Cesarean Section Under General Anesthesia

When most women think about having a cesarean section (or c-section), they usually think of the common regional anesthesia procedure that is administered in the form of either an epidural or spinal block where the mother is conscious as the baby is born via an incision in her lower abdomen. However, in rare occasions, she must be placed under general anesthesia, which means a loss of consciousness during the operation.

 

Why Have A C-Section Under General Anesthesia?

There are multiple reasons why a c-section would be performed under general anesthesia versus regional anesthesia. The most common reason is that the mother’s or the baby’s life is in immediate danger. Other reasons include an inadequate or failed regional anesthesia, and regional complications that prevent local anesthesia, such as coagulation or spinal abnormalities. A mother may also elect to have her c-section performed under general anesthesia as part of her birth plan (1, 2).  

 

What Happens During the Procedure?

To begin this procedure, the mother is given an IV muscle relaxant before going to the operating room. Along with relaxing her, this also makes her semiconscious. Once in the operating room, nitrous oxide is administered so that the mother is fully unconscious during the procedure. Finally, she is intubated to help maintain a good airway and to prevent aspiration of any potentially vomited material from entering her lungs (3). Once she is safely under the general anesthesia, the c-section operation, which is the same procedure if the mother were to have it performed under regional anesthesia, is carried out. The operation begins with a horizontal incision placed near the pubic hairline. The skin, fatty tissue, connective tissue, and fascia are all cut in a way to expose the abdominal musculature. Next, the exposed musculature is retracted and separated to expose the abdominal cavity. The last horizontal incision is made on the lowest portion of the uterus, through which the baby and placenta are delivered (4). Once the baby and placenta have been successfully delivered, sutures are placed to close all incisions and the mother is taken to recovery. (Please note: this was a very broad description of the most common c-section procedure, but circumstances may call for different incision directions and placements.)

 

What Happens After a C-Section?

During recovery, there are several complications to watch for that do not occur with regional anesthesia. A sore throat and longer recovery period are two of the most common. Other complications include being awake during the extubation process, difficulty with pain management, increased blood loss, and increased postoperative nausea. And while they are very rare complications, failed intubation or airway management as well as increased neonatal depression are the most severe and the two highest causes of maternal and neonatal fatalities that mothers should be made aware of prior to the procedure (5).

 

Some mothers elect for c-sections, others have them out of necessity. As you discuss your birth plan with your provider and your birth team, make sure that you are asking questions to make the best-informed choice for you, your baby, and your family that you can. These decisions are ideally not made hastily or under pressure from others. The transition into the calling that is motherhood is one that takes time, education, and support. And it is one that is ever-changing, just like you, as you move through all four trimesters and beyond. Surround yourself with professionals and people who love you and walk with you throughout the entire process.  

 

Rachel Viras, ATC

@RachelxKathryn @StrongFriendsFit

        

 

References

  1.     McGlennan, Alan and Mustafa, Adnan. General Anesthesia for Cesarean Section. Continuing Education in Anesthesia Critical Care and Pain, Vol. 9, Issue 5. October 2009. Academic.oup.com/bjaed/article/9/5/148/439565
  2.     American Pregnancy Association. Americanpregnancy.org/labor-and-birth/general-anesthesia
  3.     American Pregnancy Association. Americanpregnancy.org/labor-and-birth/general-anesthesia
  4.     Mayo Clinic. Mayoclinic.org/tests-procedures/c-section/about
  5.     McGlennan, Alan and Mustafa, Adnan. General Anesthesia for Cesarean Section. Continuing Education in Anesthesia Critical Care and Pain, Vol. 9, Issue 5. October 2009. Academic.oup.com/bjaed/article/9/5/148/439565

 

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