Monthly Archives: November 2007

This article caught my attention today: Stork Tries a New Strategy

While the option of a “laborist” is not at all a new thing, it’s amazing to me that so many hospitals are now promoting this idea in the literature and media. Is it a sell job to the American people to get them back into the idea of not having one-to-one care? Is it a good idea?

I’ve thought of some angles that make me more than curious. We all know how annoying it is to have someone ask us the same 15 questions, then ask again every time there is shift change with the nurses. Now we will have to be on guard for the 12-hour shift change with our doctors, too? And while I realize this is no change for those of us with multi-doctor practices, has this been shown to be a good thing? Our laborist won’t even know those little nuances that matter in a way that we’ve explained them. Will the laborist read in a notated chart “don’t stand directly behind patient” and take it to heart so well that it becomes a part of their practice or will they read that and need to know more and ask questions about a trauma that happened 15 years ago, dragging it out into a labor situation that is already fraught with emotion? They won’t have the benefits of those moments in the office where you shared something that specifically could really help in a birthing situation. Some crucial feeling you shared or how your mother would love to have seen the baby…

For surgeons, I can see how this would be beneficial. Rather than attending labors, they could be on call for the actual surgeries that arise. The surgeon could be prepped for the surgery, given the woman’s expectations or specific information and keep surgery as that kind of specializied skill. The article clearly begins with the most obvious examples of why you want a laborist.
A non-sleepy, not on-call, specially skilled surgeon.

But is that the role of a laborist? Should that be the role of a care provider for a pregnancy? It seems to me that it is still the same crossing of skills vs roles that we find in homebirth vs hospital birth. Obstetricians and laborists are being trained to be surgeons with little left of the labor sitting professional role of the midwife. If most pregnancies would end in a normal vaginal birth, then isn’t there a benefit derived from the one on one care? If we don’t get to keep the same nurse, the same doctor, the same laborist, then where is the comfort that all mammals seek during labor? Where does the feeling of a momentous occasion come from? You and your partner become the only two people in a birth who have invested time and emotion into it. There is something missing here and that is the innate knowledge of how births occur and what women need.

This article focuses on the positives to the care providers and once again ignores the needs of the mothers and babies. Yes, we need reliable, awake surgeons for those 6-15% of births that need surgery, but who is going to handle the other 85% of women who need a familiar face, a hand held, an understanding tone that knows us, knows our needs, knows our spouses, is aware that when my mil comes to gently shepherd her out into the waiting room. The harsh lights of reality in a modern hospital is so opposite of the average homebirth that those of us who cross the lines regularly are often floored as we blink back into the protocols of a hospital. And then to add in this other component of “stranger at the birth”? It’s no wonder so many women hire doulas to be at their birth! It’s the only way they can make sure there is someone there who knows what they need that they actually know personally!
Ok, I’m about to climb onto a different soapbox and off onto a different tangent, but while I’m still here in “Laborist” land I would like to just put forth the opinion that women don’t need less contact with their care providers. They need more contact. Every act that a woman does to prove to her care providers that she is NOT just another birth, not just another number on an insurance sheet and not just another lawsuit is one more where OB’s are forced to recognize that women have needs and that birth is so much more than just the physical act and the pathology.

Surgical specialty? Sure.
Laborist? No thanks, I’ll take a midwife. Continue reading →