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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.
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
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.
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.
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 firstname.lastname@example.org 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 email@example.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 firstname.lastname@example.org or call 303-355-8848 for more details.
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 email@example.com. 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.
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.
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.
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.
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.
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!
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.
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 firstname.lastname@example.org 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 email@example.com for more information. The deadline to register is December 15, and there is no charge to attend.