Cross-institutional perspectives on accommodating the request for “attending-only” neuraxial procedures in the United States: a pro/con discussion

In labor and delivery care areas across the United States, attending anesthesiologists often supervise medical trainees (anesthesia residents) or nurse anesthetists as they perform neuraxial procedures. Contrary to this standard approach, patients will occasionally request that the attending anesthesiologist exclusively perform their procedures, as an “attending-only” procedure. In this pro/con discussion, several obstetric anesthesiologists discuss considerations and provide opinions regarding why one might honor or refuse these patient requests, exploring perspectives of education, equity, medical ethics, and medical complexity. The ultimate decision should be tailored to the patient's specific needs and priorities through shared decision-making and will also be dependent on the practitioner's judgment and values.