Women's reported experience of conversion to general anesthesia for cesarean delivery with inadequate neuraxial anesthesia: a qualitative prospective multicenter Danish study

Background: The recommended anesthesia for cesarean delivery (CD) is neuraxial anesthesia. Pressure and movement are normal sensations during CD, but women should not experience intraoperative pain. However, some women do. The aim of this study was to investigate how women experience inadequate neuraxial anesthesia during CD that requires conversion to general anesthesia. Methods: Prospective, multicenter qualitative study. Women, who had experienced inadequate neuraxial anesthesia for CD and conversion to general anesthesia were interviewed three months after the CD and screened for posttraumatic stress. Interviews were transcribed and analyzed using manifest content analysis. Results: During seven months, 23 women were included, and 21 interviewed. Three themes were identified, “The experience of inadequate neuraxial anesthesia in CD”, “Not what I had expected” and “Living with the consequences”. The women found the testing of the neuraxial block complicated, described the intraoperative pain explicitly, felt unprepared for general anesthesia, and felt that they missed out on their delivery, which often complicated their bonding with the baby. Unanswered questions regarding anesthesia were frequent. In total, four (19%) women screened positive for posttraumatic stress, and 11 (52%) for symptoms of it. Conclusion: Intraoperative pain during CD necessitating general anesthesia can severely affect women's delivery experience, their early bonding with the baby and might increase the risk of posttraumatic stress. Anesthesiologists might mitigate this by providing sufficient information, before, during and after the CD, acknowledge and react to intraoperative pain while not transferring responsibility for clinical decision onto the woman, and offer follow-up consultations.