FAQs: Anesthesia for Cesareans

The following are some common question and answers about anesthesia for cesarean deliveries.

Q: Is anesthesia during a cesarean safe for the baby?
A: Both general and regional anesthesia are safe and have no significant effects on the baby. Obstetric anesthesiologists prefer to administer a regional anesthetic whenever possible as it minimizes airway (breathing) complications. It is a safe and effective anesthetic that allows you to be awake and pain free during the operation. During both regional and general anesthesia, safety monitors are applied to ensure that your vital signs are monitored and stay within the limits that are necessary for the well-being of the baby.

Q: Is it necessary to fast before cesarean delivery? 
A: Before all elective surgeries, regardless of the type of anesthesia that is administered, fasting is necessary. Before the administration of either regional or general anesthesia, you may be given an antacid to drink. This is necessary to neutralize the acid in the stomach. This precaution may reduce the chance of lung injury in the event that there is regurgitation of stomach contents into the breathing passage. Your doctor may give you anti-nausea medications through an IV.

Q: What happens if I just ate? 
A: In an elective cesarean situation, about eight hours of fasting is necessary. If you have eaten, the surgical procedure will be delayed. In an emergency situation, precautions are taken to minimize the risk of aspiration (regurgitation of stomach contents into the lungs).

Q: Can a labor epidural be used for cesarean delivery?
A: Some women who go through labor might eventually require a cesarean delivery. This can be due to non-urgent factors (labor not progressing) or urgent factors (mother or baby's condition is at risk). If an epidural catheter has been in place and functioning well, most of the time the anesthesiologist can put additional medicine into the catheter to make the numbness adequate for surgery. In other cases, a spinal or general anesthesia may be used. This choice depends on the urgency of the situation.

Q: Will I feel anything if I'm awake for my cesarean?
A: With a spinal or epidural anesthetic, you should not feel any pain with the operation. Being awake, you will still be aware of movements occurring in your lower body. Specifically, you may sense a feeling of pulling or tugging as the obstetrician separates the abdominal muscles and tissues. In addition, at the time of delivery, the obstetrician will push down on your abdomen to facilitate the delivery of the baby. You will feel this sensation as pressure in your chest.

Q: How is pain controlled after a cesarean?
A: Pain from a surgical incision on your abdomen can limit your ability to get out of bed and participate in the active care of your newborn. For this reason, postoperative pain control is necessary to maintain your comfort. Pain medication can be given orally, intravenously, or as part of the previously administered regional anesthetic. Since your stomach may not be able to tolerate much, taking medications orally may not be feasible until several hours after the surgery.

Q: How can my anesthesiologist help after my cesarean?
A: Your anesthesiologist will ensure your comfort after surgery. The method of pain relief is based on the anesthetic that you received for the cesarean delivery. If you had a regional anesthetic, pain medicine placed in the spinal or epidural area can last up to 18 hours after the surgery without making you drowsy. If you had a general anesthetic, pain is usually controlled with self-administered intravenous pain medicine (patient-controlled analgesia). Pain control after the first day is usually managed with oral medication.

Q: Are there any side effects of pain medicine after a cesarean?
A: The pain medicine is usually some form of narcotic drug. The side effects associated with narcotic administration include sleepiness, nausea, slower breathing and constipation. These side effects are usually minimal. If they are bothersome to any degree, there are medications to manage this. There is not any appreciable accumulation of these drugs in breast milk. You should not be concerned about becoming addicted to the narcotic drug. It is far more important to be comfortable enough to get up and out of bed after the surgery than to worry about potential side effects.