Regional anaesthesia, typically with a spinal or epidural block, has long been favoured for Caesarean births, due partly to concerns about the effects general anaesthesia may have on newborns during labour and delivery.
Powerful societal pressures also push the idea that mothers need to be awake during delivery to witness the first cry and capture the “perfect” birth moment. But for some women who undergo a Caesarean birth, the pain can become excruciating, even after a spinal or epidural block.
Now, research from a team at the Perelman School of Medicine at the University of Pennsylvania suggests that general anaesthesia may be a reasonable and safe alternative for many patients, according to their findings published in Anaesthesiology, the peer-reviewed medical journal of the American Society of Anaesthesiologists.
“No patient should have to experience pain during a C-section; as an anaesthesiologist, I never want someone to feel forced to choose between their baby’s health and not having to experience the pain of surgery,” said Mark Neuman, MD, MSc, the Horatio C Wood Professor of Anaesthesiology and senior author of the study.
“Since regional anaesthesia is so widely used, it’s common for patients to feel that a spinal or epidural block is the only safe option for C-section, but as our study shows, anaesthesia type during pregnancy does not need to be one-size-fits-all.”
Reducing pain
The research analysed 30 years’ worth of data from multiple clinical trials, comparing outcomes between general anaesthesia versus spinal or epidural anaesthesia for Caesarean sections.
The Penn study found that, while babies born under spinal or epidural anaesthesia had slightly higher Apgar scores than those born under general anaesthesia, the differences were small and not likely to be clinically meaningful.
While most patients experience good outcomes with spinal or epidural block for C-section delivery, recent studies show that up to one in six patients who receive an epidural or spinal may feel pain during their Caesarean, which can be traumatic and have lasting emotional impacts.
The findings come amid growing public discourse on Caesarean experiences. Recent podcasts and published news stories have featured candid patient accounts of pain under spinal or epidural anaesthesia.
“This study equips women with evidence-based context about the use of general anaesthesia during C-section.” said Sarah Langer, MD, a resident in anaesthesiology at the Perelman School of Medicine and lead author the study. “Childbirth is a physically and emotionally demanding process, but we do not want patients to feel as if there aren’t options when it comes to their anaesthesia for C-section.”
Broadening evidence-based choices
The study found that babies born under general anaesthesia were slightly more likely to need breathing support immediately after birth, but there was no increase in NICU admissions. The research does not suggest that general anaesthesia should replace regional techniques, but it can be a reasonable option in certain cases.
“For patients who are open to regional anaesthesia, spinal or epidural block remain great first choice options,” Neuman noted. “But having conversations with patients about general anaesthesia doesn’t need to be taboo. Patients deserve to know they have options, and our study helps provide the evidence to support those discussions.”
Study details
Neonatal Outcomes with Regional versus General Anaesthesia for Caesarean Delivery: A Meta-analysis of Randomised Controlled Trials
Langer, Sarah; Lim, Grace; Qiu Yue; Biaesch, Jingyuan; Neuman, Mark.
Published in Anaesthesiology on 12 November 2025
Abstract
Background
Neonatal outcomes with regional anaesthesia (spinal, epidural, or combined spinal–epidural) versus general anaesthesia for Caesarean delivery remain poorly characterised. The authors performed a meta-analysis of randomised trials to compare neonatal outcomes associated with each technique. They hypothesised that regional anaesthesia would be associated with higher Apgar scores and less need for respiratory support and neonatal intensive care after delivery.
Methods
The authors searched randomised controlled trials comparing regional versus general anaesthesia for patients undergoing Caesarean delivery between January 1994 and November 2023. They abstracted information on study characteristics, Apgar score at 1 and 5 min, need for respiratory support after delivery, and need for neonatal intensive care. They analysed summary data using random effects models and assessed risk of bias using the Cochrane Risk of Bias 2 scale.
Results
A total of 36 studies involving 3,456 neonates were included. Of the neonates, 42.7% (n = 1,476) were born to parturients who underwent general anaesthesia, and 57.3% (n = 1,980) were born to parturients who underwent regional anaesthesia. Apgar scores at 1 and 5 min were slightly higher after regional versus general anaesthesia (mean difference at 1 min, 0.58 points; 95% CI, 0.36 to 0.79; P < 0.001; mean difference at 5 min, 0.09 points; 95% CI, 0.05 to 0.13; P < 0.001). Respiratory support was less often required with regional anaesthesia (risk ratio, 0.62; 95% CI, 0.40 to 0.94; P = 0.03). Need for neonatal intensive care did not differ across techniques (risk ratio, 0.75; 95% CI, 0.46 to 1.21; P = 0.24). All studies had high or unclear risk of bias.
Conclusions
Regional anaesthesia for Caesarean delivery is associated with slightly higher Apgar scores and less frequent need for neonatal respiratory support than general anaesthesia. Additional studies are required to determine associations of anaesthesia technique with need for intensive care and longer-term outcomes.
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