Central Line
Episode Number: 94
Episode Title: Inside the Monitor – Trends in OB Anesthesia
Recorded: March 2023
(SOUNDBITE OF MUSIC)
VOICE OVER:
Welcome to ASA's Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
(SOUNDBITE OF MUSIC)
DR. DR. ZACH DEUTCH:
Hello, everyone. Welcome
to the Central Line podcast. I have the honor of being your host for this week.
My name is Zach Deutch. In this Inside the Monitor episode, we're going to be
speaking with Dr. Barbara Rogers. She is our guest editor for the May issue of
the Monitor, and she is going to talk with us about trends in OB anesthesia,
which is, of course, the topic of the main monitor and will be the topic of
this episode. So we're going to dive into a little detail about some of the
important issues in that subject, which is probably near and dear to most of
us. Thank you, Dr. Rogers, for coming here and talking with us.
DR. BARBARA ROGERS:
Thank you.
DR. DEUTCH:
And it's great to have
you. Before we start in talking about this topic, can you tell us a little bit
about your professional background and your current position?
DR. ROGERS:
Sure. I am a professor
of anesthesiology at the Ohio State Wexner Medical Center in Columbus, Ohio. I
am an active member of our neuro anesthesia team, plus the medical director of
our preoperative assessment center. And I rotate up on obstetrics also. And
I've experienced obstetric anesthesia in both a large hospital tertiary setting
like I'm in now, which I've spent most of my career, but also have done
obstetric anesthesia in a small hospital where I served as the chief of
anesthesia and had to reorganize, standardize, and update their OB care.
DR. DEUTCH:
Now, to get into that
subject matter, we've had discussions in the medical community and worldwide
about morbidity, mortality in the developed world and the non-developed world.
And one of the things that's come up is, is the problems with increasing
maternal morbidity mortality, which in the US, though we consider ourselves of
course a very developed society, have been increasing. Can you comment about
the treatment of high-risk patients in this country in the maternal setting?
What can we do better to manage their comorbidities? How can we reverse these
statistical trends? What role can we play in anesthesiology to get a better
public health situation in terms of labor and delivery?
DR. ROGERS:
Yeah. So interestingly
enough, there is a nice article put out by Blue Cross Blue Shield that talked
about and examined 1.8 million pregnancies between the year 2014 2018 among
commercially insured women. And there's some interesting outcomes that they
found. One is that there's an increased rate of what we call advanced maternal
age, and this percentage had increased by 9% between 2014 and 2018. In general,
OB patients are bringing with them their co-morbidities of all ages, and our
population in general can be getting sicker or getting more diabetes, more
hypertension, more issues, and that's a whole general population. But these
patients also, if they're female, are bringing that to OB with them. And that
causes some issues for us because pregnancy has its own physiological changes.
And when you add in some other issues such as hypertension, diabetes, obesity,
anxiety, depression, substance abuse, it can complicate the pregnancy and the
delivery. So it's really important for us as anesthesiologists to be aware of
all these things and be up to date on how to treat all these things up on the
OB ward.
DR. DEUTCH:
We all know colloquially,
either from our personal lives or medical lives that, you know, if you're over
the age of 35, advanced maternal age and all that thing, it creates a whole
host of other issues for women. Are you basically saying is there kind of a
correlation between that and overall true morbidity mortality from from our
standpoint, from anesthesiology?
DR. ROGERS:
Well, the study didn't
say that, particularly, that the older women having births are having more
complications. But in general, in the population, we are having an increased
number of older women that are having babies. But in general, we're bringing
more people into the OB ward that have underlying conditions and these
underlying conditions are going to increase their morbidity and mortality, not
necessarily just the age, but that is of interest that older women are coming
and having more babies.
DR. DEUTCH:
That makes sense because
who among us hasn't heard, All our patients are getting sicker all the time and
it doesn't matter the setting, of course. Right. So I understand what you're
saying. We touched on, you know, morbidity, mortality and complication rates.
Are there screening tools that you can identify that have come to the forefront
more recently that can help us identify patients who might be at higher risk,
whether or not they have preexisting illness, any sort of systems we can rely
on to try to help us stratify patients when we work on labor and delivery.
DR. ROGERS:
So because the ward is
going to be a mix of patients that we know are coming in with underlying
problems, you know, whatever that might be -- hypertension, diabetes, obesity,
et cetera. There's also a number of patients who we don't know are bringing
these things in with them. And because of the dynamic nature of the OB ward,
having some type of screening tool to quickly identify these patients would be
very helpful. So there is some interest in trying to identify people that have
something called SMM,or severe maternal morbidity, or will develop these
complications. So one score that has been utilized at admission is called the
obstetric comorbidity index OB-CMI score. And this is kind of a score that the
obstetrician and the anesthesiologist can go through and see if patients in
general have any of these scores. Because if you have an elevated score on
this, for example, if your score is nine or more on this scoring grid, you have
almost a 20% increased risk of having something not good happen to you, basically.
So it also shows an increased risk of maybe having to have general anesthesia for
you delivery, instead of a neuraxial block. So, yes, that is just one tool
that's kind of been thrown out there as possibly being helpful and trying to
find these patients beforehand.
But there's other
there's other issues that you might run into. How do you find out that a
patient up on the OB ward might be in some sort of early sepsis or something of
this nature? Because their physiologic changes of pregnancy sometimes mimic
some of these other things that happen. And sometimes it's hard to kind of
decide which is which. So there is some maternal, it's called maternal early
warning system grid, which some centers are using also. That is a questionnaire
where you go through and look at their diastolic pressures, heart rate,
respiratory rate, oxygen saturation, urine output. And from that kind of decide,
they have a point system, you can decide if that is possibly the patients may
be developing some sort of adverse event early on.
So those are just two
ways that a scoring system or a risk assessment can be used up in OB. Another
one that has been used by some groups is called the Sequential Organ Failure
Assessment or SOFA Score. And this, along with a high index of suspicion, might
be able to identify people that are starting to get organ dysfunction up on the
floor and that can maybe help catch these patients early also.
DR. DEUTCH:
Correct me if I'm wrong.
The number one cause of our maternal mortality worldwide and a very high cause
of mortality here in the US is hemorrhage, is that correct?
DR. ROGERS:
Yeah, unfortunately,
that is that is correct.
DR. DEUTCH:
And of course, all of us
are intimately familiar with the bleeding patient on labor and delivery, unfortunately.
We all sort of are familiar with crisis management and things like that for
working with patients that are bleeding. What about testing options at point of
care? Is there anything in our armamentarium that would help us on the OB floor
in addition to our usual massive transfusion protocols and all those other
things that we're familiar with?
DR. ROGERS:
Yes, there are some
centers that are starting to use more point of care testing if their hospital
allows them to use that up in the OB section. So point of care testing, that is
VISCO elastic testing, which there's at least two types of visco elastic
testing systems. There's one that's called the Thromboelastography or TEG, and
another one called Rotational Thromboelastometry or Rotam. They're both user
friendly and they both can give a graphical representation of hemostasis, but
they're not exactly the same. But they're both available if a hospital system
wishes to get them. Some hospitals are using them on different floors, but OB
is one that it can really help us out. Rotem may offer some advantages to TEG
because it actually provides users with like five different assays which can
specifically assess different arms of the coagulation cascade. And also it
shows the effects of anti thrombolytics and the effect of heparin. So if you
got the the heparin assay off of this, which is called heptane, it contains a
heparinase. It neutralizes the effect of heparin. So if you are trying to
figure out when's the best time to do a neuraxial block, perhaps on a patient
that you know had been on heparin, you could use this to kind of help you
decide when to place the block. It also might kind of reassure you if you want,
just that you can put a block on one of these patients who'd been on heparin.
Now, the other one, the TEG, is kind of a snapshot of whole blood, hemostasis
and clot breakdown. So either one of them can be helpful to kind of decide
where a patient is. If they look like they are starting to get some sort of
bleeding Diathesis.
DR. DEUTCH:
Okay, I've used the TEG,
but not the Rotem. It sounds like it gives a lot of additional information.
DR. ROGERS:
Yeah, it does and either
one is useful. I think it comes down to which one a person's hospital wishes to
put money into and which one that particular group of anesthesiologist feels is
the easiest for them to use up on a busy ward. Also, I think those are both
reasonable considerations.
DR. DEUTCH:
Another hot topic we
have, we've touched on some topics, obviously, that are very big and in public
health in the United States, which is morbidity and mortality. You know,
hemorrhage is big and not just in obstetrical patients. And another issue which
is really big in the media and in all types of health care settings is opioid
use, opioid use, abuse. We all know what this is about. So this is also
prevalent in pregnant women across all different types of racial and economic
groups. So how have you seen this play out in the maternal patient and how have
you in your experience or the experience of others that you know of tried to
address this problem specifically in the parturient.
DR. ROGERS:
Yeah. So we're all very
aware of the opioid crisis and just the devastation it's caused throughout our
country, really all over the world. But, you know, the United States is
certainly no different and the OB ward is no different. So according to the
Centers of Disease Control and Prevention, the national prevalence of opioid
use disorder between 1999 and 2014 increased by 333%, which is unbelievable.
And then from 1.5 cases per 1000 in delivery ward. So it's pretty scary
actually. And the review of over 57 million American women admitted to
obstetric deliveries in a nationwide inpatient sample. The prevalence of this
opioid use disorder and dependence doubled between 1998 and 2011. So it's it's
out there. If a person is thinking, oh, it's not in my hospital, it's in your
hospital, you may or may not be aware of it, but it's there. Patients a lot of
times aren't going to tell you because they're embarrassed. They have family
there when they're delivering maybe mom and dad and they don't want them to
know that they're on, you know, dependent on whatever opioid that they are
dependent on. So you may not even know necessarily that a patient is dependent
on something because they may not tell you, they may have not told their OB.
Hopefully that's becoming less stigmatized and people are going to be able to
be a little more open about that. But that's another thing just to remember,
right? If someone seems a little jittery and a little, you know, like you have
a suspicion, you might have to ask them privately when no one's around, hey,
you know, tell me about this or tell me about that, because they may not be
really willing to disclose it, but it's definitely out there.
DR. DEUTCH:
Kind of like we were
taught when we were medical students. Whenever you interview teenagers, they'll
never give you an honest answer with anybody else around. You might get it if
they're alone, but not if anybody else is around.
DR. ROGERS:
Right. And I think
that's something. Yeah. And I think that's something we just have to remember
with certain conditions and this one in particular, because they're going to
have a lot of family there probably, and you just have to be cognizant of that,
I think of their privacy, but you need the information.
DR. DEUTCH:
Out of curiosity, have
you had patients that come to you? Because I do get this from time to time,
both on labor and delivery and outside of labor and delivery that come and say,
you know, I'm a recovering opioid abuser. I don't want anything of any nature
of that. And if you do get those patients, how do you tend to manage those?
DR. ROGERS:
Yeah, I think we do get
that. And I think the best way to deal with it or to really to follow their
wishes is, number one, to explain all the options, especially an OB, right? No
one has to have an epidural. They're not required. I always tell people that
it's an option and the amount of opioid in an epidural is really not enough to
make. I mean, it's not going to make you high. It just goes to the nerves
involved. And so say, you know, it's really a good option If you want pain
control during delivery, it's not like we're giving you IV narcotics. And I
think that's kind of just the best way is to kind of educate the patients about
what we're doing for you, because that is pretty standard in most OB suites is
epidurals, but no one has to have one. I mean, if they if they just don't want
it, then that that's fine. That's kind of how I approach it up in OB anyways,
is trying to just really be quite honest about the amount of narcotic that is
in that. Or you can even have the pharmacy make one that has no narcotic and
you can just have local. I mean, that's an option too, right? So I think that
being honest about what we can offer them is the best way to ease people's
fears about getting addicted again while they're in the hospital.
DR. DEUTCH:
And since you brought it
up, what is your epidural rate at the unit that you work on?
DR. ROGERS:
Oh, honestly, it's
probably up there in 90%. Most of our patients do get epidurals, I'll be quite
honest. Yeah, there's very few that don't. And and the patients that say, Hey,
I don't want one, which is fine. I mean, everyone should be able to deliver in
the way they feel that they want to. I'm really a strong proponent of that. A
lot of them do come back later on in the day and say, Yeah, I can't do this. I
really would like an epidural, which is fine too, right?
DR. DEUTCH:
Yeah, certainly. We've
all seen that. Right? When we were talking about getting really basic true
history from people about their substance use or other things about, quote,
people in the room. So we have frequently in the environment of childbirth, we
have people in the room who are called doulas. Who who aren't necessarily
medically trained and usually aren't family members. And, you know, during
COVID, of course, we banned pretty much everyone and anyone and everyone from
the hospital, whether it was an obstetrical unit or not. And these people
really weren't around. And now, of course, everybody's starting to filter back,
including them. Can you comment about your experience with the use of doulas,
how patients reacted to not having access to this resource and kind of like how
how it's viewed in your facility at the present time?
DR. ROGERS:
Yes, I would love to. So
basically a doula, this term was actually coined by a medical anthropologist
back in like 1969. And then the first Organization for Doulas was formed in 1992
called Doulas of North America, or DONA. And the organization defines the role
and limitations of doulas. So a doula is a person who does not perform any kind
of clinical or medical tests, so they don't measure blood pressure, they don't
take temperatures, they're not going to monitor fetal heart rate. They don't
diagnose, they don't treat anything. Their function is a patient advocate, the
advocate for the patient between all the multiple people that are going to be
in the room -- anesthesia, OB nurses, all these different people that come in
contact with this mother who's going to have a baby soon. And so this model,
the doula model, is it's improved their childbirth experience for the moms,
it's decreased C-sections. And it's really it's really helpful because it's not
a person that's actually a personal care giver. It's not the husband or the the
significant other. It's a it's another person. So it takes some strain off of
the actual family members. I think it helps the nurses to have someone who's just
an actual just a support person. That's all they're there for, advocating and
being supportive. So yeah, during COVID, unfortunately, because of all the
people that were banned from the hospital, basically everybody was banned from
the hospital. Doulas are also banned. And so I feel that that was very
unfortunate. But now that we've opened up after COVID, they're back in the
hospital, they're back advocating and helping participants and it's really
good. So actually it's so good that there's been some bills that Medicaid
related bills to help pay for some of these doulas in the hopes that we're
going to decrease health disparities while improving maternal and fetal
outcomes. At least ten states right now are allowing doula coverage in both
Medicaid and private insurance plans, which I think is very good.
DR. DEUTCH:
I have not heard that.
DR. ROGERS:
Yes, actually, it's
California, Michigan, Florida, Maryland, Minnesota, New Jersey, Nevada, Oregon,
Virginia, Rhode Island. So ….
DR. DEUTCH:
Wow. Quite the spread
there.
DR. ROGERS:
Yeah. Yeah. And so it's
becoming more popular. So, yes, we have them at our hospital. The interesting
thing is sometimes you don't realize who they are necessarily because you go in
and you might do your epidural and go and you go in and out and you may think
they actually are a family member, you know, unless you ask. But I will say
that they are very supportive and patients that have them are very, very
appreciative just to have an extra person there that's literally just for them,
like just for their emotional support and their advocacy. I think that's huge,
actually.
DR. DEUTCH:
Yeah, I have the similar
experience that they are not uncommon where I work, but I often don't really
recognize them except as the behaviors take place. Like they'll quietly explain
something after I've explained it. Like I'm just thinking, Oh, it's just
another family member. But you then see the person who's taking a position of
not authority, but of, you know, sort of translating the information. And for
us at least, it's tended to be positive. I haven't found any trouble in terms
of, you know, clashing with them in any way, which is good.
DR. ROGERS:
I agree. I think the
time that we've realized that they weren't doulas or we thought there some sort
of like aid or something because when you ask them to do something, they're
like, Yeah, I can't do that. You're like, Oh, okay, you're the doula. But yes,
I think I've been actually pretty impressed with the ones we have at our
medical center. They've been quite helpful. People are very, very happy with
them.
DR. DEUTCH:
I want to talk with you
a little bit more about some innovative things we're seeing in the ORs on
obstetrics. But le let's take a short break for our patient safety message.
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DR. JONATHAN COHEN:
Hi, this is Dr. Jonathan
Cohen with the Patient Safety Editorial Board. One of the health care
professionals most crucial skills is that of communication with patients and
other professionals. Barriers include misinterpretation of context and
nonverbal cues, as well as differences in language, culture and health care
literacy. Several techniques that are simple to employ have been shown to
overcome these barriers and improve communication. One of the most difficult
conversations to have with a patient or involved health care professional is
when an adverse event has occurred. Approaching these important discussions
using evidence-based strategies has been shown to strengthen the relationship
between the patient and health care professional, decrease malpractice litigation,
and diminish the psychological trauma that health care professionals feel after
being involved in an adverse event.
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For more information on
patient safety visit asahq.org/patientsafety22.
DR. DEUTCH:
So, you know, we've talked
about having patients, whether it's cause of maternal age or because of other
conditions or whatever it is under the sun, or patients being much more
challenging and complex in the obstetrical setting. And obviously, these
patients are going to filter to a place like Ohio State more commonly because
that's the place that can handle, quote, these problems. So you have trainees
working in this environment. You have experienced people, you know, experienced
attendings. Many of them are all of them may be fellowship trained, but then
you have the trainees. So how do you how do you manage to manage these patients
with a mixture of people that may not have the expertise and are being faced
with not just learning how to put an epidural or a spinal, but how to manage a
complex patient.
DR. ROGERS:
The OB floor during the
day when most of the learners are up there, of course, or if they're a night
too. But most of them are up there during the day. We have two attendings up
there. They split the roles so they have somebody who does the OR part and
someone who does the epidural part. They have a whole system of of going
through seeing all the patients, updating their charts, getting any kind of
consent early on. Even if someone doesn't want any type of anesthesia involved,
we try to get consent in case something emergent were to happen. And that's
explained to the patient. Look, we're not trying to force anything on you, but
if something happens, we would like to have a consent so we don't take time
away from saving you and your baby to get a consent. So they go through and
have a very organized way of seeing the patients, triaging the patients, going
out in the Antepartum floor. You know, people are coming in, in preterm labor,
that kind of thing. All those roles and all those jobs are very organized into
a daily kind of schedule of how they do things. They also have a white board
that has, you know, any kind of alarming kind of patient like a patient with
something that, you know, a cardiac patient, a patient, a patient that's out in
the heart hospital, a patient that's out in the ICU, because we do have that,
too. And we have to follow those patients also. So the two anesthesiologists of
the day kind of organize between themselves and all the people that are up there
for the day. To be sure, all the things are organized and covered in different
white boards have different information, plus a list of phone numbers and huge
print in the office where the OB team sit. So at any moment, if you have to get
ahold of somebody, you you can get ahold of somebody. Plus we have some
overhead pages for emergencies also. But that's basically kind of how how it's
done. The learners are very supervised. I think that's the key.
DR. DEUTCH:
Are you able to fit didactics
into that or is it just too, too hectic?
DR. ROGERS:
No, the didactics occur.
So the night person during the week stays till seven in the morning. The night
person during the weekend stays till eight. So during the week they have
didactics that usually start about six in the morning. So they're required to
come in on certain days earlier than their shift starts. Basically the
residents shift start. So the attending will basically sign up to give these
lectures usually once a week could be more than that depending on what they're
doing. But at least once a week that they come in at 6:00 for like an hour
lecture. And then I believe there's usually a smaller kind of like a more of a
in-service type thing during the during the day, maybe only 15 minutes where
they're going to sit down and say, hey, we're in a real quickly, talk about
topic of X, Y, Z. And then they keep a list of that, too. It's very organized.
They have the name, what the topic is, and they kind of rotate through the same
topics every month. So every resident gets a chance to hear the lecture. Plus
the fellows also will jump in and do some of this mid day teaching also.
DR. DEUTCH:
There was some talk
about 3D printers being used in the obstetrical unit to improve the patient
experiences. Can you tell me what that's about?
DR. ROGERS:
Yeah. So there's
evidently a group in Boston at Tufts that in their desire to kind of make
things easier for the patient because, you know, patients come to delivery
C-section room with cameras and cell phones and all sorts of stuff, sometimes
religious artifacts that they want to carry with them or specific things, you
know, that they feel like they have to have, you know, for whatever reason,
good luck or whatever. And so they actually have come up with and designed this
3D printed phone holder that they have made that can be attached to an IV pole
and the patient's accessible to the patient and their support person. It's
disposable. You know, it can go with the patient or you can throw it away. And
they, anecdotally I guess, have seen that patients just really like it because
they have somewhere they can put their phone, they can see it, it's not
somewhere, hopefully won't get splashed with products or blood or whatever. And
so that is kind of very innovative. And I, they're the only place I know
currently that's doing this, but I think it's kind of a cool wave of innovation
and quality improvement for patients that are in the OB suite or those in the
particularly having a C-section. So, you know, the anesthesia provider isn't,
you know, putting the phone somewhere. It falls off and who knows what happens
to it.
DR. DEUTCH:
That's interesting. I
mean, it's quality improvement for me personally because I'm often asked to
take pictures and I usually do a very bad job and I feel guilty like they're
going to get home, be like, I can't believe what a terrible job this guy did.
So there's another issue
that comes up, which I think is it's a little different now because, you know,
there's just so many chaotic forces at work in our labor market for
anesthesiology. But I frequently get this question working in academic setting,
and I'd love to hear what your thoughts are. Do I need to do a fellowship in
OB? It could be coming from any perspective. I love OB. I hate OB. I'm neutral
about OB. I want to take a job. I want to be successful. Do I need to do a
fellowship? If I'm really interested in OB, If I go to an academic center, will
it hurt me if I want to work on a unit occasionally? Like how should residents
approach this issue of whether or not to do a fellowship, if they have interest
in OB or if they're concerned that it might stunt their career in some way if
they want to maintain it as a competency.
DR. ROGERS:
Yeah. Well think
obstetric training and OB really currently. Maybe we need to do kind of a
little bit of a, you know, examining what we're doing, especially as the patients
are getting sicker and coming to OB with all sorts of issues that maybe they
weren't coming in with 20 years ago. You know, currently to be competent, our
residents not fellowship trained residents, but just our general residents are
supposed to do about like 40 that would be involved in like 40 vaginal
deliveries, 20 C-sections, 40 epidurals, 40 spinals. And depending on where
someone trains, that may be hard to get. Somewhere else it may be, you know,
the numbers are way beyond that because they're so busy. They're three times
those numbers because every day they're doing multiple, multiple, multiple. So
I think it's a good question. Are we training our residents enough to just go
out and practice OB anesthesia? Of course, it depends on where they're going to
go. Are they going to be somewhere that's going to have a lot of OB going on,
or are they, you know, a very low it's all healthy people. But I think it's a
good question. Basically, our residents have 48 months of anesthesia training
and only two of those months are dedicated to OB. So are they actually getting
proficient? And is there anything we can do actually to make it better?
One option that has come
up has possibly been for residents to be involved in more kind of simulation
training, which is getting more popular across the anesthesia and medicine in
general to kind of prepare people for those events that aren't common but are
life threatening. And you need to be prepared and kind of know what to do in
these situations. So that is one idea that's kind of come up, is that maybe our
residents, our residents should be involved in more educational simulation
training to improve their knowledge performance communication, behavioral
skills and basically overall preparedness for different critical clinical
events and scenarios. Right now, that isn't necessarily something that
everybody does, although the intraoperative simulation participation for
residents is now in the ACGME. But that's not necessarily for OB, it's just in
residency in general.
Another thing that might
help our residents is for them to be more versed in point of care
ultrasonography or POCUS. This may be something to help them anesthesia in
general, but also maybe on the OB ward. There's been some studies that have
shown that it's helped with first pass placement of epidurals and obstetric
patients and enables the anesthesiologist to effectively deliver goal directed
therapy very quickly, especially if the mother is clinically unstable and needs
an urgent delivery. So these are other things that may be worth looking into in
our education programs for our residents. And this is just for residents that
are in general residency programs, not even for fellows.
DR. DEUTCH:
Right. And you bring up
a really good point because when you look at the, you know, the required number
of certain tasks that they need to perform that some of them don't really seem
to correlate with clinical proficiency. And the hospital where I trained, I
think we did, they were doing 10,000 deliveries a year. So, you know, people
people got more OB than they wanted. But that's not every program. And it
doesn't mean.Those programs are necessarily deficient overall, but there's just
so many different settings out there.
That brings me to one
other question that I wanted to touch on with you, which is, you know, what I
always see is the biggest problem is in OB is you could work at a tertiary
center that that can do cardiac surgery and a C-section at the same time. They
can handle patients that are simultaneously in you. They're doing all these
sorts of things, you know, that has the white boards and the multidisciplinary
teams.The hardest part about OB is what rolls in the door. And so no matter
what type of unit you have, you know, whatever level ACOG level it is, people
can just walk in, in labor with all these sorts of conditions. Do you feel that
pain the same way it seems like everyone else does? And do you have and sort of
commentary on that?
DR. ROGERS:
Yeah, I think that's
that's the kind of the terror of OB. You know, there's, there's a lot of
satisfaction being an OB and making people very comfortable for delivery and
they're very happy, high satisfaction. But also there's, I think that's the
terror, whyome people don't want to be working OB. Because you truly don't know
what's going to come. And even if something you seem like, oh, it's a very calm
day, the patient that you thought was doing fine, something abruptly happens.
You know, there's an abruption, there's a cord, there's all sorts of things can
happen. So that is just the nature of the beast. But I think, yes, in large
centers, we have so many people around to help. Not that it makes it less
terrifying, but I think education, communication, having protocols and having communication
beforehand, if you're in a smaller hospital, is really important. Having things
in place for that 1 in 1,000,000 thing that might happen is very critical. So
if you're at a smaller hospital, I think knowing what the plan is beforehand so
everyone on the team, all the nurses, all the OB-GYNs, everyone knows what the
plan will be if something really large happens that is more than that hospital
can handle in place beforehand is probably the best way to deal with that. I
know when I was at the smaller hospital that I was head of anesthesia. That's
basically what we did. We kind of had to cultivate where we're sending people.
Everyone knew what the drill would be and luckily we never had to use it. But
but it was there, right? It's there in case you do have to use it and
everyone's aware of it.
DR. DEUTCH:
Yeah. So what I'm
hearing and we do some of this too, it's the idea of multidisciplinary and
servicing and whether it's formal simulation or not. It's discussion. How do we
do this? How do we do that? Where is this located? Who does what when it's not
just run of the mill, everyone smiling and taking those pictures with the 3D
printer, but someone's actually very ill. That goes a long way when you're not
in a setting that has. Seven people on call because certainly many of us don't
practice in those environments.
DR. ROGERS:
Exactly. No, I think
that's that's exactly it. Yeah. Having a plan and training with that plan and
everyone's on board with the plan is, is key.
DR. DEUTCH:
Well, I've had you for a
little while here. It's been great talking with you. I really appreciate you coming
on the Central Line here. And we also really appreciate, of course your agreeing
to guest editor, an edition of the Monitor, which is just so great for the readers.
Is there anything else you want to share with members or readers of that
particular issue before we sign off?
DR. ROGERS:
Well, I just want to
throw out there that I think that OB anesthesia is really going to have a lot
of changes in the future, and they're all pretty much going to be good changes.
I think that our inquisitive and educated anesthesiologists out there are
coming up with all sorts of new ways to participate in the care of the patient.
And it's going to be a really exciting future.
DR. DEUTCH:
That's good to hear. Thanks
so much for being with us. And thank you, everyone, for listening in to this
episode.
DR. ROGERS:
Thank you.
DR. DEUTCH:
And listeners, remember
to read more about the issues we touched on today with Dr. Rogers at asamonitor.org.
And of course, join us back here for the next Central Line podcast.
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