MDNews

Robert Hecht, M.D., FACOG Spotlights What’s Behind Good 
Samaritan Hospital’s High Birth 
Numbers and Low C-Section Rate




It’s no accident that the number of newborns delivered at Good Samaritan Hospital in Suffern, NY, is on the rise despite falling birthrates across the country.

Under the steady and supportive hand of Robert Hecht, M.D., FACOG, Director of Obstetrics and Gynecology, a highly experienced and dedicated group of physicians, midwives and nurses provide patients with exceptional care in a convenient and comfortable setting. “We have been blessed with a very strong team across the board, and we come together to provide an excellent service,” explains Dr. Hecht. “I think that’s in many ways fueled our growth in the past several years.”

Conversely, Good Samaritan Hospital reports one of the lowest C-section rates in New York even as they continue to soar nationally. Dr. Hecht attributes its rate of 21.2% to a combination of factors. Because the hospital’s labor and delivery unit has many “‘repeat customers,” those who’ve delivered vaginally the first time around are more likely to do so again. At the same time, says Dr. Hecht, “Our doctors are keeping current with the recommendations from our professional organization and striving to provide the highest level of care and making sure that we’re not in a rush to act on things that we may be able to watch and monitor and allow the patient more time to deliver.” A vaginal birth means a shorter recovery time with less risk of bleeding, infection and injury to abdominal organs.

In addition to being on top of its game when it comes to the essentials in labor and delivery, the hospital and its team are expertly equipped to handle more complex scenarios, such as vaginal birth after cesarean and high-risk pregnancies with complications like gestational diabetes, preterm labor, preeclampsia and multiple gestations.

Patient/Practitioner Partnership Is Key

Patients who come to Good Samaritan Hospital to deliver their babies bring to the table a variety of expectations. These range from how they see themselves laboring and the support they might need during labor to pain management preferences and available options in the cases of high-risk pregnancies.

Good Samaritan Hospital’s labor and delivery unit is equipped to meet the many different needs and desires of all of its patients. This is achieved, first and foremost, by cultivating a partnership between patient and practitioner well in advance of the “big day.” “When someone comes in and they have a lot of requests,” says Dr. Hecht, “the most important thing is to really take the time to discuss those requests with the patient and find out what their motivations are.”

That includes the option of having a midwife oversee pregnancy and birth. “We want to make that available to people who have a preference for a midwife,” explains 
Dr. Hecht. Midwifery is based on an approach of one-on-one care and letting childbirth take its course with little or no medical intervention. Good Samaritan Hospital’s certified nurse midwives have collaborative agreements with staff obstetricians who provide supervision, consultation and immediate availability should a patient require a 
doctor’s care.

The Birthing Center

Good Samaritan Hospital prides itself on the comfortable, visually pleasing and private environment it provides its patients during one of the biggest events in their lives. Its Union State Family Birthing Center is equipped with seven labor, delivery and recovery suites, which include private baths and therapeutic showers with benches for laboring mothers. Two surgical suites are at the ready if necessary.

Patients of the birthing center also have the option of utilizing a doula, a professionally trained labor support specialist, during childbirth. Doulas provide emotional and physical comfort for the laboring woman and also guide spouses and partners on how best to help their loved ones. The hospital’s doula program is a resource that Dr. Hecht feels is very valuable. “There are studies that have shown that women who have doulas with them during labor actually have a lower C-section rate.”

Nineteen private patient rooms provide ample space for newborn rooming-in and have sleep chairs for spouses or partners who plan to stay the night. Board-certified lactation consultants are on hand to offer guidance and support, including outpatient visits and a monthly support group.

The center has two newborn nurseries, along with a Level 2 neonatal intensive care unit for infants who are born prematurely or have other medical needs.

High-Risk Pregnancies

When pregnancies and deliveries fall outside the continuum of standard, Dr. Hecht and his team are at the ready to provide specialized treatment. They care for patients with high-risk conditions, such as gestational diabetes (abnormally high blood sugar levels during pregnancy), preeclampsia (high blood pressure during pregnancy) and preterm labor (contractions that begin to open the cervix before 37 weeks of gestation).

A variety of approaches may be taken depending on the situation and degree of risk to mother and baby. “Most of us trained at large, academic institutions and had a lot of experience taking care of high-risk patients and feel comfortable dealing with many complicated situations,” says 
Dr. Hecht. When necessary, Good Samaritan Hospital doctors work closely with outside specialists. For some patients, a high-risk obstetrician will be called in to comanage. Others might be referred directly to a perinatologist, a specialist in maternal-fetal medicine. “Depending upon where the patients fall in that spectrum, we try to match them with the type of treatment that’s best for them,” says Dr. Hecht.

Gynecologic Surgery

In addition to its full scope of obstetric offerings, Good Samaritan Hospital is also an expert resource for those patients needing gynecologic surgery. While the need for this type of surgery can occur at any point in a woman’s life, it’s much more common in the perimenopausal and menopausal age brackets. The department’s team of doctors and surgeons regularly perform complex surgeries, including laparoscopic hysterectomies and many procedures that are alternatives to hysterectomy, such as endometrial ablation and hysteroscopy.

A hysterectomy may be necessary for fibroid tumors, chronic pelvic pain, endometriosis, unmanageable bleeding and cancer. “The advantage of having it performed laparoscopically,” explains Dr. Hecht, “is it allows a woman to recover much more quickly.” In some cases, it can be done as outpatient surgery, allowing patients to return home the same day and get back to doing most things in three to five days, as opposed to two weeks with traditional, open surgery. After a laparoscopic hysterectomy, patients are back to full activity in four weeks, compared to six or more weeks with the open procedure.

For those women experiencing problems with recurrent bleeding, a successful option is a minimally invasive treatment called endometrial ablation. It’s used to cauterize the lining of the uterus, and it eliminates or significantly reduces bleeding. “For women who are sometimes advised to have a hysterectomy for problems with abnormal bleeding, this can be a much simpler solution when appropriate,” 
Dr. Hecht points out.

Another alternative to hysterectomy for patients who have fibroid tumors that protrude into the lining of the uterus is a hysteroscopy. The tumors are removed with the aid of a hysteroscope, a thin, telescope-like device that is inserted through the vagina and cervix and transmits an image of the uterus onto a viewing screen. A surgeon removes the tumors using instruments passed through the hysteroscope. 
Dr. Hecht explains, “It’s a procedure that requires no incision and has minimal recovery and sometimes can resolve the problem in the same way a hysterectomy might.”

A Finely Tuned Team

Whether a woman is coming to Good Samaritan Hospital to give birth or be treated for gynecological reasons, behind the expert care she receives is a committed, compassionate and hard-working staff. “People really do go above and beyond for their patients, and I think part of that is because we’re all part of the same community,” says Dr. Hecht. “We all have that feeling that we’re taking care of our friends or neighbors.”

This heartfelt dedication to patients fuels the staff’s desire to be the best they can be. Case in point: a department-wide educational program on electronic fetal monitoring interpretation. Staff members came on their evenings and days off to attend the learning sessions and share their knowledge. “We had nurses teaching doctors, nurses teaching nurses, doctors teaching nurses,” says Dr. Hecht. “It’s definitely led to an improvement in people’s skills and, ultimately, will help lead to a safer unit and better patient care.”

This ability to work together to provide superb care was put to the test recently during an extreme emergency. A patient at eight months of pregnancy was rushed to Good Samaritan Hospital. She was severely hemorrhaging because her placenta had separated prematurely from her uterine wall. In order to stop the bleeding that was life threatening to both mother and baby, the patient was in need of immediate delivery. Dr. Hecht recalls that within moments, everything the patient needed — from admission to delivery — was efficiently and seamlessly provided by the rapidly assembled team. The operating room was set up, the neonatologist was ready and waiting, and two anesthesiologists were expertly stabilizing the patient for an emergency C-section.

“It was one of the best examples of teamwork I can recall being part of,” says Dr. Hecht, “a moment when the whole of the care we provided together was greater than the sum of its parts.” Dr. Hecht remembers that there was a steady stream of people appearing at the operating room door — nurses, nurse managers, more anesthesiologists — all looking to help and make sure that everything possible was provided. The outcome of this life or death experience: mother and baby promptly proceeded through the delivery and are happy and healthy.

Passion With a Purpose

It’s obvious that their passion for providing extraordinary care and the connection they feel to the patients they serve is what drives Dr. Hecht and his obstetrics and gynecology team. The fact that so many patients return for subsequent deliveries and recommend the hospital is testimony to the outstanding services Good Samaritan Hospital provides. “Most of the doctors, midwives and nurses in the department live in Rockland and Orange counties,” says Dr. Hecht. “We take pride in the reputation we have earned with our neighbors, friends and family members and work extremely hard to give each and every one of them the best care.”

Dr. Hecht’s relationship with his patients and love for his work runs deep. He’s been in practice for over 16 years and finds the notion that he’s had patients for that long very fulfilling. “I feel like I know their history like the back of my hand, and I’ve enjoyed sharing their lives with them for a long period of time,” he says. In addition, he derives enormous gratification from the surgical portion of his job and being able to fix a problem with his hands. “We have patients with a ruptured tubal pregnancy or an abruption, and you walk in and you can somehow correct that; there’s a certain satisfaction that I think is unique to the surgical field,” says Dr. Hecht. “For me, obstetrics is the best of both worlds.”

Salient is the pride Dr. Hecht takes in his position as Director of Obstetrics and Gynecology and in his staff’s unwavering dedication to upholding and surpassing the exceptional care they give day in and day out. He says, “When you make changes on an administrative level, you can do things that impact hundreds and thousands of people in a positive way.” Good Samaritan Hospital’s high birth numbers and low C-section rate are validation that Dr. Hecht and his team are doing just that.

MD News December 2010, Mid Hudson


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