Will an anaesthetic affect my baby or pregnancy?
There are numerous situations when an operation or anaesthetic may be required
while you are pregnant before the baby is due. There are two concerns people
have about this. Will it affect my baby, and does it have any effect on the
pregnancy? The drugs used for an anaesthetic have been examined at some length
to see if they have had any effect on either of these. Virtually all drugs used
for the actual anaesthetic have not been shown to be harmful to the baby. Those
that are questionable have not been conclusively shown to be of harm but are
easily avoided. Some other drugs that may be required for the operation, such as
antibiotics, have been shown to be potentially harmful, so alternatives are
often used. Finally, X-Rays may be required as part of an operation and these
might be harmful. Almost all harmful drugs can be avoided during an anaesthetic
as long as it is known that you are pregnant, and steps can be taken to minimise
the baby's exposure to XRays. In terms of the actual pregnancy, simply having an
anaesthetic does not increase your risk of having a miscarriage. There are,
however, some high risk operations - such as those in the abdomen - that
increase the risk of miscarriage greatly. It is important, therefore, that if
you are, or may be, pregnant that your anaesthetist and surgeon know about this
in advance. Then a decision can be made about how important it is that the
operation be done while you are still pregnant, and what sort of anaesthetic is
most suitable for you.
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What sort of pain occurs during labour and delivery?
Childbirth is well known as one of the most painful experiences someone can
endure. It is therefore quite frightening to those who have not had a child,
without knowing if and how pain can be relieved. A brief summary of the pain is
as follows. Labour pains start as a dull crampy ache in the abdomen and/or the
back which subside in less than a minute and come back at fairly regular
intervals many minutes apart. The intensity and duration of the pain increases
as labour progresses, and the pain free intervals between painful contractions
decrease. The pain is then intensified at the site of the birth as the baby is
pushed out. This whole process takes a variable length of time in each person
and with each baby but is about 12 hours on average for a first baby.
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What sort of pain relief can I have?
There are numerous options available but I will discuss the most commonly used
ones here. This is only a guide and by no means an exhaustive description.
Training and experience decrease the pain of pregnancy. By training I mean going
to antenatal classes when you are pregnant and learning about the delivery
process, knowing what to expect and how to control your breathing to cope.
Having knowledge decreases the anxiety and can decrease the pain. First
deliveries are usally more painful and longer also as your birth canal is primed
and experienced from then on. Support is also important - having a helpful
partner and midwife can help you cope better during the delivery. The next step
is laughing gas or Nitrous Oxide. While there is little laughter during labour,
Nitrous Oxide is a very helpful weak anaesthetic gas that is used in dentistry.
Breathing on a mask will give you the nitrous oxide and you can breath it
whenever a painful contraction is occurring and stop it between contractions.
For it to be most effective you need to breath on it from when the contraction
first starts before it gets to it's worst. This is a very simple and effective
method that you can use even with other pain killers. The next major step up are
strong pain killers like pethidine. These are given to you by
injections and are
very potent pain killers but can make you drowsy and nauseated. The disadvantage
is they last a limited time and have to be repeated. Also these pain killers get
across to the baby and have a tendency to make the baby sleepy but have no long
term effect on the baby. The most effective method of pain relief is the
The advantage is that it doesn't tend to make you sleepy (but you
usually go to sleep from exhaustion), takes away most of the pain and has
virtually no effect on the baby. The disadvantage is the procedure of having the
needle in the back, the need to have a drip and possibly a urinary catheter, and
the inability to get up and walk around - not that you will feel like doing that
anyway. Some people are concerned that losing the feeling and making your
muscles weaker with the epidural running will decrease your ability to push the
baby out yourself. The evidence suggests that those who have pain bad enough to
require an epidural are less likely to do this regardless of whether they have
an epidural or not. What about less mainstream forms of pain relief like TENS
and aromatherapy? While we have yet to see any evidence that these have any
useful effect, you are welcome to use them.
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How much pain relief is enough?
Every labour is unique, and every child-bearing woman will have different pain
from labour. How painful your labour will be and how long it will last is
unpredictable. While some people advocate a labour without pain relief we
believe this is unfair to those who have more painful and longer labour. What is
commonly used is a step up approach for pain relief, stepping up the strength of
the pain relief to match the intensity of pain that can not be tolerated. If you
have labour pains throughout that you can tolerate without any pain relief then
that is fine. If the pain is intolerable from the start and you need strong
immediately then that is also fine. There is no point in feeling like a
failure for requiring stronger pain killers than the next person because your
labour is unique. The best advice is cope with what you can, and if it's
overwhelming, simply ask for more. We have no desire to control your delivery
except for safety purposes. Otherwise you get to say when you need something.
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What happens during a caesarean section?
A caesarean section is almost never planned for a first baby. It is performed
for the safety of the baby, mother, or both. It is one of the few operations
which is safer under regional anaesthesia
than general anaesthesia, for both the
mother and the baby. Most women want to be awake anyway when their baby is born.
The mother is usually prepared in the anaesthetic room or operating theatre by
being given her anaesthetic. If she has an
epidural this is usually topped up to
make her abdomen very numb. If not, she may be given either a
spinal or an
epidural or both. When the anaesthetic has been given, she is put on the
operating bed and after some preparation her support person is usually allowed
in for the delivery. Neither the mother nor the support person will actually see
the operation as drapes are placed vertically between them and the surgeon.
Although regional anaesthesia is safer than general, rest assured that general
is still overrall a very safe anaesthetic. If general anaesthesia is required, the
support person will usually not be invited into the operating room.
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How does anaesthesia affect breast feeding?
Many drugs given during anaesthesia
do go into breast milk. Some of these drugs
can have the same effect on the baby as if they were given to the baby, but in
smaller doses. Most anaesthetic drugs are out of the body within 16 hours of an
anaesthetic, although some drugs remain in very small quantities for up to 5
days. There is also a small incidence of breast milk stopping after an
operation. Given this fact it is important you tell your anaesthetist you are
breastfeeding so that a suitable anaesthetic technique be chosen. The safest
drugs can be chosen, a regional anaesthetic
may be an option and other
precautions can be taken to decrease the chance of breast milk stopping. What
you can do is breast feed or express milk just before having your operation.
After the operation if you have had a
general anaesthetic you should express
milk and discard the first lot. After this time it is likely to be fine to
breastfeed. If you are on strong pain killers
after your operation then you
should be aware that your child may become sleepy from these but is unlikely to
come to harm.
|Recovery room (Click for larger image)