Obstetric Anesthesia

The Division of Obstetric Anesthesia at Columbia University is a Society for Obstetric Anesthesia and Perinatology Center of Excellence. All of our patients receive the highest-quality obstetric anesthesia care.

The Society of Obstetric Anesthesia and Perinatology initiated this designation in 2019. Renewable every four years, it recognizes institutions and programs that demonstrate excellence in obstetric anesthesia care. Our division received this designation in 2019 and in 2023. Learn more here about how and why the Centers of Excellence designation was created.

Division News

• Anjan Saha, MD, PhD has been awarded the 2023 SOAP/Kybele International Outreach Grant for his project, “Obstetric Anesthesia Capacity Building in a Public Teaching Hospital in Sierra Leone.” The award funds international outreach projects in collaboration with host countries to enhance obstetric anesthesia practice. Dr. Saha is an Apgar scholar and CA-2 resident. Congratulations, Dr. Saha!
• Congratulations to Assistant Professor Dr. Jean Guglielminotti on his first R01, a highly competitive award from the National Institute on Minority Health and Health Disparities. His project,“Reducing Racial and Ethnic Disparities in Maternal Health through Policy Interventions” will be funded by the NIH for five years.

Mission

To create and foster an environment of excellence in clinical care, learning, and inquiry and to provide exceptional, compassionate care during pregnancy and childbirth.

We train future leaders in anesthesiology and medicine and inspire them to conduct ethical research that contributes to the advancement of obstetric anesthesiology and perinatology.

Our Vision

Safe, effective, compassionate, evidence-based and timely care.

Our Values

Personalized care, safety, comfort, well-being, recovery, respect, equity, inclusivity, excellence, professionalism.

Clinical Services

Our division provides services at the Sloane Hospital for Women at Morgan Stanley Children’s Hospital main campus (approximately 5000 annual deliveries) and at the Allen Hospital (approximately 2000 annual deliveries).

A great number of high-risk or critically ill parturients require close consultation and cooperation between the Department of Obstetrics & Gynecology and the Department of Anesthesiology through the Mothers Center.

At the Morgan Stanley Children’s Hospital, there is a special emphasis on Critical Care Obstetrics (CCOB). We have a “high-risk unit” with 6 beds on the labor suite, equipped for full hemodynamic monitoring and other aspects of critical care for parturients with cardiopulmonary and other critical diseases with a referral program for Cardio-Obstetrics and Critical Care Medicine. We have an active placenta accreta spectrum (PAS) program, and a fetal surgery program covered by the Division of Obstetric Anesthesia.

At the Morgan Stanley Children’s Hospital, the neuraxial labor analgesia rate is ~90 percent; it is ~80 percent at the Allen Hospital. The cesarean delivery rate is ~35 percent at both campuses, reflecting the referral nature of much of the practice.

Division faculty provide coverage of the main campus L&D suite 24 hours a day, 7 days a week, and for the Allen Hospital during daytime hours.

Education

The Division of Obstetric Anesthesia provides residency and postgraduate fellowship training in state-of-the-art techniques and strategies of labor analgesia and obstetric anesthesia.

Much of the training and education occurs in the Margaret Wood Center for Simulation & Education, with a strong emphasis on use of simulation and serious games for education of rare events. The Obstetric Anesthesiology Fellowship program has been accredited by the ACGME since 2012, the first year such accreditation was available.

More than 25 fellows have graduated in our program since 2012. We currently have 3 fellowship positions, and some of our fellows complete dual fellowships (OB and Peds Anesthesia, OB and Critical Care Medicine, OB and Cardiac Anesthesia).

Research

After investigating for over two decades the effect of genetic variability on preterm labor, the response to vasoactive agents, pain and the response to opioids, we conduct clinical trials aiming to improve patient outcomes, during labor and delivery and the postpartum period.

Aligning with our values, our research focuses on identifying strategies to reduce opioid consumption while improving the birthing experience, and generating data that promotes patient driven, safe and equitable obstetric anesthesia care.

Key themes and publications by our group

Pharmacogenetics and response to vasopressor agents during cesarean delivery

Landau R, Liu SK, Smiley R, Blouin JL, Ngan Kee W. The effect of maternal and fetal β2-adrenoceptor and nitric oxide synthase genotype on vasopressor requirement and fetal acid-base status during spinal anesthesia for cesarean section. Anesth Analg 2011;112:1432-7. PMCID: PMC3102860

Landau R, Kern C, Columb MO, Smiley R, Blouin JL. Genetic Variability of the m-Opioid Receptor Influences Intrathecal Fentanyl Analgesia Requirements in Laboring Women. Pain 2008;139:5-15

Shared decision making and individualized opioid prescription after surgery

Landau R, Romanelli E, Daoud B, Shatil B, Zheng X, Corradini B, Aubey J, Wu C, Ha C, Guglielminotti J. Effect of a stepwise opioid-sparing analgesic protocol on in-hospital oxycodone use and discharge prescription after cesarean delivery. Reg Anesth Pain Med. 2021 Feb;46(2):151-156. PMID: 33172902.

Prabhu M, McQuaid-Hanson E, Hopp S, Burns SM, Leffert LR, Landau R, Lauffenburger JC, Choudhry NK, Kaimal A, Bateman BT. A Shared Decision-Making Intervention to Guide Opioid Prescribing After Cesarean Delivery. Obstet Gynecol. 2017;130(1):42-46.

Marziali ME, Giordano M, Gleit Z, Prigoff J, Landau R,* Martins SS.* Development and design of a mobile application for prescription opioid clinical decision-making: a feasibility study in New York City, USA. BMJ Open. 2023 Feb 28;13(2):e066427. doi: 10.1136/bmjopen-2022-066427. PMID: 36854603; PMCID: PMC9980329. (*joint senior authors).

Combined spinal epidurals for labor analgesia (and adjuvants)

Landau R, Schiffer E, Morales M, Savoldelli G, Kern C. Dose-sparing Effect of Clonidine added to Ropivacaine in Labor Epidural Analgesia. Anesth Analg 2002;95:728-34

Goodman S, Smiley RM, Negron M, Freedman P, Landau R. Combined Spinal-Epidural Versus Epidural Analgesia in Parous Women. Anesth Analg. 2009;108:246-51

Lee A, Landau R, Lavin T, Goodman S, Menon P, Smiley R. Comparative efficacy of epidural clonidine versus epidural fentanyl for treating breakthrough pain during labor: a randomized double-blind clinical trial. Int J Obstet Anesth. 2020 May;42:26-33. doi: 10.1016/j.ijoa.2019.11.003.

Examining maternal outcomes and complications in large datasets

Guglielminotti J, Landau R, Wong C, Li G. Adverse event, and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries. Anesthesiology 2019;130:(6):912-922

Lee A, Guglielminotti J, Janvier AS, Li G, Landau R. Racial and Ethnic Disparities in the Management of Postdural Puncture Headache With Epidural Blood Patch for Obstetric Patients in New York State. JAMA Netw Open. 2022 Apr 1;5(4):e228520. doi: 10.1001/jamanetworkopen.2022.8520. PMID: 35446394.

Guglielminotti J, Landau R, Daw J, Friedman AM, Chihuri S, Li G. Use of Labor Neuraxial Analgesia for Vaginal Delivery and Severe Maternal Morbidity. JAMA Netw Open. 2022 Feb 1;5(2):e220137. doi: 10.1001/jamanetworkopen.2022.0137. PMID: 35191971; PMCID: PMC8864505.

Taha B, Guglielminotti J, Li G, Landau R. Utilization and Outcomes of Extracorporeal Membrane Oxygenation in Obstetric Patients in the United States, 1999-2014: A Retrospective Cross-Sectional Study. Anesth Analg. 2022 Aug 1;135(2):268-276.

Research in education

Lee A, Goodman S, Corradini B, Cohn S, Chatterji M,  Landau R. A serious video game—EmergenCSim™—for novice anesthesia trainees to learn how to perform general anesthesia for emergency cesarean delivery: a randomized controlled trial. Anesthesiology and Perioperative Science. 2023 June  Vol 1, Article number: 14 https://doi.org/10.1007/s44254-023-00016-4

Lee AJ, Goodman SR, Banks SE, Lin M, Landau R. Development of a Multiple-Choice Test for Novice Anesthesia Residents to Evaluate Knowledge Related to Management of General Anesthesia for Urgent Cesarean Delivery. J Educ Perioper Med. 2018 Apr 1;20(2):E621

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