One Overlooked Detail That Could Improve Postpartum Health

The story of my birth has reached mythological proportions in my family. Much of it is probably hyperbole, but two facts remain: I was a bold and lengthy 10-pound baby, and a woman named Maica delivered me on my parents’ own bed.

Maica, the town midwife, is now 101. The deep wrinkles in her face resemble a complex roadmap, with each line and intersection sharing a story from a time when most births took place right at home. I recognize my own story on Maica’s sage face. And I will always remember her name.

Today, I am an obstetrician who specializes in high-risk pregnancies. I have helped countless women with complex medical problems achieve healthy pregnancies and deliveries. And I vividly remember the first time I welcomed a baby into the world. Her tiny fingers grabbed mine with a surprising strength. My heart raced. I’d found my calling.

I remember that baby’s name, and she remembers mine. I doubt that’s the case for many of the other babies I’ve delivered over the years.

To prevent medical errors related to provider fatigue, our health care system has adopted a model in which physicians are scheduled to work pre-designated shifts for a limited number of consecutive hours. And for safety reasons, we generally discourage home births. In the U.S., babies born at home ― even when those home births are planned ― are almost 2.5 times more likely to die than those born in the hospital. Furthermore, maternal mortality in the United States has risen despite improvements in health care. The exact reason for this increase is complicated but is likely at least in part due to mothers having babies later in life and entering pregnancies ― both planned and unplanned ― with previous health complications, such as obesity and other chronic illnesses.

That said, communication failure is another contributor to maternal mortality. Today, the physician who cares for a patient during pregnancy may not be the one who performs the actual delivery or treats the patient afterward. In the labor and delivery unit especially, patients are often cared for by a team of providers and experience multiple shifts in personnel during their stay. This can make it difficult to recall the names of their various providers.

In this high-tech era, it is increasingly important for physicians to personalize care, and I wanted to learn if remembering a physician’s name could be related to patient outcome. In the study I recently published in Maternal Child Health Journal, “Whiteboard Use in Labor and Delivery: A Tool to Improve Patient Knowledge of the Name of the Delivery Provider and Satisfaction With Care,” nearly every postpartum woman I surveyed ― 96.6 percent ― said it’s important she know the name of the physician who delivered her baby. However, only 20.8 percent of the women in my study actually knew the name of their own delivery physician. I confess I was somewhat disappointed by this.

The good news? When care teams used dry-erase whiteboards to keep track of their names, roles and patient care information, the number of women who recalled the name of their delivery physician increased by 43 percent.

But remembering a physician’s name simply for the sake of remembering a name isn’t the primary issue here. Patients who recalled the name of their delivery physician expressed greater satisfaction with their care, and patient satisfaction is a pillar of patient care; it’s been linked to higher quality of hospital care, reduced hospital readmission rates and decreased inpatient mortality. In my research, patients who were more satisfied with their care were also more likely to attend their postpartum visit ― a medical checkup that typically takes place one to six weeks after the birth, depending on the patient’s medical history and complications. This visit gives the physician an opportunity to identify potential problems that could affect the woman’s well-being and ensure the mother is recovering well.

There are many reasons why postpartum patients don’t recall the name of the doctor who delivered their baby. For one, “pregnancy brain” is a very real thing. It is well-documented that pregnant and postpartum women experience memory difficulty. Furthermore, the average woman interacts with an overwhelming number of health care providers throughout a pregnancy, delivery and post-delivery, and this can cloud her memory. These providers may come from a variety of backgrounds, and their names may be difficult to pronounce or accurately recall.

I know this last part from personal experience; some patients have trouble remembering my last name. To help them, I’ll give them my business card or share the story of my pepper-selling ancestors (Pimentel comes from “pimenta,” which means “pepper” in Portuguese). Some women will still forget my name, and that’s OK. It’s more important they remember the quality of care their physician provides.

I don’t claim remembering my name will directly translate to patient satisfaction, appointment keeping, care compliance or lower mortality. I wish it were that simple. Still, a woman’s ability to recall her delivery physician’s name is indicative of the quality of the doctor-patient relationship, and the stronger this relationship is, the more likely the patient is to experience a positive health outcome.

The United States has the worst maternal death rate in the developed world, but we spend the greatest number of health care dollars per patient. The reasons for our maternal death rate are complex and will require multiple interventions. Still, there are simple, low-tech and low-cost approaches we can use ― like a dry-erase whiteboard ― to improve communication between providers and patients (and among providers, for that matter). Better communication in turn enhances the patient experience and improves health outcomes.

This past summer, I heard someone shout my name from across the street. When I turned, I saw a smiling woman holding her child. “Dr. Pimentel, come meet our baby!” she called out. A few seconds passed before I recognized my patient without her pregnant belly and ill-fitting hospital gown. As I held “our” baby girl, I recalled how she and her mother almost died from high blood pressure complications.

Few things make me feel more personally and professionally satisfied than moments like these. While I may never be remembered with the similar affection as the centenarian midwife who delivered me, I will consider it a success if, in a very distant future, one of the babies I have delivered sees her story in my wrinkly face.