What's a 'Laborist' and Why is She At Your Birth?

Madeline Holler — Mon, 09 Mar 2009 19:56:00 GMT

Go home and go to bed, OBs! Stay in the margins, skilled midwives! There's a new birth attendent in town and she's coming to a hospital near you.

Or, perhaps, she's already there.

In an effort to fill the void of obstetrician-gynecologists who have stopped delivering babies, hospitals are increasingly staffing "laborists" or "OB specialists" to attend the births up in Labor and Delivery. Maybe one attended your recent birth?

These laborists are, indeed, doctors themselves. They just don't have their own OB practices, don't pay astronomical malpractice insurance and typically work only part time -- maybe a weekend shift or a few nights a week.

Some hospitals think having laborists fill in during birth will make giving birth in the hospital safer since they can be with the laboring mother from the time she arrives at the hospital. Laborists also won't suffer sleep deprivation, since their shifts are defined. The fact that laborists will attend the births also means OBs won't have to cancel the morning's appointments to rush to the hospital. So it's win-win ... for doctors and hospitals!

But let's focus on the mom for a sec. Is it fair that after doing all her research and getting to know her OB over nine-ish months that she should show up on the big day and be greeted by a perfect stranger? After discussing her birth plan, hopes and dreams, should she have to go over it all again, presumably between contractions? What about philosophical clashes between the pre-natal OB and the laborist? Is this the final step in the McDonald's-ization of L&D?

The woman featured in this Boston Globe article on laborists was pleasantly surprised by her laborist and all the attention she got while in labor. She says she had never spent so much time with a doctor. And this was BEFORE she even began pushing out the baby. What's interesting to me is that this woman wasn't even told a laborist might be there attending her birth. That would bother me greatly.

I'm all about midwives and homebirth, but I've had a hospital birth and I do kind of like the idea of (1) someone attending the birth who's pulling a shift and not anxious to get home and (2) a doc who is well-rested and not burned out on birth.

Is a laborist for you? Is this any different than getting care from a large practice of OBs who share responsibility anyway? Or does this make you want to hug your midwife a little closer?

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Photo: Boston Globe

Mother Sues OB Who Said She "Deserved Pain"—And Gave It to Her

Miriam Axel-Lute — Fri, 02 Jan 2009 22:00:00 GMT

Catherine Skol, former Chicago cop and mother of five, is suing her OB for abusive treatment during the birth of her fifth, nine months ago. If you've heard of the case, and the arguments that she's "just suing over rudeness" and should quit it because she's going to make malpractice rates go up, I suggest you go here, and read the details of the allegations.

I don't suggest you read it if you are pregnant and about to head into a hospital delivery however.

According to the suit, defendent Scott Pierce, who was filling in for the Catherine Skol's primary OB, was so incensed that she hadn't called him before heading to the hospital (an instruction her main OB had never given her) that he decided she "deserved" pain, refused an epidural, put her in intentionally painful positions, insisted she push before she was sufficiently dilated, kept telling her she was going to hemorrhage, wouldn't give her enough anesthesia before stitching her up and told her husband to "hold her down" instead, and talked loudly and crudely on a cell phone about an abortion in the room. There's more. It's truly astounding, in a nauseating kind of way.

(Confidential to "Linka" who called Skol a wimp for complaining about not getting her pain meds: I'm no fan of routine epidurals and had my kid with none, but I would never claim to know out of context when one was appropriate. And I'd like to see you get stitches for a severe laceration on your vulva without anesthesia, not mention all that other crap.)

As much as I've heard plenty of horror stories about OBs and their attitudes, I have to say that this is a category all its own, and sounds to me like the sort of extremely aggressive behavior that arises when people are on something illegal or are having, shall we say, certain brain chemical imbalances. Not that there aren't people out there who are just that awful, but they don't generally keep a job like doctor very long.

In fact, his behavior bothers me less than the commenters who say that because she and the baby are physically healthy, she should shut up and deal. Aside from being cruel, the behavior described was dangerous. If it's anything like she described, he should have his license revoked. People sue all the time for doctors failing to prevent problems they couldn't have prevented—that's one of the reasons our c-section rate (and malpractice insurance) is so high. Here's a case where the doctor was actually in the wrong rather than just getting the blame for a tragedy. This is what lawsuits are for.

Photo by Bloomsberries.

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What's a 'Laborist' and Why is She At Your Birth?

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Baby-Faced Boy Becomes a Father

The Trouble With Wanting a VBAC

Mother Sues OB Who Said She "Deserved Pain"—And Gave It to Her