Data analysed by Penn researchers clarifies risks associated with general anaesthesia, giving patients more control over their delivery experience.
Regional anaesthesia has long been favoured for caesarean births due in part to concerns about the effects that general anaesthesia may have on newborns during labour and delivery. Powerful societal pressures also push the idea that mothers need to be awake during delivery to witness the first cry and capture the ‘perfect’ birth moment. But for some women who undergo a caesarean birth, the pain can become excruciating, even after they received a spinal or epidural block.
Now, new research from a team at the Perelman School of Medicine at the University of Pennsylvania, finds that general anaesthesia may be a reasonable alternative for many patients. The findings are published today in Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists.
“No patient should have to experience pain during caesarean section; as an anaesthesiologist, 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, Professor of Anesthesiology and senior author of the study. “Since regional anaesthesia is so widely used, it’s common for patients to feel that a spinal or epidural block is the only safe option for caesarean section. But as our study shows, anaesthesia type during pregnancy does not need to be one-size-fits-all.”
Reducing pain during C-section delivery
The research analysed 30 years’ worth of data from multiple clinical trials, comparing outcomes between general anaesthesia versus spinal or epidural anaesthesia for C-sections. The Penn study found that, while babies born under spinal or epidural anaesthesia had slightly higher Apgar scores than those born under general anaesthesia, the differences were small and not likely to be clinically meaningful.
While the majority of patients experience good outcomes with spinal or epidural block for caesarean delivery, recent studies show that up to one in six patients who receive an epidural or spinal may feel pain during their C-section. These experiences can be traumatic and have lasting emotional impacts.
The findings come amid growing public discourse on caesarean experiences. Recent podcasts and published news stories have featured candid patient accounts of pain under spinal or epidural anaesthesia. “This study equips women with evidence-based context about the use of general anaesthesia during c-section.” said Sarah Langer, MD, a resident in anaesthesiology at the Perelman School of Medicine and lead author the study. “Childbirth is a physically and emotionally demanding process, but we do not want patients to feel like there aren’t options when it comes to their anaesthesia for c-section,”
Broadening evidence-based choices
The study found that babies born under general anaesthesia were slightly more likely to need breathing support immediately after birth, but there was no increase in NICU admissions. The research does not suggest that general anaesthesia should replace regional techniques, but it can be a reasonable option in certain cases.
“For patients who are open to regional anaesthesia, spinal or epidural block remain great first choice options,” Neuman emphasised. “But having conversations with patients about general anaesthesia doesn’t need to be taboo. Patients deserve to know they have options, and our study helps provide the evidence to support those discussions.”
The authors note that most of the trials included in the analysis were conducted outside North America, highlighting the need for more US-based research in this area. They also point to historical barriers in studying women during pregnancy, which have limited the availability of robust data.
Source: Perelman School of Medicine at the University of Pennsylvania
