Regional anesthesia-typically with a spinal or epidural block-has long been favored for cesarean births due in part to concerns about the effects that general anesthesia may have on newborns during labor 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 cesarean 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 anesthesia 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 cesarean section; as an anesthesiologist, 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, the Horatio C. Wood Professor of Anesthesiology and senior author of the study. "Since regional anesthesia is so widely used, it's common for patients to feel that a spinal or epidural block is the only safe option for Cesarean section. But as our study shows, anesthesia type during pregnancy does not need to be one-size-fits-all."
Reducing pain during C-section delivery
The research analyzed 30 years' worth of data from multiple clinical trials, comparing outcomes between general anesthesia versus spinal or epidural anesthesia for cesarean sections. The Penn study found that, while babies born under spinal or epidural anesthesia had slightly higher Apgar scores-a measure of newborn health-than those born under general anesthesia, 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 cesarean delivery, recent studies show that up to one in six patients who receive an epidural or spinal may feel pain during their cesarean section. These experiences can be traumatic and have lasting emotional impacts.
The findings come amid growing public discourse on cesarean experiences. Recent podcasts and published news stories have featured candid patient accounts of pain under spinal or epidural anesthesia. "This study equips women with evidence-based context about the use of general anesthesia during c-section." said Sarah Langer, MD, a resident in anesthesiology 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 anesthesia for c-section,"
Broadening evidence-based choices
The study found that babies born under general anesthesia 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 anesthesia should replace regional techniques, but it can be a reasonable option in certain cases.
"For patients who are open to regional anesthesia, spinal or epidural block remain great first choice options," Neuman emphasized. "But having conversations with patients about general anesthesia 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 U.S.-based research in this area. They also point to historical barriers in studying women during pregnancy, which have limited the availability of robust data.
