Guidelines for Regional Anesthesia in Obstetrics: potential impact on obstetric anesthesia services in rural Alabama

When the American Society of Anesthesiologists published its Guidelines for Regional Anesthesia in Obstetrics, I did a survey to determine what impact a broadly implemented strict interpretation of those guidelines might have on obstetric anesthesia care in small rural Alabama hospitals. Thirty-six rural Alabama hospitals with fewer than 200 beds were included in the survey, with a response rate of 50%. Data included total deliveries, cesarean section rates, utilization rates of anesthesia services, personnel providing anesthesia care, and identification of physician personnel available during labor and cesarean section. Results showed that anesthesia care is provided for approximately 52% of births in the responding hospitals. Of these, approximately 60% of cesarean sections and 90% of vaginal deliveries are not routinely attended by anesthesiologists. If these data also reflect the nonrespondent hospitals, statewide access could be limited for approximately 6000 parturients annually. The Guidelines should be interpreted with caution. Rather than conform to related policies, interpretation should allow implementation consistent with the capabilities of the individual institutions, while ensuring quality anesthesia care for the parturients.