Women’s Anesthesiology Division

The Women’s Anesthesiology Division was formally established at Duke in 1997 with the appointment of Dr. Donald Penning. The model of the division evolved from coverage by a pool of anesthesiologists, some of whom were non-specialists, to a model where faculty trained in obstetric anesthesiology provided 24/7 coverage for the labor and delivery unit. This led to increased academic focus in educational and research productivity and formalization of the division. Since then, the volume of deliveries has significantly increased. With the development of a strong Maternal Fetal Medicine group and an impressive Neonatal Intensive Care Unit, Duke began to accept more high-risk pregnancies. Today, high-risk patients comprise a majority of our patients. This growth was directly related to a dramatic change in the patient referral pattern over time. Furthermore, the diverse faculty interests have contributed to the development of global obstetric anesthesia solutions, research into causes of preterm labor, optimization of labor analgesia and recovery following cesarean delivery, and solutions to reduce morbidity in obstetric hemorrhage. The division has continued to grow and expand under the leadership of Dr. Holly Muir (2000-2013) and Dr. Ashraf Habib (2013-to date) and is a nationally recognized division within the field.

In 2019, the Women’s Anesthesiology Division, or DWA, was recognized by the Society for Obstetric Anesthesia and Perinatology as a “SOAP Center of Excellence.”

The Duke Birthing Center is a Level 3 regional referral center with approximately 3,600 deliveries per year that encompass a range of maternal and fetal conditions. Division faculty work closely with neonatology faculty in the Duke Intensive Care Nursery, a 50-bed, Level IV neonatal intensive care nursery.

In addition to staffing the Duke Birthing Center 24-hours a day, 365 days a year, this division’s faculty are experts in delivering state-of-the-art care to a range of patients undergoing surgeries of the reproductive and urologic systems using strategies such as Enhanced Recovery After Surgery (ERAS). Although the work hours involved can be grueling, the opportunities for professional growth and satisfying patient interactions are limitless. Faculty and trainees working in the DWA gain invaluable experience in a variety of complex and highly-stimulating cases and enjoy the benefit of the unique spirit of collaboration that this type of work environment engenders.

Furthermore, the specialty is constantly evolving. Today, 90 percent of parturients at Duke (including high-risk patients) receive epidural analgesia for labor. The division was one of the first in the nation to offer patient controlled epidural analgesia. The DWA has recently introduced the most current epidural delivery mode, programmed intermittent bolus, to optimize pain relief during labor. In addition to exceptional labor analgesia, the DWA promotes and supports a relaxed, family-centered birthing environment. They have collaborated with their obstetric colleagues and the nursing staff to optimize patients’ experiences during Cesarean delivery using the principles of ERAS, and a family-centered approach that has been recently been described as the “Gentle Cesarean.”

Faculty from the DWA have worked with their colleagues in maternal-fetal medicine, gynecologic oncology, interventional radiology and transfusion medicine for years to develop a clinical care pathway for patients with placenta accreta spectrum, a high-risk type of Cesaeran delivery that requires intense collaboration between specialties to keep mother and baby safe and healthy.

https://physicians.dukehealth.org/articles/alternative-placenta-accreta-spectrum-treatment-can-improve-outcomes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567476/

These improvements have occurred in spite of the fact that the volume of deliveries the division handles annually has tripled since obstetric anesthesia first became a specialty at Duke in 1997. The number of cesarean deliveries performed has more than quadrupled. This growth is directly related to a dramatic change in the patient referral pattern over time. With the development of a strong Maternal Fetal Medicine group and an impressive Neonatal Intensive Care Unit, Duke began to accept more high-risk pregnancies. Today, high-risk patients comprise a majority of patients cared for at Duke Birthing Center.

The Women’s Anesthesiology Division has trained obstetric anesthesia fellows for more than 20 years and has maintained ACGME-accreditation since its inception in 2012. The fellowship has recently expanded from one fellow to two fellows per year. Each year, fellows receive rigorous training in the anesthetic care of high-risk mothers and fetuses. Many of our previous fellows have become division faculty, and others have gone on to obtain positions of national prominence at other institutions. Dr. Jennifer Dominguez is the fellowship program director, and she is also the obstetrics councilor for the Association of Anesthesia Sub-Specialty Program Directors.

The Women’s Anesthesiology Division has a strong commitment to resident and medical student education. Residents spend a significant portion of their CA-1 year in this division learning the fundamentals of anesthesia under the guidance of Drs. Jennifer Dominguez and Jennifer Mehdiratta, who are responsible for resident rotations in obstetric and gynecologic anesthesia. In addition to mastering the fundamentals, residents are encouraged to pursue research ambitions, conduct QI projects, and present cases at national meetings. Residents also complete a senior rotation in obstetric anesthesia during the CA-2 year, and an advanced elective in obstetric anesthesia is available to CA-3 residents. Several members of this division are trained in simulation education and mentor residents and fellows in the Duke Human Simulation and Patient Safety Center throughout their training where they learn crisis management skills. Dr. Ashraf Habib is a third-year medical student mentor, and several medical students spend their research year performing clinical research in the field of obstetric anesthesia under his mentorship.

In recent years, the Women’s Anesthesiology Division’s research activity has focused on improving pain relief and safety for these high-risk patients. In addition to their own work, members of this division collaborate on projects with fellows, residents and medical students. Click on each division faculty’s name to learn more about their work at Scholars@Duke.

Division Chief Ashraf Habib, MBBCh, MHSc, FRCA, leads the clinical research in the division, focusing on optimizing hemodynamic management during Cesarean delivery and improving outcomes such as pain and postoperative nausea and vomiting. Dr. Habib is nationally and internationally recognized for his work, and has held a number of national leadership positions and authored national guidelines.

Terrence Allen, MB BS, FRCA, is studying mechanisms involved in preterm labor such as premature rupture of membranes and optimizing management of massive obstetric hemorrhage. Allen also serves as a consultant on the North Carolina Maternal Mortality Review Committee.

Jennifer Dominguez, MD, MHS, is investigating obstructive sleep apnea in pregnant women and aims to improve identification and treatment of this condition in the parturient. She is nationally recognized as a leader in this area and is currently the chair of the Society of Anesthesia and Sleep Medicine’s Obstetrics Committee.

Mary Yurashevich, MD, is the recent recipient of Duke Anesthesiology’s DREAM Innovation Grant and is studying the potential markers of postpartum depression and postoperative pain in the cerebrospinal fluid of women undergoing Cesearan delivery.

Marie-Louise Meng, MD, is fellowship-trained in both obstetric anesthesia and cardiothoracic anesthesia and focuses her research on cardiac disease in pregnant women.

View the department’s competitive and non-competitive research grant awards by calendar year.

Maternal-Fetal Medicine Specialists: The Women’s Anesthesiology Division faculty members work closely and have developed and maintained close-knit relationships with MFM specialists to improve safety and to develop careful plans for pregnant women with complex medical conditions. They attend joint weekly multidisciplinary conferences to develop delivery plans specific to each patient’s needs. They also run an anesthesia consult service and clinic to meet high-risk patients requiring special planning for their care.

Gynecologic Surgery Specialists: Our faculty have worked closely with different divisions of Duke Obstetrics & Gynecology to develop care pathways for enhanced recovery after surgery specific to those patient populations.

Duke Anesthesiology Global Health Program: Global outreach is a major emphasis of the Women’s Anesthesiology Division. The obstetric anesthesia faculty and their colleagues in obstetrics and neonatology have partnered with the Duke Global Health Institute (DGHI) and Kybele, a non-profit organization based in North Carolina, to improve delivery of maternal and neonatal care in low and middle income countries. Dr. Adeyemi Olufolabi leads the Kybele work in Ghana and recently expanded his outreach efforts to Rwanda through the Human Resources for Health grant from the Clinton Foundation. Dr. Olufolabi was the recipient of a Fulbright Scholar Award in 2017-18 to support his work in Rwanda, and was recently recognized by the Duke University School of Medicine with the 2020 Leonard Tow Humanism in Medicine Award for his work both here and abroad. Senior anesthesiology residents and obstetric anesthesia fellows have had opportunity to spend a month’s rotation in either country, a rotation recognized by the American Board of Anesthesiology.

Please contact the Women’s Anesthesiology Division’s staff assistant, Valerie Parker, at 919-668-2024 or valerie.parker@duke.edu with inquiries.