Which anesthesia is better for caesarean section. Which anesthesia is better for caesarean section: types, indications, contraindications, reviews

If for some reason the pregnant woman is about to give birth surgically(via caesarean section), then one of the most important issues There will be a choice of method for carrying out such an operation, or more precisely, a method of pain relief.

Today, obstetricians use three types of anesthesia during Caesarean births: general anesthesia, epidural and spinal anesthesia. The first is resorted to less and less as an outdated method, but there are situations when it is the only possible method of pain relief. Preference today is given to two other types of anesthesia as safer and easier in terms of administration and in terms of “recovery” from anesthesia. They have other advantages, as well as disadvantages, of course.

The decision on the method of performing a CS (caesarean section) is made by the doctor together with the patient. It largely depends on the state of health of the mother and unborn child and on the characteristics of the pregnancy. But the desire of the woman in labor also plays an important role.

Today we invite you to take a closer look at spinal anesthesia in childbirth, since among all types it is the highest priority among Western, and even domestic doctors.

Spinal anesthesia for caesarean section: pros and cons, consequences, contraindications

Like epidural, spinal (or spinal) anesthesia refers to regional anesthesia, that is, a method of pain relief in which the sensitivity of a certain group is blocked nerve impulses- and the effect of pain relief occurs in the part of the body needed for medical manipulations. IN in this case"turns off" Bottom part torso: the woman does not feel pain below the waist, which is enough for a painless, comfortable birth and unhindered comfortable work for doctors.

The huge advantage of regional anesthesia is that the mother remains conscious, can think and talk clearly, understands what is happening to her and is able to see, pick up and even put her newborn baby to her breast immediately in the first minutes of his life.

If we talk specifically about the spinal method of administering an anesthetic, then it has the following advantages compared to other methods:

• Fast onset of action. During spinal anesthesia, drugs administered for pain relief begin to act immediately. About two minutes - and doctors can already prepare the abdominal cavity for surgical intervention. This is of particular importance when a CS has to be performed unscheduled, as an emergency: in this case, spinal anesthesia is the first choice and a life-saving remedy.
• Very effective pain relief. The analgesic effect reaches 100%! This is a big plus not only for the woman in labor, who participates in the process but does not feel pain, but even a huge advantage for obstetricians, who can carry out their work in comfortable conditions. In this case, a smaller amount of anesthetic drugs is required than with epidural anesthesia.
• No toxic effects on the mother's body. Unlike other methods, this one is quite gentle in terms of negative effects on the woman’s body. In particular, intoxication of the central nervous and cardiovascular systems is minimized.
• Minimal risks to the fetus. With a correctly selected and administered dose of anesthetic, the baby does not experience any negative effects of the drug, respiratory centers the baby (as with other types of anesthesia) in this case is not depressed. This is exactly what most women in labor who are about to give birth via CS worry about.
• Easy to carry out. The choice of a qualified specialist is of paramount importance, and in this regard, a woman will have less fear and anxiety, because spinal anesthesia is easier to administer. In particular, the anesthesiologist has the ability to feel the “stop” of the needle, so there is no risk of inserting it deeper than is acceptable.
• Using a fine needle. The needle itself is thinner than that used for epidural anesthesia. This allows for pain relief with a single injection of medication without inserting a catheter (as with an epidural).
• Minimum postoperative complications . After just a few days (and sometimes even hours), a new mother can lead normal life- move, get up, care for the child. Recovery period very short and easy to pass. The resulting consequences in the form of headache or back pain are minor and short-lived.

Meanwhile, spinal anesthesia also has disadvantages:

• Short validity period. The blockade of nerve impulses that transmit pain lasts for several hours (from one to four depending on the type of drug, but on average for two hours) from the moment the medicine is administered. Usually this is enough to safely deliver the baby. But in in some cases longer time is required. If such situations are known in advance, then preference is given to another type of anesthesia.
• Possibility of complications. In this case, much depends on the professionalism of the anesthesiologist and obstetric staff. But even with quality work, some complications cannot be ruled out, because each organism reacts individually to such interventions and influences. In particular, so-called post-puncture headaches (in the temples and forehead) often occur, which can persist for several days; Sometimes loss of sensation in the legs persists for a period of time after surgery. It is also important to prepare for spinal anesthesia, in particular to administer drugs that prevent a strong sudden fall blood pressure, which happens very often during spinal anesthesia. If the dose of anesthetic was calculated inaccurately, then additional medication can no longer be administered, otherwise neurological complications are possible.
• Presence of contraindications. Unfortunately, this type of pain relief is not always applicable. You cannot resort to spinal anesthesia in cases where there are complications and circumstances that require more long acting anesthesia, and when the woman took anticoagulants on the eve of childbirth. Contraindications to spinal anesthesia include any bleeding disorders, severe cardiac pathologies, central nervous system dysfunction, exacerbation of herpes infection and other infectious and inflammatory processes, high intracranial pressure, patient disagreement, fetal hypoxia. This operation is not performed if the woman has lost a lot of fluid or blood.

Despite the presence of some disadvantages, this type of anesthesia for caesarean section is the most profitable in many respects, including from a financial point of view: spinal anesthesia is cheaper than epidural.

Technique of spinal anesthesia for caesarean section

As we have already noted, the technique of such anesthesia is simple to perform. The specialist uses a very thin needle to make a puncture in the lumbar region (between the vertebrae) and inject an anesthetic into the subarachnoid space - into the cerebrospinal fluid that fills the spinal canal. Thus, the sensitivity of those passing here is blocked. nerve fibers- and the lower part of the body “freezes”.

Spinal anesthesia requires puncture of the membrane surrounding the spinal cord. This sheath is quite dense, that is, the anesthesiologist feels the moment of its puncture, which allows him to accurately determine when the needle “entered” the right place and avoid unwanted complications.

Spinal anesthesia drugs are administered to the woman in labor in the lateral position (usually on the right), but possibly also while sitting. In this case, it is very desirable that she tuck her legs bent at the knees as high as possible towards her stomach.

When the medicine is administered, the woman feels virtually no pain, except for a slight, very short-term discomfort. A feeling of numbness soon sets in lower limbs- and the operation begins.

It should be mentioned that when planned implementation A CS with spinal anesthesia requires some preparation, which the woman in labor will certainly be told about. In particular, on the eve of the operation you should not drink or eat, or take sedatives or blood-thinning medications. After surgery, you will need to stay in bed for a while and drink plenty of water. If necessary (based on the results of a study of the mother's condition), medications are prescribed to relieve unwanted symptoms (nausea, itching, urinary retention, chills, etc.).

Feelings during spinal anesthesia: reviews

No matter how thoroughly we study theory, we are also not least interested in practice. And so women go to the forum and ask women who have already given birth in this way many questions: how does a caesarean section work with spinal anesthesia, is it painful, is it dangerous, is it scary, what effect does it have on the child, and so on.

You can easily find on the Internet many reviews, descriptions and even entire stories about how this or that woman gave birth, including with the use of spinal anesthesia. They talk in detail about everything: what sensations they experienced at the time the medicine was administered, how long the labor lasted, how they felt the next day and a few days after the operation.

But if we sum it all up, the main conclusions, according to the women’s stories, will be the following:

1. The biggest disadvantage of spinal anesthesia for CS is fear. It’s just scary, because it’s still an operation, it’s still anesthesia, it’s still the unknown (how everything will go, how the body will react, how the doctors will work). In practice, it turns out that everything ends wonderfully! Women are very happy with this kind of birth. But fear is inevitable for many.
2. Very often, after the administration of an anesthetic, a sharp drop in blood pressure occurs - shortness of breath occurs, and it becomes very difficult to breathe. This is not dangerous: doctors immediately give the woman in labor an oxygen mask and inject medications- and her condition quickly stabilizes. If you use medications with for preventive purposes, then similar side effects can be avoided altogether. The same goes for sedatives: taking them in advance allows you to avoid “shaking” during and after such births.
3. Quite often, after such births, mothers suffer from back pain, and they even have to resort to painkillers. But such pain after a cesarean section does not always appear, it is not always very strong, and, as a rule, it lasts no more than 2-3 days.
4. For some time after the operation, tremors may sometimes occur, It's a dull pain numbness at the injection site.

Individual reactions to anesthetics can never be ruled out. In some cases, women note a burning sensation in the lower extremities, loss of sensitivity in them for a long time after surgery, persistence of headaches, especially in vertical position, vomiting after surgery, poor tolerance low temperatures. But these are all exceptional individual cases. However, if numbness or pain at the site of injection of the anesthetic persists for more than a day after the CS, then you must tell the doctors about this.

In general, women who have undergone spinal anesthesia during a caesarean section note that it is not painful, the postoperative period is quite favorable, and that they do not find any particular negative aspects in it, remaining satisfied with the results. Especially those who have something to compare with, that is, whose previous birth took place under general anesthesia.

Therefore, if you are facing such a birth, then there is no reason to worry. If surgical delivery is inevitable, then spinal anesthesia for caesarean section in the absence of contraindications is really the best solution.

Good luck to you!

Especially for - Margarita SOLOVIOVA

Then, as a rule, general anesthesia is used, since it requires less time (compared to regional, local methods). During general anesthesia, the woman is immersed in deep dream, sees nothing, hears nothing, feels nothing. General anesthesia is also used quite often.

In this article we will look at how this type of anesthesia is performed, what are the indications for its use, the disadvantages (complications) and advantages of general anesthesia.

How is general anesthesia performed?

When using general anesthesia for a planned operation, measures to preoperative preparation taking into account the condition of the fetus, the woman’s objective data and the choice of anesthesia.

On the eve of a planned operation, it is advisable to prescribe sedatives, in order to achieve psychological peace and eliminate the fear of surgery. 30 minutes before surgery, premedication is performed (preliminary medicinal preparation). It is carried out with the aim of preventing preoperative experiences of women, preventing allergic reactions, and enhancing the effect of pain medications.

General (also known as endotracheal) anesthesia is performed sequentially, in three stages.

• A woman is injected intravenously with a drug that completely turns off consciousness and puts her to sleep.
• Into the trachea (lower part windpipe) a tube is inserted and a mixture of oxygen and anesthetic gas flows through it.
• A drug is injected that relaxes all the muscles of the body, including the uterus.

After this, the operation itself begins.

Advantages of general anesthesia for caesarean section

• The immediate effect of anesthesia is very important when emergency operations when every minute counts;
• This is a long-tested procedure that does not require special skill of an anesthesiologist;
• Stable work of cardio-vascular system during the operation;
• Low probability that arterial blood will drop pressure during surgery. Let us remember that a drop in blood pressure in the mother leads to disruption of blood flow to the placenta and fetal hypoxia.
• Control of the strength of the anesthesia, there is always the opportunity to extend the anesthesia if necessary.
• The woman’s body muscles are completely relaxed, which is convenient for the surgeon’s work.
• Modern drugs for general anesthesia are made in such a way that their negative impact on the child is minimized.
• The woman is asleep and cannot (even if she wanted) to worry about anything. She doesn't see the operation. At local species During anesthesia, she also does not see the operation area itself; there is a screen there. But she hears everything, sees the doctors’ faces, and so on. But under general anesthesia, she doesn’t see, doesn’t hear, doesn’t feel, and doesn’t worry.

Note. This can hardly be regarded as a “plus”, but both times I personally reacted to general anesthesia with a state close to euphoria. This state lasted about a day (). I was absolutely happy with everything that was happening.

Disadvantages and complications of general anesthesia for caesarean section

• The most common is cough and sore throat (after insertion of a tube with an oxygen and anesthesia mixture). This is not very pleasant, because the stitch hurts, and it’s scary to even think about coughing. As a rule, it is enough to clear your throat (cough several times) two to three times a day. Try to hold your stomach in the area of ​​the seam, it will hurt less. If you cough in your sleep, it is better to try to sit down or stand up, this will put less strain on the stitch.
• A fairly common complication: dizziness, weakness, muscle pain, confusion, nausea. At modern drugs occurs less frequently than before.
• Less common complications: pneumonia, respiratory tract infections, allergic reactions.

Complications during general anesthesia (for a child)

• Lethargy of the child, increased sleepiness. The baby may cry less and move less.
• Disturbances in the child's breathing.
• Development perinatal encephalopathy(at toxic effects on the brain narcotic substances).

In fairness, it must be said that the level of drugs now (2013) is already quite high, and the listed complications in children are rare. And if something does arise, then correction is made in the maternity hospital, and the mother “goes” home with a healthy baby.

Indications for general anesthesia for caesarean section

• If .
• The patient's refusal regional anesthesia.
• If there are contraindications for local anesthesia.
• With transverse, oblique. Note. Today, with a transverse and oblique position of the fetus, the operation can also be performed under regional anesthesia, but this is not a common practice, and the decision will depend on the individual doctor and. The preferences and wishes of the mother in labor are unlikely to be taken into account.
• When the umbilical cord loops fall out.
• If there are complications that lead to removal of the uterus. For obstetric bleeding.
• Systemic infections, some diseases of the central nervous system.

There are practically no contraindications for the use of general anesthesia.

You can read more about choosing anesthesia in the article.

A cesarean section operation is performed exclusively under anesthesia, since it is an abdominal operation. Surgical anesthesia is discussed in advance if the operation is planned. And a woman can choose one or another type of anesthesia, but not always. Sometimes this should only be done by a doctor. In this article we will talk about what choice options exist, how they differ, what are their advantages and disadvantages, and also describe situations in which a woman cannot make an independent choice.

What is taken into account when choosing?

The operation involves cutting the anterior abdominal wall, uterus, extraction of the baby and manual separation of the placenta, after which they first apply internal seams on the uterus, and then externally on the incision in the peritoneum. The surgical intervention lasts from 20 minutes to an hour (in particularly severe and complex cases), and therefore Such an operation cannot be performed under local superficial anesthesia.

Today, when performing a caesarean section, two types of anesthesia are used - epidural (and as a variation - spinal or dorsal) and general anesthesia. In an emergency caesarean section, which is performed to save the life of the baby and mother if something goes wrong during a natural birth, general anesthesia is usually used by default. The question of choosing a method of pain relief for caesarean section is usually decided in advance only when the operation is planned in advance.

In this case, doctors evaluate a lot of factors. First of all, the condition of the pregnant woman and the fetus, the possible effect of medications used for pain relief on the child and mother. It is necessary to take into account certain contraindications and indications for different types anesthesia. Regional (epidural) anesthesia has contraindications, while general anesthesia There are no contraindications.

Epidural anesthesia

In this way, up to 95% of all caesarean sections in Russia are anesthetized today. maternity hospitals. The essence of the method is that the administration of the drug, which leads to loss of pain sensitivity in the lower part of the body, is done through a thin catheter inserted into the epidural space of the spine.

As a result of this injection, the transmission of nerve impulses to the brain through the spinal canal is blocked. When such a “gap” appears in the central nervous system chain, the brain simply does not perceive and associate the ongoing violation of tissue integrity during surgery as a reason for activating the pain center.

The scope of application of such anesthesia is quite wide, but during natural childbirth to relieve pain and during caesarean section, such anesthesia is considered less dangerous than with anesthesia cervical region spine or arms for operations on the upper body.

As a rule, anesthesiologists administer special, carefully purified solutions that are originally intended exclusively for this use. To relieve pain during natural childbirth, lidocaine and ropivacaine can be administered. But such anesthesia will not be enough to perform a caesarean section. A certain amount of opiates, such as promedol, morphine or buprenorphine, may be administered simultaneously with lidocaine. Ketamine is often used.

The dosage of substances is determined by the anesthesiologist, taking into account the woman’s health, weight and age, but spinal anesthesia of opiates always requires less than with intravenous anesthesia, and the effect can be achieved longer.

How do they do it?

The woman lies on her side with her back bare, her legs slightly tucked and her shoulders brought forward. Anesthesiologist one of existing methods determines where exactly the catheter needs to be inserted. To do this, they usually use a syringe filled with air that is connected to a catheter. If the piston encounters significant resistance, then the catheter is in the ligamentous space. If resistance is unexpectedly lost, we can talk about the correct detection of the epidural space, where the drugs will be slowly injected.

The introduction is gradual. This means that the doctor administers a test dose first. After three minutes, the condition is assessed, and if the first signs of anesthesia and loss of sensitivity appear, the remaining parts of the dosage prescribed for a particular woman are administered in several stages.

A woman can first ask the anesthesiologist, who will definitely meet with her a day before the operation, about the name of the drugs that are planned to be administered. But it is better not to ask about the dosage, since its calculation is extremely complex and is based on numerous factors.

The operation begins after a complete blockade of the lower body occurs. A screen is placed in front of the woman’s face so that she does not see the surgeons’ manipulations. Throughout the operation, the mother in labor can communicate with doctors, see main point- the first breath and the first cry of your baby.

After this, the doctors will begin to apply stitches, and the baby may well be left next to the mother for a few minutes so that she can admire the long-awaited baby to her heart’s content.

Advantages and disadvantages

Complications after such anesthesia are possible, but in practice they occur only in 1 case out of 50 thousand births. What unexpected and negative manifestations can there be? It happens that blockades nerve endings does not occur, sensitivity remains, and this, according to statistics, happens in one woman out of 50 operations. In this case, the anesthesiologist urgently makes a decision on general anesthesia.

If a woman has problems with blood clotting, a hematoma may develop at the site of insertion of the catheter. When inserting a needle, the anesthesiologist may accidentally puncture the dura mater of the spinal cord, which can lead to leakage. cerebrospinal fluid and subsequent problems with severe headaches.

Inaccurate movements of an inexperienced doctor can lead to injury to the subarachnoid space, as well as to the development of paralysis. Opponents of general anesthesia say that with epidural anesthesia, the injected drugs do not have any effect on the child, in contrast to the total drug-induced sleep into which a woman in labor is immersed under general anesthesia. This is wrong. Medicines given to block pain may cause a decrease in heart rate in the baby, as well as a state of hypoxia or respiratory failure after birth.

Many women in labor complain of back pain and numbness in their legs for quite a long time after surgery. It is officially believed that the recovery time from spinal anesthesia is about 2 hours. In practice, the output takes longer.

The advantages of epidural pain relief include the stability of the woman’s heart and blood vessels throughout the operation. A significant disadvantage is that not all nerve receptors are blocked. The woman will not feel pain directly, but discomfort At times she will still have to endure it.

Many women are wary of such anesthesia, since it is not even the complications that scare them, but the very need to be present at their own operation - psychologically this is quite difficult.

Often women consider epidural anesthesia and spinal anesthesia to be the same type. In fact, there is no difference for the patient; in both cases, the drug is injected into the back. But with the spinal injection, the injection is deeper, and therefore the sensitivity is reduced more effectively.

If the question is fundamental, specify where the doctor plans to administer anesthesia - in the epidural space of the spine or in the subarachnoid space. Otherwise, everything will proceed exactly the same.

General anesthesia

Previously, this was the only type of pain relief for caesarean section. Now to general anesthesia they come running less and less often. This is officially explained by the fact that general anesthesia harms the child and the woman. It is unofficially known that the cost of drugs for spinal or epidural anesthesia is lower, and therefore the Ministry of Health in Russia strongly recommends that anesthesiologists do their best to convince women to choose regional anesthesia. This question is complex and ambiguous.

General anesthesia for CS surgery is usually endotracheal. With it, the woman does not feel, hear or see anything, she sleeps peacefully throughout the entire surgical intervention, without worrying herself, and without bothering with questions from the doctors who are helping her baby to be born.

How do they do it?

Preparation for such anesthesia begins in advance. In the evening, on the eve of the day for which the operation is scheduled, premedication measures are taken - the woman needs to relax, get a good night's sleep, and therefore she is prescribed a dose of barbiturates or other serious sedatives before going to bed.

The next day, in the operating room, the woman is given a dose of atropine to prevent cardiac arrest while in medicated sleep. Analgesics are administered intravenously. At this stage, the woman, not having time to be frightened by what is happening, falls asleep.

When she is already asleep, a special tube will be inserted into her trachea. Intubation is necessary to ensure pulmonary respiration. The tube will supply oxygen mixed with nitrogen and sometimes narcotic vapors into the lungs throughout the operation.

The sleep will be deep, the anesthesiologist will monitor the condition of the woman in labor throughout the entire intervention, measure blood pressure, pulse, and other indicators. If necessary, the doses of administered support drugs will be increased or decreased.

Shortly before the end of the operation, at the surgeon’s command, the anesthesiologist begins to reduce the doses of muscle relaxants, anesthetics, and narcotic substances. When the doses are “reset”, the process of smooth awakening begins. At this stage, the tube is removed from the trachea, since it is possible to breathe independently, without a device artificial ventilation lungs, is one of the first to return.

Advantages and disadvantages

Psychologically, general anesthesia is much more comfortable than regional anesthesia. The woman does not see what is happening and does not hear the doctors’ conversations, which can sometimes plunge anyone into shock, and even more so about a patient lying on the operating table. The woman recovers from the state of relaxation and lethargy quite easily, but she finally recovers from anesthesia only 3-4 days later. The final solution is considered to be the complete cessation of the effect of anesthesia at all levels of physiological and biochemical processes in the body.

Great advantage - complete absence contraindications, that is, this method is used for everyone who requires surgical intervention, without regard to possible negatively influencing factors. The quality of pain relief is excellent.

No sensations - neither pleasant nor painful women will not feel. TO possible complications Endotracheal anesthesia may include possible injuries to the larynx, tongue, teeth (at the time of insertion and removal of the tube), laryngospasm, and the development of an individual allergic reaction. Quite often, after such anesthesia, women have a sore throat for several days, a dry cough (which is especially painful with fresh stitches on your stomach!).

If a woman decides to choose general anesthesia, she should understand that she will not meet the child right away. She will be able to see the baby only in a few hours, when she is out of the ward intensive care, where all operated women in labor are placed, will be transferred to the postpartum room.

However, in some situations this issue is resolved on the spot - the woman can ask the operating team to show her the baby immediately after she comes to her senses. True, no one can guarantee whether the new mother herself will remember this moment or not.

When is the issue decided only by the doctor?

If a woman undergoing a planned cesarean section has her heart set on a certain type of anesthesia, she can tell her doctor, who will pass the information on to the anesthesiologist. The woman signs an informed consent stating that she agrees to epidural anesthesia or writes a refusal of regional anesthesia.

A pregnant woman should not indicate the reasons why a decision was made in favor of general anesthesia. She may not justify her decision at all, even in a conversation with a doctor.

According to the law, if a woman in labor refuses epidural or spinal anesthesia in writing, general anesthesia is automatically used for her. There can be no second solution here. But the opposite situation, when a woman would like to be conscious during the operation, can turn out differently.

Epidural anesthesia has its contraindications. And no matter how a woman begs the doctor to make an angle in her back before surgery, the request will be denied if:

• there have been previous injuries or deformities of the spine;
• there are signs of inflammation in the area where the needle is supposed to be inserted;
• the woman in labor has low or low blood pressure;
• the woman has started bleeding or is suspected of starting bleeding;
• there is a state of fetal hypoxia.

For women with such features, general anesthesia is considered the best.

They will not ask the patient’s opinion about the preferred type of anesthesia even if there is prolapse of the umbilical cord loops, if the woman has a systemic infection, if it is necessary to remove the uterus after removing the baby (according to indications). Such women in labor also undergo only general anesthesia. Other options are not even considered.

Needless to say that childbirth naturally are not only physiological, and therefore more “correct,” but often less risky for the fetus and even for the woman. However, unfortunately, in some situations it is the birth of a child naturally that poses a great threat to his life.

Modern medicine allows us to minimize these risks by offering an alternative - surgical birth by caesarean section. The operation is performed either planned (in cases where natural childbirth impossible for medical reasons), or as an emergency (if there is a acute situation when delivery must be carried out immediately).

Because a caesarean section involves cutting abdominal cavity, then, of course, you can’t do without pain relief. And here, mothers and doctors are given a choice between several methods of anesthesia. It is carried out depending on medical indications, the condition of the pregnant woman and the fetus, the clinical situation that has arisen, the woman’s tolerance of drugs used during anesthesia, and sometimes taking into account the preferences of the woman herself. Not the least important role is played by the presence of highly qualified specialists and necessary equipment to carry out the operation.

Each type of anesthesia for caesarean section has its own characteristics, indications and contraindications, advantages and disadvantages. All this is taken into account when making the final decision.

Anesthesia for caesarean section: which is better

As with any other operation, general and local anesthesia. Local in this case is called regional, and there are two types: spinal and epidural anesthesia. These types of pain relief have much in common, but still differ from each other.

It is regional anesthesia for caesarean section that today is a priority, more preferable, safe, modern and widespread than general. However, in some cases it is necessary to resort to general anesthesia as the only possible way pain relief during caesarean section. However, let's talk about this in more detail.

The peculiarity of general anesthesia is that during the period of its influence the woman’s consciousness is completely “switched off”. She falls asleep, does not feel or understand what is happening to her. Even spontaneous breathing stops: it is carried out thanks to a special tube inserted into the trachea, which is connected to a ventilator.

General anesthesia is performed by intravenous administration of certain drugs. Their effect occurs instantly, which is used in critical situations when there is not a minute to wait and childbirth must be carried out urgently. First, medicine is administered to put the woman in labor to sleep, and then for complete muscle (including uterine) relaxation.

Indications and contraindications for general anesthesia for caesarean section

Anesthesia for caesarean section is used less and less due to the high risks of side effects. But in some situations it turns out to be the only possible or priority method of pain relief during cesarean section, although, as a rule, it is suitable only for healthy, strong women who have endured pregnancy. this pregnancy without complications. Doctors resort to general anesthesia if:

• it is necessary to carry out an urgent delivery (continuation of pregnancy is vitally dangerous for the mother or child, their condition will rapidly deteriorate);
• fetal presentation is oblique or transverse;
• there is prolapse of the umbilical cord;
• the woman has heart pathologies (with regional anesthesia, the load on the mother’s heart increases);
• childbirth is impossible in any other way (there are contraindications to natural delivery and to the use of regional anesthesia);
• a pregnant woman suffers from morbid obesity.

Using general anesthesia during childbirth is a responsible decision, and you should definitely weigh all the risks before making it.

General anesthesia for caesarean section: pros and cons

The complete shutdown of a woman’s consciousness during a caesarean section is a great advantage for those who, due to various reasons they are very afraid of the upcoming birth, and this also allows the surgeons to act more calmly and greatly facilitates their work (all the muscles of the woman in labor are completely relaxed). But this same circumstance can also be considered as a huge minus if a woman wants to participate in the birth process and be the first to meet in this world long-awaited baby, to share this great happiness with him.

Under general anesthesia, the woman in labor feels no pain at all. But the consequences of this can be serious. It is almost impossible to predict their appearance. Therefore, you should just know that as a result of general anesthesia, the condition of the newborn can significantly worsen. The drugs administered to the mother through the umbilical cord also reach the baby, and in greater quantities, the longer the fetus remains in the mother’s womb from the moment of administration of anesthesia. Therefore, doctors have to rush or at the beginning of labor carry out a more superficial anesthesia, with minimal administration of drugs, in order to minimize risks. But at the same time, the woman in labor can remain conscious to some extent and feel pain.

On the other hand, if a woman has arterial hypertension, for safety reasons it is necessary to increase the dosage of anesthesia, which means that the baby is exposed to greater danger.

The consequences of anesthesia for a newborn child may include difficulties with work. respiratory system, slowdown of the nervous system, depression of the brain, etc.

The woman in labor herself can come out of it in different ways. unconsciousness: muscular and headache, nausea, weakness, fatigue, confusion is observed. The consequences of such anesthesia are pain and sore throat, injury to the lips and oral cavity. Allergic reactions occur less frequently infectious processes, pneumonia.

Period postoperative rehabilitation due to anesthesia it lengthens. A new mother cannot immediately put her baby to her breast.

General anesthesia always carries certain risks, but the state of pregnancy increases them even more. Therefore, this type of anesthesia for caesarean section is extremely rarely used today.

In addition, during the operation, a woman may experience aspiration of the respiratory tract due to the reflux of stomach contents into them. It is possible that an acute lack of oxygen may develop in a woman in labor who is under general anesthesia.

The use of regional anesthesia for cesarean is much more justified. It is not only safer for mother and child, but also has a number of other advantages, although it is also not without its disadvantages.

When performing spinal anesthesia, an anesthetic is injected into the spinal canal of the woman in labor (into the cerebral fluid) using an ultra-thin needle. This procedure is almost painless, does not cause much discomfort (sometimes the woman only feels pressure in the back), can be performed in a sitting position, but is more often performed on the side.

Spinal anesthesia acts only in the area below the waist, while the woman remains fully conscious and aware of what is happening. In this way, natural childbirth is simulated: without feeling pain, the mother can remain a participant in the birth process (albeit passive), immediately see and even kiss the newborn baby.

Spinal anesthesia for caesarean section: indications and contraindications

Typically, spinal anesthesia is used in cases where gentle pain relief is required, as well as when pregnant women have certain health problems: heart and kidney diseases, diabetes mellitus, gestosis.

But it also has a number of contraindications:

• Eclampsia.
• High intracranial hypertension.
• Reduced level of platelets in the mother's blood.
• Disturbances in the blood coagulation system.
• Infectious inflammation in the puncture area.
• Disturbances in the structure of the spine;
• Intolerance to drugs used in anesthesia.

Spinal anesthesia for caesarean section: pros and cons

Compared to other types of anesthesia, spinal has perhaps the most advantages. It begins to act quite quickly with the introduction of a minimal dose of anesthetic. Already 5-10 minutes after the administration of the drug, you can begin the operation, and therefore, if time is patient, this type of anesthesia can be used when performing an emergency cesarean section. Sensitivity in the lower part of the mother's body is blocked almost completely. At the same time, the muscles relax well, which greatly facilitates the work of surgeons. In addition, it is an easier procedure to perform than a Caesarean section under epidural anesthesia.

When using spinal anesthesia, the respiratory tract of a woman in labor is not damaged, as with general anesthesia, which is especially important for women suffering from asthmatic diseases. The same goes for epidural anesthesia.

Although with regional anesthesia approximately the same undesirable consequences, after the use of spinal anesthesia they occur noticeably less frequently than after an epidural.

The low concentration of drugs administered during spinal anesthesia makes it possible to greatly reduce the likelihood of their negative impact on the fetus, although it does not completely eliminate it. Possible development of fetal hypoxia during childbirth, slowing of the heart rate and depression of the infant’s respiratory functions.

There are other disadvantages of such births:

• The implementation of spinal anesthesia requires the participation of highly qualified experienced anesthesiologists and auxiliary medical staff, specific equipment and materials, and strict adherence to sterility during the operation.
• 1 in 10 women in postpartum period headaches of varying intensity occur, which, however, are easily relieved with the help of appropriate medications. Due to the decrease in blood pressure, weakness and nausea are also felt.
• Sometimes temporary urination problems occur.
• Allergic reactions to medications used for anesthesia are possible.
• Neurological disorders in a postpartum woman are extremely rare. However, doctors assure that they disappear within one to two months after birth.

In some cases, the dose of medicine administered during spinal anesthesia turns out to be insufficient to completely block the pain, and then general anesthesia has to be used, since it is impossible to add medicine: the needle is removed immediately after its administration. But if, God forbid, any complications arise during the operation, then provide emergency assistance will be almost impossible due to the lack of resources necessary for this (qualified personnel and special equipment) in Russian maternity hospitals. And in this regard, spinal anesthesia is safer. But it should also be said that unforeseen situations practically do not arise during Caesarian operations.

Epidural anesthesia for caesarean section

Epidural anesthesia is very similar to spinal anesthesia in its mechanism of conduction and action. However, there are still some differences. It is also carried out using a puncture in the lumbar region, but it also involves the placement of an epidural catheter: if during the operation it is necessary to prolong or intensify pain relief (as well as in the postoperative period), this can be easily done by adding anesthetic through a catheter, which is impossible during spinal anesthesia.

In addition, thanks to the same catheter, drugs can be injected into the bloodstream to prevent and stop postpartum hemorrhage, which further shortens and facilitates the postoperative recovery period.

Epidural anesthesia for caesarean section: indications and contraindications

The decision to use an epidural for caesarean section is usually made if there are some pregnancy complications and a stronger anesthesia is contraindicated or may be dangerous. Such indications include, in particular, late gestosis during pregnancy, arterial hypertension, other cardiovascular diseases. You cannot resort to this method of pain relief if the structure of the patient’s spine is anatomically incorrect, an infection develops at the site of the intended injection, or the pregnant woman’s blood clotting is impaired.

Epidural anesthesia for caesarean section: pros and cons

During childbirth under epidural anesthesia, the mother also remains conscious, but does not feel pain, which is the biggest advantage of regional anesthesia. However, it would not be amiss to mention here that there are reviews on the Internet that an injection with regional anesthesia is far from painless. This depends not only on the patient’s sensitivity threshold, but to a large extent also on the type of needle used for puncture and the experience of the anesthesiologist. Therefore, you need to be prepared for different sensations. However, the main thing is that pain relief still occurs, which is the purpose of the injection.

The effect of epidural anesthesia occurs gradually, increasing, which reduces the load on the mother's cardiovascular system. Due to the fact that the duration of the epidural can be increased during the operation, this type of pain relief is especially important for labor, which for various reasons takes a long time. But there are also negative aspects.

Possible consequences for the fetus during an epidural are similar to those during spinal anesthesia. In both cases, to restore sensitivity to a woman’s legs, it is necessary certain time upon completion of the operation. The consequences of epidural anesthesia for the mother are almost the same as with spinal anesthesia.

Epidural anesthesia, like spinal anesthesia, is relatively complex in its technique and requires special training on the part of doctors. If spinal anesthesia begins to act after 5-15 minutes, then epidural - after 20-40 minutes, and therefore it cannot be used in emergency cases (only planned). But headaches occur less frequently after such an operation, although their intensity can be higher. But in general, epidural anesthesia acts more slowly, and therefore is more gentle, and creates less stress on the heart than other types of pain relief.

So, summing up and comparing which anesthesia for caesarean section will be best, we can definitely say that spinal anesthesia is preferred as it is safer for the fetus. And with the advent of anesthesiologists in their arsenal, more and more modern medicines and equipment, spinal anesthesia is increasingly less likely to cause undesirable consequences for the mother. However, everything is determined by the situation and medical indications.

Approximately 20% of babies are born in a non-standard way - through a surgical incision in the anterior wall of the abdomen and uterus. This operation is called a caesarean section and has been practiced for decades. For what indications and for what period is a caesarean section performed, how is the procedure carried out, under what anesthesia - these and many other questions prevent expectant mothers from sleeping peacefully. All the most interesting and important information we will try to present it here.

Any surgical intervention, even the most minor one, to a certain extent carries a potential danger to the health (and sometimes to the life) of the patient. That’s why a pregnant woman cannot “order” a caesarean section from her attending physician just like that, for no apparent reason. And although in society one can find an opinion about the attractiveness of artificial childbirth due to its efficiency and painlessness, with medical point From our point of view, natural delivery will always be a priority.

There are absolute and relative reasons for surgery.

Absolute readings:

1. The first child was born by cesarean section and independent childbirth can lead to complications.
2. The baby is positioned across the uterus or “sat” on the butt.
3. The expectant mother has been diagnosed with any disease or condition that could cause the death of the baby during childbirth.
4. The baby's head is too large to fit through the pelvic bones.
5. Severe late toxicosis.
6. Multiple pregnancy.

Relative readings:

1. Anatomically abnormal development of the mother's skeleton (for example, narrow pelvis, not intended for natural delivery).
2. Big baby with breech presentation.
3. Pregnancy beyond the expected due date.
4. Varicose veins of the genital tract in a pregnant woman.
5. Pathologies of uterine development.
6. Questionable condition of scars from previous operations on the uterus.
7. Spicy and chronic diseases mothers who can help Negative influence on the course of labor or harm the mother in labor ( high degree myopia, arterial hypertension).
8. Late birth.
9. Artificial insemination, spontaneous abortions or a history of stillbirth.
10. Severe swelling.

A planned caesarean section is usually prescribed in the following cases:

1. Heavy infectious diseases from the expectant mother.
2. The pregnant woman is HIV-infected.
3. During prenatal diagnostics, symphysitis was discovered (excessive enlargement of cartilage in the area of ​​the pubic symphysis).
4. Shortly before birth, intrauterine fetal hypoxia was established.

Caesarean section: contraindications to surgery

Artificial birth is not performed if:

• the child died in the womb;
• the baby was diagnosed birth defects developments incompatible with life;
• the mother's skin and genitals became infected.

In all of the above situations, during a cesarean section, the risk of developing sepsis and peritonitis due to infection in the blood increases sharply.

How many weeks is a caesarean section performed?

A planned caesarean section is prescribed during pregnancy, and only the doctor can determine the final date of the operation. Optimal time to start the procedure – the first contractions. In order not to miss an important moment, the expectant mother goes to the maternity hospital 1 - 2 weeks before the birth date.

A planned caesarean section is prescribed no earlier than 37 weeks of pregnancy. In what week a cesarean section is performed depends on the decision of the specialists. When choosing a day for surgery, the doctor always focuses on the expected date of birth of the baby. To prevent the development of intrauterine hypoxia, cesarean section is performed at 38–39 weeks.

If the first pregnancy is over operative delivery, the second child will also be born via caesarean section. A repeat operation, as with the first birth, is prescribed for a period of 38 to 39 weeks, however, if the doctor is confused by the condition of the suture from the first cesarean section, the woman in labor will be operated on ahead of schedule PDR.

How to do a caesarean section: the preparatory stage

The doctor will definitely inform the woman in labor about the necessary preparations for the operation. 12 hours before the procedure you need to refrain from eating and 5 hours from drinking. An enema is given immediately before a cesarean section. There is little pleasure, but the risk of contracting an infection during childbirth is practically absent, and the rehabilitation process will go faster.

During the operation, the integrity of the abdominal muscles is disrupted by a large incision. At first, after artificial childbirth, even the slightest abdominal tension will cause noticeable discomfort, despite drug pain relief. And an enema done before the operation will relieve the young mother from the agony of trying to go to the toilet “in a big way” in the first days after a cesarean section, since the intestines will be relatively empty.

If it matters expectant mother will warn you about the need to epilate your pubis.

How to do a caesarean section: procedure sequence

The operation is carried out in several stages and is certainly accompanied by anesthesia. The woman in labor will be offered three options for pain relief: epidural, spinal anesthesia or general anesthesia. We'll talk more about them a little later.

Once the painkillers have taken effect, the doctor will make an incision in the pregnant woman's abdomen. Most often, this manipulation is carried out using the Pfannestiel method - the incision runs along the pubic hair growth line. In emergency cases, when every second counts, a lower-median incision is performed - from the navel along the midline down to the pubis. During a planned operation, the uterus is cut, like the abdomen, horizontally. Vertical section performed at multiple pregnancy or pathological attachment placenta.

Through an incision, the doctor removes the baby from the uterus, separating the placenta. Afterwards, the newborn is placed on the happy mother’s chest or handed over to the father’s hands. Then the baby is sent to the ward of the children's department.

After the baby is removed, oxytocin and methylergometrine are injected into the uterus, which help the cavity. muscular organ shrink faster. The operation is completed by suturing the cut tissues with a self-absorbing suture material. First, the uterus is sutured, then the peritoneum, muscles, ligaments and skin. The skin is fastened with a regular or intradermal (more accurate and aesthetic) suture.

How long does a caesarean section take? The operation takes approximately 30 – 40 minutes. After its completion, the new mother is sent to the intensive care unit to recover from anesthesia, and then to the postpartum ward. To avoid the development of vein thrombosis, the woman is raised from bed immediately a few hours after the anesthesia has stopped working. Walking – best prevention blockage of blood vessels. It is strictly forbidden to lift anything heavy.

Who performs a caesarean section in the maternity hospital depends on the policy medical institution and on the health status of the mother and her baby. Usually these are 2 obstetricians-gynecologists, 1 anesthesiologist, 1 midwife who receives the child and 1 neonatologist.

Anesthesia for caesarean section

Artificial birth - serious abdominal surgery and it is carried out only with preliminary anesthesia. There are several types of anesthesia that are used to make a woman feel comfortable during surgery.

Epidural anesthesia for caesarean section

To deprive a woman in labor of sensation using this method, an injection is made under the spine in the area lumbar region- Spinal nerves are located there. A catheter is left at the puncture site, through which an anesthetic is periodically injected during the operation.

The main advantage of epidural anesthesia is that the woman in labor does not fall asleep and is perfectly aware of everything that is happening to her, but does not feel the lower part of her body. The woman is immobilized below the waist and will not suffer from severe pain when doctors make cuts to remove the baby.

Among other “advantages” of this type of anesthesia, we note:

• ideal for women who suffer from bronchial asthma;
• does not distort the functioning of the cardiovascular system, since the painkiller is supplied to the body in doses;
• Thanks to this injection, the administration of opioid anesthetics after surgery is allowed.

Despite the obvious advantages of the procedure, epidural anesthesia for caesarean section has certain disadvantages and consequences.

This type of anesthesia is not suitable for:

• blood clotting disorders;
• infections;
• allergies to painkillers;
• transverse presentation of the child;
• uterine scar;
• the presence of inflamed or purulent areas in the puncture area;
• curvature of the spine.

We also list the disadvantages of the method. There are women for whom they are of decisive importance:

• the likelihood of the anesthetic drug getting into the choroid or arachnoid membrane of the spinal cord, as a result of which the woman in labor develops convulsions and the pressure drops sharply;
• high degree of complexity of the procedure;
• anesthesia gains strength only 15 - 20 minutes after the injection;
• sometimes anesthesia is only partially effective, so the woman in labor is forced to experience obvious discomfort during the operation;
• the likelihood of pain medication entering the placenta, which causes disturbances in the baby’s heart rhythm and breathing.

If anesthesia in the form of epidural anesthesia is performed during a caesarean section, the pregnant woman must be warned about the consequences of such a step: back pain and headaches, tremors of the lower extremities, problems with urination.

Spinal anesthesia for caesarean section

This type of anesthesia is in many ways similar to the previous technique. The injection is carried out in the back, but in this case a very thin needle is inserted even deeper, directly into the spinal lining. The injection is made strictly in a specific place (between 2 and 3 or 3 or 4 vertebrae) so as not to damage the spinal cord. For spinal anesthesia during cesarean section, a smaller volume of anesthetic is required than in the previous version.

Advantages of spinal anesthesia:

• complete loss of sensitivity;
• rapid onset of effect – a few minutes after the anesthetic enters the body;
• low likelihood of complications due to the precise location of drug administration;
• absence unexpected reactions in case of incorrect injection.

Disadvantages of spinal anesthesia:

• short duration - the injection lasts no more than 2 hours;
• the possibility of a decrease in blood pressure if the anesthetic is administered too quickly;
• the risk of developing headaches, which persist on average up to 3 days after surgery.

Doctors are forced to refuse to perform surgery under spinal anesthesia if a pregnant woman has contraindications to such anesthesia:

• rash or pustular formations at the site of the intended injection;
• circulatory and blood clotting disorders;
• blood poisoning;
• neurological diseases;
• pathologies of spinal development.

General anesthesia for caesarean section

Today, general anesthesia for artificial childbirth is used less and less often, since of all types of anesthesia it has the most negative effect on the mother and child. The procedure involves intravenous administration an anesthetic that makes the pregnant woman fall asleep within a few seconds. A tube is then inserted into the woman's trachea to artificially supply oxygen.

General anesthesia for caesarean section is performed in the following cases:

• obesity, previous spinal surgery, blood clotting pathologies - other types of anesthesia for these diseases are not suitable;
• fetal presentation, prolapse of the umbilical cord;
• the need for an emergency caesarean section.

Advantages of general anesthesia:

• almost instant loss of sensitivity.
• no interruptions in the functioning of the cardiovascular system;
• no difficulties in administering anesthesia.

Disadvantages of general anesthesia:

• probability of penetration gastric juice into the lungs with subsequent development of pneumonia;
• probability harmful influence anesthetic on the central nervous system of a newborn;
• the risk of developing hypoxia in a woman in labor.

The best anesthesia for caesarean section is the one chosen by an experienced specialist. Only a doctor can take into account the advantages and disadvantages of each type of anesthesia and correlate them with the well-being and condition of a particular woman in labor. In this matter you should trust exclusively professionals.

Possible complications after cesarean section

During the birth of a child, a woman experiences an enormous burden and is subjected to extreme stress, regardless of whether the birth is natural or artificial. The surgical intervention is not very long, but may result in some complications for the woman in labor, including:

• bleeding;
• inflammation of the uterus;
• thromboembolism;
• adhesions;
• hernia in the scar area;
• damage to certain organs during cesarean section (for example, the bladder).

WITH unpleasant complications Due to the operation, not only the woman, but also the newborn child may experience:

• the risk of being born prematurely if a planned caesarean section is scheduled for an earlier date than the PDR. In this regard, it will be difficult for the baby to adapt to the outside world. In addition, practice shows that “Caesarean babies” get sick more often than children born independently;
• anesthesia, even the weakest, also affects the baby. In the first hours of life, the newborn is sleepy and inactive. There is a risk of developing pneumonia due to anesthesia;
• After a caesarean section, mother and child are not together for some time. This may subsequently affect breastfeeding not in the best way.

Rehabilitation period after cesarean section

It will take several months after the operation before the woman fully recovers and feels well. During this period, it is important to treat your health with great attention.

1. On the first day after cesarean section, you are only allowed to drink. Choice is limited still water room temperature. The next day you can eat yogurt, porridge, sweet tea and lean meat. Light diet should be observed for about a week after surgery.
2. After surgery, the stitch hurts a lot for some time, so the woman is prescribed painkillers. As you recover, the discomfort weakens every day.
3. For 2 - 3 weeks after a cesarean section, a woman will have to carefully observe intimate hygiene, since during this time she will still be disturbed bloody issues. Then they will completely disappear.
4. About 2 weeks after the birth of the baby, you need to regularly treat the suture on the abdomen to prevent it from becoming infected and rotting. At the same time, the state of health is overshadowed by strong cutting pains in the area of ​​the incision. The tissue at the site of stitching first turns red, and later, when the scarring process begins, turns purple. In the future, the color of the scar will almost merge in color with the skin. The incision on the uterus will heal within six months.
5. 2 months after the operation, the woman is recommended to gradually get involved in sports. Intensive training is allowed only after 6 months. It is best to resume sexual life 1 month after childbirth.

IN Lately More and more expectant mothers are thinking about the possibility of giving birth to a baby through a caesarean section. Perhaps women are afraid of the pain during natural childbirth. However, the risk of complications is present both during independent and operative childbirth. Before you finally decide on how the little man will come into this world, you need to carefully listen to the arguments of your attending physician about the “pros” and “cons” of a cesarean section.

How to do a caesarean section. Video