The MUSC Obstetric Service is an active tertiary care unit performing approximately 2,700 deliveries annually. Anesthesiologists in the Division of Obstetric Anesthesia offer expertise in obstetric anesthesia and are involved in the management of high-risk pregnancies and are available for pre-delivery consultation. Between 30-40 percent of the patient population is high risk. Staff anesthesiologists are available in the hospital 24 hours a day to provide care for obstetric patients. All staff anesthesiologists are extensively experienced in OB anesthesia.
The Labor and Delivery suite has two operating rooms, two exam rooms and nine rooms for laboring patients. On the obstetric service, we continue to enjoy great relationships with our Maternal Fetal Medicine (MFM) group under the Chairmanship of Dr. Donna Johnson. Through the efforts of Regina Fraiya, nursing manager of the Labor and Delivery Unit, we have maintained a full nursing compliment; this has allowed for an improvement in care delivery. The expansion of the Neonatal Intensive Care Unit and the recruitment of additional MFM faculty have led to an increase in our high-risk patient population. We are continually faced with interesting and challenging clinical problems.
Labor Analgesia: We provide all major modalities of labor analgesia including combined spinal-epidural analgesia (CSE), patient-controlled epidural analgesia (PCEA), dural puncture epidural (DPE), nitrous oxide inhalation, and fentanyl PCA. Our epidural rate is approximately 80 percent for laboring patients. We provide a very efficient service for our laboring parturients with an average response time of 6.7 minutes for placement of a laboring epidural.
Cesarean Delivery (CD): Our cesarean delivery rate is approximately 35 percent. 90 percent of our CDs are done under neuraxial block. The first 24 hours post-CD pain management is the responsibility of our team and we use a multimodal approach using neuraxial narcotics and scheduled acetaminophen and ketorolac and TAPS block if needed.
Preoperative consult: All our high-risk parturients are seen by anesthesia staff on L&D during their prenatal visit and an assessment and plan is devised.
Resident education is a major mission of the section. We have three residents (1 CA-1, 2, and 3) rotating on obstetrical anesthesia at all times. Rotations are done in epochs of 4 weeks. With a good balance of high-risk and normal pregnancies, we are confident that our residents get an education in obstetrical anesthesia that is second-to-none. During the preliminary stage, the new junior residents are closely supervised and advised about clinical techniques and management of high risk and normal patients. Residents always perform the techniques under direct supervision. However, senior residents are allowed to place laboring epidurals independently, but a staff anesthesiologist is always in close proximity for any advice or assistance. Board rounds along with the obstetricians are performed every morning and are a compulsory part of the clinical management. During this time, residents absorb considerable information about the patients in the labor and delivery area. The educational schedule for the 4 weeks is very rigorous and complete. There are daily scheduled discussions which spans the whole curriculum. OB simulation and team training exercises including drills for stat CD, OB hemorrhage and maternal cardiac arrest are also a key part of the training program. All residents are required to meet with Dr. Hebbar prior to start of the rotation in order to review the Goals and Objectives of the rotation. CA-1s take a pre-test at the beginning of the rotation. At the end of the rotation, all residents do a post-test and mock orals in OB anesthesia.
There is on-going collaborative research work with our MFM Division. In addition, there is ongoing clinical research by our faculty. Residents are encouraged to be involved with ongoing research. Some of our research interests include epidural fever, labor analgesia modalities and post CD multimodal pain management strategies. We have had resident abstracts related to OB anesthesia presented at annual meetings of the Society for Obstetric Anesthesia and Perinatology (SOAP), IARS and ASA. We have published our research in peer reviewed OB and anesthesia journals.
Obstetric Anesthesia Faculty
Latha Hebbar, M.D., FRCA, FFARCS
Director, Obstetric Anesthesia