Bad News for Birthing

An article by Katherine Hobson in a recent issue of U.S. News & World Reports discusses an emerging but not yet common trend in obstetrics - the use of "OB hospitalists" or "laborists" to deliver babies in hospitals. These are OBs employed by hospitals who only attend labors and deliveries in hospitals, meaning that a woman's personal OB/midwife would oversee her prenatal care and this new professional, who she would not meet until she was checked in at the hospital, would attend her birth. The reasons for this trend's emergence stem from strategies being explored to alleviate the exhaustion and overwork that plague the lives of most OBs and that could potentially dull their reflexes in an emergency - good things to be trying to fix. I don't think this is a good way, though. The article quotes a large hospital system's regional administrator of women's heath services expressing that most women don't mind the model because most women see OBs in practices where any OB in the practice, and not the woman's own, might attend her birth anyway. This is sadly true, although in most such practices, a woman at least gets to meet the other OBs if she wants to do so. It is true, but it isn't good.

In more progressive practices, a midwife or OB will give their home number to a woman who expresses preferences about the sort of birth she wants to have so that the attendant can attend the birth whether she or he is on call or not. Also, if they are not going to be available, they will discuss the case with their back-up to see to it that the family's wishes can be respected in their absence. It does not sound like much of this would happen with the new system.

Most U.S. births today occur in ways that stress convenience and lack of legal liability for physicians and hospitals. They do not, unfortunately, stress safety for mothers and babies. Study after study has shown that midwife attended births, which usually are more personalized and occur in the context of a relationship between family and birth attendant and which emphasize natural methods of pain relief and labor progression, rather than over-reliance on less safe chemical and surgical methods, are actually safer births, with better outcomes for mothers and babies alike. Innovations that move mothers more into the hands of hospitals, which specialize in drugs and surgery, are not true progress. We are all glad that hospitals are there with their medicines and surgeries for emergencies, but natural methods, employed by attendants who know a laboring woman and her needs, should be the norm. This trend would just move the norm even further from that ideal.