Anesthesia Patient Safety Podcast

#280 Speak Up To Save Lives

What if the biggest risks in maternal care are not just clinical, but cultural? We dig into the hard truth that speaking up can feel risky, pain during cesarean is often underestimated, and rare obstetric crises can overwhelm memory. From there, we chart a path toward safer births with practical tools that any team can use: psychological safety to unlock communication, structured pre‑briefs and rapid debriefs, and cognitive aids that turn chaos into coordinated action. We walk through the lived reality of intraoperative pain—why negative skin tests don’t guarantee visceral coverage, how fear of general anesthesia can delay needed care, and the downstream consequences for bonding, breastfeeding, and mental health. You’ll hear clear, patient‑centered steps: standard sensory assessment, explicit pain check‑ins, decisive treatment or conversion when indicated, and honest conversations that validate experience. The message is simple and urgent: pain is preventable harm, and timely action saves more than minutes—it protects families. Readiness matters beyond big hospitals. Rural teams face OB unit closures, low volumes, and limited resources. Mobile simulation and statewide programs show how to keep skills sharp for postpartum hemorrhage, eclampsia, and high‑risk transfers. We also highlight the Four Ps for anesthesia professionals—presence, preemption, proficiency, and platform—to embed safety into daily practice, from risk screening to standardized pathways. Finally, we extend the safety net into the community with sepsis bundles and accessible education so patients and their support networks recognize warning signs and act fast. Along the way, we touch on pediatric safety and emerging evidence that EEG‑guided anesthesia can reduce emergence delirium. If transforming maternal care speaks to you, join us. Subscribe, share this episode with a colleague, and leave a review with one change your team will make this month. Your insight could be the spark another unit needs to save a life. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/280-speak-up-to-save-lives/ [https://www.apsf.org/podcast/280-speak-up-to-save-lives/] © 2025, The Anesthesia Patient Safety Foundation

#279 From Birthrooms To Boardrooms: Preventing Trauma And Elevating Maternal Anesthesia Care

Power, control, and communication shape every birth—and too often, they decide whether care feels safe or traumatic. We dig into practical ways to prevent harm in obstetric anesthesia by centering trauma-informed care, reducing stigma around substance use disorder, and giving real choice during cesarean delivery. We start by distinguishing complications from trauma and laying out the six pillars that make care safer: safety, transparency, peer support, collaboration, empowerment, and cultural humility. From there, we map prevention across three levels—primary disruption of trauma through clear communication and environment, secondary recognition and mitigation of events, and tertiary support for patients with PTSD. You’ll hear concrete steps for SUD in pregnancy, including continuing methadone or buprenorphine, optimizing regional anesthesia, avoiding medication switches, and using person-first language that builds trust rather than barriers. We also spotlight the Elevate project, which advances patient-centered anesthesia choices for cesarean delivery through stakeholder engagement, research, and an in-person summit focused on equity and shared decision-making. The aim is simple and vital: align what clinicians must do with what patients most value, from how we speak at the drape to who is present in the room. Finally, we share life-saving resources from the AFE Foundation—education, an international registry, and a stabilization checklist—to turn rare crises into moments of coordinated, effective response. If these ideas resonate, share this episode with a colleague, subscribe on your favorite platform, and leave a review with one change you plan to make on your next shift. Your feedback helps more clinicians find these tools and deliver safer, more humane maternal anesthesia care. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/279-from-birthrooms-to-boardrooms-preventing-trauma-and-elevating-maternal-anesthesia-care/ [https://www.apsf.org/podcast/279-from-birthrooms-to-boardrooms-preventing-trauma-and-elevating-maternal-anesthesia-care/] © 2025, The Anesthesia Patient Safety Foundation

#278 Transforming Maternal Care Through Equity, Science, And Tech

Maternal care is at a breaking point: delivering hospitals are disappearing while deaths that could be prevented keep climbing. We pull back the curtain on how structural racism, policy headwinds, and technology blind spots compound risk for birthing people—especially Black, Hispanic, rural, and low‑income patients—and what it takes to change the trajectory now. We start by naming the problem with data: stable birth rates alongside a steep decline in maternity units have created care deserts. From there, we dig into disparities in obstetric anesthesia, including lower neuraxial labor analgesia use and higher rates of general anesthesia for cesarean delivery among Black and Hispanic patients. Drawing on ASA recommendations, we outline practical actions that reduce harm: accurate documentation of race, ethnicity, and language; disparities dashboards; education on bias and structural racism; shared decision making; and proactive epidural management to improve conversion to surgical anesthesia without general anesthesia. Then we turn to implementation science—the missing link between guidelines and reliable practice. We map a simple decision pathway from efficacy to effectiveness to context and strategy, and we share the real levers that move systems: targeted education, inter‑institutional collaboration, policy mechanisms like bundles, and the business case that earns C‑suite commitment. When leaders see the return on investment in safety, liability reduction, and community trust, sustained resources follow. Finally, we explore technology as an equity engine. AI‑guided ultrasound can extend expertise in low‑resource settings. Predictive analytics may flag fetal heart rate decelerations before they turn critical. And we confront the accuracy gaps in pulse oximetry tied to skin pigmentation and low perfusion, especially during the neonatal transition. With vendor accountability, rigorous validation across diverse populations, smarter sensor selection and placement, and frontline education, monitoring can serve every patient equally. If this conversation resonates, help us spread the word. Subscribe on Spotify or YouTube, share this episode with a colleague, and leave a review so more clinicians can join the effort to make labor and delivery the safest unit in the hospital. Your feedback and stories shape where we go next. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/278-transforming-maternal-care-through-equity-science-and-tech/ [https://www.apsf.org/podcast/278-transforming-maternal-care-through-equity-science-and-tech/] © 2025, The Anesthesia Patient Safety Foundation

#277 Transforming Maternal Care: Faster Sepsis Recognition, Smarter Hemorrhage Response, and Safer VTE Prevention

Welcome back to our 2025 Stoelting Conference Podcast Series.  Fever isn’t the fail-safe it’s made out to be—especially in pregnancy. We walk through the subtle ways maternal sepsis hides in plain sight, why a quarter of those who died never had a fever, and how early warning tools, rapid antibiotics, and source control change the odds. From there, we pivot to maternal hemorrhage and show how quantifying blood loss with calibrated drapes plus a treatment bundle outperforms the old habit of visual estimation. We dig into TXA timing for high‑risk cesarean patients, the evidence gaps on transfusion strategies, and how placenta accreta spectrum demands regionalized teams and rehearsed playbooks. The conversation then turns to venous thromboembolism, still a leading cause of maternal mortality. Risk climbs five- to six-fold and peaks postpartum, so we stress reassessment at prenatal intake, during any antepartum admission, at delivery, and before discharge. We compare heparin and low molecular weight heparin in real-world settings, highlight extremely low neuraxial hematoma risk when following ASRA guidance, and share concrete workflow tactics: pre-delivery anesthesia consults, unit-wide alerting, anticoagulant hold triggers, and pre-procedure huddles that keep patients safe while preserving neuraxial options. Threaded through each segment is a practical theme: faster recognition, standardized bundles, and tight communication save mothers’ lives. If you’re building a safer unit, start with tools that measure what matters, empower nurses to escalate, and remove delays between suspicion and action. Subscribe, share with your team, and leave a review with one change you’ll make this week—what will you implement first? For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/277-transforming-maternal-care-faster-sepsis-recognition-smarter-hemorrhage-response-and-safer-vte-prevention/ [https://www.apsf.org/podcast/277-transforming-maternal-care-faster-sepsis-recognition-smarter-hemorrhage-response-and-safer-vte-prevention/] © 2025, The Anesthesia Patient Safety Foundation

#276 Maternal Care, Transformed

Maternal safety changes when we stop relying on heroics and start building systems. We open the door to the 2025 APSF Stolting Conference series with a fast, practical tour of what truly reduces morbidity and mortality: collaboration across anesthesia, obstetrics, cardiology, and nursing; open‑source AIM bundles; early warning tools; and standards that compress time-to-treatment when minutes matter. Along the way, we confront the three deadly D’s—denial, delay, dismissal—and replace them with teamwork, tools, timeliness, and trust. We dig into the history that got us here, from case reports and confidential inquiries to robust maternal mortality review committees and rapid-cycle data that power real change. Then, we zero in on the leading cause of pregnancy-related death—cardiovascular disease—and why risk spikes in the postpartum period. A vivid case of peripartum cardiomyopathy shows how quickly decompensation unfolds and why anesthesia must be in the room early: shaping plans, managing hemodynamics, placing monitors, coordinating with cardiology and OB, and, when needed, activating ECMO. We highlight actionable steps like antenatal anesthesia consults for high‑risk patients, postpartum telemetry monitoring, and pregnancy heart teams that make escalation the rule, not the exception. Progress is real for hemorrhage and hypertension, but disparities remain stark for Black, Hispanic, and Asian Pacific Islander patients. We talk about implicit bias, access, and respectful care, and we share multilingual urgent maternal warning signs so patients and clinicians recognize danger sooner. The ASA’s recommendations give a clear roadmap for anesthesiologist leadership—on review committees, quality teams, simulation programs, and implementation of SOAP and ACOG frameworks—so that safety becomes predictable. If this conversation sparks ideas for your unit, we’d love to hear them. Subscribe, share with a colleague who works on labor and delivery, and leave a review telling us the one system change you’ll champion this month. For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/276-maternal-care-transformed/ [https://www.apsf.org/podcast/276-maternal-care-transformed/] © 2025, The Anesthesia Patient Safety Foundation