The ASA Committee on Obstetrical Anesthesia serves the members of our great organization by fulfilling the following mission: to promote the best possible anesthesia care to mothers and their children during pregnancy and childbirth by: 1) encouraging and developing the interest of the anesthesi-ologist in the clinical practice of obstetrical anesthesia and the care of the newborn; 2) promoting study and investigation in the field of obstetrical anesthesia; 3) acting as liaison representatives to the various obstetrical organizations, including the American College of Obstetricians and Gynecologists (ACOG); and 4) advocating for obstetrical anesthesia and for our patients with state and federal regulatory and legislative bodies.1 The mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) is to improve the pregnancy-related outcomes of women and neonates through the support of obstetric anesthesiology research, the provision of education to its members, other providers and pregnant women, and the promotion of excellence in clinical anesthetic care.2 In effect, only subtle differences exist between these two missions, which explain the great working relationship that exists between the ASA committee and the SOAP Board of Directors.
Committee on Obstetrical Anesthesia Activity
The following documents were extensively reviewed by the committee this past year:
- Statement on Pain Relief During Labor (joint statement with ACOG)
- Guidelines for Neuraxial Anesthesia in Obstetrics
- Optimal Goals for Anesthesia Care in Obstetrics (joint statement with ACOG)
- Statement on the Role of Registered Nurses in the Management of Continuous Regional Analgesia (in conjunction with the Committee on Regional Anesthesia)
While reviewing the first three guidelines, it was recognized that there are difficulties encountered with joint statements since each organization has different cycles for reviewing and approving documents. Another difficulty that must be addressed is that the statement might be referring to an outdated or even updated reference which may have changed in content. For example, while reviewing Guidelines for Neuraxial Anesthesia in Obstetrics, it was recognized that Guideline IX references our Standard for Post Anesthesia Care, which contains a reference to an outdated American Society of PeriAnesthesia Nurses Standards of Perianesthesia Nursing Practice. Whether this is an editorial change of date or a substantive change must be determined in order to maintain accuracy. Why is any of this important? Because the committee feels a responsibility to our members to produce documents that have merit and can be used in all practice settings.
In collaboration with the Committee on Regional Anesthesia, the Statement on the Role of Registered Nurses in the Management of Continuous Regional Analgesia was reviewed. Due to the current stance of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWOHNN) (2011-published second edition of “Nursing Care of the Woman Receiving Regional Analgesia/Anesthesia in Labor”) concerning the adjustment of epidural infusions on the labor floor, the committee suggested that all references to labor analgesia/anesthesia be removed from the document and a statement added for the reader to refer to the Statement on Pain Relief During Labor.
All these statements were approved by the ASA Board of Directors and will be presented to the House of Delegates at the ASA annual meeting in San Francisco this month.
The committee also discussed what constitutes an emergency cesarean delivery for billing purposes and what elements are required for postoperative cesarean delivery notes and post-procedure notes. In cooperation with SOAP’s Committee on Economics and Governmental Affairs, and Sharon Merrick, ASA’s Director of Payment and Practice Management, Curtis Baysinger drafted an article for the SOAP newsletter for informational purposes on the above issues, which was reviewed by ASA prior to publication.
Meetings With External Organizations
Members of the committee have met with the AWOHNN leadership three times since October 2012. The discussions centered on patient safety, quality of care and pain relief during labor. The committee has welcomed the opportunity to have these discussions in order to promote continued collegiality and educational opportunities. We have plans to meet in the near future to discuss pain relief during labor.
Craig M. Palmer, M.D., the previous ASA liaison to the ACOG Committee on Obstetric Practice (COOP), has been involved in the ongoing discussions about our joint statements with ACOG and has been influential in some of ACOG’s committee opinions.
Drs. Jill Mhyre and Barbara Scavone were involved in a multidisciplinary working group sponsored jointly by ACOG, the Society for Maternal Fetal Medicine (SMFM) and the Centers for Disease Control and Prevention (CDC), designed to develop strategies to improve maternal health and safety and reduce harm. The group’s goal is to introduce patient safety bundles for obstetric hemorrhage, thromboembolic disease and severe hypertensive disease into birthing centers in the United States. Dr. Mhyre chaired a subgroup that delineates vital sign triggers (so-called “early warning signs”) that should prompt escalation of care for obstetric patients.
Educational and Research Opportunities
- Anesthesia Illustrated videos on a variety of educational topics are available on the SOAP website at www.soap.org or a direct link at www.anesthesiaillustrated.com.
- Our subspecialty organization (SOAP) is pleased to announce that it is seeking applications for the 4th Annual SOAP/Gertie Marx Education and Research Grant. The application deadline is October 1, 2013, with expected funding of the grant in early 2014 www.soap.org/gertie-marx-award.php.
Future Meetings of Interest to All ASA Members Who Practice Obstetrical Anesthesia:
The 2014 Sol Shnider, M.D. Obstetric Anesthesia Meeting
March 6-9, 2014
Grand Hyatt Hotel - San Francisco, California
The 2014 SOAP 46th Annual Meeting
May 14-18, 2014
Sheraton Toronto City Centre - Toronto, Ontario, Canada
To Michael Lewis, M.D., Section Chair, and Arnold J. Berry, M.D., ASA Vice President for Scientific Affairs.
To ASA for its support of the subspecialty societies.
To the members of the ASA office staff for their support and responsiveness.