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What is an Obstetric Hospitalist?

By Jennifer Lincoln, MD, IBCLC, Board Certified OB/GYN

When you are pregnant and deciding where you want to deliver your baby, most expectant parents think about many of the same things: How close is the hospital to my house? Does the doctor or midwife I like deliver there? Have my friends had babies there and had good experiences?

However, one factor you might not even think to consider is one that could possibly make a big difference in your birth experience: whether or not an obstetric hospitalist is present on Labor and Delivery.

An obstetric hospitalist is an OB/GYN physician who works only in the hospital on Labor and Delivery. This means that there is always a physician present who can care for pregnant women — 24 hours, 7 days a week.

This differs from the traditional model that many OB/GYNs still practice today, in which they multitask and may be seeing patients in their offices at the same time they have a patient in labor in the hospital. In these scenarios, the labor nurse does much of the labor management and calls the doctor when the mom is ready to deliver or if an emergency arises, such as concerns for the baby’s heart rate or the need for an emergency Cesarean section.

What this means is that in the most extreme emergencies, care may be delayed some until the doctor can make it to the hospital. When an obstetric hospitalist is present, however, emergencies such as these can be dealt with as soon as they arise, since these doctors are physically present on Labor and Delivery at all times. In some cases, this may make the difference between life and death, or a good outcome and a less than ideal one.

Having an obstetric hospitalist present can also mean more than just managing emergencies. For safety reasons, if a woman wants to undertake a trial of labor after cesarean (also known as a TOLAC), a physician must be present in the hospital for her entire labor for the safety of the mom and baby. Because of this, many OB/GYNs who are unable to provide this level of care (because they also must be in clinic, for example) will not offer TOLACs to their patients and only allow them to deliver by repeat C-section. This can lead to many unnecessary surgical births, and in some parts of the country it means many women don’t have the choice to try for a TOLAC. Having an obstetric hospitalist takes this barrier away, and gives women more choice in how they want to give birth.

Additionally, since obstetric hospitalists work only on Labor and Delivery, this means they become quite experienced at dealing with many urgent situations such as eclampsia, postpartum hemorrhage, and shoulder dystocia – scenarios that don’t happen every day and that the traditional OB/GYN may only manage occasionally. As compared to the OB/GYN who only works on Labor and Delivery a few times a month, the obstetric hospitalist does this daily and because of it becomes proficient at managing these high-risk issues.

Overall, having an obstetric hospitalist present can lead to lower C-section rates and better outcomes for moms and babies. Because of this, it may be worthwhile to ask at your next prenatal visit whether or not your Labor and Delivery employs one of these doctors so you can know someone is always present to care for you when you are in labor.

Sources:

  • B McCue et al
  • Definitions of Obstetric and Gynecologic Hospitalists
  • Obstetrics and Gynecology, February 2016
  • Vol 127, Issue 2.

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