Maternal choice as an indication for cesarean section
There are many who argue strongly that maternal request or demand for cesarean delivery
in the absence of any medical indication is very difficult to justify. An obstetrician
who agrees to such a demand is not necessarily doing the woman a favor. The bottom
line remains that despite the tremendous strides made in the area of surgical safety,
compared to vaginal delivery; the rate of complications remains significantly higher
with cesarean section.
Anesthesia for cesarean section
There are two main types of anesthesia: general, where the patient is rendered both
pain-free and unconscious (asleep) and regional, where the patient is pain-free and
her lower body is paralyzed but she is fully awake.
A general anesthetic is used when:
Ø Rapid induction of anesthesia is required (it is usually reliably quicker),
Ø In case of difficulties with regional anesthesia or
Ø Where there is contraindication for this and, of course;
Ø If and when the mother concerned does not wish to be awake during the operation.
Regional anaesthesia, which is either spinal or epidural, is used much more often
for cesarean section, though this differs from hospital to hospital and country to
country. There is evidence that the majority of mothers prefer this method of anaesthesia.
Difference between spinal and epidural anesthesia
The difference comes from the space in the spine where the local anesthetic is injected.
Both are quite effective but an epidural (commonly used for labor) takes effect more
slowly. An epidural is therefore not ideal where a rapid induction of anesthesia
Comparing epidural or spinal (regional) anesthesia to a general anesthetic
Spinal or epidural anesthesia allows the mother to be awake and therefore witness
the birth of her baby. She can hold the baby moments after delivery while the surgeons
are continuing with their work.
There is also the fact that her partner is allowed to be by her side, if she is awake.
This allows for the family atmosphere to be maintained at this very crucial and emotive
time in their lives. It all augurs well for bonding.
Additionally, complications are fewer with regional anaesthesia, compared to general
Why is spinal or epidural termed ‘regional’ anaesthesia?
The reason for this term is because the effects are confined to only a particular
section (or region) of the body and the upper half is left unaffected.
Potential complications of regional anaesthesia
The most common potential complication is a drop in blood pressure, and this is easily
Occasionally, patients have post-spinal headache, which may last a few days and can
be quite debilitating. It is felt with change of posture (usually from a flat position
to a sitting or standing position). This can also be effectively dealtwith.
An abscess or blood-clot (hematoma) may form at the injection site. The symptoms
are progressively worsening backache within a day or so of the procedure. It occurs
with the epidural rather than spinal. This complication is rare.
Occasionally, after starting the operation, it may be discovered too late that the
spinal or epidural is not fully effective and the patient is in some pain. There
is then no choice but to resort to giving a general anaesthetic. This can be quite
upsetting for someone who had wanted to stay awake. Fortunately, this is quite uncommon.