The Obstetric Anesthesiology Fellowship is accredited by the ACGME for four fellows. The Section of Obstetric Anesthesiology in the Department of Anesthesiology at the Northwestern University Feinberg School of Medicine is actively involved in the care of obstetric patients at the Prentice Women’s Hospital of Northwestern Memorial Hospital. Located in the heart of downtown Chicago, the Labor & Delivery Unit at Prentice Women’s Hospital is designated a Level 3, high-risk obstetrical unit. The physical facility is 7 years old and contains state-of-the-art facilities for providing care to obstetric patients and their babies.
Prentice Women’s Hospital performs the largest number of deliveries in the state of Illinois, over 12,000 per year. The patient population is a mix of private and service patients, routine and high-risk. The Anesthesiology Service is involved in the care of approximately 90% of obstetric patients. The Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology is nationally recognized and is part of the NICHD Maternal Fetal Medicine Network Units Network. Many patients are enrolled in clinical obstetric trials or clinical anesthesiology trials.
The Fellowship in Obstetric Anesthesiology at Northwestern University Feinberg School of Medicine is a 12-month program that commences on July 1. There are four available fellow positions.
Fourteen dedicated obstetric anesthesiologists are the primary educators in the fellowship program. In addition, faculty members in the Medical School’s Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine (MFM), Neonatology and Critical Care Medicine are integral to the fellows’ education experience.
The Section of Obstetric Anesthesiology in the Department of Anesthesiology has primary clinical responsibilities on the Labor & Delivery Unit. Faculty members in the Department of Anesthesiology, whose primary subspecialty interest is Obstetric Anesthesiology, are dedicated to providing a well-rounded educational experience for anesthesiologists interested in a career in obstetric anesthesiology. The OB Anesthesiology Fellows are expected to gain experience in advanced clinical care, including the care of healthy and high-risk parturients and pregnant women undergoing nonobstetric surgery (7 months total clinical rotation). Fellows are also required to participate in the management of patients scheduled for fetal surgery procedures.
Fellows will be expected to participate in at least one research project, with the goal of one abstract and publication (3-month research rotation). Additionally, fellows rotate to the MFM and Neonatology services for 2-week rotations and participate in a formal simulation curriculum. Fellows meet for a weekly didactic session with one of the faculty members. One meeting per month is held jointly with the MFM fellows, usually a journal club. Fellows participate in regular patient care conferences and other multidisciplinary conferences. Our goal is for fellows to complete the program as well-rounded anesthesiologists whose primary interest and expertise is obstetric anesthesiology.
The modern anesthetic management of parturients requires an in-depth knowledge of not only anesthesiology, but also knowledge of obstetrics and the issues facing physicians involved in the care of high risk parturients..
- Successful completion of an ACGME- or Royal College of Physicians and Surgeons of Canada- accredited program in anesthesiology is a prerequisite.
Northwestern Memorial Hospital, Prentice Women’s Hospital, delivers over 12,500 babies per year. The cesarean delivery rate is 27% (3500 cases/year) and labor neuraxial analgesia rate is 90% (11,000 procedures). Anesthesiology residents in the core program average approximately 175-200 cases in their 2-month obstetric anesthesiology rotation. There is no competition between residents and fellows for cases. Case assignment is based on level of trainee experience and competency and anticipated difficulty of patient care, as well as learning needs.
The obstetric anesthesiology fellowship will enable the fellow to acquire an advanced body of knowledge and level of skill in the management of parturients, particularly of high-risk parturients. This should allow the fellow to assume a future leadership role in academic or private practice in the field of obstetric anesthesiology. The objectives include:
- understanding the obstetric management of high-risk parturients.
- understanding fetal heart rate measurement and interpretation.
- understanding the anesthetic management and the interdisciplinary approach to the management of the high-risk parturient.
- understanding neonatal resuscitation (American Academy of Pediatrics Neonatal Resuscitation Certification).
- understanding the moral and ethical issues in the care of the parturient, including maternal vs. fetal well-being.
- understanding the economic issues in obstetric anesthesiology.
- organizing a functioning obstetric anesthesiology service.
- critically evaluating the clinical literature in obstetric anesthesiology.
- teaching obstetric anesthesiology to others.
- carrying-out a scholarly project, including study design, recruitment of patients, carrying out of a study, analyzing and publishing the results.
Learn and Demonstrate Competencies in Patient Care and Medical Knowledge
|Labor & Delivery||7-8 months|
|Maternal Fetal Medicine||2 weeks|
Labor & Delivery Rotation
Fellows will complete a total of seven months in a clinical rotation that includes the Labor & Delivery Unit and the obstetric operation rooms. Fellows will provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Fellows will demonstrate: 1) technical expertise to perform all medical and invasive procedures relating to the area of obstetric anesthesiology including combined spinal epidurals, traditional epidurals, spinal catheters and any medically-indicated invasive monitors, including technical expertise in using ultrasonography to assist with transversus abdominis plane blocks and neuraxial procedures; 2) competence in the comprehensive analgesic/anesthetic management of both maternal and fetal comorbidities utilizing a multidisciplinary approach with subspecialist teams including obstetricians, maternal fetal medicine and neonatologists, including planned vaginal deliveries with a high-risk maternal co-morbidity, planned vaginal deliveries with high-risk fetal conditions, cesarean deliveries with a high-risk maternal co-morbidity, cesarean deliveries with a high-risk fetal condition; 3) competence to develop and manage an anesthetic plan that is integrated with the surgical and obstetric care plan during the first, second, or third trimesters, other than for Cesarean delivery, including antepartum procedures involving prenatal diagnosis and fetal treatment, maternal cardioversion, or electroconvulsive therapy, assessment of possible maternal co–morbidity and assessment of fetal status that includes provision for perioperative fetal monitoring; development of a plan for possible emergency Cesarean delivery if appropriate; provision for postoperative analgesia; and the development of a plan to prevent preterm birth; 4) competence to manage general anesthetics for Cesarean or vaginal delivery; including: recognizing indications for general anesthesia; efficiently and quickly allaying the anxiety of the mother and communicating the anesthetic care plan; appropriately assessing the airway; and rapidly assessing the clinical scenario and its urgency in concert with the obstetric specialist and making the clinical judgment to initiate general anesthesia after considering the maternal and fetal risks; 5) proficiency and skill preparing for and providing care, including developing a care plan, which acknowledges the patient’s birth plan goals; 6) proficiency in the anesthesia critical care of women during the puerperium; and 7) complete a course in neonatal resuscitation through the American Academy of Pediatrics/American Heart Association (AAP/AHA) Neonatal Resuscitation Program; must receive a course completion certificate prior to completion of the fellowship.
Fellows will demonstrate knowledge of established and evolving biomedical, clinical, epidemiologic and social behavioral sciences, as well as the application of this knowledge to patient care. Fellows will demonstrate competence in their knowledge, with specific emphasis on the anesthetic implications of the altered maternal physiologic state, the impact of interventions on the mother and fetus/neonate and the care of the high-risk pregnant patient.
Maternal Fetal Medicine Rotation
Fellows will complete at least one contiguous two-week rotation in maternal-fetal medicine that includes experience in antepartum fetal testing and high-risk antepartum care. Fellows will provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Fellows will demonstrate competencies in: 1) Interpretation of fetal surveillance and consultation with maternal-fetal medicine specialists and neonatologists as to the appropriate obstetric interventions and their timing; and 2) Assessment of fetal status and possible maternal co-morbidity; development of an anesthetic care plan that is integrated with the surgical and obstetric care plan.
Fellows will demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care. Fellows will demonstrate competence in their knowledge in the following areas: 1) medical disease and pregnancy, including hypertensive disorders, morbid obesity, respiratory disorders, cardiac disorders, gastrointestinal diseases, endocrine disorders, autoimmune disorders, hematologic and coagulation disorders, neurologic disorders, substance abuse, HIV infection, AIDS and psychiatric diseases; 2) obstetric management of abnormal labor, 3) tocolytic therapy, the effects of genetics on preterm labor and response to tocolytics and methods of tocolysis; 4) obstetric management of preeclampsia, including laboratory models for study of preeclampsia; etiology and epidemiology; pathophysiology; biomolecular and genetic changes; and postpartum care; 5) antepartum and intrapartum fetal monitoring, including the application of ultrasonography, biophysical profile, electronic fetal heart monitoring, assessment of uterine contraction pattern and labor and acid-base status of the fetus; and 6) legal and ethical issues during pregnancy.
Fellows will complete at least one contiguous two-week rotation in neonatal intensive care. Fellows must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Fellows will: 1) demonstrate competence in the comprehensive analgesic/anesthetic management of deliveries: planned vaginal deliveries with high-risk fetal conditions, including appropriate interpretation of fetal surveillance and consultation with maternal-fetal medicine specialists and neonatologists as to the appropriate obstetric interventions and their timing and Cesarean deliveries with a high-risk fetal condition, including interpretation of fetal surveillance and consultation with maternal-fetal medicine specialists and neonatologists as to the appropriate obstetric interventions and their timing; 2) gain proficiency in management of common neonatal disorders: metabolic derangements, sepsis, respiratory distress, persistent pulmonary hypertension and NEC; 3) demonstrate competence in the basic principles of mechanical ventilation of the neonate, including: indications for mechanical ventilation, indications for surfactant therapy, recognizing the differences between conventional ventilation and high frequency ventilation and indications and techniques of weaning ventilator support; and 4) complete a course in neonatal resuscitation through the American Academy of Pediatrics/American Heart Association (AAP/AHA) Neonatal Resuscitation Program and must have received a course completion certificate prior to completion of the fellowship.
Fellows will demonstrate competence in their knowledge, with specific emphasis on the anesthetic implications of the altered maternal physiologic state, the impact of interventions on the mother and fetus/neonate and the care of the high-risk pregnant patient, of the following areas: 1) advanced maternal physiology, biochemistry (nitric oxide, prostaglandins), genetic predispositions and polymorphisms; 2) embryology and teratogenicity, including laboratory models and use of databases; 3) fetal and placental physiology and pathophysiology, models of uteroplacental perfusion and pharmacokinetics of placental transfer; 4) neonatal physiology and advanced neonatal resuscitation; 5) local anesthetic use in obstetrics, including pregnancy-related effects on pharmacodynamics and pharmacokinetics; recognition and treatment of complications; lipid rescue of local anesthetic cardiotoxicity; effects on the fetus in different settings, including prematurity, asphyxia, fetal cardiovascular and neurological effects; and fetal drug disposition; 6) neuraxial opioid use in obstetrics, including prevention, recognition and treatment of complications; effects on the fetus; and fetal/neonatal drug disposition; 7) general anesthesia use in obstetrics, including recognition and treatment of complications, alternatives for securing the airway in pregnant women (anticipated/unanticipated difficult airway), consequences on utero-placental perfusion and opposing maternal-fetal considerations regarding the use of general anesthesia; 8) effects of maternal medications on breastfeeding, particularly effects of labor analgesia and postpartum analgesia; 9) antepartum and intrapartum fetal monitoring, including the application of ultrasonography, biophysical profile, electronic fetal heart monitoring, assessment of uterine contraction pattern and labor and acid-base status of the fetus; 10) anesthetic management of ex-utero intrapartum treatment (EXIT) procedures with and without neonatal transfer to extracorporeal membrane oxygenation (ECMO) and anesthesia for fetal surgery; and 11) transport and monitoring of critically-ill parturients and neonates within one hospital and between hospitals.
Learn and Demonstrate Competencies in Practice-Based Learning & Improvement and Systems-Based Practices
Fellows will complete a total of three months in a research rotation. The rotation will consist of 13 weeks scheduled in 1-week increments approximately every four weeks throughout the year. Fellows will complete an obstetric anesthesiology research project and successfully evaluate a journal article: (1) Be able to read and critically evaluate journal articles in the obstetric anesthesia literature. Lead a minimum of 6 journal clubs and complete 6 journal club evaluations. (2) Be able to discuss the principles and ethics of research in pregnant women, their fetuses and neonates. (3) Define a study question based on a literature review and develop a study hypothesis. (4) Design and implement one research project (i.e. write one research protocol and submit it for Institutional Review Board (IRB) approval). (5) Develop an analytic plan and interpret data from research project. (6) Submit one abstract using data from the research project. (7) Ideally, prepare one manuscript from scholarly activity performed during the obstetric anesthesiology fellowship. Fellows will also demonstrate knowledge of statistics, epidemiology and grant proposals.
Locate, appraise, and assimilate evidence from scientific studies related to their patients' health
As a tertiary-care, academic medical center with residencies in multiple disciplines, Northwestern Memorial Hospital is an academic institution with a cultural emphasis on providing evidence-based care. Evidenced-based medicine is practiced and discussed daily. Because the medical center cares for a large number of high-risk obstetric patients, multiple multi-disciplinary care conferences are held throughout the year. Both the obstetric anesthesiology and maternal-fetal medicine fellows are expected to propose evidence-based care plans for these high-risk patients.
Fellows participate twice daily in sign-out rounds for obstetric anesthesiology,and multidisciplinary rounds with the obstetric and maternal fetal medicine residents, fellows and attending staff. Daily resident teaching rounds are centered on evidenced-based care. Weekly obstetric anesthesiology journal clubs teach evaluation of scientific evidence and how the evidence relates to clinical practice. Fellows will lead six obstetric anesthesiology journal clubs during their fellowship year and complete six journal club evaluations. Fellows are asked to prepare one Department of Anesthesiology Grand Rounds presentation in which they are expected to evaluate and present scientific evidence supporting their presentation.
Participate in quality improvement activity
Fellows will participate in at least one of a number of quality improvement projects. A current project is to choreograph a multidisciplinary team approach to emergency cesarean delivery. A fellow has scripted a team approach for the anesthesia team, including describing specific roles of team members. The roles were then simulated and modified as needed. Finally, the roles are practiced by the anesthesia team, particularly at the beginning of a new resident rotation. The fellow leads these role simulations. A number of other quality improvement projects are ongoing on the Labor & Delivery Unit and fellows are invited to participate in these projects. Examples include: postpartum hemorrhage protocol, escalation of care protocol (for parturients requiring obstetric and critical care), and roll-out of the electronic medical labor analgesic record.
Complete a project with at least one of the following goals:
- Enhancing the fellow’s engagement in multidisciplinary care of obstetric patients, or
- Improving patient safety as it applies to the fellow’s practice of obstetric anesthesiology
Participate in a system improvement project based on the literature, quality improvement data and patient and family satisfaction data
Relationship to Anesthesiology Residency and Obstetric Anesthesiology Resident Rotation
Anesthesiology residents are integral members of the anesthesiology team that cares for obstetric patients. Fellows frequently directly supervise the residents in providing care to low risk patients. They may also provide care to patients during times when residents are busy with didactic educational activities. Additionally, fellows will either assist the residents or provide direct care to high risk obstetric patients.
Residents, fellows and attendings participate in twice-daily sign-out rounds. These rounds often include discussions of evidenced-based care in the context of the patients on the unit. Fellows participate in the daily resident didactic lectures. The lectures are based on a 2-month obstetric anesthesiology rotation and the fellows are expected to prepared and present each lecture topic at least once during the fellowship year. These lectures are directly supervised by at least one attending anesthesiologist. Additionally, fellows, in conjunction with an attending anesthesiologist, are assigned approximately one journal club each month. The journal club is attended by obstetric anesthesiology faculty members, students and residents rotating on the service and fellows.
Both residents and fellows help care for patients enrolled in clinical studies; however, this is primarily the responsibility of the fellows. In particular, fellow are expected to have knowledge of the enrollment criteria for all of the current clinical studies and help alert the research nurses with patient enrollment, study procedures and data collection. The core program director and the fellowship program director meet regularly to assess the quality of interactions between the fellows and residents.
- Fellows are evaluated quarterly. The Program Director and Clinical Competency Committee Chair will meet to review the fellow’s evaluation with him or her.
- Successful completion of the program will be contingent upon meeting curricular and skills requirements as judged by evaluations. In addition, the trainee must 1) complete at least one scholarly project suitable for publication, 2) make one local presentation and 3) show evidence of teaching medical students and residents.
Weekly OB Anesthesiology Fellow Lectures/PBLs
The following topics will be covered in weekly didactic sessions for obstetric anesthesiology fellows. The format may vary and may include lectures and PBLDs. Some of these didactic sessions will be joint sessions with the maternal-fetal medicine fellows. All sessions will be supervised by at least one core faculty member.
Weekly Obstetric Anesthesiology Journal Club
Weekly (Fridays) journal club articles will be presented by obstetric anesthesiology faculty members and fellows. Faculty in the obstetric anesthesiology section will assist in selection, appraisal and assimilation of evidence from scientific studies relevant to obstetric patients. Studies will include literature from perinatal medicine and pediatrics in addition to anesthesiology. In addition, obstetric anesthesiology fellows will participate in interdisciplinary education with maternal fetal medicine fellows by participating in their journal clubs.
Daily Obstetric Anesthesiology Morning Conferences
Obstetric anesthesiology fellows will participate in the daily resident morning conference lecture series based on the Obstetric Anesthesia textbook edited by David Chestnut et al. Fellows will maintain and further their knowledge on the anesthetic implications of the altered maternal physiologic state and the impact of interventions on the mother and fetus/neonate by participating in the daily obstetric anesthesiology didactic session attended by all providers on the service (medical students, residents, fellows, attending physicians). Fellows will develop their didactic skills by participating as the lead educators one or two time each month). Fellows will lead approximately 50% of the sessions. Each fellow will present each topic listed below at least once during the year. Faculty mentors will assist fellows with creating problem-based learning discussions and reviewing the latest literature on the topics.
Obstetric Anesthesiology Grand Rounds
Once a year, the obstetric anesthesiology fellows will prepare a grand rounds presentation related to controversies in obstetric anesthesiology and the most current obstetric anesthesiology practices. This will allow the opportunity to locate, appraise and assimilate evidence from scientific studies related to their patient population and obstetric anesthesia practice. Fellows will demonstrate their ability to be an educator in obstetric anesthesiology. Obstetric anesthesiology faculty will mentor them in this endeavor. Grand rounds presentations are evaluated by all attendings in the Department of Anesthesiology.
Ultrasound Workshop for OB Anesthesiology Fellows
The obstetric anesthesiology fellow should be able to decide which patients would benefit from ultrasound guided regional anesthetic techniques, obtain optimal images, interpret the images, perform the regional technique and assess the results. Additionally, knowledge and skill at performing a Focus Assessed Transthoracic Echocardiography Examination (FATE) is becoming an important to the care of high-risk obstetric patients. A 2-hour workshop at the beginning of the year will review the basics of ultrasound techniques and equipment. Emphasis will be placed on use of ultrasound for transversus abdominus plane (TAP) blocks, neuraxial techniques in patients with back pathology or morbid obesity and the FATE.
Simulation has been recognized as a strategy to provide a safe environment for deliberate practice in both clinical and behavioral skills. The Anesthesiology RRC requires that trainees participate at least once yearly in a simulation experience. Furthermore, the ABA requires that diplomates participate in a 6-8 hour simulation course in Part IV of its Maintenance of Certification (MOCA) program. The proposed simulation education curriculum for the obstetric anesthesiology fellowship provides a bridging experience from trainee to practicing anesthesiologist through a dual strategy: 1) learning through participation in simulation and 2) learning about using simulation as a life-long teaching and learning platform.
1) To practice and expand clinical management skills in challenging and/or rare clinical events; 2) To practice and expand team management skills in challenging teamwork events; 3) To reflect on upon individual, team and systems performance for practice improvement; and 4) To learn the basics of scenario design and debriefing.
1) Participate in an introductory 2-hour workshop to learn about scenario design and debriefing basics; 2) Participate in at least 2 simulations + debriefing sessions during the course of the fellowship year. Each session will be 90-minutes in duration; 3) Provide a brief written practice improvement plan (PIP) and follow-up in response to each simulation experience. The PIP will be similar to the PIP completed by MOCA participants; and 4) Design and deploy at least one simulated scenario during the year in cooperation with the simulation curriculum director. Potential arenas include resident simulation sessions, fellow simulation sessions, multi-disciplinary events, or simulation for practicing physicians.
Monthly 90-minute simulation seminars attended by 2 or more obstetric anesthesiology fellows. Other trainees, including obstetric and anesthesiology residents and nursing staff, will also be invited to participate as appropriate and available.
Sample Topics by Competency Area
- Patient care scenario: Emergency cesarean delivery in the Emergency Department.
- Medical Knowledge scenario: Recognition of post-partum diabetes insipidus after placental abruption.
- Practice-based Learning and Improvement: Design, deployment, debriefing and refinement of own scenario.
- Interpersonal and Communication Skills scenario: Severe post-partum hemorrhage with a positive antibody screen, difficult family members present with language barrier.
- Professionalism scenario: Managing confrontation/disagreement and demonstrating effective basic debriefing techniques.
- Systems-based practice scenario: Transport of unstable patient between hospital buildings and testing of a systems solution using simulation
- Facilitated debriefings after each simulation session with input from both attendings and peers.
- Self-evaluation of written practice improvement plans (PIP) following each simulation session.
- Evaluation by participants in the scenario designed and deployed by the fellow.
- A single, year-end assessment (did not meet goals, met goals, exceeded goals) by those attendings participating in the simulation curriculum based on achievement of the goals as stated above.
- The modern anesthetic management of parturients requires an in-depth knowledge of not only anesthesiology, but also knowledge of obstetrics and the issues facing physicians involved in the care of high risk parturients.
- Successful completion of a 4 year accredited program in anesthesiology is a prerequisite. The candidate must be American Board of Anesthesiology eligible or accredited.
Feyce Peralta, MD: Program Director
Nicole Higgins, MD: Section Chief and Medical Director, Labor and Delivery Unit
Paloma Toledo, MD, MPH: Fellow Research Director
Samir Patel, MD
Elizabeth Lange, MD
Jason Farrer, MD
J. Brad Bavaro, MD
Mahesh Vaidyanathan, MD
Naveen Nathan, MD
Alex DeLeon, MD
Edward Yaghmour, MD
Maternal Fetal Medicine Faculty
William Grobman, MD, MBA: MFM Program Director
Susan Gerber, MD: L&D Medical Director
Janine Khan, MD
In addition to McGaw Medical Center benefits, Obstetrical Anesthesiology fellows receive:
- $700 educational expense account
- Funding for one national society meeting: ASA or SOAP
- Additional funding for a second Academic/research meeting: Fellows who present an abstract at a national meeting will receive funding for a second meeting, based on the Program Director's approval.
- Dedicated office space with desktop computer
To be considered for an Obstetrical Anesthesiology fellowship position, candidates must be eligible for certification or fully certified by the American Board of Anesthesiology before fellowship training begins. In addition, candidates must obtain an Illinois Temporary or Permanent License and have taken USMLE Step 3 prior to training.
Applicants will be considered throughout the training year, so there is no application deadline. Please send the following application materials to Caroline Simpson.
- Common Application for Fellowship in Obstetric Anesthesiology
- Curriculum Vitae
- Evaluations from OB Anesthesia rotation
- Professional Photo
Illinois Department of Financial & Professional Regulations (IDFPR)
Applicants must obtain a Temporary or Permanent Illinois Medical License before starting their fellowship training. Licensing information and application can be found at www.idfpr.com. In order to apply for a permanent license, the applicant must already have taken the USMLE Step III. Please be aware that it may take up to 60 days for IDFPR to process and grant an Illinois license.
Contact Northwestern's Office of Graduate Medical Education:
McGaw Medical Center of Northwestern University
420 East Superior Street
Rubloff Building, 12th Floor
Chicago, IL 60611
- McGaw Benefits (McGaw Medical Center of Northwestern University)
Access the handbook to review benefits available to all residents at Northwestern Medicine
Check out the many external resources on the Student Housing section of the Augusta Webster, MD, Office of Medical Education website; the Off-Campus Life housing section of the Northwestern University Division of Student Affairs has additional resources to assist you with your housing search
Feyce Peralta, MD
Housestaff Research Portal
Feinberg has the infrastructure and resources to assist McGaw trainees interested in conducting scientific research. Visit our Housestaff Research Portal to learn more.