INFORMATION FOR PAIN MANAGEMENT IN LABOUR AND ANAESTHESIA FOR CAESAREAN SECTION

It is important to read this information carefully before going into labour, even if you don't plan to use medical intervention for pain relief during your labour and delivery and are not expecting to need a caesarean section. The purpose of this website is to help you make an informed decision about how to manage your pain in labour and to understand your anaesthetic, if you need a caesarean section. Unfortunately, this amount of information is necessary to have you well informed. If you would like to, it is a good idea to discuss this information with a member of your family or a friend. The information provided is of a general nature and does not take your individual circumstances into account. It cannot replace specific advice given to you by your own anaesthetist. I f you don't understand any of this information, or if you have any questions or concerns you should talk to your obstetrician or anaesthetist.

PAIN MANAGEMENT IN LABOUR

Everyone experiences labour differently. For some women, childbirth is associated with only mild or moderate pain and labour may be relatively quick and easy. For others, labour may be prolonged, exhausting and painful and pain relief may be essential. Most women find that their experience of labour falls somewhere in between these two extremes. Even for the same woman no two labours are necessarily the same. It is important to remember that if you have pain, only you can feel it and only you can decide whether or not pain relief is required.

There are a number of methods available for dealing with less severe pain in labour, as well as a number of methods to deal with more severe pain.

Less severe pain can be dealt with using relaxation techniques, breathing exercises, hot or cold packs, back massage or TENS machine (gentle electrical stimulation of the skin). Other methods of pain relief such as: hypnosis; acupuncture; aromatherapy and oral medication have been tried, but in general have been disappointing.

For moderate to severe pain, drugs such as nitrous oxide or opiates such as pethidine or morphine can be used.

NITROUS OXIDE

This is an anaesthetic gas that is breathed in to produce sleep and pain relief. Nitrous oxide is given in a mixture with oxygen via a mask. It is absorbed and eliminated through the lungs in the same way that oxygen is absorbed and carbon dioxide is breathed out via the lungs.

It takes 2-3 minutes for nitrous oxide to be absorbed through the lungs and the most effective way to use it, is to breath in the nitrous oxide prior to each contraction commencing.

The main side effects are sleepiness, dizziness, tingling of the face and fingers and nausea. The use of nitrous oxide in labour is believed to be quite safe. Nitrous oxide does not appear to alter the strength of uterine contractions or the progress of labour. It is not known to have any adverse effects on the baby. Some women find nitrous oxide a useful means to relieve pain in labour, while others find it to be of only limited use. Other inhaled anaesthetic drugs are not useful in labour, because they relax the uterus and may slow the progress of labour.

OPIATES SUCH AS PETHIDINE OR MORPHINE

These drugs are given as injections to relieve pain. In labour, it is usual to give the injection into a muscle; however, they may also be given into a vein. It takes half an hour after these drugs are injected into a muscle for these drugs to work. The pain-relieving effect of these injections lasts for 3 to 4 hours. The degree of pain relief achieved with opiates is variable. Around 60% of women find that opiates provide adequate pain relief.

The main side effects of these injections are: nausea and vomiting; drowsiness; and pain, swelling and bruising at the injection site. Allergic reactions are possible with any drug, but are very uncommon. Rarely opiates can cause respiratory depression; this is a reduced ability to breathe. If respiratory depression occurs, it can be reversed using a drug called naloxone (Narcan). Unfortunately, naloxone also reverses the pain-relieving action of the opiates.

The most important side effect of opiates is that they can also cause respiratory depression in the baby. If this occurs, the baby also may be given naloxone to reverse this effect. Opiates do not affect uterine contractions or alter the progress of labour.

LOCAL ANAESTHETIC BLOCKS

Local anaesthetic blocks involve the injection of special drugs that make specific parts of the body go numb, for example your dentist uses local anaesthetic to make your gums, teeth or lips go numb. For childbirth, local anaesthetic can be used as local infiltration (injected just under the skin) to make the lower birth canal and skin go numb. This is particularly useful if you need stitches.

A pudendal block is an injection of local anaesthetic, through the birth canal, around the pudendal nerve. This is used to numb a larger area of the birth canal and surrounding skin and may be used to reduce the discomfort of a forceps delivery.

The side effects and risks for these types of local anaesthetic blocks are similar to those listed below for epidurals and spinal anaesthetics

EPIDURAL AND SPINAL ANAESTHETIC INJECTIONS

An epidural or spinal anaesthetic is an injection of local anaesthetic, often with an opiate drug, into the lower back. This injection is given by an anaesthetist to make part of the body go numb. For childbirth, these injections can be used to reduce or stop pain. The pain may be due to: the uterus contracting; forceps delivery, manual removal of the placenta (afterbirth) if required or for caesarean section. Epidurals and spinals do not affect the strength or rate of uterine contractions; they do not make you sleepy and do not directly affect the baby.

In addition to pain relief, epidural or spinal anaesthetic can be used to treat medical conditions during labour such as high blood pressure or to reduce the risks of certain types of delivery, for example delivery of twins or breech delivery. There are a number of maternal medical conditions, for which an epidural may be beneficial to both the mother and baby.

WHAT IS THE DIFFERENCE BETWEEN EPIDURAL AND SPINAL ANAESTHETICS?

Running down the middle of the backbone (spine) there is a sac of fluid called the dural sac. A spinal anaesthetic is an injection of local anaesthetic into the fluid inside the dural sac. An epidural anaesthetic is an injection of local anaesthetic around the outside of the dural sac. Nerves travel both inside and outside the dural sac and the local anaesthetic blocks these nerves and makes parts of the body go numb.

Epidural anaesthetics are usually used in labour, because a plastic tube, called an epidural catheter, can be threaded into the epidural space and left there for ongoing doses of local anaesthetic until pain relief is no longer required.

Spinal anaesthetics are usually used as a single injection of local anaesthetic for an operation. The single injection lasts for 2-3 hours only and is less useful if pain relief is required for longer than this, such as in labour. Spinal anaesthetics can be better for procedures such as forceps delivery or caesarean section, because they block the nerves more completely and more rapidly than an epidural.

Sometimes a combined epidural/spinal technique is used and can offer the benefits of both techniques.

If you have concerns regarding pain management during labour then you should talk to your anaesthetist.

If you have serious heart or lung disease or previous back surgery you should see your anaesthetist.

If you have a bleeding or clotting disorder or if you are taking blood-thinning drugs (anticoagulants) such as fragmin or clexane, you need to talk to your obstetrician or anaesthetist about whether you need to alter these medications before the delivery. Your obstetrician can arrange for you to talk to an anaesthetist if required.

WHAT ELSE SHOULD YOU DO?

Stop smoking and stop taking herbal and alternative products, as some of these products may interfere with the wellbeing of the baby, anaesthetic drugs, blood clotting and blood pressure.

You need to tell your anaesthetist about any problems with your health, especially bleeding or clotting disorders or heart and lung disease, any medications you take, including herbal and alternative products, present and past use of alcohol and illicit drugs, any allergies, past history or family history of problems with anaesthetics, or past back surgery.

WHAT DOES YOUR ANAESTHETIST DO?

If you decide to have an epidural, your anaesthetist will be called. An intravenous drip will be inserted prior to the spinal or epidural injection. This is done for safety reasons and to reduce the fall in blood pressure that is the most common side effect of an epidural or spinal injection.

You may be sitting up or lying on your side to have the spinal or epidural injection. Your anaesthetist will need your co-operation and may require you to curl up as this helps to open up the spaces between the bones in your spine and makes it possible to put in the injection. You will also need to try to stay still.

After preparing your back with an antiseptic wash and drapes, your anaesthetist will inject a small amount of local anaesthetic under the skin to make the skin on your lower back numb. It is usual for local anaesthetic to sting at first and it is normal to feel pressure as the spinal or epidural needle is inserted.

For a spinal anaesthetic a long, fine needle is inserted through the numbed skin, between the bones of the spine and into the fluid of the dural sac. This needle is a similar width to the needles your dentist would use to make your mouth numb. Local anaesthetic, with or without opiates, is then injected into the fluid. This is done as a one off procedure and the needle is removed straight away.

For an epidural, a thicker needle is inserted into the epidural space and a catheter (fine plastic tube) threaded through the needle. The needle is removed leaving one end of the catheter in the epidural space. Local anaesthetic, again with or without opiates, is then injected via the catheter into the epidural space to provide pain relief. The catheter is taped to your back and further doses of local anaesthetic can be given either as individual doses or continuously in what is called an infusion. If an infusion is used, the rate of local anaesthetic administration is carefully controlled using an electronic pump. The anaesthetist arranges for the amount of local anaesthetic you receive in the infusion to be adjusted according to your needs. It is usual for extra top-up doses to be available if they are needed. The epidural catheter remains in place until you have no further need for epidural pain relief.

In many obstetric units over half of the women having their first baby will choose to have an epidural. Of these, over 95% rate their pain relief as excellent.

SIDE EFFECTS

Numbness and muscle weakness. The most noticeable side effect is numbness and weakness of the lower half of the body. How effective the pain relief is depends on how large a dose of epidural anaesthetic you receive. Larger doses of anaesthetic provide better pain relief, but are also associated with greater muscle weakness. This greater weakness means you will not be able to walk around, and may be less able to push the baby out without assistance. It is usually recommended that the dose of epidural anaesthetic be sufficient to make the labour manageable, rather than removing all sensation of contractions and causing the muscles to be weaker. The weaker the muscles, the more likely it is that a low forceps delivery will be required.

Drop in blood pressure. Although usually not noticed by the patient, the use of an epidural or spinal anaesthetic causes blood pressure to drop. Low blood pressure is usually controlled by giving fluids via the intravenous drip. Uncommonly, medication may be required to correct the drop in blood pressure. Your anaesthetist may prefer you to lie on your side once the epidural is inserted as sitting up may further lower the blood pressure and lying flat on your back reduces blood flow to the baby.

Shivering. Most women experience shivering due to the epidural. Shivering can be quite marked, but is of no medical concern. It is usually managed by keeping the patient warm.

Difficulty passing urine. A spinal or epidural injection in labour makes it difficult to sense a full bladder. It is usual to need a catheter to drain the urine. There is a small risk of bladder infection associated with using a urinary catheter; however, without a catheter, the bladder may not empty and a full bladder slows the progress of labour.

Nausea and vomiting. Nausea and vomiting can occur with spinal and epidural anaesthesia, but are far more likely to be due to the labour itself than to the anaesthetic. There are medicines that can be given to reduce nausea and vomiting if necessary.

RISKS AND COMPLICATIONS

Inadequate block. Epidural and spinal anaesthetics are often temperamental. They can be patchy, may only block one side, may block too high or too low, can miss blocking individual nerves and as epidural catheters are only held in by tape, they can leak or fall out. Changes in your position and additional doses of local anaesthetic often fix these problems, however, in some cases, it may be necessary to re-insert the epidural or spinal.

There is a lot of individual variation in people's size and shape and requirements for local anaesthetic. It is not always possible for the anaesthetist to put in an epidural or spinal.

As labour progresses, it is normal for pain to worsen. If the epidural does not cover this sufficiently, it is possible to increase the rate of the epidural infusion, or to give extra doses of local anaesthetic. Sometimes a caudal injection may be given. This is also an epidural injection, but is given lower down through the sacral bone. A caudal injection provides better pain relief for the vagina and skin around the vagina.

Pain at injection site. Low back pain is common after epidural or spinal injection, but is expected to resolve within 2 weeks. After this time, there is no difference in the rate of low back pain for women who have had an epidural in labour, compared to women who have not.

Post spinal headache. A specific type of headache, called a post spinal headache, can occur after spinal or epidural injection in up to 1% of healthy young people and is far less common in older age groups. This headache can be mild or severe and usually resolves spontaneously over 1-3 weeks. It can be cured more quickly using an epidural injection of the patient's own blood. If you have a persistent headache, you should contact your anaesthetist. It is also important to understand that there are many other causes of headache that are more common. It is also possible to experience transient deafness following a spinal anaesthetic.

Nerve Damage. Nerve damage is uncommon and usually only temporary, but rarely may be permanent. Nerve damage may range from causing a very small area of numbness or weakness to, in extremely rare cases, paraplegia or quadriplegia. It is important to understand that nerve damage is five times more likely to occur just as a result of the delivery of the baby, than because of the epidural or spinal.

Infection. Infections are extremely rare, so rare that it is not possible to give an accurate incidence. All of the needles, catheters, local anaesthetics, intravenous drips, syringes, tubing and fluids are sterile and used for one patient only. Your anaesthetist uses a sterile technique to insert a local anaesthetic block. However, it is not possible to totally eliminate the risk of infection at the injection site. With epidurals and spinal anaesthetics it is possible to develop an infection around the spinal cord, causing meningitis or an abscess. This extremely rare type of infection may have serious consequences and result in brain damage, paraplegia or death. Infection may require antibiotic treatment, or very rarely surgery.

Incidental injury. Very rarely, a patient who is numb is injured accidentally. For example, falls, pressure injury, back injury associated with being moved.

Death or serious complications. Although these risks are often lower with a local anaesthetic block than with general anaesthesia, they still exist and cannot be totally eliminated. Serious complications may include conditions such as: heart attack; stroke; brain damage; fitting; high spinal anaesthetic block; DVT (blood clot in the leg); pulmonary embolus (blood clot in the lungs); major allergic reaction; and, irregular or slow heart beat. Some of these risks are also risks of childbirth, regardless of the type of pain relief used. Even though many patients are worried about this, the chance of dying or having a serious complication because of an anaesthetic is extremely low. For a young healthy person, the chance is so low that it is not possible to measure it accurately. For those with poor general health, especially heart or lung disease, the risks may be greater. You should discuss your individual risks with your anaesthetist.

Risks for the baby. The epidural anaesthetic has no direct effect on the baby. At the usual doses of local anaesthetic and opiates used for epidural and spinal anaesthetic, the baby only absorbs a very small amount of drug.

However, a prolonged drop in maternal blood pressure has the potential to reduce blood flow to the baby. After epidural or spinal anaesthetic the blood pressure is monitored carefully and treated readily to prevent potential problems for the baby. The baby is also closely monitored for signs of any problem.

ANAESTHESIA FOR CAESAREAN SECTION

Currently over 25% of births in Australia are by caesarean section. Just under half of the caesarean sections performed are planned during the pregnancy; the decision to perform a caesarean section in the remainder is made during labour. The rate of caesarean section has been steadily increasing over the past 20 years and this has been associated with improved outcomes for mother and baby.

WHAT TYPES OF ANAESTHETIC ARE AVAILABLE

The purpose of the anaesthetic is to remove the pain or awareness of the caesarean section operation. This can be achieved using a general anaesthetic, a spinal anaesthetic or an epidural anaesthetic. There are times when these techniques may be used together. Your anaesthetist will provide the type of anaesthetic most suited to your needs. This decision is based on a balance between your state of health, the specific risks and benefits for you, the type and length of procedure and your preference.

In addition to removing the pain or awareness of the operation, your anaesthetist looks after your general well being during and after your procedure. This may include giving intravenous fluids and, when required, blood transfusions to replace bloodloss caused by the delivery of your baby, or the use of drugs to maintain optimal levels for blood pressure, heart rate and rhythm and breathing. Your anaesthetist also manages your postoperative pain relief.

EPIDURAL AND SPINAL ANAESTHETICS

Epidural and spinal anaesthetics are the most common forms of anaesthesia for caesarean section. Epidural and spinal anaesthetics do not make you sleepy and so allow you to experience the birth. They do not directly affect the baby. Your anaesthetist will often recommend an epidural or spinal anaesthetic, because they are associated with better safety, quicker recovery and better postoperative pain relief.

The difference between epidurals and spinal anaesthetics and the method of insertion are the same as described above. An epidural inserted for pain management in labour can be topped up to provide anaesthesia for caesarean section. However, for an elective or planned caesarean section, spinal anaesthetics are more commonly used, because they block the nerves more completely, more reliably and more rapidly than an epidural. Some anaesthetists will choose to use a combined technique.

The associated side effects, risks and complications of epidurals and spinal anaesthetics for caesarean section are essentially the same as for an epidural inserted during labour. However, there are some additional things you should know:

It is normal to feel pressure and pulling during a caesarean section operation. You should not feel pain. However, as discussed above, epidural and spinal anaesthetics are often temperamental. It is important to understand that there is the possibility of needing to have a general anaesthetic if an epidural or spinal anaesthetic is inadequate. The variation in people's size and shape and requirements for local anaesthetic can make it impossible for the anaesthetist to put in an epidural or spinal. This can also result in the need to have a general anaesthetic.

GENERAL ANAESTHETIC

A general anaesthetic is given using a combination of drugs that are injected into you and gases that you breathe. It is used to make you unconscious in a carefully controlled way. Your body has a number of reflex responses to the painful stimulus caused by the surgery, even when you are not aware of the pain. These responses include raising your blood pressure, raising or lowering your heart rate and changes to breathing. As well as making you unconscious, the anaesthetist also the controls changes in your blood pressure, heart rate and breathing that are caused by the surgery. Your anaesthetist closely monitors and adjusts your anaesthetic throughout the operation. General anaesthesia has been shown to be very safe for caesarean section. Although less commonly performed than epidural or spinal anaesthetics for caesarean section, it may be more suitable for patients who are very anxious, are not able to have an epidural or spinal anaesthetic or for whom a spinal or epidural is not working well. In particular, a general anaesthetic may be chosen when a caesarean section operation is of an urgent nature and time is important.

Although the mother is made unconscious, the baby absorbs only a small amount of the anaesthetic drugs and is not put to sleep by the drugs.

General anaesthetics for caesarean section are different to general anaesthetics for other types of operation. Your anaesthetist will not give you a drug to relax you before the operation, as these drugs may affect the baby. Before being put to sleep, an intravenous drip is inserted; and, the mother is taken into the operating theatre and given oxygen to breathe through a mask. As well, your obstetrician may prepare your skin with an antiseptic wash and put sterile drapes on and around you, before you are put to sleep.

Compared to general anaesthetics for other operations, there is a smaller range of anaesthetic drugs available for use during caesarean section. This is because some anaesthetic drugs, especially those related to ether or chloroform, prevent the uterus from contracting. Other drugs, such as morphine or pethidine, used for pain relief are not given to the mother until after the birth as these may slow the baby's breathing. Drugs given for the general anaesthetic and postoperative pain relief are only present in small quantities in breast milk and so do not cause problems with breast-feeding.

DURING YOUR ANAESTHETIC

The anaesthetic will be started by giving you an injection of special anaesthetic drugs into a vein. Oxygen will be given through a facemask before the anaesthetic starts. Your anaesthetist routinely uses an intravenous line (drip), a pulse oximeter, blood pressure monitor and an ECG during your anaesthetic.

Intravenous Line. An intravenous line or drip is a small plastic tube or cannula that is inserted into a vein. A vein is a blood vessel that carries blood back to the heart. Your anaesthetist uses the drip to give you drugs or fluids during and after your anaesthetic. Risks associated with an intravenous drip include pain and bruising at the insertion site that usually resolves in a few days and infection.

Pulse Oximeter. A pulse oximeter is a small peg that your anaesthetist places on your finger, toe or earlobe to monitor your pulse and the oxygen level in your blood.

Blood Pressure Monitor. Your blood pressure is monitored via a cuff placed around your upper arm. The cuff can be inflated either manually or automatically in order to measure your blood pressure .

ECG. An ECG, or electrocardiograph, monitors the electrical activity of your heart. It is not invasive and small electrodes or leads are connected to sticky patches that are placed on your chest and limbs. Your anaesthetist uses the ECG to monitor the rate and rhythm of your heart. An ECG also provides information about whether enough oxygen is getting to the heart, past damage to the heart and how well your heart is functioning. The only side effect of an ECG may be some skin irritation from the sticky patches.

All needles, syringes, drugs for injection, intravenous equipment and fluids are sterile items that are used for one patient only. Other items of anaesthetic equipment are either single patient use, are sterilized before each use in accordance with Australian Standards, or are protected by viral and bacterial filters. These measures have been shown to be extremely effective in preventing cross-infection.

AFTER YOUR ANAESTHETIC

When the operation or procedure is finished, you will be taken to the Post Anaesthetic Care Unit. Your anaesthetist hands your care over to specially trained recovery nurses in the Post Anaesthetic Care Unit. You will remain in this specialized area for at least half an hour while you recover from your anaesthetic. It is standard to be given oxygen to breathe and for monitoring of the blood pressure, heart rate, breathing and oxygen level to continue at this time. The effectiveness of pain relief is also assessed.

Postoperative pain. Your anaesthetist aims to have you as comfortable as possible following your operation or procedure and will order pain relief for you. However, it is not always possible to have you totally free of any discomfort. The use of epidurals or spinal anaesthetic blocks, with or without general anaesthetic best reduces postoperative pain. However other methods include: the use of tablets, mixtures, suppositories (medicine via the back passage), injections into muscles or veins or combinations of these which may be used following a caesarean section under general anaesthetic, or where the epidural or spinal does not provide adequate ongoing relief..

While you are in the Post Anaesthetic Care Unit, the recovery nurses will ask you whether you have any pain. As different people need different amounts of pain relief, it is important to tell the nurses how you are feeling. If you have any concerns about postoperative pain, you should discuss them with your anaesthetist.

SIDE EFFECTS OF GENERAL ANAESTHETICS

Side effects are minor, unpleasant reactions to an anaesthetic. These occur commonly and are usually of short duration.

Dizziness, drowsiness, headache and blurred vision are common and usually wear off quickly. Occasionally muscle weakness can be noticed immediately after the anaesthetic, and may cause difficulty with breathing. Occasionally patients wake up feeling agitated or teary. These problems recover quickly.

Swelling and bruising at injection sites are common and recover within a few days.

Short-term memory loss is common. Most patients do not remember being awake in the Post Anaesthetic Care Unit. Short-term memory loss usually recovers by the next day.

Nausea and vomiting are the most common side effects of a general anaesthetic and postoperative pain relief. Up to 30% of patients experience nausea or vomiting. There is a lot of individual variation, with some patients more likely to experience these side effects. If you have had problems with nausea and vomiting after anaesthetics, or following morphine or pethidine injections in the past, tell your anaesthetist, as there are ways to tackle this problem.

It is usual for your anaesthetist to place a tube in your airway to help maintain your breathing while you are anaesthetized. This may cause a sore throat or hoarse voice, which usually recovers within 24 hours.

Muscle aches and pains are common. This is caused by a muscle-relaxing drug called suxamethonium and is expected to recover within three days. The usual pain relief following a caesarean section controls these aches and pains.

RISKS AND COMPLICATIONS OF GENERAL ANAESTHETICS

Anaesthetics in Australia are among the safest in the world. For a fit and healthy person, general anaesthetic are no more hazardous than a couple of short trips in the car. This level of safety is because, in addition to being a fully trained medical practitioner, your anaesthetist has spent an additional five years completing a high level of specialist training in anaesthetics, pain relief and treating emergencies. The newer anaesthetic drugs and modern anaesthetic equipment make having an anaesthetic the safest it has ever been.

However, as with driving a car, it is not possible to totally eliminate risk. Although very uncommon, anaesthetic complications do occur and these complications may be serious. These risks may be higher for people who are less healthy, especially for those with heart or lung disease and those undergoing longer, more complex procedures.

Awareness. During a general anaesthetic, it is possible to be awake, unable to move and aware of what is happening around you. This is called awareness and occurs during general anaesthetics where muscle-relaxing drugs are used. These drugs need to be used during a general anaesthetic for caesarean section. It is also possible to dream of being aware, without it actually happening. During caesarean section, awareness may occur in up to 2% of patients who have a general anaesthetic.

Death or serious complication. This may include conditions such as: heart attack; stroke; brain damage; blindness; fitting; pneumonia; DVT (blood clot in the leg) and pulmonary embolus (blood clot in the lungs); major allergic reaction; irregular heart beat; kidney, lung or liver failure; permanent nerve damage; permanent damage to voice; eye damage; and infections or reactions to blood transfusions. Even though many patients are worried about this, the chance of dying or having a serious complication because of an anaesthetic for caesarean section is very low. For a young healthy person, the chance is so low that it is difficult to measure it accurately. These risks may be higher for people who are less healthy, especially for those with heart or lung disease. Although general anaesthetics are very safe, there are specific risks related to DVT and pulmonary embolus, or vomiting which can cause pneumonia, which are higher for general anaesthetics for caesarean section operation than anaesthetics for other operations. Although a general anaesthetic for caesarean section is very safe, a spinal or epidural anaesthetic is safer again, up to 7 times as safe. You should discuss your individual risks and any concerns you may have with your anaesthetist.

Damage to teeth. Every care is taken by your anaesthetist not to damage teeth (including false teeth, capped teeth and bridges). Although dental damage is uncommon, it is important to understand that with any general anaesthetic there is a small risk that teeth may be damaged. Although very uncommon, injury may also occur to the larynx (voice box), vocal chords, lips, throat or tongue.

Incidental injury. Very rarely, a patient who is unconscious or drowsy is injured accidentally. For example, falls from operating table, eye damage, pressure injury, stretching injury, back injury associated with being moved, or unintentional burns. Nerve damage may occur despite the best positioning or padding of pressure points, resulting in an area or region of numbness or weakness.

WILL YOU NEED TO SEE YOUR ANAESTHETIST BEFORE DELIVERY?

If you expect to have an elective caesarean section and if you have serious heart or lung disease or previous back surgery you should see your anaesthetist.

If you have a bleeding or clotting disorder or if you are taking blood-thinning drugs (anticoagulants) such as fragmin or clexane, you need to talk to your obstetrician or anaesthetist about whether you need to alter these medications before the delivery. Your obstetrician can arrange for you to talk to an anaesthetist if required.

WHAT ELSE SHOULD YOU DO?

Stop smoking and stop taking herbal and alternative products, as some of these products may interfere with the wellbeing of the baby, anaesthetic drugs, blood clotting and blood pressure.

WHAT DO YOU NEED TO TELL YOUR ANAESTHETIST?

You need to tell the anaesthetist about any problems with your health, especially bleeding or clotting disorders or heart and lung disease, any medications you take, including herbal and alternative products, present and past use of alcohol and illicit drugs, any allergies, any past history or family history of problems with anaesthetics or past back surgery.

OUT OF POCKET COSTS

If you are treated as a private patient, there will be an out of pocket cost with most anaesthetic services. There are no standard charges, each anaesthetist sets his or her own fees. The level of the ‘gap' or out of pocket cost will also depend on whether or not you have Private Health Insurance, the type of insurance you have, the type of procedure you are undergoing and how long the procedure takes. You should ask your obstetrician or anaesthetist about the cost of your anaesthetic.

This information was prepared by Dr G Eastaugh MBBS, FANZCA and Dr L Eastaugh MBBS, MBA and is provided to give you a better understanding of your pain management options labour, especially to provide information regarding epidural and spinal anaesthesia. The information also aims to give you a better understanding of anaesthesia for caesarean section. It cannot replace professional advice regarding your individual circumstances. It is important that you are satisfied that you understand this information If you are unsure or concerned about any of this information you should talk to your anaesthetist. Your anaesthetist can assess you and discuss your risks during your pregnancy, if required.

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