Caesarean section

which anesthesia?

About one in five children are born with a caesarean section and twice out of three the intervention is unexpected; so a look at this page can be useful, even if you don't think you need a cesarean section.

having a baby is an unforgettable experience

kind of anesthesia

preoperative evaluation

the visit of the anesthesiologist

the day of surgery



at the end of the surgery

some reasons why general anesthesia may be needed

what happens with general anesthesia?

analgesia after surgery

advantages of regional anesthesia compared to general anesthesia

disadvantages of regional anesthesia compared to general anesthesia

the spinal and epidural do not cause chronic back pain

having a baby is an unforgettable experience

A caesarean section can give just as much joy as a vaginal delivery, and if necessary it must not be considered a defeat for this. The most important thing is the safety of the mother and the child, a caesarean section may be the best way to guarantee both.

There are several types of anesthesia for cesarean section. Here are the possible choices you can discuss with your anesthesiologist. Obstetric anesthesiologists are specialist doctors who deal with anesthesia and the good health of pregnant women and their children.

Her caesarean section may have been scheduled in advance and in this case it is called an elective caesarean section. This may be advisable when vaginal delivery suggests an increased risk of complications: for example, if at the end of pregnancy the baby is in a different position from the usual one.

Sometimes cesarean section can be recommended at the last moment, usually when labor has already begun; in this case it is an emergency caesarean section. It can be recommended because labor goes on too slowly, or because the baby's condition is not good, or for these two reasons together.

Your obstetric surgeon will discuss with you the reasons for any caesarean section and ask you to consent to the surgery.

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kind of anesthesia

There are two main types of anesthesia: you will be able to stay awake or sleep. Most caesarean sections are performed under regional anesthesia: this means that you will be awake, but the lower half of your body will be numb and therefore will not feel any pain. It is usually a safer anesthesia for the mother and baby; it will also allow you and your partner to live the birth experience together.

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Before the hospitalization for the intervention, a visit is scheduled. The midwife will visit her and take a blood sample for her tests before the operation. He will also explain to you everything that will happen. After this evaluation, most patients return home and return to the hospital on the day of surgery; however, you may have to go to hospital the previous evening. It may be that they give you tablets to reduce the acidity of your stomach and to prevent nausea: you will have to take one the evening before the operation and one on the morning of the operation, as will be explained to you.

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Before the caesarean section, she should be visited by an anesthesiologist, who will discuss her medical history and any previous anesthesia with her. It may be that the anesthesiologist must request other tests. The anesthesiologist will discuss the available anesthesia techniques with her and answer her questions.

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The midwife will give you confirmation of the time scheduled for the surgery and will ensure that you have taken the tablets. Shaving the pubis is likely to be necessary. A band with her name will be attached to your wrist or ankle. In the operating room, equipment will be applied, without any pain, to measure blood pressure, heart rate and the amount of oxygen present in the blood. The anesthesiologist will apply a drip to infuse intravenous fluids. Then the anesthesia will begin.

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She will be asked to sit or lie on her side, and curl her back. The anesthesiologist will paint her back with a disinfectant solution that will give her a fresh feeling. After finding a suitable spot in the center of the lower back, he will give her a small injection of local anesthetic to make the skin numb. This injection can cause very long lasting stinging pain.

In the case of spinal anesthesia, a thin needle will be inserted, as a rule without any pain, into the back. It is possible that as the needle is introduced you feel a tingling down your leg, similar to a small electric shock. If this happens, tell the anesthesiologist; but it is important that it remains still while the needle is inserted. When the needle is in the right position, the anesthetic and a pain reliever drug will be injected; then the needle will be removed. Usually everything lasts a few minutes, but if there were any difficulties, it is possible that it will last a little longer.

In the case of an epidural, a larger needle must be used to insert the catheter into the epidural space. Again, as with the spinal, she may feel a tingling or a small electric shock down her leg. While the anesthesiologist inserts the catheter, it is important that you remain still; but when the catheter is in place, the needle is removed and it is no longer necessary for her to remain still.

If an epidural catheter has already been placed for analgesia during labor, all the anesthesiologist will have to do is inject a stronger dose of local anesthetic through the catheter, sufficient for cesarean section. If cesarean is urgent, there is likely not enough time to wait for epidural anesthesia to take effect; in this case another type of anesthesia may be recommended.

You will notice that the spinal cord, or epidural, has an effect, because you will begin to feel heavy and warm legs. It is possible that they begin to tingle. Gradually, a sense of numbness will rise from the legs along the body. The anesthesiologist will check how far the anesthesia has gone up, to decide when it is possible to start the operation. Sometimes it is necessary to change position to allow anesthesia to act better. Your blood pressure will often be measured.

As the anesthesia begins to act, the obstetrician will introduce a tube (bladder catheter) into the bladder to keep it empty during surgery. This shouldn't bother you. The catheter will be left in the bladder until the following morning, so you don't have to worry about being able to urinate.

During the operation she will be lying on her back, slightly inclined from the left side. If you feel sick, tell the anesthesiologist; often nausea is caused by a drop in blood pressure, and in this case the anesthesiologist will be able to remedy it immediately.

Until the birth of the baby, it is possible that oxygen is administered through a transparent plastic mask, to be sure that, before being born, the baby receives all the necessary oxygen.

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A sterile drape will separate it from the operation area. The anesthesiologist will be around you all the time. You will hear all the noises of surgery preparation, because obstetric surgeons work with a team of midwives and operating room nurses.

The skin is usually incised a little below the bikini line. Once the surgery has started, she will be able to feel the pull and push, but she will not feel bad. Some women described this feeling as "if someone was washing the laundry inside my tummy". The anesthesiologist will monitor the progress of the anesthesia throughout the operation, and, if necessary, will administer an additional dose of pain relieving drugs. Although it rarely happens, it is sometimes necessary to switch to general anesthesia.

As a rule, 10 minutes pass from the start of the operation until birth. As soon as the baby is born, the baby is dried and visited by a midwife. Even a pediatrician is usually present to check on the baby. Then the baby will be washed and weighed by the midwife in the presence of her partner and finally brought to her, so that she can pamper him.

After birth, a drug called Sintocinon will be put into the drip, which serves to contract the uterus and detach the placenta. An antibiotic will also be introduced into the drip, to reduce the risk of infections. The surgeon usually takes another half hour to finish the operation. Before the end of the operation you will be given intravenous or intramuscular pain relievers to decrease pain when the effect of the anesthesia begins to disappear.

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She will be helped to get up in a semi-seated position and then she will be transported to the recovery room, where she will remain under observation for some time. Your partner will probably be able to stay with you and if you want you can start breastfeeding the baby. In the recovery room, the anesthesia will disappear a little at a time and you are likely to feel a tingling sensation in your legs. Within a couple of hours he will be able to move them again. The pain relieving drugs that had been administered with the spinal or epidural will continue to take effect for a few hours. If you feel you need it, you can ask the midwife for other painkillers.

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Before general anesthesia, you will be given an antacid to drink and a bladder catheter will be inserted. The anesthesiologist will ask you to breathe oxygen with a mask for a few minutes. When the surgeon and his collaborators are ready, the anesthesiologist will inject the anesthetic through the drip tube to make her fall asleep. Sometimes, immediately before you fall asleep, the anesthesiologist's assistant will press lightly on the neck. This is to prevent liquid from the stomach entering the lungs. Anesthesia will take effect very quickly.

When she is asleep, a tube will be placed in her trachea to prevent the passage of fluid from the stomach to the lungs and to let her breathe with the help of a machine. The anesthesiologist will continue the anesthesia to keep her asleep and to allow the obstetrician to safely give birth to her baby. But she won't realize anything.

Upon awakening, he may feel a little sore throat from the tube and will feel a little sore from the operation. For a short time he may also feel sleepy and perhaps feel a little nauseous. But in short everything will return to normal. She will be transported to the recovery room, where she will meet the child and her partner. It is likely that you have already been given analgesics to control postoperative pain, but you can ask the midwife for an analgesic whenever she feels the need.

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There are several ways to decrease pain after a cesarean section:

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They can also cause:

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Unfortunately back pain is very common after childbirth, especially among women who have suffered from it before and during pregnancy, however the spinal and epidural do not make it more frequent.

Cesarean section is a surgical intervention and only in case of appropriate medical indication is it able to guarantee benefits that outweigh the potential risks that it inevitably entails.

When it is necessary to resort to it, cesarean section can be a very beautiful experience and many women prefer to stay awake during the surgery. Others must be asleep for the reasons discussed above.

I hope these pages will help you make a more informed choice in case of caesarean section.