Night Float Schedule vs Traditional OB Call = Improved Obstetric Outcomes?

As a result of mandatory work hour restrictions, residency programs have moved from the traditional call schedule, where they worked up to 36 hours at a time, to a night float system with distinct day and nightime shifts similar to the ones nurses have worked for years.

While no work restrictions exist for attending physicians, some obstetric attending practices are moving towards a night float system similar to that of the young doctors they supervise, with some not-so-surprising changes in labor management and patient outcomes.

When a 6 person academic OB generalist practice at Northwestern University’s Feinberg College of Medicine changed from a traditional call schedule to a night float system, there were  –

• Less inductions;
• More labor augmentation with pitocin;
• Less manual extractions of placentas;
• Less episiotomies;
• Less 3rd and 4th degress lacerations;and
• Improved neontal unbilical artery pH (A sign of fetal well-being)

Of course, this is just one small study in a single practice, and the results may not be generalizable to other practices in other settings. But it makes sense. If you’re not worried about getting some shut eye, you’re less likely to feel the need to use induction to move deliveries to daytime, more likely to move along a night time stalled labor with a little pitocin, and more likely to wait for the perineum to stretch fully and the placenta to take it’s sweet time to deliver.

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Type of Attending Obstetrician Call Schedule and Changes in Labor Management and Outcome. Barber, Emma L. MD; Eisenberg, David L. MD; Grobman, William A. MD, MBA. Obstetrics & Gynecology: December 2011 – Volume 118 – Issue 6 – p 1371–1376

Image – Van Gogh’s Starry Night from Wikimedia Commons