Is General Anesthesia Safe During Pregnancy?

What is general anesthesia? Is it safe? And what are the risks and concerns about anesthesia use during pregnancy? These are just some of the questions you might ask if you or someone you know is required to go under general anesthetic during pregnancy.

Key takeaways:
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    Anesthesia is a controlled way to manage pain during labor and delivery, surgeries and procedures.
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    General anesthesia is sometimes needed for surgeries unrelated to the pregnancy that may be urgently needed during the pregnancy.
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    It is recommended to defer or delay surgeries until after pregnancy, or at least until after the first trimester.
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    If this is not possible, doctors take measures to decrease the risk to the mother and baby.

What is anesthesia?

Anesthesia is a medical treatment that involves controlled, temporary loss of sensation or awareness. The treatment prevents or reduces pain. Anesthetics are medications that are used for pain control, typically during surgeries or procedures.

It’s generally recommended that pregnant women defer or delay surgeries that would require anesthesia until after the pregnancy is finished. Depending on the medical condition and urgency, this may not always be possible. Some women will have accidents, emergencies, or need surgeries that cannot afford to be delayed until after pregnancy, but this is a rare occurrence (0.5-2%).

Why would anesthesia be used during pregnancy?

The most common surgeries that are needed during pregnancy are repair of the cervical os (opening), appendectomy (in cases of appendicitis), ovarian surgeries (such as a rapidly growing cyst or tumor), and repair of fractured bones.

Labor and delivery of a baby can be severely painful for the mother. She will experience contractions of the uterus that may start weeks or even months before delivery. The delivery process involves stretching the cervix (the opening of the uterus), the vagina, and all the tissues in the pelvic region as the baby is pushed through the vaginal canal.

Anesthesia is an option for pain relief. Some birthing women choose to use anesthetics to help make their delivery process less painful. Others opt for childbirth without the use of any medications.

Types of Anesthesia

General anesthesia, or “going under,” is the most extreme form of anesthesia in which a patient is put into a state of unconsciousness. Medications can be injected into the bloodstream through an IV (intravenous) line, and inhaled from a mask.

Either a doctor with specific training in managing anesthesia called an anesthesiologist, or a certified, registered nurse, called an anesthetist, will closely monitor the patient. The patient's breathing will be assisted if needed.

Some commonly inhaled anesthetics are:

  • Halothane.
  • Enflurane.
  • Isoflurane.
  • Nitrous oxide.

Some common IV medicines are:

  • Fentanyl.
  • Propofol.
  • Ketamine.

General anesthesia is typically required for major surgeries, such as an emergency cesarean birth (c-section), not for typical vaginal deliveries.

For vaginal deliveries, the mother must be conscious enough to be able to push to aid in the delivery of the baby. It’s for this reason that epidural or spinal anesthesia may be used instead of general anesthetic for pain relief.

What is an epidural, and what does it involve?

An epidural is the most common procedure for labor and delivery. It involves the injection of medication into the epidural space surrounding the spinal cord to block off or reduce signals of pain sent from the spinal cord to the brain. The injection site is important because it affects which part of the body will be numbed.

The provider uses a long needle to access the epidural space in the patient’s lower back, specifically the lumbar spine, to provide pain relief in the pelvis area. They may use an analgesic rather than a fully numbing anesthetic to reduce pain. An analgesic will maintain some movement in the legs, allowing the mother to push.

They will then remove the needle but leave a catheter (long flexible small hollow tube) in the patient’s back to allow more medication to be administered. The medication is given either continuously or in doses. The patient can self-administer their doses by pressing a button, but the settings do not allow them to overdose if too much medication has been given already.

What is a spinal block, and when might it be used?

A spinal block is a one-time injection into a different area of the spine, the dural sac of the spinal cord which contains cerebrospinal fluid. The procedure provides anesthesia for a known or estimated limited amount of time. In pregnant women, it is also injected at the level of the lower back to provide anesthesia to the pelvic region.

It is typically used for c-sections which do not usually last over 2 hours, rather than natural labor and birth which can last several days. The spinal block’s pain relief takes effect faster than an epidural due to the location of the medication. Sometimes a combined spinal-epidural is used to provide fast pain relief with the option of giving further doses if the pain is ongoing.

Concerns about general anesthesia use in pregnancy

The risks of general anesthesia must be considered for both the mother and baby. Risks to the mother include:

  • Blood clots in the legs or lungs.
  • Aspiration (stomach fluids going into the lungs due to muscle relaxation, increased pressure in the stomach, and vomiting).
  • Acute respiratory distress syndrome (fluid in the lungs).

Risks to the baby include:

  • Miscarriage if it is used in the first trimester of pregnancy.
  • Lower birth weight.

It is unclear if miscarriage is due directly to the anesthesia itself, the stress on the body from the surgery, or the condition that required the surgery in the first place.

Another possible risk is preterm labor and delivery (before 37 weeks) if the surgery with general anesthesia is performed in a later trimester of pregnancy. Some studies have found an increased risk, while others have not. Some studies have also found that surgeries during pregnancy were associated with prolonged hospital stays and increased risk of c-sections, but others have not.

Fortunately, general anesthesia has not been found to increase the risk of fetal defects (which remains at 3-5%).

Final thoughts

Doctors will typically do all that they can to decrease the risks. They typically transfer pregnant patients who come to the ER with traumatic injuries from accidents to the maternity section of the hospital, unless in life-threatening situations.

Always discuss your specific case with your doctor. General anesthesia should not be taken lightly, or ruled out in cases of pregnancy, especially in life-threatening scenarios.


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