Making Informed Choices
About Caesarean Birth.
What sort of anaesthetic is 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 have 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 and 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)7. 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.
To find out how to obtain a free copy, or how you
can organise to distribute the booklets, please click
here.
