The Women’s Anesthesiology Division was formally established at Duke in 1997 with the appointment of Dr. Donald Penning. The model of the division evolved from coverage by a pool of anesthesiologists, some of whom were non-specialists, to a model where faculty trained in obstetric anesthesiology provided 24/7 coverage for the Labor and Delivery Unit. This led to increased academic focus in educational and research productivity and formalization of the division. Since then, the volume of deliveries has significantly increased. 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 our patients. This growth was directly related to a dramatic change in the patient referral pattern over time. Furthermore, the diverse faculty interests have contributed to the development of global obstetric anesthesia solutions, research into causes of preterm labor, prevention and treatment of maternal sepsis, management of women with cardiac disease in pregnancy, optimization of labor analgesia and recovery following cesarean delivery, and solutions to reduce morbidity in obstetric hemorrhage. The division has continued to grow and expand under the leadership of Dr. Holly Muir (2000-2013) and Dr. Ashraf Habib (2013-present) and is a nationally recognized division within the field.