"We know that women in general would prefer to have their own physician
that they've been seeing through their pregnancy to care for them.
We're lucky, because 93 percent of our patients have early prenatal
care – and excellent prenatal care," says
Dr. Allyson Brooks, executive medical director of the Women's Health
Institute at Hoag Memorial Hospital Presbyterian in Newport Beach, California, which has an OB hospitalist program. "But
many patients don't have prenatal care, and programs that have laborists
in place – those patients don't have a preference – they
just want a safe healthy delivery."
Hospitals turn to OB-GYN hospitalist programs to provide round-the-clock
inpatient care. "For the women who deliver at Hoag, we hope to provide
a meaningful layer of additional patient care and support in labor that
extends beyond back-up for potential emergencies," says
Dr. Tomekia Lynn Strickland, an OB-GYN hospitalist at Hoag. "In many ways, we are a hospital-based extension of the excellent
care provided during their pregnancy by their primary OB/GYN."
Most women who undergo regular prenatal care, still see their primary OB-GYN
or someone else from that group on-call, when they give birth. But as
with primary care doctors conceding time spent on inpatient care to general
hospitalists, increasingly some OB-GYNs are deferring to OB-GYN hospitalists
to reduce the time they need to spend in the hospital.
"I think that's one of the major problems is how do patients perceive
the idea of just being delivered by someone they don't know?"
says Dr. Edward Yeomans, chairman of the department of obstetrics and
gynecology at Texas Tech University Health Sciences Center in Lubbock,
Texas, and a maternal-fetal medicine physician.
"Obstetrics and gynecology was never designed to be a lifestyle specialty,"
Yeomans contends. He says working "longer hours, and harder and off
hours" to be there for the birth of a child, comes with the territory.
"The idea of controlling your hours is one of the driving forces
behind this hospitalist movement: You work a shift; and it's not compatible
with my concept of why I went into OB-GYN." But, Yeomans says he
understands why some doctors would be drawn to that.
Experts say whatever the arrangement may be, it's important to discuss
well in advance who is going to be available for the birth of a child.Yeomans
tells his patients, "'If I am in town, I will come in for your
delivery.' So that gives them some degree of confidence. I have speaking
engagements, I'm away from the campus from time to time, I don't
take much vacation, but really I'm available to them," he says.
"Whereas others who practice in a group practice would say myself
or one of the group members will deliver you. So the woman has to be comfortable
with that."
In a 2016 committee opinion, the American College of Obstetricians and
Gynecologists said it "supports the continued development and study
of the obstetric and gynecologic (ob-gyn) hospitalist model as one potential
approach to improve patient safety and professional satisfaction."
Though with various models of care and terms used for OB-GYN hospitalists,
it can be difficult to track. ACOG noted that as of 2014, it's estimated
about 1,700 OB-GYN hospitalists were working at approximately 10 percent
of the hospitals in the U.S. that offer obstetric care, with one study
finding about a quarter of community hospitals in California using OB-GYN
hospitalists.
In regards to the potential impact on patient care, the opinion noted,
"In one study, a dedicated ob-gyn hospitalist service was associated
with a 27 percent reduction in the cesarean delivery rate as compared
with the traditional model of care." A separate study found a link
between care managed by OB-GYN hospitalists in conjunction with certified
nurse-midwives and a significant reduction in the C-section rate in comparison
with a traditional OB-GYN care model. But the way the studies were designed,
it wasn't possible to determine if the hospitalist approach was the
cause for the decrease in C-sections. And individual OB-GYN hospitalist
C-section rates can vary significantly, as is the case for other OB-GYNs.
In general, ACOG notes, more study is needed to determine what impact
care by OB-GYN hospitalists might have on patient outcomes.
Critics say what's potentially lost in the handoff from a primary OB-GYN
to a hospitalist is personalization of care and a deeper understanding
of what that patient might need. But though it takes effort to share patient
notes and special care needs, those overseeing hospitalist programs say
this is a top priority – and that having doctors dedicated to in-patient
care extends what could be done by a primary OB-GYN, rather than detracting
from care. OB-GYN hospitalists can, for example, provide immediate emergency
services, so there's no need to wait for an on-call physician to arrive.
"I think many patients want to choose hospitals that have a laborist
program, because they feel that it has well thought out comprehensive
care and they see that as a very positive thing," says Dr. Manuel
Alvarez, chairman of the department of OB-GYN and reproductive science
at Hackensack University Medical Center in Hackensack, New Jersey, which
has an OB-GYN hospitalist program.
Still as the model of care evolves, patient-doctor communication is critical
to set expectations, experts say, to discuss well in advance what to expect
– and who's going to be there – for the birth of the child.
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