What are the options in relation to anaesthesia for a c-section?

Caesarean section (C-section) can be planned (“elective”) or unplanned (“emergency”). Either way, a c-section is an operation, so you’ll need anaesthesia (pain relief) to deliver your baby this way.

For a c-section, you can either be awake or asleep. The vast majority of women are awake, with either a spinal anaesthetic, an epidural, or a combination of the two (a “CSE”). It’s generally better to be awake as there is less anaesthetic risk to you and the baby. Being asleep is known as general anaesthesia, commonly referred to as “going under” anaesthetic. It’s often quicker to do a general anaesthetic and so it is most used in emergency situations where the baby needs to be delivered quickly.

In all circumstances, your anaesthetist will remain with you throughout the whole anaesthetic and operation. Caesareans are always performed in an operating theatre. It is mandatory for you to be monitored (blood pressure readings, ECG, oxygen levels) and to have an IV drip (cannula).

Spinal Anaesthesia

This is the most common form of anaesthesia for c-section. Your anaesthetist will meet you beforehand, assess your suitability for a spinal anaesthetic, and explain the technique. A spinal is a one-off injection into the back (no tube or cannula is left in place) and is quick to perform. Within 2-15 minutes of the injection you will feel a warm sensation across your bottom and legs, and notice that you become numb from the bra-line downwards. The resultant numbness to your lower ribs might make your breathing feel a bit different, but you should not feel breathless. Spinal anaesthesia is generally very safe and reliable. See our article on spinal anaesthesia for full details of how the procedure is done, and the discussion of risks and benefits.

Epidural Anaesthesia

This is usually used for women who already have an epidural in place during labour and require an unplanned c-section. Occasionally it is used in planned c-section, mostly in combination with a spinal. Your anaesthetist will meet you beforehand and assess how well your epidural has been providing pain relief for your labour. If it has been working well, then it can be used to provide anaesthesia for your c-section. If it has been patchy, one-sided, or in any other way ineffective, then your anaesthetist might suggest removing the epidural and performing spinal anaesthesia instead.

Using an existing epidural is quick and effective and very safe as no additional injections in the back are required. A strong dose of anaesthetic is given down the epidural tube (often called a “top-up”, which is much stronger than doses used for pain relief in labour). Within 5-15 minutes you will feel a warm sensation across your bottom and legs, and notice that you become numb from the bra-line downwards (like a spinal).

See our article on epidural pain relief for more information.

What will I feel during the operation?

You will be awake throughout, but pain-free. It is very common to feel sensations of pulling or stretching during the operation, but you should not feel any sensations of pain, sharpness, or cutting. Your anaesthetist will check that you are suitably numb before the c-section starts, using cold spray (cold and pain sensation are carried by the same nerves – if you can’t feel cold, you can’t feel pain).

During the c-section, it is common to feel shivery, itchy, and sometimes sick or dizzy if you have had a spinal or epidural (which has been “topped up” for the operation).

Your birthing partner can usually be present while spinals or epidurals are being performed as well as throughout your c-section.

General Anaesthesia

This is used for women who cannot have spinal or epidural anaesthesia. This might be because of infection, blood clotting problems, technical difficulties in placing a spinal/epidural, or because c-section is required very rapidly in an emergency. In the unlikely situation you are unhappy with your pain relief during your c-section, your anaesthetist can offer you a general anaesthetic while the operation is ongoing.

A general anaesthetic starts with you breathing oxygen via a mask over your mouth and nose. An anaesthetic assistant will place their hand on the front of the neck to feel the airway. You will be given IV medications via your cannula (drip) that will drift you off to sleep. Once asleep, your anaesthetist will place a breathing tube in your mouth to support your lungs.

You will be completely asleep, unaware that the caesarean section is happening and will not feel anything during the procedure.

Once the c-section is fully finished, you will be woken up and the tube will be removed. You will be moved to a recovery area, where specialist nurses and midwives will look after you until you can move to the postnatal area. In contrast to spinal or epidural anaesthesia, general anaesthesia does not make you numb, so you will need strong pain relief after your c-section. This is discussed below.

Although general anaesthesia in pregnant women is riskier than in non-pregnant people, overall, it is still safe.

Typically, your birthing partner will not be allowed to be present while a general anaesthetic is being performed, or while you are asleep throughout your c-section.

Who decides what kind of anaesthesia I have?

The type of anaesthesia given for your c-section is decided following a discussion between you, your partner, your anaesthetist, your obstetrician and your midwife. There are some reasons why certain techniques are not appropriate or possible for some women. Your anaesthetist will assess you carefully and explain your options. In emergency situations, this discussion may be necessarily limited.

Although your anaesthetist and the rest of your clinical team will do all they can to address your birth plan, the priority is the safety of you and your baby.

Who will administer the anaesthesia?

A trained anaesthetist will administer your anaesthetic. This person is a doctor who has years of specialist training and qualifications in medicine, anaesthetic techniques and patient safety. Anaesthetists always work with a trained assistant called an Operating Department Practitioner (ODP) or anaesthetic nurse, who will also introduce themselves to you before the procedure.

What are the risks of anaesthesia for c-section?

No anaesthesia is totally risk-free, but anaesthesia for c-section is, on average, low risk and safe. Risks are summarized below (adapted from statistics published by the Obstetric Anaesthetists’ Association):

Will the anaesthesia affect my baby?

Spinal and epidural anaesthesia are very unlikely to affect your baby. General anaesthesia can make your baby a little sleepier when they are delivered, but this effect wears off quickly.

Recovery from anaesthesia and pain relief

The different types of anaesthesia have different effects and your recovery will depend upon which has been used for your c-section.

Spinal and Epidural

After a spinal or epidural for c-section, numbness and loss of muscle power in the lower body (“heavy legs”) usually wears off after about 2-4 hours. This occurs gradually, and varies from person to person. Your sensation and your muscle power may return at slightly different times, so be very careful when moving around or getting out of bed for the first time!

Spinal and epidural anaesthesia provide some pain relief after c-section, because you will have some numbness over your scar while they wear off. This is not the case with general anaesthesia.
You can ask for pain relief, which your anaesthetist will prescribe. This might include paracetamol, ibuprofen or diclofenac (which can also be given as a suppository during the c-section) and morphine. Your anaesthetist will check that you are not allergic to any of these drugs, and that they are safe for you. You will also be offered anti-sickness medicine if you need it.

Spinal and epidural anaesthesia have a low rate of complications, and do not cause chronic back pain. You should be fully recovered (i.e. able to walk, able to pass urine, and without headache or acute back pain) within 24 hours. An anaesthetist will visit you on the post-natal unit to check.

General anaesthesia

Without the numbness and loss of muscle power, you will be able to move around immediately after you wake up from general anaesthetic. However, you may feel a little groggy and tired — this effect can last for up to 24 hours, but usually fades within 2 hours.

Your anaesthetist will give you strong painkillers while you are asleep during your c-section, because you will not benefit from the numbing effect of a spinal or epidural. You can also have other painkillers when you wake up, as described above.

Read our article on “What to Expect After a Caesarean Section” for more information about your recovery and aftercare.

Main points

• Having a c-section is a big operation that requires pain relief and we will always check that you are comfortable before starting the operation.
• The options are epidural, spinal, a combination of the two or general anaesthesia.
• A spinal is a single shot of pain relief into your back. It is reliable and safe and often used for elective caesarean sections.
• If you had an epidural in labour that was giving you good pain relief, this may, if you undergo an unplanned c-section, be “topped up” with stronger pain medication down the plastic cannula into your back.
• Your partner can stay with you during the anaesthetic and the caesarean section.
• You will be awake but you will not be able to feel pain. It is very common to feel movements such as stretching or pressure, but this is normal and will not be painful.
• Sometimes a woman cannot have an epidural or spinal anaesthetic, or the baby needs to be delivered very urgently. This is often when a general anaesthetic is used.
• When you have a general anaesthetic, you will be put to sleep and you will not feel anything during the c-section. Your partner cannot stay with you before or during a general anaesthetic.
• After a c-section, all women move to a recovery unit. Here the anaesthetist will check on you and make sure you are still comfortable after the operation. A general anaesthetic does not have a numbing effect and you may need more pain relief earlier on compared to a woman who has had a spinal or epidural top-up.
• Anaesthesia for c-sections is considered low risk and safe. For a full list of the potential risks, see the article above.