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Chief, Division of Obstetric Anesthesiology
Associate Professor, Harvard Medical School Anesthesia and Pain Management
Clinical Associate Professor, Division of Obstetric Anesthesiology, Stanford University School of Medicine
Why did you pursue an obstetric anesthesiology fellowship?
MF: I was drawn toward obstetric anesthesiology for both its clinical and research appeal. As a resident, I loved caring for obstetric patients to ensure their safe delivery and realized what a privilege it was to be a part of a life-changing experience. I started doing OB anesthesia research during my CA-2 year. Thinking of clinical questions and doing the research to directly answer those questions and refine care was incredibly rewarding. I still feel the same way today, many years later!
CP: As a first-generation, son of Mexican immigrants, I personally witnessed the barriers that my family faced in receiving culturally competent and informed care in the obstetric setting. On my path toward becoming a doctor, I realized that labor and delivery is a critical time period with potential generational consequences to our patient’s health. This experience shaped my perspective as I decided to pursue an obstetric anesthesiology fellowship to become a better patient advocate and immerse myself in the latest scholarly activities relating to maternal health. I ultimately completed two fellowships (obstetric anesthesiology and critical care medicine) with my ultimate focus on maternal health disparities, obstetric critical care, and utilizing risk assessment tools in the obstetric setting.
What is the goal of an obstetric anesthesiology fellowship?
MF: Obstetric anesthesiology fellowships are designed to provide comprehensive training for state-of-the-art care of obstetric patients and their newborns. Fellows refine their neuraxial techniques and explore the very latest dosing strategies for optimal labor analgesia and cesarean anesthesia. They become experts in crisis management for high-acuity emergency situations. They rotate in both MFM and NICU to gain perspective on the multidisciplinary team and our integral role in those specialties. They acquire refined point-of-care ultrasound and critical care OB anesthesia skills. Fellows also embark on their own research projects, refine their teaching and speaking skills, and ultimately graduate with the capacity to step up to any academic or private practice leadership role.
CP: The goal of an obstetric anesthesiology fellowship is to become a maternal health advocate. Our greatest value to our obstetric patient population is our clinical skills, which also include the utilization of novel tools such as transthoracic echocardiography. Teaching residents and fellows the latest in maternal echocardiography is teaching another way to advocate for patient care. The future of our field is an increasingly complex parturient population, and an obstetric anesthesiology fellowship prepares you for the clinical complexity of our patients.
What does the application process look like?
MF: The application process for OB anesthesia is very well-coordinated because the vast majority of programs are now ACGME accredited, we utilize a common application and general timeline, and we adopted the SF Match process 3 years ago. The common application and other information (general and program-specific) can be found at soap.org.
CP: In general, the application process is laid back. The total process is not cumbersome at all, as you will need to write a personal statement and have an updated CV. In addition, you should request 2-3 letters of recommendation from your trusted advisors before you apply. The process itself is through the match. As there are many OB anesthesia fellowship programs in the country, the process is not at all like applying to a residency program! Do not be surprised if you get your first, second, or third choice!
Are there specific career paths that fellows take – private practice vs. academic?
MF: We encourage fellows to pursue either academic or private practice after their training [a typical split is 85% academic, 15% private], and their actual fellowship year can be tailored accordingly. Fellowship training in OB anesthesia enhances hire-ability in both settings and increasing OB anesthesia expertise outside of academic practice – in private practice – is a crucial strategy to increase the quality-of-care women receive everywhere in the US.
CP: This totally depends on your personal goals, ambitions, and philosophy! However, this answer is not binary. You can work in a private practice setting and still be involved academically with national societies. Similarly, you can work in an academic center and not be obliged to do research. In my opinion, meeting with your advisors ahead of time, and planning a 5–10-year vision is helpful in determining which path suits you best.
Where do you see the future of obstetric anesthesiology heading?
MF: The sky’s the limit! This specialty is pushing its boundaries in every direction. OB Anesthesiologists are evolving into true peri-delivery specialists; our services extend so much further beyond labor epidurals and spinals! We’re deeply engaged in pre-delivery risk assessment and planning, crisis management and multidisciplinary leadership for high-risk deliveries, point-of-care and critical care management, and enhanced recovery after cesarean delivery. We’re advocates for maternal health and play an integral role in applying strategies to lower maternal morbidity and mortality. We’re continuously refining our practice in these areas through clinical research, with a recent expansion of multi-center trials and collaboration.
CP: The U.S. has the highest maternal mortality ratio (per 100,000 births) when compared to other high-income countries, and racial disparities in maternal health persist. Similarly, patient complexity has increased dramatically in the past 30 years. In my opinion, the future of obstetric anesthesiology will evolve to meet the clinical demands of our patient population. We, as obstetric anesthesiologists, are front and center in our efforts to reduce maternal morbidity, mortality, and racial disparities. Skills such as transthoracic echocardiography are becoming invaluable resources in detecting early clinical deterioration. We are evolving towards “maternal critical care,” and it is up to the next generation of obstetric anesthesiologists to address these critical issues.
What type of resident would you expect to be successful in an obstetric anesthesiology fellowship?
MF: Obstetric anesthesiology fellows thrive if they are compassionate about providing the best maternal care, enjoy the camaraderie of fellow anesthesiologists and the multidisciplinary team, gravitate toward crisis management, and take an interest in quality initiatives that enhance maternal safety. I don’t believe there’s a cookie-cutter type of person, though. Every fellow carves their own pathway and can thrive during the fellowship, with the help of their program director and mentors. It’s incredibly exciting to be a part of that pathway!
CP: Any type of resident! Our field is inclusive to people from ALL walks of life, ethnicity, gender, etc. In general (and this applies to all fields in medicine), we look for diligence, industriousness, compassion, and dedication in commitment to providing clinically excellent care.
Do you want to highlight other resources/advice for prospective applicants?
MF: There’s never been a more exciting time to be an obstetric anesthesiologist. From basic bench research for a better understanding of uterine atony, and clinical research to mitigate morbidity from hemorrhage to global health initiatives that impact women worldwide – our role is critically important, and the career you can create in this specialty is absolutely fulfilling.
CP: Absolutely! Check out the Society for Obstetric Anesthesiology and Perinatology (SOAP) for the latest in fellowship programs, educational programming, and resources for prospective applicants. SOAP is a fantastic resource and network for the obstetric anesthesiology community!
Many thanks to Dr. Michaela Farber and Dr. Cesar Padilla for their time and thoughtful answers for prospective OB anesthesiology applicants!
Where can I find more information?
• Society of Obstetric Anesthesia and Perinatology
• SF Match
• ASA Resident Component Fellowship Resources
• Join the SOAP Medical Student & Resident Special Interest Group
Interview questions and webpage organization by Natalie Koons, DO, Anesthesiology Resident at Stanford Health Care.
Last updated by: Residency Engagement
Date of last update: August 9, 2023
