OBSTETRIC ANESTHESIA WORK-FORCE SURVEY, 1981 VERSUS 1992

Background: In 1981, with support from the American Society of Anesthe siologists and the American College of Obstetricians and Gynecologists , anesthesia and obstetric providers were surveyed to identify the per sonnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations. Methods: Comments and questions from the Amer ican Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice mere added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Us ing the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, greater than or equal to 1,500 births; stratum II, 500-1,499 births; stratum I II, <500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital one for the chief of obstetrics and one for the chief of anesthesiology. Results: Compared with 1981 data, th ere was an overall reduction in the number of hospitals providing obst etric care (from 4,163 to 3,545), with the decrease occurring in the s mallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992) More women received some type of labor analgesia, and there w as a 100% increase in the use of epidural analgesia However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal ana lgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% i n 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decreas e in the use of general anesthesia. Anesthesia for cesarean section wa s provided by nurse anesthetists without the medical direction of an a nesthesiologist in only 4% of stratum I hospitals but in 59% of stratu m III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981. Conclusions: Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having c esarean section deliveries. In the smallest hospitals, regional analge sia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse ane sthetists Without medical direction by an anesthesiologist. Obstetrici ans are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscita tion.