Silent saviours: the crucial role of obstetric anaesthesiologists in reducing maternal mortality

The Hindu

4 days ago

Maternal mortality is a key indicator of healthcare quality. According to the Sample Registration System's (SRS) 2019–21 data, India's Maternal Mortality Ratio (MMR) has dropped from 130 (2014–16) to 93 (2019–21). States including Kerala (20), Maharashtra (38), and Telangana (45) have already met the Sustainable Development Goal (SDG) target. However, others like Madhya Pradesh (159) and Bihar (100) continue to lag, despite some progress made. As nations strive to meet the SDG of reducing maternal deaths to fewer than 70 per 100,000 live births, the contribution of obstetric anaesthesiologists is indispensable.
The role of obstetric anaesthesiologists
While obstetricians often stand at the forefront of maternal care, a less visible but equally vital figure operates behind the curtain — the obstetric anaesthesiologist. Obstetric anaesthesiologists are highly trained physicians who specialise in providing safe and effective anaesthesia and pain relief during pregnancy, labour, and delivery, particularly in high-risk obstetric cases. Their role extends far beyond the operating theatre, integrating deeply with emergency obstetric care and intensive maternal monitoring.
As maternal healthcare systems evolve to handle increasingly complex pregnancies, these specialists are proving instrumental in reducing maternal mortality and ensuring safe delivery outcomes. High-risk pregnancies are rising due to factors like advanced maternal age, IVF and multifoetal pregnancies, obesity, hypertension, diabetes, and pre-existing cardiac conditions. In such cases, anaesthetic management becomes a matter of life and death — not just comfort.
Emergency care
Obstetrics is the only specialty where emergency surgical procedures far outnumber elective and planned surgeries. Of these emergencies, 6-7% are stat surgical procedures that demand the highest of skills and clinical algorithms. In emergency caesarean sections, postpartum haemorrhage, or preeclampsia cases, anaesthetic decisions must be swift, safe, and tailored to the mother's physiology. Delayed or inappropriate care by the team can lead to complications such as cardiac arrest, aspiration, or uncontrolled bleeding — all major contributors to maternal deaths globally.
Another critical service provided by obstetric anaesthesiologists is labour analgesia — the management of labour pain through techniques such as epidural anaesthesia or several alternative options like IV - PCA (patient-controlled analgesia) using safe medications. Not only does this improve the birthing experience, but studies have shown that well-managed labour pain can reduce maternal exhaustion, lower the incidence of emergency interventions, and even decrease the rate of postpartum depression.
Importantly, labour analgesia also allows high-risk women — including those with cardiac or neurological disorders — to undergo delivery with reduced physiological stress.
Multidisciplinary model
Modern obstetric care increasingly adopts a multidisciplinary model, where trained anaesthesiologists in critical care, collaborate closely with obstetricians, obstetric physicians, foetal medicine experts and neonatologists. This is especially critical in managing patients in Maternal Critical Care Units (MCCUs), where anaesthesiologists works with the motto – giving best to both the lives– and monitor not only sedation and pain control, but also look after invasive monitoring, ventilation, and provide organ supports.
The need for more training
Experts advocate for greater recognition for, and investment in the training of obstetric anaesthesiologists, especially in resource-limited settings. Obstetric anaesthesiologists play a pivotal role in this ecosystem, ensuring safer deliveries and better coordination in emergencies—thereby supporting India's push toward the SDG goals.
In many developing regions, a lack of trained anaesthesiologists is a significant barrier to safe obstetric care. The Association of Obstetric Anaesthesiologists, India has made a curriculum and accredited several centres in India to train obstetric anaesthesiologists. We need to prioritise staffing and protocols that integrate anaesthetic services from the first trimester through to the postpartum period.
In the quiet precision of their work lies a profound truth: obstetric anaesthesiologists save lives — often silently, always critically.
(Dr. Sunil T. Pandya is chief, department of anaesthesia, perioperative medicine & critical care, AIG Hospitals, Gachibowli, Hyderabad and national chairman, Anaesthesia Patient Safety Forum, India. [e-mail])