The recent article “” offers fascinating insight into the commendable goal of reducing cesarean sections. Born from concern for both mother and baby and increased costs with surgery, it’s easy to understand why national and local maternity care organizations are so focused on reducing c-sections for first-time moms.
Supported in the literature and recognized by caregivers, hospitals are seeking creative ways to safely minimize the element of time when managing patients in labor. Birthing coaches or doulas have long been appreciated for their ability to reassure anxious patients unfamiliar with the complexities of contemporary labor and delivery units. They also can be invaluable as consumer advocates when sometimes dated protocols and timetables are summoned to justify surgery for a prolonged labor course.
One promising trend observed at both small and large hospitals entails the use of “laborists.” Similar to hospitalists who are present in the hospital around the clock, these physicians don’t come and go. Rather, they remain in labor and delivery for a given shift, caring for any laboring patients in the hospital during that time. Although this can be a disadvantage to those patients expecting their doctor to be present for delivery, the advantages are quite compelling. Freed from the demands of patients in the office or outside commitments on a weekend or evening, the laborist can deliver the patience likely to ensure best practice and ultimately reduce cesarean sections.
Creative models of providing care inside and outside of maternity units are likely to be the future, as hospitals, physicians and patients adapt to an evolving landscape. In this scenario, such changes in practice are likely to not only improve outcomes for moms and babies, but reduce costs in the process.
Michael R. Udwin, MD, FACOG
National Medical Director