For the Times They Are A-Changin’

Come gather ’round people…  

…If your time to you’s worth savin’  

Then you better start swimmin’ or you’ll sink like a stone  

For the times they are a-changin’ ~Bob Dylan

I began my ACOG Presidency this past Wednesday by reciting some of Bob Dylan’s famous verse from the 1960’s. It rings true today, especially in medicine and our specialty as obstetrician-gynecologists.

As the times change I thank our now past-president, Dr. John Jennings, for his leadership and friendship during this past year. With the counsel of his past president, Dr. Jeanne Conry, John tackled some of the very difficult issues facing our practices and our workforce. I will continue his fine work and advance it on behalf of our patients, our specialty and our organization, ACOG.

Continue reading

Help Educate Women to Drink Responsibly

For some women, alcohol is an occasional indulgence – a glass of wine with dinner, a cocktail at a special event. For other women, drinking is a much more frequent and dangerous activity. Thirteen percent of women in the US consume more than seven drinks per week, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). And according to the Centers for Disease Control and Prevention (CDC), about 1 in 8 women and 1 in 5 high school girls report binge drinking.

Continue reading

Reducing Maternal Mortality with Obstetric Care Designations

Maternal deaths related to childbirth in the United States have been rising in the past decade. According to a 2014 report published in The Lancet, the maternal mortality rate in the U.S. is now more than double the rate in Saudi Arabia and Canada, and more than triple the rate in the United Kingdom.

To address this trend, ACOG and the Society for Maternal-Fetal Medicine (SMFM) recently issued Levels of Maternal Care, the first consensus document establishing levels of care for perinatal and postnatal women. It is the second document in the joint ACOG and SMFM Obstetric Care Consensus series.

Continue reading

How to Counsel Patients about Immunizations

In recent years, we’ve made great strides in encouraging vaccination in pregnant women. During the 2009 H1N1 pandemic, influenza vaccination rates in pregnant women increased from 15% to around 47%. Since then, rates have been sustained around 50%, increasing to 53% in the 2013-14 flu season. However, there are still patients who choose not to be vaccinated, possibly due to misinformation about vaccines.

Continue reading

Help Prevent Group B Strep this Month

July is International Group B Strep Awareness Month. Group B Strep (GBS), found in 10–30% of pregnant women, is the leading cause of sepsis and meningitis in newborns, according to the US Centers for Disease Control and Prevention (CDC).

Ob-gyns have long been aware that preventing GBS is a key part of our commitment to protecting the health of newborns. Now we have the tools at our fingertips—literally—to be more effective. Continue reading

Our Patients Deserve Our Patience

Recent reports of rising cesarean delivery rates in the United States are a significant concern, both to the public and to those of us who are practicing obstetrics. Cesarean delivery rates vary dramatically across geographic areas of the country but also from one neighboring hospital to the next.

Certainly the variations in cesarean delivery rates are multi-factorial. It is easy to understand if a tertiary care hospital receiving high-risk pregnancies from a broad referral area would have an elevated cesarean delivery rate. However, it is disturbing to see that some hospitals with a high percentage of low-risk deliveries have higher cesarean delivery rates than the tertiary care hospitals in their referral area.

Continue reading

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.

Talk to Your Pregnant Patients about Immunization

As an ob-gyn, I believe in the importance of vaccines. They are one of our best options for preventing the spread of certain infectious diseases. Usually, this is the time of year that we start reminding women to get their annual flu vaccine, especially during pregnancy. But based on the troubling recent reports of whooping cough (pertussis), measles, and mumps outbreaks across the country, it’s clear that flu isn’t the only vaccine reminder that our patients need.

These recent disease outbreaks are worrisome, especially since pertussis, measles, and mumps had been extremely rare in the US. Because of many years of widespread vaccination against these diseases in the US, the population had developed “herd immunity”—because most of the “herd” was immunized and not susceptible to infection, the few not vaccinated still received protection. But in recent years, anti-vaccine sentiments have grown, and more and more children are skipping important immunizations, leaving many vulnerable to these diseases. Outbreaks often start when an unvaccinated person comes in contact with a disease (usually during a trip abroad) and brings it back to a community where a number of people are unvaccinated.

Pregnant women and infants are hit especially hard by disease outbreaks. Pregnancy causes changes to the immune system that make women more vulnerable to infections like pertussis and flu, and most vaccines cannot be administered to infants until they are about six months old. Vaccination of the mother during pregnancy becomes especially important because it provides protection for both mom and baby. Ob-gyns have a real opportunity to increase vaccination rates during pregnancy, a time when we see our patients more regularly and have repeated opportunities to discuss the benefits of immunization. While the measles, mumps, and rubella vaccine should not be given until after delivery, the tetanus, diphtheria, and pertussis (Tdap) vaccine can be given during pregnancy. The Centers for Disease Control and Prevention now recommends that all pregnant women receive the Tdap vaccine with every pregnancy. ACOG also recently issued updated recommendations on Tdap immunization for pregnant women.

Some women may worry about the safety of vaccines. Research has overwhelmingly shown vaccines are safe and are not linked with autism. Because of all that’s at stake, ethical considerations prohibit extensive scientific and medical research during pregnancy. However, millions of pregnant women have received immunizations over the years with minimal side effects and no serious adverse events linked to the vaccines. Learn more on ACOG’s immunization website: www.immunizationforwomen.org.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

No Sushi during Pregnancy…and Other Hard-to-Swallow Rules

I love sushi—living in California this is no surprise. Lucky for me my office is across the street from one of the best local sushi restaurants in town. It’s a favorite destination for me, my staff, and my patients. I recommend it to everyone—EXCEPT my pregnant patients. Why? Because I am inherently cautious.

We know raw fish is more likely to contain parasites or bacteria than cooked fish is. Sushi-related infections are rare, but this doesn’t erase my concern about the risk of adverse outcomes, mercury exposure, and the potential complications of treating an infection should one occur. As an ob-gyn, this is my job. It’s my business to consider potential problems, make my patients aware of them, and advise them to avoid unnecessary risks. If you really want to have some sushi, it’s a good idea to eat only cooked or vegetable sushi.

My goal is not to worry or alarm my patients, but to make suggestions based on solid, high-quality research. I use evidence to guide my recommendations, support my practice, and help my patients make healthy decisions for themselves and their fetuses. That’s why a recent essay by an economist and mom, who asserts that many common pregnancy recommendations are not fully supported by evidence, caught my attention.

Ob-gyns understand there’s often conflicting data and that the changes we suggest during pregnancy can sometimes be overwhelming: nine months can seem like an eternity when you have to give up your favorite things. Sometimes we even look back and realize our advice missed the mark. I remember a time when bed rest was prescribed for many patients with preterm labor, which we now realize accomplished little. But as doctors, we’re continuously learning. Advising patients to avoid things that we KNOW can cause harm is a good practice. Why take the risk of drinking alcohol when you know it could cause a problem? Given the risks, most patients don’t want to use their own child as a test subject.

In other areas, the evidence is very clear. For example, obesity and its impact on pregnancy, the fetus, and a woman’s long term health. Research has shown that excess weight gain increases the risk of maternal and neonatal complications. Obese women have a higher risk of having children born with birth defects. Excess pregnancy weight also increases the risk of maternal obesity eight to 10 years after delivery, especially if women do not lose their pregnancy weight within six months. I would argue that we have not focused enough on weight gain. Ob-gyns could go even further to support women on appropriate weight gain and exercise during pregnancy and healthy weight loss and exercise after delivery.

Certainly it is up to women to make their own decisions during their pregnancy. It’s also important for ob-gyns to remember not to lecture patients, but to partner with them to help them achieve the healthiest pregnancy possible. We must stay tuned in to the recommendations put forth by ACOG and the dedicated practicing physicians who spend countless hours reviewing the latest literature and developing guidance and best practices for ob-gyn care. And it’s also OK to listen to that precautionary voice in the back of your head. Evidence first, but better safe than sorry.

Listen to Dr. Conry’s NPR interview: The Facts Behind Pregnancy Rules

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

Oral Health and Pregnancy: Tell Your Patients to Say “Cheese”

A healthy smile is more than a way to make a good first impression. It can be a strong health indicator, too. Poor dental health has been linked to heart disease, diabetes, and respiratory infections. Maintaining good oral health through the years is extremely important and pregnancy is no exception.

Pregnancy can cause changes in the gums and teeth and roughly 40% of pregnant women have some form of periodontal disease such as gingivitis (inflammation of the gums), cavities (tooth decay), and periodontitis (inflammation of ligaments and bones that support the teeth). Despite this, 56% of pregnant women report that they have not been to the dentist during pregnancy.

Dental care during pregnancy has been a source of confusion for women, their doctors, and dentists. Some people mistakenly think that pregnant women cannot be treated for oral health problems. However, the opposite is true. Pregnancy is an excellent time to discuss dental health with women, and ob-gyns can play a major role.

In a new Committee Opinion, ACOG urges ob-gyns to support good dental hygiene among pregnant patients by performing routine oral health assessments at the first prenatal visit and encouraging women to see a dentist. This can also help us reassure our patients that common treatments and procedures, such as teeth cleaning, dental X-rays, and root canals, are safe during pregnancy.

We can also reiterate important healthy mouth basics:
• Limit sugary foods and drinks
• Brush teeth twice daily with a fluoridated toothpaste
• Floss once daily
• Visit the dentist twice a year

With just a few questions and suggestions, we can help patients—some of whom may not have seen a dentist in years—take a step toward a healthier mouth. And, the benefits may reach beyond mom. Studies show that women with good dental hygiene are also less likely to pass cavity-causing bacteria on to their babies—two for one protection. By performing oral health screenings, ob-gyns can help ensure a healthier smile for women and their babies. So check in with your patients about their dental health and make sure they’re smiling for all the right reasons.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.