A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.
As leaders in patient safety, anesthesiologists are committed to improving patient care and positively impacting the experiences of expectant mothers to ensure the health and safety of mom and baby. Along with primary health care providers, anesthesiologists are available to help expectant mothers develop a plan to have the best possible labor and delivery experience.
Not only are we the physicians who lead the anesthesia team to ease labor pain during childbirth, but we take care of mom and baby to set them up for health success when they go home.
Anesthesiologists have their patients’ backs! Literally and figuratively.
Anesthesiologists play a key role in pregnant women’s short- and long-term health. Not only do we ease their labor pain, but we help manage and minimize health effects of pregnancy, such as chronic pain after delivery, and opioid addiction following Cesarean delivery. We’re also at the forefront of preventing maternal mortality and morbidity and addressing racial and ethnic disparities prevalent within maternal health care.
We help plan women’s pain management after childbirth.
Acute pain after surgery or delivery has been associated with greater risks of chronic pain and postpartum depression, and we are continually working to improve provider and patient education and treatment choices. Anesthesiologists have standardized care plans to decrease and control pain after delivery, such as providing various types of medications at once (known as multimodal analgesia) and enhanced recovery after Cesarean. Even a severe positional headache or “spinal headache,” an uncommon complication resulting from an epidural or spinal anesthesia, can have long-term side effects if left untreated (see the American Society of Anesthesiologists’ [ASA] statement on post-dural puncture headache management).
Sadly, 1 in 300 women who have a Cesarean delivery still take opioids one year later. We encourage patients to take the time to learn how they can optimize their pregnancy health and review their options for pain relief during and after delivery. Together with their anesthesiologist and primary health care providers, they can discuss and decide what types of pain relief might be best, also known as “shared decision making,” and express their concerns or fears about postpartum depression. Decisions made with the patient’s health care team, in addition to standardized protocols involving routine acetaminophen and anti-inflammatories, has been shown to decrease opioid consumption after delivery and reduce long-term opioid use.
We help prevent maternal mortality and morbidity.
What patients may not see or even be aware of is that anesthesiologists actively plan and participate in ways to reduce serious maternal morbidity (e.g., blood transfusions or intensive care unit admission) and mortality. We examine adverse events to identify the systemic root causes of these serious issues and provide solutions to improve care at the hospital and state levels.
For example, a state perinatal quality collaborative reduced severe maternal morbidity from hemorrhage in California. Additionally, we’ve helped recognize and treat preeclampsia/high blood pressure during pregnancy and responded to the need for specialized labor and delivery equipment, such as rapid transfusers to combat hypothermia and blood loss, and video-laryngoscopes for assistance intubating, as pregnant women have a higher incidence of difficult intubations (placement of breathing tube).
We help address health care disparities.
Unfortunately, we continue to combat increasing maternal mortality across the nation, as well as racial, ethnic, and socioeconomic disparities within maternal health care. A recent Centers for Disease Control and Prevention report shows the overall maternal death rate in the U.S. rose from 20.1 deaths per 100,000 live births in 2019 to 23.8 deaths per 100,000 in 2020, marking an 18% increase. For non-Hispanic Black women, that number jumped to 55.3 deaths per 100,000 live births.
Black women are three to four times more likely to die from pregnancy-related causes than white women and are at a higher risk of severe maternal morbidities. Additionally, Black and Hispanic women in the U.S. are less likely to receive epidural analgesia for labor pain than white women.
In October 2021, ASA’s Committee on Obstetric Anesthesia issued recommendations for reducing racial and ethnic disparities in maternal anesthesia care, which can be summarized in five themes: 1) Measuring disparities; 2) Recognizing disparities at personal and systems-levels; 3) Increasing awareness of the magnitude of disparities; 4) Overcoming communication barriers; and 5) Addressing differences in the structure of care. The use of standardized protocols, like the Society of Obstetric Anesthesia and Perinatology’s Consensus Statement and Recommendations for Enhanced Recovery after Cesarean, can help reduce health care disparities as well.
Mark Zakowski is an obstetric anesthesiologist.
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