[wr_row width=”boxed” height=”auto” background=”none” solid_color_value=”#ffffff” row_bg_opacity=”100″ gradient_color=”0% #FFFFFF,100% #000000″ gradient_direction=”vertical” repeat=”full” img_repeat=”full” video_mp4 video_url_mp4 autoplay=”yes” position=”center center” paralax=”no” border_width_value_=”0″ border_style=”solid” child_of=”none” div_padding_top=”10″ div_padding_bottom=”10″ div_padding_right=”10″ div_padding_left=”10″ ][wr_column span=”span5″][wr_text #_EDITTED el_title=”What We Do” text_margin_top=”0″ text_margin_left=”” text_margin_bottom=”0″ text_margin_right=”” enable_dropcap=”no” appearing_animation=”0″ css_suffix=”” id_wrapper=”” disabled_el=”no” wrapper_padding_top=”0″ wrapper_padding_left=”0″ wrapper_padding_bottom=”0″ wrapper_padding_right=”0″ wrapper_bg_color=”” wrapper_bg_opacity_slider=”” wrapper_bg_opacity=”100″ wrapper_border_top=”0″ wrapper_border_left=”0″ wrapper_border_bottom=”0″ wrapper_border_right=”0″ wrapper_border_style=”solid” wrapper_border_color=”” wrapper_rounded_topleft=”0″ wrapper_rounded_topright=”0″ wrapper_rounded_bottomleft=”0″ wrapper_rounded_bottomright=”0″ responsive_hide=”no” ]

What We Do:

The Center for Peripartum Optimization in OB (CPO OB) is a specialized perioperative center focused on improving the wellbeing of expecting mothers. The goal of the center is to prepare for a safe and stress free delivery through coordinating care management between anesthesia, ob, nursing and the labor and delivery suite. Our specialized group of fellowship trained OB anesthesiologists provides personal consultation for a wide range of questions and concerns. Patients are referred to our center by their obstetricians or surgeons based on their past medical history. Our care team is committed to ensuring that you are medically prepared for your delivery so that you can focus on the happiness that your delivery day has to bring, and rest assured that your anesthetic needs have already been addressed. [/wr_text][/wr_column][wr_column span=”span7″][wr_image #_EDITTED el_title=”Obstetric Anesthesia Fellowship” image_file=”https://anesthesiology.hopkinsmedicine.org/wp-content/uploads/2016/07/EpiduralInOr.07152016-600x400px.jpg” image_file_button=”” image_size_wrapper=”” image_size=”full” image_alt=”” link_type=”no_link” image_container_style=”no-styling” image_alignment=”inherit” image_margin_top=”” image_margin_left=”” image_margin_bottom=”” image_margin_right=”” appearing_animation=”0″ css_suffix=”” id_wrapper=”” disabled_el=”no” wrapper_padding_top=”0″ wrapper_padding_left=”0″ wrapper_padding_bottom=”0″ wrapper_padding_right=”0″ wrapper_bg_color=”” wrapper_bg_opacity_slider=”” wrapper_bg_opacity=”100″ wrapper_border_top=”0″ wrapper_border_left=”0″ wrapper_border_bottom=”0″ wrapper_border_right=”0″ wrapper_border_style=”solid” wrapper_border_color=”” wrapper_rounded_topleft=”0″ wrapper_rounded_topright=”0″ wrapper_rounded_bottomleft=”0″ wrapper_rounded_bottomright=”0″ responsive_hide=”no” ][/wr_image][/wr_column][/wr_row][wr_row width=”boxed” height=”auto” background=”none” solid_color_value=”#ffffff” row_bg_opacity=”100″ gradient_color=”0% #FFFFFF,100% #000000″ gradient_direction=”vertical” repeat=”full” img_repeat=”full” video_mp4 video_url_mp4 autoplay=”yes” position=”center center” paralax=”no” border_width_value_=”0″ border_style=”solid” child_of=”none” div_padding_top=”10″ div_padding_bottom=”10″ div_padding_right=”10″ div_padding_left=”10″ ][wr_column span=”span5″][wr_buttonbar #_EDITTED el_title=”OB Menu” buttonbar_alignment=”center” buttonbar_margin_top=”10″ buttonbar_margin_left=”0″ buttonbar_margin_bottom=”10″ buttonbar_margin_right=”0″ distance_between=”0″ buttonbar_show_title=”yes__#__ ” buttonbar_show_icon=”yes__#__ ” buttonbar_group=” ” appearing_animation=”0″ css_suffix=”jhaccm-division-side-btn” id_wrapper=”” disabled_el=”no” wrapper_padding_top=”0″ wrapper_padding_left=”0″ wrapper_padding_bottom=”0″ wrapper_padding_right=”0″ wrapper_bg_color=”” wrapper_bg_opacity_slider=”” wrapper_bg_opacity=”100″ wrapper_border_top=”0″ wrapper_border_left=”0″ wrapper_border_bottom=”0″ wrapper_border_right=”0″ wrapper_border_style=”solid” wrapper_border_color=”” wrapper_rounded_topleft=”0″ wrapper_rounded_topright=”0″ wrapper_rounded_bottomleft=”0″ wrapper_rounded_bottomright=”0″ responsive_hide=”no” ][wr_item_buttonbar button_text=”Obstetric, Gynecologic and Fetal Anesthesia” link_type=”page” button_type_url=”https://” single_item=”819″ open_in=”current_browser” icon=”” button_size=”default” button_width=”” button_height=”” style=”default” button_color=”btn-primary” css_suffix=”” id_wrapper=”” disabled_el=”no” ][/wr_item_buttonbar][/wr_buttonbar][/wr_column][wr_column span=”span7″][wr_accordion #_EDITTED el_title=”” div_margin_top=”0″ div_margin_left=”0″ div_margin_bottom=”25″ div_margin_right=”0″ initial_open=”0″ multi_open=”no” filter=”no” appearing_animation=”0″ css_suffix=”” id_wrapper=”” wrapper_padding_top=”0″ wrapper_padding_left=”0″ wrapper_padding_bottom=”0″ wrapper_padding_right=”0″ wrapper_bg_color=”” wrapper_bg_opacity_slider=”” wrapper_bg_opacity=”100″ wrapper_border_top=”0″ wrapper_border_left=”0″ wrapper_border_bottom=”0″ wrapper_border_right=”0″ wrapper_border_style=”solid” wrapper_border_color=”” wrapper_rounded_topleft=”0″ wrapper_rounded_topright=”0″ wrapper_rounded_bottomleft=”0″ wrapper_rounded_bottomright=”0″ responsive_hide=”no” ][wr_item_accordion heading=”Hours & Location” icon=”” tag=”” disabled_el=”no” ]Hours of Operation are 8:00 AM – 5:00 PM
Clinic Days are held every two weeks on Mondays and one Thursday a month.
We see patients at two locations on the Johns Hopkins Hospital campus. Please confirm the office location at the time you schedule your appointment.
Nelson Building, Maternal Fetal Medicine Center
Nelson 2nd Floor
600 North Wolfe Street
Baltimore, MD 21287
The Johns Hopkins Outpatient Center
Center for Obstetrics and Gynecology
601 N. Caroline Street, 6th Floor
Baltimore, MD 21287

Download map of campus  [/wr_item_accordion][wr_item_accordion heading=”Patient Qualifications” icon=”” tag=”” disabled_el=”no” ]

  • Pregnant and scheduled for surgery
  • Complex pathologies of the spine (scoliosis, vertebral fusion, disc disease, spinal canal defects, neuropathies, and nerve disease, etc.)
  • Neurologic pathology (cerebral ischemia, tumor, increased intracranial pressure, cerebral vascular disease, etc.)
  • Cardiac disease (congenital, valvular, PHTN, cardiomyopathy, ischemic disease, arrhythmia, etc.)
  • Pulmonary disease (H/O PE, interstitial lung disease, severe asthma, cancer, etc.)
  • Morbid Obesity (OSA, equipment considerations)
  • Hematologic Disorders (thrombophilia, coagulopathies, patients on anticoagulation)
  • Cancer
  • Abnormal placental presentations (accrete/increta/percreta)
  • Airway concerns
  • Fetal Therapy patients requiring specialized management (EXIT procedures)
  • H/O adverse anesthetic reactions or experiences
  • Pain: chronic pain, pain disorders, PTSD, and generalized concerns

[/wr_item_accordion][wr_item_accordion heading=”Epidurals for Labor Fact Sheet” icon=”” tag=”” disabled_el=”no” ]Download Epidural Handout  
About the Epidural Procedure

  • Epidurals are a very common method of pain relief during labor. Approximately 60-70% of laboring women get epidurals annually.
  • Once it is determined by your physician/mid-wife that your labor is progressing, you have the option to request an epidural for pain relief.
  • Epidurals are usually placed during the first stage of labor when you are having regular contractions.
  • Epidurals are usually placed while you are in a sitting position, or you may be lying on your side.
  • Epidurals for labor are placed in your lower back, known as your lumbar spine.
  • Local anesthetic, or numbing medication, will be placed prior to insertion of the epidural to reduce the pain.
  • It is common to feel a little pressure in your back while the epidural is being placed.
  • An epidural catheter is then inserted. Its diameter is about the size of a piece of angel hair pasta.
  • Once the epidural is in place, you will receive medications through the catheter which should help alleviate your labor pain.

Will I still feel pain after the epidural?

  • An epidural may take anywhere from 5-15 minutes to start working after insertion.
  • With an epidural, you should expect significant pain relief, but not complete pain relief.
  • You should expect to feel some pressure as the baby moves through the birth canal, and this helps you know when to “push”.

What are the side effects of getting an Epidural?

  • Common side effects include mild itching, difficulty passing urine, no feeling in your lower tummy and legs, and inability to move your legs until the medication wears off (usually up to 8 hours).
  • Other side effects include nausea and mild back pain after delivery.
  • You may not be able to get an epidural if you have a bleeding or clotting disorder, current infection, very low blood pressure, are too close to delivery or are unable to cooperate

Frequently Asked Questions

What are the alternatives to an epidural for pain control during labor?
Alternative pain control options include intravenous pain medications and learned relaxation techniques. Although some women find these alternatives helpful, these options are less effective and do not relieve pain to the same degree as an epidural.
What are the risks of an epidural?
In general, epidural analgesia is very safe, but not risk free. Risks include hypotension or low blood pressure (10-20%), infection (<0.01%), bleeding (<1%), puncture in spinal cord (“wet tap” or Dural puncture) (1%), headache (<1%), allergic reaction (<1%), failed block, and intravascular injection (1%). You and your baby are closely monitored during and after epidural placement. If they occur, most adverse events are recognized immediately and safely treated. What are the benefits of an epidural?
The intense pain and stress of labor may decrease oxygen transfer and blood flow to your baby. Adequate pain control during labor can reverse these effects. The epidural can also be used if a vacuum (or forceps) delivery or C-section is eventually required.
If at first I decline an epidural, can I change my mind during the course of labor?
You may request an epidural at any time during your labor. However, it is important to remember that it may take up to 15 minutes to experience pain relief from an epidural. In late first stage of labor when women have more intense pain, a spinal or combined spinal-epidural (CSE) technique may be performed. With these techniques, the onset of pain relief is much faster (usually 5 minutes) because the medication is deposited directly into the cerebrospinal fluid (CSF). If you are unable to remain still because of intense labor pain, your physician may not be able to perform any of these techniques.
Who cannot get an epidural?
Patients with a skin infection where we need to place the needle, history of bleeding disorders, certain brain or spine disorders, or certain back surgeries. You also cannot get an epidural if you cannot cooperate with the procedure.
Can an epidural slow down the progression of my labor?
There has been no conclusive evidence to show that epidurals slow down the progression of labor or increase the frequency of cesarean delivery.
How does an epidural work if I need to have a C-section?
You can use the same epidural catheter if you need to have surgery for any reason. The catheter will be dosed with a stronger medicine that will take away the pain associated with surgery and allow you to be awake for the birth of your baby. You will still feel pressure, touch and pulling but no sharp pain associated with surgery.
Does it hurt?
The anesthesiologist will use a small needle to numb the area of your back where the epidural will be administered. This medicine may sting for 5-10 seconds. You will feel pushing and pressure when the epidural is being placed, but it should not be painful.
Can I become paralyzed from an epidural?
Labor epidurals are placed below the termination of the spinal cord, therefore, there is no risk of spinal cord puncture. Hence, paralysis from a labor epidural is exceptionally rare.[/wr_item_accordion][wr_item_accordion heading=”CPO OB Visit Types” icon=”” tag=”” disabled_el=”no” ]We offer four types of appointments at our center depending on your specific needs. These include: Preoperative Consultation for Non-obstetric surgery, High Risk OB Anesthesia Consultation, Follow-up Examinations and Anesthetic Preoperative Consultation.[/wr_item_accordion][wr_item_accordion heading=”How to Prepare and What to Bring” icon=”” tag=”” disabled_el=”no” ]Please bring the following with you for your Preoperative Visit or Anesthesia Consult:

  • Insurance Information and a Photo ID
  • List of your current medications along with dosage and frequency
  • Name and phone number of your obstetrician and any specialist you see
  • Copies of any outside imaging or testing (i.e EKG’s, xrays, CT’s, MRI’s, Echocardiograms, lab/blood tests, etc)

Please bring a list of any questions you have.[/wr_item_accordion][wr_item_accordion heading=”What to Expect” icon=”” tag=”” disabled_el=”no” ]We will make every effort to schedule your consultation to coincide with your OB visit. However, due to limited scheduling this is not always possible.
At the time of your arrival, you will be seen by one of our fellowship trained OB Anesthesiologists and fellows for an Anesthesia focused detailed medical history and physical exam. Based on your individual presentation we will determine whether additional studies or consultations with other specialists are needed in order to prepare a coordinated plan with the obstetricians and labor and delivery staff regarding your delivery.
We will make every effort to provide you with an anesthesia plan of care at that time. However, these plans may change in response to your evolving pregnancy and underlying health care concerns.[/wr_item_accordion][wr_item_accordion heading=”For Healthcare Professionals” icon=”” tag=”” disabled_el=”no” ]To schedule an appointment for your patient to see one of our OB Anesthesia providers please contact Rhonda Thomas at 410-502-3200.[/wr_item_accordion][wr_item_accordion heading=”Faculty” icon=”” tag=”” disabled_el=”no” ]Steven Beaudry, DO
Gillian Isaac, MD, PhD
Karen Lindeman, MD
Courtney Masear, MD
Jamie Murphy, MD[/wr_item_accordion][wr_item_accordion heading=”Contact” icon=”” tag=”” disabled_el=”no” ]For an appointment, please call Rhonda Thomas at 410-502-3200[/wr_item_accordion][/wr_accordion][/wr_column][/wr_row]