Family-Centered Maternity Care

I’ve been delivering babies for 34 years now, so I’ve had a chance to see fads and fancies swing back and forth.  I remember when all the laboring mothers were on one ward, many of them moaning or crying in pain.  Then the “natural childbirth” phase emerged, and women learned how being prepared for labor removed most of the anxiety and much of the discomfort.

Then epidurals came along, and with that expensive innovation developed the expectation that childbirth could, or should, be mostly pain-free.  For a long time the goal was to reduce the C-section rate as the measure of good obstetrical practice; then vaginal birth after section (VBAC), under the pressure for perfection from plaintiffs’ attorneys, was deemed too dangerous.

Now it’s once a C-section, always a C-section. Next, maybe, is the concierge delivery: C-sections for everybody, on a schedule-- it‘s already 85% in some areas of Brazil.  Then things will swing again.  Of all the medical specialties, obstetrics is most subject to the winds of whim.

There is good evidence to believe that we’ve got too much technology for our own good in the labor process, but that’s not going to change.  It’s easier for nurses to watch a monitor than to time a contraction and count fetal heart tones, and a monitor strip is better evidence in court.  I think the courts are running the delivery rooms.

Still, I enjoy doing deliveries, because I enjoy family practice-- and you don’t get much more family than ushering a new life into the world.  The advantages of using a family physician for your obstetrician are pretty much the advantages for every other aspect of medicine.  You get one-stop-shopping for most medical problems, and a lot of free advice about family members.

How many times have I treated a rash on Mom during baby’s six-month checkup? Or given advice about Grandma’s swollen ankles?

But the best part about coming to a family physician for your delivery is that 95% of the time the doc who has followed you for nine months will be there in the delivery room.  I don’t share a call rotation for deliveries. If I’m within two hours of Topeka, I’ll be there for you.

Topeka is a great medical community, and if you choose an obstetric specialist for your prenatal care, you’ll get great service.  What you won’t get is a familiar face at crunch time, unless you get a scheduled "convenience" induction.  The problem with that is that convenience inductions sometimes produce an accidental early birth, and recent evidence indicates that being even a few weeks early may not be good for baby's brain.  No matter how much you whine, I'm putting the baby first.  You'll thank me later..

On the other hand, being on call 24/7 can be too burdensome for one person. So I’ll only take 30 deliveries per year.

If I take care of the babies, too, my wife and I will make a house call at two weeks postpartum, bringing dinner with us.  It’s our pleasure.