Anesthesiology Department Phone: (718) 670-1080
“The degree of pain that a patient in labor might experience is and individual matter,” says Peter A. Silverberg, M.D., chairman of Anesthesiology. “It depends on many factors, such as the level of pain tolerance, size and position of the baby, strength of uterine contractions, and prior birth experience.” Dr. Silverberg emphasizes that NewYork-Presbyterian/Queens wholeheartedly supports a statement from the American Congress of Obstetricians and Gynecologists, which says that no one should experience severe pain while under a physician’s care, as long as safe intervention is available. The statement stresses that a request from the mother is enough justification for pain relief during labor.
At NewYork-Presbyterian/Queens more than 80 percent of all patients request and receive pain relief for labor and delivery. Pain management is provided by a team of specialized obstetrical anesthesiologists who are available 24 hours a day. “The scientific and technological advances that led to the introduction of programmable pumps – along with the use of ultra-low-dose mixtures of pain medications for epidural infusions – have revolutionized obstetrical anesthesia practice and improved patient safety,” says Isaac P. Lowenwirt, M.D., director of Obstetrical Anesthesiology. “By using patient-controlled epidural analgesia (PCEA), women are now able to be pain-free during labor and delivery while retaining the muscle strength to walk during labor and to effectively push the baby out.”
Obstetrical anesthesiology also plays a major role should there be an emergency during delivery that requires quick thinking and lots of helping hands. Postpartum hemorrhage is an obstetrical emergency that can be fatal. In 2001, the hospital appointed a patient safety team to address the care of women with major obstetric hemorrhage. It included representatives from Anesthesiology, Maternal Fetal Medicine, Hematology and the Blood Bank, as well as the departments of Nursing, Communication, and Administration.
The group created “Team Blue,” a rapid response team using the cardiac arrest team as a model. It also developed rigorous protocols for the diagnosis, assessment, and management of patients at high risk for hemorrhage, involving members of the trauma team, as well as Anesthesiology, and OB/GYN clinical and ancillary personnel.
“The women coming to us are very concerned about pain management and its potential side effects,” Dr. Lowenwirt continues. “We counsel patients both during a pre-delivery conference and during delivery on the safety of these new analgesic techniques, which allow them to make decisions without conflict or guilt.”
Obstetrical patients with selected pre-existing medical conditions, or those whose pregnancy is considered high risk by the obstetrician, are assessed by the OB anesthesiologist during the seventh or eighth month of pregnancy, well before delivery is expected. The list of conditions includes heart disease, hypertension, lung disease, morbid obesity, neurological problems, and scoliosis. The pre-delivery conference gives the anesthesiologist an opportunity to identify high-risk patients and to contribute to their care plan.
“Two very effective pain management techniques are available to assist the patient,” Dr. Lowenwirt explains.
“Patient-controlled epidural analgesia gives the patient autonomy in her control of pain during early labor. Combined spinal-epidural anesthesia is the perfect technique to offer women in advanced labor. By injecting a small dose of pain medication into the spinal canal, we help women to achieve immediate pain relief, and they can effectively push throughout the second stage of labor.”
Dr. Lowenwirt has recently introduced ultrasound-guided epidural
placement to the unit that helps the clinician place epidurals in
morbidly obese patients or those with severe scoliosis, who would
otherwise be laboring in pain because of the difficulties in
epidural catheter placement in that population.
All obstetrical patients are given a booklet containing extensive information about pain management. The booklet gives a detailed explanation of the pain relief options for both vaginal and Cesarean deliveries as well as pain management options following delivery. The booklet also contains the numbers to call if the patient has questions.