Obstetric anesthesia workforce survey: twenty-year update.

“THE position of woman in any civilization is an index of the advancement of that civilization; the position of woman is gauged by the care given her at the birth of her child.” Although many developments have occurred in obstetric anesthesia since this quote’s first publication in 1929, advances in the subspecialty have been complicated by medicolegal, financial, maternal, and fetal considerations. In addition to these concerns, recent economic pressures, variations in payment, patient expectations, and the technical aspects of providing these services have challenged obstetric anesthesia practice. Surveys are frequently used to define and detect changes in practice. Since data were collected more than 20 yr ago for the first obstetric anesthesia workforce survey, there have been improvements in delivery of obstetric analgesia and anesthesia. Many factors affect the number and type of available anesthesia care providers and the services they provide. The most recent obstetric anesthesia survey reported that although the availability of both regional analgesia and anesthesia for labor and delivery had improved in the previous decade, improvement was still needed in staffing patterns and availability of personnel. Organizations outside the practice of anesthesiology (e.g. American College of Obstetricians and Gynecologists [ACOG], Association of Women’s Health Obstetric and Neonatal Nurses [AWHONN]) have published their own guidelines, which impact the management of pain relief. Newer approaches to regional analgesia for labor (e.g., patient-controlled epidural analgesia, combined spinal–epidural [CSE] analgesia) may aid practitioners in meeting the increased demands of obstetric anesthesia practice, but whether these newer approaches are used substantially is unknown. The 2001 obstetric anesthesia workforce survey was performed in conjunction with the Society for Obstetric Anesthesia and Perinatology to estimate and assess current trends in obstetric anesthesia practice as well as to identify potential areas needing improvement.