Meet the Physician: Dr. James Light

Dr. Light is the chief of the Ob/Gyn division of the UAB Huntsville regional medical campus. He has been practicing obstetrics in Huntsville since 1986. Recently Valley Babies had a chance to visit with him.

VB: What changes have you seen over the years?
Dr. Light: A lot – The standard of care is so much better than when I first started. In my residency, you may or may not have been able to get an ultrasound to check for pregnancy or miscarriage. I think the outcomes have improved in maternal and neonatal survival, too. The babies have probably made a bigger improvement than the adults. When I first started babies born before 26 weeks weren’t viable. Now babies at 23 weeks have a 50% survival rate. There is also a significant integration with other professions. We are seeing a lot more people now for whom medical practice in other fields have really made a differences in their lives. People who never lived long enough to get pregnant before are living to child-bearing years and getting pregnant – especially patients with heart defects. It requires a lot of integration.

VB: What is your basic philosophy about childbirth?
Dr. Light: Pregnancy is not a disease. It is a normal physiologic process that the body adjusts and adapts to very well. Most of the things that the body has been doing it can still do.

VB: How do you feel about elective cesarean birth?
Dr. Light: I think there is a lot of data that we don’t have yet. It certainly is not the natural way to do things. I do enjoy mothers who want a natural unmedicated birth. If you look at the history of the elective C-setion, it brings up a lot of questions. In our profession we have certain subspecialties like reproductive endocrinology, uro-gynecology (which handles women as they get older). A lot of the female uro-gyn residents refused to have vaginal deliveries because they could see the long-term effects. So we started doing elective C-sections for female Ob/Gyn residents…Now we have gotten to the point where we have to ask, can we ethically deny one to someone on the street who wants one when we aren’t denying it to someone in the medical field? Data is changing so that maternal morbidity is not that significantly different after C-section. There are definite benefits and definite risks. One of the things we do now is explain those benefits and risks. Is it my preferred thing? No, but I occasionally do one when someone really understands what’s going on. I’m still of the old school – First do no harm, but now the risk is reduced.

I really encourage breastfeeding moms to get started within the first hour, and C-sections aren’t really set up for that. The last few I’ve done, I’ve managed to transfer to an open bed so they could breastfeed within that first hour. The setting has to be right, though, and we can’t always do that.

VB: As an instructor for residents, what mindset do you seek to impart to your students?
Dr. Light: Primarily that these are people who are having what generally is a very positive experience. And you want to try to help make that as positive as you can. You have 2 patients, mother and baby, and you want to give them the best medical care possible, and also make it as pleasant as possible. The first time they show up, they’re scared to death to touch a pregnant lady, but after a few they can’t wait.

VB: The midwife issue is a hot topic in Alabama. What is your perspective on midwives?
Dr. Light: I feel that there is a place for a CNM (certified nurse midwife). I have worked with them in the past both here and in Florida. I found it very enjoyable and thought they did a good job. We have a major problem here in that BCBS will not pay, so you really can’t afford to have them. I think the risks with midwives who aren’t CNM’s are so great that I’m not in favor, but I don’t see the ones whom they took care of and delivered…I see the ones who had problems. That little life is so special you want to try to give it the best start possible.

VB: What advice would you give a woman who has just learned she is pregnant?
Dr. Light: To get started with care early and talk to her friends to see who they’ve been going to and the personalities of those people. I have found in just knowing a lot of people that most Ob/Gyn’s practice good medicine. The experience someone is going to have has to do with how well they get along. You want it to be a nice, pleasant experience, and the best way to do that is to avoid problems from the beginning.