During your pregnancy there will be many healthcare providers that will support your plan of care and decision making. If you have complex medical conditions, you may be required to see an anaesthetist.
These include:
- Certain respiratory disorders
- Cardiac disorders
- Neurological disorders
- Hematological disorders
- Metabolic/ endocrine disorders
- Musculoskeletal disorders
- Obstetric conditions
- Raised BMI (over 40)
You’ll still have the usual choice of pain relief, such as Entonox, Pethidine or Diamorphine.
In most cases, it is better for you to have a regional anaesthetic (a spinal or an epidural) for a Caesarean section. This means the injection is given into your back (either by injection into the spine or through a tube placed into your back) to make the lower part of your body numb. With a regional anaesthetic, you stay awake during the operation.
Being awake has many advantages for you and your baby, during and after a
caesarean section. This includes recovery, as the effects of a general anaesthetic
may take longer to recover from for you and your baby. There are times when we
need to deliver a baby as quickly as possible. If you have an epidural that is working
well whilst in labour, we can often use it for a caesarean section or if we need to
deliver your baby using special equipment, for example forceps or ventouse (a
suction cup).
If you have a high BMI this can make anaesthetic procedures more difficult. It may
be harder to find the correct place to put the needle in to give the anaesthetic and be
more difficult to get the anaesthetic to work properly straight away. Therefore,
having an appointment with an anaesthetist prior to the birth of your baby allows for
a thorough assessment of your needs and for a plan to be made with you, which will
be documented within your maternity records.
During your appointment
You will meet the anaesthetist either face to face or via a telephone consultation (if
appropriate). This will allow us to examine you and review your medical history
before the date you are due to give birth. We can discuss and plan pain relief and
anaesthetic choices with you for your labour and delivery. It is easier to do this
ahead of time, in relaxed surroundings, rather than trying to explain things when you are
having contractions. Things can happen very quickly during labour and the more
information you have beforehand, the more prepared you will be.
After this discussion, the Anaesthetist will discuss with you the options that will suit
your requirements and preferences. This may include:
- A normal labour, without an epidural
- An epidural if labour is not straight forward
- Any other options you would like to discuss and explore
When you are admitted in to hospital, please tell the midwives that you have seen
an anaesthetist. This will allow the midwife to look over the plan suggested by the
anaesthetist who saw you during your pregnancy. You may also need to see the
anaesthetist on duty for review of the plan made.
In summary
If your BMI is 40 or above, you are more likely to need some sort of help with the
delivery of your baby than someone with a lower BMI, which means:
- It may be best to have an epidural in labour, in case we need to deliver your baby quickly, and you need a Caesarean Section, forceps or ventouse
- It is generally better to stay awake while your baby is delivered
- Giving you a general anaesthetic may be more difficult and the Anaesthetists need to plan for that
Date of issue: February 2023
Review period: February 2026
