This chapter describes the level of service required from anaesthesia departments providing services for obstetric units. In addition to clinical duties, consultant anaesthetists are involved in teaching, training, administration, research and audit. The Obstetric Anaesthetists' Association (OAA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) jointly published Guidelines for Obstetric Anaesthesia Services. These guidelines aim at developing national standards for maternity care. A clear line of communication from the duty anaesthetist to the on-call consultant should be assured at all times. All obstetric departments should provide and regularly update clinical protocols, which should be readily accessible. Obstetric units with an anaesthesia service should have a nominated consultant responsible for training in obstetric anaesthesia and there should be induction programmes for all new members of staff, including locums. There should be an audit programme in place to audit anaesthetic complication rates, such as accidental dural puncture.

The formation of a service to appropriately deal with vulval problems inevitably requires time, enthusiasm and resources. Vulval disease may be the subject of shame and embarrassment, with some women delaying seeking advice for months or years because of fears about the source of the condition or the examinations and investigations that may be necessary. Clinics should have clear clinical and operational guidelines. Usually, the lead clinician would be responsible for these guidelines. All women with suspected vulval problems should have prompt access to a clinic specialising in the management of such disorders. This would usually be hospital-based but delivering care in a community setting may be more appropriate, depending on local needs. To facilitate audit, a clinic pro forma which captures the required dataset should be designed. Clinics should be adequately staffed by appropriately trained individuals including a specialist gynaecology nurse.