Obstetric Anesthesia: The 1982 American College of Obstetricians and Gynecologists Standards and the Role of

To the Editor:—In their recent obstetric anesthesia workforce survey, Bucklin et al. observed that anesthesiologists provided regional analgesia for labor more often in 2001 than in 1992 or 1981. Obstetricians provided correspondingly less, with the main decrease occurring between 1981 and 1992. In 1981, obstetricians provided 26, 31, and 46% of regional analgesia in the three sizes of institutions surveyed, whereas in 1992, they provided 0, 5, and 3%. Similarly obstetricians administered 3, 4, and 9% of anesthetics for cesarean deliveries in 1981 but none in 1992. Hawkins et al. and Lagasse and Santos previously noted these dramatic decreases between 1981 and 1992, relating them in part to concerns about medicolegal liability by obstetricians. The source of these liability concerns was the publication in 1982 of revised professional standards by the American College of Obstetricians and Gynecologists (ACOG). For the first time, ACOG discouraged the concurrent provision of both an anesthetic and a procedure by an obstetrician, a previously common occurrence, and required the inclusion of anesthesia departments in privileging practitioners for obstetric anesthesia. The fifth edition of the Standards for Obstetric-Gynecologic Services, published in 1982, states,