Obstetric anesthesia units in Israel: A national questionnaire-based survey

Background: This survey was performed to assess the organization and practice of obstetric anesthesia units in Israel. Methods: A written questionnaire was mailed at the end of December 2005 to all Israeli anesthesia departments providing labor and delivery services in 2005 (n = 25). Results: A response rate of 100% accounted for 125,340 deliveries. All labor and delivery suites had on-site anesthesia department services. Data are presented as mean (range) or frequency. Eleven hospitals performed 2500-4999 deliveries/year, 6 hospitals 5000-7499 deliveries/year, and 4 hospitals 7500-9999 deliveries/year. The overall cesarean delivery rate was 20% (0-27). Anesthesia for cesarean delivery (elective and emergency combined) was provided by: general anesthesia 15% (0.5-50), epidural 14.5% (0-99.5), spinal 68% (0-98), or combined spinal-epidural technique 0% (0-30). There was an operating room within or immediately adjacent to the labor ward in 16/25 units, including 10/11 units with >5000 deliveries/year. Labor analgesia was provided by epidural techniques in 50% (4-93) and nitrous oxide in 0.5% (0-90) of deliveries. A total of 11 units had 24 h dedicated anesthesiologist coverage, including all units >7500 deliveries but only 3/8 (38%) with 5000-7500 deliveries. Two of the 4 units with >7500 deliveries had no faculty member with formal training in obstetric anesthesia. Written protocols were available for labor analgesia (17/25), post-partum hemorrhage (12/25), aspiration prophylaxis (15/25) and maternal resuscitation (8/25). Conclusion: In this national appraisal of Israeli obstetric anesthesia services, a notable lack of written protocols, wide variations in staffing, and few specifically trained obstetric anesthesia personnel were observed.