Choices may dwindle for moms-to-be

Philadelphia - October 16, 2008

Reena Schaeffer, of Haddonfield, N.J., said she had a great experience at Pennsylvania Hospital when her first son Jaxson was born. She wanted the same for number two.

"I knew my doctor very well, I was very comfortable with him and I went through two trimesters thinking this is the man who will deliver me and all of a sudden there was a possibility he wasn't," she said.

That's because Pennsylvania Hospital hired four 'laborists.' Dr. Jack Ludmir, director of OB services there, explains laborists are obstetricians, or OB-doctors who don't follow women throughout pregnancy but they're there at the end. Their sole job is to deliver babies.

"The reason we established this new model of care is to make sure we always have an obstetrician present when someone comes to the labor floor," Dr. Ludmir said.

Typically when a woman comes into the hospital in-labor, her doctor may be seeing patients in the clinic or could be off-duty, at home. Nurses and residents care for the patient until it's time to deliver. Then the attending doctor arrives.

Laborists ensure that an attending physician is there from the beginning. "The main reason for this is safety and the quality of care we are providing," Ludmir said, adding in the past five years the number of deliveries there has jumped 25-percent.

Kathy Silverster, of Mullica Hill, N.J. just delivered her third baby at Pennsylvania Hospital. She did not meet the staff delivering her until she arrived in-labor, but said she welcomes the added staff. "They're there, they're available, they're alert," she said.

But other moms aren't comfortable not knowing who will deliver their baby. Reena left Pennsylvania Hospital. She's also a doctor and says as a professional she understands the reason for laborists, but as a mom it wasn't the experience she wanted.

"I figured if I had the choice to know who's going to be delivering me, I'm gonna take that choice," she said.

But Dr. Ludmir says that choice for many moms could soon be going away. Other hospitals are expected to follow the laborist trend because it could help lower malpractice premiums if hospitals choose to only have laborists deliver. Dr. Ludmir said they are not doing it to save money because all their doctors carry delivery insurance. And the original OB's will still deliver babies but only when they're scheduled to work the delivery floor. They won't be called away from other patients or called in from home.

Reena said while this is better for doctors and could be safer, she still thinks it takes away from the 'doctor-patient relationship.'

"When this becomes commonplace, I don't think anyone will expect to have rapport with the person who delivers them," she said.

Dr. Ludmir said they did lose about one- to two-percent of expectant mothers with the change but otherwise the response has been positive. Pennsylvania Hospital is part of the University of Pennsylvania Health System. Ludmir says we could see laborists added there as well in the future.

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