New frontiers in obstetric anesthesiology: Advocacy through innovation

Reductions in global maternal mortality have stagnated since 2015, and rates continue to rise in the United States, with glaring disparities [ , ]. For every maternal death, 30 or more women experience severe morbidity that can complicate their childbirth and have long-term detrimental impact on their well-being [ ]. Obstetric anesthesiologists are ideally suited to dismantle the barriers that are perpetuating such maternal morbidity and mortality, particularly in-hospital events and events deemed to be preventable.

Since preventable morbidity and mortality continue to plague mothers worldwide, obstetric anesthesiologists should feel inspired for the chance to do more. Our specialty embodies the act of advocacy for new mothers-to-be through its innovation and advances in quality improvement for maternal care. This issue of Best Research & Practice in Clinical Anesthesiology can serve as a checkpoint for those who want to make a difference and lower maternal morbidity and mortality. For women in labor, we highlight the latest refinements and state-of-the-art of both neuraxial analgesia techniques and non-neuraxial strategies for pain relief. For women who need a cesarean delivery, innovations in spinal anesthesia, latest evidence on vasopressor choices, general anesthesia considerations, and enhanced recovery abound. A broader scope on postdural puncture headache highlights the need for further treatment research, longer-term follow-up, and support of patients. Here we focus on the latest research in these areas, and how it translates to best clinical practice for maternal recovery with minimal morbidity.

For more severe, preventable morbidity and mortality, obstetric hemorrhage is a concern that deserves high priority. Here, we cover the latest in uterotonic agents, blood loss quantitation, transfusion and coagulation, and placenta accreta management strategies. As the age of parturients advances, so do their rates of comorbidity – we highlight morbid obesity and cardiovascular disease for the risks they create around the time of delivery. Preeclampsia and eclampsia also warrant our focus, and we cover advances in risk assessment through biomarker sampling and how electronic record systems may be applied for faster and better blood pressure control. Perhaps the most meaningful life-saving skillset that obstetric anesthesiologists bring to the table is critical care expertise – including prompt action for resuscitation when maternal cardiac arrest occurs, use of extracorporeal circulation, and point-of-care ultrasound diagnostics. As we advance our practice in each of these areas, obstetric patients will benefit by having lower rates of morbidity, positive experiences, and safe care.

The clinical scope of obstetric anesthesiology is growing at a rapid pace; the only predictable feature of obstetric anesthesiology research and how it defines best practice is that it will continue to expand. Obstetric anesthesiologist engagement in such advances will continue to help new mothers have better delivery experiences and safer maternal and newborn outcomes. In this issue of the journal, each and every topic that is highlighted by international, renowned obstetric anesthesiologists can be framed as a strategy to lower maternal morbidity and mortality. The time to advocate for maternal safety is now! There has never been a more exciting time to be an obstetric anesthesiologist. We hope you are as inspired to action by this series as we are, and we extend our gratitude to the authors who contributed their expertise to this series.

CRediT authorship contribution statement

Michaela K. Farber: Conceptualization, Writing – original draft. Marc Van de Velde: Conceptualization, Writing – review & editing.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michaela K. Farber reports a relationship with Flat Medical that includes: funding grants. Michaela K. Farber reports a relationship with HemoSonics LLC that includes: board membership. Michaela K. Farber reports a relationship with Octapharma that includes: board membership and consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.