November 17 is World Prematurity Day. It gives us, as health professionals, an opportunity to direct our attention to a devastating health issue that impacts 15 million babies each year and rededicate ourselves to reducing that number. Several organizations, including ACOG, are supporting the cause through education, awareness, and advocacy events. However, there’s one event in particular that, coincidentally, started this week and stands to make the most significant impact in terms of lowering the preterm birth rate in this country and that’s open enrollment through the Health Insurance Marketplace.
Prevention of preterm birth starts with a healthy mom and that means access to prenatal care and preventive services. There are several risk factors for preterm birth, some of which include high blood pressure, low pre-pregnancy weight, alcohol and drug abuse, smoking, a prior preterm birth and a birth less than 12 months ago. Adequate health insurance coverage can make the difference between a pregnant woman carrying to term or delivering too early and the Affordable Care Act has helped make that coverage accessible to millions of women.
When confronted with so many different types of infections and viruses that can threaten the health of an unborn baby, it’s unfortunate that drinking during pregnancy is still the leading cause of birth defects in this country and abroad. Without knowledge of the devastating effects, it’s easy to have a casual attitude toward drinking but when a fetus is exposed to any amount of alcohol it can lead to a number of permanent and debilitating conditions. These are known as fetal alcohol spectrum disorders (FASD) and can include anything from severe brain damage and growth deficits to lifelong learning and behavioral problems in children. September is designated as FASD Awareness Month but my hope is that at some point in the near future there is no longer a need to observe it because the fact is—FASD is 100 percent preventable.
Only 22 percent of mothers in the United States are exclusively breastfeeding their babies at six months. Although most U.S. women initiate breastfeeding, more than half wean earlier than they desire and fall short of their personal goals. These are startling statistics given all the research and evidence we have that shows how beneficial it can be for both women and babies. That says to me that we, as providers, can do more to empower women with the knowledge to make this critical decision. As National Breastfeeding Month comes to a close, it seems like an appropriate time to remind us how important our guidance really is and the potential impact it could make on health outcomes.
There are many barriers to successful breastfeeding but I believe the key to overcoming them starts with education—the one factor that physicians have the most control over. Misinformation can often be the culprit when it comes to a mother making the decision not to breastfeed. Discussions about breastfeeding should be integrated into maternity care. Providers should obtain a thorough history and find out early what expectant mothers know or have heard about breastfeeding. Often times, it’s as simple as mitigating fears regarding pain associated with breastfeeding and letting mothers know that it might not come naturally at first and that, with the right support, techniques are learned and will improve over time. Providers should respect and support a woman’s informed decision whether to initiate or continue breastfeeding, as each woman is uniquely qualified to decide which feeding option is best for herself and her infant. However, pregnant mothers take their doctors’ advice seriously, so we shouldn’t underestimate our influence. By saying nothing, we imply that it doesn’t matter—and it does.
As ob-gyns, we know the important role that vaccination plays in the health of mother and baby. It is one of our best options in reducing their chances of morbidity and mortality from vaccine-preventable diseases. Additionally, vaccination helps prevents the spread of certain infectious diseases.
The fall is usually when we start reminding women to get their annual flu vaccine, especially if they are pregnant. However, recent reports of whooping cough (pertussis) and measles exposure underscore the need to discuss other vaccinations with our patients. August is National Immunization Awareness Month and a great time to talk to your pregnant patients about immunization.
The White House has declared this week Zika Provider Action Week. This call to action could not come at a better time. The Zika virus has occupied our profession and our patients nearly non-stop since news of it broke last fall. There is no doubt that Zika presents a very real concern to patients and challenge to health care providers. With the discovery of virus transmission by mosquitoes here in the United States, many of us are faced with the even more real possibility of treating patients with potential or confirmed exposure.
As ob-gyns, we are on the front lines of patients’ concerns about Zika. As each new finding is played out in the news, our patients call or come in looking for answers to help their understanding of the risk, and more often than not, assuage their fears. Unfortunately, in the instance of Zika, we too are often scrambling for knowledge, seeking elusive answers from research institutions and government agencies. The Centers for Disease Control and Prevention (CDC) has done an admirable job working quickly and efficiently to assess, address, and educate the American public about the Zika outbreak.
Vineeta Gupta MD, JD, LL.M
Technical Director, Global Women’s Health
American College of Obstetricians and Gynecologists
A woman dies from pregnancy or childbirth every two minutes. Almost all of these deaths (99%) are in developing countries. The most heartbreaking part is that the vast majority of these deaths are preventable.
As the nation’s leading group of physicians providing health care for women, ACOG strongly advocates for quality health care for women – everywhere.
That’s why, in an effort to demonstrate the urgency of global action to protect maternal health and rights, ACOG recognizes today as the International Day for Maternal Health and Rights.
As obstetrician-gynecologists, we understand the importance of providing safe, high quality care for our patients. But as the nation focuses on better ways to provide this care, the overuse of resources is an issue of considerable concern and many experts agree that the current way health care is delivered in this country contains too much waste and inefficiency. It’s crucial that providers across all specialties and patients work together to have conversations about wise treatment decisions. That’s why ACOG is a proud partner of Choosing Wisely®, a campaign led by the American Board of Internal Medicine (ABIM) Foundation, with a goal of advancing a national dialogue on avoiding unnecessary medical tests, treatments and procedures. The key word here is “unnecessary.”
The New Year is upon us. Unfortunately, it also coincides with flu season and we still have a long way to go when it comes to educating our patients on the benefits of the influenza vaccine. A recent poll found that many Americans don’t believe they need the flu shot. Those who haven’t been immunized cited a variety of reasons including the belief that the flu shot is unnecessary, belief that the vaccination is ineffective, concerns about the side effects or risk and worries that the vaccine could infect them with the flu. As clinicians, we know that the flu shot is safe, effective, and the best protection our patients have against influenza. It is our job to communicate these messages to all of our patients, especially pregnant women.
December 6th marked the beginning of National Influenza Vaccination Week, a national campaign to urge everyone to get the flu vaccine. Throughout the entire flu season, I encourage all health care providers to strongly recommend the flu shot to your patients, emphasizing the importance of this simple preventative health action.
It’s hard to believe that it’s been half of a century since President Lyndon B. Johnson signed Medicaid, along with Medicare, into law. Even though Medicare more commonly provides coverage for a smaller fraction of the patients in a typical ob-gyn practice, it still is an example of a national program that works very well, providing coverage for more than 50 million people. Over the past 50 years, Medicaid has grown to cover more than 71 million Americans — nearly one in ten women relies on Medicaid for health coverage which includes family planning, screening for breast and cervical cancer, and long-term services and support. In fact, Medicaid covered 45% of all U.S. births in 2010 and plays a critical role in ensuring access to pregnancy-related care. Without Medicaid, many women would struggle to access or be unable to afford the care we provide.
Ah, summertime is here again and you know what that means. Warmer weather and longer days: the perfect time to remind our patients (and ourselves) to enjoy the outdoors and get active in the fresh air. Walking, riding bikes, and swimming are all ways to work out while making the most out of the season.
This is not about getting back into a swim suit, but about fighting obesity. Just last month in my inaugural address, I challenged ACOG members to join me in the fight against obesity. Why? Because, in our country alone obesity claims 300,000 lives a year. The health hazards of being obese are quite well known: diabetes, heart disease, high blood pressure and stroke. Obese women are also at a higher risk for numerous types of cancer, including esophageal, pancreatic, colorectal, postmenopausal breast, endometrial, ovarian and renal.
Approximately 36% of adult women in the United States are affected by obesity, and that number has been on the rise. Therefore, physicians have been faced with the challenges inherent in caring for these patients. As ob-gyns, we are, for many patients, the only physician a woman sees on a regular basis. Moreover, we have highly trusted relationships with our patients due to the sensitive nature of our specialty. Ob-gyns are in an ideal position to help educate women and provide counsel on the importance of a healthy lifestyle and fighting obesity.