Obstetric anesthesia work force survey, 1981 versus 1992

Area of Science:

• Anesthesiology
• Obstetrics
• Healthcare Management

Background:

• A 1981 survey established baseline data on obstetric anesthesia practices in the U.S.
• The survey was repeated in 1992 to track changes and identify trends.
• Supported by the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists.

Purpose of the Study:

• To compare obstetric anesthesia personnel and methods used in 1981 versus 1992.
• To identify changes in the provision of labor analgesia and anesthesia for cesarean section.
• To assess variations in practice based on hospital size and U.S. region.

Main Methods:

• A stratified random sample of U.S. hospitals was selected based on annual birth volume and census region.
• Surveys were sent to hospital administrators, chiefs of obstetrics, and chiefs of anesthesiology.
• The 1992 survey incorporated new issues while maintaining comparability with 1981 data.

Main Results:

• A decrease in the number of hospitals providing obstetric care, particularly smaller facilities.
• Significant increase in labor analgesia use, with a 100% rise in epidural analgesia.
• Reduced use of general anesthesia for cesarean sections, with increased regional anesthesia utilization.
• Decreased involvement of anesthesia personnel in neonatal resuscitation.

Conclusions:

• Labor analgesia is more common, and general anesthesia for cesarean sections is less frequent compared to 1981.
• Regional analgesia remains limited in smaller hospitals; nurse anesthetists provide a majority of cesarean anesthetics in these settings without anesthesiologist direction.
• Obstetricians' direct provision of epidural analgesia has declined, as has anesthesia personnel's role in neonatal resuscitation.