The Delaware Section of the American College of Obstetricians and Gynecologists recently hosted its first Maternal Health Awareness Day.
In this week’s Enlighten Me, Delaware Public Media’s Sophia Schmidt talks with the group’s leader, Dr. Gordon Ostrum, about ongoing challenges to maternal health in the First State.
OBGYN Dr. Gordon Ostrum practices at Christiana Hospital and is the chair of the Delaware Section of the American College of Obstetricians and Gynecologists (ACOG).
Gov. John Carney signed a proclamation last week naming Jan. 23, 2019 “Maternal Health Awareness Day.”
Ostrum says it is important to raise awareness about maternal health because it is integral to overall population health — and often misunderstood.
“There's no question that maternal health is entrée to all health. That’s where babies start and that's where we can start making an impact on public health in general,” said Ostrum.
“The maternal health awareness piece has really risen to the fore recently because I think we tended to overlook the fact that there are continuing issues with maternal health,” he added. “We all know the quote-unquote wonders of modern medicine and science and so forth have made our lives so much easier and better. Life expectancy has increased. And these are things that maybe lull us into a sense of complacency. And when we look around us we see there are still significant complications associated with pregnancy and childbearing, both for the mother and of course for the baby. These are disparate in regards to their frequency in different demographic groups but they’re alarming across all demographic groups.”
Ostrum says much of maternal health during and after pregnancy comes down to the timing of appointments.
“In general what has been recognized is as many as 50 percent of women do not come back for their suggested postpartum follow-up, and that number is somewhat skewed by demographic considerations as well,” said Ostrum. “By educating people we can encourage them to come back and achieve the care that they should be getting. Additionally it has been recognized that we can decrease readmissions after delivery, which are costly, are detrimental to the health, and can often be avoided if you set up earlier postpartum post-delivery follow-up.”
“Rather than the traditional six weeks which has always been used, we’re now suggesting that people with elevated blood pressure for example be evaluated within 3-5 days of their discharge from the hospital. It has been proven that that can decrease maternal readmissions significantly. Again, less of an impact on the neonatal issue, although obviously childcare to people who are readmitted is a significant problem,” he added.
But is lack of understanding really the only thing keeping women from their postpartum appointments?
“Education is certainly a part of it, and it’s education not just of the patient, but also the provider. Insurance considerations are a problem because many insurance carriers are reluctant to reimburse for care outside of that six-week visit that we spoke about. There are initiatives involving insurers to help them understand them that this is money well spent because it might prevent more significant problems in the future. And I think improving access to transportation is certainly an issue. Because I think many people have trouble getting back to the hospital even if they are interested in getting there.”
Ostrum says poverty can be a barrier to women’s health — but it’s not the only barrier.
“Delaware in general is underserved by women’s healthcare physicians, if you look at the numbers of actively practicing physicians. Confound that with the point that that is very geographically determined. Obviously New Castle County has way more women's health providers than Kent and Sussex, absent the beach area. So there are definitely opportunities to have outreach centers and improve opportunities there,” said Ostrum.
“Consider yourself coming from Sussex County, wherever, with a complicated pregnancy that was referred to Christiana for management and ultimate delivery. You’re sent home. Where do you go? The people in Sussex County— maybe you didn't have a provider there. It's a trek for you to come up two hours to Christiana to achieve your care,” he added.
Ostrum notes the Delaware Health Information Network can help. “The information’s out there, but the ability to coordinate with providers and outpatient facilities would be another step,” he said.
A focus of the recent maternal health awareness day in Delaware was what some OBGYNs call the “fourth trimester.”
“It’s obviously a little bit of wordsmithing,” said Ostrum. “Trimester does suggest three, but this has been the impetus for this concept. One of our speakers, Dr. Haywood Brown, who is the immediate past president of ACOG, kind of coined this term and has run with it. What it means is, don’t ignore that postpartum period and the importance of maintaining health.”
Ostrum says the “fourth trimester” concept translates into interpregnancy care. “The ability to optimize medical conditions when you’re not pregnant, so for the next pregnancy you’ll be in the best possible conditions to go through the stresses of pregnancy. Helping to plan pregnancy, pregnancy spacing,” he said. “And we are also looking at screening for other medical illnesses— blood pressure, diabetes.”
Ostrum says many women use their OBGYNs as their primary care physicians. “Because many people who are otherwise healthy don't see their primary cares expect for, I’ve got the sniffles or whatever. So by seeing people on a regular basis for reproductive care and contraceptive advice and so forth, we have an opportunity to say, have you had your cholesterol checked? What's your blood pressure doing? What's your family history?”
“I hate to ignore the rest of the population,” said Ostrum. “These are habits that should spread from our ladies to everyone around them.”
Ostrum says “behavioral” factors — like opioid addiction or depression— can play a large role in maternal health. He thinks good communication between OBGYNs and patients is key to setting up referrals to ensure better care going forward.
“I’ve been thinking, yeah you know there’s not much I’m doing here, the pressure’s fine, baby’s fine, sounds good — how are you? What’s going on with you? And I think if we remind people to do that, we’ll be more attentive to everything.”