What has changed dramatically since I began my training is both increasing reliance and benefit from technology applied to clinical care. You may think of me as early-career, yet as a resident I hand-recorded vital signs on a paper anesthesia record, and placed central lines using landmark techniques. Technology innovations specific to obstetric anesthesia seem to have transformed the subspecialty even within my career. Instead of visually estimating blood loss, we quantitate it using wireless scales and tablets, which send automated hemorrhage alerts to the watches and phones of responding clinicians. Instead of choosing empiric transfusion ratios, we can use point-of-care devices to identify low fibrinogen and resuscitate with increasing sophistication. Have a laboring patient with acute shortness of breath? A quick transthoracic echo can provide some critical distinctions for diagnosis and treatment. Even the medication doses, rates, and techniques for labor epidural pain relief have transformed in the past decade. It’s thrilling to see this evolution and how we might apply all of these advances to enhance the quality of care in obstetric anesthesia.
What do you think your peers on the strictly clinical side typically get wrong about anesthesiologists in academia? What do you most want them to understand about your daily challenges and experiences?
As someone who is still quite clinical and happy to be, I may share more similarities than differences with my 100% clinical colleagues. I do, however, want to reveal a best-kept secret about doing clinical research. Those who are 100% clinical may think that doing research requires “all work, all the time” with inherently less work-life balance. On the contrary, conducting clinical research brings me huge satisfaction through “work-research” balance, less burnout and more life-energy. I’m a strong advocate of diversification at work as a strategy to curtail burnout. Frequently changing gears from clinical to administrative to research allows renewed perspective and purpose. Being able to mentor and teach safe practice and inspire trainees’ passion for obstetric anesthesia is profoundly rewarding. There is constant positive feedback in the academic culture at BWH – I thrived from it as a resident and fellow, and hope that I continue to perpetuate that culture now as an attending!
What motivates you at the beginning of every new training cycle? Any particular highlights from past years that you draw on as you gear up for the new one?
I was fortunate to run the OB anesthesia fellowship program at BWH for 12 years, and train 56 fellows who are now carving out incredible careers of their own. It’s really that sense of purpose that inspired me over time, and still does in my role as Division Chief. Yes, the summer months of an academic year are pretty exhausting as new residents and fellows get up to speed. But there’s this tangible energy and opportunity to get people on a positive and productive trajectory. I’m finding that increasing numbers of medical students, interns and junior residents are expressing interest in obstetric anesthesia. It’s incredible to watch the subspecialty grow in real-time.
Is there any aspect of the job that you secretly dread?
I have struggled most of my life with public speaking. I do not like to be the center of attention! However, I see the value in sharing knowledge by delivering an impactful lecture. So, over the years I’ve overcome my apprehension for the most part and may someday actually enjoy myself! To those of you out there who despise public speaking – don’t let it hold you back. Practice, know your topic as well as you can, listen and learn from others, and then practice some more. It truly gets easier with time and if you keep a growth mindset you’ll always be improving.
Is there anything you’d like to discuss here that we haven’t yet covered?
I continue to be inspired by my mentors, friends and colleagues on the L&D unit. We have this special opportunity to work in a dynamic multidisciplinary environment with high value placed on our leadership. Obstetric anesthesiologists are called upon to provide excellent maternal care and advocate for maternal safety. There’s incredible camaraderie that comes with this shared passion. I’m grateful to be a part of it and am very optimistic about the future. There has never been a better time to be an obstetric anesthesiologist. We can and should be driving initiatives to lower maternal morbidity and mortality at the local, state, national, and global levels. With focus on disparities and preventable morbidity and mortality, obstetric anesthesiologists can catalyze change and be direct advocates for maternal safety and well-being.
Dr. Michaela Farber is Chief of the Division of Obstetric Anesthesia at Brigham and Women’s Hospital (BWH) and Associate Professor of Anaesthesia at Harvard Medical School in Boston, Massachusetts. An advocate for maternal safety, she also serves on the Massachusetts Maternal Mortality Review Committee for the Department of Public Health and two task forces for the Massachusetts Perinatal-Neonatal Quality Improvement Network. Dr. Farber currently serves on the SOAP Board of Directors and was nominated to give the 2022 honorary SOAP Gerard W. Ostheimer Lecture, “What’s New in Obstetric Anesthesia.”