Division of Labor
There's a new doc in town. But mom probably won't meet this obstetrician until her labor pains start
Jolene Taylor was 21 weeks pregnant with her first child when she found herself in a pickle. Her obstetrician, whom she'd been seeing for routine care for more than four years, decided to stop delivering babies. Meantime, the high-risk-pregnancy specialist she'd also been seeing as a precaution for a potential virus exposure--she's a registered nurse--didn't practice at her nearby hospital, Legacy Salmon Creek, in Vancouver, Wash. So after talking with her specialist, Taylor, 27, opted to have her baby delivered by a new breed of obstetrician called a "laborist" or, as her hospital calls it, an "OB hospitalist." Both job titles mean the same thing: an obstetrician who works exclusively in the hospital, keeping watch over women in labor and performing deliveries.
Separating the prenatal care process and the actual birth is a smart solution for doctors who are frustrated by high malpractice premiums and burned out by the demanding lifestyle. Like other hospital-based doctors--emergency room physicians come to mind--OB hospitalists work in shifts, covering the maternity ward as well as dealing with emergency obstetric cases. Since they are employed by the hospital, their malpractice premiums are covered, and there are no back-office expenses like those of an outside practice. Laborists can also be a plus for the new mother, since the limited hours keep them fresher and less prone to errors, and their job description focuses on attending to her during labor. Sounds great, but birth is not just a medical procedure. Having a baby is also one of the most precious moments of a woman's life. It might be tough for some women to entrust their special day to someone they've just met.
A handful of hospitals have had laborists on staff for about five years. But the idea really began to percolate in 2003, when Louis Weinstein, now chairman of obstetrics and gynecology at Philadelphia's Thomas Jefferson University, proposed the idea in an editorial in the American Journal of Obstetrics and Gynecology . Weinstein thought laborists could help solve one of the profession's most vexing problems: grueling daily schedules. A doctor may end up driving across town several times a day to see patients at different hospitals and often gets up in the middle of the night to deliver a child. The resulting fatigue can have many consequences. "When things go wrong in labor and delivery, they go wrong exceedingly quickly," says Weinstein. "If you aren't responsive in minutes, the baby may be damaged or die and mom may die. And if I'm in the office seeing patients and a nurse calls me, by the time I get there it may take me 20 minutes." Because of the hours and stress, burnout among obstetricians is common. Working 70 or 80 hours a week, Weinstein says, "doesn't make sense for my health or for patients' health." And improved safety, he says, will lead to lower malpractice insurance costs.
Having a life. Laborists devote their full time and attention to mothers in labor, without worrying about an office full of patients. It also may be a better deal for private obstetricians, who can opt to hand over labor supervision and the delivery--although many OBs still prefer to deliver their patients' babies. Both kinds of OBs can have a life, a key factor for doctors now entering the profession. "Young people are smarter than we were," says Duncan Neilson, an obstetrician and chief of women's services at Legacy Health System, which owns Legacy Salmon Creek. "The idea that a person's work would be totally dominated by professional commitments and would show complete disregard for family isn't holding anymore."
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