Prior to surgery, the obstetrician will take a medical history and perform a physical examination to evaluate the overall physical health of the patient as part of her prenatal care, especially if the Caesarean section is planned in advance. During the presurgical consultation, the surgical technique, the type of anesthesia to be used and the patient’s expectations are normally discussed.

If the C-section was planned, the expecting mother will most likely meet with an anesthesiologist prior to the procedure. This meeting is an opportunity to discuss the options for anesthesia. It is also a good time to discuss any concerns or known disorders with the anesthesiologist including coagulopathy (clotting disorder), obesity, any abnormalities of the spine, as well as a personal history of cardiovascular or respiratory diseases.

The type of anesthesia will be determined based on the condition of the mother and her baby. It will also depend on the reasons for the Caesarean delivery (e.g., in emergencies general anesthesia may be necessary). The three most common options include:

• Spinal anesthetic. This form of anesthesia is administered at the subarachnoid space in the lower back, which contains the cerebrospinal fluid. This causes total numbness, but the mother is still awake.
  
  
• Epidural anesthesia. When this type of anesthesia is used, the medication is injected in the epidural space that surrounds the fluid-filled sac around the spine. This form of anesthesia numbs the mother’s abdomen and legs.
  
  
• General anesthesia. This form, which keeps the mother asleep during the entire procedure, is used less often.

Patients may be asked to donate blood in case a transfusion later becomes necessary, although it is unlikely. Patients are typically asked to refrain from eating or drinking for eight to 12 hours prior to surgery.

Before the procedure, the patient will be prepared for surgery. This includes the abdomen being prepped with special antiseptic solutions and occasionally shaved. A catheter (small tube) is also placed in the bladder, allowing urine to empty into it. Other preparations will include a small tube being placed in the vein of the patient’s arm to allow for fluids and medications, including possibly anesthesia, during surgery.

Prior to the procedure, the woman’s arms are often secured to the table for her own safety. Depending on the standard procedures of the individual physician, the patient may be given an oral dose of an antacid to lower the amount of acid in the stomach. It is also possible that the patient will be given medication to decrease the amount of secretions of the mouth and nose.

Shortly before the anesthesia is administered, a curtain is hung across the woman’s chest to prevent any adverse reaction by the patient or her spouse in viewing the procedure, and to maintain a sterile operating field. At all times, the patient’s blood pressure, heart rate and rhythm and blood oxygen level are monitored closely.