SOAP: Celebrating 40 Years of Service

he Society for Obstetric Anesthesia and Perinatology (SOAP) will celebrate 40 years as an organization at our next Annual Meeting, scheduled from April 30 to May 4, 2008, at the Renaissance Chicago Hotel, Chicago, Illinois.

It was in Chicago that the founding fathers of SOAP met 40 years ago to form a society dedicated to the well-being of women and newborns. Our founders provided a forum for discussion for all physicians involved with the care of the parturient: anesthesiologists, obstetricians and pediatricians. As we celebrate this milestone anniversary, it is time for reflection. For us to judge how far we have traveled since our inception is to measure how much further we must go. In a time when anesthesiology is being steadily Balkanized into increasing special interest groups and societies, it is time to examine if we do have a Raison d’être. If at its core is the principle “Make every mother and child count,” then our Society has both a place and a meaning.

Maternal mortality in the United States, despite the highest per capital medical expenditure, lags woefully behind those of other developed countries. The Centers for Disease Control and Prevention reports in 1990-1999 that the U.S. maternal mortality was approximately 12/100,000 live births, almost two times more than our neighbor Canada.¹ This is significantly higher than the goal set by the U.S. Department of Health and Human Services in “Healthy People 2010,” which set a target for maternal mortality at less than 3.3/100,000 live births.² While this is undoubtedly multi-factorial, uneven access and delivery of quality health care are major factors. With this in mind, we as a Society have at our core these obligations:

• To further the science and practice of obstetric anesthesiology.

• To disseminate this information to the practitioners of obstetric anesthesiology to ensure safer and more scientific practice for all physicians who deal with a parturient.

• To nurture new graduates in our field.

We have, to a measure, done this. Through our commitment to both basic and clinical sciences, we have focused our continuing medical education (CME) program to cross specialties. SOAP has shown leadership at a professional level by integrating multidisciplinary lecturers in our core CME program, “What’s New in Obstetrics,” and more recently, “What’s New in Obstetric Medicine.” Cross-pollination at a professional level is key, as increasing evidence is generated that near-misses can be avoided by improving interdisciplinary communication.³

SOAP has shared this view for a long time, evidenced by obstetricians, neonatologists and maternal fetal medicine physicians participating in the meeting and as past board members of our Society. Most of these achievements have been possible due to the vision of our founding members, close friendships among Society members and a commitment to improve patient safety.

As we enter the 21st century, however, we do have to increase our footprint and recognize that a Society with merely a parochial attitude risks sinking under the weight of its own irrelevance. We must strive to improve impact within the geographical boundaries of the United States and then step boldly beyond, bringing closer the day when every cradle has a mother’s loving hand to rock it and every child has a decent chance to reach his/her full potential.

Disparity in the United States fades into insignificance when compared to the huge disparity in the world, with the lifetime risk of maternal death being as high as one in seven in Afghanistan. Admittedly, geopolitics plays a role, and the ones who suffer are always the most vulnerable; however, there is no wrong without a remedy. To tackle global maternal mortality, SOAP established and supported its outreach program, together with the assistance of the Obstetric Anaesthetists’ Association in the United Kingdom and Kybele (a nonprofit organization promoting maternal welfare in developing countries). Turkey, Croatia, Brazil, Ghana, the Republic of Georgia and the Republic of Armenia have all had teams of obstetric anesthesiologists working within the infrastructure of the hosts to contribute in protocols that can be sustained and promoted by the locals. This effort has resulted not only in the improvement of the parturient but has given support to the awareness of the special needs of women in their societies. This is not a one-way gift; it is a great opportunity to learn lessons from other countries where infrastructure and practice patterns are different such that parturients present with new challenges related not only to the medical condition but also social, economic and cultural differences. These lessons learned are applicable to all.

In the journal Pediatrics, there is a multicenter trial indicating that communication between obstetrics and pediatrics improves fetal outcome.⁴ Four common causes of obstetric emergencies are fetal distress, uterine rupture, shoulder dystocia and misdiagnosis of rare but lethal events.⁵ In most cases, failure to recognize and initiate rescue therapy could have been avoided had the team discussed the management of labor and delivery.

SOAP has faced these challenges by conducting integrated workshops on high-risk obstetrics presented by a multispecialty team, each emphasizing the important issues guiding the overall care of the parturient. We have further taken this into simulation sessions where participants can experience firsthand the frustrations of poor communication. This is not a fad but is an important tool in learning crew resource management and conflict resolution skills. The future of simulation is closely linked to improvement of communication and an appreciation of specialty priorities. To orchestrate the quality of care, SOAP formed a standing committee focused on patient safety.

Reputation and learning are akin to capital assets; like the goodwill of an old partnership, SOAP has formed professional alliances with the North American Society of Obstetric Medicine and the Society of Maternal Fetal Medicine, focusing on multidisciplinary collaboration. As CME evolves from one anesthesiologist teaching another, it is time for all of us to envision the endpoint of CME. I would hope that we can show an improvement of patient care rather than a collection of feel-good evaluations. When our labor and delivery colleagues learn about our concerns, they are more likely to alert us to potential problems early. Our specialty will still be reactionary rather than proactive in obstetric emergencies, but with time for early intervention.

It is increasingly recognized that pain amelioration is a right rather than a privilege. “The unreasonable failure to treat pain is poor medicine, unethical practice, and is an aberration of a fundamental human right.”⁶ The quintessential role of obstetric anesthesiologists will come under ever-increasing demand and appreciation — with that, we need to acknowledge and heed the ASA Practice Guidelines for Obstetric Anesthesia to ensure that we meet the expectations of our patients.⁷ With this dedication, we continue to maintain that every woman should have access to safe, effective pain relief during childbirth.

We welcome our newly formed Resident Committee and Resident Presentation Forum. At the 2007 meeting in Banff, Canada, 120 students, residents and fellows displayed their scholarly activities, thus adding to the induction of new talent to the pursuit of improving maternal care through education, research and practice. By providing opportunities for innovation and supporting talented young stars with research grants, SOAP is investing in the future.

For all in medicine who look after women, SOAP is a unique learning forum that brings all specialists together to help patients. Our future looks as strong as do our accomplishments over the last 40 years. In keeping with our foundation — wherein James O. Elam, M.D. (Chicago Lying-In Hospital) said, “The purpose of such a society might include the education of physicians on the safe practice of obstetric anesthesia, (education of) the public on their right to receive the best possible care, and the stimulation of intellectual development of OB anesthesia” — I welcome you to join us and celebrate the pursuit of a noble mission in maternal well-being at our Annual Meeting in Chicago, on April 30 to May 4, 2008. SOAP: 40 years and on … .


References:
1. Chang J, Elam-Evans LD, Berg CJ, et al Pregnancy-related mortality surveillance — United States, 1991-1999. MMWR Surveill Summ. 2003; 52:1-8.
2. Christiansen LR, Collins KA. Pregnancy-associated deaths: A 15-year retrospective study and overall review of maternal pathophysiology. Am J Forensic Med Pathol. 2006; 27:11-19.
3. McDonald PW, Viehbach S. From evidence-based practice making to practice-based evidence making: Creating communities of (research) and practice. Health Promotion Practice. 2007; 8:140-144.
4. Zabari M, Suresh G, Tomlinson M, et al. Implementation and case-study results of potentially better practices for collaboration between obstetrics and neonatology to achieve improved perinatal outcomes. Pediatrics. 2006; 118 (suppl 2):S153-158.
5. Mavroforou A, Koumantakis E, Michalodimitrakis E. Physicians’ liability in obstetric and gynecology practice. Med Law. 2005; 24:1-9.
6. Brennan F, Carr DB, Cousins M. Pain management: A fundamental human right. Anesth Analg. 2007; 105:205-221.
7. Hawkins JL. American Society of Anesthesiologists Practice Guidelines for Obstetric Anesthesia: Update 2006. Int J Obstet Anesth. 2007; 16:103-105.

Gurinder M. Vasdev, M.D., F.R.C.A., is Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota.