Background In Denmark, approximately 20% of all children are born via cesarean section
(C-section), making it the most common surgical procedure (also internationally). The
recommended anesthesia for cesarean sections is regional anesthesia (spinal or epidural,
"spinal anesthesia"), as it has several advantages: the woman is awake and experiences
the delivery of her child, she maintains spontaneous breathing (the risk of difficult
airway management is significantly higher in pregnant women), and the risk of aspiration
of stomach contents into the lungs (which is clearly increased in pregnant women) is
reduced. Furthermore, regional anesthesia can contribute to early postoperative pain
management to some extent.
With spinal anesthesia, most women feel pressure and touch but no pain during the
cesarean section. However, some women do experience pain during the procedure,
necessitating a change in the plan. If inadequate anesthesia is detected before the
surgery begins, one may choose (depending on, for example, the urgency of the cesarean)
to administer renewed regional anesthesia (typically an epidural). However, if the woman
first experiences pain after the surgery has commenced, it is necessary to place her
under general anesthesia for the remainder of the procedure. Experience shows that this
process can be challenging, and there are frequent examples in clinical practice of
inappropriate courses of action, where women have experienced unacceptable pain during
their cesarean sections without being placed under general anesthesia. It is difficult to
obtain an exact figure on how many women experience inadequate anesthesia during cesarean
sections under regional anesthesia, as not all cases are recognized or followed up on.
Studies indicate that up to 12% experience pain during a cesarean section.
The consequences of inadequate anesthesia for cesarean sections can be quite significant
for women, including impaired bonding with the child, poorer establishment of
breastfeeding, increased risk of postpartum reactions and post-traumatic stress, as well
as (anecdotally) the risk of women opting out of future pregnancies, as they may be
reluctant to subject themselves to a similar situation again.
Aim The aim of this study is to investigate how women experience insufficient regional
anesthesia during cesarean sections that require conversion to general anesthesia. The
focus is on exploring the factors that contribute positively and negatively to the
woman's experience in this situation.
Method Qualitative study in six Danish hospitals.
Inclusion criteria:
Women undergoing elective or emergency cesarean section, aged over 17 years
Regional (spinal or epidural or combined epidural-spinal) anesthesia converted to
general anesthesia intraoperatively (i.e., after surgery has commenced) due to
insufficient regional anesthesia (i.e., not for obstetric indications, such as in
cases of difficult fetal extraction)
Exclusion criteria:
The woman will be contacted for the first time on day 1 or 2 after the cesarean section
(before she is discharged from the hospital). She will be informed about the project and
invited to participate. As a potential project participant, she is entitled to a 24-hour
consideration period, and if desired, a new contact will be arranged for the following
day. If she wishes to participate, she will be contacted again after 3 months. At this
time, she will receive a call to schedule a follow-up telephone interview within a few
days. This will take place as a semi-structured interview, initiated with open questions
and concluded with a few more specific questions. At the end of the interview, a
screening for post-traumatic stress will be conducted using the PTSD-8 tool. Follow-up
interviews will be recorded digitally and transcribed verbatim.
Sample Size The project encompasses all women at the participating centers who experience
insufficient regional anesthesia during a cesarean section and conversion to general
anesthesia during 1 year.
