The Center for Peripartum Optimization

Inclusion Criteria: * Records of all female, obstetric patients of child-bearing age who were evaluated in the Center for Peripartum Optimization during the period between January 2017 and January 2018. * Controlled group will include parturients with match high risk comorbidities or history of nonobstetric surgery during pregnancy who delivered at Johns Hopkins Hospital (JHH) during July 1, 2016 - Dec 31, 2016 * Patients with any one or more of these high risk comorbidities: * Complex spine pathologies (Scoliosis, vertebral fusion, disc disease, spinal canal defects, neuropathies, and nerve disease, etc.) * Neurological pathology (Cerebral ischemia, tumor, increased intracranial pressure, cerebral vascular disease, etc.) * Cardiac disease (Congenital, valvular, pulmonary hypertension, cardiomyopathy, ischemic disease, arrhythmia, etc.) * Pulmonary disease (History of pulmonary embolism, interstitial lung disease, severe asthma, cancer, etc.) * Morbid Obesity (Obstructive Sleep Apnea, equipment considerations) * Hematologic Disorders (Thrombophilias, coagulopathies, patients on anticoagulation) * Cancer * Abnormal placentation (Previa, accreta / increta / percreta) * Anesthetic concerns (Airway abnormalities, history of adverse anesthetic reactions or experiences (i.e. recall, anaphylaxis)) * Fetal therapy patients requiring specialized management (Ex utero intrapartum treatment (EXIT), Fetoscopic endotracheal occlusion (FETO), Twin-to-twin transfusion syndrome (TTTS), Percutaneous Umbilical Blood Sampling (PUBS), etc.) * Chronic Pain Exclusion Criteria: * Records of CPO participating parturients outside the specified timeframe. * Records of obstetric patients of child-bearing age without high-risk comorbid conditions described in inclusion criteria. * Records of patients seen in CPO clinic that did not deliver at our institution