>
> A problem came when hospitals started sponsoring childbirth
> classes........then the passion was removed, and other people (such as  anesthesiologists) got
> to have a say in what was taught.

I have to respectfully say that I am not aware of any institution
where anesthesiologists have *any* say in what is covered in
childbirth classes.  It has been my (somewhat limited, admittedly)
experience that most anesthesiologists don't particularly like doing
OB anesthesia.  It is a poorly reimbursed service for an anesthesia
department, often resulting in losses, and can be, excuse the
inevitable pun, quite labor-intensive to be the anesthesiologist up on
the L/D floor.  We are *consultants* -- I have NEVER "pushed" an
epidural on anyone, nor have I been taught to, unless there is some
indication that a urgent c-section might be likely (for example, the
300+ pound 19-yo wanting to VBAC twins with a class 4 airway that I
saw a few weeks ago).  I do see everyone on the L/D floor when I am on
call, even if they are hoping for an unmedicated birth, are antepartum
patients, etc., because I want to at least know what their airway
looks like in case of an emergency, and I certainly talk about
epidurals then if they are interested.

I really wish that epidural anesthesia risks/benefits could be covered
in childbirth classes or at least realistically discussed during
prenatal visits, because I often end up spending a huge amount of time
trying to explain everything and answering questions for patients.
Not that I mind doing this (and I have been told that I am far too
sympathetic to these moms because of my own pregnancy), but I
frequently feel very pressed for time.  Then there are the moms that
come in in active labor, screaming for the epidurals and who I have to
have sign a consent form and they just yell at me, "let me sign the
thing and just bring the drugs already!" and they won't listen to a
word I say.  I know I'm the only anesthesiologist at my hospital who
says, "So you'll be breastfeeding this little one?" and then talk a
bit about how some research shows that babies may be more sleepy after
an extended epidural infusion and it might make breastfeeding more
difficult and a few things that can help (am sure I'm also the only
one who uses time during a cesarean delivery to discuss breastfeeding
and will sometimes help them latch on right after we get them back to
their room). :)

Anyway, all this is meant to say that virtually every anesthesiologist
I know (except for our dept. head of OB anesthesia) finds OB
anesthesia a relatively distasteful, necessary evil part of their day
if they need to be up on the L/D floor.  I will occasionally look at
anesthesia job postings online (oh, can't wait for the day when I'm
done and can get a real job!) and it's funny how many of them make a
big deal if positions do not include doing OB anesthesia -- it's
considered a real benefit...  Good thing I at least like it. :)

-Sarah Reece-Stremtan M.D. (Anesthesia resident, but not back to work
until next July.  And sorry for the rambling here, my 10-day-old's
still in the NICU and the sleep deprivation is getting intense!)

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