General anesthesia

General anesthesia produces a total loss of sensation and consciousness. General anesthesia involves using both intravenous (IV) and inhaled drugs, which are also called anesthetics. During general anesthesia, you can’t feel pain and your body doesn’t respond to reflexes. A doctor called an anesthesiologist will monitor your vital signs when you’re under anesthetic and also bring you back out of it.

General anesthesia intends to bring about five distinct states during surgery:

  • analgesia, or pain relief
  • amnesia, or loss of memory of the procedure
  • a loss of consciousness
  • motionlessness
  • a weakening of autonomic responses

Childbirth requires your participation, so it’s rare to receive general anesthesia during delivery because it makes you unconscious.

What is the purpose of having general anesthesia during delivery?

An ideal anesthetic given during childbirth provides pain relief so that you can still actively participate in the birth and push when you need to do so. It also doesn’t stop contractions or slow your baby’s life functions. However, an emergency calls for a general anesthetic sometimes.

Doctors rarely use general anesthesia in vaginal deliveries. They use general anesthesia in emergencies and sometimes for cesarean delivery. Other reasons for you to have general anesthesia during delivery include the following:

  • The regional anesthetic doesn’t work.
  • There’s an unanticipated breech birth.
  • Your baby’s shoulder gets caught in the birth canal, which is called shoulder dystocia.
  • Your doctor needs to extract a second twin.
  • Your doctor is having difficulty delivering your baby using forceps.
  • There’s an emergency in which the benefits of general anesthesia outweigh its risks.

If you’re having general anesthesia, it’s important to reduce your baby’s exposure to the anesthetic as much as possible.

What are the risks of general anesthesia during delivery?

General anesthesia causes a loss of consciousness and relaxes the muscles in your airway and digestive tract. Typically, your anesthesiologist will insert an endotracheal tube down your windpipe to ensure you get plenty of oxygen and to protect your lungs from stomach acids and other fluids.

It’s important to fast when you start having contractions in case you do need to go under general anesthesia. The muscles that control your digestion become relaxed during general anesthesia. This increases the risk that you might breathe in stomach fluids or other fluids into your lungs, which is called aspiration. This can cause pneumonia or other damage to your body.

Other risks associated with general anesthesia include:

  • an inability to place an endotracheal tube down the windpipe
  • toxicity with anesthetic medications
  • respiratory depression in the newborn baby

Your anesthesiologist may do the following to lower your risks:

  • provide oxygen before the anesthesia
  • give an antacid to lower the acidity of your stomach contents
  • give fast-acting medications to relax your muscles for quick and easy placement of the breathing tube
  • apply pressure to your throat to block the esophagus and decrease the risk of aspiration until the endotracheal tube is in place

Anesthesia awareness occurs when you wake up or remain partially awake while under general anesthesia. This can occur because you receive muscle relaxants first, which can make you unable to move or tell your doctor that you’re awake. This is also called “unintended intraoperative awareness.” It’s rare, and experiencing pain during it is even more rare. For some, it may cause psychological problems similar to post-traumatic stress disorder.

What is the procedure for having general anesthesia?

You should stop eating as soon as you start having contractions. This is good for all women who are in labor to do in case they need a general anesthetic.

You’ll receive some medication through an IV drip. Then, you’ll probably receive nitrous oxide and oxygen through an airway mask. Your anesthesiologist will place an endotracheal tube down your windpipe to assist in breathing and to prevent aspiration.

After the delivery, the drugs will wear off and your anesthesiologist will bring you back to consciousness. You’ll likely feel groggy and confused at first. You may experience common side effects such as:

  • nausea
  • vomiting
  • a dry mouth
  • a sore throat
  • shivering
  • sleepiness

What are the benefits of anesthesia during delivery?

Regional blocks, such as a spinal anesthetic or epidural, are preferable. However, general anesthesia can be applied quickly in an emergency or if you need a cesarean delivery quickly. If part of your baby is already in the birth canal when you need general anesthesia, you can get it without having to sit up or change positions.

Once under general anesthesia, pain relief isn’t an issue because you’re essentially asleep. Other anesthetics, such as an epidural, sometimes only give partial relief of pain.

For some women who require a cesarean delivery and have had back surgery or have back deformities, general anesthesia may be an acceptable alternative to regional or spinal anesthesia. These can be difficult to administer because of prior health issues. If you have a bleeding disorder, a brain tumor, or increased intracranial pressure, you may not be able to receive an epidural or spinal anesthetic and you may need general anesthesia.

What is the outlook?

Your doctor will try to avoid using general anesthesia during childbirth because the delivery process requires you to be conscious and active. However, you may need general anesthesia if you have certain health issues. Doctors mainly use general anesthesia for childbirth when it’s a cesarean delivery. Using general anesthesia during childbirth does have higher risks, but it’s relatively safe.