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District VIII on FacebookIn an effort to provide you with current information regarding women’s health, District VIII has joined Facebook. We are updating our page regularly with news specifically relevant to District VIII members. You can find us at facebook.com/ACOGDistrictVIII.

ACOG national is also on Facebook at facebook.com/ACOGNational. If you’re a Facebook member, log in and click on the “Like” button on the ACOG national and District VIII pages. Then, you’ll be able to comment on and share any updates posted. You’ll also get ACOG national and District VIII news sent directly to your Facebook news feed.

Anyone can view Facebook pages, but only Facebook members can interact with ACOG national and District VIII. To become a Facebook member, sign up at facebook.com.

ACOG national is also on Twitter at twitter.com/acognews. To follow its feed, go to twitter.com and sign up as a member. You’ll be the first to hear ACOG news!



From the chair

Dr. Susan M. LemagieSusan M. Lemagie, MD

Happy holidays! This is my favorite time of year in Alaska. Those of you who live in the lower 48 states may think of Alaska as dark and cold this time of year. However, our snow cover actually makes the days bright, and our extended dawns and twilights result in beautiful colors in the sky.

Northen LightsThe Northern Lights dance in the sky above my pond each winter, and give a static, million-miles-away sound effect to long-distance phone calls.

Women’s health
With the presidential election over, I hope we can regain a sense of bipartisanship at the national level. It was disconcerting to see women’s health targeted repeatedly this past year. Thankfully, ACOG President James T. Breeden, MD, past District VIII chair, rose to the challenge, telling legislators to “get out of our exam rooms” in a
letter-to-the-editor in The New York Times.   

Additionally, ACOG Executive Vice President Hal C. Lawrence III, MD, co-authored an important opinion piece, “Legislative Interference in the Patient-Physician Relationship,” in the New England Journal of Medicine with leaders from the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and American College of Surgeons.

I’ve watched women’s rights in the US change over the last 50 years, and I am well aware of how fragile they are and how vulnerable women remain, in the US and in the rest of the world. I hope you watched the recent Public Broadcasting Service documentary inspired by the book Half the Sky: Turning Oppression into Opportunity for Women Worldwide by Nicholas Kristof and Sheryl WuDunn. The presentation focused on real-life stories of worldwide misogyny. I also recommend reading When Everything Changed: The Amazing Journey of American Women from 1960 to the Present by Gail Collins.

We must remain vigilant or women’s health will be in jeopardy. To that end, the ACOG Executive Board issued a Statement of Policy on Global Women’s Health and Rights in July 2012.

Physician burnout
The other half of the patient-physician relationship is also facing challenges. With health care reform, physicians are being asked, or in some cases being told, that we must do more with less. We must cover the expenses of patient care as reimbursement remains the same or is lowered in the face of decades of rising expenses. As religious and secular institutions merge, what we say to patients and offer in care is being restricted. Work-life boundaries are being violated and causing more physicians to experience symptoms of burnout. The Atlantic magazine ran an interesting article in August, “
The Physician Burnout Epidemic: What It Means for Patients and Reform.”

It may be time to develop a Physicians’ Bill of Rights. Have you been in a situation where you felt you were being asked to do more than humanly capable? Where patient safety was being compromised? Where you felt intimidated to not speak out because of malpractice fears, religious dogma, or threats of being labeled disruptive or unethical? Email me at slemagie@gmail.com with your stories, or let your section officers know about challenges you’ve face. Our profession is suffering, and making our voices heard can help turn things around.

Congressional Leadership Conference
The 2013 ACOG Congressional Leadership Conference, The President’s Conference, will be held March 3–5. Attendance at this event, where we learn how to advocate for our profession and patients with members of Congress, rises every year. The first two days of the conference inform us about key legislative issues for the year and teach us how to lobby. Then, we meet with senators and representatives to use our new knowledge and skills.

District VIII often has the highest number of participants at this event. Contact your district or section officers if you are interested in attending. There are sponsorships available, in addition to individual attendance registration, with CME provided.

Annual District Meetings
The 2012 Annual District Meeting in Phoenix was successful, and the program focusing on patient safety was well received. ACOG held its first-ever flash mob to promote “Dancing with the Docs.” This event was oversold, and everyone had a great time cheering on the competition. Who knew ACOG had so many great dancers?

I am proud to report that District VIII Junior Fellows and friends won the coveted mirror ball trophy. But it was close! So close that we are having a rematch with Districts VI and IX, and, joining us for the first time, District V, in Maui, HI, at our 2013 ADM.

This quad-district meeting will be held at the Grand Wailea Resort on September 26–28. For program information, read “2013 ADM: Interactive learning in Maui” by Tod C. Aeby, MD, District VIII program chair.

The Grand Wailea Resort is on one of the best beaches in the islands. The kids’ pools, slides, and lazy river are family favorites. District IX will also be leading yoga sessions on the beach at dawn as part of their physician wellness program. 

Maintenance of Certification
As you prepare for your Maintenance of Certification (MOC) exam, remember to take advantage of the
Pearls of Exxcellence on the Foundation for Exxcellence in Women’s Health Care website. A mobile version of the site was released in October, so you can review “Management of Adnexal Masses” in your spare moments. 

Larry C. Gilstrap III, MD, American Board of Obstetrics and Gynecology (ABOG) executive director, has kindly written an article on the MOC exam for this issue of the Gazette. The exam becomes available in January 2013. Also, check out the practice exam and other useful information on the
ABOG website.

Annual Clinical Meeting
New Orleans is the site of ACOG’s 61st Annual Clinical Meeting May 4–8. Under Dr. Breeden’s guidance as ACOG president, it is sure to be thought-provoking, innovative, and practical. Read more about the 2013 ACM.



From the editor

Dr. Stella M. DantasStella M. Dantas, MD, District VIII secretary

It was so great to see many of you at the Annual District Meeting in September. What a wonderful meeting! Thank you to program co-directors Paul A. Gluck, MD, and John P. Keats, MD, for their impressive meeting agenda. 

I would also like to thank Laura A. Dean, MD, District VI vice chair and program chair, for combining an excellent educational experience with networking, mentorship, and even a dance competition (during which I am happy to say I competed with a fantastic group of Junior Fellows).

District VIII once again had a number of medical students attend the ADM and continued its support of medical student recruitment. A total of 35 medical students registered for the ADM, 29 of whom were from District VIII. Eight District VIII students received housing support, 13 received stipends from their sections, and a remaining 10 students funded themselves solely. 

Devon Rasmussen, Vancouver Fraser Medical Program, University of British Columbia, wrote about his experience for this issue of the Gazette. Reading his article, “2012 ADM: Medical student perspective,” should make you feel proud of District VIII’s efforts to encourage the best and brightest to choose our specialty.

The sections in our district continue to be at the forefront of legislative initiatives, patient safety and protection, cultural awareness, and education. British Columbia is working on a campaign to help address increasing cesarean delivery rates. Read about the “Power to Push Campaign in British Columbia” from Nicole J. Todd, MD, University of British Columbia resident. The campaign is an educational initiative empowering women with information to help them chose the safest birthing options.

Another University of British Columbia resident, Flora F. Teng, MD, shares her experiences from a one-month medical rotation in China in this issue of the Gazette. Learn about her illuminating journey into a foreign ob-gyn culture and how one must have “cultural humility” in “Junior Fellow shares lessons learned from rotation in China.”

Maternal mortality in the US continues to be a concern. As measured by the Centers for Disease Control and Prevention, the aggregate US pregnancy‐related mortality ratio was 14.5 per 100,000 live births for the eight-year period 1998–2005—higher than any other period in the previous 20 years. In response to this increase, sections are working on developing or resurrecting a formal process for maternal mortality review. William J. Peters, MD, past District VIII chair and past Montana Section chair, reports on Montana’s legislative work on this issue in “Saving moms in Montana: A maternal mortality review initiative.”

For more on legislative initiatives in our sections, read “Government Relations Committee: State legislative update” by Tony Ogburn, MD, District VIII legislative chair.

In Utah, Fellows are increasing education in their state on patient safety. Read “Utah Section reaches out to rural hospitals” by W. Lawrence Warner, MD, Utah Section vice chair, to learn more.

Also, do not forget to mark your calendar for the 2013 ADM at the Grand Wailea Resort in Maui on September 26–28. Read “2013 ADM: Interactive learning in Maui” by Tod C. Aeby, MD, District VIII program chair, for more information.

Lastly, learn all you need to know about the American Board of Obstetrics and Gynecology’s “Maintenance of Certification: Part three­—cognitive expertise test” from Larry C. Gilstrap lll, MD, American Board of Obstetrics and Gynecology executive director. This test will be a new experience for everyone, and Dr. Gilstrap kindly agreed to explain the process.

Please do not hesitate to contact me with questions, comments, or ideas at maddogcoutu@yahoo.com. The Gazette is your publication, and feedback is always appreciated. I look forward to hearing from you, and I hope to see you all in 2013 at either the Annual Clinical Meeting or ADM.



2013 ADM: Interactive learning in Maui

Dr. Tod C. AebyTod C. Aeby, MD, District VIII program chair

What if you went to a three-day conference, got hours of CME instruction, and never once thought of falling asleep or checking your email?

A lofty goal, I know, but that is exactly what the Planning Committee would like to achieve with the 2013 Annual District Meeting in Maui, HI. The committee has been hosting focus groups to help develop the ADM, and the results from those groups keep rolling in. We are starting to get a good idea of what potential attendees want from the ADM.

If you want to make your voice heard, there are still several online focus group meetings in the works. Email me at aeby@hawaii.edu if you’re interested in participating.

The ADM will be held at the Grand Wailea Resort September 26–28, and it will be in what we’re calling a “sandwich format.” The presentations that make up the first slice of bread will follow breakfast or lunch and will feature important contemporary topics that spouses and significant others will also enjoy. 

As an example, Charles Miller, PhD, assistant professor at the University of Minnesota and an explorer and expert in mobile learning, will give the keynote address on new and exciting methods for improving interaction and learning in face-to-face and distance educational environments. Dr. Miller will share his interactive learning system, “Flipgrid,” which we will be using throughout the ADM.

Flipgrid offers the potential for virtual attendance at the ADM, so members won’t have to travel to Maui to participate. (But really, who doesn’t want to travel to Maui?)

The meat of the sandwich will be the “Maintenance of Confidence: Learning You Won’t Forget” program, which will consist of several short, interactive sessions reviewing approaches to common ob-gyn conditions. These sessions will be heavily based on ACOG educational materials.

The last slice of bread will be “Controversies in Ob-Gyn.” The topics of these sessions will be selected (about three months before the ADM) based on suggestions from members.

The Planning Committee is excited to take on the challenge of keeping everyone awake and engaged. Will we pull it off? You won’t know unless you participate!

Additional attractions include:

  • Social events—Welcome Reception; “Dancing with the Docs;” and an astronomy lecture
  • Breakout sessions—“Taking Mobile and Interactive Learning Back Home;” “Personal and Professional Financial Planning;” and one more to-be-decided session based on focus group input
  • Leadership training—Organized by Junior Fellows and young physicians, though everyone is invited to attend
  • Clinical symposia—Scheduled throughout the three-day conference at times that will not interfere with the main learning agenda



Junior Fellow news

Dr. Stacy TsaiStacy Tsai, MD, District VIII Junior Fellow chair

As I reflect on this past year, some of my most memorable experiences were spent with District VIII Junior Fellows. We had an amazing exchange with ob-gyn residents in Costa Rica during the 2012 Interim District Meeting in March. I was surprised to learn that contraception is part of universal health coverage in Costa Rica and that all women have equal access to it. The country’s health policies are in many ways more advanced than those of the US.

District VIII Junior Fellows recognize the importance of advocacy in improving women’s health care in the US. We started a new task force on leadership and advocacy. Part of its task is to communicate with young people via email to get them more involved in national elections. This idea evolved into an ACOG national campaign, “Every Vote Counts,” with the help of Stacie Monroe, ACOG associate director of political advocacy, and Luke A. Newton, MD, Junior Fellow Congress Advisory Council chair. 

In addition to reproductive health services, the 2012 ACOG election guide focused on two Junior Fellow-specific issues: medical student loan repayment and graduate medical education funding. With the increasing cost of medical education (the average debt of a medical student entering residency is $150,000), the issue of loan repayment is at the heart of every young physician. The Affordable Care Act addresses an array of workforce issues, including loan repayment. I encourage Junior Fellows to become engaged in conversations on these issues, which will affect their future. 

At the 2012 Annual District Meeting, Junior Fellows from Districts VI, VIII, and IX organized a bowling event to encourage interaction between medical students, Junior Fellows, young physicians, and Fellows. The event was a huge success, with more than 80 people in attendance. 

District VIII Junior Fellows also entered as contestants in “Dancing with the Docs,” a fundraising event for ACOG’s federal political action committee, Ob-GynPAC. After hours of practice, we performed a dance choreographed to the song “I Gotta Feeling” by The Black Eyed Peas. We were thrilled to win and bring home the mirror ball trophy! View photos from this event and more at the ADM on Facebook.

District VIII Junior Fellows continue to fundraise for our Central American Education Project. We are in the process of selecting our first scholarship recipient. 

I want to thank the Fellows of District VIII for being so supportive of Junior Fellow activities. I am excited for another memorable and productive year in ACOG.



Young physician update

Dr. Nicole E. MarshallNicole E. Marshall, MD, District VIII young physician

The Third Annual Young Physician Luncheon was held during the 2012 Annual District Meeting in September. This year’s focus was on mentoring. The luncheon featured “speed mentoring” sessions with opportunities to meet and ask questions of Fellows from various districts with special expertise in areas important to young physicians just starting their practice.

Young physicians also had a chance to sign up to receive mentoring and to be a mentor to Junior Fellows and medical students still in training. Materials on mentoring will be available on the young physician website soon. I encourage you to check out these resources.

The next young physician meeting will be a breakfast forum at the 2013 Annual Clinical Meeting in New Orleans. I’ll have an update on the expected agenda in the next issue of the Gazette. We are also starting to plan the Young Physician Luncheon for the 2013 ADM. Please email me at marshani@ohsu.edu if you have any suggestions for topics or speakers for this meeting.

As a reminder, the young physician category represents ACOG Fellows in their first eight years of Fellowship. Each district has young physician representatives who sit on their District Advisory Council and report to the young physician officers who sit on the ACOG Executive Board.

Your young physician representatives want to make sure we’re bringing issues that are important to you to the attention of your section, district, and national leaders. Please feel free to contact me with comments and suggestions. I encourage you to get involved with ACOG.



Maintenance of Certification: Part three—cognitive expertise test

Dr. Larry C. Gilstrap lllLarry C. Gilstrap lll, MD, American Board of Obstetrics and Gynecology executive director

The year 2013 is important for the American Board of Obstetrics and Gynecology (ABOG) Maintenance of Certification (MOC) process because it will be the first year of the cognitive expertise test. It is in year six that each diplomate of ABOG must complete part three of MOC by taking and passing a secure written examination. This requirement currently affects approximately 7,000 of the 27,000 diplomates who are enrolled in MOC.

Applications for MOC 2013, including those in year six, will be available on the ABOG website until November 15, 2013. Physicians are encouraged to apply early in the year. When year-six diplomates apply for MOC, they will be notified that they must pass a secure written examination before December 15, 2013. They will also be required to pay an additional fee of $175 to cover the administrative costs of preparing the examination and the test center fee. This fee will be in addition to the $245 fee for MOC parts one, two, and four.

When a diplomate’s application has been approved, information will be emailed to the diplomate explaining the process for scheduling a test at a Pearson VUE test center, which are located throughout the US. Seats at each test center can be scheduled most days of the year on a first-come, first-served basis. Physicians are encouraged to schedule their examinations as soon as possible.

If a physician does not pass the written examination, it may be retaken (a maximum of five times). A new application must be completed with a new test fee of $175. The last day an application for a retest can be submitted is November 15, 2013. If a physician fails to pass the MOC part three examination by December 15, 2013, his or her certificate will expire. A re-entry test must be taken and passed to reinstate his or her ABOG certification. In addition to passing the written examination, year-six diplomates must also complete MOC part two (lifelong learning) and part four (quality improvement).

The cognitive expertise test will consist of two 50-question selectives chosen by the diplomate (obstetrics only, gynecology only, office practice only, or a combination of all three). For example, a laborist could take both selectives in obstetrics. The test will last 105 minutes. The questions will be multiple-choice with one best answer and will be based on common clinical problems. An MOC practice test is available on the ABOG website.

Eligible diplomates should refer to the 2013 online MOC Bulletin for more detailed information about the requirements, dates, deadlines, and fees for the examination.



Government Relations Committee: State legislative update

Dr. Tony OgburnTony Ogburn, MD, District VIII legislative chair

The Annual ACOG State Legislative Roundtable was held in Washington, DC, September 14–15, and District VIII was well represented. State legislative chairs and lobbyists (from the states that have one) discussed a variety of state legislative issues at this meeting. In addition to a number of topics that have been at the forefront of ob-gyns’ minds for some time—reproductive rights, home births, and medical liability—several emerging issues were addressed.

Environmental toxins and reproductive health
ACOG President Elect Jeanne A. Conry, MD, PhD, gave an overview of how environmental issues affect reproductive health. There is growing concern that exposure to a variety of toxins may have a negative influence on fertility and pregnancy. Currently, there is not enough sound data to guide this discussion, but ACOG should continue to address this issue.

Dense breast legislation
A number of states have considered or passed laws regarding notification and/or evaluation of women if their mammogram shows they have dense breasts. Research indicates that further evaluation of these women creates a lot of anxiety and expense but doesn’t prevent cancer or decrease mortality. Still, advocates for such laws have a strong, emotional message that is hard to counter effectively.

Over-the-counter oral contraceptives
There is increasing interest by a number of organizations in making oral contraceptives more readily available to decrease our nation’s persistent, unacceptably high unintended pregnancy rate. A large body of literature generally supports the safety of increased access. ACOG released a Committee Opinion in November recommending oral contraceptives be available over the counter. However, it could take years before the US Food and Drug Administration takes action. Novel approaches to increase access can occur at the state level though, especially if ACOG is supportive of the concept.

Health care reform
Attendees heard an excellent summary of the potential effects the Affordable Care Act will have on women’s health by Joan Alker, research associate professor at Georgetown University Health Policy Institute. I encourage you to review the State Health Care Reform page on the ACOG website, which is dedicated to this issue.

Please consider attending the 2013 ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, March 3–5. The meeting is a great opportunity to learn more about advocacy and get involved. Contact your district or section officers for more information.



Patient Safety Committee: Common problems found in hospitals

Dr. Sandra KochSandra Koch, MD, District VIII patient safety officer

The Voluntary Review of Quality of Care (VRQC) Program has been visiting hospitals across the country for more than 25 years. The most common problems encountered by the VRQC during these visits are: disruptive physicians; lack of teamwork and compliance with national guidelines; poor communication; and absence of simulation drills and standardization.

If any of these issues are present in your hospital, it’s important to take steps to correct them as soon as possible. Here are some things you can do:

  • Adopt a zero tolerance policy for disruptive behavior. If you have a problem you can’t solve, move quickly to use outside resources
  • Use a program like TeamSTEPPS to improve communication
  • Implement a standardized system of communication such as SBAR (Situation-Background-Assessment-Recommendation) to reduce miscommunication
  • Conduct multidisciplinary programs, meetings, and drills to foster teamwork. These activities have been shown to improve performance in emergent situations and increase understanding of everyone’s roles. Use them as an opportunity to improve teamwork and communication
  • Standardize care to reduce errors. Start by making sure that everyone working on labor and delivery has been trained in Eunice Kennedy Shriver National Institute of Child Health and Human Development terminology. The Electronic Fetal Monitoring Program on the District VIII website is helpful, quick, and inexpensive
  • Use guidelines to improve outcomes. It’s important to stay current with ACOG publications. New Practice Bulletins, Committee Opinions, and Statements of Policy are featured on the ACOG website homepage in a menu on the left-hand side. Patient safety checklists and VRQC worksheets are also available online

If you would like to learn more about the VRQC program and its resources, email vrqc@acog.org or call 800-266-8043.



Saving moms in Montana: A maternal mortality review initiative

Dr. William J. PetersWilliam J. Peters, MD, past District VIII chair and past Montana Section chair

Currently, there is a state legislative initiative to re-establish a formal Montana maternal mortality review. The initiative is an effort to improve maternal safety and quality of care by clinically correlating rising maternal death rates in Montana and the nation.

The average maternal mortality ratio for 2000–09 in Montana was 13.7 deaths per 100,000 live births. This ratio was consistent with rates across the US. Increases in this ratio prompted the Centers for Disease Control and Prevention to set a nationwide goal to reduce it to 11.4 deaths per 100,000 live births by 2020.

One issue with this goal is that Montana and 15 other states do not have a formal process for maternal mortality review. Thirty-four states do have a formal process. We have maternal mortality statistics from the Montana Department of Public Health and Human Services; however, no clinical correlation review process currently exists.

Prior to 1985, the Montana Medical Association (MMA) had a Maternal Welfare Committee. The Montana Department of Public Health and Human Services provided the MMA with maternal death records. The MMA Maternal Welfare Committee then requested the Montana Section review the maternal deaths. The review process was disbanded in 1985 due to questions of its lack of non-disclosure and the medical liability crisis that year.

The Montana Section would like to re-establish a maternal mortality review by legislatively amending the existing Fetal, Infant, and Child Mortality Review (FICMR) Prevention Act (established in 1997). Adding “M” (for “maternal”) to FICMR would provide a budget-neutral infrastructure, which has non-disclosure and confidentiality agreements in place. It would take advantage of an established process by using the 28 local FICMR teams across Montana and avoid establishing a new duplicative, separate process with added costs and no infrastructure.

This amendment to FICMR requires legislation. The MMA Legislative Committee assisted the Montana Section with this legislative effort. An important legislative step and successful turning point happened on August 20, with the unanimous acceptance of the FICMR Amendment Bill by the Legislature’s Montana Children, Families, and Health and Human Services Interim Committee. It was the only unanimous legislative decision made that day by the bipartisan committee.

The FICMR Amendment Bill now has appropriate sponsorship by State Rep. Liz Bangerter (R-Helena) and State Sen. Jason Priest (R-Red Lodge). The bill will be introduced to the Montana Legislature before the December 15 deadline. The FICMR Amendment Bill, having had unanimous, bipartisan acceptance and support from the Montana Children, Families, and Health and Human Services Interim Committee, is favored to be passed by the Legislature.



Utah Section reaches out to rural hospitals

Dr. W. Lawrence WarnerW. Lawrence Warner, MD, Utah Section vice chair

Last year, Utah Section leaders recognized a need to improve communication with our members. We began sending a monthly email to them about various clinical and legislative issues. We then realized that greater than 50% of the counties in Utah do not have an ACOG Fellow practicing in their communities. So, we contacted the nursing director of obstetrics in 18 rural hospitals throughout Utah and set up an email program with them. An introductory letter was sent to explain our intentions, and we asked the nursing directors to present the communication to their obstetric providers, both physicians and nurses.

Since the initial outreach, we have sent out five emails covering various patient safety subjects and standardized clinical protocols. The nursing directors forward the information to their obstetric staff and encourage them to take the topics and attached materials for discussion at a joint physician-nurse meeting to see if there are areas they can improve.

To date, I have personally visited 12 of these hospitals and given lectures on patient safety initiatives and the importance of standardization with minimization of variation. The feedback has been positive. I hope we have helped our maternity providers feel that they have a resource for current obstetric information.



Junior Fellow shares lessons learned from rotation in China

Dr. Flora F. TengFlora F. Teng, MD, University of British Columbia resident

I was recently welcomed for a one-month rotation by the incredible staff of the Women’s Hospital School of Medicine at Zhejiang University in Hangzhou, China. These are five important lessons I learned.

There is power in numbers.
In China, I observed some of the most skilled laparoscopic surgeons in the world. With tens of thousands of gynecologic surgeries per year, 19 dedicated gynecology operating theaters running five days a week, 91,900 outpatients, and 11,000 deliveries, Chinese physicians have finely honed skills from attention to detail and immense surgical volume.

Jade is not polished without rubbing, nor is a man perfected without trials.
This Chinese proverb is exemplified day in and day out as Chinese physicians painstakingly shape and mold their residents into perfection. As parents teach their children, Chinese physicians coach residents through each surgery. The instruction may be harsh at times, but the residents accept criticism, remembering they need to be polished in order to shine.

Competency-based education may take longer, but it allows for greater mentorship.
Residents in China undergo a competency-based approach to surgical education, which is starting to take shape in the US and Canada. Opportunity in the operating room is commensurate with experience. If you assist in a particular procedure 50 times and perform the procedure 50 times with direct supervision, you take a test. (The exact number varies with each procedure.) After passing, you are allowed to perform the procedure independently.

If you are planning for a year, sow rice. If you are planning for a decade, plant trees. If you are planning for a lifetime, educate people.
I had the privilege to be in China during Teachers’ Day, a day of honoring teachers for the invaluable gifts they give us. From allowing multiple observers in the operating room to taking an extra hour on rounds for the foreign observer, I could see people have a great respect for education in China and an understanding that everyone can be your teacher.

Practice cultural humility, not cultural competency.
I witnessed so many differences in practice while I was in China, and I wasn’t sure how to interpret them relative to what I know from my home institution. Healthy patients remained in hospitals for days without discharge, asymptomatic fibroids were removed, and hormonal treatment for gynecologic complaints was rarely offered.

Were they right? Were they wrong? I soon realized that they were neither. These differences were born out of a specific cultural and political context, not a difference in medical evidence. It was only through humility and understanding cultural context that I was truly able to appreciate the care I observed during my rotation.



Power to Push Campaign in British Columbia

Dr. Nicole ToddNicole J. Todd, MD, University of British Columbia resident

In 2010, as a response to increased cesarean delivery rates in British Columbia, the Power to Push Campaign was launched, providing information to women and encouraging them to know their options, advocate for their choices, and push for the safest births possible.

The British Columbia Women’s Hospital Cesarean Task Force, which includes ob-gyns, family doctors, midwives, nurses, researchers, and other health professionals, developed the campaign. Integrating medical consultation, an interactive website, and social media platforms, the campaign seeks to lower the overall cesarean birth rate at British Columbia Women’s Hospital in Vancouver.

The Best Birth Clinic, located in the diagnostic ambulatory program area at British Columbia Women’s Hospital, offers consultations with ob-gyns for women who have had previous cesarean deliveries, women with breech presentations for external cephalic version (ECV), and women who desire a vaginal breech delivery. In addition, counseling services are offered to women who are considering a primary elective cesarean delivery and women who have recently experienced a difficult or traumatic birth.

Labor support handouts are available in multiple languages at the clinic and on the
Power to Push Campaign website. For maternity care providers, protocols are available for early, active, and second-stage labor management, and informed consent forms are available for vaginal birth after cesarean delivery (VBAC), ECV, and vaginal breech delivery.

Task force research is ongoing, including a randomized controlled trial examining the effect of doulas on intrapartum outcome for VBAC. Upon review of the first 14 months of operation, consultation breakdown includes 53% VBAC, 39% ECV, and 8% vaginal breech delivery. The majority of consults were from midwives (59%), followed by family physicians (31%) and obstetricians (10%).

After counseling, 65% of women chose to attempt VBAC, and 60% of those women were successful. The success rate for ECV approached 33%, with 78% of those women achieving vaginal delivery. The success rate for vaginal breech delivery was 49%, with equal success between primiparous and multiparous women. Data regarding cesarean delivery rates are pending.

The Power to Push Campaign provides patients with information and options to assist with making the best choices surrounding their births. Further, it allows maternity care providers to provide consistent information and care to facilitate the safest births.



2012 ADM: Medical student perspective

Devon RasmussenDevon Rasmussen, Vancouver Fraser Medical Program, University of British Columbia

In September, I had the privilege of attending the Annual Meeting of ACOG Districts VI, VIII, and IX in Phoenix. Though I was already quite sure ob-gyn was the right match for me, my excitement for the specialty was magnified tremendously by my experience.

The meeting was far more medical-student friendly than I could have imagined. The program had fantastic sessions that engaged medical students and young physicians, including hands-on workshops, didactic career planning seminars, and social networking events.

I attended a medical student forum, where students learned about the specialty, residency, and various subspecialty options. I also participated in the Young Physician Luncheon, where students were able to speak with Fellows and gain different perspectives on the specialty and residency match.

I had candid conversations with Fellows and Junior Fellows at a bowling night and during the “Dancing with the Docs” fundraiser. I was even fortunate enough to speak with residents and attendings from cities where I am strongly considering moving for residency.

Before attending the conference, I had never heard of ACOG and didn’t know that ACOG had Canadian sections. Following the conference, I feel better than I ever have about my plans to move toward a career in ob-gyn. I hope to get more involved with ACOG in the future. Thank you to everyone who made it possible for me to attend the ADM! 



Section reports

Alaska SectionAlaska
Kathryn M. Ostrom, MD, section chair

In October, an Anchorage Superior Court judge upheld a parental notification law for teens electing to undergo abortion. The law went into effect in late 2010 and, quickly thereafter, Planned Parenthood and local ob-gyns sued to block it. The law could delay or prevent vulnerable teens from receiving a timely abortion in a state where navigating the legal system is made more difficult by the remote and insulating nature of Alaska’s villages.

The number of teens younger than 17 requesting abortion has dropped from a high of 125 in 2009 to 87 in 2011, although it is too early to tell if this is directly attributed to the new law. An appeal is expected and most likely will wind up before the State Supreme Court.

Many activities to reduce non-medically indicated elective deliveries prior to 39 weeks’ gestation have been completed by section members. Over the last 18 months, we provided information through press conferences, newspaper articles, epidemiology publications, grand rounds lectures, and mailings of physician and patient education materials. We partnered with the March of Dimes, pediatric groups, midwives, and hospitals for these efforts.

Most hospitals in Alaska now have policies against scheduling elective deliveries prior to 39 weeks. Our goal is to continue these activities until all Alaska birthing hospitals have an active “hard stop” policy and quality improvement data collection in place.

Section members would like to start a formal simulation training program for Alaska’s birthing hospitals. Currently, we are working with residency staff members in neonatal intensive care units, labor and delivery, and family medicine as well as with private obstetricians to have ongoing training available. Efforts will start with Anchorage-area hospitals and the state’s only level-three neonatal intensive care unit at Providence Alaska Medical Center.

 

Alberta SectionAlberta
Karen J. Bailey, MD, section chair

Alberta physicians have been working without a contract since March 31, 2011. Negotiations continued throughout the summer. Fee-for-service rates remain at the 2011 rates. 

According to media reports, the Alberta Finance Minister recently made reference to no “new money” for public sector negotiations, including physicians and teachers. A news release from the government states, “Going forward in 2012–13, government will cap overall operating spending, increase in-year savings to at least half a billion, review capital spending, and respond to emergent needs as necessary.”

However, the release also indicates the government will continue to invest in key priorities such as health, education, and social programs. These mixed messages are making it hard for physicians to negotiate in good faith.

The Alberta Perinatal Health Program released its 2012 Provincial Perinatal Report in July. The following obstetrics statistics from 2010 were included:    

  • Total number of women giving birth: 50,777 (mean age was 29)
  • Live births: 51,313 (a decrease of 1.5% from 2009, and the first decrease since 2000)
  • Stillbirths: 371
  • Total planned out-of-hospital births: 602
  • Women age 20 or younger giving birth: 2,245
  • Women age 30 or older giving birth: 23,592
  • Women giving birth for the first time: 21,404
  • Total cesarean deliveries: 13,673 (15.6% were primary cesarean deliveries; 11.4% were repeat cesarean deliveries)
  • Attempted vaginal birth among women with previous cesarean delivery: 27.5%
  • Epidurals in labor: 45.7%
  • Preterm birth rate: 8.8 per 100 live births
  • Multi-fetal birth rate: 3.4 per 100 live births
  • Low birth weight (less than 2,500 grams) rate: 6.9 per 100 live births
  • Crude neonatal mortality rate: 4.4 per 1000 live births
  • Maternal deaths that occurred during pregnancy or up to 90 days postpartum: 6

 

Arizona SectionArizona
Maria Manriquez, MD, section chair

It was wonderful to see so many ACOG members in Arizona at the 2012 Annual District Meeting in Phoenix. As I write this on the day before the general election, I’m reminded of the importance of advocacy. Whether it’s at our offices, the State Capitol, or the national level, we must continue to advocate for the health and wellbeing of our patients. Women throughout their reproductive years and beyond are depending on us to put their health and safety first. 

On February 4, our section will hold its first State Legislative Conference to complement our Meet with the Legislature Day. We have morning sessions planned and will visit with state representatives and senators in the afternoon. The key issues of the day will be graduate medical education funding and access to reproductive health services, namely preventing unintended pregnancies and reducing the Arizona abortion rate. One hurdle we face is inadequate reimbursement for long-acting reversible contraception and in-office sterilization procedures from the Arizona Health Care Cost Containment System (Arizona Medicaid).

Plans are in the making for section meetings in 2013 and 2014. The Arizona Section will work with other leaders in the community to advocate for ACOG’s Making Obstetrics and Maternity Safer (MOMS) Initiative at a local level.

 

Central America SectionCentral America
Luis A. Villatoro, MD, section chair

The Central America Section participated in the Federation of Central American Societies of Ob-Gyn (FECASOG) Congress in San Jose, Costa Rica, June 4–8. On June 5, we held the second Executive Board meeting of the Central America Section. Four members in our section participated: Flory Morera, MD; Floridalma Rivas, MD, section treasurer; Cesar Reyes, MD; and me.

That same day, we held a high-risk pregnancy symposium featuring distinguished ob-gyns from the US: Luis A. Izquierdo-Encarnacion, MD, from Jacksonville, FL; and Jack Ludmir, MD, from the University of Pennsylvania in Philadelphia. Topics highlighted were: disorders of fetal growth, use of Doppler in obstetrics, security and new models in obstetric care, and cervical insufficiency. The program received excellent comments from attendees.

On June 7, Fellows and Junior Fellows held a meeting where I gave an update on current section activities. Throughout the Congress, the Central America Section managed an informational booth about the section and ACOG. We had education materials from ACOG available.

Photos from the Congress are on the
Central America Section website.

Finally, I’d like to thank my mentor Luis B. Curet, MD, past District VIII chair; the ACOG Executive Board; Sterling B. Williams, MD, ACOG vice president of education; Janet Chapin, RN, MPH, ACOG director of women’s health issues; Ruth Moreno, ACOG project administrator; Drs. Rivas, Reyes, and Morera; and my wife, Suyapa Quiroz de Villatoro, for their support. All these people have been very important in the development of the Central America Section.

 

Colorado SectionColorado
Stephen L. Stoll, MD, immediate past section chair

The Colorado Section has transitioned from monthly meetings to two larger meetings each year. For Fellows on the Western side of Colorado, one meeting will be held in June in Aspen. (The next one will be June 21–22 at the Hotel Jerome.) The other meeting will be our annual fall symposium held in the Denver area. Information will be posted on the Colorado Section website as it becomes available. You can also email colo.acog@gmail.com or call 303-355-8848 if you have any questions.

My term as section chair has come to an end. Kimberly D. Warner, MD, is now section chair, and Steven C. Holt, MD, is section vice chair. The Section Executive Committee plans to meet on a monthly basis (or as needed when the Legislature is in session). The committee is split into two subgroups. One will work with our lobbyist on legislative matters, and the other will work on the educational programs of our two yearly meetings. Please email colo.acog@gmail.com or call 303-355-8848 if you are interested in participating in these subgroups or meetings.

An initiative for a constitutional amendment that would define “personhood” as beginning at fertilization was scheduled to be on Colorado’s ballot in November. However, it was not allowed due to a lack of legitimate signatures. This measure has been defeated in two previous elections by a large margin each time.

Cerebral palsy is being addressed by several groups in our area. The groups are crafting a bill that would provide additional funds to a limited group of cerebral palsy patients without needing to go through the legal system. They are trying to define which patients would be eligible for assistance and how the program will be funded.

A bill seeking to modify Colorado criminal laws was signed into law by the governor. It declares any information obtained during prenatal care to be inadmissible in criminal proceedings. The bill was brought to the Legislature by a coalition of health care professionals who believe this change will make women using drugs more willing to seek care when pregnant.

We continue to encourage mentoring as a way to introduce students to our specialty. Interested physicians in the area are encouraged to email colo.acog@gmail.com or call 303-355-8848 for more details.

 

Hawaii SectionHawaii
Lori E. Kamemoto, MD, MPH, section chair

The Hawaii Section is working on establishing a proactive presence to make a difference in our community. One of our initiatives is to propose two bills during the 2013 legislative session. The first bill would establish a maternal mortality review committee in our state. Hawaii had a committee more than 15 years ago, which was disbanded due to loss of funds. The Hawaii attorney general reviewed the current law, determined it was inadequate, and recommended a new statute. The second bill would protect physicians who treat partners of patients with chlamydia. ACOG supports expedited partner therapy, and the Centers for Disease Control and Prevention has recommended it since 2006.

Working on these initiatives has been a great learning experience for our section (and more work than one may think at first glance). We have held several conference calls and meetings regarding these issues with the Hawaii Department of Health, established community partners who have signed support letters, and met with two of our legislators who appear to be supportive. We have more meetings and presentations scheduled for the near future. Kathryn Moore, ACOG director of state legislative and regulatory affairs, and her staff have been helpful in our efforts, providing quick answers to our questions and sample legislation from other states.

Our Legislative Committee met with residents in Hawaii to discuss advocacy on October 26. Advocacy training has recently increased in significance for our ob-gyn residency programs. If you are interested in learning more, email me at lkamemot@hawaii.edu. I would be happy to email our presentation to you. It would be wonderful if ACOG sections could take the lead on this training.

In addition, we have provided expert advice in Department of Health and March of Dimes initiatives in our state, regarding issues such as reducing preterm birth, increasing awareness of and vaccination for pertussis during pregnancy, and improving awareness and prevention of fetal alcohol spectrum disorders. 

It has been a busy year, and I hope to report on more good news and success in the future.

 

Idaho SectionIdaho
Darin L. Weyhrich, MD, section chair

The Idaho Board of Midwifery indefinitely suspended the licenses of two lay midwives in our state recently. After the accumulation of multiple poor outcomes for mothers and infants at the midwives’ birth center, as well as ill-timed transfers, the board felt that re-education and/or corrective action short of suspension would not be appropriate. The facility is still operational under the direction of another lay midwife, and communication between the facility and the local obstetrics community has been much improved.  

The 2013 Idaho legislative session is impending. After last session’s failed legislation regarding forced transvaginal ultrasound for pregnancy termination, it will be interesting to see what women’s health issues arise. There was a considerable turnover of state legislators after the election in November.

 

Montana SectionMontana
Kathleen G. Nelson, MD, section chair

The Annual Montana Section Meeting will again be held in Big Sky, January 31–February 2. Tyler J. Bradford, MD, section vice chair, has assembled a group of outstanding speakers. It should be another excellent clinical meeting. Everyone is welcome to attend!

There were a number of health-related initiatives on the ballot in Montana for this year’s election cycle. The following three initiatives passed: 

  • Legislative Referendum 120, requiring parental notification prior to abortion for a minor
  • Legislative Referendum 122, blocking the state or federal government from requiring purchase of health insurance
  • Initiative Referendum 124, repealing the existing medical marijuana law and replacing it with a new medical marijuana program with tighter regulations, lower volume, and no profits for growers

Shaun J. Gillis, MD, section secretary-treasurer, is the Montana Medical Association’s incoming president. Dr. Gillis practices in Bozeman and has already been active on legislative projects in our state. 

Three Montana ob-gyns will attend the 2013 ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, March 3­–5. One attendee will represent the section, one attendee will represent the district, and the final attendee, Tersh McCracken, MD, District VIII treasurer, will go as a member of the District VIII Executive Committee.

The section plans to sponsor one medical student to attend the 2013 Annual Clinical Meeting in New Orleans and one to attend the 2013 Annual District Meeting in Maui, HI.

 

Nevada Section Nevada
Timothy C. McFarren, MD, section chair

I have exciting news to share from the University of Nevada School of Medicine. Eight of the school’s 63 fourth-year medical students have applied for ob-gyn residency positions. The Nevada Section sponsored most of these students to attend an Annual Clinical Meeting or Annual District Meeting.

ACOG President James T. Breeden, MD, past District VIII chair, gave a presentation on hot topics facing ACOG at a recent Northern Nevada Ob-Gyn Society meeting. The event was well attended, which I hope will spark more meetings.

Nevada is in compliance with national guidelines for reporting vital statistics and will be starting a maternal mortality review board. It will be under the direction of the Maternal Child Health Advisory Board. Nevada’s legislative session begins in January, which is always an exciting and challenging time for us.

 

New Mexico SectionNew Mexico
Cynthia Lewis, MD, section chair

The New Mexico Section held its Annual Women’s Health Care Symposium March 2–3 in Albuquerque. It was our 14th year working with the University of New Mexico (UNM) ob-gyn department and the New Mexico Chapter of the American College of Nurse-Midwives to host this event. Richard N. Waldman, MD, past ACOG president, was an outstanding keynote speaker.

The section continues to support Fellows and Junior Fellows to attend the ACOG Congressional Leadership Conference, The President’s Conference (CLC); Annual Clinical Meeting (ACM); and Annual District Meeting (ADM). We will send approximately five physicians to the 2013 CLC. Additionally, the section will support up to two medical students to attend the ACM and ADM. 

In collaboration with our Junior Fellows, the section is planning its Third Annual Advocacy Training and Lobby Day in Santa Fe, focusing on issues related to reproductive health. We remain fortunate to have the services of Linda Siegle as our lobbyist. She works on issues of concern to our membership and patients, specifically reproductive health access.

The New Mexico Section is partnering with UNM and the March of Dimes to initiate a program to eliminate elective deliveries prior to 39 weeks’ gestation at UNM hospitals. We hope to become a model for other hospitals in the state to pursue partnerships with the March of Dimes.

 

Oregon SectionOregon
Marguerite P. Cohen, MD, section chair

The Oregon Legislature has been working on legislation for the last two years in anticipation of implementation of the Affordable Care Act. House Bill 3650 created a system of coordinated care organizations, which will replace the current managed care delivery systems. The intent of this change is to improve the availability, quality, and reliability of health care.

The Legislature also formed a Patient Safety and Defensive Medicine Task Force. The mission of this task force is to improve the practice environment to allow physicians to learn from medical errors, to effectively compensate individuals who are injured as a result of medical errors, and to reduce the collateral costs associated with the medical liability system. The task force’s legislation will address issues such as disclosure, confidentiality, mediation, dispute resolution, litigation, discovery, and patient safety. 

The Oregon Section and the Oregon Medical Association have been lobbying for mandatory licensure of direct-entry midwives (DEMs). A legislative work group that includes ob-gyns, DEMs, certified nurse-midwives, and legislators is approaching consensus on the issue. It is anticipated that legislation will be introduced in the 2013 session. 

We are looking forward to sending a delegation of Fellows and Junior Fellows to the 2013 ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, March 3–5. Attendees always find the conference worthwhile. If you are interested in attending, please contact your district or section officers for more information.

We would like to invite everyone in District VIII to the 21st Annual Oregon Section Meeting in Sunriver, April 5–7. The theme for this year’s meeting is “Finding Our Place in the World: A Local View of World Medicine.” Our speakers will include experts in medical economics and health policy, maternal mortality, urogynecology, infectious disease, and service abroad. Come join us for bracing discussions in beautiful Central Oregon!

 

Utah Section

Utah
Alan T. Rappleye, MD, section chair

The Utah Section continues to make efforts to stay in contact with and help educate providers in rural areas—places where there may be no ob-gyns available. W. Lawrence Warner, MD, section vice chair, has visited 12 hospitals in these areas to deliver educational messages and to discuss any concerns. You can read more about these efforts in Dr. Warner’s article “Utah Section reaches out to rural hospitals.”

Section leaders are also emailing current recommendations to our members for best practices on issues we see as important, such as our most recent email on prevention of chorioamnionitis. Ob-gyns in Utah must minimize complications that are preventable and, to some degree, standardize our approach to problems. Most of us would agree that hospital policies tend to change our methods of care—I hope for the better.

In November, we held a conference on prematurity and its prevention with the University of Utah maternal-fetal medicine department. Prematurity is one area where we have yet to see significant change. I’m optimistic that we will come to some agreement on options for better care. In the meantime, we remain committed to improving the care of our patients and the education of our peers.

 

Washington SectionWashington
Judith M. Kimelman, MD, section chair

The Washington Section is maintaining its involvement in advocacy at the state and federal level with issues important to ob-gyns. Each year, we have a substantial presence at the ACOG Congressional Leadership Conference, The President’s Conference (CLC), where ob-gyns from each state gather in Washington, DC, to learn and lobby Congress about issues affecting our specialty.

If you are interested in attending this conference, I encourage you to apply for funding from our section. Please email waacog@gmail.com for more information. Grants will cover the costs of the conference, travel, and lodging. The 2013 CLC is March 3–5.

The Washington Section offers a similar experience to the CLC at the state level. Our Fifth Annual Washington State Ob-Gyn Resident Legislative Day will be held on February 6 in Olympia from 9 am to 3 pm. If you are interested in joining us for a day of learning about advocacy and lobbying state legislators, email waacog@gmail.com for more information. The deadline to register is December 15, and there is no charge to attend.



2013 ACM: Join ACOG in New Orleans

2013 ACM in New OrleansThe 61st Annual Clinical Meeting will be held in New Orleans, May 4–8. Attendees can expect to participate in a wide variety of hands-on courses and educational and interactive sessions related to ob-gyn practice. Visit the ACM website now for more information.

2013 ACM educational session topics include:

  • Updates in contraception
  • Noninvasive prenatal testing
  • Cervical cancer diagnosis guidelines
  • Endometrial cancer staging
  • Global health
  • Maternal mortality reduction
  • Environmental exposures to the unborn child
  • Cultural and religious perspectives on abortion

The ACM program will also feature sessions on work-life balance, family and professional relationship building, and leadership skills. The President’s Program will focus on the themes of patient safety, women’s health care advocacy, communication and technology, and practice and leadership in the 21st century. New this year will be three interactive surgical tutorials on pelvic anatomy, laparoscopic surgery, and techniques in abdominal wound closure. You won’t want to miss these outstanding presentations!

New Orleans is known for its rich history, culture, and traditions. The French Quarter (including the St. Louis Cathedral and Bourbon Street), New Orleans Botanical Garden, Audubon Zoo of New Orleans, and Audubon Aquarium of the Americas are just a few of the attractions attendees can look forward to visiting.

Save the meeting dates, and join thousands of ob-gyns and other women’s health care professionals at the ACM. It will be an experience to remember!



Free ACOG poster available for ob-gyn offices

Lifetime of Care Order this oversized poster developed by ACOG’s Office of Communications for your office today!

Email communications@acog.org or call 800-673-8444, ext 2560. The poster is complimentary, but supply is limited.

















Calendar of events 

2013

January
31–February 2 
Montana Section Meeting
Big Sky
Contact: Kathleen G. Nelson, MD,
kgnelson@centurytel.net


February
4
Arizona Section State Legislative Conference
and Meet with the Legislature Day
Phoenix
Contact: Maria Manriquez, MD,
maria_manriquez@dmgaz.org


6
Washington State Ob-Gyn Resident Legislative Day
Olypmia
Contact:
waacog@gmail.com

March
3–5
Congressional Leadership Conference,
The President’s Conference
Washington, DC
Contact: Stacie Monroe, 202-863-2505


April
5–7
Oregon Section Meeting
Sunriver
Contact: Marguerite P. Cohen, MD,
mpcohen@teleport.com

May
4–8
Annual Clinical Meeting
New Orleans
acog.org/acm

June
21–22
Colorado Section Meeting
Hotel Jerome
Aspen
Contact:
colo.acog@gmail.com or 303-355-8848

September
26–28
Annual District Meeting (with Districts V, VI, and IX)
Grand Wailea Resort
Maui, HI
Contact: Linda Minor, 202-863-2488