The introduction of the new laborist program at Saint John’s Health Center played a crucial part in the decision by Peter Weiss, MD, and the three physician-partners in his busy Beverly Hills obstetrics and gynecology practice to begin admitting their patients primarily to the hospital.
Under the program, which started Jan. 1, experienced obstetrician-gynecologists, also known as laborists, are on duty at the Health Center 24 hours a day, seven days a week, 365 days a year. The in-house laborists are there to help in the event of a medical emergency, to provide care for pregnant women who arrive at the emergency room without their own OB/GYN, or just to serve as backup for any private OB/GYN who requests their assistance with a delivery at the hospital.
“It’s an excellent standard of care to have obstetricians available around the clock like this,” said Dr. Weiss. “Some teaching hospitals have residents who perform this role – under supervision – but they’re not necessarily experienced OB/GYNs. Saint John’s has gone one step further.”
Help for Physicians, a Safety Net for Patients
The laborist program at Saint John’s is designed to be an accommodation for physicians and a safety net for patients, according to William Frumovitz, MD, Chairman of the hospital’s Department of Obstetrics and Gynecology.
“For doctors, it means that if their patient comes to the hospital ready to deliver and they’re stuck somewhere in traffic, an experienced obstetrician-gynecologist – not a nurse or a resident – will be there to deliver the baby,” Dr. Frumovitz explained. “For patients, it means there will always be someone available in an emergency with the same capabilities and qualifications as their private OB/GYN. All in all, it’s an incredible program.”
A total of 20 local OB/GYNs are contracted with Saint John’s to provide the service. All are current members of the hospital’s medical staff. “The intent is to provide high-quality, personalized obstetrics services for local OB/GYNs and patients,” said Irena Zuanic, RN, Director of Women’s Health at Saint John’s. “It is important to note that women are still taken care of by their own OB/GYN if they have one. But the laborists are available to respond to emergency deliveries, to treat patients who do not have an OB/GYN or to assist private doctors who request their help.”
She continued, “It’s an added value that not many hospitals can offer. From a nursing perspective, it’s exciting to have the laborist always immediately available in an emergency.” The new program may also help to discover and address problems during the delivery more quickly.“With the laborist present, problems may be recognized earlier, which means they can be taken care of earlier,” said Lawrence D. Platt, MD, a maternal-fetal medicine specialist and Co-Medical Director of Maternal-Fetal Medicine at Saint John’s. “From a maternal-fetal medicine perspective, I can’t think of a better way to enhance quality of care at Saint John’s.”
Potential for More VBAC Deliveries
An added benefit of the Saint John’s laborist program is that it may allow more women who have had a cesarean delivery to give birth to their next child vaginally if they choose to do so. So-called vaginal birth after cesarean (VBAC) deliveries require additional monitoring because of the potential for serious complications, including – rarely – a ruptured uterus.
“VBACs require a certain amount of on-site supervision by a physician,” said Dr. Frumovitz. “As an OB/GYN, it’s hard to encourage your patients to have a VBAC when you can’t be at the hospital 24/7. With the laborist program, you don’t have to be on site all the time, because the laborist is there to cover any emergencies.”
According to the American Congress of Obstetricians and Gynecologists (ACOG), the rate of VBAC deliveries fell from 28 percent to 8.5 percent from 1996 to 2006, in part because of restrictions placed by some hospitals and insurers but also due to patient choice when presented with the risks and benefits. In 2010, ACOG released less restrictive VBAC guidelines, saying VBAC is a safe and appropriate choice for most women who have had a prior cesarean delivery.
“Most women do not have to have a c-section; they can have a vaginal delivery most of the time,” said Dr. Frumovitz. “C-sections are major surgeries and have their complications. VBACS have their complications, too, but in selected patients the risks are very low.”
Added Dr. Platt: “The Saint John’s laborist program enhances the ability of the hospital to care for women who have had a c-section and are considering vaginal delivery. It significantly reduces the risk for patients who wish to have a VBAC.”
For Dr. Weiss and his physician-partners Rebecca Brown, MD, Kathleen Valenton, MD, and Stacey Rosenbaum, MD, the program illustrates the seriousness of Saint John’s commitment to high-quality, individualized patient care. “This is not ‘industrialized medicine,’” he said. “Saint John’s is very attuned to the needs of both the individual patient and the private physician. We are extremely pleased with the service that both we and our patients have received at Saint John’s. It’s refreshing to see such great attention and care for our patients.”