Planning Your Childbirth

Analgesics & Anesthetics
Regional Blocks for Labor
Anesthesia for Cesarean Births

Epidural, spinal or general anesthesia may be given safely for cesarean-section deliveries. Choices depend on several factors, including the medical conditions of you and your baby and, when possible, your preferences.

How is the epidural block given for a cesarean delivery?
If you already have a labor epidural catheter in place and then need a cesarean delivery, it is usually possible for your anesthesiologist to inject additional anesthetic medication through the same catheter to enhance pain relief safely. This stronger concentration of medication converts the analgesia to anesthesia. Anesthesia is necessary to numb the entire abdomen completely for the surgical incision. If you prefer to have an epidural block during your cesarean childbirth and you did not have labor epidural analgesia, there usually is enough time to provide epidural anesthesia.

What is spinal anesthesia?
Spinal anesthesia is given using a much thinner needle in the same location of the back where an epidural block is placed. The main differences are that a much smaller dose of anesthetic medication is needed for a spinal block, and it is injected into the sac of spinal fluid below the level of the spinal cord. Once the spinal anesthetic medication is injected, the onset of numbness is quite rapid.

When is general anesthesia used?
General anesthesia is used when a regional block is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness. It is used when an urgent vaginal or cesarean delivery is required, as in rare instances of problems with the baby or vaginal bleeding. In these circumstances, general anesthesia is quite safe for the baby.

One of the most significant concerns during general anesthesia is whether there is food or liquids in the mother's stomach. During unconsciousness, "aspiration" could occur, meaning that some stomach contents could come up and then go into the lungs. Here they could possibly cause pneumonia. Your anesthesiologist, therefore, takes extra precautions to protect your lungs, such as placing a breathing tube into your mouth and windpipe after you are anesthetized. Before your cesarean delivery, you also may be given an antacid to neutralize stomach acid.

It is best to remember, though, that YOU SHOULD NOT EAT OR DRINK ANYTHING AFTER YOUR LABOR PAINS BEGIN, regardless of your plans for delivery or pain control. Sometimes during labor, small sips of water, clear liquids or ice chips are permissible with your physician's consent.

Will I receive a separate bill from the anesthesiologist?
Your anesthesiologist is a physician specialist like your obstetrician or pediatrician whose medical services have been requested. You likely will receive a bill for your anesthesiologist's professional service as you would from your other physicians. If you have any financial concerns, your anesthesiologist or an office staff member will answer your questions. You will note that your hospital charges separately for medications and equipment used.

Modern anesthesiology offers today's mothers a variety of choices for a more comfortable childbirth. It is the goal of your anesthesiologist to answer your questions, ease your fears and make your labor and delivery as safe as possible for you and your baby.

Please discuss your anesthesia-related questions or concerns with your obstetrician. A consultation with an anesthesiologist usually can be arranged before your anticipated delivery. The more prepared you are -- in other words, the more you "plan your childbirth" -- the more comfortable and memorable the birth of your baby will be.

"Anesthesia & You ... Planning Your Childbirth" has been prepared by the American Society of Anesthesiologists through the cooperative efforts of the Society's Committee on Communications and the Committee on Obstetrical Anesthesia.