If you suspect you’re having a heart attack, you’ll be seen by a doctor. If you suspect you’re having a stroke, you’ll be seen by a doctor. But if you suspect you’re about to have a baby, you will most likely be seen by … a nurse.
As an obstetrician, I have long been surprised by our medical culture’s habit of having nurses and nurse practitioners evaluate pregnant women who come to the hospital for assessment. Nurses are well-trained and highly skilled, but if you are pregnant and you’re having a problem that brings you to a hospital, wouldn’t you like to be seen by a doctor?
That’s why I’m so enthusiastic about the new Obstetrics Emergency Department opening at Hoag Hospital Newport Beach. The new OB-ED will staff three full-time and two part-time laborists (OB-GYNs who work full-time in a hospital, delivering babies only) and two nurses to follow the four-room emergency department dedicated solely to mothers-to-be.
The OB-ED laborists and nurses at Hoag will ensure that every woman over 16 weeks of pregnancy will be seen by a dedicated laborist for any obstetric emergency – whether her obstetrician is thousands of miles away on vacation or nearby.
If a patient prefers to be seen by her private doctor, the doctor is called and can evaluate the patient at the Hoag OB-ED within the hour, ensuring both continuity of care and quick treatment if any is needed.
The biggest impact that we can have is for the patients under 37 weeks of pregnancy, when babies and mothers are most at risk. In pregnancy, there are a lot of variables to consider when trying to determine what is happening. Is a patient experiencing the normal lingering pain of uterine growth? That’s fine, we’ll send her home with peace of mind. Does lab work need to be done? We can tend to her needs effectively and immediately.
I have always believed that it is important that a doctor personally see and interact with a patient during an assessment, rather than relying on a nurse to relay a patient’s complaints to the doctor over the phone – the current standard of care across the country.
The OB-ED can even come in handy after a woman’s doctor delivers her baby.
For example, in Florida an OB-GYN left the hospital after the successful delivery of a healthy baby. After he left, his patient started hemorrhaging, and the doctor’s partner was delayed in getting to the hospital. There was a potential 45-minute gap where this woman could have died had a laborist not been there to step in.
When you think about it, pregnancy is potentially the most vulnerable time in a person’s life – with so many emergencies that arise and so many things that could go wrong.
It’s a wonder that emergency departments dedicated solely to expectant mothers aren’t the norm, but, hopefully, we’ll be seeing the birth of a new standard in obstetrical care.
– Michael White is an obstetrics and gynecological hospitalist at Hoag Memorial Hospital in Newport Beach.
