Once it’s determined that an evaluation is indicated, a visit to the office or labor triage unit is arranged. When active labor is confirmed, the CNM will attend the patient and care for her until delivery occurs and she’s stable. Physicians will be updated on the progress of labor and will assume care any time complications arise. Certain high-risk conditions (such as previous cesarean in labor or gestational diabetes requiring medication) require physician involvement in the intrapartum care by protocol
A physician is always available to evaluate patients experiencing new problems. Protocols governing midwifery practice govern the conduct of labor and delivery and the factors requiring physician presence at delivery.
The board-certified physicians of OB Hospitalist Group (www.obhg.com) provide immediate physician backup of our certified nurse midwives when Drs. Wagaman and Perry are not available. The sign-out process updates the covering hospitalists on each patient’s status. In most cases, even high-risk patients will be delivered by their nurse midwife with the attending or covering physician immediately available to intervene if problems manifest at any time.
Benefits of this practice model of care relate to the presence of a caregiver who is known to the patient and who is able to provide an up-to-date chart and communicate her history and wishes to a covering physician who may not know her. Most solo or group physicians who sign out to the hospitalists or other covering physicians are unable to provide this continuity and must rely solely on their written records for this critical communication. Every laboring patient, including those with conditions requiring physician attendance at their delivery, benefits from the presence of a highly-trained Certified Nurse Midwife attending them through their active labor and communicating their progress to the physician responsible for backup of the CNM.
*Discharge usually occurs 36 hours after uncomplicated vaginal delivery and at 48 hours after uncomplicated cesarean delivery