A day in obstetrics
Obstetric Anesthesia at UVA
Three residents share the responsibility and privilege of providing obstetric anesthesia over a four week period at UVA. The basic outline of the schedule divides between weekdays and weekends. During the week, two residents alternate working a short and long shift, 7am to 1pm and 7am to 7pm respectively, while the third resident covers the night shift from 7pm to 7am. The weekend is covered by 24-hour call shifts, with the night call resident having a “golden” long weekend off.
Residents do one month of OB anesthesia in both their CA-1 and CA-2 year. During the CA-3 year, residents will typically rotate for 1 week on OB anesthesia at UVA and then have the option of working 3 weeks at Fairfax Hospital in Northern Virginia. Most senior residents elect the Fairfax rotation, as it is a high-volume center that helps them fine tune their neuraxial procedural skills.
Described below are the events of a long day shift from my last rotation on OB.
Rob Nicholson, CA2
One long day shift
0645 Will, Emily, and I meet a few minutes before teaching conference to make sure the two OB operating rooms are set for the day and to go over the current list of patients on the labor and delivery unit. Will, our night resident, kept busy overnight with a pair of c-sections and a labor epidural that is still running.
0700 Our attending, Dr. Sachin Mehta, arrives and discusses hypertensive disorders of pregnancy as part of our daily teaching conference in the obstetric anesthesia workroom. Will departs after the conference.
0730 Emily and I meet with the OB residents to discuss the current list of patients and their anticipated anesthesia needs. They would like to perform one c-section and feel that another patient would benefit from a labor epidural. Emily takes on the epidural, while I go meet the patient for a c-section.
This is her first pregnancy and she is lucky enough to have twins; however, the first twin is in a breech position. She is otherwise healthy and her labor has just started. I present the patient to Sachin and suggest we perform a spinal anesthetic. He agrees to the plan and we discuss implications of twin-pregnancy on neuraxial anesthesia, including the risk for exaggerated hypotension.
0830 Emily has finished the epidural and helps me position the patient in OB OR 1 for a spinal anesthetic. The patient tolerates the spinal block well, and after ensuring a T4 sensory level, the surgical procedure begins.
1100 Two new patients have arrived on L&D during the c-section. Emily already met them and consented for potential epidural analgesia while I was in the previous case. Emily departs for the main operating rooms to help out with a few lunch breaks before heading home at 1pm. She is planning on using the afternoon to train for her first marathon.
1230 Reading in the call room.
1400 One of the patients Emily met earlier is requesting a labor epidural. She is a multiparous patient and has already advanced to 7cm dilation. She appears in considerable discomfort and we decide to perform a combined spinal-epidural. Within minutes her pain begins to subside from the spinal component. After starting the epidural infusion, I return in an hour to assess the sensory spread of the epidural catheter. She is still comfortable and it is not too much longer until she delivers.
1800 The OB resident calls to ask for an urgent c-section for fetal decels on an antepartum patient. I’ve previously met the patient, but go to reassess her and discuss options for anesthesia. She is amenable to a spinal anesthetic. The OB nurses help to get her back to the operating room and the procedure is soon underway.
1900 Will arrives to start the night shift and take over for the c-section. I think he keeps even busier during his time off, as he is an avid mountain biker and runner. In contrast to Will and Emily, my physical activity for the evening will involve my feet up on a sofa and looking forward to the short shift tomorrow.