Physician at Work: Making childbirth safe and enjoyable

Ferne R. Braveman, MD, cares for patients at a life-changing moment in their lives: during labor and delivery. Her goal is to make the experience safe for mom and baby and as enjoyable as possible, by providing pain relief during labor or, if the patient requires a cesarean section, making it possible for her to be awake and involved with her baby right after childbirth. “Obstetrical anesthesia is fun because we can make such a difference to the patient’s experience,” she said.

Braveman provides epidural analgesia for vaginal deliveries, but because Yale attracts an increasing number of high-risk patients, 30 to 40 percent of deliveries are C-sections. As often as possible, she provides regional anesthesia in the form of an epidural or spinal. “If you have to have a surgical delivery it provides the best obstetrical experience possible,” she said, adding that general anesthesia is used only if the mother or baby is unstable. She usually recommends a spinal if a patient has not had an epidural during labor because it only takes a few minutes to provide anesthesia that’s adequate for surgery. If an epidural is already in place, however, a change in medication gets the job done.

In addition to her work in obstetrics, Braveman also handles pain management for other types of patients. More than 20 years ago, she established one of the first postoperative pain management services in the country with Raymond S. Sinatra, MD. She cares for patients who rely on such analgesic techniques as continuous catheter analgesia, as well as those who have complicated opioid or chronic pain issues. New ultrasound techniques have paved the way for an increase in the use of nerve catheters. By placing local anesthetic in the sheath surrounding nerves, Braveman can numb a specific area, such as a knee or a foot, without numbing the entire lower body.

She began her career in family medicine, but anesthesia soon fascinated her. The combination of obstetrical anesthesia and pain management brings her back to her roots in primary care, allowing her to interact with her patients and help them at important moments in their lives. In fact, it’s not uncommon for obstetrical anesthesiologists to move into post-op pain management. “We’re used to having patients who are awake and which allows us to talk with them, not unlike obstetrical anesthesia,” she said.