Patients' Anesthesia Preferences for Cesarean Delivery: Exploring the Role of Personality Beliefs in Spinal vs. General Anesthesia

Cesarean deliveries (CD) under general anesthesia continue to be common in many countries, though the practice varies in frequency. In the United States, about 5.8% of CDs are performed under general anesthesia. In Europe, the rate is higher in some countries, with 10% in Germany, 30% in Spain, and 34% in the Czech Republic. The exact rate in the study's country is not known but is assumed to be high. Clinical guidelines suggest that neuraxial anesthesia (spinal or epidural) should be the preferred choice for CD unless there are specific contraindications. This recommendation stems from the increased risks of general anesthesia, which include airway complications, aspiration risks, significant blood loss, and the potential for intraoperative awareness.

General anesthesia may still be a suitable option when spinal anesthesia is contraindicated or in cases with severe complications such as fetal bradycardia, uterine rupture, heavy bleeding, or placental abruption. Despite these risks, many patients still choose or are administered general anesthesia, often rejecting neuraxial anesthesia. The use of general anesthesia for CD carries higher risks of anesthesia-related complications, surgical site infections, and venous thromboembolism. This highlights the need to minimize the unnecessary use of general anesthesia by better understanding the factors that influence patients' anesthesia preferences.

One of the most common reasons patients refuse regional anesthesia (spinal or epidural) is the fear of spinal injury, concerns about the pain from the needle insertion, or anxiety about witnessing the surgical procedure. On the other hand, those who opt for regional anesthesia often cite the fear of not waking up from general anesthesia and the desire to remain conscious during childbirth. Research also suggests that anxiety levels are linked to the choice of anesthesia, though previous studies have yielded conflicting results.

Study Hypothesis and Aim: The study hypothesizes that patients' anesthesia preferences during CD might be influenced by their personality traits. While no prior studies have examined the relationship between personality traits and anesthesia preferences specifically in CD patients, some studies have explored the impact of personality on maternal delivery preferences (whether a woman chooses CD or vaginal delivery). The primary aim of this study is to compare the personality belief scores of expecting mothers who undergo CD with either general or spinal anesthesia, according to their preferred anesthesia type.