Introduction
The recommendations provided in this guideline focus on analgesia and anesthesia during labor, anesthesia for cesarean section, analgesia after birth, and anesthesia during surgery for breastfeeding women. In addition, the guideline provides vital information regarding the agents that are used for pain management. This article focuses on the guidelines on anesthesia for cesarean section concept.
A Brief Overview of the Guideline
The guideline was revised in 2012 with the aim of suggesting recommendations that would guarantee safe, as well as the proper application of pharmacological agents, anesthesia, and pain relief, particularly in females who are breastfeeding during labor. It also includes postpartum mothers and those who are lactating during a surgical operation. The guideline targets women in labor pain, painful postpartum period, as well as breastfeeding mothers who have already been subjected to a surgical procedure. Among the outcomes that are considered in this guideline include pain management, events in the breastfed newborn that could pose adverse effects as a result of treatment, milk drug levels, and the safe initiation and continuation of breastfeeding.
Anesthesia for C-Section
Summary
The guideline hereby recommends that regional anesthesia; that is, epidural or intrathecal, should be preferred for general anesthesia. Further, the mother and the infant ought not to be separated longer than is inevitable. Instead, the newborn can begin breastfeeding even in the operation room. It is advisable to commence breastfeeding while the mother is in the recovery room because the surgical wound is still under anesthesia. Finally, the guideline recommends that mothers who have undergone general anesthesia are ready for postoperative breastfeeding immediately they get alert enough to hold the newborn (Montgomery, Hale, & Academy of Breastfeeding Medicine, 2012).
How Anesthesia for C-Section Could Improve the Working Environment
Improved Pain Management
These guidelines are definitely indispensable. The rate of cesarean births is on a steady increase. This is accompanied by painful experiences; therefore, guidelines on pain management are very vital because mothers are expected to breastfeed immediately they have delivered. According to the CDC report of 2005, 30.2% of women undergo a cesarean section. This is a 46% increase from the 1996 statistics (Hamiliton, Martin & Ventura, 2006). This high rate is worrying owing to the fact that cesarean section has been associated with maternal and newborn morbidity, mortality, depression, and low maternal satisfaction, among other experiences (Nolan & Lawrence, 2009).
The bonding between the mother and the newborn is very crucial; thus, the longer the postoperative pain, the longer the separation between the mother and the infant. This results in poor bonding that apparently affects the connection between the two even in later years because the foundation for bonding spans from pregnancy through the post-delivery period (Young, 2013). Ross (2012) argues that the level of the bonding between the mother and the fetus is manifest in the mother’s self-sacrificing acts to ensure safe delivery, as well as the health of the child. This further cements the importance of having safer and better delivery methods.
Mothers who go through a C-section during delivery have a lot of pain in the initial days after the operation (Karlstrom et al., 2009). This is very detrimental because it directly affects the post-delivery events. Breastfeeding and caring for the newborn during the recovery phase of a C-section is important. However, this is adversely affected by the post-operative pain that the mothers may be subjected to. Karlstrom et al. (2009) report that when women are subjected to high levels of pain, regardless of the mode of cesarean section employed, it substantially affects breastfeeding and newborn care negatively. In this study, women who had experienced high levels of pain post-surgery exhibited poor breastfeeding and childcare significantly.
Safety
The safety of patients is of great concern for those who provide prenatal health care for women during labor, pregnancy, and childbirth. It is more complex to deal with pregnant mothers because one deals with two parties. If the mother’s wellbeing is compromised, then the infant’s health is bound to be affected too (Gaiser, 2009). A study conducted by Karlstrom et al. (2009) found that a substantial number of women have difficulties in breastfeeding and child care due to post-operative pain. On the other hand, low levels of pain after a cesarean section facilitated better breastfeeding, as well as the care for the infant. Pregnant women differ significantly from non-pregnant ones, both physiologically, as well as anatomically; therefore, they are bound to experience more complications.
It should be noted that women who have undergone a cesarean section are expected to adopt motherhood immediately after recovery from the surgery. However, as noted, this is not possible if they are subjected to high levels of pain. Therefore, it is very important for the post-operative pain relief to be properly applied to ensure optimal pain relief. Chung and Lus (2003) found out that post-operative pain slows recovery and it can result in complications like impaired respiration, venous thrombosis, and immobility, among others. Postoperative pain is accompanied by physical limitations that affect the early days of a mother who is breastfeeding.
Cost
It is advantageous to have an improved post-operative pain management approach in as far as finances are concerned. In Sweden, for instance, Källén, Rydström, and Otterblad-Olausson (2005) found out that cesarean section birth lengthened the period of hospital stay by two days in comparison to vaginal birth. This had financial implications because the longer the stay in the hospital, the more the financial expenses incurred. However, the study by Karlstrom et al. (2009) discovered that optimal pain relief reduced the period of hospital stay by one day. This is beneficial to both the woman and her family and the hospital, as well.
Applying Anesthesia for C-section
Local anesthesia is better than general anesthesia. Gaiser (2009) argues that regional application of epidural anesthesia promotes a pharmacological sympathectomy that could lower blood pressure, as well as delay a compensatory reaction to supine and hypotension syndrome. It is, thus, important to ensure safe regional anesthesia. This calls for specialized education and competence. Karlstrom et al. (2009) report that the pre-operative, as well as the post-operative pain experience is greatly improved for the women who are undergoing a cesarean section when opioids are added to spinal anesthesia. The same study found out that the change in the anesthetic routine yielded significantly better results with regard to pain relief for the women subjected to cesarean section. This provided for easier transition to motherhood even a day after the surgery.
Conclusion
The guidelines for anesthesia for the mothers undergoing cesarean birth are very important as demonstrated in the discussion above. It is notable that post-operative pain has serious consequences on the infant care after birth and possible complications for the mother. Furthermore, financial expenses are incurred, whereby the longer the period of pain, the more expensive the procedure turns out to be. It is, therefore, crucial for anesthesia to be improved in cesarean births. Specialized, as well as competent care should also be considered to ensure safe and better management of post-operative pain.
References
Chung, J., & Lui, J. (2003). Postoperative pain management: Study of patients’ level of pain and satisfaction with health care providers’ responsiveness to their reports of pain. Nursing & Health Sciences, 5(1), 13–21.
Gaiser, R. (2009). “Physiologic changes of pregnancy.” In D. H. Chestnut, L. S. Polley, L. C. Tsen, & C. A. Wong (Eds.), Chestnut’s obstetric anesthesia: Principles and practice (4th ed., pp. 15–36). Philadelphia, PA: Mosby Elsevier.
Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2006). Births: Preliminary data for 2005. National Vital Statistics Report, 55(11), 1-20.
Källén, K., Rydström, H., & Otterblad-Olausson, P., (Eds.). (2005). Kejsarsnitt i Sverige 1990–2001 (Caesarean Sections in Sweden 1990–2001). Epidemiological Center, Swedish National Board of Health and Welfare, Stockholm.
Karlstrom, A., Engstrom-Olofsson, R., Nystedt, A., Sjoling, M., & Hildingsson, I. (2009). Women’s postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesarean section. Journal of Clinical Nursing, 19(9-10), 1326-1334. Web.
Montgomery, A., Hale, T. W., & Academy of Breastfeeding Medicine. (2012). ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding mother, revised 2012. Breastfeeding Medicine, 7(6), 547-553. Web.
Nolan, A., & Lawrence, C. (2009). A pilot study of a nursing intervention protocol to minimize maternal-infant separation after cesarean birth. J Obstet Gynecol Neonatal Nursing, 38(4), 430-42. Web.
Ross, E. (2012). Maternal-fetal attachment and engagement with antenatal advice. British Journal f Midwifery, 20(8), 566-575.
Young R. (2013). The importance of bonding. International Journal of Childbirth Education, 28(3), 11-16