Through a series of didactic lectures, journal clubs, and conferences, the obstetric anesthesia fellow is expected to master the subspecialty of obstetric anesthesia.
The areas that are stressed include:
- Maternal physiology
- Embryology and teratogenicity
- Fetal and placental physiology and pathophysiology
- Neonatal physiology and neonatal resuscitation
- Obstetric management of labor, including normal labor and abnormal labor; indications for urgent and emergent delivery
- Tocolytic therapy
- Pain of labor, pain pathways
- Local anesthetic use in obstetrics; recognition and treatment of complications
- Neuraxial opioid use in obstetrics; recognition and treatment of complications
- Regional anesthetic techniques; recognition and treatment of complications
- General anesthesia use in obstetrics; recognition and treatment of complications
- Anesthetic and obstetric management of obstetric complications and emergencies, including preeclampsia, eclampsia, placental abruption, placenta previa, placenta accreta, vasa previa, uterine rupture, uterine atony, amniotic fluid embolism, and umbilical cord prolapse
- Medical disease and pregnancy: hypertensive disorders, morbid obesity, respiratory disorders, cardiac disorders, endocrine disorders, autoimmune disorders, hematologic and coagulation disorders, neurologic disorders, substance abuse, HIV infection and AIDS
- Cardiopulmonary resuscitation and advanced cardiac life support of the pregnant women
- Postpartum tubal ligation
- Post-operative pain management in the parturient
- Non-obstetric surgery during pregnancy
- Effects of maternal medications on breastfeeding
- Ethical issues during pregnancy
- Principles and ethics of research in the pregnant women, their fetuses ,and neonates
- Organization and management of an obstetric anesthesia service
- Transport and monitoring of critically ill parturients within the hospital and between hospitals
- Maternal mortality
- Medical economics and public health of women during reproductive years as it applies to obstetric anesthesiology. For example, availability of obstetric analgesia, reducing cesarean section rates, etc.
The fellow will be expected, under the supervision of one of the obstetric anesthesia attendings, to manage the labor and delivery suite. This will include direct patient care and supervision of the Anesthesiology residents. The fellow will spend a total of 10 months working on the labor floor. Additionally, the fellow will rotate in the neonatal intensive care unit and in the Division of Maternal-Fetal Medicine of the Department of Obstetrics, Gynecology, and Reproductive Science.
Clinically the fellow will be expected to be proficient beyond the level of the non-obstetric anesthesiologist in providing anesthesia care for women during labor and vaginal delivery and for women undergoing cesarean delivery, postpartum tubal ligation, dilation and curettage, and removal of the placenta. Training will also include experience with patients having anesthesia for non-obstetric surgery during pregnancy. During the labor floor rotation the fellow will also supervise and teach the anesthesia residents during their core rotation.
Members of the Division of Obstetric Anesthesiology are very academically involved in both national and international professional societies and symposia. As members of national committees, our attendings have helped develop practice guidelines for the safe care of the parturient. Our attendings have authored numerous peer-reviewed articles and textbook chapters, and have edited major obstetric anesthesia textbooks. The areas of active research include: obstetric outcome, safety of anesthetic agents, coagulation, and analgesic techniques.