Why not all births are conducted under general anesthesia in modern times

The decision to choose anesthesia during childbirth, particularly general anesthesia, is a complex one. Throughout the world, regional anesthesia such as epidurals and spinal anesthesia are the norm for pain management during labor and delivery, especially during Cesarean sections. General anesthesia, while used in emergencies, is rarely the chosen method for routine childbirth. This article aims to explore the reasoning behind this choice, backed by medical expertise and practical considerations.

The Risks of General Anesthesia During Childbirth

Medical Risks: General anesthesia involves putting the mother into a complete state of unconsciousness. While it can be life-saving in emergencies, the risks associated with this method must be weighed against the benefits. For instance, the baby can absorb part of the anesthesia, which could lead to respiratory issues and the need for resuscitation. Considering the vital importance of the mother and baby's health, the risks are considered too high for routine procedures.

The Decision-Making Process

Personal Wishes and Empowerment: “Because it’s more dangerous! Anyway, I wouldn’t want to not be able to deliver my babies myself; I wouldn’t miss them for the world!” Overwhelmingly, mothers desire to experience the birth of their child, even if it is painful. Techniques such as epidurals and regional anesthesia help manage the pain without fully anesthetizing the mother. This allows her to participate in the birthing process and bond with the baby, creating an invaluable and memorable experience.

Active Participation: Childbirth is a natural process that often requires the mother to be awake and involved. Regional anesthesia is designed to keep the mother conscious and engaged throughout the labor and delivery. General anesthesia can disrupt the process, making it more prolonged and resource-intensive. The final stages, especially the pushing phase, require the mother to be awake and active, which is crucial for the baby's safe delivery. If the mother is unconscious, the use of forceps or vacuum extractors might be necessary, which can increase the risk of complications for both mother and baby.

Placental Anesthetic Absorption and Newborn Health

Placental Absorption: All anesthetic agents, with the exception of muscle relaxants, cross the placenta and can affect the baby. While regional anesthesia ensures minimal absorption, general anesthesia, even in short-term procedures like emergency Cesareans, can expose the newborn to significant amounts of anesthetic, leading to the need for resuscitation. To minimize these risks, general anesthesia is reserved for emergencies. In other cases, regional anesthesia is preferred to avoid these complications.

The Real-World Impact

Healthcare System and Cost Considerations: Implementing general anesthesia for all childbirths would be extraordinarily costly. The United States, for example, already faces significant healthcare challenges, and the added cost of prolonged general anesthetic procedures would be immense. In first-world nations with free healthcare, this added financial burden would be unsustainable. Second and third-world nations, lacking the infrastructure to support such procedures, would be entirely unable to afford them.

Conclusion

The decision to use general anesthesia during childbirth is not taken lightly. While it can be a lifesaving measure in emergencies, its use during routine procedures is deemed too risky. Regional anesthesia, such as epidurals, offers a safer and more controlled method of pain management, allowing the mother to participate in the birth of her child, and ensuring the safety of both mother and baby. The ongoing debate and scientific advancements should continue to explore alternative methods that minimize risks and enhance the overall birthing experience.