OBSTETRICS
Caesarean Section - Your Choice Of Anaesthesia
For optimum safety, you will require a Specialist Anaesthetist to provide anaesthesia care during your forthcoming procedure. A Specialist Anaesthetist is a doctor who has completed a medical degree and also further specialist training in Anaesthesia. Of particular importance in this field is the safe use of Anaesthesia drugs and other techniques, careful monitoring of patients, pain management, resuscitation and intensive care, as well as extensive training in Anaesthesia for other specialised areas such as obstetrics and paediatrics.
Anaesthesia For Caesarean Sections
On average, one in five babies in Australia is born by Caesarean Section.
A caesarean section may be planned in advance as an elective procedure due to choice, or because there is an increased chance of complications developing during a vaginal delivery.
In some cases, caesarean section may be recommended in a hurry, usually when you are already in labour. This is classified as an emergency caesarean section. This may be recommended because of poor progress of labour; because the baby’s condition is deteriorating or a combination of the two.
If your obstetrician decides to proceed to a caesarean section, the Anaesthetist will be by your side and ensure to discuss with you what type of Anaesthesia is appropriate. The time interval in which your baby must be delivered may influence the type of Anaesthetic you have.
The Hobart Anaesthetic Group are here to provide the women of Hobart obstetric Anaesthesia care around the clock; 24hrs a day, 7 days a week, 365 days of the year.
Types Of Obstetric Anaesthesia
When it comes to caesarean sections, there are two main types of Anaesthesia.
Regional: Where you are conscious by sedation from the lower body is numbed.
General Anaesthesia: Where you are unconscious for the duration of the operation.
Analgesia for Labour & Delivery
Regional Anaesthesia is a technique used whereby local Anaesthetic drugs are injected near the nerves of the spinal cord. These nerves carry signals from that area of the body being operated on to the brain.
There are three types of regional Anaesthesia:
(1) Spinal Anaesthesia (the most commonly used)
Spinal Anaesthesia involves a single injection through a very fine needle into the back. You will be asked to sit or lie on your side, curling your back. The Anaesthetist will numb your skin with local Anaesthetic. A fine needle is then passed through the ligaments in your back and local Anaesthetic and a pain-relieving drug injected and the needle removed.
You may notice a warm, tingling feeling as the Anaesthetic begins to take effect. It is common to feel as though the part of your body which is Anaesthetised “does not belong to you”.
Spinals are single injections which take only a few minutes to work and last about two hours. They cannot be topped up to make them work longer.
(2) Epidural Analgesia
With an epidural, a larger needle is needed to allow the epidural catheter to be threaded down it into the epidural space. As with a spinal, this sometimes causes a tingling feeling down for leg.
Epidurals can take up to half an hour to work but can be used to relieve pain for hours. It can be topped up as often as required.
(3) Combined Spinal/Epidural
A combination of spinal and epidural may be used. It has the advantages of quick onset and improved quality of block, like a spinal Anaesthetic. It also allows for the administration of extra local Anaesthetic drugs into the epidural space should the effect of the spinal be inadequate or too short lived.
Long-acting painkilling drugs, like morphine, may also be injected through the epidural to provide pain relief in the post-operative period.
Regional Anaesthesia
General Anaesthesia
General Anaesthesia late in pregnancy can be more complicated and is therefore avoided if possible. However, in some situations it may be necessary, for example:
In an emergency when there is not time to site a spinal or top up an epidural
If the patient has a blood clotting disorder, reginal Anaesthesia is best avoided.
If the mother has a damaged/abnormal spine which makes regional Anaesthesia difficult or impossible.
If the epidural/spinal fails to work.
If the mother doesn’t want to stay awake.
Regional Compared With General Anaesthesia
Advantages
Spinals and epidurals are usually safer for you and your baby.
They enable you and your partner to share in the birth.
You will not feel sleepy afterwards.
It allows earlier feeding and contact with your baby.
You will have good pain relief afterwards.
Your baby will be born more alert
Disadvantages
Spinals and epidural can lower blood pressure, although this is easily treated.
They take longer to set up than a general Anaesthetic.
Occasionally they can make you very shaky.
Rarely, they don’t work effectively; so a general Anaesthetic is still necessary.
1 in 3,000 women experience temporary damage to spinal nerves. Virtually all these cases recover within a few weeks-months. Temporary nerve damage can also be caused by labour rather than by the epidural or spinal.
In 1 in 10,000 cases, some permanent nerve damage may occur.
Itching during the caesarean or afterwards, but this can be treated.
1 in 100 women suffer severe headaches, but this can be treated.
Local tenderness in your back for a few days. This is not unusual.