In hopes of improving patient care and possibly lowering malpractice insurance costs over time, Spokanes two largest hospitals now are staffed better to handle child-birth emergencies in which every minute is critical.


Sacred Heart and Deaconess medical centers, in cooperation with obstetricians here, have established round-the-clock coverage through which an obstetrician will be on duty at each hospital nights and weekends. In the past, obstetricians were called in from home for emergencies outside of normal business hours, responding in the five to 20 minutes it took them to get to the hospital from their home.


Any normal pregnancy can turn high risk in a moments notice, says Sherry Maughan, director of womens services at Sacred Heart. We feel like its important to have an obstetrician who can respond in very short order to an emergency that occurs. It takes a situation that can be potentially very bad, and it can turn that into an outstanding outcome.


Both Deaconess and Sacred Heart started offering round-the-clock obstetrics coverage on March 1. Holy Family Hospital, on Spokanes North Side, has had obstetricians on hand around the clock for almost 20 years. Valley Hospital & Medical Center, meanwhile, has such specialists there on some nights and weekends, says Cindy Preston, Deaconess assistant vice president of womens and childrens services. Deaconess and Valley both are owned by Empire Health Services.


Dr. Shawn Barrong, an obstetrician and gynecologist with Northwest OB/GYN who is serving emergency shifts at Sacred Heart, says most delivery emergencies involve unusual situations in which a fetuss oxygen or blood supply has been cut off or greatly reduced or a mother is losing blood rapidly. Such situations require an emergency Caesarian section procedure, through which a baby is delivered via surgery rather than vaginally, or an emergency forceps or vacuum delivery, through which a baby is delivered vaginally with the assistance of a forceps instrument or vacuum device attached to a babys head.


Another condition that warrants an emergency delivery is called vasa previa, in which blood vessels that normally would be inside the umbilical cord or placenta instead run through the bags of water that surround a baby in the womb. Such blood vessels can rupture, causing hemorrhaging that must be treated quickly.


Dr. Pam Silverstein, a Spokane obstetrician and gynecologist who is working shifts at Deaconess, says another potentially emergent condition is placental abruption, in which a placenta detaches from the uterine wall, causing excessive bleeding in the mother and a disruption in the fetuss oxygen supply. Yet another occurs when the uterus ruptures during vaginal birth by a woman who previously had a Caesarian section. Such a rupture also cuts oxygen supply to a fetus.


Such conditions, if not addressed immediately, can result in death or permanent brain damage for a baby, Barrong says. All of the potential emergencies, however, rarely occur, both he and Silverstein say.


Its usually about three or four times a year where there is an emergency of these types at Sacred Heart, Barrong says.


Excessive bleeding also can result in the mothers death, though such occurrences are rare these days, they say.


Sacred Heart and Deaconess had talked separately with obstetricians here for several years about providing round-the-clock coverage, but both Maughan and Preston say the doctors were split on whether the benefit of such coverage was worth the time commitment. Through the coverage, an individual obstetrician will cover three or four night or weekend shifts a month. Maughan says Sacred Hearts annual cost for providing the coverage is $350,000, all of which goes toward paying the physicians to be there.


Preston says malpractice insurance costs are high for obstetricians and hospitals alike and are climbing annually. She says both physicians and hospitals are looking for ways to reduce claims and eventually lower insurance costsor at least stop them from growing as quickly.


Barrong says launching round-the-clock emergency coverage wont lower premiums immediately.


Weve spoken to the malpractice insurance companies, and they werent interested in changing the premiums, he says. We told them this may decrease everybodys exposure to a bad outcome, but they werent convinced.


Silverstein says another factor swaying obstetricians to provide the coverage is new information that rupture of the uterus during vaginal births by women who have had a Caesarian might be occurring more often than believed.


We used to think that was a small and rare risk, she says. Studies have shown that risk is greater.


Shift work


At Deaconess, physicians take turns serving weeknight shifts that run from 8 p.m. to 8 a.m. and two similar 12-hour weekend shifts that start or end at 8 p.m. and 8 a.m. The shifts at Sacred Heart are similar6 p.m. to 7 a.m. on weeknights and 12-hour shifts on weekends that change at 7 in the morning and evening.


Physicians are paid by the hospital for being there for emergency purposes, Maughan and Preston say.


During the day, obstetricians frequently are in the hospitals, and several obstetric-gynecological practices are on each hospital campus and able to send a physician quickly to respond to any emergencies that occur during the day.


Barrong says the sole intent of the round-the-clock coverage is to provide quick response to emergenciesthe in-house obstetrician doesnt do rounds or handle normal deliveries. Attending physicians still come in on nights and weekends to tend to their own patients during normal deliveries and to cover emergency situations for those patients.


When theres an OB in the hospital, they can get started while the patients own physician is en route from home, he says.


The system is somewhat different from the one Holy Family Hospital has used for the past 19 years.


Jane OHara, the North Side hospitals director of womens services, says obstetricians take 14-hour shifts on weeknights and 12-hour shifts on weekends.


The obstetrician whos on duty at night or on weekends at Holy Family, however, handles most all obstetric needs during a shift, including normal deliveries. Consequently, other physicians arent called into the hospital outside of normal business hours, OHara says.


She says it was easier for Holy Family to maintain 24-hour obstetric coverage, because it works with fewer medical professionals than Sacred Heart or Deaconess.


We dont have as many groups that have to play well together, she says. The size of our hospital allows us to do these types of hospital services quickly and well.