If you are going to give birth by caesarean section and are concerned about the anesthesia, you should know that the procedure is safer than ever before. Anesthesiologist do everything possible to make sure you're comfortable during delivery—and that you and your baby are safe. 

“It’s really about the mother’s experience,” says Ferne Braveman, MD, director of obstetrics and gynecological anesthesiology at Yale Medicine. Yale Medicine has dedicated obstetrical anesthesiologists who are highly skilled in helping women through both planned and emergency C-sections.

Regional anesthesia involves the use of local anesthetics to block sensations of pain from part of the body, and anesthesiologists use it for C-sections whenever possible. “This way mothers are awake to hear their baby’s first cry,” says Dr. Braveman. 

Essentially, regional anesthesia numbs a woman’s midsection so that she won’t feel any pain from the surgical incision or the delivery. 

Prior to delivery, pain medication is typically given by injection, one of two ways: 

Spinal: A woman whose C-section is planned in advance will typically receive a spinal, also known as a subarachnoid block. The anesthesiologist injects pain medication, typically a combination of an opiate and a local anesthetic, through the lower back into the spinal fluid, bathing the spinal cord. In rare cases, a catheter is placed in the spinal space, so the medication can be given continuously.

The spinal allows the pain medication to quickly reach the nerve receptors transmitting the pain signals and provides pain relief for up to two hours, “which is anywhere from half an hour to an hour and a half longer than the surgery, so there is plenty of extra time,” Dr. Braveman says.

Epidural: A woman who requires a C-section after she has gone into labor may already have an epidural catheter, which delivers pain medication just outside the sac of fluid around the spinal cord. The medication diffuses into the spinal space to reach the relevant nerve receptors.

For the actual C-section delivery, the anesthesiologist will administer a more potent anesthetic through the catheter. “They're similar drugs, just in different concentrations,” Dr. Braveman says.

In some cases, general anesthesia is used for a cesarean. These include cases where the mother is bleeding or medically unstable, when there’s an emergency with the baby, or when the mother has a strong preference for general anesthesia. 

While general anesthesia is safe for pregnant women, it’s not usually the first choice, unless it’s medically necessary. “We recommend the regional approach because we think it’s a better experience for the patient, but the patient always has final say,” Dr. Braveman says.

A woman preparing for a C-section will be asked to sit in a bent position with her back in a c-shape to speed the anesthesiologist’s work. (Some patients might lie on their sides instead.) The doctor first places local anesthetic in the skin and then pokes in the larger needle. “There’s uncomfortable pressure, but not quite pain,” Dr. Braveman says.

It’s important to remain still. An epidural takes about 10 to 15 minutes from when the prep solution is on the back to when you are again able to lie down. A spinal, with no catheter, is even faster.  

General anesthesia is usually delivered intravenously.  “At the start of a C-section, we keep the anesthetic light, so there’s less to the baby,” Dr. Braveman says. “The patients won’t feel pain, but they may hear us talking because the sense of hearing is one of the later senses to be totally anesthetized.”

The patient is not conscious when the incision is made, while the baby is being delivered or while the incision is being closed. Many women report having a sore throat afterward. This is from the breathing tube that was inserted after she’d been anesthetized.

A woman given regional anesthesia for a cesarean section will typically feel some pressure and be aware of the hospital staff working on her but will experience no pain. “What patients often say they know doctors are doing something,’” Dr. Braveman says, but they can't feel pain.

“If they do feel discomfort, we either give them more medicine or proceed to a general anesthetic. We don’t leave patients uncomfortable.” Of course, a patient who undergoes general anesthesia won’t feel anything and is not aware of the surgery or the arrival of her baby.

New mothers often have pain and soreness after a C-section and while healing. “We give enough pain medicine in the spinal or epidural, so they’re comfortable for the first eight to 20 hours post-partum with just a pill,” Dr. Braveman says. “They can bond with the baby, have visitors and still be more comfortable.”

A common side effect of an epidural or spinal is a headache that results from spinal fluid leaking into the epidural space of the spine. Though this is not serious, the headache can be annoying and may last up to 10 days after the birth. “We can treat it,” Dr. Braveman says. “Depending how bad it is, we’ll go for more aggressive therapy versus Motrin.”

Risks of general anesthesia are the same as for any other procedure. The most common one is a sore throat from the breathing tube. More serious, a patient who has eaten before the surgery (perhaps because she wasn’t anticipating a C-section) could aspirate the contents of her stomach. “This is a very rare occurrence, and we give medication to minimize the risk,” Dr. Braveman says.

The anesthesiologist tries to minimize the amount of time between administering general anesthesia and the delivery, so it has little effect on the baby. But anesthesia must start sooner in some more complicated cases, so the baby may also be affected. “We have pediatricians at all our caesarean deliveries,” Dr. Braveman says, and they can also take care of what doctors call “a sleepy baby.”

Yale New Haven Hospital is the only hospital in Connecticut with dedicated obstetrical anesthesiologists caring for patients 24/7. A minimum of three anesthesiologists are available at all times to care for women on the labor floor, which is where many routine C-sections take place.

Yale Medicine anesthesiologists meet with high-risk obstetrical patients in advance either in person or by phone, including those with planned C-sections. “We will consult with the patient ,and talk with the obstetrician so that we have a plan,” Dr. Braveman says.

Yale Medicine gets referrals of challenging cases from other hospitals. “We can handle the deliveries other places can’t,” Dr. Braveman says.