Key takeaways:
- A University of Pennsylvania study found that general anesthesia during cesarean section is safe and effective for both mother and baby.
- Concerns that general anesthesia harms newborns were not supported by the data, with similar Apgar scores and NICU admission rates across anesthesia types.
- Up to 1 in 6 patients receiving spinal or epidural anesthesia reported pain during c-section, underscoring the need for alternative options.
- Researchers emphasized that discussing general anesthesia should not be stigmatized, as patients deserve informed choices about pain management.
- Additional research linked c-section recovery challenges, including pain and sleep disturbances, to long-term impacts on maternal health and well-being.
Researchers from the Perelman School of Medicine at the University of Pennsylvania have found safety and efficacy for general anesthesia use during cesarean section (c-section), publishing their findings in Anesthesiology, journal of the American Society of Anesthesiologists.1
This data contradicts concerns about the impact of general anesthesia toward newborns during labor and delivery. These worries, alongside societal pressures, often lead to women being awake during delivery, which can cause excruciating pain even after administration of a spinal or epidural block.1
“No patient should have to experience pain during cesarean section; as an anesthesiologist, I never want someone to feel forced to choose between their baby’s health and not having to experience the pain of surgery,” said Mark Neuman, MD, MSc, senior author and Horatio C. Wood Professor of Anesthesiology.1
Comparing anesthesia methods in cesarean deliveries
Thirty years of clinical data from multiple trials were assessed to compare outcomes of general anesthesia to those of spinal or epidural anesthesia during c-sections. While positive safety outcomes were reported for spinal or epidural anesthesia, 1 in 6 patients utilizing this method reported pain during the procedure.1
The lowest pooled pain reported was 14% in patients receiving spinal anesthesia, while the highest was 33% in those receiving epidural top-up.2 Overall, a pooled incidence of 17% has been reported for patients receiving neuraxial anesthesia.
Investigators warned that there are traumatic and long-lasting emotional adverse impacts from pain during c-section.1 While the data indicated a greater newborn Apgar score from spinal or epidural anesthesia, the difference was minor and likely not clinically meaningful compared with general anesthesia.
Expanding patient options and informed choice
Neonatal intensive care unit admission rates did not differ between newborns based on the type of anesthesia used during c-section. According to investigators, this does not indicate general anesthesia should replace regional techniques but highlights this option as reasonable in certain cases.1
“For patients who are open to regional anesthesia, spinal or epidural block remain great first choice options,” said Neuman. “But having conversations with patients about general anesthesia doesn’t need to be taboo. Patients deserve to know they have options.”1
Other long-term health impacts have been identified c-section, including sleep issues, as discussed by Moe Takenoshita, MBBCh, postdoctoral scholar at Stanford Medicine, in a discussion with Contemporary OB/GYN.3 These risks were observed in the first year after childbirth, with a 16% increase in odds vs patients undergoing vaginal delivery.
Persistent pain and postpartum sleep challenges
Patient interviews were conducted to determine why these associations were observed. Responses indicated that more severe and persistent pain from c-section adversely impacted patients’ ability to function during the day and sleep quality. While the disparity was not fully explained by pain alone, it was highlighted as a major factor of sleep disorders in c-section patients.3
According to Takenoshita, there were severe long-term impacts of poor postpartum sleep quality in new mothers. These include mood disturbances, reduced daily functioning, and increased odds of cardiovascular complications. Therefore, effective, evidence-based treatments are needed to improve recovery after childbirth.3
“I would encourage anyone who is struggling… to actually have conversation with their [obstetrician primary care physician], because they could actually have a sleep disorder which is treatable, and they can get access to [care],” said Takenoshita.3
