Undertaking a fellowship at CMDHB with a subspecialty interest in Obstetric Anaesthesia provides experience working with our unique maternal population. The community we serve is home to over 120,000 women of child-bearing age, the second largest Maaori population and largest population of Pacific peoples in New Zealand. The characteristics of our population are vibrant and diverse. Many of our women and children live in areas of high socio-economic deprivation.
CMDHB has over 7000 deliveries annually and a significant proportion of the women we manage have high-risk pregnancies. The caesarean section rate has slowly been increasing annually and is currently around 28%. In 2018 75% of all LSCS were emergencies. Many are performed out of hours (39%) and Obstetrics accounts for ~50% of the total overnight workload in theatre. The proportion of women requiring general anaesthesia for LSCS is consistently high compared to other centres in NZ (around 12-14%). We also have a disproportionate number of women requiring management for PPH, pre-eclampsia, medical complications of pregnancy such as GDM and pregnant women with obesity.
In a typical week the fellow should expect to be rostered to 4-5 obstetric anaesthesia sessions (taking into consideration after hours commitments/leave/teaching/other service requirements). These sessions could include:
Additional involvement in individual cases of interest/HROC patients will also be possible.
In-hours supervision for Obstetric cases will initially be 1:1 or 1:2 (depending on previous experience with our service). It is expected that after a period of familiarisation, fellows will take independent responsibility for elective lists. When rostered to acutes they will independently manage the workload on Birthing and Assessment, including co-ordination of patients for theatre alongside the supervising anaesthetist and theatre nurse co-ordinator. Fellows may also be rostered with junior staff and be required to teach and provide supervision as appropriate.
The fellow will play an integral role in the High Risk Obstetric Clinic (HROC). There will always be an SMO rostered to clinic alongside the fellow however as the fellow attends fortnightly, they provide important continuity for the clinic and patients. It is expected they become the point of liaison with other services for individual patients and are involved in interesting/high-risk cases throughout pregnancy and delivery.
We have a core group of SMO’s in the department who have an interest or specialise in Obstetric Anaesthesia. The Obstetric SIG (special interest group) meets quarterly throughout the year and the fellow will be involved in the activities of the group including on-going research, audit and other projects. There will be a nominated fellow supervisor for the year from the SIG. A meeting with the supervisor will occur prior to commencement of the fellowship to discuss goals and objectives for the year, followed by further meetings at intervals agreed by the fellow and supervisor.
We have been developing a new role for anaesthesia in B&A. Originating as a morning session it has expanded to become a full day involving an SMO from the core group Obs anaesthetists (of which the fellow is included). This new role is in addition to the acute Obs anaesthetist. The B & A anaesthetist attends the handover meeting at 8am, participates in the B&A round with the obstetric team, has involvement with identifying and reviewing patients who may require anaesthetic involvement, and assists the APS (acute pain service) nurse with post-natal/maternity pain round. This aims to provide an opportunity for inter-disciplinary support and learning, fostering positive relationships with our obstetric and midwifery colleagues as well as improving time for teaching opportunities for our junior staff and managing the busy acute workload.
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