The Match: How ACOG Is Helping Reduce Stress around Entering Residency

While graduating medical school is a huge milestone in a future ob-gyn’s career, it comes with its own stressors, such as matching to a residency program. The match process can be difficult and stressful for many medical students—and that pressure only increases when students consider everything they need to do to prepare for residency itself.

So what makes the matching process so stressful? To start, United States Medical Licensing Examination (USMLE) results can be overemphasized, which may cause medical students to focus on test results to the point of neglecting other educational and curricular opportunities. And although the number of residency positions has increased over the last five years, the number of residency applications that programs receive has drastically increased, making matching more competitive than ever before. This is especially problematic when you consider that each program has a designated number of interview spots. Interviews can also be logistically difficult, financially burdensome, and time-consuming for students and programs, a problem confounded by the fact that because each student will only select one program, training programs may need to repeat interview processes to fill all openings. The difficulties don’t stop once you’re matched, either: PGY-1s can vary in skill level on day one of residency and may need extra resources to shore up their knowledge in different areas.

ACOG recognizes the challenges that medical students face and is committed to helping the future leaders of our profession succeed. We’re considering ways to change the match process itself. Indeed, many issues with the transition to residency could be alleviated by restructuring the process. We are also actively working to ensure that medical students are informed about the ob-gyn specialty and have the resources they need to be prepared to enter the profession. The Step Up to Residency Program, developed by CREOG and the Association of Professors of Gynecology and Obstetrics, is a partial post-match curriculum that helps PGY-4s hone the skills and knowledge they’ll need in the early stages of residency. Step Up to Residency features hands-on training and covers fetal monitoring, the basics of ultrasound, neonatal resuscitation, and more. PGY-4s will also have the chance to discuss the aspects of residency that extend beyond the hospital; for example, resident wellness, financial planning, and career planning. CREOG is also launching a comprehensive post-match curriculum for all soon-to-be residents that will build the specific knowledge base and skill set that ob-gyn interns can use before the first day of residency.

Finally, ACOG offers a residency fair at our Annual Meeting and local medical student days, provide students with hands-on support as they prepare for residency, through our Districts and Sections.

Preparing for and transitioning to residency can be daunting, but the initiatives ACOG is involved in will help pave the way for medical students to become confident, informed, and well-prepared residents. ACOG is committed to being a valuable resource for all its members, starting with your first steps of training and continuing throughout your entire career.

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.

Let’s Make Speaking Out on Surprise Billing a Priority

Balance billing, more commonly known as “surprise billing,” has garnered national attention and Congress is preparing to take action. The issue of surprise medical billing may arise when a patient goes to an in-network facility to receive care, such as emergency care, surgery, or childbirth, and receives care from out-of-network physicians. Finding a solution to surprise billing is critical, and ACOG is hard at work to ensure that the solution protects our practices and our patients. Our members of Congress need to hear from us – the physicians who would be impacted.

Billing disputes can impact the patient-physician relationship, as many patients look to you to answer their billing questions. Any solution must shield patients from out-of-network payment disputes between physicians and insurers. Patients are not always able to choose an in-network provider and shouldn’t be financially punished for circumstances beyond their control. It is also critical that legislation to address surprise billing ensure that physicians are appropriately compensated for the quality care they provide. Some congressional proposals would jeopardize physician reimbursement and access to care.  I was fortunate to be on Capitol Hill earlier this year with the “Group of 6*” to advocate for legislation to address this issue.  ACOG supports an independent dispute resolution process—like the one used in New York state—that protects patients and preserves the financial stability of physician practices.

This August Recess, ACOG is partnering with the physician community to make protecting our patients and our members from surprise medical bills a priority. In a joint letter to the US Congress signed by 57 medical specialty societies and nearly every state medical association, we let legislators know where we stand on this issue. But we need your help!

As a physician, your voice is powerful in impacting new legislation. Send a message to your members of Congress and tell them to support surprise billing legislation that relies on the proven dispute resolution process. Then, connect with them in person. Most members of Congress share their town hall and constituent engagement schedules on their websites. Find out when they’ll be in your neighborhood, consider getting a few of your colleagues together, and let them know that addressing surprise medical bills is a priority for ob-gyns.

Never advocated before? It’s easier than you may think. Here’s a simple message you can send to your representatives:

I’m an ob-gyn. Please work in Congress to protect my patients from surprise medical bills and ensure a solution that is fair for everyone and that enables me to continue to provide high-quality health care to the women of (YOUR STATE), similar to the proven model in New York state. When you get back to Washington, D.C., reach out to my specialty society, ACOG, to keep this conversation going.

Whether the issue is surprise medical billing, maternal mortality, or Violence Against Women Act reauthorization, ACOG will continue to advocate on behalf of you, our specialty, and our patients year-round. You can always join our efforts by visiting our ACOG Action web page, and stay up to date with breaking advocacy news by following @ACOGAction on Twitter.

Let’s do this!

* The Group of 6, representing America’s frontline physicians, is comprised of ACOG, The American Academy of Family Physicians, The American Academy of Pediatrics, The American College of Physicians, The American Osteopathic Association, and the American Psychiatric Association.


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.

Noticed Changes to Reimbursements? Understanding the RUC and Why It’s Important

As ob-gyns, we got into the field of obstetrics and gynecology because we’re passionate about women’s health. We’re naturally curious people who love that this great specialty covers everything from surgery to bringing new life into the world. As the health care landscape changes with new technology and new business models, it’s critical that we understand how payment models are decided and the ways in which ACOG and you are involved in the process.

In 1992, Congress transitioned to a physician payment system based on a resource-based relative value scale, which mandated that payment for services be based upon the resources required to perform a service and the related practice expense. The AMA subsequently formed the Relative Value Scale Update Committee (RUC), which advises the Centers for Medicare & Medicaid Services on the relative value units (RVUs) that should be assigned to new or revised codes in the Current Procedural Terminology codebook. Although the RUC provides the work RVU recommendations, CMS makes the final decision on the RVUs, even for services they don’t cover. Today, you may know the RUC as the group responsible for the often murky process of reimbursement for procedures and services. But do you know ACOG’s role in the RUC?

The RUC is primarily comprised of representatives for specialties that accept payment through Medicare. Membership was initially determined by the amount of Medicare expenditure in certain specialties. Though ob-gyns and pediatric physicians make up a smaller portion of Medicare expenditure, they also have RUC seats because their services are essential. ACOG has a permanent seat on the RUC. This means that when the RUC decides on recommendations for RVUs, which determine reimbursement rates, ACOG is right there at the table, advocating for ob-gyns and women’s health care physicians. Barbara Levy, MD, ACOG’s vice president of health policy, served as RUC chair for six years and recently appeared in a three-episode series of ACOG’s CHEC Your Practice podcast to explain RVUs and the RUC in depth.

So, how is reimbursement determined? The process begins when the RUC sends out a randomized survey that gauges how much time physicians spend on certain procedures and services, including preservice and postservice time. Based on the survey results, the RUC presents analyzed, aggregated survey data in the form of RVU recommendations to CMS, which then takes those recommendations into account when determining a code’s final RVUs. From there, the CMS contributes additional data, such as data from their personal database on the length of hospital stays, which brings in a different perspective.

Have you noticed changes to reimbursements for certain procedures? A large part of this may be due to technological advances that make procedures quicker and easier. For example, laparoscopies, which used to include two days of hospital stay on top of the time it took to do the procedure itself, are now usually outpatient procedures. In past code reviews, a significant amount of RVUs were assigned to the amount of time spent in the hospital. Now, because the CMS records shorter hospital stays for laparoscopies, reimbursement payments are lower.

Even though you may not feel represented in the reimbursement process as an individual physician, you and your peers can make an impact on RVU valuation by participating in the RUC survey whenever you receive one. Filling out the RUC survey as thoughtfully as possible helps the RUC get a better understanding of the resources required to perform certain services. Providing the most accurate responses to the survey is extremely important; for example, Dr. Levy notes that surgeons tend to think of themselves as “fast and efficient” and may not consider the amount of time a service takes to complete. In the end, says Dr. Levy, the “determination of RVUs . . . what we as ACOG can present to the RUC is only as good as the survey data we get from ACOG members.” Let’s do this!

Welcoming a Year of Change

Today, at the 2019 ACOG Annual Meeting in my hometown of Nashville, TN, I had the unique opportunity to stand before our peers as ACOG’s newly inaugurated 70th president. I’m honored and humbled to be able to serve as ACOG president and enjoyed seeing some of you at the Meeting. And, as I think about my time as ACOG president and what I’d like to accomplish, I can’t help but keep coming back to the common theme of refining and advancing our profession in times of change.

Obstetrics and gynecology is an ever-evolving profession. As the premier women’s health care association, ACOG has always been on the front lines of women’s health care as we develop new guidance, bring new perspectives, and advocate for our patients and our profession in the halls of Congress. But as obstetrics and gynecology continues to advance in leaps and bounds, we as physicians can’t just keep up with that progress …we have to get in front of it.

My presidential initiatives will focus on reenvisioning the system of delivery of surgical care to optimize patient safety and outcomes and supporting more research in women’s health care.  So as I begin my year of presidency, I’d like to challenge us all to consider three questions:

  • What is the best way to deliver the best care to our patients?
  • What is the best way to prepare today’s trainees to deliver the highest-quality care in the future that maximizes safety and accessibility?
  • How do we ensure the highest-quality health care for women for generations to come?

Levels of Gynecologic Care will help us answer those questions. This new concept, loosely modeled after the Levels of Maternal Care program, is centered on the robust and diverse task force I assembled to investigate what future practice patterns might best deliver the highest-quality and most effective gynecologic surgical care in the most efficient and safest manner. By anticipating the future, we can ensure that we are prepared to adapt to changing trends, patient needs, and new health care systems and processes.

While these initiatives are incredibly important to improving women’s health, I’m equally excited for the opportunity to get to know you, my colleagues. ACOG’s members are some of the most passionate, dedicated physicians out there and have helped shape the course of women’s health care throughout our history. I’m eager to hear from you about the work you’re doing to ensure health care of the highest possible quality for patients everywhere. Please connect with me on Twitter at @DrTedAnderson. 

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.

Critical Steps to Reverse Rising U.S. Maternal Mortality Rates

Last week on my flight from our nation’s capital to the Texas capital, I heard the amazing news! Congress took a critical step in combating the U.S. maternal mortality crisis by passing the Preventing Maternal Deaths Act. The bill is now on its way to the president’s desk for enactment.

This achievement follows nearly a decade of ACOG advocacy and active engagement by ob-gyns, our partner organizations, and members of Congress. We all worked together consistently and tirelessly on this bipartisan legislation to ensure that no more mothers die from preventable causes before, during, or after pregnancy. It is an important step, and by no means is it the last that we will take to end preventable maternal deaths.

Why This Bill Matters

The Preventing Maternal Deaths Act will provide federal funding to create or expand maternal mortality review committees (MMRCs) in every state. MMRCs bring together multidisciplinary teams made up of local ob-gyns, nurses, social workers, and other community stakeholders to review the causes of maternal deaths and find local solutions to prevent them.

While we have all heard and read the appalling statistics of rising maternal mortality rates, what drives us all to end this crisis goes beyond the numbers. It is the lived experiences we have with our patients and their families and with our mothers, aunts, sisters, and daughters. This issue touches every one of us.

My motivation for ending maternal mortality was kick-started early in my career. I witnessed the death of a healthy new mother who lost consciousness on arriving to labor and delivery. Like so many of these deaths, there is no one person to blame. There is a complex set of contributing factors that cause maternal deaths. MMRCs are a vital step to understanding the causes of maternal mortality and how we can prevent similar cases in the future. Supporting the work of MMRCs has been a key initiative of mine as ACOG president and is part of a larger ACOG effort to make every facility in the United States a safer place to deliver.

Implementing AIM at the Hospital and State Level

The Preventing Maternal Deaths Act is only one piece of the puzzle. Through the Alliance for Innovation on Maternal Health (AIM), ACOG leads a national partnership of provider, public health, and advocacy organizations dedicated to reducing maternal complications and deaths. With plans to expand to 35 states next year, AIM teaches hospitals how to prepare for, recognize, and respond to emergency situations. AIM maternal safety bundles (sets of best practices) support doctors, nurses, and hospitals with tools to be fully prepared. The bundles include things such as

  • Checklists and team training
  • Risk screening to identify women who may need additional attention
  • Processes to recognize potential problems early
  • Workflows that help team members respond quickly and consistently in circumstances where you might only have a few minutes to save a mother and child

AIM has already seen promising improvements in maternal complication rates from the first four states that joined the initiative. Its success relies on state teams comprised of state health departments, health associations, perinatal collaboratives, provider groups, and hospitals all working together to implement consistent maternity care practices and gather and report data on outcomes and process measures. The data allow them to measure progress and determine which practices are working.

There Is Still More We Need to Do

While positive steps are being made, real progress requires fundamental changes in women’s health care — not just from hospitals and providers but also from policy makers at every level. ACOG has been working to make our voices heard on this vital issue, but we need your help because our work is far from over.

Stay tuned as we continue our work with the U.S. Congress and in statehouses across the country next year. I look forward to continuing to stand shoulder to shoulder with you, my colleagues and friends, as we work together to improve women’s health and make childbirth safer for all.

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.