Obstetric hospitalists manage care during labor, delivery

Recent years have brought the advent of the “hospitalist,” a physician whose practice revolves solely around caring for patients while they are in the hospital.

In the evermore complex field of healthcare, a specialized hospitalist has emerged: an obstetrical hospitalist who focuses on the inpatient care of women.

Sometimes referred to as a laborist, much of an obstetrical hospitalist’s day is spent in managing the care of pregnant women during labor and delivery.

Dr. Kendreia Dickens, obstetrical hospitalist at Dixie Regional Medical Center, notes that the use of laborists has grown steadily over the past five years. “Being an OB/GYN can be very busy and demanding on a person’s life.” In part because of this, fewer physicians are choosing to specialize in obstetrics. In addition, “so many more of them are women. In the past, when most OBs were men, there was someone at home to run the family. That is not the case for women. It would be very difficult to be an OB/GYN and work 24/7 and still be a good mom.”

The use of obstetrical hospitalists represents a shift in the care for pregnant women. In the past, a woman’s own obstetrician would be called into the hospital when it was time for a baby to be delivered. With laborist availability, a woman’s OB cares for her before and after delivery, but a laborist attends during labor and delivery.

According to Dr. Dickens, there are several advantages to this model, the most important being the health and safety of mom and baby. “Labor is an acute situation. Even if a doctor’s office is just across the parking lot, they can miss a delivery. It has been shown that when there’s a doctor on the labor and delivery floor 24/7, the outcomes are better, especially in emergency situations. And nurses feel safer when there’s always a doctor there.” Even if an OB chooses to come make a delivery, “an obstetrical hospitalist can get things moving until the mother’s own physician can get to the hospital.”

Some doctors prefer to deliver their own patients. For those, “We are extenders when the doctors are not readily available,” said Dr. Dickens.

Other physicians find it increasingly difficult to take time away from seeing patients to come to the hospital and wait for a delivery, especially with the way reimbursements now work with insurance companies. In that case, “We provide specialized care to get women over that hump of delivery.”

In Dr. Dickens’ experience, “When it comes time to actually give birth, most women would much rather deliver with the doctor that is available than wait for their OB to arrive.”

Physician laborists also provide a valuable service for women who may be passing through town and go into labor unexpectedly, as well as for women who have no physician of their own.

The obstetric hospitalist program at Dixie Regional is still in its infancy, but Dr. Dickens expects it to expand over the next few months with a full staff of doctors sometime early next year. “Intermountain is always seeking to get better,” she said. “We put the patient first. As a physician, it is exciting to work here, and to have input as we build this program.”