Statement on Anesthesia Services Staffing Labor and Delivery

Developed by: Committee on Obstetric Anesthesia
Original Approval: October 15, 2025

The delivery of anesthesia services for labor and delivery (L&D) units is critical to maternal and neonatal outcomes and thus requires strategic alignment of staffing resources with institutional goals, patient acuity, and national quality standards. Anesthesiologists not only provide highly technical procedures for childbirth analgesia and anesthesia while simultaneously respecting individual preferences, providing emotional support throughout the birthing process, but also process complex medical decision making in acute critical situations, all of which contribute to cognitive workload. Direct procedural care constitutes only a portion of anesthesiologists and anesthesia professionals' responsibilities, with significant time dedicated to supervision, rounds, safety initiatives, and education. Flexible, and at times surplus, anesthesia professional staffing helps ensure patient safety, maintain rapid responsiveness to urgent and emergent needs, and provide high-quality, consistent care in a high demand, high variability environment. Staffing for labor and delivery must prioritize a careful balance of clinical expertise, operational agility, and human compassion. 

While balancing multiple priorities, hospitals must ensure timely anesthesia services availability to support neuraxial labor analgesia, cesarean deliveries, and obstetric emergencies, ensuring the safety of both mothers and newborns. Anesthesia professional staffing models will vary and should reflect the hospital’s American College of Obstetrics and Gynecology (ACOG) Level of Maternal Care¹ and desired timeliness for anesthesia services. Staffing allocation models based solely on average anesthesia workload is fundamentally flawed when extrapolated to L&D units.² Average case numbers and procedure times do not capture the unpredictability and variable nature of the clinical demand.³ Staffing models reliant solely on averages thus risks underestimating the routine yet unpredictable variable peak demand periods, leading to potential anesthesia service gaps during critical events. High-acuity cases, unanticipated emergencies, and volume spikes require timely access to additional personnel and resources (See Table 1).

Key Considerations for Anesthesia Services Staffing:

• Basic volume metrics are useful but insufficient as a sole guide to planning. Delivery volumes, neuraxial analgesia rates, and cesarean delivery rates only provide a baseline for staffing; variability in urgent and emergent delivery needs requires flexible or surplus anesthesia professional staffing.^3,4
• Workload efficiency varies: Direct clinical care accounts for only 0.19–0.48 clinical work per hour efficiency by attending anesthesiologists, excluding essential tasks such as rounds, safety initiatives, and teaching.²
• Timeliness expectations guide staffing: Best practice recommendations in the UK for anesthesia request-to-arrival within 30 minutes (with a ≥90% compliance goal) and clear definitions of emergency cesarean categories inform local response expectations. These may vary by institution based on local characteristics (e.g. rural, low delivery volume)^.4,5
• Clear quality metrics are critical: United Kingdom guidelines specify 30- and 75-minute decision-to-delivery targets (with a 90% compliance goal) depending on emergency/urgency of cesarean, whereas ACOG recommends delivery for Category III fetal heart rate tracings ‘as expeditiously as feasible’ without a fixed timeframe.^4,6
• Scalable and efficient staffing: The Anesthesia Care Team is one method of providing efficient care, allows scaling up staffing, while maintaining quality and safety standards.⁷ 
• Surge planning strategies: Effective anesthesia services for L&D include well-defined surge planning, i.e., real-time capacity assessment, escalation protocols, cross-coverage models, and administrative preparedness to maintain patient safety during peak demands.
• Hospital resource allocation is critical: Hospitals should provide L&D units with a level of resources comparable to those available in main operating rooms including nursing support, pharmacy services, patient transport, and environmental services. Hospitals may need to provide financial and other support for anesthesia services staffing to achieve their desired level of service, well-being and safety.
• Hospitals, payors and health care systems should support anesthesia services⁸ to improve maternal morbidity/mortality, neonatal outcomes and patient safety. 

Conclusion: Anesthesia professionals and services staffing is best based not only on basic measurements but also incorporating workload variability, acuity and peak demand scenarios to ensure patient safety and service reliability.³ Hospitals should design and support anesthesia professional services that prioritize prudent patient safety goals, align with the acuity of their patient population, and meet national quality standards for better maternal and neonatal outcomes—while also delivering the timely, patient-centered care that families expect. 

Table 1: Domains and Factors Influencing Anesthesia Professional Staffing

References:

1. ACOG: Levels of Maternal Care: Obstetric Care Consensus No, 9. Obstet Gynecol 2019; 134: e41-e55
2. Mary Im, MD; Edward T. Riley, MD; Dan B. Hoang, DO; Grace Lim, MD, MSc; Mark I. Zakowski MD, FASA; Brendan Carvalho, MD, FASA: Obstetric Anesthesia Procedure-Based Workload and Facility Utilization of Society of Obstetric Anesthesia and Perinatology Centers of Excellence Designated Institutions. Anesth Analg 2022; 135: 1142-1150
3. Yehuda C.Ginosar, BS, BSc, MB; Ariel Wimpfheimer, MD, MHA; Charles Weissman, MD: Using Mean Anesthesia Workload to Plan Anesthesia Workforce Allocations: The "Flaw of Averages". Anesth Analg 2022; 135: 1138-1141
4. Dr. James Bamber, MB, CHB, FRCA; Dr. Sophie Kimber-Craig, MB ChB; Dr Nuala Lucas, MBBS, FRCA, MBE; Felicity Plaat, MA MBBS FRCA: Chapter 9: Guidelines for the Provision of Anaesthesia Services for an Obstetric Population 2025, Guidelines for the Provision of Anaesthesia Services. Edited by Anaestist’s RCo, 2025
5. Association of Anaesthetists of Great Britain & Ireland Obstetric Anaesthetists’ Association: OAA / AAGBI Guidelines for Obstetric Anaesthetic Services 2013. Edited by AAGBI, 2013
6. American College of Obstetricians and Gynecologists: Practice bulletin no. 116: Management of intrapartum fetal heart rate tracings. Obstet Gynecol 2010; 116: 1232-40
7. ASA Committee on Anesthesia Care Team: Statement on the Anesthesia Care Team. Edited by ASA, 2023
8. ASA Statement on Economic Credentialing and Contracting, 2024. https://www.asahq.org/standards-and-practice-parameters/statement-on-economic-credentialing-and-contracting