Mark Neuman, MD, discusses benefits of general anesthesia in childbirth

In an interview with Contemporary OB/GYN, Mark Neuman, MD, discussed findings from a meta-analysis evaluating neonatal outcomes associated with general anesthesia compared with neuraxial anesthesia—spinal or epidural—during cesarean delivery.^1,2

Cesarean section is the most common inpatient surgery globally, yet data comparing anesthesia-related neonatal effects have varied widely. To better quantify these differences, Neuman and colleagues reviewed 36 randomized controlled trials involving approximately 3,400 infants.

The analysis revealed that while some neonatal outcomes differed between general and neuraxial anesthesia, the magnitude of these differences was relatively small. APGAR score differences at 1 and 5 minutes were less than 1 point on average—about half a point at 1 minute and a tenth of a point at 5 minutes.

Neonates exposed to general anesthesia had modestly higher rates of requiring respiratory support, but the researchers found no significant differences in NICU admission rates. Neuman emphasized, however, that many included studies were small, dated, or conducted outside the United States, limiting the ability to assess rare outcomes such as neonatal death or longer-term developmental effects. As a result, he stressed the need for more contemporary, US-based research that evaluates both immediate and long-term child health outcomes after anesthetic exposure.

Neuman noted that one of the most valuable aspects of the study is its ability to provide clinicians and patients with concrete, quantitative information rather than broad impressions. He observed that clinicians often describe general anesthesia as “worse for the baby,” but such statements lack nuance.

By presenting actual numbers—such as a 97% versus 94% rate of achieving a 5-minute APGAR of 7 or higher—patients can better understand the true scale of risk differences. This supports more informed, individualized decision-making, particularly as some APGAR rates in the historical trials were higher or lower than what is typically seen in current US practice.

Ultimately, Neuman emphasized that the study’s purpose is to empower patients to participate meaningfully in anesthesia decisions during childbirth. While the findings suggest only modest neonatal differences between anesthesia types, they also highlight substantial gaps in up-to-date evidence. Neuman underscored the importance of continued research to provide clearer, more relevant data that reflect today’s clinical standards and help ensure care that is both patient-centered and aligned with individual values.

No relevant disclosures.

References

1. Pain during a C-section? New study challenges fears about general anesthesia. University of Pennsylvania School of Medicine. November 12, 2025. Accessed November 13, 2025. https://www.eurekalert.org/news-releases/1105316.
2. Charles EA, Carter H, Stanford S, et al. Intraoperative pain during cesarean delivery under neuraxial anesthesia: A systematic review and meta-analysis. Anesthesiology. 2025;143(1):156-167. doi:10.1097/ALN.0000000000005486