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Wednesday Nov 05, 2014

Labor of Love: Maternity Care Offers Unique Chance to Partner With Patients

Many of us who graduate from medical school and residency in this country are trained in maternity care in a similar way. Typically, that training represents a rather "medicalized" form of labor and delivery.  

Patients come to the hospital, get hooked up to monitors, see their doctor for occasional checks throughout the day (or night) and then see us again just as they are about to deliver. For some physicians, contact with the patient -- and her child -- ends there. Unless it is one of our continuity deliveries that we follow throughout pregnancy and delivery, we rarely see the mother or baby after they leave the hospital. Equally frustrating is caring for a laboring patient throughout the day but having to leave before she delivers because our shift is over.  

Patient Tawny Ashbaugh and I listen to her baby's heart beat.

Patients may bring a birth plan to the hospital, but this is sometimes not even seen by the resident scheduled to deliver the infant. And anything too out of the norm might be seen as a patient being difficult or eccentric. I trained at a hospital with high maternity volume during residency, and this was how I functioned.

However, once I moved to a rural community and began my own practice, I began to develop a much different relationship with my maternity patients. I now see it as my responsibility to educate and help them throughout their pregnancy, guide them through their labors, and provide to the best of my ability the deliveries that they envision.  

I admit that when first going into practice, I didn't have a lot of skill or experience in dealing with special labor requests. Three years later, I've accommodated a wide range of requests: essential oil diffusers, dark environment, limited checks, meditation, working with a doula, delayed cord clamping, delaying vaccinations until an hour or so after birth, etc.

During my residency, my position on such requests was that they were nice thoughts, but they often were an annoyance because I thought patients were trying to direct what I was supposed to do. I was the doctor with medical training, and my feelings on birth plans were not generally positive.  

Today, I have a different perspective. My growth in this regard began when I started my practice and began seeing women I would be with from their first visit onward. Not only would I be caring for them at every prenatal visit and through delivery, but I also would be seeing them and their child for years to come.

I began to plan hourlong visits for all of my new maternity patients to allow us to discuss everything: their questions, their medical history, what to expect from me during their pregnancy, and what they envision for their pregnancy and delivery. In this way, we become partners in the process.  

I was taken aback the first few times a patient came to interview me at her first visit, to see if I was the right fit for her. I now appreciate this and understand why choosing the right health care professional for the journey is so important.

During the past year, I had the opportunity to supervise a nurse midwife. She had an enormous impact on my practice and taught me many things about how to facilitate the childbirth process each patient desires. I am now much more skilled at recommending position changes to help the mother progress, suggesting alternative pushing positions, and allowing the patient to tell me what feels right for her. I have delivered women in kneeling, standing, squatting and side-lying positions, and although this would have felt foreign and bizarre to me on graduating residency, it is now normal to try several things until we find a position that works best for each patient.

Another change we have brought to our hospital is water birth. Our facility is the only hospital in Kansas that offers this option. We have had women travel as far as four hours to be able to have a water birth. Implementing this option in our facility required training for all relevant staff, as well as research into policies and procedures, but it has been a wonderful addition to our program.  

There is good evidence that these practices -- patient involvement in care decisions, mobility during labor, and labor support -- reduce cesarean section rates, decrease need for pain medication and improve patient satisfaction.  

I am proud of what we can offer to our mothers and families, and yet I am humbled every time I get to be part of a birth. There are three physicians in our facility who provide birth care, and two additional physicians who do cesarean sections. We have an 8 percent primary C-section rate, and we have built a reputation for patience with the labor process. After having an unplanned C-section myself, I fully understand the desire of patients to ensure they will be in a facility where it is considered something to be done only in case of medical need and not because their physician is tired of waiting.

I'm grateful that my own birth experience has made me a much more understanding physician. I will continue to strive to provide the best care I can for my patients, keep our facility up-to-date on guidelines and best practices, and accommodate my patients' vision for their births in any way I can.

What unusual requests or alternative birthing processes have you experienced with your patients?

Beth Loney Oller, M.D., practices full-scope family medicine in Stockton, Kan.

Posted at 01:53PM Nov 05, 2014 by Beth Oller, M.D.

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