A new trend is emerging in certain hospitals that provide maternity care, and it appears that it will spread: the replacement of the OB you chose as your care provider during pregnancy with an OB who is on the hospital staff, and is called a “laborist” (as a specialty) who oversees your labor and birth.
The desire to ensure the presence of the OB of their choice has led some women to have an induction or a C-section, putting their health and the health of their babies at risk. (Inductions and C-sections are both riskier than normal birth, with medical complications as well as death rates being higher than in births that are not interfered with.) Other women are more accepting of “fate” and submit to the fact that their chosen doctor may not be in attendance, little realizing how much their care may differ from doctor to doctor.
Now here we are in the first decade of the 21st century, and the care women receive during labor and birth is becoming even less mother-friendly, less personal than before. With the advent of “laborists,” there is actually a guarantee that women will not meet the doctor who will be making decisions in their healthcare prior to going into labor. Does it bother you that someone you have never met, don’t know, have never had a conversation with will be deciding what medications or procedures you will have and when? If you are educated about childbirth, you may be knowledgeable about certain drugs or procedures that are commonly used in labor but you wish to avoid. Your OB may agree with you on not doing these things, but what is the opinion of this unknown, nameless, faceless laborist who may think that these procedures are preferable?
Do you know how much weight the opinion of the doctor has on the care you receive? Some doctors have very high intervention rates, others have very low rates–even with identical clientele. Why do some doctors think women “need” Cesareans or inductions or labor augmentations when other doctors don’t? If your doctor thinks you “need” a Cesarean (even if another doctor would not make the same call), what do you think the odds are that you will be pressured into accepting this surgery? While you may be able to discuss this with your OB, what if the doctor on call has a different opinion?
To end on a positive note, I can see one area in which having doctors on schedule like this may possibly improve women’s care (although having continuity of care is known to improve the labor experience and birth outcomes). Under the current system, doctors must come in to oversee their clients’ births, which means they often want to speed things up (by augmenting labor, calling for a Cesarean, using forceps or a vacuum to speed up birth, etc.), so that they can get back to their lives–seeing patients during office hours, eating supper with their families, going on vacation, sleeping more than a few hours each night, having a weekend without going to the hospital, etc. Doctors are human too, and want to have time for themselves and their families, and while this should not happen, this can lead them to suggest interventions or even urge a woman to accept a Cesarean when they are not truly necessary, but will be preferable for the doctor or his schedule. I sympathize with the demands on a busy obstetrician’s time, but that is not an excuse for using an otherwise unnecessary and potentially harmful intervention. Under a “laborist” system, the doctor will be at the hospital for a certain period of time, regardless of how long any particular woman is in labor. He will get to go home to his family at the same time, whether Mrs. Smith has had the baby or not, so there will be no internal pressure to suggest something to speed up a normal labor, just so he can go home early.