- Regional or General Anaesthesia
The vast majority of Caesarean Sections in the Western world are performed under a regional
anaesthetic, either a spinal or an epidural or a combination of the two, however it is sometimes
necessary or advisable to have a general anaesthetic, for example where there is no time to establish
a regional anaesthetic or where there is a particular reason that regional anaesthesia is not possible or
not advisable. For more information see our section on General Anaesthesia.
Regional anaesthesia is generally preferred because:
- Pregnancy causes a number of changes in the mother’s body to help with development of the
baby and to prepare for delivery. While completely normal, some of these physiological changes
do make general anaesthesia more risky than in an equivalent non-pregnant patient.
- Drugs used for general anaesthesia cross the placenta so the baby also receives a general
anaesthetic and will have some extra hurdles immediately after delivery.
- Studies have shown that in the short term, babies do better if delivered under a regional
- Being awake for the delivery also allows mother and baby to bond immediately after delivery
without having to wait for recovery from a general anaesthetic.
- Less post-operative pain and other side effects.
While ultimately it is every woman’s choice whether they have a regional or general anaesthetic for
Caesarean Section, most anaesthetists would strongly recommend regional anaesthesia as being safer
for both mother and baby. If you have questions or concerns, you are welcome to contact our rooms
so you can have a consultation with one of our specialist anaesthetists in advance of delivery.
Spinal and Epidural anaesthesia are very similar techniques but there are a couple of important
differences. Both involve a needle inserted in the back and the use of local anaesthetic that blocks
transmission of nerve impulses in the spinal cord. Both result in a loss of pain sensation from the
lower half of the body so that you are temporarily numb and weak from the breasts down. Both mean
that you can be wide awake for the delivery of the baby yet feel no pain. Neither technique involves
the spinal cord itself.
An epidural deposits the anaesthetic just outside the fibrous sac that
covers the spinal cord and fluid. A spinal deposits the anaesthetic inside this sac. In simple terms an
epidural is slow onset, long duration while a spinal is fast onset, short duration
Typically an epidural is used when the block may need to last a long time because a thin plastic
catheter can be left in the epidural space and further doses (top ups) can be given later if necessary.
Generally, though not always, a spinal is a single shot technique with a single injection and no
catheter left behind. As a general rule a spinal will easily last long enough to perform a Caesarean
An elective Caesarean Section is usually done with a spinal anaesthetic while an epidural is used if the
patient requires pain relief in labour. If the patient subsequently has to have an emergency Caesarean
the epidural can be easily topped up for this purpose. Sometimes a spinal can be combined with an
epidural to give the advantages of fast onset and long duration.
Risks of Anaesthesia for Caesarean Section
Anaesthesia for Caesarean Section is not dangerous but everything in life has risks and this is no
different. It is important that you are aware of possible risks before proceeding but remember that
serious complications are incredibly rare. The vast majority of people have anaesthesia with no
problems and this information is designed to inform you, not to frighten you. It is fair to say that the
very process of childbirth carries more risk than the anaesthesia.
- Minor complications can include headache, nausea, vomiting, light-headedness, backache,
muscle aches and pains, stiffness, damage to teeth, sore throat and bruising. If these
complications do occur they are only short-lasting in most people.
- Nausea and vomiting is less common with regional anaesthesia than with general anaesthesia.
There are many hormonal changes that can cause nausea, and if you start eating and drinking
too soon after a Caesarean Section this can cause vomiting. A regional anaesthetic can cause
nausea if your blood pressure drops too low so we keep a fairly close eye on this.
- Headaches due to leakage of the fluid occur about once in every 100 procedures. The
headaches usually only last a few days and go away by themselves. However on occasion the
headache can be so severe or long lasting that a second epidural procedure may be needed.
- Back pain is a common problem after pregnancy and is no more likely if you have a regional
anaesthetic for Caesarean Section than if you have a normal delivery.
- Serious complications can include allergic reactions to drugs, nerve damage or damage to vital
organs including heart, brain, lungs, kidney or liver. The risk of dying due to anaesthetic
complications is somewhere around 1:40,000 procedures, or about the same degree of risk as
flying in a commercial aircraft. The risk of serious permanent nerve damage (such as paralysis
or having bowel or bladder problems) is probably less than 1:150,000 procedures.
The majority of mothers can have a regional anaesthetic. Sometimes the procedure can be particularly
difficult, for example in patients who are overweight or who have had back problems or back surgery,
however even in these patients it is often still possible to do a regional anaesthetic. Occasionally there
may not be enough time to perform a regional anaesthetic or there may be some other reason that
makes a general anaesthetic more appropriate.
What Happens During the Epidural or Spinal?
The anaesthetist will usually see you before your procedure in the pre-op clinic, in the ward or outside
the operating theatre. Any questions or concerns that you have can be discussed and the best
management plan for you will be formulated.
An intravenous cannula (or “IV drip”) will be put into a vein, usually on your arm or hand. This process
usually causes a short sharp pain but can sometimes be associated with bruising. Sometimes it can be
difficult to insert the cannula and even very experienced anaesthetists sometimes need several
You will have several monitors attached to look at your heart-beat, blood pressure and oxygen levels.
You may be given oxygen to breathe through a mask or nasal prongs but this is not universal.
The epidural or spinal may be inserted with you sitting up or lying on your side curled up into a ball. It
is important that you arch your back outwards towards the anaesthetist, remain as still as possible
and obey all instructions. Your back will be cleansed with anti-septic solution and a sterile drape
applied. There is a short sting with local anaesthetic in the back then a bit of pushing and prodding for
a minute or two and that is about it. Most people are pleasantly surprised that the needle in the back
is nowhere near as bad as they had feared.