title: Establishing an obstetric neuraxial service in low-resource areas.
abstract: The proportion of laboring women utilizing neuraxial techniques for labor analgesia has steadily increased over the past decades in North America, the UK and parts of Europe. Anesthesiologists in many other countries may want to introduce an obstetric neuraxial service but may lack the knowledge and experience necessary to ensure its safety. The focus of this article is to address the necessity, benefit and challenges of establishing such a service in a resource-limited environment. Even successful financial institutions may be considered resource-limited if critical components necessary for an obstetric neuraxial service are missing due to either perceived unimportance or non-availability. There is a need to deploy a culture of safety by ensuring the availability of resuscitation equipment, developing protocols and training, fostering communication among members of the care team and initiating quality-control measures. Patient education and satisfaction are additional key components of a successful service. Even in financially low-resource settings, proper safety measures must be adopted so that the neuraxial procedure itself does not contribute to morbidity and mortality. A viable and safe neuraxial service can be developed using innovative strategies based on local constraints.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: bkodali@partners.org.
authors.forename: B S
authors.initials: BS
authors.lastname: Kodali
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Jagannathan
authors.affiliation: Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Owen
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000191:economics; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000191:economics; D005260:Female; D006801:Humans; D008507:Medically Underserved Area; D008991:Monitoring, Physiologic; D010353:Patient Education as Topic; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D012151:Resuscitation
keywords: Low-resource areas; Obstetric analgesia