These changes, and the increasing wealth of options, including the use of ob-gyns, family-practice physicians with obstetric services, midwives, hospitals, birth centers and home delivery, are very positive for women in Washington. But the state is also facing some new challenges, according to Jane Uhlir, M.D., who is executive director of Women & Infants and of The Gossman Center for Advanced Simulation at Swedish Medical Center as well as a board-certified ob-gyn. What concerns Uhlir these days is that “the U.S. is getting more unhealthy—with more obesity, diabetes and high blood pressure—which means more mothers are unhealthy, increasing the number of complicated pregnancies and newborns with health problems. There are also a lot of people without good health insurance and good health care because of the economy,” Uhlir says. “We see those people when they are sicker than we wish they were.”
To combat these trends, says Uhlir, Swedish has initiated a huge educational effort directed toward the public about healthy pregnancies and deliveries and has added new facilities, such as The Lytle Center for Pregnancy & Newborns (see sidebar, page 23). “Hopefully, we’ll be able to see them earlier and refer them to the right place for timely care,” Uhlir says.
Working mom Carol Salerno, M.D., a board-certified ob-gyn, has been at Meridian Women’s Health for 10 years and is also one of the physicians who provides back-up for the midwives who practice at Northwest Hospital. She is impressed with advances that have been made in the technologies for genetic screening and prenatal genetic testing. “In the past, fetal testing for anomalies like Down’s Syndrome had to be done by amniocentesis, which was invasive and risky,” says Salerno. Now patients can do the Counsyl panel in the first trimester, a noninvasive blood test that is a comprehensive carrier screen for genetic diseases, testing the mom’s DNA.
These tests are especially important now that women are delaying childbirth—a notable trend in the Seattle area. Salerno also says another fairly new process is proving to be an important technological breakthrough. Freezing oocytes (eggs) benefits women at risk of infertility because of cancer treatments. “Previously, only sperm could be stored for long periods of time,” says Salerno. “Now, oocyte preservation is possible through freezing.”
A pregnancy may start out as low risk, but the situation can change, as it did in Tina Lechner’s situation. If complications develop, says Chalmers, patients are transferred to an OB for care and delivery in a hospital, often with their midwife present. Most transfers that occur during labor are non-emergency transfers of patients whose labor has stalled or who become uncomfortable with the level of pain they are experiencing. “It’s rare to have an emergency transfer,” Chalmers says.
“The midwives work closely with us and they remain with their patients, even assisting with C-sections,” says Salerno, “to provide continuity of care.”
With the increased use of midwives comes an increased interest in freestanding birth centers. Like Tina Lechner, many women have discovered the allure of birth in a cozy facility with soft lighting, soothing music, serene décor and plenty of room for friends and family. Between 2001 and 2011, there was a 63 percent increase in births at these centers in Washington.
Home births have been gaining in popularity, too. Many women who choose a birth center for their first pregnancy opt for a home birth with their next child. But it’s not for everyone: Both mothers and practitioners have strong feelings about the risks and rewards. Moms often describe it as “magical” and cherish the experience. Others, including Seattle Mama Doc blogger Wendy Sue Swanson, M.D., a highly respected pediatrician, have reservations. In her case, the fear is based on personal experience. She had two hospital births that required C-sections and “all sorts of interventions,” including a bedside resuscitation.
For those who care for women through pregnancy, labor and delivery, it’s not just a job; it’s a calling. Salerno loves meeting new patients and couples, developing long-term relationships, watching them grow their families—traveling that road with them. “I’m a mom myself,” she says. “I’ve taken the same journey.” ✚