Anaesthesia Product News

Dear Editor,

Subject: Elective caesarean section under spinal anaesthesia: the partner’s perspective

Elective caesarean section is a stressful event for a pregnant women and much focus has rightly been placed on improving this experience. The partners, however, have received much less attention in the literature. We chose to focus on the partner’s perceptions of spinal anaesthesia itself in the context of elective section. In our unit, it remains most common practice not to admit the partner into theatre until the spinal block is established. National practice appears to favour the partner being present throughout². We, therefore chose to ask the partners’ opinion. One previous study sought to measure stress levels in partners of women undergoing elective caesarean section under regional anaesthesia¹.

So we devised a short questionnaire and the partners of women attending for elective caesarean section were asked to complete the questionnaire by the duty anaesthetist during the 24 hours following the procedure. The questions related to their prior knowledge of the procedure, any concerns they held and preference for being present or not during the spinal procedure. Verbal consent was gained, refusal being the only exclusion criterion. The forms were anonymous.

33 questionnaires were collected over a 3-month period and the results were as follows:

	Yes (%)	No (%)
Had the partner attended antenatal clinic?	22 (66.6)	11 (33.3)
Had the partner heard about spinals prior to admission?	30 (90.9)	3 (9.1)
Could the partner briefly describe a spinal*?	25 (75.8)	8 (24.2)
Had the partner any concerns about the spinal?	12 (36.4)**	21 (63.6)
Would the partner have liked to be present during the spinal?	19 (57.6)***	13 (39.4)

*Eg. “an injection into the spine to numb the lower body”.
**7 (21.2%) were concerned about spinal damage or paralysis, 3 (9.1%) about their partner’s wellbeing and 2 (6.1%) about “something going wrong”.
***6 partners (18.2%) were actually present for the spinal procedure. 1 did not answer this question.

We found that only 36.4% of the partners surveyed stated concerns relating to the spinal anaesthetic compared to 52.7% expressing anxiety about anaesthesia in the previous study¹. Most of the partners in our study had heard about spinal anaesthesia prior to the day of admission and could give a brief description of the procedure. The concerns most often raised by the partners in our study related to the risks of spinal damage or paralysis. This is not really surprising given the implications despite the very small risk of these complications. Indeed, the risks of regional anaesthesia that women most commonly recalled in another study were headache, paralysis and nerve damage³.

It has been shown that maternal fear and anxiety is greatest at the point of administration of the spinal block⁴ therefore this may be the time at which the partner can be of greatest support. Given this it may be appropriate to consider a policy of at least inviting all partners to be present throughout the procedure. We found that of those partners not invited or requesting admittance, half would have preferred to be with their partner during the spinal. A substantial number, however, 39.4 % of the overall sample, would not want to be present so we should not expect all partners to accept our invitation.