There’s no place like labor and delivery for the holidays


It’s that time of year when the weather outside is growing colder, the evenings seem to kick off way too early in the day, and the decorations around town remind all of us all of the fast-approaching holiday season.

But for many of us obstetricians, this can often translate into anxiety over how often we’ll be pulled away from long-scheduled holiday activities to rush to the hospital for an emergency.

I spent more holiday seasons than I care to remember darting out of restaurants, missing family events, and nervously checking my pager. At the same time, I was keenly aware of “the weekend effect,” in which infant and maternal mortality rates spike during weekends and holidays. Some have attributed this to the lack of highly trained, more senior-level full-time staff wanting to cover “undesirable shifts,” that may go to newer, less experienced physicians. Others have pointed to clinician burnout as a result of compounding stress throughout the week and holidays.

And while having a “holiday baby” can be a time of great joy for many families, holidays can be an especially hard time for patients facing less than ideal pregnancy-related situations. Miscarriages, postpartum concerns, and unexpected complications during the birthing process take no breaks in lieu of the holidays. With the heavy emphasis on family and being “home for the holidays” throughout this time of year, the impact on patients can be especially hard-hitting when things go wrong.

Seven years ago, I became an OB hospitalist. I embraced many of the benefits of a regular schedule, including the opportunity for greater predictability and control over my schedule. An average workday now finds me providing coverage, team leadership, and clinical support, either until the patient’s assigned obstetrician arrives at the hospital, or as their primary caregiver when the patient is unassigned. When the community obstetrician arrives, I either turn over patient care to the designated provider, or continue to co-assist as part of the care team. This model allows the hospital to provide the highest standard of care regardless of when the patient arrives, with seamless coverage from the perspective of the patient.

I will never forget one winter shift a few years ago when I was put in charge of assisting a pregnant woman whose holiday cheer was cut short when she was suddenly rushed to the hospital. She was suffering from an embolism characterized by sudden cardiorespiratory collapse and acute hemorrhage and was bleeding out. Her distraught husband seemed to be in shock, pleading with our team to save her life. This was a far cry from the joy of childbirth most new parents yearn for.

Our team immediately jumped in. We worked for hours to deliver the baby, stop the bleeding, and stabilize her. While it was among the more stressful medical situations I’ve had to work on, my greatest holiday gift that year was knowing that I could help that family return home with a new, healthy addition in tow. What could have been a tragedy under different circumstances was averted because of the care our team provided that night.

It is during these short winter days and cold nights that I often find myself reflecting on how no day in the hospital from the patient perspective is an average day. It is within my ability to positively affect their experience, no matter how wonderful or tragic that situation may be. Ironically, I often welcome the opportunity to cover other physicians who want to spend some much-deserved time with their own families during the holidays because of this. No one wants to be in a hospital on a holiday, but being there for our patients as a source of comfort, safety, and care during this critical time is the greatest gift that we, as physicians, can give.

Rakhi Dimino is an obstetrician-gynecologist and medical director of operations, Ob Hospitalist Group.

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