A Hospitalist's Guide to Navigating Modern ObGyn Practices
Jun 18, 2020
I spoke with practicing Ob Hospitalist and Women's Wellness Coach Dr. Nicole Calloway Rankins to discuss the growing popularity of large ObGyn practices, and how moms can best advocate for themselves during pregnancy and labor.
We are seeing fewer and fewer obstetricians practicing alone. Practices are getting bigger. Patients typically have more than one OB provider during their pregnancy. Why is this happening and what are benefits and drawbacks for patients?
Being a solo practitioner is challenging. It's a lot for one person to see patients in the office every day and be on call 24/7. There are safety concerns regarding fatigue and issues with the quality of life with that type of model. Doctors have formed groups in order to help ameliorate these concerns.
Another reason groups are forming is that fewer doctors choose to own their own practice so they can focus more on caring for patients and less on the business side of medicine. When hospitals buy practices, they usually consolidate physicians together into larger groups.
The benefits of group practices are that you're less likely to have appointments canceled or have to wait while your doctor is in delivery. You may also have an easier time getting an urgent appointment. In general, physicians are also happier in group practices which may translate to them taking better care of you.
The drawbacks are that you may not know the doctor who is there for your birth. Also when you meet many different doctors during your pregnancy you may not feel like you know anyone doctor very well. The doctors similarly have less of an opportunity to get to know you.
What is an Ob Hospitalist? Why are hospitalists beneficial?
An OB Hospitalist is an Ob/Gyn physician whose focus is caring for women in the hospital. Their primary role is to care for women in labor and delivery.
A major benefit of hospitalists is safety. Hospitalists are in the hospital 24/7 and are thus available to attend to obstetric emergencies right away. Another benefit of hospitalists is it reduces the unneeded pressure to rush labor. One study has shown a 27% reduction in cesarean births at hospitals that have a hospitalist program.
Many people are worried about not knowing the person that helps them deliver their baby. Do you have any tips for patients who have a provider they’ve never met before when they are in labor?
It's perfectly understandable to be worried about not knowing the doctor or midwife who's there for your birth. The best way to combat that is to educate yourself and ask questions BEFORE your birth. Review your birth wishes during your prenatal appointments to make sure everyone is on the same page about supporting your wishes for your birth. Ask your doctor who could potentially be there for your birth, and if there is anyone who may not support your wishes. if you need help, I have a free online class to help you make your birth wishes.
Equally important is to understand the culture of the hospital where you give birth. A supportive hospital can combat an unsupportive provider. Tour the hospital and ask questions to help you know if they support the type of birth you want.
Also, if you have someone you've never met attending your birth, try to connect with that person on a human level. Tell them about your excitement, wishes, and fears. A human connection can go a long way.
And lastly, have someone there who can advocate for you on your behalf if need be (this is actually important whether you know the provider or not). In the throes of labor, you may not be in a position to best advocate for yourself.
How can people best advocate for themselves both during and after pregnancy?
The best way to advocate for yourself is to empower yourself with education. Read books about pregnancy and birth, listen to pregnancy and birth podcasts, and take an in-person or online childbirth education class (I have a podcast called All About Pregnancy & Birth as well as an online childbirth education class called The Birth Preparation Course that you can check out!).
Also, don't forget to prepare yourself for the postpartum period! I've seen many women regret not taking more time to learn how to manage the physical and emotional changes that occur postpartum. The reality is that with one visit at 6 weeks, your doctor is not going to be of much help. Read books or take a class like Dr. Sterling's Prepared Postpartum so you don't find yourself unprepared.
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