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1. Key recommendations
1. A duty anaesthetist must be immediately available for emergency work on the delivery suite
24 hours a day.
2. There must be a nominated consultant in charge of obstetric anaesthesia with time allocated
for this role.
3. There should be a clear line of communication from the duty anaesthetist to the supervising
consultant at all times.
4. The workload of the obstetric anaesthetist continues to increase. As a basic minimum there
must be 12 consultant sessions per week to cover emergency work on delivery suite.
5. Scheduled obstetric anaesthetic activities (e.g. elective caesarean section lists, clinic) require
additional consultant sessions over and above the 12 for emergency cover.
6. Women should have antenatal access to evidence based information about the availability
and provision of all types of analgesia and anaesthesia. This information should be provided
or at least ratified by the department of obstetric anaesthesia.
7. There should be an agreed system whereby the anaesthetist is given sufficient advance
notice of all potentially high-risk patients.
8. When a 24-hour epidural service is offered, the time from the anaesthetist’s being informed
that a woman is requesting an epidural and ready to receive one until attending the mother
should not normally exceed 30 minutes. This period should only exceed one hour in
exceptional circumstances. Responses times should be regularly audited and if the above
standards are missed frequently, consideration should be given to alteration of staffing
arrangements.
9. Provision should be made for those who cover the delivery suite on-call, but do not have
regular sessions there, to spend time on the delivery suite in a supernumerary capacity with
one of the regular obstetric anaesthetic consultants.
10. There must be separate provision of staffing and resources to enable elective work to run
independently of emergency work, in particular to prevent delays to both emergency and
elective procedures and provision of analgesia in labour.
11. The person assisting the anaesthetist must have no other conflicting duties, must be trained
to a nationally recognised standard and must work regularly and frequently in the obstetric
unit.
12. The training undergone by staff and the facilities provided in the maternity recovery unit must
be of the same standard as for general recovery, as defined in current, published guidelines.
13. Appropriate facilities should be available for the antenatal and peripartum management of the
sick obstetric patient as defined in the document Providing Equity of Critical and Maternity
Care for the Critically Ill Pregnant or Recently Pregnant Patient.
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