Staffing Your Pregnancy Support Team

(BPT) – Many people would be surprised to learn that among developed countries, the United States not only has the highest rate of maternal mortality (death during pregnancy or within one year of birth), but that it increased 56% between 1990 and 2015. The American Society of Anesthesiologists says expectant mothers should talk with their obstetrician and physician anesthesiologist to develop a plan that ensures the safest pregnancy, childbirth and recovery.

“Thanks to the miracles of modern medicine more women are giving birth in their late 30s and 40s, but this does not come without some risk,” said ASA President Linda J. Mason, M.D., FASA. “Expectant mothers know they shouldn’t drink or smoke while pregnant, but many aren’t aware how important it is to focus on their overall health, for their safety as well as their baby’s. Older mothers, certain health conditions and multiple cesarean deliveries are some reasons the maternal death rate has risen. Physician anesthesiologists not only are experts in managing pain during and after childbirth, they work closely with obstetricians to combat the growing mortality trend.”

To ensure the safest care for you and your baby, ASA recommends the following:

• Take care of yourself: If you are older, overweight or have diabetes or high blood pressure, work closely with your physicians to address your condition prior to labor and delivery to ensure you understand all possible complications and have a plan. About halfway through your pregnancy meet with your physician anesthesiologist, who will provide information to help you feel safe by developing an optimal labor, delivery and recovery plan.
•  Express your concerns: If you have had a bad experience with anesthesia, have any fears about childbirth or if something doesn’t feel right, let your obstetrician and physician anesthesiologist know. Be sure to ask about other issues, such as if you can have an epidural if you have a slipped disk or lower back tattoo.
• Ask about an emergency plan: Your physicians will always prioritize your safety as well as your baby’s. But it’s important to know your hospital has an emergency plan in place. Physician anesthesiologists have extensive critical care training and are experts in treating emergencies such as postpartum hemorrhage and preeclampsia.
• Plan your pain management: Untreated post-delivery pain can lead to post traumatic stress disorder (PTSD) in some women, so don’t downplay your pain. Ask your obstetrician to reach out to your physician anesthesiologist if you have questions regarding how to manage pain after birth and if opioids are an option.

Physician anesthesiologists are leading the way to develop protocols that improve safety during and after childbirth, including:

• Best practices for managing common causes of maternal death, including postpartum hemorrhage and high blood pressure that can lead to preeclampsia, seizures, coma, brain damage, blood clots and death.
• “Early warning systems” that trigger an immediate evaluation if a mother’s health declines.
• Refining labor and delivery pain management techniques, including epidurals and spinal anesthesia.
• Multi-disciplinary review committees to examine maternal deaths, identify causes and implement prevention efforts.

“The maternal death rate is 26 deaths in 100,000 births, but even one death is too many. The rising rate in the United States is a wake-up call for this country,” said Dr. Mason. “With more awareness and proactive management, it can be decreased.”

To learn more about the critical role physician anesthesiologists play in managing emergency care, including during labor and delivery, visit www.asahq.org/WhenSecondsCount. For more information about pain management during labor and delivery and the importance of seeing a physician anesthesiologist, including a downloadable birth plan, visit asahq.org/birth.