Division of Obstetric Anesthesiology
Physicians in the Division of Obstetric Anesthesiology, part of NYU Langone Health’s Department of Anesthesiology, Perioperative Care, and Pain Medicine, are committed to ensuring that women have the option of receiving safe and effective pain relief for childbirth. Under the leadership of Gilbert J. Grant, MD, division director, our educational, research and clinical services are focused on this mission.
Our Role in Education
Our educational mission is an integral part of our clinical care: Patients benefit from our culture of promoting advanced obstetric anesthesiology practices. We also provide patient education and discuss pain relief options for childbirth as well as answering any questions patients may have.
We lead in situ simulations in labor, delivery, and postpartum venues for other members of the obstetric care team, including obstetricians, obstetrical residents, and nurses. These experiences allow the obstetric care team to practice their response to emergency scenarios in a high-quality setting.
In addition, our division faculty are dedicated to educating medical students through an anesthesiology elective. We also train physicians in our Anesthesiology, Perioperative Care, and Pain Medicine Residency and offer a comprehensive, one-year Obstetric Anesthesiology Fellowship, both under the aegis of the Accreditation Council for Graduate Medical Education.
Our Role in Research
Our division is focused on advancing research in the practice of childbirth pain relief. As part of the Department of Anesthesiology, Perioperative Care, and Pain Medicine’s research program, we are studying the effectiveness of the gravity flow technique for administering an epidural, as well as pain control after cesarean and vaginal delivery in the era of the opioid epidemic.
Our Role in Patient Care
The Division of Obstetric Anesthesiology’s philosophy is that all women should understand their pain relief options for childbirth. With this information, they can make informed decisions about whether and which type of pain relief they prefer. This approach is consistent with the position of the American College of Obstetrics and Gynecology: “Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience severe pain amenable to safe intervention while the individual is under a physician’s care.… Maternal request is a sufficient medical indication for pain relief during labor.”
Our obstetric anesthesiologists serve as on-site, full-time consultants in the labor and delivery suite at NYU Langone’s Tisch Hospital and NYU Langone Hospital—Brooklyn. We assist our obstetric colleagues in the management of patient care, administer pain relief for labor and for cesarean delivery, and manage emergencies that may arise. Each year, nearly 6,000 women give birth at Tisch Hospital, and more than 80 percent receive epidural pain relief for labor. Among first-time mothers, more than 90 percent choose epidurals.
Our commitment to relieving the pain of childbirth does not end at the moment of delivery. We understand that pain after delivery can be intense. It can also have negative effects on the mother and impact her interactions with her baby. Tisch Hospital is one of the few hospitals in the nation that offers epidural pain relief after delivery to mothers of newborns.
Pain Relief During Labor
At Tisch Hospital, we relieve labor pain with epidural analgesia, although occasionally women receive spinal analgesia or combined spinal–epidural analgesia. Epidural and spinal medications are given in small doses, so patients are alert during childbirth. Epidural medication is administered through a catheter continuously throughout labor and delivery, so the pain relief lasts for as long as needed. Our anesthesiologists advocate placing the epidural catheter early in labor, while the mother-to-be is still relatively comfortable. Spinal medication is administered as a single dose, so the pain relief only lasts for an hour or two. Although spinals take effect a few minutes faster than epidurals, they may have more side effects.
Low-Dose Epidural During Labor
The childbirth epidural that we use combines low doses of local anesthetics, synthetic opioids, and adrenaline. The small doses of these three medications work together to relieve pain with a low incidence of side effects. We have been using the low-dose epidural since the early 1990s, and the concentration of local anesthetic we administer (0.04 percent bupivacaine) is among the lowest used at any hospital. We continue to refine our low-dose epidural to improve the quality of pain relief while minimizing the likelihood of muscle weakness.
Patient-Controlled Epidural Analgesia for Labor and Delivery
Our obstetric anesthesiologists use patient-controlled epidural analgesia (PCEA) during labor. PCEA enables women to self-adjust the amount of pain medication they receive. This provides patients with control over their pain relief and individualizes their treatment. An anesthesiologist is on-site 24 hours a day, 7 days per week to provide additional pain relief if needed.
Anesthesia Options for Cesarean Delivery
For cesarean delivery, pain relief options include epidural anesthesia, spinal anesthesia, combined spinal–epidural anesthesia, or general anesthesia. Very few women receive general anesthesia; most prefer to be awake when their baby is born. We reserve general anesthesia for emergency situations in which there is insufficient time to administer epidural or spinal anesthesia. General anesthesia may also be necessary if a spinal anesthetic or epidural anesthetic is contraindicated (for example, if a skin infection is present on the lower back). Our anesthesiologists typically do not use spinal anesthesia alone because an epidural catheter must be in place so that PCEA can be used after the cesarean delivery to provide postoperative pain control.
Pain Relief After Cesarean and Vaginal Delivery
Tisch Hospital is the only hospital in Manhattan to provide PCEA after delivery, and we have been doing this since 1996. We do so because we believe it is the best means of pain control, resulting in a comfortable and alert mother, while minimizing the need for postoperative oral opioids. We provide PCEA routinely after cesarean delivery and also after difficult vaginal delivery, for example, with associated lacerations. PCEA pain relief is unlikely to cause drowsiness because relatively small doses are used. This can be important for postpartum women who wish to breastfeed their newborns. If the mother is comfortable, she is better able to interact with and breastfeed her baby. In contrast, using oral opioids for pain relief may cause the mother to become drowsy. Opioids are also transferred to the baby during breastfeeding, causing drowsiness in the baby as well.