National Obstetric Anaesthesia (NOA) Network
NOA provides national representation of obstetric anaesthetists and aims to consolidate and amalgamate best practice, share guidelines, provide support for clinical practice in difficult cases, and to encourage and support members to foster training and education. This is particularly important for obstetric anaesthetists working in isolated regions.
NOA is jointly supported by the New Zealand Society of Anaesthetists (NZSA) and the Australian and New Zealand College of Anaesthetists New Zealand National Committee (ANZCA NZNC), with both organisations taking turns to host the annual three to four face-to-face network meetings. The network also has a joint meeting with Midwives and the Obstetricians once a year which the Society and College helps to sponsor. The NZSA provides secretariat services for the network and updates to the membership.
NOA meetings are held in Wellington, the dates for 2019 are as follows: 18 March – ANZCA Office; 12 August – Wellington Airport (TBC); 18 November – ANZCA Office.
The Chair of NOA is Dr Aidan O’Donnell (pictured above), Lead Obstetric Anaesthetist at Waikato Hospital. Aidan is also the author of Anaesthesia: A Very Short Introduction and the assistant editor of the Oxford Handbook of Anaesthesia.
Epidural Pain Relief in Labour – NZSA and WDHB is available on Vimeo. The video was recorded in 2006 as an educational tool for patients and maternity caregivers.
OAA have given us permission to use two of their factsheets OAA NZSA Pain Relief in Labour – How do the options compare? and OAA Epidural Information. These are also available to women under the patient section of this website here.
Your Epidural is a brochure for patients. Feel free to download a copy.
National Obstetric Anaesthesia (NOA) Meetings
The meeting comprised of representatives from 15 DHBs and discussed topics including massive obstetric haemorrhage and its management. Drs Bell, Collis, James and Ms Eadey joined the meeting via Skype to present their use of ROTEM guided transfusion as part of the Obstetric Bleeding Strategy for Wales (OBSCymru) and the 1000 lives campaign. NOA members present found the discussion extremely valuable and all were impressed with the model for planning change and reducing practice variation nationally. Later in the meeting, Dr Fisher presented the WOMAN study which was followed by extensive discussion of a clinical scenario regarding the management of obstetric haemorrhage, and the anaesthetic management of smaller abruptions.
The location – the conference centre at Wellington Airport – was chosen to allow a joint meeting with obstetricians and midwives for part of the day. Delivery ward guidelines regarding timing of anaesthesia, the Choosing Wisely campaign and again, the national drive to implement the Maternity Clinical Information System was discussed. MCIS was still not supported by clinicians or midwives, due to risks that the system continues to pose in the acute setting. It was felt that there were still serious flaws relating to how the information is entered into the system with multiple data entry points and equally, concerns were raised about the ability to extract relevant information from the system in a timely manner.
A response from the Obstetric SIG to the SPANZA advisory regarding the use of tramadol in breastfeeding mothers was presented and discussed. NOA members had provided assistance with this response earlier in the year. This led to a discussion of analgesia following caesarean section and a national survey of practice undertaken at the time of the debate over tramadol was presented.
All NOA members commented on the usefulness of the network, particularly with regard to the cohesion and ability to provide national standards of care for all pregnant women in NZ.
SPANZA Advisory for Tramadol use in breastfeeding mothers postpartum
Previous Meeting Briefs
The meeting was well attended with 15 DHBs represented. A variety of topics were discussed:
MCIS – An update was provided by MCIS project speakers, from both Badgernet and the MoH. Discussions were based on the continued risk the system places in acute settings. MCIS is pending a review.
Enhanced Recovery in Obstetrics (EROS) – an overview was provided from the three years since this was established.
Reasons for failed Spinals
2017 Sepsis Trust – Maternity Sepsis Pathway Tool
Epidural Certification for midwives
The meeting was held at Wellington Airport, to briefly combine with the annual Midwifery and Obstetrician meeting. There were 14 DHB representatives.
Obesity and the risks to pregnancy were discussed at length in the combined meeting. BMI guidelines differed considerably between regions.
Antenatal education – current resources are promoted online and on the NZSA website.
USS for neuraxial blocks – the technique was demonstrated to reduce the number of attempts required and reduce the number of failed attempts.
MCIS issues were discussed – some midwives reported using paper records instead of V10 and Obstetricians and Anaesthetists had issues retrieving information which highlighted a significant risk.
Three case studies were discussed.
The meeting was well attended, with representatives from 16 hospitals from around the country. There was wide-ranging and stimulating discussion on a variety of topics.
The national Maternity Clinical Information System (MCIS), previously known as BadgerNet, continues to cause safety concerns. While the idea of a national obstetric database is welcomed, the system is slow and cumbersome to use.
Opioids in labour – There was discussion about using morphine and fentanyl in labour. Midwives have been legally entitled to prescribe fentanyl and morphine for almost two years, although the uptake of this seems to vary in different regions. Some DHBs have provided frameworks, but it was agreed that a standard nationwide approach would be helpful. The group will work on options which may be easily adapted to local requirements if needed.
Other topics discussed included: Antenatal pain education; Obesity in the obstetric population; and Neuraxial techniques
The NZSA facilitated a new National Obstetric Anaesthesia (NOA) Network initiative, which is being jointly supported by the NZSA and the NZ National Committee of ANZCA. The network will bring together obstetric anaesthetists from DHBs throughout the country to discuss issues and share information to improve patient care.