In 2019, the Women’s Anesthesiology Division, or DWA, was recognized by the Society for Obstetric Anesthesia and Perinatology as a “SOAP Center of Excellence.”
The Duke Birthing Center is a Level 3 regional referral center with approximately 3,600 deliveries per year that encompass a range of maternal and fetal conditions. Division faculty work closely with neonatology faculty in the Duke Intensive Care Nursery, a 50-bed, Level IV neonatal intensive care nursery.
In addition to staffing the Duke Birthing Center 24-hours a day, 365 days a year, this division’s faculty are experts in delivering state-of-the-art care to a range of patients undergoing surgeries of the reproductive and urologic systems using strategies such as Enhanced Recovery After Surgery (ERAS). Although the work hours involved can be grueling, the opportunities for professional growth and satisfying patient interactions 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. The division was one of the first in the nation to offer patient controlled epidural analgesia. The DWA has recently introduced the most current epidural delivery mode, programmed intermittent bolus, to optimize pain relief during labor. In addition to exceptional labor analgesia, the DWA promotes and supports a relaxed, family-centered birthing environment. They have collaborated with their obstetric colleagues and the nursing staff to optimize patients’ experiences during Cesarean delivery using the principles of ERAS, and a family-centered approach that has been recently been described as the “Gentle Cesarean.”
Faculty from the DWA have worked with their colleagues in maternal-fetal medicine, gynecologic oncology, interventional radiology and transfusion medicine for years to develop a clinical care pathway for patients with placenta accreta spectrum, a high-risk type of Cesaeran delivery that requires intense collaboration between specialties to keep mother and baby safe and healthy.
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 deliveries 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 of patients cared for at Duke Birthing Center.