Female faculty may not be leaning in to promotion and leadership roles because of increased role conflict, work-life concerns, and organizational factors; this seems to be more of a factor for female clinical rather than research faculty. Work-family conflict affects male and female faculty differently and should be addressed in efforts to retain faculty and to remove barriers for female faculty seeking leadership opportunities.

Despite concerns that obesity may cause difficulty with neuraxial technique, some obese patients have surprisingly easy neuraxial block placements. When approaching any neuraxial anesthetic in a pregnant patient, and especially in the obese parturient, back flexion and landmark palpation predict neuraxial technique difficulty.

No abstract

A nesthesia providers may have increased difficulty in placing neuraxial blocks in obese parturients compared with nonobese patients; however, this issue has not been systematically investigated to determine the pertinent risk factors. This prospective, observational study attempted to identify factors that can predict neuraxial technique difficulties in pregnant patients.

Study Objective: Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of “difficulty” and “failure” of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement. Design: Single center retrospective chart review. Setting: Labor and Delivery Unit of an inner city academic teaching hospital. Patients: 2485 parturients, ASA status 2 to 4, receiving labor epidural analgesia for anticipated vaginal delivery. Interventions: none. Measurements: We reviewed quality assurance and anesthesia records over a 12-month period. “Failure” was defined as either inadequate analgesia or a positive test dose, requiring replacement, and/or when the anesthesia record stated they failed. “Difficulty” was defined as six or more needle redirections or a note indicating difficulty in the anesthesia record. Main Results: Overall epidural failure and difficulty rates were 4.3% and 3.0%, respectively. Patients with a BMI of 30 kg/m2 or higher had a higher chance of both failure and difficulty with two and almost three fold increases, respectively. Regression analysis indicated that failure was best predicted by BMI and less provider training while difficulty was best predicted by BMI. Additionally, increased BMI was associated with increased time of discovery of epidural catheter failure. Conclusions: Obesity is associated with increasing technical difficulty and failure of neuraxial analgesia for labor. Practitioners should consider allotting extra time for obese parturients in order to manage potential problems.