Q: I am scheduled for a Csection for a breech pregnancy. What is the best anesthesia for a C section?

A: Cesarean Section, C-Section or CSX, as it is often called, is one of the most common surgical procedures in the United States today. About 20 to 25% of all births are delivered surgically by C-Section. There are many indications for a C-Section, such as "failure to progress with labor", fetal distress, non-reassuring tracing of the fetal heart tones, multiple births (twins, triplets, quadruplets, and other multiple births), breech and difficult presentations, and one of the most common indications, a history of previous Cesarean Section, or repeat Csection.

The incidence of C-Section has been on the rise due to increasing medical liability. The surgical delivery lends more control over the birth than the normal vaginal delivery. Thus it is very rare in the United States today to find an Obstetrician who will deliver a breech baby via natural vaginal delivery after a history of Cesarean Section delivery previously. This is named VBAC for Vaginal Birth After Cesarean.

C Section can be elective scheduled surgery or they can be emergencies. The emergency C-Sections occur when there is fetal distress or a problem during labor. These emergencies are most often done under General Anesthesia or General Endotracheal Anesthesia, in which the patient is completely asleep. The breathing tube (endotracheal tube) protects the patient airway while she is asleep. General Anesthesia is used because it is, in most circumstances, the fastest way to anesthetize the patient so as to deliver the baby as quickly as possible.

During an elective scheduled Cesarean Section for breach presentation, the most common choices in anesthesiology would be Epidural Anesthesia or Spinal Anesthesia. The mother is awake during both epidural and spinal anesthesia. There is also a combined technique, where a spinal is placed for the immediate procedure, then an epidural catheter is placed for treatment of post-operative pain. Many anesthesiologists have a favorite anesthetic method for C-Section, as do many anesthesiology departments.

Both Spinal and Epidural anesthesia have advantages and disadvantages. Spinal Anesthesia has the advantage of being easy to put in, it is quick acting and gives a solid level of numbness. An additional benefit is the low incidence of spinal headache with today’s microfine spinal needles. Disadvantages of Spinal Anesthesia include hemodynamic changes, which can occur quickly, such as low blood pressure or low heart rate, high anesthetic level of numbness, failure of the block, occasional spinal headache 1%, and very rare nerve injury or infection. Some benefits of Epidural Anesthesia are the advantage of being easy to insert, a longer onset of action, so hemodynamic changes are slower and a tiny epidural catheter that remains in place for post-operative pain relief. Disadvantages include a 1% incidence of epidural headache, failure of the block, catheter malfunctions and rare nerve injury or infection.

My personal favorite anesthetic type for Cesarean Section is Epidural Anesthesia, because for me, they provide very consistent, reliable and predictable anesthetic levels for the patient plus the added benefit of the post operative pain relief for 24 to 48 hours. Although there is no one "best" anesthesia for surgical delivery, a preoperative discussion with your anesthesiologist will address your questions and help you choose the anesthetic type that is right for you.