Office Delivery

When it comes to delivering babies, many a doctor in a sparsely settled section of the U.S. finds himself between the devil and the deep blue hills. Some patients have so little cash income that if the doctor sends them to a hospital, there is nothing left to pay him. On the other hand, the thought of kitchen-table deliveries fills him with horror.

In the current General Practice, Dr. David G. Miller and his wife, Registered Nurse Blanche Miller, describe some of their experiences in the 19303 around Morgantown, Ky. (pop. 859): "Long trips over poor or nonexistent roads, often time after time when the labor was long; the long hours spent in a lamplit home, with a flickering log fire that barely warmed our shins and left our backs freezing . . . Often we had been forced to change the mother's gown and bed and to improvise diapers, bands and clothing for the baby who had already been greased . . . We had even cooked and served meals . .."

More Cleanliness. Much of the doctor's and nurse's time spent this way could far better have been spent on other patients, the Millers contend. And there was the matter of personal cleanliness: ''We wished to avoid the constant and real threat of bedbugs, fleas and other insect pests which we had brought home .. ."

The Millers found a way to get around the disadvantages of both home and hospital deliveries. They got the idea after a few women had come to the office so far advanced in labor that they had to be delivered there as emergency cases, then sent to relatives. Why not make this a regular practice in cases where no complications could be foreseen?

Dr. Miller and his wife fixed up two rooms in their offices, one as a labor room, the other for the actual delivery. Patients were encouraged to go to the office as soon as definite labor began. The doctor thus had a chance to examine them and keep tabs on their progress far more easily than he could have elsewhere; he was left free to see other patients most of the time, and often he could get four to six hours' sleep in his own bed, instead of having to catch catnaps in odd corners.

More Confidence. Patients feel more confident under their system, the Millers report, because they know that emergency equipment and other doctors are at hand if needed. The doctor feels more confident, too, because "most obstetric errors are caused by haste on the part of the attending physician. Usually this haste is the result of anxiety to return home to bed or a desire to rush back to an office full of patients."

Only two hours (on an average) after an office delivery, mother & child are sent home in an ambulance. After 50 such cases, with no maternal or infant deaths and few complications, the Millers are confident that office deliveries are often just what the country doctor should order.

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