Our First 40 Years
The following is excerted from the "A Celebration of
Forty Years -
Milestones and Pioneers" (PDF 227KB)
In 1948, U.S. maternal and neonatal mortality rates were unbelievably
high by today's standards. Anesthesia accounted for 3 to 10 percent of all
maternal mortality, yet in 1971 the American College of Obstetrics and Gynecology
(ACOG) reported that in hospitals delivering over 500 babies annually,
fully 97 percent of all mothers received some form of anesthesia, but only 12
percent of these received their anesthetic from the hands of a physician and
only 25% from a nurse actually trained in anesthesia! Only 24 percent of hospitals
offering obstetrics reported 24 hour availability of either an anesthesiologist
or nurse anesthetist. Hicks et al reported that even in 1975 only 39
training programs employed a full time physician at the head of Obstetric
In mid century most mothers received heavy narcotic-scopolamine
sedation during labor (“Dammerschlaf”). Delivery rooms were often quiet due
to anesthetized mothers and sedated newborns. The “saddle block” technique
had been introduced by John Adriani in 1946, but did not catch on rapidly.
Epidural anesthesia (caudal route) for vaginal delivery had been introduced
in 1942 by Robert Hingson, but was rarely used outside of a few universities.
Hingson joined the Hopkins staff in briefly in 1949, but was not successful in
popularizing his technique.
In 1940, there is thought to have been only one person practicing full
time Obstetric Anesthesia in the entire United States, Dr. Bert Hershenson
at Boston Lying-In Hospital (BLI). He later wrote the first book dedicated to
U.S. Obstetric Anesthesia. In the early 50's he was joined by pioneers Chester
White and Jess Weiss at the BLI, who began to espouse regional block. About
the same time Herb Ebner in Providence became a strong advocate and became
the first anesthesiologist named as an Associate Fellow of the ACOG!
In 1949 Virginia Apgar left the Chair of Anesthesiology at Columbia
University in New York and took up full time Obstetric Anesthesia. Frank
Moya joined Virginia Apgar in New York in 1957 and he was joined by Sol
Schnider for four years before Schnider migrated to San Francisco in 1963.
Moya attracted Bradley Smith (in 1960 the first ever Obstetric Anesthesia
Fellow), Mieczyslaw Finster, Paul Poppers, and others. As a full time Obstetric
Anesthesiologist from 1959-1962 at Johns Hopkins, Robert Hustead made
strong progress in introducing continuous lumbar epidural.
John J. Bonica, in Tacoma and Seattle became an early advocate of
lumbar paravertebral block and lumbar epidural block in obstetrics. Otto C.
Phillips stirred alarm with his reports on maternal mortality due to anesthesia
in the Baltimore area. At Yale, Fred Hehre, a former Apgar resident, became
the first truly influential champion and reporter of the benefits of
lumbar epidural in obstetrics, beginning in 1956.
In 1964, and again in 1965, Bradley Smith began correspondence
with several others in an attempt to raise interest in a study group for Obstetric
Anesthesia. In 1965, Sol Schnider surveyed teaching programs and
found only 15 people around the country interested in even forming a mailing
list to circulate pertinent Obstetric Anesthesia reprints. At this time, it was
Otto Phillips, then Chair of the American Society of Anesthesiologists (ASA)
Committee on Maternal Welfare (later the Obstetric Anesthesia Committee)
who began to refer to the idea of an “Association of Obstetrical Anesthesiologists.”
James Elam and Robert Bauer corresponded in 1967 regarding
Phillip's suggestion. In March 1968, Elam and Phillips agreed on plans for an
initial organizational meeting for which Elam obtained funding. Finally, on
Saturday, May 25, 1968, the organizational meeting of the group, which later
became known as SOAP, was held at the O’Hare Airport in the Admiral’s
Club Lounge. Those present at this first meeting included Bauer, Elam,
Smith, Hustead, Richard Clark, and James Evans. These six became known
as the “Founders” of SOAP.
Clark, Evans and Smith were delegated to begin work on a constitution
for the group. They represented divergent views of the direction in which
the group should plot its course. Smith hoped to merge SOAP activities into
the ASA; Clark felt that affiliation with one of the major societies was important
and sensed that resistance in the ASA would make that route impractical.
He believed that establishing a section under the American Society of
Obstetrics and Gynecology (ACOG) could be feasible.
In order to further explore guidance from potential members on
these constitutional issues, Smith (now in the role of Chair of the ASA Obstetric
Anesthesia Committee) advertised and convened an “interest group”
meeting at the ASA Annual Meeting in Washington, D.C. on October 20,
1968. (In a grand gesture, the incoming President of ASA, John Bonica, left
his own ASA Presidential dinner party, came to the meeting, and offered firm
support for the formation of SOAP.)
To further this exploration, Smith advertised and convened another
“interest group” meeting at the Annual Meeting of the ACOG on Monday,
April 28, 1969 in Miami Beach. Several anesthesiologists, including Fred
Hehre, Gertie Marx, Bob Hustead, Dick Clark and Ed Hanish attended, as
did several obstetricians including Frank Greiss and William Gottschalk.
The initial interest of ACOG in affiliating was not sustained, and despite
the enthusiasm of this, as yet small, group, the ASA decided against encouraging
anesthesia specialty groups. However, although SOAP was clearly
the first, other specialty societies similar to SOAP began to appear, and ASA
eventually reversed its position. Not only were the activities of the specialty
groups encouraged, but several, with SOAP again the first, obtained direct
representation in the ASA House of Delegates.
Temporarily rebuffed, the group decided to go ahead on its own.
Hustead volunteered to host a nationwide invitational meeting in Kansas
City, Kansas in connection with a continuing education program on Obstetric
Anesthesia problems and procedures. This meeting convened September 19 -
21, 1969 at the University of Kansas in Kansas City. Those in attendance
were later christened the 64 “Charter Members” of SOAP (listed in this book.)
At the first formal business meeting on Sunday, September 21, 1969 it was
decided that a new organization had been born, and it should be called the
Society for Obstetric Anesthesia and Perinatology. (See attached note by
Adolph Giesecke describing how the name came about.)
The 1970 Annual Meeting was convened in Nashville, Tennessee on
September 26-27, 1970, by its host, Smith, with Hustead presiding. (There
was still no charter or constitution). There were 64 registered enrollees,
bringing the total SOAP membership to 91. Since the O'Hare group had
never presented their proposed constitution and bylaws, they were again
charged to do so by the next meeting.
The 1971 Annual Meeting was convened in Atlanta from April 23 -
25, with Evans as host and Smith presiding. Approximately 74 attended. The
CME program was jointly sponsored by Emory University, Departments of
Anesthesiology, Gynecology/Obstetrics, and Pediatrics. In addition to a long
discussion of the practical financial side of Obstetric Anesthesia practice, the
business meeting laboriously and carefully reworked the report of the Constitution
and Bylaws Committee, and the first by-laws of SOAP were adopted.
The official SOAP membership had increased to 185 names.
The 1972 Annual Meeting was convened in Denver, Colorado on
March 24-26, by the co-hosts, Alice Basford and Ed Crawford, with James
Evans presiding. Business included extensive discussion and acceptance of
further amendments to the new articles of organization. Because the newly
enacted bylaws included an attendance requirement, the official membership
rolls were purged down to 78 members.
Wouldn't you like to know more of SOAP's 40 year history? So would
we all! Unfortunately, much of it is LOST! The records of SOAP, our achievements,
a glimpse of the personalities of our pioneers, their tribulations and
the history of our evolution is GONE!
The 2007-2008 SOAP “Repository Task Force” pledges our best efforts
to begin the restoration of this priceless heritage. Each present or past
SOAP member can help the Task Force by finding and preserving documents
or artifacts from SOAP's history. Contact Felicia Reilly, Archivist, Wood
Library-Museum, Park Ridge, Illinois, e-mail: f.reilly@ASAhq.org or a
member of the “Repository Task Force.
Robert F. Hustead, Richard B. Clark, and Bradley E. Smith"