This leaflet contains information about the different types of anaesthetic available for caesarean birth. It is designed to help you understand your options. Where time allows, you and your anaesthetist will discuss and agree a plan together. In more urgent situations, your anaesthetist may need to make a recommendation based on what is safest for you and your baby.
Using the BRAIN framework to make your decision
When thinking about your options, it can help to ask:
- Benefits - what are the intended benefits of this option for me and my baby?
- Risks - what are the possible risks or side effects?
- Alternatives - are there other options I could choose?
- Important – What is important to me?
- Nothing - what happens if I do not have this option?
Your anaesthetic options
There are two main types of anaesthetic for caesarean birth: regional anaesthesia (where you are awake but numb from the top of your tummy down) and general anaesthesia (where you are asleep). Regional anaesthesia is recommended for most caesarean births because it is usually safer than General Anaesthesia (GA) for both you and your baby, it enables both you and your birth partner to experience the birth together, and your recovery from it will also be easier.
There are three types of regional anaesthesia: spinal, epidural, and combined spinal - epidural. Your anaesthetist will discuss which is safest for you.
| Type | Main benefit | Most used when |
|---|---|---|
| Spinal |
Main benefit
Generally safer GA for you and your baby. Both you and your partner can experience the birth together. You will usually be more comfortable afterwards. |
Most used when Most caesarean births |
| Epidural |
Main benefit
Can be used for pain relief in labour and then topped up for caesarean birth |
Most used when
You already have an epidural in labour, and it has been working well |
| Combined spinal epidural (CSE) |
Main benefit
The ability to prolong the anaesthetic if needed or allow a slower onset of anaesthesia. |
Most used when
Longer and more complex operations, or certain medical conditions where a more gradual onset of anaesthesia is needed |
| General anaesthetic |
Main benefit
You are asleep during the operation. An alternative to regional anaesthesia. Sometimes quicker than regional anaesthesia and sometimes safer than regional anaesthesia if you have certain medical conditions |
Most used when
When regional anaesthesia cannot be used or has not worked, or when speed is essential |
Before your anaesthetic
Your anaesthetist will meet with you before your operation to discuss your individual circumstances, answer your questions, and agree a plan with you.
If you are having planned surgery this will be on the day of the operation. Some people with certain medical conditions are invited to clinic earlier to discuss their health and the anaesthetic options available to them for their birth.
In an unplanned situation, you will see the anaesthetist before the surgery. The amount of time available for this discussion will depend on how urgently your caesarean birth needs to happen. It is useful to read this leaflet even if you are not planning a Caesarean Birth.
Your anaesthetist is a fully qualified doctor who has completed specialist training in anaesthesia, pain relief, and the care of people during and after surgery. They are responsible for your wellbeing and safety throughout your caesarean birth, from the moment you receive your anaesthetic until you are safely in the recovery area.
To help inform your decision and the discussion of your anaesthetic options, they will need to know about:
- Your general health, including any previous and current health problems.
- Any previous problems with anaesthesia, or any family history of problems with anaesthesia.
- Any blood disorders or if you are taking blood-thinning medicines (anticoagulants).
- Any medicines or drugs you use, including herbal, over-the-counter medicines or weight loss drugs.
- Whether you smoke.
- Any spine or back problems, including previous surgery.
- Any abnormal reactions to medications or other allergies, particularly to latex or anaesthetic drugs.
- Your teeth, including whether you wear dentures or have any caps, crowns, or loose teeth.
Spinal anaesthesia
A spinal anaesthetic is the most common type of anaesthetic for caesarean birth. An injection is made with a very fine needle into the fluid filled sac around your spinal cord in your lower back. This numbs the nerves to your lower body quickly and reliably. More information on this procedure can be found in our antenatal education portal.
What are the benefits?
- Generally safer for you and your baby.
- You are awake and able to experience the birth of your baby.
- Your birth partner can usually be with you in theatre.
- It works quickly, usually within a few minutes.
- You feel less sleepy afterwards.
- Your baby will be more alert when it is born.
- You will usually be more comfortable afterwards and need fewer strong painkillers.
- Less chance of feeling sick afterwards.
- It uses a very fine needle, so most people find it less uncomfortable than expected.
What does it involve?
Before your anaesthetic, a cannula (a plastic tube) will be placed into a vein in your hand or arm. This allows for fluids and any medicines you need quickly during the operation. Monitoring equipment will also be attached to keep a close eye on your observations throughout.
You will be asked to sit up and curl forward / slouch, or to lie curled up on your side. The anaesthetic assistant will clean your back with a cold spray. The anaesthetist will then inject a small amount of local anaesthetic to numb the skin. They will then use a very fine needle to inject the anaesthetic into the fluid filled sac around your spinal cord. The procedure usually takes a few minutes, though there are times when it can be more difficult and take longer.
Once the injection is in place you will begin to feel your legs becoming warm and heavy. The team will help you to lie down and the bed will be tilted to the left. While the anaesthetic is working it is normal to feel pins and needles. The anaesthetist will test that the anaesthetic is working before the operation begins. You will be numb from the top of your tummy down. During the operation it is normal to feel pressure and movement, but you should not feel pain. If you feel anything that concerns you, tell your anaesthetist immediately and they will discuss it with you.
While the anaesthetic is taking effect, the midwife will insert a catheter (a plastic tube) into your bladder and clean your vagina ready for the operation.
What are the risks and side effects?
Most side effects from a spinal anaesthetic are temporary and manageable. Serious complications are rare.
| Possible risk or side effect | How common | What it means |
|---|---|---|
| Possible risk or side effect Low blood pressure (hypotension) | How common Common - around 1 in 50 |
What it means
Caused by the anaesthetic temporarily widening blood vessels. Your anaesthetist will give you fluids and medication to prevent and treat this. |
| Possible risk or side effect Itching | How common Common |
What it means
Caused by the pain-relieving medicine in the spinal. Usually mild and can be treated with medication. |
| Possible risk or side effect Feeling sick or vomiting | How common Common - up to 1 in 8 | What it means Anti-sickness medication will be given. |
| Possible risk or side effect Shivering | How common Common |
What it means
A normal response to the anaesthetic. More common during unplanned operations. |
| Possible risk or side effect Headache after the procedure | How common Uncommon - around 1 in 500 |
What it means
A specific type of headache. If it happens it can usually be treated effectively. You can find more information here |
| Possible risk or side effect Anaesthetic not working well enough | How common Uncommon - around 1 in 50 |
What it means
Occasionally the spinal does not provide complete pain relief. Your anaesthetist will give additional pain relief or may recommend changing to a general anaesthetic. |
|
Possible risk or side effect
Temporary nerve damage (tingling, numbness, weakness) |
How common Uncommon - around 1 in 1,000 | What it means Usually resolves fully within a few days to weeks. |
| Possible risk or side effect Permanent nerve damage | How common Rare - around 1 in 13,000 |
What it means
The risk of permanent harm from a spinal is very small. |
| Possible risk or side effect Severe injury, including paralysis | How common Very rare - around 1 in 250,000 |
What it means
Very rare but serious. Your anaesthetist takes every precaution to minimise this risk. |
| Possible risk or side effect Infection (meningitis or abscess) | How common Very rare - around 1 in 100,000 |
What it means
Strict sterile technique is used to minimise this risk. |
|
Possible risk or side effect
Blood clot forming around the spine where the injection was performed (epidural haematoma) |
How common Very rare - around 1 in 170,000 |
What it means
Very rare but requires urgent treatment if it occurs. Tell staff immediately if you cannot start to move your legs four hours after your operation. |
Spinals do not cause chronic backache. Backache is common after childbirth, especially if backache occurred before or during pregnancy. Spinal anaesthesia does not make it more common.
Epidural anaesthesia
An epidural is most often used when you already have an epidural in place for pain relief in labour. If it has been working well, the anaesthetist will perform some checks and, if it is suitable, use it to provide the anaesthesia for your caesarean birth. This avoids the need to perform a separate spinal anaesthetic.
What are the benefits?
- Generally safer for you and your baby.
- If your epidural has been working well in labour, it can be used for your caesarean birth, avoiding a separate spinal injection.
- You are awake and able to experience the birth of your baby.
- Your birth partner can usually be with you in theatre.
- You will usually be more comfortable afterwards and need fewer strong painkillers.
- Less chance of feeling sick afterwards.
- The epidural catheter can remain in place after surgery to provide continuing pain relief.
- The dose can be adjusted if the operation takes longer than expected.
What does it involve?
During labour a weak local anaesthetic is used through the epidural catheter to provide pain relief. If it has been working well, the anaesthetist can give a larger volume of a stronger local anaesthetic through the same catheter to provide the deeper anaesthesia needed for caesarean birth.
An epidural takes about 20 to 30 minutes to take full effect. The anaesthetist will test the level of numbness before the operation begins.
| Possible risk or side effect | How common | What it means |
|---|---|---|
| Possible risk or side effect Low blood pressure (hypotension) | How common Common - around 1 in 50 |
What it means
Caused by the anaesthetic temporarily widening blood vessels. Your anaesthetist will give you fluids and medication to prevent and treat this. |
| Possible risk or side effect Itching | How common Common |
What it means
Caused by the pain-relieving medicine. Usually mild and can be treated with medication. |
| Possible risk or side effect Feeling sick or vomiting | How common Common - up to 1 in 8 |
What it means
Usually brief. Anti-sickness medication will be given. |
| Possible risk or side effect Shivering | How common Common |
What it means
A normal response to the anaesthetic. More common during unplanned operations. |
| Possible risk or side effect Epidural not working well enough | How common Around 1 in 20 |
What it means
The epidural may not provide sufficient pain relief for surgery. This is higher than the risk with a spinal, which is why an epidural is only used for caesarean birth if it has been working well in labour. If it is not working well enough, your anaesthetist may recommend replacing it with a spinal or general anaesthetic. |
| Possible risk or side effect Headache after the procedure | How common Uncommon - around 1 in 100 |
What it means
A specific type of headache caused if the epidural needle accidentally enters the spinal fluid space. If it happens it can usually be treated effectively. You can find more information here |
|
Possible risk or side effect
Temporary nerve damage (tingling, numbness, weakness) |
How common Uncommon - around 1 in 1,000 | What it means Usually resolves fully within a few days to weeks. |
| Possible risk or side effect Permanent nerve damage | How common Rare - around 1 in 13,000 | What it means The risk of permanent harm is very small. |
| Possible risk or side effect Severe injury, including paralysis | How common Very rare - around 1 in 250,000 |
What it means
Very rare but serious. Your anaesthetist takes every precaution to minimise this risk. |
| Possible risk or side effect Infection (epidural abscess) | How common Very rare - around 1 in 100,000 |
What it means
Strict sterile technique is used to minimise this risk. |
|
Possible risk or side effect
Blood clot forming around the spine where the injection was performed (epidural haematoma) |
How common Very rare - around 1 in 170,000 |
What it means
Very rare but requires urgent treatment if it occurs. Tell staff immediately if you cannot start to move your legs four hours after your operation. |
Epidurals do not cause chronic backache. Backache is common after childbirth, especially if backache occurred before or during pregnancy. Epidurals do not make it more common.
Combined spinal-epidural (CSE) anaesthesia
A combined spinal-epidural uses both techniques together. The spinal part provides rapid, reliable numbness for the operation. The epidural catheter is placed at the same time and can be used to give additional anaesthetic if needed, or to provide continuing pain relief after surgery. For some people with certain medical conditions this technique can be used to provide a slower, more controlled onset of anaesthesia. Your anaesthetist will discuss this option with you if it is appropriate.
What are the benefits?
- The benefits are the same as those described in the spinal and epidural sections above.
- Flexibility if the operation takes longer than expected.
- Useful for more complex or longer operations.
- Can be used to provide pain relief after surgery through the epidural catheter.
- Safer with certain medical conditions where a slower or more controlled onset of anaesthesia is needed.
What are the risks and side effects?
The risks are a combination of those from both spinal and epidural anaesthesia. Please see the sections above for details. Your anaesthetist will discuss the specific risks relevant to you.
General anaesthesia
With a general anaesthetic, you will be asleep during your caesarean birth. General anaesthesia is used less often for caesarean birth than regional anaesthesia. It may be needed in certain situations.
Sometimes a regional technique is offered alongside a general anaesthetic to help provide pain relief after the operation.
When might a general anaesthetic be needed?
- When regional anaesthesia is not suitable for you, for example due to certain blood disorders, medical conditions, back problems, or some allergies.
- If your caesarean birth is more complicated, for example if there is an increased risk of bleeding.
- If your regional anaesthetic has not worked.
- In an emergency.
- If you would prefer to be asleep.
What are the benefits?
- Works very quickly, which can be important in emergencies.
- You are completely unaware during the procedure.
- Suitable when regional anaesthesia is not possible.
- Safe for some people with certain medical conditions.
What does it involve?
You will be offered an antacid drink to reduce the level of acid in your stomach. Monitoring equipment will be attached to keep a close eye on your observations throughout. A cannula (a plastic tube) will be placed into a vein in your hand or arm to allow the team to give you fluids and any medicines you need quickly during the operation.
Before you go off to sleep you will be asked to breathe oxygen through a clear mask over your nose and mouth. As you go off to sleep, the anaesthetist's assistant will apply gentle pressure to the front of your neck to help prevent stomach contents entering your lungs. After you are asleep, a breathing tube will be placed in your throat to keep your airway open during the operation. In an emergency, this sequence may happen very quickly.
To reduce the time between you going off to sleep and the birth of your baby, the obstetrician may clean your tummy and the midwife may place a catheter (a plastic tube) into your bladder so that they are ready to start the operation as soon as you are safely asleep.
Your birth partner will not be able to be with you in theatre during a general anaesthetic. They will be close by and will be kept informed. Your baby will initially be cared for by a specialist baby nurse or doctor. If your baby does not need any specialist care, the midwife will look after them until you are out of theatre.
Once the operation is complete, the anaesthetic will be stopped and you will gradually wake up. The breathing tube will be removed. You will then be moved to the recovery area where you and your birth partner will be reunited with your baby as soon as it is safe to do so.
| Possible risk or side effect | How common | What it means |
|---|---|---|
| Possible risk or side effect Sore throat | How common Common - around 1 in 10 |
What it means
Caused by the breathing tube. Usually mild and resolves within a few days. |
| Possible risk or side effect Feeling sick or being sick | How common Common - around 1 in 10 | What it means Anti-sickness medication is given. |
| Possible risk or side effect Shivering and feeling cold | How common Common |
What it means
A response to the anaesthetic. Warming blankets can be used. |
| Possible risk or side effect Drowsiness and confusion | How common Common |
What it means
Usually settles within a few hours as the anaesthetic wears off. |
| Possible risk or side effect Minor chest infection | How common Uncommon - around 1 in 100 |
What it means
It is important to have good pain relief after your operation, do deep breathing exercises, and get out of bed as soon as you can to reduce this risk. |
| Possible risk or side effect Muscle pains | How common Uncommon - around 1 in 100 |
What it means
Usually short-lived. This can be related to the medications used during anaesthesia. |
|
Possible risk or side effect
Breathing problems leading to low blood oxygen levels |
How common Uncommon - around 1 in 250 |
What it means
Passing the breathing tube can be more difficult when you are pregnant, but the anaesthetic team are trained to do this and monitor your breathing throughout. |
| Possible risk or side effect Severe chest infection | How common Uncommon - around 1 in 300 |
What it means
It is important to have good pain relief after your operation, do deep breathing exercises, and get out of bed as soon as you can to reduce this risk. |
|
Possible risk or side effect
Corneal abrasion (scratch on the eye) or damage to teeth |
How common Uncommon - around 1 in 1,000 |
What it means
Your anaesthetist takes care to protect your eyes and teeth. Please tell your anaesthetist about any crowns, caps, or loose teeth beforehand. |
| Possible risk or side effect Awareness during the anaesthetic | How common Uncommon - around 1 in 1,000 |
What it means
A small number of people have some awareness of events during a general anaesthetic. Most do not feel pain. Anaesthetists are trained to monitor for this and special monitors which measure how deeply asleep you are can be used. |
| Possible risk or side effect Severe allergic reaction | How common Rare - around 1 in 10,000 |
What it means
The anaesthetic team are trained to recognise and treat allergic reactions. |
| Possible risk or side effect Aspiration (stomach contents entering the lungs) | How common Rare |
What it means
This is why fasting and taking the antiacid medications before planned surgery is important. Your anaesthetist takes precautions to reduce this risk. |
|
Possible risk or side effect
Brain damage or death caused directly by anaesthesia |
How common Very rare - around 1 in 100,000 |
What it means
Anaesthesia is very safe. Serious harm caused directly by anaesthesia is extremely rare. |
After your anaesthetic
After your caesarean birth under regional anaesthesia, you will be transferred to recovery where you will be monitored for a couple of hours. The numbness will gradually wear off over a few hours. You should be able to start to move your legs after around four hours. You may notice some itching as the anaesthetic wears off. Pain relief will be given to keep you comfortable. You can start to eat and drink as soon as you feel able to. Your catheter will remain in place until you are able to walk.
After your caesarean birth under general anaesthesia, you may feel drowsy, confused, or nauseous for a few hours. You will be monitored in recovery until you are fully awake and comfortable. Pain control can be more difficult after a general anaesthetic and some people may need to have a morphine PCA (a pump that allows you to give yourself small doses of pain relief by pressing a button).
Please tell your midwife, doctor, or recovery nurse if your pain is not under control.
If you have any concerns after your anaesthetic
Please speak to your midwife, recovery nurse, or the anaesthetist at any time. If you develop a severe headache which does not improve with simple painkillers, weakness in your legs, problems passing urine, or any unexpected symptoms after discharge, contact the Maternity Assessment Unit on 01223 217217.
Further useful information
For more information about anaesthesia for caesarean birth, the Obstetric Anaesthetists' Association (OAA) website (opens in a new tab) provides independent, evidence-based information written by a multidisciplinary group of doctors, midwives, and parents. You can also find detailed information in your antenatal education portal.
For more information about headache after an epidural or spinal anaesthetic, visit: Headache after epidural analgesia or a spinal anaesthetic | CUH
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