the obstetrician and anesthetist can maintain constant contact with the patient, which makes it easier to identify possible complications.

Epidural Anesthesia Procedure

Before answering the question of what is better to do anesthesia for cesarean section, it is worth finding out what constitutes epidural anesthesia. This is a procedure in which an anesthetic is injected into the epidural space of the spine in the lumbar region. After anesthesia produced by this method, the woman in labor during the operation is conscious, but does not experience any pain.

Local anesthesia for cesarean section allows a woman to take an active part in the process of childbirth: communicate with medical personnel or the spouse present in the ward, immediately pick up the newborn and put it on her chest. At the same time, the woman in labor does not feel pain, although some note slight discomfort during the operation.

True, there is one very important nuance. It is psychologically difficult for many women to decide to stay in the operating room, they are scared that during a caesarean section they will be conscious and not feel half their body. Often, women in labor insist on general anesthesia. It is advisable to discuss your fears with your doctor and anesthetist, who will tell you in detail about how the procedure of pain relief will proceed.

Advantages of Epidural Anesthesia

Among the main advantages of epidural anesthesia are the following:

• Stable functioning of the cardiovascular system, the absence of pressure surges.
• Preservation of the ability to carry out the movement.
• Upper respiratory tract injury is excluded and there is no risk of aspiration.
• Long duration of anesthetic effect. If necessary, anesthesia can be extended for any period of time, which is very important if after cesarean section you need to perform any other operations, for example, to perform ligation of the fallopian tubes.
• The woman quickly gets out of anesthesia, the period of postoperative recovery is reduced: only 24 hours after the operation, many patients can independently get up and move around.
• The child can be picked up and put to the chest immediately after the operation.
• It is possible to reduce pain after childbirth by injecting pain medications into the epidural space.

Disadvantages of Epidural Anesthesia

Despite all its advantages, the effects of epidural anesthesia for caesarean section can be disappointing. This must be known to every future woman in childbirth:

• If the anesthetic is not administered by an experienced specialist, there is a high risk of the drug getting into the bloodstream. In this case, convulsions develop, blood pressure drops sharply and consciousness is inhibited. The result may be the death of a woman in childbirth or irreversible damage to the nervous system.
• In approximately 17% of cases, anesthesia does not block some nerves, which is why a woman in labor during Caesarean section experiences unpleasant sensations. Therefore, before starting the operation, it is necessary to check the sensitivity using special neurological tests, for example, pricks with a pin. If the anesthetic does not work properly, re-administration of the drug is required.
• If a medication, due to improper insertion of a catheter, has fallen under the arachnoid membrane of the spinal cord, a spinal block may occur, the result of which often is a failure of the respiratory system. To avoid this, a small dose of the drug is first introduced: the surgical team only needs two minutes of waiting to determine if the procedure is performed correctly.

Unfortunately, epidural anesthesia during cesarean section surgery is quite complicated, and its success often depends on the experience and skills of a specialist. Tactile detection of the epidural space is rather vague, while with spinal anesthesia, a reliable marker is the exit to the surface of the cerebrospinal fluid. Therefore, it is important to choose a doctor that inspires confidence in you, and carefully study the reviews about the work of the hospital, in which your baby will be born.

Spinal anesthesia

At first, epidural anesthesia seemed to be a real salvation, because it allowed not only to make the process of the birth of a child completely painless, but also gave women the opportunity not to lose the clarity of thinking and perception at the time of the birth of the long-awaited baby. However, due to numerous contraindications and the likelihood of a number of negative consequences listed above, epidural anesthesia gradually gives the spinal palm. Many argue that this is the best anesthesia for cesarean section.

Spinal anesthesia is the introduction of anesthetic into the lumbar spine. The drug enters the subarachnoid space of the spinal cord. At the same time, the effect of both types of anesthesia is similar: some time after the injection, the woman in labor ceases to feel the lower half of her body, and the doctor can proceed with the necessary surgical procedures.

The benefits of spinal anesthesia

What anesthesia is best for cesarean section? It is rather difficult to answer this question, as everything is individual. But we can highlight the main advantages of spinal anesthesia:

• No toxic effect. In case of accidental ingestion of anesthetic into the bloodstream, reactions from the heart or nervous system are practically not observed, and there is no risk for the child.
• After the operation, the body recovers quite quickly.
• Quality anesthesia: during the operation, the woman in labor does not experience pain.
• Spinal anesthesia additionally relaxes the muscles, which facilitates the work of the doctor.
• Surgery can be started a few minutes after the administration of the drug, so the intervention takes less time.
• Spinal anesthesia is much simpler than epidural. In addition, the anesthetist uses a much thinner needle to administer the drug, so that the risk of spinal cord injury or erroneous administration of the anesthetic is minimized.
• Many doctors recognize spinal anesthesia as the most advanced option for cesarean section pain relief.

Spinal anesthesia for cesarean section: contraindications and main disadvantages

Unfortunately, spinal anesthesia has some disadvantages:

• The drug is effective for two hours, so this type of anesthesia will not work if you need to perform any additional manipulations, and if complications arise during the operation, additional anesthesia may be required.
• Spinal anesthesia is not possible if the patient has some types of spinal injuries.
• Due to the rapid onset of anesthesia, blood pressure may decrease.
• If the instruments used to administer the preparations were not thoroughly disinfected, various infectious complications, such as meningitis, can occur.
• After the operation, many women in labor experience severe headaches, which can last for several days or even weeks.
• Incorrect insertion of the catheter can damage the nerve center, called the ponytail. This may cause the innervation of the sacrum and lumbar region to be disrupted.
• Spinal anesthesia is not possible with some forms of spinal deformity.
• Spinal anesthesia is not possible with premature detachment of the placenta and some other obstetric conditions.

Despite the disadvantages listed above, spinal anesthesia is considered one of the best and safest pain relief techniques for cesarean section.

Anesthesia for cesarean section: reviews

What anesthesia is better for cesarean section? Reviews of how women feel during this or that type of anesthesia will help us find the answer to this question.

Young mothers note that the process of overcoming general anesthesia is rather unpleasant: there is a sensation of blurred consciousness, nausea, headaches and muscle pain. In addition, there is no opportunity immediately after childbirth to pick up a baby. There is another negative consequence of general anesthesia: often after it the child has respiratory depression.

What anesthesia is better for cesarean section? Reviews about epidural anesthesia are mostly positive. Women in labor note that after the procedure there are no unpleasant sensations, and the child can immediately be attached to the chest. However, as evidenced by the reviews, discomfort in the area of ​​drug administration is often noted, and in the first few hours after cesarean section, when the anesthetic is excreted from the body, the lower half of the body trembles greatly. However, only a day after the operation, it is possible to stand up, move independently and take care of the newborn.

Spinal anesthesia for cesarean section reviews, in general, deserved positive. Patients note that they did not experience pain during the operation. However, in some cases, for several weeks, women suffer from headaches and discomfort in the abdomen.

How to choose anesthesia?

So what kind of anesthesia is better for cesarean section? This article aims to familiarize expectant mothers with what types of anesthesia are used to anesthetize cesarean section surgery. But remember, in no case should you be guided by the above information when choosing anesthesia!Only a doctor who has all the data on the health status of the woman in labor can correctly choose the type of anesthesia. Of course, the wishes of the patient cannot but be taken into account. Therefore, before deciding on which anesthesia it is better to do a cesarean section, you should weigh all the pros and cons of a particular method, and consult with a surgeon and anesthetist.

In order for the selected anesthesia to be successful, it is necessary to follow all the recommendations of specialists who will advise how to eat on the eve of the operation, when to get up after a cesarean section and what to do in order for the body to recover as quickly as possible.