11 - Maternal Death due to Anaesthesia

Summary

Obstetric anaesthesia dates from 1853, when John Snow gave chloroform to Queen Victoria. Spinal anaesthesia was described in 1898 but became common only in the 1990s. Nitrous oxide and oxygen ('gas and air') became widely used in the 1960s. The 1930 Report on Maternal Mortality recommended that the same person should not act as anaesthetist and obstetrician. The anatomical and physiological changes of pregnancy increase the risks. In the 1952-4 CEMD Report anaesthesia was involved in nearly 1 in 20 deaths: a major factor was inhalation of stomach contents. The next Report advised tracheal intubation to reduce this risk. The need for an experienced anaesthetist became obvious and in 1969 the Obstetric Anaesthetists’ Association was formed. The 1973-5 Report recognised that anaesthetists require skilled help and later Reports recommended practice drills. In the 1980s there was a move towards regional anaesthesia, first as epidural and in the 1990s spinal anaesthesia. Both require considerable expertise. Improvements in staffing, training and equipment continued, and in the year 2000 anaesthesia was 5 times safer than in 1983 and 38 times safer than in 1963.