Obstetric Anesthesia
Unit Head
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. 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, childbirth, and postpartum.
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, respectful, 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 patients 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. James Conwell and Dr. Ruth Landau.
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. We have a “high-risk unit” with 6 beds on the labor suite, equipped for enhanced hemodynamic monitoring and other aspects of critical care for patients with cardiopulmonary and other critical diseases with a referral program for Cardio-Obstetrics and Critical Care Medicine. This service is led by Dr. James Conwell and Dr. Ruth Landau. 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 and the cesarean delivery rate is ~40-45% percent, reflecting the referral nature of the practice. Obstetric Anesthesia faculty provide 24/7 clinical coverage with residents, fellows and CRNAs.
At the Allen Hospital, the neuraxial labor analgesia rate is ~80 percent and the cesarean delivery rate is ~30% percent. Faculty provide 24/7 coverage with CRNAs.
Education
The Division of Obstetric Anesthesia provides residency and postgraduate fellowship training in state-of-the-art techniques and strategies of labor analgesia, anesthesia for cesarean delivery with a focus on preventing pain during cesarean delivery and improving patients’ experience and providing care for critically ill patients.
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 30 fellows have graduated from 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 birth experience, including a reduction of pain during cesarean delivery and childbirth related post traumatic syndrome disorder. We thrive to generate data that promotes patient driven, safe and equitable obstetric anesthesia care.
Key themes and publications by our group
Pharmacogenetics, vasopressor agents and spinal hypotension 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(link is external and opens in a new window)
Landau R, Smiley R. Pharmacogenetics in obstetric anesthesia. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):23-34. doi: 10.1016/j.bpa.2017.01.004. Epub 2017 Feb 6. PMID: 28625302.
Landau R, Liu SK, Blouin JL, Smiley RM, Ngan Kee WD. 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 delivery. Anesth Analg. 2011 Jun;112(6):1432-7. doi: 10.1213/ANE.0b013e3182179424. PMID: 21613201; PMCID: PMC3102860.
Lee AJ, Landau R. Aortocaval Compression Syndrome: Time to Revisit Certain Dogmas. Anesth Analg. 2017 Dec;125(6):1975-1985. doi: 10.1213/ANE.0000000000002313. PMID: 28759487.
Lee AJ, Landau R, Mattingly JL, Meenan MM, Corradini B, Wang S, Goodman SR, Smiley RM. Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid-Base Status: A Randomized Controlled Trial. Anesthesiology. 2017 Aug;127(2):241-249. doi: 10.1097/ALN.0000000000001737. PMID: 28598894.
Jackson KL, Smiley RM, Lee AJ. Neonatal acid-base status before and after discontinuing routine left uterine displacement for elective cesarean delivery: a retrospective cohort study (2014-2017). Int J Obstet Anesth. 2025 May;62:104350. doi: 10.1016/j.ijoa.2025.104350. Epub 2025 Mar 8. PMID: 40106999.
Pain during cesarean delivery, shared decision making and individualized opioid prescription after surgery
Landau R, Sultan P. Neuraxial anesthesia and pain management for cesarean delivery. Am J Obstet Gynecol. 2025 Jul 16:S0002-9378(25)00334-5. doi: 10.1016/j.ajog.2025.05.018. Epub ahead of print. PMID: 40888444.
Vozzo P, Zilber S, Landau R.Intrathecal dexmedetomidine for cesarean delivery: a scoping review. Int J Obstet Anesth. 2025 Jul 23;64:104738. doi: 10.1016/j.ijoa.2025.104738. Epub ahead of print. PMID: 40882345.
Sharpe EE, Landau R. Pain during cesarean delivery: risk factors, mitigation, and current approaches. Curr Opin Anaesthesiol. 2025 Jun 1;38(3):169-178. doi: 10.1097/ACO.0000000000001488. Epub 2025 Apr 1. PMID: 40162544.
Gonzalez-Fiol A, Fardelmann KL, Landau R. Shedding more light on the management of intraoperative pain during cesarean delivery: a review of the American Society of Anesthesiologists statements. Int J Obstet Anesth. 2025 May;62:104360. doi: 10.1016/j.ijoa.2025.104360. Epub 2025 Apr 1. PMID: 40199022.
Smid MC, Clifton RG, Rood K, Srinivas S, Simhan HN, Casey BM, Longo M, Landau R, MacPherson C, Bartholomew A, Sowles A, Reddy UM, Rouse DJ, Bailit JL, Thorp JM Jr, Chauhan SP, Saade GR, Grobman WA, Macones GA; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network*. Optimizing Opioid Prescription Quantity After Cesarean Delivery: A Randomized Controlled Trial. Obstet Gynecol. 2024 Aug 1;144(2):195-205. doi: 10.1097/AOG.0000000000005649. Epub 2024 Jun 10. PMID: 38857509; PMCID: PMC11257794.
Lim G, Carvalho B, George RB, Bateman BT, Brummett CM, Ip VHY, Landau R, Osmundson S, Raymond B, Richebe P, Soens M, Terplan M. Consensus statement on pain management for pregnant patients with opioid use disorder from the Society for Obstetric Anesthesia and Perinatology, Society for Maternal-Fetal Medicine, and American Society of Regional Anesthesia and Pain Medicine. Am J Obstet Gynecol. 2025 Oct;233(4):B1-B29. doi: 10.1016/j.ajog.2024.12.006. Epub 2025 Mar 11. PMID: 40074574.
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(link is external and opens in a new window). 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.(link is external and opens in a new window)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.(link is external and opens in a new window)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(link is external and opens in a new window)
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(link is external and opens in a new window)
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.(link is external and opens in a new window)
Examining maternal outcomes and complications in large datasets
Harkins SE, Hazi AK, Guglielminotti J, Landau R, Barcelona V. Discrimination, racism, and bias in childbirth pain management in the United States: a scoping review and directions for research and clinical care. Int J Obstet Anesth. 2025 Aug;63:104379. doi: 10.1016/j.ijoa.2025.104379. Epub 2025 Apr 26. PMID: 40349529; PMCID: PMC12276919.
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. (link is external and opens in a new window)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(link is external and opens in a new window). 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(link is external and opens in a new window). 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(link is external and opens in a new window). Anesthesiology 2023; 139:274–86
Guglielminotti J, Daw JR, Friedman AM, Landau R, Li G. Medicaid expansion and risk of eclampsia(link is external and opens in a new window). Am J Obstet Gynecol MFM. 2023 Aug;5(8):101054. doi: 10.1016/j.ajogmf.2023.101054. Epub 2023 Jun 15. PMID: 37330007.
Other
Duron V, Miller R, Feldstein N, Schmoke N, Wu YS, Shirel T, Ring L, Landau R, Azizi H, Ingrassia R, Breslin N, Simpson L. Outcomes Following Fetoscopic Repair of Myelomeningocele: A Prospective Single-Center Experience. Prenat Diagn. 2025 May;45(5):658-667. doi: 10.1002/pd.6781. Epub 2025 Mar 25. PMID: 40133605.
Berman D, Landau R. "This is how we do it": disseminating protocols for enhanced fetal safety and maternal recovery after fetoscopic myelomeningocele repairs. Int J Obstet Anesth. 2025 Feb;61:104319. doi: 10.1016/j.ijoa.2024.104319. Epub 2024 Dec 21. PMID: 39855030.
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. (link is external and opens in a new window)J Med Educ Curric Dev. 2024 Feb 12;11:23821205241229778. doi: 10.1177/23821205241229778. PMID: 38357687; PMCID: PMC10865962.
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