ACOG’s Executive Board is Working for You

In my role as ACOG President, I have the opportunity to work with many talented and dedicated people who serve on the Executive Board. The Board consists of national officers, district chairs, members at large, subspecialty representatives, and a public member. Our purpose is to carry out the objectives of ACOG by conducting the general management of the organization.

The recent meeting on July 12-14 was particularly productive. Continue reading

How Ob-gyns Can Celebrate National Women’s Health Week

Womenshealth.gov National Womens Health WeekNational Women’s Health Week, led by the U.S. Department of Health and Human Services’ Office on Women’s Health, starts on Mother’s Day, May 11. The goal is to empower women to make their health a priority.

For ob-gyns, it’s a great opportunity to help our patients and communities learn more about what it means to be a well woman.

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Every Woman, Every Time…Cada Mujer, Cada Vez

What a difference a year makes. It was only a year ago that I said 2013 was “The Year of the Woman” and asked ob-gyns around the nation to lead efforts on behalf of women’s health. We saw a rocky start to the Affordable Care Act, yet as ob-gyns we have appreciated that so much of what we value for our patients is now considered a health benefit:  cervical and breast cancer screening, preconception health, maternity care.

The challenge in front of us is to provide care, lead change efforts in our hospitals and communities, and sustain our practices. At times it is daunting. This last year, we heard your concerns and worked on your behalf to improve our care delivery, to empower safety efforts, and to challenge those who fight reproductive health access, payment reforms and medical liability reform. We have worked hard to keep legislators out of our exam rooms!

A year ago I introduced a mantra that reinforces all that we hold dear: Every Woman, Every Time. For every woman, at every encounter in our health care delivery system, we need to help her achieve optimal health and wellness in the context of reproductive choices. This year has seen uncertainty and changes in health care delivery. I challenged all of us as ACOG Fellows to take the lead, because the changes in medicine will come at a cost that requires each and every one of us to foster change and collaboration.

No longer can we sit back and let change happen. Rather, we need to direct the changes, to lead the transformation that places women first. Only if we place the focus on quality, on service and on attaining health care access for all women will our practices—and our skills—flourish. By making women our focus, we will succeed. This past year, ACOG led a well-woman task force, to achieve consistency in well-woman care across all medical providers. We have opportunities to share with colleagues in internal medicine, pediatrics and family practice, and with our partners who are nurse midwives and nurse practitioners, in all aspects of well-woman care.

It has been an honor to represent the most wonderful specialty, both here and abroad. ACOG has a strong voice—in the halls of Congress, amongst our colleagues across the US, and amongst our sister organizations around the world. We are leaders.

ACOG relies on the work of all our Fellows. I thank each and every one of you for the gift of this year, to represent women, to represent Fellows, to represent ACOG

For Every Woman, Every Time.

The Key to Women’s Health: Collaboration

Collaborative practice is the true hallmark of highly-functioning ob-gyn practices and medical systems. When we use the term ‘collaborative practice,’ we need to focus on the elements that make collaboration a success for our patients.

ACOG benefits when we collaborate with our partner organizations to improve women’s health. The past two weeks have demonstrated extraordinary collaboration.

Dr. Haywood Brown, Chair of District IV, recently led ACOG’s new Well-Woman Task Force, gathering experts from numerous specialties, including physicians from family practice, ob-gyn, pediatrics, and internal medicine, along with nurse midwives, nurse practitioners, and physician assistants. He asked his colleagues to collaborate and define the elements of the annual well-woman visit. Women see a variety of health care practitioners, so we need to ensure that we are consistently addressing the same common elements during a well-woman visit, regardless of patient age or health care provider. The meeting brought focus to the importance of ‘Every Woman, Every Time’ that places women’s health and reproductive needs together.

Carrying on with the collaborative theme, the Council on Patient Safety in Women’s Health Care, convened under Dr. Paul Gluck’s expertise, brought together ob-gyns, family practice doctors, anesthesiologists, midwives, and nurse practitioners, along with the Joint Commission, American Hospital Association, and many others. This group’s “Three Bundles, Three Years” initiative is aimed at improving birth outcomes in every birthing location in the US by tackling the three of the most common complications we see in labor and delivery:

  • Hemorrhage: Every center will have a guideline in place so that we respond effectively when a hemorrhage occurs.
  • Hypertension: Every center will implement the hypertension guidelines outlined recently by ACOG’s Task Force Report on Hypertension in Pregnancy.
  • Blood clots: Every center will focus on reducing the risks of clotting complications, such as pulmonary embolism.

At the SMFM meeting, Dr. George Saade brought together experts to address “Pregnancy as a Window to Women’s Health,” a day-long symposium co-hosted by SMFM, ACOG, and NICHD. We can predict a woman’s risk for later health problems—notably diabetes and hypertension—by evaluating her pregnancy complications or disease processes. Out of this collaborative symposium will eventually come recommendations for care and guidance for future research.

I have already started discussing with my patients at their first prenatal visit how their pregnancy will be a “window to future health.” Afterall, the patient-provider relationship is one of the most important collaborations in our careers.

 

Behind Many Olympic Champions Stands a Mom

I confess: I am an Olympics junkie. In 2012, I had the good fortune to spend two weeks in London for the Summer Olympics. Now, I’m getting ready to watch the Winter Games. I say I’m a junkie because I watch anything and everything leading up to the Olympics, and then I watch any event I can. Luge—wow! Snowboarding—so cool. And there’s curling, of course. And ice skating, downhill skiing, hockey, and speed skating. I love them all!

Now why would I mention this personal passion in my blog? Because of the moms. I enjoy the commercials that highlight the sacrifices of athletes—the arduous practice, the long journey, and living away from home are just a few of them. Then, the athletes acknowledge that it was their mothers who helped them succeed. Well, of course.

As we celebrate the Olympic Games, let’s remember that caring for all moms is our investment in the next generation. Optimum health does not happen by accident. Just as their child’s Olympic success depends on maintaining healthy lifestyle choices, including proper nutrition, avoiding tobacco and alcohol, and getting enough sleep, so, too, do moms need to make their own health a priority.

The Affordable Care Act ensures that moms—indeed all women—are covered for annual well-woman preventive health care with no co-pays or deductibles. Annual well-woman visits are important to help keep mothers healthy and strong so that they can raise healthy children. It’s all full circle!

So, let’s take a minute to applaud these mothers and remind all women that their children’s health begins with them. Here’s to the Olympics, to athletes, and to moms everywhere.

 

Broadening the Reach of Well-Woman Care

In years past, the primary care physician was a patient’s main point of contact for health care. Today, it’s not uncommon for a patient to regularly see three or more doctors for a combination of primary and specialty care needs. But even though we share patients, we don’t often collaborate across specialties on how to provide the best care for individual women. This can cause obvious complications—such as errors in prescribing medications—but, more importantly, it can lead to missed opportunities for improving health and wellness during face-time with our patients.

As part of my presidential initiative, I convened a task force of women’s health professional organizations, including primary care physicians, obstetrics nurses, midwives, physicians assistants, and others, to discuss well-woman care and look at ways we can work together to take advantage of each patient interaction. Bringing all these groups to the table to talk consistency and continuity in treating the whole woman is an important step toward more comprehensive care with Every Woman, Every Time she sees a doctor.

A woman’s reproductive health and goals affect many facets of her care. For example, a neurologist needs to be aware of a patient’s desire to breastfeed or become pregnant before prescribing certain medications. And I believe that contraception is as important a topic for a reproductive-age woman with diabetes as her blood sugar level is. Every woman of reproductive age, seeing any provider, should be asked about her reproductive goals. And while we ob-gyns talk extensively about reproductive concerns, we should be talking to patients about wellness-related issues such as a woman’s risk factors for heart disease and the importance of getting to or maintaining a healthy weight.

To make meaningful changes in the way we think and conduct patient care, all of us in the medical community must deliberately seek out the bigger picture. We will have to work together to set shared goals and establish referral relationships. As ob-gyns, we should make a point to reach out to our colleagues in other specialities, underscoring the importance of preconception care and reducing unplanned pregnancies, and encouraging them to always consider the reproductive health of their female patients.

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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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With Routine Medical Tests and Procedures, Choose Wisely

Hal C. Lawrence III, MD, ACOG Vice President, speaking during the press briefing.

Hal C. Lawrence III, MD, ACOG Executive Vice President, speaking during the press briefing.

Open lines of communication are the basis of successful doctor-patient interactions. However, when it comes to medical tests and procedures, doctors and patients alike can easily slide into cruise control without taking the time to discuss what’s truly needed, appropriate, supported by evidence-based research, and in the best interest of the patient’s care.

With this in mind, ACOG has teamed up with the Choosing Wisely campaign—an initiative that aims to spark a conversation about commonly performed tests and exams in different areas of medicine. By taking a critical eye to routine health care practices, we can make better decisions on how to provide thorough and comprehensive care while avoiding unnecessary, redundant, or even risk-increasing procedures.

Today, at a joint press conference with 16 other partnering organizations, ACOG made the following recommendations:

1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.

2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
Ideally, labor should start on its own initiative whenever possible. Higher cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.

3. Don’t perform routine annual cervical cytology screening (Pap tests) in women 30–65 years of age.
In average–risk women, annual cervical cytology screening has been shown to offer no advantage over screening performed at 3-year intervals. However, a well-woman visit should occur annually for patients with their health care practitioner to discuss concerns and problems and to have appropriate screening with consideration of a pelvic examination.

4. Don’t treat patients who have mild dysplasia of less than two years in duration.
Mild dysplasia (Cervical Intraepithelial Neoplasia [CIN 1]) is associated with the presence of the human papillomavirus (HPV), which does not require treatment in average–risk women. Most women with CIN 1 on biopsy have a transient HPV infection that will usually clear in less than 12 months and, therefore, does not require treatment.

5. Don’t screen for ovarian cancer in asymptomatic women at average risk.
In population studies, there is only fair evidence that screening of asymptomatic women with serum CA-125 level and/or transvaginal ultrasound can detect ovarian cancer at an earlier stage than can be detected in the absence of screening. Because of the low prevalence of ovarian cancer and the invasive nature of the interventions required after a positive screening test, the potential harms of screening outweigh the potential benefits.

Learn more.

Guest Blog: With the ACA, Many Ounces of Prevention

Barbara S. Levy, MD

Barbara S. Levy, MD

Have you ever heard the phrase “an ounce of prevention = a pound of cure”? It’s an often-used mantra in the medical community and a message we continuously repeat to our patients. That’s because intervention through prevention makes good sense. In many cases, catastrophic illness can be avoided by nipping small problems in the bud or diagnosing and treating disease early. In addition to living a healthy lifestyle, regularly visiting your doctor for routine screenings and counseling is paramount to achieving this goal.

As women, we are often the primary (or sole) caregiver for our families—not to mention the cook, head nurse, and chief financial officer among many other roles. Without a second thought, we may put the needs of others before our own. This is especially true if money is tight and it’s a decision between getting an annual well-woman exam, paying $50 for a birth control prescription, or meeting the needs of a child, spouse, parent, or friend. But this philosophy doesn’t serve women well—if you’re sick, who will look after the people you care about?

The Affordable Care Act (ACA)—the new US law that expands health care coverage by making health care more affordable and accessible—focuses on expanded access to preventive services. Making preventive services available for little or no out-of-pocket cost makes it easier for women to do the right thing for their health and put themselves first. As I discussed in my last post, a growing number of women are now eligible to receive contraception and other preventive health services without a co-pay.

Preventive services that are now covered include:

  • Annual well-woman visit
  • Human papillomavirus (HPV) testing
  • Preventive vaccinations including HPV, flu, hepatitis A & B, shingles, and chicken pox
  • Sexually transmitted disease prevention counseling
  • Obesity screening and counseling
  • Smoking cessation
  • Depression screening

The ACA chips away at many of the barriers to access and care that women have faced for years. Here at ACOG, we’re closely monitoring the implementation of the law and will continue to advocate for comprehensive care for the women we serve. I believe this legislation is a major step in the right direction to improving women’s health and improving health outcomes for all Americans.

Check out these links to learn more about ACA and how it will affect you:

Prevention, Wellness, and Comparing Providers (HealthCare.gov)

Benefits for Women and Children of New Affordable Care Act Rules on Expanding Prevention Coverage (HealthCare.gov)

Effective Date: Women’s Preventive Health Coverage Requirements (ACOG)

Barbara S. Levy, MD, is vice president of health policy at ACOG.

Healthy Women = Healthy Families

A personal note from ACOG President James T. Breeden, MD: This week, I became the 63rd president of ACOG. I am looking forward to the year ahead and to the opportunity, through this blog, to address key health issues for women and the ob-gyn specialty. 

In the week leading up to Mother’s Day, many people (myself included) are busy buying flowers, gifts, cards, and candy for the special women in our lives. During this time, I also like to remind my patients that the best gift they can give to their families and friends is a healthy self.

“Take care of yourself first” may be advice that you’ve heard before, but it bears repeating. So often, women juggle schedules, home life, and work for everyone in their household. In the midst of keeping others on track, their own needs get sidelined. The family calendar may include soccer games, birthday parties, business dinners, and school projects, but what about a spa treatment, time for regular exercise, and a yearly well-woman doctor’s visit?

Mother’s Day kicks off National Women’s Health Week. This year’s theme, “It’s Your Time,” encourages women to take time every day to do something healthy. Try incorporating good habits, such as being more active each day, making smarter food choices, getting a full night’s sleep, or finding a new way to keep stress under control. If you haven’t had your annual exam, now’s a good time to schedule your appointment.

Starting now and throughout the entire year, remember to make self-health a top priority.