White paper: Safer births, stronger systems
How the OB hospitalist model grew over 25 years into a core part of maternity care, and where it goes next.
The gap
Maternity care has more to deliver than the system was built for
Obstetric medicine has advanced, but outcomes have not kept pace. Pregnancies are more complex, clinicians are in shorter supply, and units are closing.
- 17.9 maternal deaths per 100,000 births in 2024, up from 10 in 1990. Rates have risen since the late 1990s.
- 537 U.S. hospitals lost obstetric services between 2010 and 2022, including 238 rural and 299 urban hospitals (JAMA, 2024).
- 2035 is the year all but six states are projected to have an OB/GYN shortage. Rural areas face the sharpest shortfall.
A more complex patient population
Between 6% and 8% of women in the U.S. have high-risk pregnancies each year. More patients arrive with hypertension, diabetes, obesity or cardiovascular disease, and more give birth at older ages. The average age of first-time mothers rose from 21 in 1972 to 27.5 in 2023.
The traditional on-call model, where a community obstetrician travels in from home or clinic, no longer consistently meets today's expectations for patient safety and speed of response. Burnout among OB/GYNs ranges from 40% to more than 75% across studies, and nearly half of U.S. practicing physicians are over 55.
The model
An obstetrician in the hospital, at every hour
An OB hospitalist is a physician whose primary focus is hospitalized obstetric patients. OB hospitalist programs work alongside community OB/GYNs and do not replace them.
| Immediate availability | 24/7 on-site coverage allows rapid response to obstetric emergencies. |
| Team coordination | Continuous physician presence strengthens communication across the labor and delivery team. |
| Workforce sustainability | Inpatient coverage reduces the call burden on community physicians, supporting recruitment and retention. |
| Standardized care | Hospitalists lead clinical protocols, simulation training and quality improvement. |
| Hospital performance | Clinical leadership supports efficient operations, risk management and stable maternity services. |
The OB emergency department (OBED)
Historically, nurse triage evaluated unscheduled obstetric patients and consulted a clinician by phone, which made labor and delivery the only emergency location where a qualified clinician did not consistently see patients.
With an obstetric emergency department (OBED), introduced by OBHG founder Chris Swain, MD, in 2006, a physician or certified nurse midwife and an OB nurse see any patient with an emergency condition at any stage of pregnancy, including the postpartum year.
Read the full white paper
Thirteen pages on the history, evidence and future of OB hospitalist programs in the U.S. Download the white paper.
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