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 is required.

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 anaesthesia.

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 dealt with.

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 dealt with.

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.

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