Labor and delivery trends in Central PA (full transcript)

Leslie Penkunas: How does Pinnacle’s birthing center or hospital laboring room differ from what it might have looked like 15 to 20 years ago?

Dr. Oken: We’re in the process of just building a new unit. It’s scheduled to open in the next several months. I’ve been practicing for 25 years, and I think initially patients often were moved from a labor room into an OR or into a different room. Now pretty much people labor and deliver all in the same room. We encourage more family members to be present, and visitors, if they should want people to accompany them. So it’s been really made to be more patient friendly and less, I’d say, sterile. And most of our rooms have Jacuzzi tubs.

Penkunas: Is that for laboring? Is that for relaxation?

Dr. Oken: Laboring. We don’t do water births at Pinnacle. But they encourage it throughout labor for comfort measures. A lot of patients get some relief by going in the tub. So pretty much most all of the rooms do have Jacuzzi tubs.

Penkunas: Is that something that a patient would request specifically before going in, or is it just the luck of the draw?

Dr. Oken: I’d say even in our new facilities, all but one room has a Jacuzzi tub it. The other thing is, I think just for layout, we have developed a ‘hospital within a hospital’ concept. Patients will have one elevator to come up to labor and delivery, so they don’t have to traverse the entire hospital.

Penkunas: That’s good.

Dr. Oken: The parking and everything will be made easier. They can come right in, go right up and not have to deal with the rest of the hospital. During the night, the middle of the night, they used to have to come to the emergency room. They don’t have to do that and they also stay on one floor. So they’ll have their babies and be moved to post‑partum. On top of the Alex Grass Building, there is a brand-new, 39-bed, post‑partum facility. With those rooms now, it has been significantly changed.  Post‑partum, that is a big thing.

Penkunas: How is that?

Dr. Oken: Those have been made much larger to accommodate patients and their families. One of the biggest complaints [from patients] that we had in looking at developing the new unit was that for the spouses and their family, there is no room. Often they pull out a chair with very little space for the people who are their support people, their significant other that was staying with them. Now, it’s much larger and much more patient-friendly. A big change over the last 25 years is that babies really stay with the mother the entire time. We strongly encourage rooming in. The nursery, where it used to occupy a certain amount of square footage, has now really shrunk down. The only babies that go to the nursery are patients that their babies need to be there. The mothers have medical complications that prevent them from keeping the babies with them. So that is a big change.

Penkunas: I’ll say. I remember when I had both of my kids—different hospitals, different states—but at both they’d say, ‘Do want the baby to stay with you? Or we’ll take him, we’ll take her.’ The first time I said, no, I want him to stay. The second time, I’m like, oh, yeah, just take her and let me rest while I can.

Dr. Oken: It’s really not even a question anymore. It’s pretty much standard that the baby is staying unless, you know, they had a complicated C‑section, or a complicated delivery or they had an issue and they can’t care for the baby.

Penkunas: Is that what you encountered, Carley?

Carley Evans: Well, I’m thinking about the labor and delivery with the Jacuzzi tub. That saved my life I feel like. I definitely took advantage of that, because I labored at UPMC right down the street and then we had Mack in the room with us. We just had our baby in June.

Penkunas: The rates of women waiting until they’re in their 30s to have a child have been trending higher and a number of them, are of ‘advanced maternal age,’ over 35. I was one of those with both my pregnancies. Are there special considerations in place for those of advanced maternal age during labor and delivery? It’s been 14 years since I had my daughter. And there were lots of things one could do to exercise and relax. I couldn’t do anything, because I had monitors attached to me and tethering me to the bed. Has any of that changed?

Dr. Oken: Yeah, a lot of changes. There is probably less monitoring. There are portable monitors where the patient can ambulate with the monitor on them, if need be. But I think we realize that not every patient has to be continuously monitored just because they’re 35. You know, certainly a patient in advanced maternal age may have more medical risk factors and more associated issues—diabetes, high blood pressure. They may be higher risk pregnancies, but it doesn’t necessarily translate into they have to be continuously monitored, stuck to the bed the entire time.

We strongly encourage patients to ambulate, get up and move around in the tub. That’s definitely changed. With these portable monitors, the patient can get up and move around, get up from the chair. Even if they do have to be continuously monitored, they’re still able to get around. The other thing is with more patients waiting longer, these patients tend to be much more educated, too.  They’ve done their homework. They know what to expect. They have certain expectations from our end, too. So we have to try and accommodate what they want. There are a lot of birthing balls and things, different positional changes that you can do.

We encourage people. If they have a particular plan or they have a request, there are very few things we can’t do. I mean, there are very few things we won’t accommodate. If something is completely off the wall. I think most of the time we can work with the patient as long as it’s safe. If it’s what they want, it’s not out of the question.

Penkunas: What changes or trends maybe have you seen in pain management during labor in recent years?  Obviously the Jacuzzi in nearly every room. But what else have you seen?

Dr. Oken: We have a huge change for us, which is not new nationally, but we’ve recently added nitrous oxide as an option. This is something in the last several months that we’ve added. We know the nitrous oxide doesn’t really change the rates of epidurals and other pain modalities they’re going to use, but it is just an added option that they have. I’ll be honest with you. I was pretty skeptical at first, but I’ve seen patients get off their labor and delivery with nitrous oxide.

It’s also helpful for after delivery, if they have not had any anesthesia, not had an epidural. It can help with repairs and sometimes delivery of the placenta. Sometimes they require a little bit of extra pain management. [Nitrous oxide] is just enough. I think it gives them a sense of control when they use the nitrous oxide.

Lucas: I used an epidural.

Penkunas: I definitely would have used it. I mean, I probably would have used [the nitrous oxide] in addition to an epidural. But before, just for the anxiety, for just the calming, right?

Dr. Oken: It’s been really helpful early on, but I’ve had patients here I would have sworn would have gotten an epidural and used the nitrous all throughout.

Penkunas: Wow. The nice thing about that is — and I know from having my son without having an epidural — that if you don’t have an epidural, as soon as the baby is born you can get up. You can go to the bathroom. You can walk around. You don’t have to worry about waiting for an epidural to wear off.

Dr. Oken: The nitrous oxide gives the option. It doesn’t prevent you from getting anything else. You can get an epidural right after it. It’s a very short half-life. There are very few risks or complications and, again, patients have control over it. They can do it when they want it. It’s been a nice adjunct. It’s been a nice addition since we really haven’t had anything new for years, besides IV pain medication, epidurals.

We also have patients that do HypnoBirthing, which is another new thing. It’s been offered through the childbirth education area of Pinnacle. They do a great job with that. But, again, I think just giving patients additional options, knowing that they don’t have to — it doesn’t have to be all or nothing. It doesn’t have to just be an epidural or nothing. I think pain management in labor and delivery has been a little bit behind the times. The nitrous oxide is not new. It was around years ago and it’s kind of made a comeback nationally. But, again, in the beginning, I kind of didn’t buy into it. But for certain patients, it seems to be a great option. It’s much safer too. It’s 50/50. The dosage is not what you get if an anesthesiologist would give it to you. It’s a mixed dosage with options.

Penkunas: Do the laboring women —

Dr. Oken: It’s self‑administered. They stop and start.

Penkunas: They’re taking control over it.

Dr. Oken: Right.

Penkunas: That’s huge.

Dr. Oken:  And then we see a trend lately towards some patients doing, you know, laboring without any pain medication, which I find —

Penkunas: More power to them.

Lucas: Yeah.

Dr. Oken: If that’s what they want to do, it’s great, but that’s —

Lucas: I would not do that.

Penkunas: I’ve done no pain medication. I’ve done epidural. I enjoyed the epidural.

Dr. Oken: I’ve seen thousands of births. I don’t know how they do it, but they do it and I think, again, it just gives them self‑control.

Penkunas: Well, that makes sense. Like I said, there are benefits to not having the epidural and that’s just the immediate aftermath.

Dr. Oken: At Pinnacle, we don’t have walking epidurals. You really can’t move around. So, right, it gives you all these other options. It gives you options. Even if you get IV medication, you’re really not going to get up out of bed after that. These other things give you definite options.

Penkunas: I think you answered one of my questions. Are more moms-to-be designing their own birth plans, and have you seen those birth plans change in recent years?

Dr. Oken: Certainly there is a large percentage of patients that will go online and just pull up a birth plan, not really sometimes knowing what’s on the birth plan. So we see a lot more of just generic birth plans. But then you have people that have really tailored a birth plan to what they want. It kind of waxes and wanes. I think it was rare to ever see a birth plan 20 years ago. Now we see more and, again, most people, through childbirth classes or through the Internet, we’ll ask do we allow something.  Like I alluded to before, there are very few things within reason that — [addressing Carley] I don’t know if you had a special request — that we won’t allow.

Penkunas: I think she requested pain medication.

Lucas: I did. I have a friend that was in labor and delivery, a nurse at Pinnacle for a number of years.  She was at my shower and she asked me what my birth plan was. Because we have another friend of ours that is extremely particular. With her two boys, she had a particular music and [a request for] incense, or whatever it was, and, you know, somethings that were strange and off the wall and she’s very particular and very demanding. She’s sitting there through this entire conversation. I said, my birth plan is to go in, to make sure that the pain is managed, and to get the kid out safely. My husband and I want my husband to be there and that’s it. She said, that sounds about like the most simple birth plan that you can have. I’m pretty sure everybody in the delivery room is going to love you for it, because they get some pretty intense or specific requests.

Penkunas:  When should someone present their birth plan? How do they present it? And how does the hospital follow? How does that work realistically?

Dr. Oken: We encourage people to present the birth plans in the office certainly ahead of time, so it can be discussed with the provider and we’ll review it. In my particular office, we’ll actually pass it around so all the providers see it, look at it, sign off on it. We like to discuss it ahead of time. You know, it’s kind of hard when in labor you present a birth plan. The train has already left the station.

Along the lines of birth plans, I think the biggest thing with birth plans is flexibility. You know, and this comes up a lot. A first time mother will make a birth plan and really not know what she’s asking. And what she’s requesting is something she looked at online. [She will] put something in the birthing plan. ‘I don’t want any pain medication. Do not ask me about pain medication.’ The first thing they do when they go up to labor and delivery is they want their epidural. And they feel like they’ve been defeated. So flexibility is very important. The birth plan is not a contract. It’s a guide for us.

A lot of the things too that people are asking for now has become standard care. Delayed cord clamping — they want to hold their baby. We do skin-to-skin in well over 90 percent of our deliveries.  Skin-to-skin is a big thing. We know that it helps the baby afterwards transition. We know that it helps the bonding. That used to be a big thing. They wanted to hold them. They didn’t want anybody else.  They wanted delayed medication. A lot of these things are fine. They just need to be asked ahead.  Sometimes, I think, with the birth plan, too, is it involves other disciplines, pediatrician, the nursing staff. It has to be really discussed. It should be presented in the office with the provider so they can look at it. Then when you come in in labor, I like to ask the patient. Do you have special requests? Is there something that you really want? They’ll say the delayed cord clamping. They’ll say we want the lights down. We want it to be quiet or we want the father to announce the sex of the baby, things like that. So it’s just really communicating with the provider to make sure they know. Not, you rush in and you’re in the throws of labor and, oh, my God, my birth plan says I can’t get an epidural. There are patients that actually struggle with that with Pitocin. They want Pitocin, but they absolutely didn’t want Pitocin. Well, you didn’t know that you were going to be at five centimeters for five hours. Probably a good idea to get Pitocin. Communication is central.

Lucas: Pinnacle was very good with that with us, because there were things like delayed cord clamping.  I mean, that wasn’t something that we discussed it going in. For those that don’t know, delayed cord clamping encourages a more positive blood flow to the baby after birth before they cut the cord and that sort of thing. The cord is still attached for maybe five to seven minutes after birth, something like that. So there is still more of the natural blood flow coming from the mother to the baby.

Dr. Oken: They want to wait until it stops pulsing. Which, if you think about nature, it’s probably a little bit more natural to have this.

Lucas: Yes. And they asked if my husband wanted to cut the cord and that was just something that Kyle was not interested in. He was just like, ‘Nope, I’m good. I know that this is supposed to be a big moment for dad. But I just feel like I’m going to do something wrong.’

Dr. Oken: Yeah, and that’s the point too. If that’s part of the birth plan that the father does not want to be involved in the cord, that’s fine.

Lucas: Pinnacle, for us at least, was very good about as the situation of things progressed, ‘Do you want to do this or do you want to do that?’

Penkunas: Touching bases with you.

Lucas: Yes. You have a choice here at this time in the process. You have X amount of timeframe here.  We want to wait for you to have an epidural for a little bit. Okay. Do you want to sit in the Jacuzzi or do you want to walk around? While your husband is here, do you want him to take a leg while you’re pushing or do you want to just have the staff handle it and you want him to stay waist up or, you know, whatever it was.

Dr. Oken: Did you have a birth plan?

Lucas: We had talked about it with the OB. We had both, a midwife.

Dr. Oken: That’s another good point. Midwives. Patients may, as part of the birth plan, say they want a midwife. We have patients say they want a physician. So it’s really that kind of thing should be communicated ahead of time. Because the discussion that I would then pursue would be, okay, you want a midwife. Our group has two, soon to be three midwives. We have midwives on 70 percent of the time but not all the time. So if you wanted a midwife, we could plan and we would do it and then some say that they want a physician. Again, that’s something you’d want to communicate ahead of time. If she wanted a midwife to be at her delivery today, we would have a midwife on call. We may be able to work to get somebody there. But if she was going to be induced, we’d make sure you were induced when a midwife was on call.

Lucas: We had both. We were lucky enough to have both there.

Dr. Oken: There are some people that feel very strongly they want a doctor there, which for most births is not necessary. And there are some that say they want to do it more natural with a midwife. But a doctor is always on call. At Pinnacle there is always a doctor in labor and delivery 24 hours a day, seven days a week. If you’re with a private group, there is always a doctor on call regardless, even if there is a midwife there. There is a backup.

Penkunas: So it’s either going to be a midwife or a doctor? Or is there anybody else who might be delivering?

Dr. Oken: Yes, one or the other.

Penkunas: About 10 percent of women opt for midwives. Are you finding that percentage to be the same at Pinnacle or more or less?

Dr. Oken: The question too is when you say opt for midwives. We offer. At Pinnacle there are no sole midwifery practices. I’m not sure about Lancaster. But some hospitals nationally there are solely midwifery practices. They have physician backup. We work collaboratively with the midwives. You can choose during your pregnancy to just see a midwife. That’s fine. Within our practice, you could just see one physician. Knowing, though, when you come in in labor, he’s on call. Unless it can be scheduled. I don’t even know if you want to go down the whole road of their recent discussions about inducing everybody at 39 weeks.

Penkunas:  Yes. When I was induced for both of mine, one was a scheduled induction. Another one, I went into labor on my own and I’d still be in labor today if I hadn’t been induced. My body just doesn’t like to cough out kids on their own.

But when I was in the later stages of pregnancy with my son, I was put on bedrest because I had lost too much amniotic fluid. I still ended up going four days past my due date before my OB would schedule me. She said, ‘There is no point to induce before your cervix is ready.’ So even though I was on bedrest and she was very concerned about me losing the amniotic fluid, she wouldn’t do it. Now there seems to be not a 180 completely; they’re saying that it’s okay to induce early, that outcomes are better?

Dr. Oken: There is some data. We just had a speaker last week come in from Pittsburgh to speak about it. He was part of the study. It says that inducing patients at 39 weeks may, and I would definitely underline may, be safer. May be safer and actually reduce the C‑section rate by inducing at 39 weeks.  I think we have to take that with a grain of salt. In ACOG, which is American College of Ob‑Gyn, it still says that that’s not the standard. But that in certain cases, there may be some value in doing that.  We will not be inducing all of our patients at 39 weeks. I think more study needs to be done. It’s one trial. There were trials years ago that showed that there was a higher C‑section rate if you induce people. Now they’re saying there is a lower C‑section rate if you induce people. Again, I think you have to take it with a grain of salt.

Penkunas: Right.

Dr. Oken: And I think really that’s where it should be discussed with your physician. Are there other factors? Are there other reasons that you need to be induced? And the other thing is, is your cervix favorable? Do you have medical indications? And then again, it’s something that should be discussed with the physician. But at this point I don’t think anybody is saying that every person should be induced at 39 weeks.

Penkunas: So, C‑sections. They’re always a lightning rod for moms-to-be. They don’t want one. Or they do want one. I have friends who said, ‘Just schedule me for a C‑section.’ How has an OB’s approach to C‑sections changed over the last few years, if at all?

Dr. Oken: Having done this for, you know, 25, 30, years, it kind of waxes and wanes. Years ago there was a big trend to vaginal birth after C‑section, trial of labor after C‑section, and then we kind of got away from it and we saw the C‑section rate rise. I think in the medical legal climate you see the C‑section rate, depending on what’s going on there, you see more C‑sections being done.

With the C‑section rate right around 30 percent, we really feel that it should be lower. There are clearly cases that it should be lower. The VBAC, I think, it’s dependent on doing more of the vaginal births after C‑section in the right setting. That will help reduce the C‑section rate.

I think we would all universally like to see a lower C‑section rate. It’s just that there are a lot of demands. You talk about the advanced maternal age. You know, the AMA patients, their expectations may be a little bit different. Certainly a patient who is 40 years old in labor, some of those patients are requesting C‑sections.

Penkunas. Yes. I was going to say the one mom was 41 and she’s like, ‘Nope. You’re scheduling me for a C‑section.’ Months ahead of time she requested one.

Dr. Oken: Right. There is a place for on demand C‑section where patients can request it. I think we have to look at all the factors, but that plays into this somewhat. That’s rare. I don’t think we do one a week. We may do a couple a year. But then you also have patients waiting longer and have more medical complications so that’s going to increase the C‑section rate. The obesity issue nationally, globally, has increased our C‑section rate, no doubt. There are a lot of factors. But I think as providers, we have to do a better job of lowering that C‑section rate. We know that it’s probably safer to have a vaginal delivery, but there are situations where C‑sections are clearly indicated. But I think we’d like to see [the number of C-sections] somewhere between 20 and 25 percent. Getting there is difficult. But we’re being held to standards and we have to report these figures and we have a task force and we have work groups working, but I can tell you that’s a tough move.

Penkunas: You’ve already talked about the post‑partum rooms and how they’re bigger and they allow for more family members to be present. Have you found keeping the baby with the parents has resulted in better outcomes for the baby, as far as the next couple of weeks?

Dr. Oken: We’re a baby-friendly hospital. We strongly encourage breastfeeding. It probably increases the breastfeeding rates. I can’t speak to fetal outcomes. But certainly bonding is probably better. I think just the whole setup of being a much more family friendly and geared toward getting them to see what it’s going to be like when they go home.

Penkunas: My first night home with my son I —

Dr. Oken: It’s a nightmare.

Penkunas: It was. He was crying. I guess he wanted to be fed. He had a wet diaper.

Lucas: You don’t know what to do.

Penkunas: Right. So my husband is going to change his diaper and he said, ‘I don’t know what to do.  Show me.’

Dr. Oken: He’ll figure it out.

Penkunas: Exactly. I said, ‘I don’t know what to do. You know, he did not come with an owner’s manual.’ I think that had he been in the hospital room with us longer, we would have maybe had a little more comfort.

Dr. Oken:  Sure. I remember the tremendous amount of teaching and education that goes on. The amount of teaching and education that goes on the floor before the patient goes home between bathing, feeding, car seats, you know, safety things. How baby sleeps. They do all that stuff before, and the nurses are under a tremendous amount of pressure to get all this done before the patients leave.

Lucas: I was going to say the education process post‑partum, especially with the baby in the room, I think made us feel much better about taking the baby home. Anything from the simplicity of changing a diaper to caring for the umbilical cord. Our son was circumcised, so care for that. There is a channel in the hospital, a television channel, that has information on SIDS prevention. Things that you can do.  So, for instance, having a pacifier in is an indicator that the child might be a lighter sleeper. So when the pacifier pops out, they might wake up. But that’s a good thing for SIDS prevention. I know it’s not great for the parents, you know, just constantly waking himself up.

And Pinnacle, this is a safety thing that Pinnacle had us do that I was very surprised at. On the umbilical cord of the baby, there is an alarm that they put to prevent somebody from stealing your baby. That if they end up leaving the hospital walls, the alarm goes off and —

Dr. Oken: Everybody knows.

Lucas: Everybody knows. The other thing was that Pinnacle actually went as far as having us sign paperwork that we would not fall asleep while holding the baby and that was to prevent accidents and we have taken that practice into our home. We don’t fall asleep while holding the baby. Once you fall asleep and you’re not cognizant, motion, and that sort of thing, and so it prevents [suffocation]. They went through stuff like the bathing process with us.  They went over everything. I mean, so we were very well educated.

Dr. Oken: I remember when my baby, the first baby, was born. I obsessed over when is the cord falling off. When is the cord falling off? I have four daughters. I never had to worry about a circumcision, but we do the circumcision. But I tell patients, you know, there are many different ways to do it, but this is one way that I do it. You don’t have to obsess about the circumcision. If you do the cuoco clamp or you go home with the ring around it.

Lucas: We went home with both, yeah.

Dr. Oken: Right. So you’re obsessing about not only the cord falling but when is this thing coming off.

Lucas: And we had some risks. During my pregnancy, I tested positive for the cytomegalovirus [CMV]. Because my son during his 20 week ultrasound — had some calcifications on his liver. So we were sent to maternal and fetal and there were some complications there and that led us to a torch test, which — anyway long story short, I had no idea what this was when I went into the pregnancy, that CMV is something that is the thing that everybody has that nobody knows that they have. And so then we were concerned about his hearing and his vision and those sorts of things. That was a whole other education process before we went home. I was testing his hearing and his vision. There was some special care that was involved in that.

Penkunas: I guess vision is a little hard to test on a newborn.

Lucas: Yeah. We were referred to a pediatric ophthalmologist, but everything was good.

Dr. Oken: Everything was fine?

Lucas:  Yes.

Penkunas: More new moms in Pennsylvania are breastfeeding their babies. It’s up 10 percent from a decade ago. You’ve already addressed some of what might —

Dr. Oken: Right. Pinnacle has had a huge initiative over the last several years and was designated baby friendly — one of the first hospitals in the area designated that.

Penkunas: So what does baby friendly mean? What does the designation mean?

Dr. Oken: So just a huge educational piece in nursing care and physician care. Even the obstetricians were required to do educational pieces to educate them and make them aware of the benefits of breastfeeding. That there are better outcomes with breastfeeding. That worldwide breastfeeding is a huge initiative because of the health benefits. But within the system, to eliminate formula from the hospital. I shouldn’t say eliminate. It’s not promoted. Formula is no longer promoted.

Penkunas: So they don’t say, oh, are you going to breastfeed or are you going to use formula? It’s assumed that everyone is going to breastfeed unless there are complications.

Dr. Oken: You’re going to breastfeed. And the support that’s provided by a lactation consultant that is provided. Another huge educational piece that goes on while you’re there.

Lucas: Yes.

Dr. Oken: You talk about education. People who want to leave the hospital right away. You can stay after a vaginal delivery two days with the amount of education that has to be done, I’m not sure how patients leave within 24 hours, especially with the first baby. With the second or third, it’s a different story. But with the first baby, the amount of education, breastfeeding, all the other stuff, just there is not enough time.

Lucas: Yes.

Dr. Oken: The promotion that no longer occurs, diaper bags with a formula company, given by a formula company. Samples don’t exist anymore. The hospital eliminated that and that was in the hospital’s part, a big deal, too. Because financially they provided the formula. And some babies are going to still need formula. The hospital now has to purchase this formula and a lot of the physicians’ offices also have eliminated it. We used to give out formula samples and diaper bags from the formula company in our office. We no longer have them. And that’s been a pretty concerted effort on all parts to make this happen.

Penkunas: That’s huge. I had it. Until you mentioned that, I hadn’t remembered. But with my first child at GBMC [Greater Baltimore Medical Center] 16 years ago —

Dr. Oken: You got everything. The same thing goes for things like pacifiers. They are discouraged in the hospital. It probably hinders the breastfeeding.

Lucas: Less than a month you’re not supposed to use them.

Penkunas: And then after a month you give it to them to prevent SIDS.

Lucas: Yes.

Penkunas: And then when they’re 3 years old you want them to stop using them. We had to send them away to Santa. At first we tried to send them to a child who was more in need, but my son said that was gross so we sent them as a gift to Santa.

Dr. Oken: And then you find they have them hidden under their bed or crib.

Penkunas: Or if they don’t, you wish they did with that first night.

Dr. Oken: You have to keep them.

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Penkunas: With all the various changes in laboring and birthing, how receptive do you think hospitals have been?

Dr. Oken: That’s a great question. Hospitals have finally seen that women and babies are a huge area. They’ve always concentrated on the cardiac, orthopedics, and Pinnacle especially. Now you see Hershey just announced they are building a new unit. But women and babies are an area that really wasn’t focused on. It starts when you have a baby. Many people’s first contact with the hospital is having a baby, and [hospitals] have realized that this is an area that they need to focus on and spend money on and technologically I think we’ve been pretty good at it. Our new NICU, is going to be a 40-bed NICU.

When we went down to Mercy in Baltimore and looked at the new models for NICU care, believe it or not there were private rooms for the NICU. NICUs were always these pods of 10 or 15 beds. Now, we’re going to have private rooms, a 40-bed NICU. Even with a baby as young as 25 weeks, the family will be able to stay there.

Penkunas: That’s incredible. That’s such a huge commitment and dedication by a hospital because of the expenses.

Dr. Oken: Space, a huge expense. We have a very, very nice donor who made the donation for the NICU in the Alex Grass Building. Actually the Grass Foundation provided this new unit up there. It’s going to be state of the art — but really, it’s for the families. The hospital I think has recognized that women and children services are huge. You know, I think we had a decent facility. Now we’ll have a great facility.

Lucas: I was actually very impressed [with the current facility]. I was thinking that it would be just like a regular hospital room and it was a suite. So it was very roomy.  As soon as the baby was born, they had him testing vitals and giving Vitamin K shots and all that stuff in an area very close to me and then there was the bathroom suite with the Jacuzzi tub. Even when I was laboring and my husband couldn’t do anything, he was very comfortably sitting there watching the game on TV. We were very pleasantly surprised.

Dr. Oken: I think historically women and children’s services have been on the back burner. Pinnacle has been a leader in the field in the area with close to 4,000 births a year. Pinnacle has really made that commitment to stay there and keep the facilities. It’s been a passion of mine for the last several years to get this done and I think the administration. I think what you see on that end too is the donors.  People willing to give. Our goal for the funding can be obtained.  It just shows how willing people are for this kind of thing. It’s always been about cancer. And not that it shouldn’t be about cancer, orthopedics, and hearts, but now it’s also about women and babies.

Lucas: I have one more question. Out of the thousands of births that you have witnessed or partook in, do you have one or two that stick out?

Dr. Oken: Yeah, my own kids. I didn’t deliver my oldest, but my other three. My wife would say I didn’t deliver them, but I was there and helped her. They were actually very easy, but it was fun. I think OB in general 99 percent of the time is fun and exciting. It’s the times that it’s not that it gets to be stressful, but 99 percent of the time it’s great. I wouldn’t do any other job.

Penkunas: You’re bringing a new life into the world.

Dr. Oken: It’s a great job. It’s fun. But it can be stressful.

Penkunas: Because you’re just bringing a new life into the world, or trying to.

Dr. Oken: And I think people expect outcomes to always be perfect. We would love for them to always be perfect, but it’s not always. That’s why I think you need a facility that can provide when things don’t go as planned. And they don’t go by the book and by the birth plan that you’re prepared for. I think it also speaks to the experience of the hospital and the people you’re working with. If you’re at a place that only does a couple hundred deliveries a year, they don’t see everything.

Penkunas: So this new facility. When is it opening?

Dr. Oken: It’s opening in phases. The post‑partum is opening. [addressing Carley Lucas] For your next baby, it will be nicer.

Penkunas: Let’s not rush her. We just got her back.

Dr. Oken: You know, when they start coming and they —

Penkunas: Come one after another.

Dr. Oken: The post-partum part will be probably December. And then the NICU will be within — by the end of the year, by the end of ‘19.

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