Anesthesia for a Cesarian Section - Step by step

If you're approaching your due date and a cesarean section is planned for you - it's natural to have concerns and lots of questions about the whole process. In this video I'll explain what kind of anesthesia is used for a C-section, how it's done, what you'll feel during surgery, and answer common questions about anesthesia for a cesarean - so you can arrive at this moment more prepared and at ease.

I'm Dr. Elisheva, I'm an anesthesiologist, and here you'll get clear, direct medical information - no scare tactics and no drama - so you can make informed decisions about your health.

Let's go.

## What anesthesia is used for a C-section?

Let's start with the fact that a cesarean is surgery in every sense, and therefore it requires anesthesia in every sense so you don't feel the incision. That also means that in terms of your preparation - it's like any surgery and requires 6 hours fasting from food and 2 hours from clear liquids (see my video on general anesthesia).

A cesarean can be done under general anesthesia or under regional anesthesia - I have a whole video on general anesthesia, so if you want to know more about that, you're welcome to watch it.

But our anesthesia of choice for a cesarean is actually regional anesthesia - meaning anesthesia where you're fully awake and experience the birth, but don't feel the surgical area.

Sounds perfect, no?

The regional anesthesia we use for cesareans is called spinal anesthesia, and it's similar to epidural anesthesia (link to that video) but works a little differently - it doesn't just numb, it strongly blocks sensation so we won't feel the surgical incision.

Briefly, how it works -

In the spinal cord there are tracts made up of bundles of nerve fibers (image) - these transmit electrical signals, which is information about pain from an organ to the brain. Around the spinal cord there's spinal fluid. In spinal anesthesia we inject local anesthetic directly into this fluid, completely blocking the transmission of those electrical signals.

## How is the anesthesia done?

How does it happen in practice? When you arrive at the OR admissions area you'll meet the operating room nursing team, the surgeon, and the anesthesiologist. We always ask questions about your medical condition, and we'll ask whether you're fasting.

After that you enter the operating room, we connect you to monitoring - ECG stickers that check heart rhythm, a blood pressure cuff, and a saturation probe that checks oxygen in the blood. If you don't already have an IV, we insert one and connect you to fluids.

To perform the anesthesia, you need to sit on the bed and we'll ask you to sit in a "banana" or "angry cat" posture - the goal is a rounded back that opens the space between the vertebrae.

The needle itself goes into your lower spine (image), in the part called the lumbar spine.

We put a little local anesthetic on the skin there, and then enter with a needle in the space between two vertebrae, injecting local anesthetic there. If you've ever had an epidural, the needle is thinner than the epidural needle and it's less painful.

The most important thing is to cooperate and be in the right position - the procedure itself can take a few minutes and during it it's very important to maintain the posture and not move at all - so as not to cause harm, and so it goes smoothly and safely.

## What will I feel during surgery?

After the anesthesia is given we'll lay you on your back right away so the medication spreads properly inside the spinal cord. Unlike an epidural, which should numb pain but allow you to move your legs fairly freely, with a spinal you'll feel a sensation of tingling and currents in your legs and then you'll barely be able to move them - a sign that the anesthesia is working as it should.

We always, always make sure the anesthesia is working before starting the surgery!

What will you feel during the surgery? You won't feel pain, but you will feel touch - because the sense of touch is mediated by different nerves than those that mediate pain - and there are also moments in the surgery where you'll feel a bit of pressure.

During the surgery there's a curtain between you and the surgical team; some hospitals have a special curtain with a transparent window that can be opened only when the baby comes out so you can witness that moment. In almost all hospitals, especially if the cesarean is planned in advance, a partner can come in and be with you until the baby is delivered. When the baby comes out and everything is fine, the midwife will place the baby on you for a few minutes before leaving with the baby and whoever accompanied you. At this stage you may feel a kind of fatigue, like a drop in blood pressure, and that's completely normal - even though you feel like you didn't do anything, you actually just gave birth!

## Side effects of spinal anesthesia

One side effect we sometimes see right after the anesthesia is given is a drop in your blood pressure - don't worry, we're prepared and treat it immediately, but sometimes it can cause a feeling of nausea or dizziness. If you feel anything like that, tell your anesthesiologist right away - we don't leave the room for a second, we're with you the whole time, our job is to monitor you continuously and care for you throughout the surgery. Also during the surgery, if anything hurts or is unpleasant, don't hesitate - our job is to treat you. And some of us can even entertain you during the surgery.

Besides that, sometimes there's itching and shivering - they can be annoying but they're not dangerous.

In terms of complications that are life-threatening or related to serious long-term harm - any medical intervention has complications, but spinal anesthesia is a very, very safe procedure, and complications like infection or bleeding at the puncture site are very, very rare.

## What happens after surgery?

After the surgery is over we transfer you to recovery. The anesthesia basically wears off on its own, within an hour or two from when you go to recovery, and slowly you'll feel sensation returning to your legs - it can also feel like a tingling sensation. When you can already move your legs freely, you'll be transferred to the ward. Some hospitals offer a "zero separation" option for cesareans and allow the baby to come into recovery to be with you during that time, but in some places the baby will stay with your partner and you'll see them only when you go up to the ward.

In terms of pain after the cesarean - in many hospitals they add a medication into the back injection that helps with pain for up to 24 hours after the cesarean, even after you've regained full sensation in your legs, and of course you can add oral medications like paracetamol on top of that, which is safe during breastfeeding.

## Frequently asked questions

**Can I ask for general anesthesia?** The answer is yes, no one will force you to have spinal anesthesia if you don't want it. But you have to take into account that you also won't experience the birth, and general anesthesia for a cesarean is considered less safe than regional anesthesia. From our perspective, we do general anesthesia only when there's a contraindication to performing regional anesthesia, or when the surgery is so urgent, God forbid, that there's no time to do spinal anesthesia.

**Can the anesthesia harm the baby?** The answer is no. The drugs injected locally into the spinal cord don't affect the baby, and you can also breastfeed after a cesarean with no problem.

**What happens with an emergency cesarean?** If it's an unplanned cesarean and you were transferred from the delivery room with an epidural in place, we usually don't do a new injection if the epidural was good and effective - we use the epidural and add a much more concentrated medication than what you received in the delivery room, to make the anesthesia as strong as spinal anesthesia.