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.
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.
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.
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.
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.
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
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.
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.
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.
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