Debating the laborist model of care
Boon to obstetric outcomes or bellwether of lifestyle choice?
In this first installment of Contemporary OB/GYN’s Point/Counterpoint department, two physicians discuss the advantages and disadvantages of the laborist (or “hospitalist”) model of care. What are the pros and cons for ob/gyns and their patients?
PRO by Karenmarie K. Meyer, MD, FCOG
It’s 2 pm, you had 2 deliveries after midnight last night, and you are still in scrubs. You’ve been in the office since 10 am. You are 45 minutes behind and have 15 patients left to see. A call comes from the hospital labor and delivery department informing you that a term VBAC patient just arrived in labor and you need to be present. You will have to cancel the rest of your office patients and deal with all that goes along with doing so. You have to call home to say that once again you won’t be coming home for dinner. It’s a scenario familiar to most ob/gyns.
Now consider this scenario, which you would experience as an ob/gyn practicing at one of the more than 185 hospitals that have ob/gyn hospitalists available. You can sign out of your hospital practice to a board-certified, experienced, emergency-ready obstetrician who can admit and manage your patient for you. You can finish your office appointments, go home for a family meal, take a needed nap, and then go to the hospital and take back management of your patient’s labor, more alert and more focused than you otherwise might have been.
Ob/gyn hospitalists (also known as “laborists”) are available 24/7 to support and assist private physicians, nursing staff, midlevel caregivers, and patients. We are immediately present and respond to obstetric and gynecologic emergencies. We can take on unassigned patients, monitor tracing strips, perform triage, and quickly facilitate the transfer of patients to higher-level units when needed.
MORE ARTICLES IN THIS ISSUE
In the nearly 40 years since the Yuzpe method was first described, options for emergency contraception—including over-the-counter availability—have expanded. Yet misunderstandings about these methods still exist.
This is an unusual case. Litigation doesn’t usually take decades, but this case went through multiple plaintiffs’ attorneys and sat quiet on the court’s docket until the court was clearing old cases and reexamined it.
Having unprotected sex is not the only impetus for use of emergency contraception (EC) among US women of reproductive age, according to data from a recent study by the Centers for Disease Control and Prevention (CDC). Nearly half the women represented in the National Survey of Family Growth (NSFG) said they turned to EC because of fear of contraceptive failure.
Women whose pregnancies are complicated by hyperemesis gravidarum in the second trimester are at a much higher risk of placental dysfunction disorders such as placental abruption and small-for-gestational age (SGA) babies, according to a study appearing in the January 30, 2013, issue of BJOG: An International Journal of Obstetrics and Gynaecology.
On October 24, 2012, the Advisory Committee on Immunization Practices (ACIP) of the CDC voted to recommend administering the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) to pregnant women with every pregnancy, regardless of the women’s previous Tdap history.