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.

 

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.

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

Teaming Up with Our Nurse-Midwife Friends

Earlier this month, I had the good fortune to attend the American College of Nurse Midwives (ACNM) annual meeting in Nashville, TN. What a fabulous meeting in a great location. The meeting program was diverse and holistic, with an emphasis on the same issues ob-gyns are struggling with: improving safety in our birthing centers, improving global women’s health, and changing the delivery of care right here at home so that we see healthier moms and babies.

An ACOG delegation—including myself, Executive Vice President Dr. Hal Lawrence, Past President Dr. Richard Waldman, and President Elect Dr. John Jennings—attended the opening ceremonies and were greeted with a thunder of applause, an acknowledgment that collaboration in improving women’s health and access to care is a shared goal of our organizations. ACNM also gave ACOG a very special award: the Organizational Partner Award for aiding in the development and practice of midwifery. This award was very meaningful to us. It was recognition that ob-gyns and nurse-midwives do collaborate, share delivery services, and very much depend on one another. The changing face of health care ensures that our professions will continue to interact, innovate, and work together.

Change is tough, because often it means separation from our comfort zone and having to adopt different behaviors or different approaches. Some physician practices have quickly incorporated midwives, and others have not. According to trends in the ob-gyn workforce, we do not have enough physicians in our specialty to meet the challenges ahead. The reality as we look toward the future? It is likely that many models of collaborative practice will be adopted by more and more physicians, both out of necessity and because it just makes sense. Expanding our access to patients with physician assistants, nurse-midwives, and nurse practitioners when possible both serves our patients and allows ob-gyns an opportunity to focus on the work that specifically requires our special skill set. We will need to look closely at how we provide care, and particularly on how we collaborate on the delivery of care, over the next decade. I’m personally looking forward to sharing more information on successful strategies to provide our patients with the best coordinated care we can.

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

Choosing a Hospital or Home Birth

Home or hospital? The question of where to give birth is a topic of ongoing discussion among expectant moms, doctors, midwives, and home birth advocates. As the number of women who give birth at home increases, the sometimes heated debate about which is safer for women, babies, and families will surely continue. The author of a recent New York Times Magazine article wrote “It is unfortunate that the choices and the rhetoric around birth—like many of the choices and rhetoric around motherhood in general—are so polarized.” It’s a big decision.

A woman’s health and risk factors should be central considerations in deciding on a birth venue. Although studies have shown that absolute risks of planned home birth are low, home births don’t always go as planned. Planned home birth is associated with increased risk of neonatal death when compared with planned hospital birth. Risks also increase in women with certain medical conditions such as hypertension, breech presentation, or prior cesarean deliveries, or in births where there are inadequately trained attendants. It is important for any woman choosing home birth to have a certified nurse-midwife, certified midwife, or physician practicing within an integrated and regulated health system with ready access to consultation and a plan for safe and quick transportation to a hospital in case of an emergency.

While ACOG believes that hospitals and birthing centers are the safest place for labor and delivery, we respect a woman’s right to make a medically informed decision about her birth experience. ACOG also continues to support collaborative practices between physicians and certified nurse-midwives/certified midwives to further improve outcomes for pregnant women and their babies.

Ultimately, women have a choice in where to give birth. As ob-gyns, it’s our job to educate our patients on the risks and benefits of hospital vs. home delivery and help them make the best decision for themselves and their families.