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"Please be sure you can care for our patients."

When Dr. Michael Foley edited the first edition of his Obstetric Intensive Care Manual, I was still actively involved in patient care. I used that first edition and the editions that followed as an essential resource in the care of my patients. I rarely left my office without it in the pocket of my white coat, and I was sure there was another copy on Labor and Delivery. Since then, Dr. Foley's manual has become an invaluable resource for so many of us as it has been updated and the coverage of important topics expanded. This fourth edition builds on this excellent foundation. Readers will find information on the advances of noninvasive hemodynamic assessment, a new chapter on the management of sickle cell crisis, tables, and algorithms that are easier to use, and significant expansion of the chapter on neurologic emergencies including Guillain-Barré syndrome, autonomic dysreflexia, and spinal cord injury. We no longer need to carry the book in our pockets, because the content is available in a variety of electronic versions including for our smartphones or tablets.

For nearly five years, I have been the Chief Executive Officer of The Ohio State University Wexner Medical Center. In this role, I have become increasingly aware of the importance of critical care for our obstetric patients as well as for so many others who experience often unforeseen medical emergencies. As I travel around our region meeting with the leaders of rural hospitals in our hospital network, they often emphasize to me, "Please be sure you can care for our patients when they need critical care." Many of these hospitals have had to cut back on the services they offer and now rely on our institution when patients need the intensive care that can only be offered in large medical centers. This need was so evident during the H1N1 influenza epidemic, which impacted pregnant women so dramatically. Our intensive care beds were full. We had to acquire additional equipment for hemodynamic and ventilatory support and our staffing needs increased. But we did everything we could do to meet the needs of our community and region and that effort was much appreciated.

As many of you know, for more than a decade, I have been interested in burnout in those who provide medical care. Burnout is especially common among those who provide obstetric care and critical care. The three key factors in burnout are demand, control, and support. Clearly, the demand for those in obstetrics and critical care is significant and, as we all recognize, we may have little control over when our patients go into labor or when they have an emergency that requires intensive care. For that reason, support is so important. As I emphasized in my foreword for the third edition, patients needing intensive care must be managed by a multidisciplinary team of skilled individuals. Support for each member of that team is essential if they are to deal with the stresses of their important work. In recognition of this need, we established the STAR program at our medical center several years ago. STAR stands for Stress Trauma and Resilience. We have a skilled team of mental health specialists and counselors who are available to provide preventive services and, when necessary, interventions to support not only our physicians, nurses, and other team members in our critical care units, but the patient's families as well. We have found these services effective in reducing compassion fatigue and burnout. Of course, control can also be improved by the knowledge that one has the necessary information to provide complex patient care and the support of not only your colleagues but a reliable resource for this information. For that reason, I again thank Dr. Michael Foley and his collaborators for providing us with this updated fourth edition of the Obstetric Intensive Care Manual. I know that it will be of great benefit to those of you on the front lines of patient care, and most importantly, to our patients.

Steven G. Gabbe, MD
Senior Vice President for Health Sciences
The Ohio State University
Chief Executive Officer
Wexner Medical Center
Columbus, Ohio

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