A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
I love to see the pure joy that floods over mothers as they hear their new baby’s first cry! The ability to help make childbirth safer for mothers and babies led me to a career in obstetric anesthesiology — in the high-risk, high-reward environment of the labor and delivery department.
I first met the Tuckers, a couple in their late 30s, as they waited in the holding area for a planned cesarean delivery. The husband paced, while soon-to-be mother swiped her phone searching for distraction. They’d tried a dozen years for a baby and couldn’t wait to finally meet him. Excitement built in the operating room—their baby was breech, meaning a cesarean delivery would be necessary. “Uterine!” I heard, signaling delivery would follow soon. A baby bottom, legs, and arms squeezed out. With some twists, pushes, and pulls, out he came. I knew immediately he wasn’t going to cry.
One of the best OB nurses I’ve ever worked with aggressively stimulated him. Nothing. He was like a blue ragdoll, heart beating dangerously slow, and not responding. As our team of three quickly worked, I heard the familiar screech of overhead alarms, signifying an unfolding emergency and calling others to help. I placed a mask over his tiny face and began breathing life into his lungs. His heart rate slowly climbed, then a breath, and finally, his first cry!
The rapid progression of obstetric anesthesiology has helped provide excellent care for women and babies. However, dramatic, life-threatening events still unfold. Physician anesthesiologists, who have extensive critical care training, are experts at crisis management and saving lives. Mothers – this is the person you want taking care of you when seconds count during labor and delivery.
Across the country, obstetric anesthesiologists are leading patient safety initiatives and implementing protocols to save women’s lives. They are tackling maternal mortality, racial disparity in maternal care, high blood pressure, blood clots, and severe bleeding by implementing hemorrhage protocols and carts.
As experts in pain control, physician anesthesiologists are leading efforts to confront the national opioid crisis. They are working to ensure labor and delivery pain is controlled, while exploring ways to reduce postpartum opioid prescriptions, many of which go unused. A colleague of mine who is an obstetric anesthesiology fellow at Vanderbilt University in Nashville hopes personalized care will prevent excess opioid prescriptions. Dr. Britany Raymond is set to unveil a new formula which predicts the number of pills postpartum patients need prescribed based on the amount of pain medication they used while in the hospital. For its part, the American Society of Anesthesiologists (ASA) is exploring mothers’ perception of labor and delivery pain with a national survey. Together, these efforts will help to further ensure women have their labor pain treated compassionately, safely, and with their expectations met.
The varied and critical role of obstetric anesthesiologists is recognized by the American College of Obstetricians and Gynecologists in its Levels of Maternal Care guidance, a document which describes the resources a hospital needs to safely care for pregnant patients at increasing levels of complexity. A physician anesthesiologist with special obstetric training must be available in every setting, except for birthing centers. Hospitals are widely adopting the guidance.
On Mother’s Day, we celebrate the most important women in our lives. We must remember and honor those we have lost – an estimated 800 women in the United States die each year from pregnancy-related causes — and black women are 3 to 4 times more likely than white women to die in childbirth. The death of these women has profound effects on their families and communities. Celebrate their memories and honor their lives by advocating for better women’s health care and the best team watching over every important woman in our lives! As for the Tuckers, a beautiful baby boy met his parents for the first time just minutes after delivery, they returned home on schedule and are enjoying the family they waited so long to have.
James Lozada is an anesthesiologist.
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