Maternal Care Under Pressure: Providing Obstetric Anesthesia During Disasters and Low-Resource Settings

Abstract

This article is a narrative review of obstetric anesthesia in low-resource and disaster-affected settings, employing a comprehensive synthesis of experiences from natural disasters and low- and middle-income countries. The methodology involved a search of recent literature and organizational guidelines to identify challenges, ethical dilemmas, and strategic approaches. The review categorizes deficiencies in infrastructure, workforce, and equipment, examining feasible anesthesia and analgesia techniques during crises and outlining ethical considerations relevant to resource allocation and triage. Disaster conditions frequently result in loss of electricity, oxygen supplies, monitoring equipment, sterile facilities, and trained personnel. Spinal anesthesia remains the preferred technique for cesarean section, while ketamine-based total intravenous anesthesia provides a safe alternative when monitoring is limited. Epidural analgesia may be unavailable, necessitating reliance on systemic or non-pharmacologic pain management strategies. Early risk triage, simplified protocols, and multidisciplinary teamwork are essential for safe care. Strategies such as simulation training, telemedicine supervision, and resilient infrastructure can mitigate risks, but ethical dilemmas---such as prioritizing high-risk patients and resource allocation---must be addressed within predefined frameworks. Overall, obstetric anesthesia in these settings requires adaptability, preparedness, and ethical awareness. Through context-specific protocols, task shifting, and interprofessional collaboration, anesthesiologists can sustain safety and improve maternal and neonatal outcomes despite severe constraints. Strengthening disaster readiness and resilience within maternity anesthesia services is increasingly vital in light of global instability.