The Inequities of Motherhood: The Challenges of Obstetric Anesthesia in Low-Income Countries

The maternal mortality rate (MMR) is unconscionably high around the world, with women in low to middle income countries (LMICs) disproportionately passing away from potentially preventable causes. While this is a complicated and multifaceted problem, anesthesia has been identified as a contributing cause of death. From the moment the parturient enters the operating room, the anesthetist is responsible for their well-being. This integrative review was designed to further explore relationship between anesthesia and the MMR in LMICs. Twelve articles published within the last 15 years were selected through an extensive literature search using Medline and CINAHL. Each article was examined using the Polit and Beck (2017) assessment criteria followed by a cross table analysis. The results identified common themes across the studies including lack of infrastructure such as access to reliable power, water and oxygen, resources such as medications and basic anesthesia equipment, training focusing on maternal care and anesthesia and continuing education for providers. Knowing these deficiencies in anesthetic care, nurse anesthetists can assist in implementing changes to help reduce the MMR. Recommendations include encouraging hospitals and governments to make updating hospital infrastructure a priority, reaching out to groups such as the World Health Organization who help fund basic equipment such as pulse oximeters, establishing relationships with medical institutions in other regions to provide training and guidance, and focusing on the development of non-physician anesthetist programs to increase the number of proficient providers.