If you suspect you're having a heart attack, you'll be seen by
a doctor. If you suspect you're having a stroke, you'll be seen
by a doctor. But if you suspect you're about to have a baby, you will
most likely be seen by … a nurse.
As an obstetrician, I have long been surprised by our medical culture's
habit of having nurses and nurse practitioners evaluate pregnant women
who come to the hospital for assessment. Nurses are well-trained and highly
skilled, but if you are pregnant and you're having a problem that
brings you to a hospital, wouldn't you like to be seen by a doctor?
That's why I'm so enthusiastic about the new Obstetrics Emergency
Department opening at Hoag Hospital Newport Beach. The new OB-ED will
staff three full-time and two part-time laborists (OB-GYNs who work full-time
in a hospital, delivering babies only) and two nurses to follow the four-room
emergency department dedicated solely to mothers-to-be.
The OB-ED laborists and nurses at Hoag will ensure that every woman over
16 weeks of pregnancy will be seen by a dedicated laborist for any obstetric
emergency – whether her obstetrician is thousands of miles away
on vacation or nearby.
If a patient prefers to be seen by her private doctor, the doctor is called
and can evaluate the patient at the Hoag OB-ED within the hour, ensuring
both continuity of care and quick treatment if any is needed.
The biggest impact that we can have is for the patients under 37 weeks
of pregnancy, when babies and mothers are most at risk. In pregnancy,
there are a lot of variables to consider when trying to determine what
is happening. Is a patient experiencing the normal lingering pain of uterine
growth? That's fine, we'll send her home with peace of mind. Does
lab work need to be done? We can tend to her needs effectively and immediately.
I have always believed that it is important that a doctor personally see
and interact with a patient during an assessment, rather than relying
on a nurse to relay a patient's complaints to the doctor over the
phone – the current standard of care across the country.
The OB-ED can even come in handy after a woman's doctor delivers her baby.
For example, in Florida an OB-GYN left the hospital after the successful
delivery of a healthy baby. After he left, his patient started hemorrhaging,
and the doctor's partner was delayed in getting to the hospital. There
was a potential 45-minute gap where this woman could have died had a laborist
not been there to step in.
When you think about it, pregnancy is potentially the most vulnerable time
in a person's life – with so many emergencies that arise and
so many things that could go wrong.
It's a wonder that emergency departments dedicated solely to expectant
mothers aren't the norm, but, hopefully, we'll be seeing the birth
of a new standard in obstetrical care.
– Michael White is an obstetrics and gynecological hospitalist at
Hoag Memorial Hospital in Newport Beach.