Types of Anesthesia Used in Elective Cesarean Births

Surgical team performing Caesarean section on pregnant woman.

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It is normal to worry about having the right amount of pain relief before having any surgery. When that surgery is scheduled in advance, such as a planned cesarean, it gives you plenty of time to ponder, think, and worry about whether or not everything will work out for you in regards to pain management. The good news is that there are many types of pain relief that can be used today for birthing people, even those having a scheduled cesarean.

Factors Determining Anesthesia Given During C-Section

The answer that you receive about the best fit for the type of c-section anesthesia will depend on a couple of factors, including, but not limited to:

  • Your medical history
  • Your place of birth
  • Your doctor's preference
  • Whether the delivery is an emergency
  • If you will be expected to have a longer surgery, such as additional procedures, or a concern about scar tissue

Once this information is gathered, you may also have a physical exam. This may include looking at your back or in your mouth. It may also include blood work or other tests. There are some people who are not good candidates for epidural anesthesia.

Although you may have heard about this on the news, it is extraordinarily rare—almost unheard of—to undergo a c-section under local anesthesia, even in urgent and emergent situations.

Types of Anesthesia

There are two main types of anesthesia typically used: regional anesthesia, which makes an area of your body numb, like a spinal block, combined spinal-epidural anesthesia (CSE) or epidural anesthesia; and general anesthesia, where you go to "sleep" for the surgery.

Some facilities and providers may offer an injectable, long-acting local anesthetic during c-section in addition to the regional or general anesthetic. This is an effort to minimize the need for post-operative pain medications, specifically opioids.

The regional anesthesias, like an epidural, will block pain sensation in your abdomen and nearby parts. You will be wide awake during the surgery and aware of everything.

You will feel pushing, pulling and tugging, but not pain. One of the regional anesthesia choices is the most common type of anesthesia for an elective cesarean section. Additional medications can be given if you are experiencing nausea, anxiety, etc.

If you have regional anesthesia, you are typically allowed one support person to stay in the operating room with you, though some policies will differ on when they join you. Your hospital may allow your doula to stay for the administration of anesthesia. Other types of regional c-section anesthesia in this category also include spinal anesthesia, combined spinal-epidural anesthesia (CSE), etc.

General anesthesia is used when your medical history or an emergency dictates that regional anesthesia is too risky or not possible.

Since there are more potential risks to you and your baby using general anesthesia, it is not preferred. You usually may not have a support person with you if you have a general anesthesia.

Discuss Your Options With Your Doctor

Talk to your obstetrician about the choices that are available to you, and when possible and/or needed, ask to have a consultation with the anesthesia department prior to giving birth. They will want to take many different things into account as discussed above.

This individualized appointment with the person actually doing the anesthesia or even the potential anesthesia, if you don't know if you will need a cesarean, can help you have peace of mind prior to the end of your pregnancy. This allows you to design your birth plan to reflect the actual options that you have for your birth.

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