Superman Hangs Up His Cape

An historic moment passed this week as obstetrician John Labban, MD, delivered his last baby in Bloomington, Indiana. For twenty-two years the man has been on call round the clock for his pregnant patients, while running a busy solo practice, with only occasional trips out of town to rest and restore his energy. He came by this work ethic naturally, following in the footsteps of his father and grandfather, physicians Raymond and Jacob Labban, the latter honored by a statue in his native Tripoli, Lebanon, for his dedication to the poor. John has childhood memories of his father leaving home in the middle of the night to pay house calls on his patients. After completing his medical training at the American University in Beirut, he came to the United States, repeating his residency in Florida before taking a job in Alabama caring for underserved patients in exchange for his green card. From there he worked in St Louis for a time, before being hired in 2001 to partner with another obstetrician in solo practice here, Dr Clark Brittain. 

At that time Dr Brittain had recently begun providing medical back-up services to home birth families and their midwives, and my fellow midwives and I were invited to a reception welcoming Dr Labban and his wife, Ghada, to town. We were urgently curious to learn if he shared his new partner’s willingness to help us midwives, even more so when only months later, Dr Brittain decided to himself retire from obstetrics and just practice gynecology. Before we could do much more than fret, we each received a letter from Dr Labban that began, “Dear Colleague…” and promised to continue what Dr Brittain had started. This was an enormous relief, and for me the beginning of a beautiful professional friendship.

Soon after receiving his letter, I met Dr Labban for lunch downtown, discussing how to best collaborate and mapping out the plan that we have held to ever since. He would let me send my patients into his office in each trimester for their lab work and ultrasounds, and to refer them to him for any issues that arose during the pregnancy that were outside my scope of care. In this way, he would have a chart on them and his own opportunity to screen them for complications. Should one arise during labor, requiring a transfer to the hospital, he was a phone call away. I stayed with my patients through their hospital births, providing advice and support as needed. Their disappointment and worry when their home birth unexpectedly required medical intervention was alleviated by this continuity of care, and the obvious warmth between myself and their doctor. 

Roughly ninety percent of home birth transports are not emergencies; they involve, instead, very long labors that are not progressing to delivery. In those scenarios, when all the midwifery tricks have been tried and failed, it is time for medical help, and I would call Dr Labban. Too often, it was the middle of the night. I have woken that man up so many times over the years, and never was he less than courteous. He would let the labor and delivery unit know I was coming in with a patient, and we would be met by sympathetic nurses eager to help an exhausted mom get some rest and birth her baby. Though an excellent surgeon, Dr Labban has been masterful at teasing vaginal deliveries out of difficult circumstances, and the families we served together loved him for that. As for the rare emergencies, the fact that my medical back-up was quickly available led us to good outcomes in each case. For that my gratitude only increases as we reflect on our years together. Doctors and midwives share heavy responsibilities in getting mothers and babies safely through childbirth, and the successful resolution of complicated cases is what allows us to keep up our spirits and continue working.

When Dr Labban began working with us, certified professional midwives existed in a legal gray zone. An effort begun in the early 1990s to create a license for CPMs was moving glacially through the Indiana General Assembly. His letters and testimony before a legislative committee were influential in the ultimate passage of a bill in 2013 that legalized and regulated our practice, making home birth safer for families throughout Indiana. I’ll never forget the day he and Ghada sat with us in the Statehouse for hours, waiting to testify on our behalf.

Dr Labban’s lasting devotion to women’s health will continue via his gynecology practice and in conjunction with his office partner, nurse-practitioner Samantha Crusenberry. But his decision to leave obstetrics signifies the end of an era in our town, as he is the last of the private practitioners. Every other obstetrician in all the counties surrounding ours are IU Health employees. Patients no longer have the power to choose their doctors: the hospital is now their doctor. Only in exceptional cases will there be genuine relationships between pregnant women and the physicians who attend their births. Most of them will receive care from someone they may—or may not — have met; it will not be someone they know.

Equally concerning, Dr Labban takes into retirement time-honored skills that the younger generation of practitioners have not seen fit to maintain, skills that help women avoid surgical deliveries —the ones midwives call unnecesareans. He is an excellent operator of forceps, and has an uncommonly high success rate turning breech babies into head-down positions. He is unafraid of delivering certain breech babies vaginally, as he was trained to do in Lebanon. My home birth moms have benefited more times than I can count from his discernment and special expertise. There is no one at our hospital ready or able to fill his shoes, and this saddens me for our community.

But for my dear friend, it is time for a rest from the relentless pace of solo practice. The three little boys he and Ghada brought to town — Jad, Raymond, and Andrew — are men now, and the Labbans are ready for more time together, as a couple and a family. In that light, I celebrate his decision, after so much sacrifice and service. I will miss working with him terribly, both the serious shop talk and the long, laughing conversations we sometimes fell into, when time allowed. He not only made childbirth a safe, personal experience for so many women, he was a true pioneer in creating a midwifery-medical model of collaborative care that honored the individual choices of women, even when those choices strayed beyond his personal comfort zone. He put me in the ideal position of always having his greater skill set only a phone call away, and I cannot imagine having remained in the beautiful, dramatic world of midwifery for over thirty years without his stabilizing presence.