This article is part of Improving Birth’s “Care You Can Trust” campaign–identifying, describing, and honoring great care and great care providers. To see photos and examples from mothers about their own experiences with great care, CLICK HERE, and to read our article “12 Signs You Can Trust Your Care,” CLICK HERE.
“I value people. Therefore, I see my role as more than a technician. Creating a healing environment where a patient feels like she is heard and understood is important to me. When I combine this environment with up to date, evidence-based care, I am able to provide the best care possible.” – Dr. Peter Chandler
Since 2007, Dr. Peter Chandler has been the Medical Director of Obstetrics and Gynecology at the Natividad Medical Center, a teaching hospital in Salinas, California that serves a high proportion of people on Medicaid. He and his colleague Dr. Caleb Liem are credited with transforming the way the department cares for women and babies; it has been “Baby Friendly” since 2013 (thanks to Carole Swain, Lactation Services Coordinator) and is now in the process of becoming “Mother Friendly”—an esteemed designation that means practices meet the highest standards for being evidence based and family centered.
Natividad’s nurse supervisor for labor and delivery said in the Monterey County Weekly (2010), “When Dr. Chandler and Dr. Liem came here, it just felt like everything clicked into place. It’s progressive; it’s evidence-based.”
[box] Can you imagine switching doctors and hospitals in labor? Well, that’s what one woman did when her doctor went out of town unexpectedly and she wasn’t comfortable with how inflexible that hospital’s policies were. Dr. Liem welcomed them to Natividad when she and her husband called during labor, and was there when she delivered a healthy baby girl… in the dark. Read the full story here.[/box]
We contacted Dr. Chandler and Dr. Liem for our #CareYouCanTrust campaign. Dr. Chandler told us that one of the most influential experiences he had about patient care took place at a clinic in Washington State, where he said, he began to understand the importance to the community of safe maternity care systems. He worked closely with eight “tremendously experienced and passionate” midwives. He said, “[T]hey taught me that the process of birth was as important as the safety and quality initiatives I was working so hard on. I now understand that excellent obstetrical care is not less than great outcomes but includes a birth experience that honors the wishes of each woman.”
[box] “If I had been at any other place they probably would have done a C-section. They were just so patient. They met my every need, emotionally and physically.” – Sara Phelps, Monterey County Weekly (2010)[/box]
He took that experience to Natividad in California, where he, Dr. Liem, and their colleagues have been “relentlessly pursuing excellence.” Here are some of the highlights of the model they have developed:
Vaginal birth after Cesarean (VBAC): Natividad is the only facility in the area that welcomes mothers planning vaginal births after Cesarean, and VBAC has been offered since 2009, when Dr. Chandler and Dr. Liem spearheaded efforts to make it
available. “We’re watching our C-section rates fall while the rest of the country’s trending up,” Dr. Chandler said. Supporting VBAC is not only an ethical practice—since the alternative is mandatory surgery policies—but it is also a major public health benefit, helping to prevent more serious health complications and riskier pregnancies down the road from multiple Cesareans.
Immediate care, always: The hospital features 24/7 coverage for all obstetric needs. Dr. Liem said, “Having the same provider work full time in the office, yet be available 24/7, is unsafe, especially in a busy practice. We all know that when a provider is fatigued and sleep-deprived, there is increased chance of making errors. Theoretically, there may also be a tendency to resort to c-sections sooner for prolonged labors.”
At Natividad, “fresh” providers come in every 24 hours, providing continuous coverage of labor and delivery, anesthesia, and the Neonatal Intensive Care Unit (NICU).
Keeping sick babies with their moms: Natividad contracts with the University of San Francisco to provide two neonatology specialty physicians, so that even the smallest babies can stay at Natividad with their mothers for excellent NICU care, rather than risking a potentially dangerous transfer to another facility. Mothers are encouraged to touch, hold, and breastfeed their sick babies.
Support for women who give birth at home: The hospital consciously facilitates transfer of care from the home to the hospital when it is needed or wanted. Licensed midwives in the community all have a direct phone connection to the obstetrician on labor and delivery.
Support for midwifery care in the hospital: Certified Nurse Midwife Jamie Meyerhoff practices at Natividad.
Support for individualized, woman-centered care: Doulas are encouraged for every patient, and are even welcome in the operating room. Birth plans are also encouraged: “Birth plans help us identify what women value in labor,” said Dr. Chandler. “They help us meet their expectations, facilitate communication, and help the patient think through what they desire.”
Support for breastfeeding: A 7-day-a-week lactation outpatient clinic provides help to women when they need it, promoting healthy starts for babies.
[box] “Dr. Liem treated me and my family (and my homebirth midwives) with absolute respect and compassion when I decided to induce labor. I am forever grateful that he was there at my son’s birth when it moved from home to hospital.” Read the full story here. [/box]
We know that one of the best insights into a provider and hospital is its reputation among local doulas—the firsthand witnesses of how births go, start to finish, and the sounding boards for women giving birth. Here’s what one doula and childbirth educator, Gail Root, M.A., had to say: “[Dr. Chandler] has positively changed the culture of the Labor and Delivery system there. [In the recent births I’ve attended] the entire staff was considerate, kind, respectful of the laboring woman. They asked for the birth plan and reviewed it with the parents. They welcomed me as a doula, as part of the team! This was a new experience for me! However the birth evolved, the joint (family and staff) decisions were made, there was an amazing attitude of respect and empowerment for the laboring woman.”
Another doula, Kat Ogletree, relays that at the first Improving Birth rally—right in front of the hospital—Dr. Liem approached her and asked what was going on and who was in charge. By the time she returned from getting a cup of coffee, he had joined the rally, holding a sign next to local home birth midwife, Maggie Bennett. Kat said, “I liked him a lot before, but after that, I loved him.”
All those efforts to pursue excellence in patient satisfaction and clinical care have paid off. Natividad is one of just two hospitals in the state of California that have been awarded the Beta Health Safety Award each of the last 6 years. It consistently beats state rates for important markers like primary Cesarean section (at 13.4%) and vaginal birth after Cesarean (22.9%). Their track record shows that great outcomes are achievable in “at-risk” communities: that supportive, respectful, evidence-based care WORKS.
Natividad’s track record shows that great outcomes are achievable even in “at-risk” communities: that scientific care delivered in a supportive environment WORKS. Improving Birth salutes Dr. Chandler, Dr. Liem, April Ritchie (Director of Women’s and Children’s Services), and everyone else at Natividad Medical Center for modeling how respectful, evidence-based care fosters healthier families and communities.
Dr. Chandler was recognized by California’s Monterey County Board of Supervisors in November 2014 for his dedication and service as a member of the Natividad Medical Center Board of Trustees, saying, “Peter J. Chandler’s credentials and experience in obstetrics and gynecology were tremendous assets to the Board providing oversight of the development of this vital clinical service line while focusing on respect for patient choices.”