Obstetric Anesthesia

The Division of Obstetric Anesthesia at Columbia University is a Society for Obstetric Anesthesia and Perinatology (SOAP) 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 it was renewed in 2023. Dr. Landau now serves as chair of the SOAP Center of Excellence Committee.

Learn more here about how and why the Centers of Excellence designation was created.

Division News

• Dr. Ruth Landau, chief of the Division of Obstetric Anesthesia, is appointed editor-in-chief of the International Journal of Obstetric Anesthesia.
• Dr. Brian Waldman received the Best Case Report award for "Management of a pregnant patient on dual antiplatelet therapy after percutaneous intervention: Cangrelor bridging as a path to neuraxial anesthesia for delivery” at the annual meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) in May 2024. About 300 case reports are presented at SOAP annually.
• PGY-1 resident Jose Sanchez, MD is first author of a study about pain management during cesarean delivery: “Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients’ Satisfaction with Pain Management During Cesarean Delivery.” The publication first appeared online in May 2024, and is part of the November 2024 Anesthesia and Analgesia themed issue on diversity and inclusivity. Dr. Sanchez's co-authors are Pain Medicine fellow Rohan Prabhu, MD, MPH; Associat Professsor of Anesthesiology Jean Guglielmiotti, MD, PhD, and Ruth Landau, MD, the Division Chief of Obstetric Anesthesia.  Dr. Sanchez and his co-authors also published "Pain during cesarean delivery: A patient-related prospective observational study assessing the incidence and risk factors for intraoperative pain and intravenous medication administration" in the October 2023 issue of Anaesthesia Critical Care & Pain Medicine.
• Dr. Jean Guglielminotti, Associate Professor of Anesthesiology and a clinical investigator in obstetric anesthesia safety and maternal health outcomes, received two SOAP Patient Safety awards for the following public health studies: in 2023, for a study on the effectiveness of the Affordable Care Act Medicaid expansion in reducing severe maternal morbidity [American Journal of Obstetrics & Gynecology MFM 2023;5(8):101054]; and in 2022, for a study on the effectiveness of a racially and ethnically diverse healthcare workforce in reducing severe maternal morbidity [American Journal of Obstetrics & Gynecology MFM 2022;4(5):100689]. Dr. Guglielminotti also received the 2020 Outstanding Article of the Year Award for “Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries.” The article was one of only three selected as “outstanding” by the Healthcare Cost and Utilization Project (HCUP), a set of databases and software sponsored by the Agency for Healthcare Research and Quality. It includes the largest collection of longitudinal hospital care data in the United States.

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. The antepartum and Mothers Center consultation services are led by Dr. Kyra Bernstein.

At the Morgan Stanley Children’s Hospital, there is a special emphasis on Critical Care Obstetrics (CCOB), with a CCOB designation for patients requiring tailored obstetric anesthesia care. This service is led by Dr. James Conwell and Dr. Kyra Bernstein. 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, both led by Dr. Laurence Ring.

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 about rare events (performance of general anesthesia for emergent cesarean deliveries). 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.

Shared decision making and individualized opioid prescription after surgery

Sanchez J, Prabhu R, Guglielminotti J, Landau R. Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients' Satisfaction With Pain Management During Cesarean Delivery. Anesth Analg. 2024 May 20. doi: 10.1213/ANE.0000000000006764. Epub ahead of print. PMID: 38768069.

Sanchez J, Prabhu R, Guglielminotti J, Landau R. Pain during cesarean delivery: A patient-related prospective observational study assessing the incidence and risk factors for intraoperative pain and intravenous medication administration. Anaesth Crit Care Pain Med. 2024 Feb;43(1):101310. doi: 10.1016/j.accpm.2023.101310. Epub 2023 Oct 20. PMID: 37865217.

Landau R, Cavanaugh PF, DiGiorgi M. Persistent opioid use after cesarean delivery in the United States of America: a systematic review. Int J Obstet Anesth. 2023 May;54:103644. doi: 10.1016/j.ijoa.2023.103644. Epub 2023 Feb 27. PMID: 37004281.

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, Lee A, Landau R, Samari G, Li G. Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People. Obstet Gynecol. 2024 Feb 1. doi: 10.1097/AOG.0000000000005519. Epub ahead of print. PMID: 38301254.

Guglielminotti J, Samari G, Friedman AM, Landau R, Li G. State-Level Indicators of Structural Racism and Severe Adverse Maternal Outcomes During Childbirth. Matern Child Health J. 2024 Jan;28(1):165-176. doi: 10.1007/s10995-023-03828-9. Epub 2023 Nov 8. PMID: 37938439.

Guglielminotti J, Landau R, Daw J, Friedman AM, Li G. Association of Labor Neuraxial Analgesia with Maternal Blood Transfusion. Anesthesiology. 2023;139(6):734-745.

Guglielminotti J, Daw JR, Landau R, Friedman AM, Li G. Association of the United States Affordable Care Act Dependent Coverage Provision with Labor Neuraxial Analgesia Use. Anesthesiology 2023; 139:274–86

Guglielminotti J, Daw JR, Friedman AM, Landau R, Li G. Medicaid expansion and risk of eclampsia. Am J Obstet Gynecol MFM. 2023 Aug;5(8):101054. doi: 10.1016/j.ajogmf.2023.101054. Epub 2023 Jun 15. PMID: 37330007.

Research in education

Lee AJ, Goodman SR, Bauer MEB, Minehart RD, Banks S, Chen Y, Landau R, Chatterji M. Validating Parallel-Forms Tests for Assessing Anesthesia Resident Knowledge. J Med Educ Curric Dev. 2024 Feb 12;11:23821205241229778. doi: 10.1177/23821205241229778. PMID: 38357687; PMCID: PMC10865962.

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