Obstetric Anesthesia

Philosophy


Gilbert J.Grant, M.D. Director,
Obstetric Anesthesia

The physicians of the Division of Obstetric Anesthesia are dedicated to the premise that every woman has the right to a safe and comfortable delivery. Our clinical and research efforts are focused on realizing these dual goals. Obstetric anesthesiologists serve as on-site, full-time consultants in the Labor and Delivery Suite, poised to assist our obstetrical colleagues in the management of the pain of labor and delivery, to administer anesthesia for cesarean section, and to manage emergencies that may arise.

Staff and Coverage

Our team is comprised of approximately 20 attending anesthesiologists who share a commitment to providing the highest quality state-of–the-art obstetric anesthesia available. Their innovative approach to pain management during labor, delivery and after cesarean has provided safe and comfortable birthing experiences for many women who have delivered their babies at NYU Langone Medical Center. Obstetric anesthesiologists provide coverage of the Labor and Delivery suite 24 hours per day, 365 days per year.

Number of Patients Served

Approximately 6,000 women give birth each year at NYU Langone Medical Center, and more than 80% of them receive epidural pain relief for labor. Among first-time mothers, more than 90% use epidurals.

Array of Services Provided

Our patients benefit from the latest innovations in obstetric anesthesia techniques. One of the most significant advances in recent years in obstetric anesthesia was the introduction of the so-called "epidural lite.” This technique, made possible by the development of sophisticated microprocessor-controlled infusion pumps, takes advantage of the combination of effects of local anesthetics, synthetic narcotics, and alpha adrenergic agonists. These three distinct classes of analgesic medications work together to relieve pain, so that only small doses of each are required, resulting in excellent pain relief with a low incidence of side effects. The benefit of this combination approach is that pain is relieved while muscle strength is preserved, increasing the likelihood of effective pushing during the second stage of labor. We have been using the "epidural lite" since the early 1990s, and the concentration of local anesthetic we administer (0.04% bupivacaine) is among the lowest used at any hospital. Furthermore, we routinely use patient-controlled epidural analgesia (PCEA) during labor, which permits women to self-adjust the amount of pain medication they receive..

Another measure of the progressive nature of our practice is the routine use of patient-controlled epidural analgesia (PCEA) to provide pain relief after cesarean. We are the only hospital in Manhattan to provide this service after cesarean, and we have been doing so for 20 years. We use PCEA because we are convinced that it has distinct advantages over other means of post-operative analgesia, including intravenous PCA, which tends to produce drowsiness in the mother and relatively poor pain relief, compared to the pain relief achieved with PCEA. Furthermore, with the epidural route, pain relief is achieved with lower plasma drug concentrations. This is especially important in post-partum women, most of whom are breast-feeding their newborns. We also offer PCEA after vaginal delivery to patients who have significant perineal pain due to episiotomy or lacerations that may accompany childbirth.

Patient Evaluations and Consultations

Click here for more Information for Patients. We encourage obstetricians at NYU Langone Medical Center to refer patients with medical or surgical issues that may affect labor and delivery for an antenatal evaluation by an anesthesiologist. Referral of patients during pregnancy facilitates the development of a safe and rational anesthetic plan for labor and delivery. A multidisciplinary approach involving the obstetric anesthesiologist, obstetrician, medical and/or surgical specialists, pediatricians, and nurses is the optimal means of managing pregnant women with significant medical or surgical concerns.