What anesthesia is better for caesarean section: types, indications, contraindications, reviews

Cesarean section is an operative intervention, in which the newborn is removed by a cut 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 carried out is of concern to many future parents. At the same time, one of the most important things to think about on the eve of childbirth is the type of anesthesia.

So, what kind of anesthesia is better with caesarean section? From the article you can find out the basic information about the most frequently used types of anesthesia in this operation, their main advantages and disadvantages.

How is surgery performed?

Before you find out which anesthesia is best for caesarean section, you should say a few words about the essence of this surgical intervention.

During the 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 uterine wall. In modern maternity homes the incision is made in the lower part of the abdomen, due to which the scar after the operation is almost invisible. This method of obstetrics is very common and is widely used in practice: in some European countries, for example in Germany, this way, up to 40% of babies are born.

There are two types of surgical intervention: planned and emergency. The first is done if there is a risk of development during natural childbirth of any complications that threaten the life and health of the mother and baby. Indications for this operation are too narrow a mother's pelvis, a threat of hypoxia, births that started earlier, a multiple pregnancy, etc. Naturally, planned surgery is the preferred option, since there is time to prepare the woman in labor for the forthcoming operation.

An emergency operation is performed if there are any dangerous complications during natural delivery. In this case, urgent 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 account goes for 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 analgesia are used for cesarean delivery?

There are two main types of anesthesia, which can be used in the process of caesarean section: regional and general anesthesia. The first completely deprives the sensibility of only the lower half of the body, while with the general, the patient's consciousness completely disengages, and all her muscles relax. In this case, the choice of an adequate and most suitable method of anesthesia can be performed only by the doctor, taking into account the features of the pregnancy, the state of the mother's health and many other factors.

Types of anesthesia for caesarean 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 a complex of drugs that are injected into the venous blood stream or with a tube inserted into the respiratory tract, the patient completely disconnects consciousness, and she ceases to experience pain. It is important to note that with general anesthesia, muscle relaxation is observed, which makes it possible to create convenient working conditions for the obstetrician-surgeon.

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

• Presence of contraindications to other existing methods of anesthesia;
• The presence of obesity in the parturient woman;
• The fetus is diagnosed with hypoxia;
• Refusal of the woman from other kinds of anesthesia;
• Improper fetal position in the uterus, prolapse of the umbilical cord and other emergency obstetric situations.

Today, general anesthesia with caesarean section is used if it becomes necessary to perform it under emergency indications, and surgical intervention is required to begin urgently to save the lives of the mother and child. It is caused by the fact that general anesthesia has a number of significant disadvantages.

Disadvantages of general anesthesia

What anesthesia is better with caesarean section? Before answering this question, let's talk about its shortcomings. Doctors try to avoid this type of anesthesia with caesarean section, as anesthesia can give a much greater number of complications compared to other methods of anesthesia. Among the most common are:

• Hypoxia of the parturient woman, which is caused by the fact that during anesthesia the volume of lungs decreases and the body's need for oxygen increases;
• The risk of aspiration, that is, getting into the respiratory tract of the stomach contents, is great: if the anesthesiologist does not diagnose the condition in a timely manner, the consequences can be deplorable;
• In many parturients during the general anesthesia, the pressure increases.

An anesthetic can lead to a disruption of the respiratory activity of the newborn, and also exert a depressing influence not on his nervous system due to the penetration of pain medication through the placenta. The latter is especially dangerous if the general anesthesia is used for premature birth. However, one should not be afraid very much: modern drugs allow to reduce the risk of negative consequences for the child to a minimum, besides the newborn receives special medications that remove the effects of general anesthesia.

So, which is better to choose anesthesia for caesarean section, it is up to you and your doctor to decide, but remember that general anesthesia is far from the best way to anesthetize an operation and should be resorted to only if other options for one reason or another do not Remains. For example, if the mother has an unstable psyche or suffers from any psychiatric illnesses, the operation can be performed only under general anesthesia, because there is a great 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, that is, regional methods of anesthesia, are used in practice - these species are much safer, besides, they allow the woman to be in a state of clear consciousness during childbirth. This is important not only because she has the opportunity to immediately take on the hands of a newborn. During the caesarean section, the obstetrician and anesthesiologist can maintain constant contact with the patient, which makes it easier to identify possible complications.

The procedure for epidural anesthesia

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

Local anesthesia with a caesarean section allows a woman to take an active part in the delivery process: communicate with the medical staff or the husband present in the ward, immediately take the newborn in their arms and attach it to the chest. However, the mother does not feel the pain, although some note slight discomfort during the operation.

True, there is one very important nuance. Many women are psychologically difficult to decide to stay in the operating room, they are frightened that during Caesarean section they will be conscious and not feel half of their body. Often the mothers will insist on general anesthesia. It is advisable to discuss your fears with the attending physician and anesthesiologist, who will tell in detail how the procedure of anesthesia will proceed.

Advantages of epidural anesthesia

Among the main advantages of epidural anesthesia are the following:

• Stable functioning of the cardiovascular system, absence of pressure spikes.
• Preservation of movement.
• Exclusion of upper respiratory tract trauma and no risk of aspiration.
• Long duration of anesthetic effect. If necessary, anesthesia can be prolonged for any period, which is very important in the event that after caesarean section, it is necessary to perform some other operations, for example, to make a ligation of the fallopian tubes.
• The woman leaves anesthesia fast enough, the period of postoperative recovery is shortened: in just 24 hours after the operation many patients can stand up and move independently.
• The child can be picked up and attached to the breast immediately after the operation.
• It is possible to reduce pain after delivery, introducing painkillers into the epidural space.

Disadvantages of epidural anesthesia

Despite all its advantages, the consequences of epidural anesthesia in Caesarean section may be disappointing. This must be known to every future childbirth:

• If the anesthetic is not injected by an experienced person, the risk of getting the drug into the bloodstream is great. In this case, convulsions develop, blood pressure sharply decreases and consciousness is suppressed. The result can be the death of the mother or the irreversible damage to the nervous system.
• In about 17% of cases, anesthesia does not block some of the nerves, because of which the woman giving birth during caesarean section experiences unpleasant sensations. Therefore, before starting the operation, it is necessary to check the sensitivity using special neurological tests, for example, pin pricks. If the anesthetic did not work properly, repeated administration of the drug is required.
• If the medication, due to improper insertion of the catheter, has fallen under the spider web of the spinal cord, a spinal block may occur, which often results in the failure of the respiratory system. To avoid this, a small dose of the drug is first introduced: the surgical team needs only two minutes of waiting to determine if the procedure is performed correctly.

Unfortunately, epidural anesthesia in the operation of cesarean section is rather complicated, and its success often depends on the experience and skills of the specialist. Tactile detection of the epidural space is rather indistinct, 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 who causes you to trust, and carefully examine the feedback on the work of the hospital, in which your baby will be born.

Spinal anesthesia

Initially, epidural anesthesia seemed a real salvation, because it allowed not only to make the process of the birth of the child completely painless, but also gave women the opportunity not to lose 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 palm to the spinal primacy. Many argue that this is the best anesthesia for caesarean section.

Spinal anesthesia is the introduction of an anesthetic into the lumbar region of the back. The drug enters the subarachnoid space of the spinal cord. In this case, the effect of both types of anesthesia is similar: some time after the injection, the parturient ceases to sense the lower half of her body, and the doctor can start the necessary surgical manipulations.

Pros of Spinal Anesthesia

Which anesthesia is better for caesarean section? It is rather difficult to answer this question, because everything is individual. But we can distinguish the main advantages of spinal anesthesia:

• Absence of toxic effect. In case of an accidental ingestion of an anesthetic into the bloodstream, reactions from the heart or nervous system are practically not observed, but the risk for the child is absent.
• After the operation, the body is restored quickly enough.
• Qualitative anesthesia: during the operation the woman in labor does not experience pain.
• Spinal anesthesia further relaxes the musculature, which facilitates the work of the doctor.
• You can proceed to the operation 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 inject the drug, so that the risk of spinal cord injury or mistaken introduction of anesthetic is minimized.
• Many doctors recognize spinal anesthesia as the most perfect option for anesthetizing caesarean section.

Spinal anesthesia with caesarean section: contraindications and main disadvantages

Unfortunately, spinal anesthesia also 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 in the event that complications occur during surgery, additional anesthesia may be required.
• Spinal anesthesia is not possible if the patient has some types of spine injuries.
• Because of the rapid onset of anesthesia, blood pressure may decrease.
• If the instruments used to administer the drugs have not been thoroughly disinfected, various infectious complications, such as meningitis, may occur.
• After the operation, many women in labor give birth to severe headaches, which can last for several days and even weeks.
• As a result of improper insertion of the catheter, the nerve center, called the "pony tail", can be damaged. This can cause the innervation of the sacrum and lumbar region to be broken.
• Spinal anesthesia is impossible with some forms of deformity of the spine.
• Spinal anesthesia is not possible with premature detachment of the placenta and some other obstetric conditions.

Despite the above-mentioned disadvantages, spinal anesthesia is considered one of the best and safest analgesic techniques for cesarean section.

Anesthesia in Caesarean section: reviews

What anesthesia is better with caesarean section? Reviews about what feelings women experience during this or that kind of anesthesia will help us find the answer to this question.

Young mothers note that the process of getting out of general anesthesia is quite unpleasant: there is a feeling of confusion, nausea, headaches and pain in the muscles. In addition, there is no possibility immediately after childbirth to take the child's hands. There is one more negative consequence of general anesthesia: often after it a child experiences respiratory depression.

What anesthesia is better with caesarean section? Reviews about epidural anesthesia are mostly positive. The parturient women note that after the procedure there are no unpleasant sensations, and the baby can be immediately attached to the breast. However, as testimonies testify, unpleasant sensations in the field of introduction of a preparation are quite often marked, and in the first several hours after cesarean section when the anesthetic is deduced from an organism, the bottom half of a body strongly trembles. However, just a day after the operation, you can stand on your own, move around and take care of your newborn.

Spinal anesthesia with caesarean section reviews, in general, deserved positive. Patients note that they did not experience any pain during the operation. However, in a number of cases for several weeks, women suffer from headaches and unpleasant sensations in the abdomen.

How to choose anesthesia?

So which anesthesia is better for caesarean section? This article aims to familiarize future mothers with what kinds of anesthesia are used to anesthetize a cesarean section. But remember, in any case should not be guided by the above information when choosing anesthesia! Only a doctor who has all the data on the state of health of the woman in labor can correctly choose the type of anesthesia. Of course, the wishes of the patient can not be ignored. Therefore, before deciding on what anesthesia is best to do a cesarean section, you should weigh all the pros and cons of one way or another, and consult a surgeon and an anesthesiologist.

That the chosen anesthesia has passed successfully, it is necessary to carry out all references of experts who will advise how to eat on the eve of operation when to rise after cesarean section and what to do in order that the organism was restored as soon as possible.