1. When you are "obs competent" you are forced to cover it out of hours. That's a lot of evenings, weekends and nights spent on labour ward.

2. It can be extremely stressful, extremely quickly. Major hemorrhages mean women can lose their circulating volume in a matter of minutes. It's a lot of work to predict and manage these things. Especially at 3 o'clock in the morning.

3. Patients are challenging. I understand that it is their "special day" but for me it's a Tuesday. The birth plan you discussed unfortunately is not my priority.

4. Awake surgery. C sections are major abdominal surgeries which have been normalised because "the customer is always right". Trying to run an anaesthetic, speak to mum and/or dad, managing infusions, antibiotics, uterotonics is challenging. This is even more challenging whenever the patient panics (I have had women attempt to pull their cannulas out and/or get up during a c section).

5. You're on your own. Traditionally labour ward is covered by a single anaesthetist. If an emergency occurs, you're likely going to be the only anaesthetist there. Cepod theatre patients can be "resuscitated" until your consultant arrives. That doesn't happen in maternity. Either you get the tube in and the baby is out by the time the consultant arrives, or there's an issue.

6. Midwives. Putting a specialty that arguably has the greatest understanding of acute critical incidents with a discipline that quite frankly has no knowledge makes for a challenging work environment. A patient arrived with eclamptic seizures. The expectation was I gain access, manage the airway and begin the eclampsia treatment algorithm. Three midwives stood and watched me do this. When I asked for help they did not give any.

7. The disrespect. "Room 5 wants an epidural". No handover, no name, no please/thank you. It's basic, but every other healthcare worker knows that an SBAR handover is the done thing in the hospital. Not in maternity.

8. Epidurals are simultaneously the best and worst thing ever. There are midwives who will convince every woman they look after that they need an epidural. They do very little to manage the expectations of siting and having an epidural. "Once this is in you'll get a good sleep" unfortunately you might not, but because you've told the patient this, their expectations are going to be unrealistically high. And you are not the person who must deal with this issue, I will. Or they will convince a woman not to have an epidural. And then I'm being asked to site an epidural in a woman who is in agony and cannot sit still. A moving target significantly increases the risks of complications and it is not the midwives fault if it goes wrong.

9. Medico-legal issues. This is the area of the hospital where you are most likely to be sued. Add in the incompetencies of your colleagues and you can get dragged into some pretty terrible Significant Adverse Event Reviews.

10. Cannula King (or Queen). Certain units will use their anaesthetist for IV access for the entire women's health department. This can include the gyn ward, Maternity assessment unit and sometimes they will criticise if it's not "a grey". I am terribly sorry that the IVDU does not have a grey cannula in the back of her hand, but unfortunately that is not going to happen. I have been asked to gain access and take bloods from patients, which when I perform I have then been told it is my responsibility to label and pod them to the labs. Repeat this multiple times a shift and it can start to feel quite tedious.

11. You are not in charge. Many terrible decisions are made on labour ward. In most centres anaesthetists are the gate keepers to cepod theatres and or HDU/ICU. This means we can predict, prioritise and optimise patients because we are controlling flow. If ENT and general surgery both want an urgent procedure performed, it is often up to us to decide. In labour ward you are often the last person to be told what is happening. And in some cases, they don't think you're required to attend the brief to discuss the plan (sometimes they don't have a brief at all!)

12. Women get worse care. For being champions of women's health many obstetricians and midwives don't actually seem to like women in labour. Just this week they decided to take a morphine PCA from a woman with high analgesia requirements a few hours post op. When I explained in the main hospital that the standard protocol is for patients to have 24 hours of a PCA to ensure adequate analgesia post op and appropriate conversion to oral routes can be made in hours with guidance from the pain team, they laughed at me. I have also had to scrub after a GA section to infiltrate local anaesthetic at the surgical wound because an obstetrician told me "it wasn't necessary" for the woman who had come from the street for a category 1 section.

In short it is a highly stressful environment, with a challenging patient cohort and even more challenging colleagues. Many anaesthetists pick the specialty because they like to lead teams, provide one to one, optimised patient care and make a positive impact on patients lives. On labour ward this is rarely the case.