Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology, is a sub-specialty of anesthesiology that provides peripartum (time directly preceding, during or following childbirth) pain relief (analgesia) for labor and anesthesia (suppress consciousness) for cesarean deliveries ('C-sections'). Other subspecialty options for anesthesiology include cardiac anesthesiology, pediatric anesthesiology, pain medicine, critical care, neuroanesthesia, regional anesthesia, transplant anesthesia and trauma anesthesia.
Scope Obstetric anesthesiologists typically serve as consultants to ob-gyn physicians and provide pain management for both complicated and uncomplicated pregnancies. An obstetric anesthesiologist's practice may consist largely of managing pain during vaginal deliveries and administering anesthesia for cesarean sections; however, the scope is expanding to involve anesthesia for both maternal as well as fetal procedures. Maternal-specific procedures include cerclage, external cephalic version (ECV), postpartum bilateral tubal ligation (BTL), and dilation and evacuation (D and E). Fetus-specific procedures include fetoscopic laser photocoagulation and ex-utero intrapartum treatment (EXIT). However, the majority of care given by anesthesiologists on most labor and delivery units is management of labor analgesia and anesthesia for cesarean section.
History The administration of general anesthesia in operative procedures was publicly demonstrated by William Thomas Green Morton (1819–1868) in Boston, October 1846 as the first successful practice of its kind. This practice revealed the pain-annulling properties of ether inhalation during surgery. Pioneers of obstetric anesthesia extended these findings to cases of parturition or childbirth, notably including James Young Simpson of Scotland (1811–1870), John Snow of London (1813–1858) and Walter Channing of the United States (1786–1876). Prior to the anesthetizing of Queen Victoria in 1853, the use of diethyl ether and chloroform as obstetric anesthetics faced social, religious, and medical opposition. With the shift in social attitudes, women became less reserved towards this novel practice and began coercing physicians to administer powerful anesthetics during labor. Medical objections were similarly disintegrated with casebook publications that reflected the safety of obstetric anesthesia for both mother and child. Thus the advent of obstetric anesthesia facilitated the use of instruments during delivery as obstetricians were afforded greater scope in terms of these materials. Following Morton's use of ether as an anesthetic, James Simpson conducted his own obstetric anesthetic trial on January 19, 1847 using an open-drop approach to administer ether. However, due to its post-analgesic effect of nausea and vomiting, he later switched to using chloroform instead. Simpson's later personal discovery of chloroform's anesthetic properties inspired subsequent trials with chloroform that he went on to make public in November 1847. The Medico Surgical Society publication of Simpson's findings was not well received and required significant defense thereafter. Three months later, on April 7, 1847, ether was used for the first time in American obstetrics. Following that initial administration documented in the Boston Medical and Surgical Journal by N.C Keep, Walter Channing described several obstetric cases in which he successfully employed sulfuric ether in the United States. John Snow was responsible for anesthetizing the Queen and is also attributed for influencing public and medical opinions on obstetric anesthesia through his various recorded experiences Though the birth of the Queen's 8th child Prince Leopold on April 7, 1853, was not generally publicized, the London social elite were aware of the use of chloroform in this delivery and found it appealing. Until this time, there had been considerable public and religious opposition to obstetric anesthesia. A woman, Eufame MacAlayne, was buried alive in Scotland in 1591 just for seeking pain relief for the birth of her two sons. This societal aspect of childbirth was recognized by Dr. Churchill of Dublin and later published on the statistics of obstetric anesthesia. Churchill suggested wealthier individuals were recorded to have easier births from the use of such drugs. In the practice of obstetric anesthesia, John Snow greatly differed from Simpson in that Snow emphasized proper quantity measurements and the delay of administration until the second stage of labor commenced. Snow additionally disagreed with Simpson's argument that the laboring patient should be anesthetized to the level of unconsciousness. These differences among others are why the title "Father of Obstetric Anesthesia" has become so controversial.
Religious opposition Labor analgesia was debated on the grounds of religion and morality, which John Simpson used as his own weapon against opposition. Biblical literalism led many to interpret labor pains as punishment for sin and deemed obstetric anesthesia impious with respect to the primeval curse. Simpson advocated that "whosoever shall keep the whole law and yet offend in one point, is guilty of all". In this sentiment he is referring to many of the medical practitioners who mitigate minor pains but avoid obstetric anesthetics for fear of opposition or religious persecution. Critic Charles Meigs exemplified this belief of the physiological value in parturition pain, which the greater public supported throughout the mid 19th century. The natural benefits of such labor pains which initially inhibited the practice of obstetrical analgesia, originated from another religious consideration of perfection. Religious opponents argued that individuals of God's creation and His standard of perfection should not be in need of such obstetrical interference. Natural processes employed by the Almighty Himself should be left untouched. In support of this claim, M. Roussel advocated that the refinement of society through technical operations (i.e. anesthesia) causes more harm then good to the natural process of childbirth.
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