Obstetric Anesthesia

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Philosophy

Gilbert J. Grant

The physicians of the Division of Obstetric Anesthesia are dedicated to the premise that every woman has the right to a safe and comfortable delivery. Our clinical and research efforts are focused on realizing these dual goals. Obstetric anesthesiologists serve as on-site, full time consultants in the Labor and Delivery Suite, poised to assist our obstetrical colleagues in the management of the pain of labor and delivery, to administer anesthesia for cesarean section, and to manage emergencies that may arise.

Staff & Coverage

Since 1992, the Division of Obstetric Anesthesia of the Department of Anesthesiology has been headed by Gilbert J. Grant, MD. He is assisted by a staff of approximately 15 attending anesthesiologists who share a commitment to providing the highest quality state-of�the-art obstetric anesthesia available. Their innovative approach to pain management during labor, delivery, and after cesarean has provided safe and comfortable birthing experiences for many women who have delivered their babies at Tisch Hospital. Obstetric anesthesiologists provide full-time coverage of the Labor and Delivery suite (24 hours/day, 365 days/year).

Number of Patients Served

Over the past few years, the number of births has been steadily increasing at Tisch Hospital. During calendar year 2003 the number of births exceeded 4500. The Division of Obstetric Anesthesia has kept pace with these changes, and has facilitated them, by providing pain relief to an ever-increasing percentage of parturients. At Tisch Hospital, more than 70% of laboring patients receive regional (epidural and/or spinal) analgesia for labor, and for first-time mothers, the percentage approaches 90%. The percentage of women opting for labor analgesia is expected to continue to steadily increase as women become more enlightened about their pain relief options.

Array of Services Provided

Our patients benefit from the latest innovations in obstetric anesthesia techniques. One of the most significant advances in recent years in obstetric anesthesia has been the introduction of the so-called "walking" epidural. This technique, made possible by the development of sophisticated microprocessor-controlled infusion pumps, takes advantage of the combination of effects of local anesthetics, narcotics, and alpha adrenergic agonists. These three classes of drugs potentiate one another, so that only small doses of each are required, resulting in excellent pain relief, with a low incidence of side effects. The benefit of this combination approach is that pain is relieved while muscle strength is preserved, increasing the likelihood of effective pushing during the second stage of labor. We have been using the "walking epidural" since the mid 1990s, and the concentration of local anesthetic we administer (0.04% bupivacaine) is among the lowest used at any institution. Furthermore, we offer patient-controlled epidural analgesia (PCEA) during labor, which allows patients to self-adjust the amount of pain medication they receive.

Another measure of the progressive nature of our practice is the routine use of patient controlled epidural analgesia (PCEA) to provide pain relief after cesarean. We are one of the few institutions in the United States to routinely use PCEA to manage pain after cesarean. We use PCEA because we are convinced that it has distinct advantages over other means of post-operative analgesia, including intravenous PCA, which tends to produce somnolence and inferior quality analgesia. Furthermore, with the epidural route, analgesia is achieved with lower plasma drug concentrations. This is especially important in post-partum women, many of whom are breast-feeding. We have been providing PCEA routinely after cesarean since 1996, and it has benefited thousands of patients. We also offer PCEA after vaginal delivery to patients who have significant perineal pain due to episiotomy or lacerations.

Patient Education

Since 1997, Dr. Grant has sponsored a monthly seminar for patients to provide them with up-to-date information on obstetric anesthesia. The seminars also serve as an ideal forum for patients to ask questions regarding obstetric anesthesia issues. The seminars are provided as a service for patients and their significant others. Experience has proven that it is preferable for patients to learn about their options in a non-threatening setting prior to the onset of labor, and the seminars provide such a setting.

Patient Evaluations and Consultations

In addition to the monthly seminars, the Division of Obstetric Anesthesia encourages obstetricians to refer patients with complications of pregnancy for antenatal evaluation by an anesthesiologist. Referral of patients during pregnancy facilitates the development of a safe and rational anesthetic plan for labor and delivery. Furthermore, other potential complicating medical and surgical issues may be identified during these visits, appropriate studies may be ordered, and plans to deal with them can be devised. A multidisciplinary approach involving the obstetric anesthesiologist, obstetrician, medical and/or surgical specialists, pediatricians, and nurses is the optimal means of managing pregnant patients with significant systemic diseases.

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