Hospitals that want safer maternity care need continuous, on-site obstetric leadership. The OB hospitalist model has grown into one of the most established ways to provide it, and Ob Hospitalist Group (OBHG) has helped lead that growth for 20 years.
This year, as we mark our 20th anniversary, our new white paper, Safer Births, Stronger Systems: The 25-Year Evolution of the OB Hospitalist Model, looks at how the model developed, what the evidence shows, and what it means for hospital leaders today.
The safety gap is a systems problem
Prenatal diagnostics, fetal monitoring and critical care have all advanced, yet maternal outcomes have not kept pace. Maternal mortality in the U.S. has been rising since the late 1990s, and complications are increasing. A 2020 BlueCross BlueShield analysis found that between 2014 and 2018, pregnancy complication rates rose more than 16% and childbirth complication rates rose more than 14%.
Patients are also more complex. The average age of first-time mothers reached 27.5 in 2023, and more women enter pregnancy with conditions such as hypertension, diabetes and obesity. A 2015 study found that 17% of adverse events in a labor and delivery unit were related to healthcare management and potentially preventable.
Why the traditional model is strained
Obstetric care has long relied on community OB/GYNs who split time between clinic, surgery and the hospital, covering nights and weekends from home. That model served patients and physicians for generations. It is harder to sustain now.
Emergencies such as postpartum hemorrhage, shoulder dystocia, umbilical cord prolapse, placental abruption and eclampsia develop quickly, and a physician traveling from home has limited time to respond.
At the same time, burnout among OB/GYNs ranges from 40% to more than 75% across published studies. A January 2026 study in Obstetrics & Gynecology projects that all but six states will face an OB/GYN shortage by 2035.
From one physician’s “aha” moment to a national model
In 2006, Christopher Swain, MD, founded OBHG after a middle-of-the-night epiphany. As he recalls, private OB/GYNs were disturbed at all hours and sometimes managed patients by phone without seeing them, and delays in care can be serious.
Twenty years later, that insight still drives our work. In the same year OBHG was founded, Dr. Swain introduced the Obstetric Emergency Department (OBED), a 24/7 model based on the internal medicine hospitalist approach. Traditionally, nurses in labor and delivery triaged unscheduled patients and consulted a clinician by phone, which made labor and delivery the only emergency setting where a qualified clinician did not consistently see the patient. In an OBED, a physician or certified nurse midwife and an OB nurse evaluate any patient with an emergency condition at any stage of pregnancy, including the postpartum year.
From the start, these programs were designed to complement community obstetricians, not replace them. Hospitalists cover unassigned patients, emergencies and inpatient care, while community physicians continue to provide prenatal care and deliver many of their own patients.
Today, OBHG’s more than 2,000 clinicians partner with local OB/GYN physicians in that collaborative, non-competitive spirit.
Immediate response depends on presence
Obstetric conditions can change quickly, and the time between recognizing a problem and acting on it matters. OBHG Chief Medical Officer Mark Simon, MD, notes that having a physician physically in the hospital at all times allows the team to respond right away when a patient needs care.
That presence benefits the whole unit. OB hospitalists lead standardized protocols and simulation training, strengthen communication across the care team, and support community OB/GYNs with continuous inpatient coverage.
Looking ahead
Our 20th anniversary is a chance to thank the hospital partners, community OB/GYNs, nurses and clinicians who made this model work. It is also a reminder of how much remains to be done. As hospital partnerships expand, community OB/GYNs and OB hospitalists can work together on evidence-based practices that improve outcomes for mothers and infants, while helping hospitals maintain quality obstetric services amid clinician shortages.