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A full-time laborist model can decrease the rate of cesarean delivery, new research from the high risk pregnancy center reveals

, MD, and his colleagues at the High Risk Pregnancy Center, in conjunction with Sunrise Hospital and Medical Center, issued results today of the first study on the effects on patient experience and outcome when hospitals adopt laborist programs. Their research is published in the .

“This first published study is important for women’s health, as it shows that having dedicated full-time laborists – hospital based obstetricians dedicated only to labor care – is associated with a large reduction in rates,” said Dr. Iriye. “Our results may have important implications on care for delivering mothers and the future of laborist programs and obstetrics training within the United States.”

Laborist programs have expanded throughout the United States in the last decade, but until today, there has been no published research examining their effect on patient outcomes. The study was compiled from data reviewed for three time periods from 2006-2011. Data from 6,206 women having their first baby were retrospectively reviewed.

Key Findings

  • The cesarean delivery rates, evaluated while rates were continuing to rise in the community and nationally, were as follows:
    • 39.2% for no laborist care
    • 38.7% for community physician laborist care (part-time labor coverage by OBs and other physicians who also have an outpatient practice)
    • 33.2% for fulltime laborists
  • A full-time laborist presence was associated with a 27% reduction in cesarean delivery when contrasted with no laborist.
  • A full-time laborist presence was associated with a 23% reduction when compared to community laborist care.
  • The community laborist model was not associated with an effect upon cesarean delivery.

Cesarean delivery is major surgery associated with uncommon but increased risk of medical complications such as infection, bleeding, and blood clots that can occur in the lower extremities or lungs. These medical complications lead to increased financial costs in addition to the risks upon maternal health. Cesarean delivery also increases hospital stay for recovery leading to added costs even in uncomplicated cases when compared to vaginal delivery. The total rate in the United States is 32.8%, which represents 60% increase since 1996. The Healthy People target for 2020 is a rate of 23.9% for low-risk women with a singleton vertex (head-first) presentation and no prior cesarean births.

Source

The study was initiated by Brian K. Iriye, MD and co-authored by Wilson H Huang, MD; Jennifer Condon, RN; Lyle Hancock, BS; Judy K Hancock, RNC; Mark Ghamsary, PhD and Thomas J Garite, MD.

Implementation of a laborist program and evaluation of the effect upon cesarean delivery

American Journal of Obstetrics and Gynecology