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At least one anaesthetist in each anaesthesia department, not necessarily an obstetric anaesthetist, should take the lead in safeguarding/child protection; they should undertake training and maintain core level 3 competencies.¹¹⁵ The lead anaesthetist for safeguarding/child protection should liaise with their multidisciplinary counterparts within the obstetric unit.

There should be policies defining how women are referred to and access specialist or tertiary services (e.g. neurosurgery, acute stroke services).^9,116,117

Those who refuse transfusion of blood or blood products, whether because of adherence to the Jehovah’s Witness faith or for other reasons, should be identified early in the antenatal period. They should meet with an anaesthetist to discuss their specific wishes and should receive information about the potential risks associated with their decision to ensure informed consent process.^118...

All anaesthetists involved in the care of pregnant women should be competent to deliver high quality safe care that considers the physiological changes and other specific requirements of these pregnant women.¹²¹

There should be a nominated anaesthetist responsible for training in obstetric anaesthesia, with adequate programmed activities allocated for these responsibilities.⁵⁹

A process should be in place for the formal assessment of anaesthetists before allowing them to join the on-call rota for obstetric anaesthesia with distant supervision.^20,122

In-situ simulation training can help to identify system process gaps.¹²³ Simulation based learning techniques should assist anaesthetists in resolving these issues and developing the necessary technical and non-technical skills.^{124,125,126,127,128,129,130,131,132}

All anaesthetists working in the maternity unit should have received training in human factors, addressing key factors including situational awareness, effective teamworking and communication, decision making and the effect of biases.^133,134

There should be induction programmes for all new members of staff, including locum doctors. Induction for a locum doctor should include the following and should be documented:

•  familiarisation with the layout of the labour ward
• the location of emergency equipment and drugs (e.g. massive obstetric haemorrhage trolley/intralipid/dantrolene)
• access to guidelines and protocols
•  information on how to summon support/assistance

assurance that...

Any autonomously practising anaesthetist providing cover for the labour ward regularly or on an ad hoc basis must undertake continuing professional development (CPD) in obstetric anaesthesia and must have enough exposure to obstetric patients to maintain appropriate skills. This could be achieved through allocation of supernumerary sessions on the labour ward or in elective caesarean lists while reviewing appropriate CPD...