laborists, hospital-based obstetricians, labor and delivery

More Women, Doctors Meeting for First Time in Delivery Room

February 24, 2009 04:15 PM
by Emily Coakley
The trend toward hospitals employing obstetricians to exclusively deliver babies may make life easier for doctors, but some wonder how it will affect patients.

Laborists Part of Nationwide Trend

More hospitals around the United States are hiring laborists, or obstetricians who exclusively deliver babies, even if a mother has seen a private-practice doctor for prenatal care.

Though exact statistics are not available, a South Carolina company “said it has placed 60 doctors as laborists across the country and is looking for jobs for another 340 physicians interested in being laborists,” reported the Boston Globe.

“This is a safer way to practice obstetrics,” said Louis Weinstein in an interview with Philadelphia Magazine. Weinstein, chairman of obstetrics and gynecology at Thomas Jefferson Hospital, is a big proponent of laborists and helps hospitals around the country implement the system.

But not everyone believes the trend is a good idea.

“I think it’s going to take away from the relationship between a doctor and patient at the most sacred time of life,” said Victor Zachian, an obstetrician who has delivered babies in the Philadelphia area for more than 25 years. He told Philadelphia Magazine, “When I started out, if you had told me health care would be like it is today, I would have said no way, that patients and doctors wouldn’t stand for it.”

Hospitals started hiring laborists in 2000, according to U.S. News and World Report. Laborists are touted as a benefit to obstetricians in private practice. With a laborist waiting to deliver a baby, a private practitioner doesn’t have to be on call nights and weekends. They also don’t have to work through the night to deliver a baby and then see patients in the office the next day, or spend a weekend driving to different hospitals to see patients. The laborist also works a set schedule, and doesn’t have to be on call, either.

Private-practice doctors can also save money on medical malpractice premiums if they stop delivering babies. Obstetricians who work for the hospital are covered by the institution’s medical malpractice insurance policy and don’t have to pay their own premiums.

Laborist advocates also say that expectant mothers haven’t complained about having a new doctor in the delivery room. Many women get their prenatal care from large Ob/Gyn practices, and understand that their primary doctor may not be on call when they go into labor.

Background: Obstetrics becoming a difficult specialty

For years obstetricians and gynecologists have complained that rising medical malpractice premiums have forced them to stop delivering babies, move to places where the premiums are lower or go out of business entirely. Obstetricians are among the most-sued doctors in the medical profession, and that fact has helped reduce the number of doctors choosing that specialty.

“Many of the graduating medical students aren't going into obstetrics and gynecology because of medical malpractice premiums,” said Michael Moretti, Richmond University Medical Center’s chairman of obstetrics and gynecology, in an interview with the Staten Island Advance.

In a December 2007 article, the newspaper cited the American College of Obstetricians and Gynecologists (ACOG) in saying that their doctors have an average of approximately three lawsuits filed against them in their careers.

Opinion: Women need more choices for giving birth

Maria, a certified doula in Massachusetts, said the Boston Globe article illustrates that the state needs “more birth choices.” Midwives, she argues, could attend to more routine births “and the OB’s could care for the much smaller percentage of births that actually need obstetrical intervention.”

“This really is a call for a reform of the insurance and medical malpractice industry and how it has burdened health care and effectively damaged our understanding of birth,” Maria writes.

Philadelphia Magazine quoted some unnamed mothers who were unhappy with Pennsylvania Hospital’s move toward laborists, in an August article. “For such a personal experience, if my doctor wasn’t on call, I thought I would have someone from the practice,” one mother told the magazine.

Commenting on the U.S. News and World Report article, the blog Independent Childbirth said the article seems to blame parents in generations X and Y for the factors leading to the “dehumanization of birth.” The blog asserts that parents are instead searching for care providers. While the United States doesn’t have the best record for mother and child outcomes during birth, “we do not believe that Americans or parents around the world prefer medical birth to normal, human birth.”

Independent Childbirth went on to say that the U.S. News and World Report piece also ignores midwives, which are alive and well around the country.

Related Topics: AMA criticizes home births; study says wait on C-section

Last year the American Medical Association announced that it would support legislation to prohibit home births, which ACOG suggested.

“Choosing to deliver a baby at home … is to place the process of giving birth over the goal of having a healthy baby,” ACOG said. Approximately 1 percent of births in the United States occur at home.

But the American College of Nurse-Midwives released a statement that cited a study suggesting home births are just as safe as those in the hospital.

As the number of C-sections around the world increase, a study published recently said that women who schedule the surgery as an elective should wait until their baby is at least 39 weeks.

Looking at 24,000 full-term babies, researchers found that those born at 37 weeks to mothers who had elective repeat C-sections were two times as likely as babies born at 39 weeks to have complications, including breathing problems and bloodstream infections, reported The Washington Post.

Reference: Pregnancy Web Guide


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