Maternal sedation during scheduled versus unscheduled cesarean delivery: implications for skin-to-skin contact

• WHO and UNICEF recommend early skin-to-skin contact to promote breastfeeding.
• Maternal sedation may impact safety of skin-to-skin contact in the operating room.
• Women are more sedated during unscheduled than scheduled cesarean deliveries.
• Sedating medications to treat side effects should be used judiciously.
• Skin-to-skin protocols in the operating room should account for maternal sedation.

BackgroundEarly maternal skin-to-skin contact confers numerous benefits to the newborn, but maternal sedation during cesarean delivery could have safety implications for early skin-to-skin contact in the operating room. We compared patient-reported and observer-assessed levels of sedation during unscheduled and scheduled cesarean deliveries.MethodsLaboring women undergoing unscheduled cesarean delivery with epidural anesthesia, and scheduled cesarean delivery with spinal anesthesia were enrolled. Sedation levels, measured using patient-reported (1=least sedated to 10=most sedated) and observer-assessed (0=most sedated to 5=least sedated) scales, were evaluated at baseline and 15, 30, 45, and 60 min following a T4 sensory level. The primary outcomes were patient-reported sedation at 45 min and the areas under the sedation curves.ResultsPatient-reported levels of sedation were greater at 45 min in laboring women undergoing unscheduled (median 7.5, IQR 5–9) versus scheduled cesarean delivery (median 4, IQR 3–6) (difference in medians 3.5, 99% CI 0 to 5). Observer-assessed sedation was not different between groups. The area under the time curve for patient-reported sedation was greater in the unscheduled group, median difference 162 score min (95% CI 52 to 255). The area under the time curve for observer-assessed sedation was greater in the unscheduled group, median difference 26 score min (99% CI 0 to 41). Times to skin-to-skin contact and breastfeeding were not different.ConclusionsWomen undergoing unscheduled cesarean deliveries are more sedated than women undergoing scheduled cesarean deliveries. Skin-to-skin protocols for cesarean deliveries must consider maternal sedation and anesthesiologists should use sedating medications judiciously.