Dr. Ralph Dauterive, Jr.
A Little Extra Time and Attention Providing Better Outcomes
Ochsner Opens Family Birth Center
It’s a new age in Baton Rouge. In April, Ochsner Medical Center launched its new Family Birthing Center, complete with two birthing tubs and a team of midwives on site. Ochsner will continue to offer the “traditional” birth options of physician-assisted delivery and C-sections.
The hospital renovated the entire fourth floor of its O’Neal Lane facility into an obstetrics unit. In the labor/delivery wing, the center houses six living room-style delivery rooms, with room to expand to eight LDRs. Two of these rooms offer birthing tubs for water deliveries. Another wing contains two operative suites for performing surgical deliveries, and shelled-out space for two additional ORs. Fourteen post-partum beds are available for recovery and longer stays. Also on the floor is a Level III neonatal intensive care unit to handle premature babies. “We tend to be very family- oriented in our delivery concept,” explained Dr. Ralph Dauterive, Jr., department chairman and chief of obstetrics and gynecology at Ochsner Health Center Baton Rouge. “It’s all about patient choice, and allowing the patients to have the type of delivery that they would like. The concept allows for safe delivery choices in a hospital environment.”
For the past year and a half, Ochsner Baton Rouge obstetricians/gynecologists have practiced with a group of certified nurse midwives (certified RNs with additional training and testing as midwives). With their specialized experience, these midwives are able to spend more one-on-one time with patients, discussing delivery options as well as breastfeeding. Patients in a midwife practice are less likely to have episiotomies, surgical procedures, forceps deliveries and long-term hospital stays, and are more likely to breastfeed. “The midwives tend to be a lot more successful at allowing the natural course of events in obstetrics to take place,” Dauterive said. “You have to spend a little more time during the labor/delivery process to get those types of things accomplished. The midwives tend to be more engaged, and the patients really appreciate that.”
Over the past year and a half, the midwives program has been tremendously successful. “The delivery rate has nearly doubled,” Dauterive observed. “Patients seem to really like the midwives.”
Once the center opens, four midwives, three male ob/gyns and three female ob/gyns will be available for birthing babies. The midwives are in a collaborative practice with these board certified physicians, who oversee the patients as needed. Delivery choices will include natural childbirth, surgical procedures and midwife-assisted water births. “The midwives are the ones who really encourage the patients to consider all of the choices, and who will support the patients with the choices that are a little different, like water birth,” Dauterive said.
With water birth, the baby enters the world into a six-by-four-foot tub filled with about two feet of warm water. During labor, the water takes the load off of the mother’s back and hips, allowing for a more comfortable delivery.“The warm birth is gentler for baby and less stressful for mother,” Dauterive explained. “The concept is to let people have that natural home-like environment within the safety confines of a real hospital.”
Group prenatal care will also be offered at the Family Birthing Center. This program will combine eight to 10 patients for group teaching and education. “People will learn more from each other, rather than repeating the same message 10 times,” Dauterive explained. “And, other people’s questions may be questions that patients didn’t think about, but might learn from.”
The Family Birthing Center officially opened April 10. Ochsner’s goal is to deliver 100 babies a month. “With that unit, we think that we can bring about 80 percent of our target within the first two months,” Dauterive projected.
New Breast Cancer Surgical Techniques Preserve Tissue
Not long ago, mastectomy was the only method of doing breast cancer surgery. For many patients, this surgery left disfiguring scars, leaving them physically and emotionally traumatized. But now, ground-breaking procedures are available which preserve the breast after cancer surgery.
Today’s breast conservation surgery, or lumpectomy, removes the tumor but spares the breast. “We’re getting more away from mastectomy and more towards breast conservation surgery,” observed Dr. Reatha Williams, breast surgeon at Women’s & Children’s Hospital and The Regional Medical Center of Acadiana in Lafayette. “We can get very close to the same reoccurrence rates with lumpectomy with radiation versus mastectomy.”
The latest surgical technique is called oncoplastic breast surgery, or oncoplasty. With this procedure, the surgeon removes the tumor, then fills in the remaining gap with the patient’s own tissue from the surrounding area. “We are remodeling or reforming the breast so that it looks smoother and more natural, and leaves the patient with a much better cosmetic result,” Williams explained. “It’s a new, really innovative approach, and it’s a much, much better way of doing the surgery. You leave less of a divet and less of a scar. If you can get rid of the cancer, and also leave a good cosmetic result, then I think you have achieved a lot.”
Breast surgeons sometimes work with a plastic surgeon to achieve the best cosmetic result. “If it’s a bigger area, then the plastic surgeon can swing other tissue flaps into that area,” Williams said. “But many times, if it’s a small lumpectomy, you won’t even know the tissue’s gone. It will look just like the other breast, which is our goal – to make the breasts symmetrical.”
Another new procedure is the hidden scar technique. Surgeons now place incisions in areas which are hidden, such as along the fold of the breast, underneath the breast or along the nipple-areola complex. “Instead of making the scar right over the tumor, like in the past, we are able, in some cases, to place that scar where you can’t even see it,” Williams said. “So, you can look at that breast and can’t even tell that a patient has had surgery. Cosmetically, we’ve had very good results.”
Not all patients are candidates for these procedures, particularly where large tumors are involved. In those cases, mastectomy might be the better option. But, the good news is that surgeons are now performing skin-sparing procedures by removing all of the breast tissue, but leaving the envelope of skin. From there, the plastic surgeon can take tissue from other parts of the body or use an implant to fill the space, creating a more natural-looking breast.
Along the same lines, physicians are now doing nipple sparing operations by saving the nipple-areola complex so that it does not have to be reconstructed. This procedure can be performed when the tumor is not too close to the nipple.
With all of these new procedures, the goal is to give the patient a more natural look. “I think it’s an artful blend of plastic surgery and complete cancer surgery, where you are removing the actual cancer, but leaving patients with a more natural look that looks more like the other breast,” Williams said. “These are good things for patients, and they should ask their doctors for them.”
As for Williams’ patients, they are “very, very happy” with the results, she reports. “It’s an emotional thing to be able to see that your breast looks good, and looks just like the other breast,” she said. “I think it’s a really good thing for my breast cancer patients emotionally, and I believe that it helps with their recovery.”
Elaine M. Junca Women’s Imaging Center Seeks Patients for Breast Cancer Screening Study
Currently underway at the Elaine M. Junca Women’s Imaging Center on the Women’s & Children’s Hospital campus is a clinical research study on the effectiveness of using 3D Automated Breast Ultrasound (ABU) in addition to digital mammography, versus digital mammography alone. This research project is targeting women with very dense breasts (greater than 50 percent parenchymal density) and no history of breast cancer. Over the next two years, the somo·InSIGHT Clinical Study, will enroll more than 20,000 women nationwide.
Mammography remains the gold standard for breast cancer screening. But, studies have shown improved early detection of tumors in women with dense breast tissue when ultrasound is combined with mammography. “The goal is finding some way to pick up these cancers early,” explained Dr. Reatha Williams, breast cancer surgeon at Women’s & Children’s. “The earlier you pick it up, the smaller it is and the more likely you are to have a cure. If we can add tools to our diagnostic capabilities that will help screen to pick up these small cancers in these very dense breasts, then the studies will be worthwhile.”
The Junca center was one of nine clinical sites in the U.S. selected to participate in the somo·InSIGHT study. Qualified patients will be offered free screening ABUs in addition to their digital mammogram. Major requirements are females age 25 or older who are asymptomatic for breast cancer, not currently pregnant or planning to become pregnant in the following 18 months, and have very dense breasts.
For information, contact Junca’s study coordinator, Deborah Labranche-O’neal at (337) 593-7054 or Deborah.labranche-o’firstname.lastname@example.org.