The delivery of obstetric anaesthetic care in UK maternity units: a survey of practice in 2021

Background: Anaesthetists are crucial members of the maternity unit team, providing peri-operative analgesia and anaesthesia, and supporting the delivery of medical care to high-risk women. The effective contribution from obstetric anaesthetists to safety in maternity units depends on how anaesthesia services are organised and resourced. There is a lack of information on how obstetric anaesthetic care is resourced in the UK.Methods: The Obstetric Anaesthetists' Association surveyed UK clinical leads for their hospital's obstetric anaesthetic service and examined compliance with national recommendations.Results: There were 153 responses by lead obstetric anaesthetists from 184 maternity units in the UK (83%). The number of consultants per 1000 deliveries was 2.2 [1.6-2.7] (median [IQR]). In 20% of units, there was a dedicated on-call rota (on-call only for obstetric anaesthesia), whilst the remainder had a 'combined' on-call rota (on-call for other clinical areas in addition to obstetrics). Multidisciplinary ward rounds were held in 83% of units. Twenty-five (16%) units reported having no regular multidisciplinary ward rounds, of which nine (6%) did not have any multidisciplinary ward rounds. Planned operating lists for elective caesarean sec-tions were provided in 77% of units.Conclusions: In the largest survey of obstetric anaesthesia workload to be reported for any health system, we found significant disparities between obstetric anaesthesia service provision and current national recommen-dations for areas including consultant staffing, support for elective caesarean section lists, antenatal anaesthetic clinics, and consultant support for service development. Wide national variation in service provision was identified.

Automated summary

This study examined the resources and organization of obstetric anaesthetic care in the UK. The results showed significant disparities between the provision of obstetric anaesthesia services and national recommendations regarding consultant staffing, support for elective caesarean section lists, antenatal anaesthetic clinics, and consultant support for service development. There was also wide national variation in service provision.