Anaesthesia for caesarean section

Quality and choice in anaesthesia for caesarean section have significantly improved over the last two decades. During this time, general anaesthesia usage has decreased to the point where, in some centres, it is an occasionally used technique for severe fetal distress. This change in practice may have been responsible for the fall in anaesthetic deaths in pregnant women that has occurred over the same period. The boom in regional anaesthesia has improved the aesthetics of childbirth by caesarean section, women’s peri-operative comfort, and post-operative analgesia. It has, however, introduced new problems, such as delays in inducing anaesthesia in emergency situations, post-operative immobility and urinary retention. The increase in anaesthetic choices has led to inconsistencies in practice between individual anaesthetists, and between regions and nations. It is therefore impossible for obstetricians to make assumptions about the impact of anaesthesia on their patients. Where possible, anaesthetic protocols and guidelines should exist in every centre, with obstetricians clearly informed of relevant features. Such an approach will prevent inconsistent advice being given to patients and dangerous mistakes occurring. With every aspect of maternity care, a multidisciplinary team approach is in patients’ best interests, and anaesthesia for caesarean section is no exception.