Team Approach to Individualized Childbirth at New Women's Hospital

April 10, 2012
News Office: Kate Vidinsky (415) 502-6397

Mission Bay

Artist's rendering of the UCSF Medical Center
at Mission Bay, set to open in 2015.

With expansive two-story atriums, intimate meditation spaces, beautiful gardens and patient rooms that maximize natural light, the Women's Specialty Hospital at UCSF Medical Center at Mission Bay will set a new standard for patient- and family-centered care when it opens in 2015.

A major focal point will be the 36-bed birth center, where expectant mothers will receive the care and support they need for the labor and delivery experience they desire. Each birth room will promote a sense of calm for the intimate, anxious and joyful birthing experience, paired with a functional environment for physicians and caregivers to safely perform their services.

A unified group of UCSF doctors, nurses and midwives will bring their shared philosophy of care to the new women's hospital, in which the best evidence-based medicine is combined with a tailored approach for the individual patient. This philosophy, which governs all UCSF obstetric care, has led to some of the lowest C-section rates and highest breast-feeding rates among Bay Area hospitals.

Here, several members of the obstetrics team provide their thoughts on UCSF's approach to pregnancy, labor and delivery, and what the life-altering experience of childbirth will look like at the new UCSF Women's Specialty Hospital at Mission Bay. They are:

  • Judith Bishop, CNM, MPH, certified nurse midwife and professor in the Division of Maternal-Fetal Medicine
  • Elena Gates, MD, chief of general gynecology in the Department of Obstetrics, Gynecology and Reproductive Sciences
  • Mari-Paule Thiet, MD, chief of obstetrics at UCSF Medical Center and director of the Division of Maternal-Fetal Medicine
  • Sharon Wiener, RN, MPH, CNM, certified nurse midwife and professor in the Division of Maternal-Fetal Medicine

Q: How would you describe UCSF's overarching approach to pregnancy and childbirth?

"This depth of expertise — from midwives and doulas to neonatologists and fetal surgeons — makes us comfortable allowing women to labor their way, because we know we can handle anything that comes up." – Gates

Thiet: The UCSF obstetrics team welcomes and encourages an open dialogue for patients' birth experiences, and we invite and seek to acknowledge everyone's unique perspective. Our labor and delivery nurses and personnel are dedicated to providing an individualized birth experience that focuses on family-centered care. We look forward to bringing this team approach to the new UCSF Women's Specialty Hospital at Mission Bay, where collaboration will be at the core of everything we do.

Gates: One of the things that is special about UCSF is our expertise across so many areas. This depth of expertise — from midwives and doulas to neonatologists and fetal surgeons — makes us comfortable allowing women to labor their way, because we know we can handle anything that comes up. Labor is not a disease, and while things can happen to complicate the matter, most of the time it is a perfectly natural process.

Bishop: We like to think of ourselves as a "one-stop shop," of sorts, meaning we are equipped to care for everything from the low-risk to the very highest-risk pregnancies. This means that if you start with us, you never have to go anywhere else. Patients at the new hospital can rest assured that they will receive the best possible care no matter what develops.

Q: How will the new women's hospital at Mission Bay help facilitate this approach?

Thiet: The Mission Bay hospital will enable us to continue doing everything we do now but even better in a beautiful new facility. The on-site helipad — a first for San Francisco hospitals — will ensure pregnant women experiencing major complications receive the best available care faster. As part of a fully integrated hospital complex, patients will have access to multidisciplinary teams offering patient-centered treatments, and there will be a seamless transition for babies needing care at UCSF Benioff Children's Hospital. And as an academic hospital, we will continue to have the great advantage of involving some of the best medical residents in the country.

Gates: The obstetrics program at Mission Bay will benefit from being part of the larger UCSF Women's Specialty Hospital, which will offer complex reproductive and gynecological services with a focus on minimally invasive surgery. Every aspect of the new hospital has been designed to be patient and family-centered, with lovely gardens right outside the rooms, spa tubs in every labor room and space to accommodate whomever patients choose to support them during their stay. Women who need to be hospitalized during pregnancy will be on a special unit with green space and lounge areas, so patients can meet one another and build community.

Q: What are some programs that set UCSF apart from other facilities?

Wiener: Our nurse midwife group has created several programs that increase patient satisfaction and deliver excellent care. The Centering Pregnancy Program takes women out of exam rooms and into groups for their prenatal care. The program enrolls groups of eight to 12 women with similar due dates and has them come to the clinic at the same time. The magic occurs when we sit in a circle and discuss anything and everything related to pregnancy, breast-feeding, labor pain and coping during the postpartum period. This really empowers our patients and can lead to a better pregnancy and birth experience overall. We also have a lactation task force, an outpatient lactation clinic and lactation consultants at the hospital to support breast-feeding mothers. These services have helped UCSF become the hospital in the area with the highest exclusive breast-feeding rates. Finally, we designed the voluntary doula program to offer support for patients who are alone during labor and cannot afford to pay for private doula support. We look forward to expanding and building upon all of these programs at the new hospital.

"We get as excited about healthy normal birth as we do when a high-risk mom goes through pregnancy and delivery in stable condition and has a healthy baby." – Wiener

Bishop: We also are the only hospital in California and one of very few in the country to offer nitrous oxide as an option for labor pain. This is a less invasive and lower-tech alternative to an epidural that can be self-administered. It is something that has been routinely used for decades in Great Britain, Canada, Australia and Scandinavia. We will continue to have this option available in every labor room at Mission Bay.

Q: How does the OB team determine what interventions will be used during labor?

Wiener: If intervention is needed, it is available here, from the most routine to the most complex. When interventions are used, there is not one person who makes the decision. We have ongoing discussions about the progress of each patient and closely collaborate with our anesthesia and nursing staff. In case of emergency, we have an anesthesiologist on the unit at all times so we can act very quickly. But we get as excited about healthy normal birth as we do when a high-risk mom goes through pregnancy and delivery in stable condition and has a healthy baby.

Gates: We offer the full range of intervention options, such as epidurals and other pain medication, however our deep expertise makes us comfortable not pushing intervention. We are very committed to vaginal birth, and we are very successful doing vaginal deliveries after C-sections.

Q: How does a patient's family factor into the labor and delivery experience?

Wiener: We can only deliver the excellent care that we do because of the importance we place on communication. Respecting the time needed to make plans with patients and families is key to successful outcomes. We have patients who come in to labor and delivery with detailed birth plans, and yet even when things don’t go according to plan, they feel great because they were heard and respected.

Thiet: We are all-inclusive and recognize the importance of including the family in the childbirth experience. We have established a culture here that truly respects birthing women and their families as key members of the decision-making process. We are committed to partnering with our patients from the time they come in for their first prenatal visit to the time they leave the hospital with a healthy newborn. We are so excited to continue nurturing this partnership in a brand new world-class facility.

Read more about the labor and delivery rooms at Mission Bay.

About UCSF Medical Center
UCSF Medical Center consistently ranks as one of the top 10 hospitals in the United States. Recognized for innovative treatments, advanced technology, collaboration among health care professionals and scientists, and a highly compassionate patient care team, UCSF Medical Center serves as the academic medical center of the University of California, San Francisco. The medical center's nationally preeminent programs include children's health, the brain and nervous system, organ transplantation, women's health and cancer. It operates as a self-supporting enterprise within UCSF and generates its own revenues to cover the operating costs of providing patient care.

Follow UCSF Medical Center on or on Twitter @UCSFHospitals.

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