Every Woman, Every Time – In Chicago and Beyond

ACOG’s Annual Clinical Meeting in Chicago is just over a week away. I’d like to tell you about the three fabulous speakers that I selected for my President’s Program. I know that each of them will bring alive the spirit of my presidential theme, “Every Woman, Every Time.”

First up will be Dr. Lesley Regan who leads global women’s health efforts for the Royal College of Obstetricians & Gynaecologists in London. She also chairs the Committee for Sexual and Reproductive Rights for the International Federation of Gynecology and Obstetrics. In “Human Rights and Women’s Health in the 21st Century,” Dr. Regan will address every woman’s basic rights to health care, as well as the challenges that different cultures around the globe face in providing this care.

Our second lecturer is Dr. Mark Hanson, director of the Academic Unit of Human Development and Health at the University of Southhampton in the United Kingdom. Dr. Hanson has focused his work on new ways to reduce disease processes and improve health by championing preventive interventions during preconception, throughout pregnancy, and in infancy and childhood. In his lecture, “The Developmental Origins of Health and Disease (DOHaD) Challenge,” he’ll provide his insight into why investing in the health of our current generation is the best way to invest in the health of future generations.

The final speaker will be the distinguished Dr. Tyrone Hayes, professor of biology at the University of California–Berkeley. In “From Silent Spring to Silent Night: The Impact of the Environment on Reproductive Health,” Dr. Hayes will illustrate why we must study the impact of environmental chemicals on our health. As I have said many times, and as Dr. Hayes will demonstrate, ob-gyns need to lead efforts to shift the burden of proof away from physicians and the public back to the chemical industry. Companies must prove that chemicals are safe before they are released into the environment and the marketplace.

This year’s annual meeting promises to have something for everyone—great lectures, wonderful camaraderie with colleagues, and an opportunity for all of us to celebrate our wonderful careers in obstetrics-gynecology. See you in Chicago.

Guest Blog: The Value of Education and Outreach to Improve Global Women’s Health

Taraneh Shirazian, MD

Millions of women around the globe lack basic rights—rights to health care, rights to family planning services, and the right to lead long, healthy lives. Pregnancy and childbirth are major threats to women in underserved areas of the world with over 300,000 women dying yearly from their associated complications, unattended by trained medical professionals. While most of these deaths are preventable, these women need a voice to bring the world’s attention to what is truly a global crisis in women’s health.

As ob-gyns, awareness of the scope of issues faced by women internationally should be integral to our education. Only with this foundation can we prepare ourselves for the monumental challenges of global health care delivery. Ultimately, it is our collective responsibility as women’s health care providers to give voice to and promote care for these women, whether or not we choose to work at home or abroad.

It has been my work and passion over the last seven years to develop educational resources for health care providers interested in global women’s health, including a new online course. Preparing for cultural and ethical aspects of health care delivery abroad is critical and just as essential as our medical knowledge. These skills can also allow us to take better care of women here in the US.

All women’s health providers should educate themselves on these global women’s health topics, including maternal mortality, obstetric fistula, family planning, and female genital cutting.

I encourage you to be part of a global voice for women.

Taraneh Shirazian, MD, is assistant professor and director of Global Health in the department of ob/gyn and reproductive sciences at Mount Sinai School of Medicine in New York.

Lessons From Our Ob-Gyn Colleagues in Mexico

Last week, I had the wonderful opportunity to take part in The Federacion Mexicano de Colegios de Obstetricia y Ginegologia (FEMECOG) meeting in Mexico City. The outstanding program provided the most up-to-date discussions on all aspects of women’s health to about 4,000 of Mexico’s 14,000 ob-gyns. Imagine if ACOG was able to share cutting-edge information with 30 percent of our Fellows at one meeting.

Our own Dr. James Martin, former ACOG President, was a bit of a ‘rock star’ as he delivered seven different lectures on preeclampsia. He was surrounded by physicians afterward asking for photographs with him! The variety of lectures at this meeting was impressive—and certainly challenged my understanding of Spanish. Our hosts—from outgoing FEMECOG President, Dr. Jose Montoya, to the newly elected FEMECOG President Ernesto Castelazo, and his spouse, Gabriela—made every moment enjoyable. ACOG Mexico Section Chair, Dr. Francisco Ruiloba, and his spouse, Gabriela, attended to every detail during our stay in Mexico City.

One of the best discussions we had was about medical student and residency training in image (2)Mexico. Students there have four years of medical school, followed by a one-year internship that is required before medical school completion. Every student from each of the almost 80 medical schools must complete one year of public service to underserved populations in Mexico City or in the deepest jungles of Mexico.

Our hosts, Felipe Gonzalez and Maru Morales, discussed their concern when their eldest daughter, Sofia, accepted her public service assignment in Santa Cruz, Huamuxtitlan, in Guerrero, one of Mexico’s most remote locations. No one was willing to serve there the year before. I can only imagine leaving my daughter in a remote valley for a year of service.

Sofia says her time in Santa Cruz was one of the best and most important years of her life. In fact, Sofia thrived as she provided primary care to the 1,000 local inhabitants of the surrounding countryside. She said she learned self-reliance and independence. She saw 40 patients a day because she was one of only a handful of physicians in the surrounding towns. About 45 minutes away from her was a support clinic to handle deliveries and advanced emergency care.

image_7Sofia treated patients with diabetes and hypertension, but she also gave hope to so many in other ways. She started exercise classes in the town square (Zumba in the plaza!) to emphasize healthy lifestyle choices for everyone. She talked friends, colleagues, and a university into donating computers because there were none in town. The computer center near the town kiosk is now named the ‘Dr. Sophia Gonzalez Center.’ At her graduation, Sophia was the first recipient of her university’s newly established “Best Social Service Award.”

I also had an opportunity to discuss the desire of ob-gyn residents in Mexico to work with ACOG through our Junior Fellow programs. ACOG’s programs are inspiring the many ob-gyn residents throughout Mexico to want to exchange skills and interests with ob-gyn residents here in the US. What better opportunity than to develop exchange programs so that we can foster mutual respect, understanding, and knowledge from our diverse programs.

As we look closely at our health care system, it’s clear that we have much to learn from other countries. Most of us enter medicine with an interest in serving others, but we have never had a system dedicated to achieving such lofty goals. Although many academic programs have a global presence, often we can achieve more by collaborating closely with our ob-gyn colleagues in other countries.

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International Meetings with a Focus on Local Care

As ACOG president, I have the honor and privilege of representing US ob-gyns on an international level. This has been most exciting. In the last two weeks, I have attended the annual meetings of the Society of Obstetrics and Gynaecology of Canada (SOGC) in Calgary, and the Royal College of Obstetrics and Gynecology (RCOG) in Liverpool. It was particularly rewarding to watch our very own Dr. James Martin, an ACOG past president, become an honorary fellow of RCOG for his extensive work in hypertension. At these meetings, I was struck by the diversity of the attendees and the deep interest in global women’s health. I was also surprised and inspired by the similarities in priorities we share with our overseas colleagues.

RCOG is working toward a goal of improving maternal outcomes. RCOG President Dr. Tony Falconer, shared reports and responses to the UK’s National Health System and discussed safety in labor and delivery. He referred to all of the fellows as the “eyes and ears of the profession” who will need to address lifelong leadership and quality goals. RCOG is also setting expectations at UK delivery centers for all who provide care. Just as they are looking to improve outcomes, so are we. With our National Maternal Health Initiative, we can focus on both quality and safety in every delivery center in the US by developing standards and expectations on how to provide the best care.

Dr. Chiara Benedetto, the first female president of the European Board and College of Obstetrics and Gynaecology, is working with each of the European nations to develop expectations for the well-woman visit. We hope to accomplish the same thing in the US with our partners in family practice, internal medicine, and pediatrics, including nurse practitioners, nurse-midwives, and physician assistants. Clearly, we all agree that we must address the health of women BEFORE they conceive through improved well-woman care and contraception.

The take-home message: We are all facing the same pressures. Ob-gyns around the globe are extremely dedicated physicians who want what is best for our patients. We need training, standards, and support in developing the systems to provide the best care, and time is of the essence. As many have said, “We do not need to reinvent the wheel.” This is an especially important point as we share our global initiatives and recognize the importance of engaging each country in improving maternal health care and outcomes. We can make changes for Every Woman, Every Time, because—no matter where we live—if we put our patients first, we will succeed.

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Guest Blog: Fighting Violence Against Women Together

Susan M. Lemagie, MD

Susan M. Lemagie, MD

Every day news from around the world highlights acts of egregious violence against women: the rape and murder of a female medical student in India, acid throwing and subsequent suicides of women in Central Asia, and the Taliban bullet to the brain of a 15-year-old girl in Pakistan who was targeted for promoting education for girls and women. While the scale here at home may be different, women in the US are not immune to violence.

Today, 1 in 4 women in the US has been physically or sexually assaulted by a current or former partner. Homicide is a leading cause of pregnancy-associated mortality in the US, with the majority being committed by an intimate partner. And as demonstrated in the last election, there are still many people who attempt to dictate a woman’s relationship with her doctor and her ability to make her own reproductive health choices. These efforts teeter on the edge of reproductive and social coercion.

In defense of women, ACOG has issued several recent documents—including committee opinions on reproductive and sexual coercion, sexual assault, intimate partner violence, and human trafficking—to raise awareness of the abusive treatment that some women in the US regularly face. ACOG has also developed patient outreach materials that provide information and resources to women in need.

ACOG has partnered with Futures without Violence on a guide titled Addressing Intimate Partner Violence, Sexual and Reproductive Coercion, which encourages ob-gyns to screen patients for domestic violence and recognize the signs of abuse. It also provides tools for health care providers to help women build healthy relationships and be safe in their own homes. Many thanks to ACOG’s Committee on Health Care for Underserved Women and the ACOG National staff for their ongoing efforts to advocate for women.

Now it is our turn as ob-gyns to speak up for our patients and their families. At this year’s Congressional Leadership Conference, March 3–5, 2013, more than 300 ob-gyns will lobby Congress to support ACOG’s Women’s Health Resolution. The resolution lists 14 non-negotiable rights that every woman in the US should be allowed, including the right to be free from gender-based violence. We will also convey to our legislators that our highest professionalism emerges when we base our care on the best scientific evidence, without legislative interference in our role as women’s health care physicians.

As we prepare for our lobby day, I’m filled with both a sense of duty and of pride. We can once again stand up as supporters of our patients and champions of women. It’s what we signed up for as ob-gyns, and it’s the right thing to do.

Susan M. Lemagie, MD, is an ob-gyn in Alaska and a member of ACOG’s Executive Board.

Guest Blog: A Global Focus on Maternal Mortality: Saving Mothers, Giving Life

Herbert B. Peterson, MD

For most families, the arrival of a new child is a joyous and celebrated occasion. However, in many countries in the developing world, having a baby can be a dangerous undertaking: Approximately 800 women die during childbirth each day; 99% of all maternal deaths occur in the developing world. The loss of a mother is a tragedy for her family and her community.

Imagine you are a physician in rural Uganda: You know there is a high-risk patient who lives in a village several hours away from your regional hospital. She has no transportation, no running water, no electricity, and no cell phone access. Despite the fact that you have the skills to assist in a safe delivery, the barriers to access will likely prevent this woman from coming to the hospital, greatly increasing the chance she will die in childbirth.

Complications that cause most maternal deaths in the developing world are severe bleeding, high blood pressure, obstructed labor, and infections. Our challenge and our hope is this: We have proven life-saving interventions routinely used in the US and other industrialized nations to prevent these deaths. And while they have the potential to dramatically improve maternal outcomes, it has been very difficult to implement these interventions in low-resource settings.

We now have a wonderful window of opportunity with a groundswell of support to develop initiatives to improve maternal and infant health. The American College of Obstetricians and Gynecologists (The College) is playing an integral role in Saving Mothers, Giving Life (SMGL), an innovative public-private partnership that aims to reduce maternal mortality in the developing world. As a founding member of SMGL, The College has joined with the governments of US and Norway, Merck for Mothers, and Every Mother Counts to dramatically accelerate progress in preventing maternal death. Work has already begun in Uganda and Zambia with a goal to reduce the number of maternal deaths by up to 50% in a year, and plans are under way to expand our reach into other developing nations disproportionately affected by maternal mortality.

I’m both honored and excited to represent The College and be a part of SMGL. This coalition has a unique opportunity to make a difference. I firmly believe we can and we will. Watch for updates and opportunities on The College website to get involved in these important initiatives.

Guest Blog: Owen C. Montgomery, MD, ACOG Fellow-at-Large

Dr. Owen Montgomery

I’m Dr. Owen Montgomery, a practicing ob-gyn in Philadelphia, and I was recently elected Fellow-at-Large to ACOG’s Executive Board. This is a new position, and I’m extremely lucky and excited to be involved in molding how the Fellow-at-Large can have an impact on members and women alike.

The Fellow-at-Large is intended to fill a void. While most Fellows are represented by district (regional) and section (statewide) ACOG leadership who can voice their concerns to the Executive Board, some Fellows do not have representation. This includes ob-gyns outside of our established districts and sections and international ob-gyns from certain regions. In addition, there are ACOG members who are not Fellows, but educational affiliates or associate members who are our collaborative partners in women’s health. I will be an ear attuned to the needs of these Fellows, helping them to become more engaged in ACOG and bringing the needs of their patients to light.

Being a liaison for our international colleagues dovetails with my deep personal interest in global women’s health. One of ACOG’s missions is to provide support to colleagues who care for women around the world. As part of this effort, ACOG recently attended the “Bilateral Collaboration to Improve Women’s and Infants’ Health” forum with our colleagues in Russia.

Just like us, these physicians are passionate about doing the best for their patients. They have made tremendous strides in advancing the quality of ob-gyn care available to Russian women over the last 10 years and building stronger doctor-patient relationships. ACOG has signed an agreement that will allow for collaboration with our Russian counterparts—granting them access to ACOG documents, helping to expand their knowledge, introducing them to new and cutting-edge techniques, and building on what we’ve learned at ACOG to address the problems that women encounter in their corner of the world.

As I continue as Fellow-at-Large, I’d like to hear from ACOG Fellows out in the field, about your patients and the challenges you face. Email me at owen.montgomery@drexelmed.edu, and let’s explore the ways that ACOG can help. Let’s work together to find solutions for our patients and practices.

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Dr. Montgomery is chair of the department of obstetrics and gynecology at Drexel University College of Medicine in Philadelphia. A specialist in female pelvic reconstructive surgery, Dr. Montgomery has explored a range of concerns throughout his career, including gender education; the provision of care to underserved women, both nationally and internationally; electronic medical records; and the prevention of sexual assault.