The vocation of women’s anesthesiology requires flexibility, sacrifice and steadfast dedication. For members of Duke Anesthesiology’s Division of Women’s Anesthesia (DWA), however, these challenges are part and parcel of the incredible sense of fulfillment that comes from working in this specialty.
The DWA is responsible for obstetric, gynecologic oncologic, ophthalmologic and urologic anesthesia at Duke. The majority of cases are obstetric. Although the work hours this specialty demands can be grueling, the opportunities for professional growth are limitless. Faculty and trainees working in the DWA gain invaluable experience in a variety of complex and highly stimulating cases and enjoy the benefit of the unique spirit of collaboration that this type of work environment engenders.
Furthermore, the specialty is constantly evolving. Today, 90 percent of parturients at Duke (including high-risk patients) receive epidural analgesia for labor. Furthermore, this division was one of the first in the nation to offer patient controlled epidural analgesia. The division has also introduced the most recent epidural delivery mode, programmed intermittent bolus administration, to optimize pain relief during labor. In addition to an exceptional pain management strategy, the DWA promotes a relaxed, family-friendly birthing environment by providing patients and their families access to expansive labor and delivery suites equipped with hardwood floors, hot tubs, foldout couches, and televisions in every room. They have also collaborated with their obstetric colleagues and the nursing staff to optimize patients’ experience during Cesarean delivery, a concept that has recently been described as “The Gentle Cesarean.” Furthermore, the division was one of the first units in the nation to introduce the use of an electronic medical record on the labor and delivery suite, allowing faculty to constantly audit and improve practice.
These improvements have occurred in spite of the fact that the volume of deliveries the division handles annually has tripled since obstetric anesthesia first became a specialty at Duke in 1997. The number of Cesarean sections (C-sections) performed has more than quadrupled. This growth is directly related to a dramatic change in the patient referral pattern over time. With the development of a strong Maternal Fetal Medicine group and an impressive Neonatal Intensive Care Unit, Duke began to accept more high-risk pregnancies. Today, high-risk patients comprise a majority.
The DWA faculty members have developed and maintained close-knit relationships across all disciplines to improve patient safety. They attend weekly multidisciplinary conferences to develop delivery plans specific to each patient’s needs. They maintain contact with the patient throughout the perinatal period, and provide an on-demand anesthesia consult service. Twenty-four hours after delivery, faculty members meet with each patient to identify any possible complications.
In recent years, the DWA’s research activity has focused on improving safety for these high-risk patients. Division Chief Ashraf Habib, MB BCh, MHSc, FRCA, leads the clinical research in the division, focusing on optimizing hemodynamic management during Cesarean delivery and improving outcomes such as pain and postoperative nausea and vomiting. Terrence Allen, MB BS, FRCA, is focusing his efforts on translational research and is working under the mentorship of Dr. Amy Murtha from the Division of Maternal Fetal Medicine, to study mechanisms involved in preterm labor. Jennifer Dominguez, MD, MPH, is investigating the impact of obstructive sleep apnea on outcomes in the obstetric patient population, and aims to improve identification and treatment of this condition in the parturient, under the mentorship of Dr. Ashraf Habib and Dr. Andrew Krystal, who is a professor of psychiatry and director of the Duke Sleep Research Laboratory.
The division has a strong commitment to resident education. Residents spend a significant portion of their CA-1 year in the DWA learning the fundamentals of anesthesia under the guidance of Abigail Melnick, MD, who is responsible for resident obstetric anesthesia rotations. In addition to mastering the fundamentals, residents are encouraged to pursue research ambitions and conduct QI projects. Trainees learn how to address regulatory requirements, collect data, and present research and QI findings in an academic setting under the guidance of Drs. Habib, Allen, Dominguez and Strouch. The DWA’s equally strong fellowship program, directed by Jennifer Dominguez, MD, MHS, is constantly improving and expanding. It is one of the first ACGME accredited programs in the country.
Global outreach is a major emphasis of the DWA. Division faculty and their colleagues in obstetrics and neonatology partner with The Duke Global Health Institute (DGHI) and a non-profit organization based in North Carolina, Kybele, to improve delivery of maternal and neonatal care and prevent childbirth-related injury and death in less affluent countries. Adeyemi Olufolabi, MBBS, DCH, FRCA, leads the Kybele work in Ghana. His efforts, along with colleagues from other institutions, have continued to provide significant improvements in maternal safety and build local capacity in maternal and neonatal health care. The division also offers the opportunity for a senior resident to spend one month in Ghana under the mentorship of Dr. Olufolabi to gain experience in global health with approval from the American Board of Anesthesiology. In conjunction with the Duke Global Health Institute, the DWA also initiated a two-year fellowship program in global health which allows candidates to obtain a master’s degree in global health and undertake research/educational opportunities in a low resource country.
No matter where they are, no matter what obstacles they face, the DWA faculty take the many challenges of working in obstetric anesthesia in stride, going well above and beyond the call of duty. This unwavering dedication results in a highly rewarding experience not only for the patients, but also for the faculty members who care for them. It’s no wonder they are in such high demand!