Paediatrician attendance at caesarean section

Five hundred and twenty term singleton infants delivered by Caesarean section were categorised into six groups according to type of Caesarean section (elective or emergency), type of anaesthesia (epidural or general) and presence of fetal distress. Infants delivered under general anaesthesia had a significantly higher incidence of respiratory depression at birth with Apgar scores < 7 at both 1 and 5 min (P < 0.00001), greater need for active resuscitation (intermittent positive pressure ventilation or bag and mask ventilation) (P < 0.000001) and a higher rate of neonatal unit admission (P < 0.00001). Caesarean sections for fetal distress were associated with a significantly higher incidence of intermittent positive pressure ventilation, but not bag and mask ventilation, for both the general anaesthesia and epidural groups (P < 0.003 and P < 0.02 respectively), indicating severe respiratory depression in some cases. Under epidural anaesthesia, both elective section and emergency section without fetal distress were low risk deliveries. By excluding the non-cephalic presentation cases in these two groups, the incidence of infants requiring active resuscitation was equivalent to the incidence quoted for spontaneous normal delivery.

Attendance by a paediatrician is not routinely required at epidural Caesarean section when the infant is cephalic and when there is no fetal distress. Every effort should be made to ensure that epidural anaesthesia is provided in preference to general anaesthesia.