Offering a 24-hour delivery service

Kathleen Anne Breen — all 8 pounds, 11 ounces and 21 inches of her — lay on her mother's chest at Hoag Hospital in Newport Beach.

She had been born just hours before, and now, shielded by a blanket and tiny hat, she slept with the serenity only those recently introduced to the world can achieve.

That Kathleen's mom, Kristen Breen, 31, shared a sense of calm so soon after birthing a human being for the first time was a little more impressive.

"I feel like I couldn't have lucked out more," she said, beaming.

The obstetrician she'd come to know and trust over the course of her pregnancy was thousands of miles away in Europe. And Kristen had gone into labor about two weeks early.

But thanks to a new model of obstetric care that keeps a doctor around all the time to help deliver babies, she and husband Jim Breen, 33, said the delivery went off without a hitch.

"We thought there might've been issues with the umbilical cord," Jim said, but "everybody was open and knowledgeable."

The doctor who delivered Kathleen, Michael White, isn't on Hoag's obstetric staff — despite the fact that his portrait hung on the wall as May's nurse-chosen "Doctor of the Month."

In fact, the Breens said they'd only met White for the first time that day, when he came in for his 24-hour shift.

White, who also serves as the medical director of operations for Ob Hospitalist Group, is a laborist.

Sitting in what looked a bit like a small studio apartment with exercise equipment in place of a bed, White explained what that means.

"A true hospitalist program is dedicated [obstetricians] 24-seven," he said. The laborist, or hospitalist model, "is giving community docs a break."

Hoag's laborist program is one of more than 40 that Mauldin, South Carolina-based Ob Hospitalist Group operates throughout the country. The company was founded in 2006 and has delivered more than 32,000 babies. According to an article in Contemporary OB/GYN published earlier this year, more than 185 hospitals have laborists available.

White said a laborist delivery at Hoag likely wouldn't cost families any more than one performed by an on-staff doctor.

Under more conventional models of care, White said between peeks at a cell phone, when women go into labor, a nurse or other hospital staff member will call in her usual obstetrician.

When things go smoothly, that works just fine, he said.

But when things start to happen all at once — say, a woman's obstetrician has already performed a couple deliveries and an emergency C-section when she starts labor — that the laborist model comes in handy.

At that point, White asked, "Do you really want your doctor, who's been up for 48 hours?"

Most women, he said, don't seem to mind having a new doctor to help monitor their conditions, even if that doctor ends up delivering the baby.

Having an obstetrician already in the hospital to, as White put it in his characteristically easygoing manner, "break a bag of water," or keep an eye on a woman in labor, makes for better care and higher hospital retention rates.

White said he started in private practice before switching over to work about six 24-hour shifts a month as part of a rotation that includes three full-time and between one and four part-time laborists at Hoag. The hospital started tapping laborists in 2009.

"For me too, it was a family decision," White said. "I was having 85-hour work weeks, then we had our first kiddo."

The new gig, he said, gives him the flexibility to complete his shifts in Newport, then fly home to Colorado to "just be dad."

But Dr. Edward Yeomans, who chairs the department of obstetrics and gynecology at Texas Tech University Health Sciences Center, said something's lost when doctors aren't expected to be by a patient's side from the beginning of a pregnancy through delivery.

Lubbock, Tex.-based Yeomans wrote a counterpoint to the Contemporary OB/GYN article touting the benefits of the laborist model.

When a patient has had a chance to develop a relationship with an obstetrician, he said, "She's had a chance to tell you her fears. There's a certain element that she's counting on.

"That laborist has got to try to build that in the span of just a few hours."

Still, said Jaimie Gebler, a Hoag nurse who has nearly two decades of obstetric experience, "sometimes you need more than two hands."

She recalled that during one problematic delivery, she felt the her scrub pants inching down.

Rather than risk the baby's life by freeing up a hand to yank her pants back into place, Gebler was spared by another nurse.

"Over the years, you learn to always be ready," she said, and as a nurse, she can handle most issues. Nevertheless, the help of a laborist can turn "a potential huge crisis to a manageable one."

Dr. Allyson Brooks, executive medical director of the Hoag Women's Health Institute, said in a statement that the laborist program "has been transformational in obstetrical care."

"In addition to their 24/7/365 on-site availability for emergency interventions where time is of the essence in maternal and neonatal outcomes, these clinicians are an integral part of the labor, delivery and recovery team," she said.

As far as the Breens were concerned, White inspired plenty of confidence.

Plus, Jim joked, "He looks like George Clooney."

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