Women's experience of pain during cesarean delivery due to inadequate neuraxial anesthesia without conversion to general anesthesia: a qualitative study

BACKGROUND: Neuraxial anesthesia is the preferred technique for cesarean delivery, yet some women experience inadequate anesthesia and intraoperative pain. Little is known about the experiences and consequences when conversion to general anesthesia does not occur. This study explored women's experiences of intraoperative pain during cesarean delivery without conversion to general anesthesia. METHODS: This qualitative study included women who experienced inadequate neuraxial anesthesia during cesarean delivery without conversion to general anesthesia within the previous four years. Participants were recruited via social media, underwent semi-structured interviews and post-traumatic stress screening, and interview transcripts were analyzed using manifest content analysis. RESULTS: Twenty-five women were interviewed. Three themes were identified, "the experience of intraoperative pain", "information and communication is crucial" and "consequences". Pain ranged from discomfort to extreme pain, sometimes accompanied by fear of death. Most women were unaware that conversion to general anesthesia was an option and were reluctant to undergo it. Communication with the anesthesia team before, during, and after the CD was deemed crucial, yet most received no follow-up and lacked documentation in medical files. Many participants screened positive for post-traumatic stress or symptoms of it. CONCLUSION: Intraoperative pain during cesarean delivery without conversion to general anesthesia varies in severity but may lead to long-term psychological distress, loss of trust in healthcare, and avoidance of future pregnancies. Participants expressed a wish for timely information, a clear and explicitly communicated plan for managing intraoperative pain, and systematic follow-up by the anesthesia team if inadequate neuraxial anesthesia occurs during cesarean delivery.