Guest Blog: Growing Together: How to Use Your Personal Experience to Get Others Involved with ACOG

As a District officer, I sometimes call myself a “human highlighter.” Why? Because that’s the easiest and most effective method I’ve found to get others more involved in ACOG. For me, being a human highlighter means drawing others’ attention to ACOG by pointing out meaningful experiences and events and telling others what’s great about them. By encouraging others to get more involved in ACOG and giving them concrete ways to do it, I’ve found myself getting even more involved with ACOG while also helping my District grow! If you’re looking for more ways to get involved with ACOG and motivate others to do the same, read on for some tips that my District and I have found useful.

In order to be successful, efforts to get people more involved in ACOG must be purposeful. One of my favorite strategies to get others more involved is to give them the opportunity to experience the events that got me so excited about being involved in ACOG. I encourage others to become resident reporters so that they can attend the Annual Clinical and Scientific Meeting; apply for funding to attend different local and national meetings; and ensure that when our District puts on an event in our community, everyone who attends knows it’s an ACOG event. I’ve seen firsthand that when my fellow ACOG members experience ACOG events for themselves, they become more excited about being involved with ACOG, too!

ACOG events are a great way to get people outside of ACOG to support our organization and to spread the word about the important work ACOG is doing. In Wisconsin, there are many areas, communities, and conversations that I don’t have access to. But when we bring an ACOG event to a local community and spread the word about ACOG and the work we’re doing to everyone who attends, we can extend our reach significantly by giving people information to bring back to their communities.

Another way to help draw more people to ACOG is to be more purposeful about increasing diversity. In order to bring all kinds of people into ACOG and show them that ACOG is for them, they need to see people like themselves not only in Sections and Districts but also in Section and District leadership positions. If you’re in a leadership position and are looking for other members to bring up through the ranks, make sure you’re looking not just at the outspoken, easily visible people in the front row, but at the people in the corners of the room, who you may not know as well (or at all!) but who can bring their professional knowledge and their unique, diverse perspective to the table and enrich your discussions. Diversity doesn’t just happen; it needs to be cultivated intentionally and consciously. And when diversity is consciously cultivated, we’re all better for it, and ACOG becomes stronger as an organization.

One thing I’d ask everyone to understand and share in order to get more people involved is our advocacy. ACOG has the potential to accomplish incredible feats through advocacy not only because of the expertise and passion of our members but also because of the Government Relations staff at ACOG national, who understand the way that Congress works and can help us make real progress for our specialty and our patients. My time with ACOG has given me many chances to learn how our government works and how our advocacy can make a difference, even when things seem hopeless. I recall leaving the 2018 fly-in in tears after a meeting with a representative that my Junior Fellow companions and I thought went terribly, thinking that the bill we discussed would never pass. To my surprise, it did! During my Gellhaus Fellowship, I had the chance to ask the Government Relations team what had happened. Their answer? ACOG did! Talking to passionate, knowledgeable ACOG members and then discussing that new knowledge with other representatives had changed our representative’s mind and allowed ACOG to get a huge win. If others could have that same experience, I’m confident that they’d become more enthusiastic and more hopeful about the legislative process and feel more motivated to advocate for policies that ACOG supports.

In the end, giving others the opportunity to become ACOG fans is the best way to spread the word about ACOG and get everyone—both inside and outside of the organization—involved. I encourage all of you to advocate for your fellow members to attend more ACOG events for themselves and consider putting on or volunteering to put on ACOG events for their local community. When others see the benefits ACOG offers and the potential for change that ACOG has, they become more enthusiastic about ACOG itself—and you will, too!

Talia Coney, MD
District VI Junior Fellow Chair

Guest Blog: Giving Power to Patients and Physicians through Advocacy

Right: Heather Smith, MD, MPH
Right: Heather Smith, MD, MPH

One-on-one interaction and patient care is critical to me as an ob-gyn. It’s why I went to medical school after getting my master’s in public health and working in community education. It’s why I got involved in the Massachusetts Medical Society and the AMA during medical school. And it’s a big part of why I advocate.

Federal health policy and its effects on individual and community health first caught my attention while I was earning my master’s in public health at the Boston University School of Public Health, where I worked on a national project that evaluated the effects of welfare reform on children’s health. As I worked on this project I began to see that the intent of federal policy doesn’t always match up with the effects those policies have on an individual level, that public policy plays a significant role in determining community resources and individuals’ health, and that I could play a role in aligning federal policy with individual and community needs.

In today’s often unpredictable political and health care landscape, ob-gyns can often feel powerless to do anything for their patients outside of the exam room or for their specialty outside of their organization. But during my years spent as a practicing ob-gyn and an advocate for change in health policy, I learned that advocacy helps me give my patients and community power over their health that extends beyond my office and my one-on-one patient interactions. The time I spent working on advocacy issues with the AMA as an ACOG delegate and with ACOG’s Government Relations Committee showed me that my voice can also help move the needle on addressing maternal morbidity through establishing state-based maternal mortality review committees, extending Medicaid coverage to 12 months postpartum, surprise billing, prior authorization, and other key ACOG issues that would enable us as physicians to take care of our patients and advance our specialty as much as possible.

ACOG’s McCain Fellowship offered me an invaluable opportunity to build on my prior advocacy experience. The fellowship drove home the nuances of advocating ACOG issues to legislators and policy makers; especially the fact that getting your voice heard at all and making connections with legislators—an area in which Ob-GynPAC is critical—is just as important as the policy you’re advocating for. My time in Washington, D.C., has bolstered my advocacy in other ways, too: while learning more about how to interact with legislators and advocate on behalf of ACOG issues, I also had the opportunity to see how ACOG works behind the scenes and to understand how strong of a team ACOG truly is. Engaging with staff at ACOG national has helped me understand the difference that ACOG is making for us, our patients, and our specialty—and the difference that we can continue to make in the future.

I encourage anyone who wants to make lasting changes for their patients and their community to get started advocating today. ACOG makes it easy: for example, the Congressional Leadership Conference is a great way to learn the ropes of advocacy and get face time with the legislators who influence health care policy. Your Annual District Meeting will keep you up to date on the latest developments in women’s health care and bring issues that you may otherwise not have noticed to your attention, and your state Lobby Days will help you make a difference on issues such as reproductive health, family planning, and hospital safety on your home turf. If you’re already a seasoned advocate, you can multiply your impact by serving as a point person for your District or Section, which will allow you to share resources, get more people into advocacy, and show your fellow ACOG members what successful advocacy looks like. As an ob-gyn, I make a commitment to take care of my patients. Advocacy is one additional tool that helps me keep that promise.

Heather Smith, MD, MPH
Women & Infants Hospital
Providence, Rhode Island

Gynecological Cancers: Do Your Patients Know the Warning Signs?

Eva Chalas, MD, is ACOG president-elect. She is a professor and vice chair of obstetrics and gynecology at New York University Long Island School of Medicine, physician director at the Center for Cancer Care, and National Surgical Quality Improvement Program surgeon cochampion at New York University Winthrop Hospital. Read her guest blog:

It may surprise you to discover that September is Gynecologic Cancer Awareness Month. If it did, you’re not alone; even though 109,000 women will be diagnosed with a gynecologic cancer this year in the United States, gynecological cancers aren’t nearly as well known as other types of cancer, such as breast cancer, and certainly aren’t as well funded. In fact, gynecologic cancers are among the cancers least funded by the National Cancer Institute and are significantly underfunded compared to many other cancers. That means it’s frequently up to women’s health care professionals to raise awareness of gynecological cancers among their patients, educate patients on how to reduce their risk of cancer, and help patients take the next step if they’ve been diagnosed. So, what do you need to know in order to raise awareness about gynecological cancers?

The first step is increasing your own knowledge of gynecological cancers. Be aware of symptoms: for example, endometrial and cervical cancers can cause abnormal vaginal bleeding; presence of a mass can indicate vulvar cancer; and abdominal bloating, bladder pressure, and decreased appetite could be symptoms of ovarian, peritoneal, or fallopian cancers. ACOG has a number of informational resources about gynecological cancers, including Practice Bulletin 168: Cervical Cancer Screening and Prevention; Practice Bulletin 149: Endometrial Cancer; and Committee Opinion 716: The Role of the Obstetrician–Gynecologist in the Early Detection of Epithelial Ovarian Cancer in Women at Average Risk. You should also be aware of your options when you suspect a patient may have gynecologic cancer. One particularly helpful resource is the Society of Gynecologic Oncology’s Seek a Specialist tool, which can help you connect your patients with gynecologic oncologists.

Promoting patient awareness and education about gynecological cancers is also crucial to managing the disease. Patients may not know that being aware of their family’s history of cancer—especially in first-degree relatives—can help identify potential predisposition toward cancer, but once they do, they can speak with their physicians about whether genetic testing is appropriate. Knowing the signs and symptoms of different gynecological cancers can also help patients be proactive with their own health and could lead to early identification of cancer. You can facilitate patient learning with ACOG’s patient education materials, which include pamphlets that explain what the specific cancer is, risk factors, screening, symptoms, and more in patient-friendly language.

Lastly, it’s important to intervene early on and educate your patients on how to decrease their risk of gynecological cancers. Some risk factors can’t be changed; for example, patients who are older, who enter menopause late, who begin menarche at an early age, and who have Lynch syndrome are all at increased risk for uterine corpus cancer. But there are a number of risk factors that physicians can help their patients control.

  • Screening. Physician intervention has a huge effect on cervical cancer, the only cancer that screening and vaccination can prevent: more widespread screening has reduced the incidence of cervical cancer by more than 50% in the past 30 years.
  • Diet and lifestyle. Obesity is a risk factor for many types of cancers, including gynecological cancers. By helping patients develop healthier eating habits, sufficient exercise routines, and awareness around their physical health, physicians can play an important role in helping to decrease risk of cancer and risk of death from cancer.

The more aware patients and physicians are of gynecological cancers, the better prepared we all will be to prevent and treat them. Be sure to take advantage of this year’s Gynecological Cancer Awareness Month to make a difference in the lives of your patients.

Supporting Breastfeeding Moms is Critical to Public Health

Juliana Melo, MD MSCS, FACOG, is an ob-gyn in Sacramento, CA. Dr. Melo is also ACOG District IX, Section 1 Fellow Vice-Chair elect.  Read her guest blog below:

“It’s your choice if you want to hold up the line.”

“You’re delaying other passengers.”

“I don’t care if you miss your flight.”

Those are some of the responses I received from TSA agents about how arduous they were going to make the screening process if I decided to try to transport my breastmilk home with me.

It was the first time that I experienced what countless other women have had to endure—a humiliating, public experience when trying to continue efforts to breastfeed my baby.

Standing in the security line at the Austin-Bergstrom International Airport, a colleague and I were both harassed by TSA staff for simply attempting to transport our breastmilk home. It didn’t seem to matter that national TSA policy explicitly states that breastmilk in reasonable amounts is allowed in carry-on luggage. It also didn’t matter that we had both traveled through several other airports in the past with more milk than we had in tow that day and never had a problem.

The agents insisted my colleague had to open all of her breastmilk bags to screen for explosives. I was then told my breastmilk would need to be screened in a machine and every single bag would need to be screened individually, even those that had less than 3.4 oz. We were mocked for caring about possible contamination of our breastmilk and pump parts, and when we asked about alternative screening, we were threatened with an extraordinarily long screening process and the possibility of missing our flights. The message: it would be easier to just toss our breast milk. When I tried to bring up the TSA policy, the supervisor rudely told me I was wrong and that he didn’t care how other airports were doing it or if we missed our flights because of the screening delay.

As we observe National Breastfeeding Month, I want to affirm that it is past time for this type of treatment of breastfeeding moms to stop.

I am an ob-gyn, and like you, am committed to improving women’s health. Ironically, this harassment by TSA staff occurred while I was on my way home from a clinical meeting where we discussed ways to empower moms to meet their breastfeeding goals.

We all know breastfeeding has well documented health benefits for both babies and moms. Babies who are breastfed have improved nutrition and decreased risk of infection and illness. Women who breastfeed have lower rates of breast and ovarian cancer and, the longer they stick with it, it also lowers the rate of type 2 diabetes, high blood pressure and heart disease. To maximize the benefits of breastfeeding, ACOG recommends exclusive breastfeeding for the first six months of life with continued breastfeeding as complementary foods are introduced through baby’s first year, or longer as mutually desired by mom and baby.

As a physician, I can encourage moms to initiate and continue breastfeeding until I’m blue in the face, but my counseling is not enough if they leave the hospital and enter a society that doesn’t value their decision to breastfeed or support them in their efforts.

Breastfeeding is already one of the most difficult and labor-intensive commitments—physically, mentally and emotionally—that a woman can make. Even as an ob-gyn, I did not fully grasp how challenging it was until I became a breastfeeding mom myself. If we make breastfeeding women outcasts in public places and force them to continually encounter obstacles when they try to work, travel and carry on with tasks in their daily lives they will feel discouraged, as I did, and may assume their efforts are not worth it—and they are.

We’ve seen slow but continued progress in recent years to enable women to breastfeed in public spaces. In late 2018, a law was enacted that requires large and medium hub airports to provide lactation rooms for public use. Last year, we also saw two Philadelphia moms successfully petitioned Amtrak to provide lactation pods at five of its major train stations. And, just a few weeks ago, the Fairness for Breastfeeding Mothers Act of 2019 was signed into law, requiring certain public buildings to provide lactation rooms for public use. Currently, legislation is pending in Congress that would expand this requirement to small hub airports. 

We have the power to initiate change by bringing awareness to the importance of breastfeeding and signaling to policymakers that protecting breastfeeding mothers is critical to the public health. It’s our responsibility, especially as ob-gyns, to take action to ensure that women are never publicly humiliated or burdened when breastfeeding. We can start by reaching out to our Members of Congress and urging them to make breastfeeding moms a priority. If we persist, we can achieve the society we envision—a society that empowers and supports women in their decision to breastfeed.

Balance for Better Women’s Health Care Globally

Jeanne Conry, MD, PhD, FACOG is president elect of FIGO, ACOG Past President, and a member of the FIGO executive board. She is chair of the United States Women’s Preventive Services Initiative, a collaborative initiative of health professional organizations and consumer advocates who recommend and guide preventive health services across a woman’s life span; and cochair of the FIGO Working Group on Reproductive and Developmental Environmental Health.  Read her guest blog:

As an ob-gyn, I’ve devoted my career to doing right by women, both inside the exam room and out. That means supporting women’s health in the United States and globally through advocacy, research, and education. This International Women’s Day, let’s talk about how we as women’s health care professionals can improve women’s health to build a more equitably balanced world and propel change to improve quality of life for generations to come.

The theme of this year’s International Women’s Day is Balance for Better. Balance for better means not just supporting more diversity in the workforce but also working to advance women’s health with equal thought and care. We see women’s health inequalities every day, whether it’s U.S. taxes on menstrual products or political debates about which women’s health services should be covered by insurance. The truth is that a more equitably balanced world means better access to quality care for all women. Exceptional health care requires the empowerment of women, the elimination of violence, the rejection of reproductive coercion, and a demand for dignified, high-quality services.

Last year, when I became president-elect of the International Federation of Gynecology and Obstetrics (FIGO), I promised to use the distinguished honor to advocate for bringing women’s health to the forefront of international issues, support effective family planning choices for all women, and educate and advocate for awareness about the effect of the environment on reproductive health. FIGO is in a position to galvanize support for these objectives by partnering effectively with regional, national, and global organizations and effectively integrating and collaborating with its member societies. but all ob-gyns can play a role supporting women as we work to balance for better.

Ob-gyns are in a unique position to be a strong and effective voice for access to health care all over the world, particularly in places where the need for access to obstetric and gynecologic surgery and preventive services are critical. At ACOG, the Office of Global Women’s Health (OGWH) seeks to increase women’s access to quality health care by building provider skills, supporting implementation of high-impact interventions, and scaling proven solutions to decrease maternal mortality and morbidity and improve care throughout a woman’s life. OGWH was founded on the premise that by leveraging ACOG and its members’ unique capabilities, we can help to improve women’s health everywhere.

In 2018, the OGWH launched an effective e-learning program in India; provided consultation to the development of international guidance documents; joined a coalition to improve maternal, newborn, and child health in Madagascar; launched a new surgery training curriculum in Uganda; and successfully closed out a multiyear collaboration with the Ethiopian Society of Obstetricians and Gynecologists. These achievements advance the well-being of women, ensure women and girls access to better sexual and reproductive health care services, and improve the delivery of maternal and women’s health care around the world. You can learn more about OGWH programs and the work they are doing to balance for better by visiting their website. I also encourage you to join their Listserv to learn about new opportunities and how you can become involved.

As an ACOG member and president-elect of FIGO, I look forward to collaborating with you as we strive for excellence in our clinical practice and women’s wellness worldwide. If you haven’t yet, please take a moment today to support International Women’s Day by posting on social media using #balanceforbetter.

ACOG Battles Maternal Mortality in Texas Through Maternal Site Surveys

Eugene Toy, MD

Eugene Toy, MD, is the medical director of ACOG’s Texas Levels of Maternal Care (LoMC) Verification Program, vice chair of District XI, and an ob-gyn at the University of Texas Medical School at Houston.

Levels of maternal care play an important role in supporting Dr. Hollier’s signature initiative to reduce preventable maternal mortality. The ACOG/Society for Maternal-Fetal Medicine Levels of Maternal Care (LoMC) Obstetric Care Consensus supports this initiative by proposing uniform designations for levels of maternal care related to hospital capabilities and resources. Through the LoMC Verification Program, ACOG aims to foster collaboration among facilities at varying levels of care so that pregnant women receive care at a facility appropriate for their risk.

ACOG launched the LoMC program in Texas, where Level II, III, and IV facilities that provide maternal care must undergo site surveys to receive the level of care designations that will allow them to receive Medicaid reimbursement. I had the privilege of attending the site visits for each of the 11 surveys the LoMC program completed in 2018. Here are some observations:

  • Build purposeful partnerships. By using a collaborative and transparent approach, ACOG serves as a resource and mentor as well as a survey organization. This partnership builds trust with hospital leadership.
  • Quality is key. Maternal quality programs are the key to reducing severe morbidity and mortality. Each hospital has its strengths and excellent initiatives, but can also make improvements, including implementation of consistent triggers for quality reviews, monitoring outcomes or closing the loop, and providing education to staff.
  • It’s about the team. In many settings, the obstetrical unit is fairly isolated and lacks communication, shared processes and guidelines, joint team training, and joint quality reviews. In our surveys, we bring all key hospital services and leadership to the table over dinner to discuss how each area interfaces to work together for the maternal patient.
  • Trust but verify. Our approach is to verify that the processes put in place by the maternal leadership are utilized consistently and documented. We do this with chart reviews, hospital tours, and interviews of bedside staff.
  • Show flexibility. ACOG’s approach has been to be open-minded to how medicine is practiced in different settings, since Texas is so geographically diverse. Ultimately, our top priority is patient care.

I’m happy to report that after six months, our Texas LoMC Verification Program has already made a substantial impact in equipping hospitals, doctors, and nurses to improve care for Texas mothers. If you know someone working in a hospital in Texas, tell them to schedule their survey with ACOG and join our efforts in reducing maternal mortality.

ACEs: What You’re Not Asking Patients and How Their Answers Affects Care

Connie Gayle White, MD, MS, FACOG is an ACOG member and practiced as an OB/GYN physician in Frankfort, Kentucky for over 20 years.  She is currently the Senior Deputy Commissioner in the Kentucky Department for Public Health (KDPH) overseeing all the clinical services provided by the Department throughout the state – all chronic disease programs, women’s health services, maternal child health, and overseeing development of new programs. Read her guest blog post below. 

I once had a patient who smoked cigarettes. Over the years I treated her, I diligently counseled her on the harmful effects of smoking and gave her resources to help her quit. Yet every visit she returned a smoker. One day, I casually asked why she started smoking. She confided to me that she began smoking at the age of 10 because her father hated the smell of tobacco. She knew if she smelled like smoke he wouldn’t come into her room to assault her at night. She then revealed she had taught her younger 8 year old sister to smoke too. Tearfully, she asked if she was a bad sister. I had of course taught her all about the consequences of smoking and now she worried she had inadvertently put her sister’s health at risk. Instead of helping her, I had retraumatized her each year because I hadn’t known anything about ACEs.

Adverse childhood experiences (ACEs) are stressful traumatic events occurring in childhood — such as physical, emotional, or verbal abuse or neglect against any member within a household, or other forms of violence and household dysfunction — can interrupt healthy social-emotional development in children, and their consequences are more far-reaching than most physicians may realize. The first two years of a child’s life are a critical period wherein the brain is hardwired for social-emotional development. Secure attachment stemming from a nurturing, consistent relationship with a caregiver is the foundation of healthy social-emotional development, which in turn becomes the foundation of an individual’s cognitive development and sense of self-identity.

ACEs lead to an increase in risky and unhealthy behaviors in adolescents and adults. For example, as the number of ACEs a teen has experienced increases, it follows the dose-response curve and the likelihood that that teen will have had sex by age 15, become pregnant as a teen, or impregnate someone as a teen. More ACEs are also correlated with higher risk of attempting suicide at age 18 or below. In Kentucky, which has one of the highest rates of children with three or more ACEs in the country, adults with high ACE scores (three or more ACEs) smoke or binge drink at higher percentages than their low-ACE score counterparts.

However, risky behaviors are not the only way ACEs manifest later in life.  Chronic toxic stress resulting from conditions producing high ACEs starting at birth and beyond increases serum cortisol levels over prolonged periods Arthritis, asthma, chronic obstructive pulmonary disease, and depression are more prevalent in adults age 18 and over with low ACE scores than in adults without, and even more prevalent still in adults with high ACE scores. Astonishingly, you’re more at risk for lung cancer if your ACE score is high than you are if you are a smoker. ACEs aren’t just a matter of psychology or emotion — they’re based in science, and knowledge of them can be a powerful tool for treating patients.

I’ve seen firsthand the serious and long-lasting effects of ACEs on women’s health, and now I realize that compassionate, trauma-informed treatment is a crucial skill for ob-gyns to learn so that we can not only effectively treat our patients but also avoid retraumatizing them without realizing it. Patients with ACEs are not just bringing themselves into our exam rooms — they’re bringing their experiences, too. By learning about ACEs, ob-gyns and their staff can treat patients with compassion and find real, effective solutions to issues that neither the ob-gyn nor the patient could solve otherwise. Start by watching this TED Talk: How childhood trauma affects health across a lifetime | Nadine Burke Harris and learn how to use ACEs when evaluating patient care options.

Join Us for ACOG Advocacy Month

Katie McHugh, MD, is the Current ACOG Junior Fellow Congress Advisory Council (JFCAC) chair and an obstetrician gynecologist at Indiana University in Indianapolis. Read her guest blog post below. Connect with her on Twitter at @KtMcH.

I’m honored to take over Dr. Hollier’s President’s Blog today to share something that’s so near and dear to my heart: advocacy! As your JFCAC chair, I’ve been waiting for October all year, and not just because I love costumes and candy corn. October is ACOG Advocacy Month!

ACOG Advocacy Month is a project the JFCAC launched because we want everyone — Junior Fellows and Fellows alike — to know that ACOG is more than practice guidelines and conferences. ACOG is also how we make our voices heard around the country and around the world and speak out about the issues that matter most to our specialty. Through the strength of our numbers, using the resources and connections ACOG has established, our specialty organization can be the megaphone or the password we need to make sure our message is heard where our voices are needed the most. And the best part? It’s incredibly easy to get involved wherever you are, no matter your schedule, and make a difference on the issues that are most important to you.

Before we get into the details, watch our short video about advocacy and how ACOG can help you advocate for issues you care about.

Each week of October will have a different advocacy focus, including at least one action item to help you find your passion and take action to make a difference right away. Check out our website each week for new updates, ideas, tips, and tricks and keep an eye on #JFAdvoMonth on social media for inspiration. Whether you’re a newcomer or a veteran advocate, I promise you’ll learn something new!

I’ve loved traveling the country with ACOG since my term began, making new friends and learning all of the different things our colleagues love most about our specialty. At every meeting and event I’ve attended, I’ve been inspired to see one trait overwhelmingly present in our community: Passion. It’s no surprise that folks who sign up for a life of long work hours, constant education, and high-pressure performance circumstances are a passionate group. Our patients and our practices rely on that dedication and enthusiasm every day — but our patients need us outside of the exam room too. Our commitment to our specialty must be heard in the places where decisions that impact our lives and the lives of the women we serve are made.

Advocacy is an integral part of our mission as physicians. This month, I hope you’ll join us in learning new ways to use our clinical experience and expertise to make an even bigger difference for women’s health.

On behalf of the JFCAC, happy ACOG Advocacy Month!

How I Unexpectedly Became A Powerful Voice for Women’s Health

Lynne Coslett-Charlton, MD, is a 2018 ACOG McCain Fellow and practicing gynecologist at Ob-Gyn Associates in Wilkes-Barre, PA. She shares why she’s a passionate advocate for women’s health in the guest blog post below. 

As a young physician in practice, I witnessed the power one person can have—and the impact an entire medical community can make when we speak together. I’m from a small town in Pennsylvania and work as a private-practice ob-gyn in a community hospital near where I grew up. To paint a full picture: I even joined the practice that delivered me some 50 years ago. While my practice provided excellent clinical teaching, it offered little education on the business of medicine. In fact, I was completely unprepared for the realities of the hostile medical liability climate that dominated my early years as an ob-gyn. Malpractice cases in my hometown soared and I was disheartened to see many of my excellent mentors and colleagues forced to alter or quit clinical practice altogether.

The ACOG Pennsylvania Section quickly mobilized in my tiny community, offering ob-gyns like me guidance and support on ways we can use our voice to send a clear message to policy makers. Eventually, malpractice in my community gained national attention and then President George W. Bush’s reelection campaign took notice and added it to his presidential platform.

It was then that I realized the importance of advocating not only for our patients—but for our needs as physicians. I quickly became engaged in my Section’s work on the broad scope of women’s health issues being legislated at both the state and national levels. In May 2018, I had the honor of becoming an ACOG McCain Fellow, which gives ob-gyns like me firsthand exposure to policy development and the legislative process in the federal and state governments.

During my first week on the job, a lot of progress was made on maternal health. First, there was the second annual March for Moms in Washington, D.C., where supporters marched for improved maternal care. ACOG President Dr. Lisa Hollier spoke at the march in support of initiatives like Maternal Mortality Review Committees (MMRC), which provide critical analysis into the causes of maternal mortality. That same week, The Pennsylvania governor signed into law HB 1869, which established Pennsylvania’s first MMRC under the state Department of Health.  MMRCs have since received wide support across party lines—and our message that all states should be consistent on their abilities to evaluate maternal deaths and make recommendations based on expert reviews resonated both at the state and national level. It was voices like ours in the women’s health community that helped maternal health legislation pass with bipartisan support in a political climate where very few issues are considered bipartisan.

It’s revealing when I look back at the road to becoming the strong advocate I am today for women’s health and our profession. When I started my career as an ob-gyn, I didn’t necessarily think of myself as a political force. But we must remember that our patients need us both inside the exam rooms—and outside.

My ACOG Section gave me a platform to make my voice heard and helped facilitate opportunities to meet with my representatives about women’s health issues that mattered to me. ACOG National built on those local experiences and helped me network with like-minded ob-gyns in ways I wouldn’t have been able to otherwise. During my weeks as an ACOG McCain Fellow I not only had the timely opportunity to advocate for MMRCs, but also attended briefings on sex education, sat in on the Advisory Committee Meeting on Women’s Veterans Health, and accompanied ACOG’s Government Relations team to a multitude of political events.

Something I hear often from my peers is “I don’t have time to advocate” or “I’m interested but I just don’t know where to start.” ACOG has so many easy ways for you to be involved—whether its sending out a pre-filled message or comment to your representatives or donating to the ACOG Ob-GynPAC, which is the only federal PAC dedicated to electing representatives who support our specialty. Get started and find your voice by visiting or follow ACOG advocacy on Twitter at @acogaction.

The Case of the 132-Pound Ovarian Tumor

ACOG Member Vaagn Andikyan, MD, a board-certified gynecologic oncologist with the Western Connecticut Health Network (WCHN), and Assistant Professor for the University of Vermont Larner College of Medicine, shares his experience performing a lifesaving surgery on a patient with a 132-pound ovarian tumor in a guest blog post.

When I first saw the patient, she was unable to walk. She had shortness of breath and severe abdominal pain. She was malnourished because what we later learned was a 132-pound ovarian tumor was sitting on her digestive track, making it difficult to hold down food or water.

She sought care when she started to gain about 10-pounds a week. When she was ultimately referred to me, this 38-year-old woman had endured about two months of rapid weight gain. I saw fear in her eyes. I was determined to help her and I knew that I could at Danbury Hospital.

A computed tomography scan revealed a large ovarian mass. I suspected it was a benign mucinous ovarian tumor. The size of the tumor — measuring about three feet in diameter — along with its location made it a life-threatening situation. The tumor occupied the patient’s entire abdomen, and was compressing her aorta and vena cava. I was concerned about an underlining blood clot. The question became how do we remove this tumor and ensure the patient’s safety?

I assembled a team of nearly 25 highly skilled, caring clinical specialists, including fellow ACOG member and gynecologic oncologist Linus T. Chuang, MD, Chairman of Obstetrics and Gynecology for WCHN, plastic surgeon David Goldenberg, MD, Section Chief, Plastic Surgery Subsection at Danbury Hospital, and anesthesiologist Karl Kulikowski, MD, Vice Chairman, Department of Anesthesia, Medical Director, Operating Rooms, Department of Anesthesiology at Danbury Hospital.

Extensive pre-operative planning was crucial because there were many unknowns and hurdles to address. For example, because the tumor was so large, a concern was the amount of excess skin and our ability to close the incision.

We developed and practiced plans for five potential scenarios. Our goal was to perform the tumor resection and abdominal reconstruction at the same time to reduce the number of surgeries for the patient and improve her outcome.

In the end, the surgery took about five hours. We successfully removed the tumor — and only the patient’s left ovary. The patient went home just two weeks later and is expected to make a full recovery.

This was one of the most challenging, complex cases of my career. I might expect to see a 25-pound ovarian tumor, but a 132-pound ovarian tumor is rare. It reminded me how important it is to have colleagues you can rely on and trust. Our ability to pull together our expertise and experience is what gave us the confidence and knowledge-base to tackle this case, especially because this was the first surgery of its kind at Danbury Hospital. Danbury Hospital’s cardiovascular experts were instrumental to ensuring the patient’s safety. Medical residents conducted imperative research to aid in developing the care plan. The operating room staff prepped a room to accommodate a tumor of this magnitude. Dr. Goldenberg removed excess skin that was stretched by the tumor and reconstructed the patient’s abdomen. Danbury Hospital’s Intensive Care Unit and Inpatient Rehabilitation helped the patient to convalesce safely and quickly, and social workers helped the patient and her family to navigate her care plan.

The tumor tissue is currently with WCHN researchers at the Rudy L. Ruggles Biomedical Research Institute. They are conducting genetic tests. We want to understand why the tumor grew so quickly so we and our patient can learn from this case.

This case also reminded me how important it is to participate in community outreach to encourage women to routinely see their primary care providers and gynecologists for wellness screenings.

Thank you for the opportunity to share this extraordinary case with you all.