Midwife Laborist Model in a Collaborative Community Practice

Abstract

Since the introduction of a hospitalist physician model of care by Wachter and Goldman in 1996, important changes have occurred to address the care of hospitalized patients. This model was followed by the introduction of laborist physicians by Louis Weinstein in 2003, although large health maintenance organization practices have used this model since the 1990s. The American Congress of Obstetricians and Gynecologists supported the laborist model in a 2016 statement that was reaffirmed in 2017, recommending "the continued development and study of the obstetric and gynecologic hospitalist model as one potential approach to improve patient safety and professional satisfaction across delivery settings." Based on a recent American College of Obstetricians and Gynecologists publication, the problem is an anticipated staffing shortage of 6000 to 8800 obstetricians and gynecologists by 2020 and nearly 22,000 by 2050. The current workforce in obstetrics is aging, retiring early, and converting to part-time employment at an increasing rate. At the same time, the number of patients seeking obstetric and gynecologic care is dramatically increasing because of health care reform and population statistics. The solution is the use of alternative labor and delivery staffing models that include all obstetric providers (health care professionals). We present an alternative to the physician laborist model-a midwife laborist model in a collaborative practice with obstetricians practicing in a high-risk community setting.

Keywords: ACOG, American College of Obstetricians and Gynecologists; VBAC, vaginal birth after cesarean.