The Laborist trend: its implications
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NEWS AND VIEWS
The Laborist trend: its implications Elliot M. Levine1 · Carlos M. Fernandez1 · Norman A. Ginsberg1
© Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To offer obstetrical practitioners a current perspective about an important contemporary practice model which has implications that may not have been adequately recognized. Methods A description of individual past professional experience. Results A resultant perspective from decades of professional obstetric practice. Conclusion A description of potential clinical impact on patients and practitioners alike. Keywords Obstetrics · Clinical practice guidelines · Residency training The use of obstetric personnel in the Labor and Delivery (L&D) suite dedicated to the care of the parturient during the course of her labor from the beginning until the actual delivery describes the Laborist model. These obstetricians do not have any of the other responsibilities for their time to perform any other professional tasks. This is in contradistinction to the traditional model of obstetrical care, in which an obstetrician cares for the patient during the 9-month prenatal course, and who is then called into L&D when the patient arrives there in confirmed labor. Accurate statistics regarding the growth of this Laborist movement is hard to come by, as such data are not consistently collected, given the variety of definitions that exist for these particular practices [1]. An outstanding review of the important related issues has been provided [2], and we wish to add this additional professional perspective. Although there has been an attempt to compare these models, for their relative cost efficiency and measurable patient safety, the data may not thus far be compelling either way. For example, an investigation [3] revealed that the Laborist model provides a reduction in preterm births and inductions of labor * Elliot M. Levine [email protected] Carlos M. Fernandez [email protected] Norman A. Ginsberg [email protected] 1
Advocate Illinois Masonic Medical Center, 3000 N, Halsted, Suite 500, Chicago, IL 60657, USA
(IOL). However, it is difficult to compare the statistics of these Laborist and Traditional models, when preterm births spontaneously present to L&D (having a little impact of the setting used to prevent it), and that IOLs are typically scheduled from an obstetrician’s office, well before an admission to L&D. Before one includes this as evidence of its effectiveness, it may need to be examined more carefully. To adequately evaluate whether the Laborist model definitely improves healthcare quality, one should additionally view it from the consumer and professional perspectives, to add to the big picture. Once upon a time, patients and physicians were able to develop a rapport that could be helpful to a patient. Today, there seems to be a deterioration of this doctor–patient relationship, so it may be that the loss of this 9-month long period may not be important to the care of the parturient. We may not be able to
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