Your BIRTH Partners

Obstetrician-Gynecologist Role with Abby

February 10, 2020 Your BIRTH Partners Season 1 Episode 3
Your BIRTH Partners
Obstetrician-Gynecologist Role with Abby
Chapters
Your BIRTH Partners
Obstetrician-Gynecologist Role with Abby
Feb 10, 2020 Season 1 Episode 3
Your BIRTH Partners

This week we introduce you more to our in-house physician, Dr. Abby Dennis! Abby shares about her path to becoming a birth professional, and what made her pursue the scope of an obstetrician-gynecologist. We also dive into some of the challenges and misconceptions that surround being an OB in the US healthcare system.


[Editor's correction: Obstetricians/physicians are responsible for attending 91% of births in the US in 2018. 
Ref: Births: Final Data for 2018.  National Vital Statistics Reports, Vol. 68, No. 13. Hyattsville, MD: National Center for Health Statistics. 2019.]

Support the show (https://www.paypal.me/yourbirthpartners)

Show Notes Transcript

This week we introduce you more to our in-house physician, Dr. Abby Dennis! Abby shares about her path to becoming a birth professional, and what made her pursue the scope of an obstetrician-gynecologist. We also dive into some of the challenges and misconceptions that surround being an OB in the US healthcare system.


[Editor's correction: Obstetricians/physicians are responsible for attending 91% of births in the US in 2018. 
Ref: Births: Final Data for 2018.  National Vital Statistics Reports, Vol. 68, No. 13. Hyattsville, MD: National Center for Health Statistics. 2019.]

Support the show (https://www.paypal.me/yourbirthpartners)

Maggie, RNC-OB:

Welcome to your birth partners. We are here to break down barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we have our very own in house physician, Abby Dennis . You'll learn more about what drew Abby to this work, how she's pursuing it right now, and also you'll gain a greater understandingabout the role that OBs play in healthcare and especially when it comes to taking care of people during pregnancy, birth and postpartum. Onto the show! So Abby, hello. Welcome, welcome!

Abby, MD:

Thank you.

Maggie, RNC-OB:

So we'd love to just, you know , kind of start off, just tell us a little bit more about yourself. I know we've heard from you, you know, a little bit, but kind of more about, you know, what are your, what are your qualifications, your alphabet soup behind your name? What is it all, what does it all mean?

Abby, MD:

Absolutely. So I'm a physician, which means after college I went to, actually five, but four years of medical school and a fifth year that was more fun. I, after that actually did, I knew I wanted to deliver babies. I thought I wanted to do that as a family physician. So I did a residency in family medicine, which is three years, with the intent that I was going to do a fellowship in just women's h ealth c are. But I realized through that process that I really liked taking care of women who are pregnant but also medically more complicated. So after a lot of discussion and debate, I actually switched fields and did a four year residency in obstetrics and gynecology, which means four years in training in both of those fields. So learning how to deliver babies and also learning how to be a surgeon. Since that time I've practiced in a couple of different capacities. I've practiced as an academic OB GYN. I've practiced as a hospitalist/laborist, meaning supporting midwives and physicians on labor and delivery and helping with births and w ith births t hat are more complicated. And now I'm in my own practice with several partners.

Maggie, RNC-OB:

That's great. And so what, you know , what was the, what brought you into this field? You've had quite a little journey throughout kind of figuring out where you wanted to settle within it, but what was that first, you know , inspiration?

Abby, MD:

Yeah, I feel like that journey continues. Um, but I'll tell you that when I caught my first baby in medical school, I was completely hooked. I actually remember being on labor and delivery as a second year medical student, just sort of shadowing and watching because I wanted to see a baby born. And I remember there was a complicated delivery of triplets and literally everybody in this academic teaching institution started gravitating towards the operating room where these babies were going to be delivered. And an OB-GYN just tapped me on the shoulder and was like, "Hey, have you actually seen a baby be born?" And I was like, "no." And she's like, "you're going the wrong way." So she grabbed me and pulled me into the delivery, which was I think the fourth baby of one of her friends. And she put her hands on top of mine and she let me deliver. Well in retrospect, as an academic physician, I know I didn't really do much, but in my brain at the time, she let me deliver a baby and it was beautiful and it was just such an awesome, powerful, magical moment. And I knew I wanted to do that. How I wanted to do that has continued to evolve though.

Maggie, RNC-OB:

Aww I love it. That's beautiful. And I think it is like I know we talked about before , you know, we all have that kind of that calling something that just hooks us and tells us that like, yes, this is absolutely where, you know, it's our passion, it's what fires us up and makes us want to have, have more, even though that changes as we, you know, as we grow through it. So you talked a little bit about going in, you know, different residencies and how do you feel like, had there been like certain defining things that have happened that really shaped your professional journey, like moments or you know, experiences that kind of led you on this path. If you were, you know, if you were 20 years ago, you, you know, as a medical student looking again at all of that, what do you think you would see?

Abby, MD:

Sure. I think there have been deliveries on the way that have certainly shaped the journey. I remember as I was really struggling to figure out if I had figured, you know, chosen the wrong path within medicine. In the middle of my family medicine residency I had a very challenging, fairly traumatic delivery, a hard delivery , which really opened my eyes to the fact that I didn't have the full skill set that I wanted to, to be able to deliver babies. I think that was one of the things that really made me recognize that I wanted to push myself further and get more training so that I could help out situations where birth wasn't going exactly as planned. I think another really like defining moment for me in terms of, of training and figuring out the skill set that I wanted , um, came the first time I did a C-section on somebody who had pushed for six hours. It sounds really dumb, but I had only delivered babies as a family medicine physician. And I remember, you know when you start training as an OB GYN, you also do C-sections. And I remember the first C-section I did when somebody had essentially pushed too long, had really had obstructed labor and a baby that wasn't going to fit. And I remember walking away from that delivery with a real recognition of how hard that C-section was and how if you push things too far in obstetrics, you actually can really put people at risk. On the other side of this, I think my own journey to motherhood has really shaped how I practice obstetrics. Particularly in being very aware of, you know, little things like having an IV placed and the medical interventions of birth . I think I've tried really hard since then to think about what is necessary and what's not and how, how can we be making this amazing life experience for women feel like such, while also providing good care.

Maggie, RNC-OB:

Yeah, I think that, I mean, that balance, obviously we're all, you know, we're all trying to kind of hit that magic mark, kind of the Goldilocks, you know, piece of it where we're providing, you know, exactly the right amount of safety and support and guidance. While still, you know, preserving as much of that, really just kind of broad transformational power of birth as we can. And I love that you, you know, you talk about kind of the different trainings that you went through and how they prepared you because obviously in this, you know, in this industry, in this world, we need people who love taking care of, you know, really low risk, low intervention, they feel most at home, you know, in that kind of piece . And that's where, that's what just sets their heart on fire. And we need people who are, you know, willing and able to do a tremendous amount of studying to really be experts in complicated birth and to be able to help when things are not going right. And I love that you in your personal journey that you've been able to see kind of both, you know, both sides of that and kind of grow within that piece of it. So tell us a little bit more about, you know, kind of, you talked a little bit about your, your births and how they impacted it, but how do you feel, like, do you feel like, like intuition plays a role in it versus kind of the book learning? How does those kind of go back and forth, you know, as you're practicing.

Abby, MD:

I feel like the longer you do this and the better you get, the more intuition and like the art of medicine plays into things. I really do believe that people who deliver babies really need a solid background and, and a background that relies on the expertise of people who have done this before us. But I always laugh. I think about, you know, the point in training where you're really like book smart and detail smart. And then the part in training, you just get to a point where you can start to close your eyes and do it. And then I look at some of my more senior colleagues, people that have been doing this for a really long time, one of my partners in particular, she can just call things before they happen. You just, you get this real sense and, I don't know, that comes with experience. So I do think intuition plays , plays a role. Yeah, I do.

Maggie, RNC-OB:

I think it's, as you said, obviously there's, you know, we all kind of go through these different transformations as we're practicing and each, you know, each birth that you get to be part of certainly shapes, you know , your understanding of what birth can look like and what can happen. And that, you know, I think you get a lot of value between people who are, you know, obviously paying attention to, you know, the best research and what is , you know, evidence based care showing us about stuff. And then still remaining that, that you're there in the room and you're, you know, you're listening to what you know and what, you know, what the patient's telling you, what your body's telling you about what's going on.

Abby, MD:

I think there's a real art to reading people, you know, to being able to meet people where they're at, read them, figure out what their goals are and help them safely meet those goals.

Maggie, RNC-OB:

Yeah, absolutely. And then, so I think, you know, it's complicated as we're kind of getting diving into what are all these different, you know, these different professions, kind of what is your role within, you know, within the birth world? I think in an ideal world, you know, we have lots of people involved in the care of, you know, each person going through pregnancy and birth and postpartum because none of us can be the one person for, you know, for anyone else. We really, we function best, you know, when we have that, that community, that village of support really surrounding someone. So can you just, you know , kind of talk a little bit more about the role of, you know, an OB within birth?

Abby, MD:

Sure. So I think our role in maybe a better day sometimes is to take care of, you know, the births that don't need as much intervention, to be there and to catch babies and to just get to celebrate in that moment with, with patients and their families. But we are also qualified to take care of women who become pregnant and have medical complications or women who suddenly develop a medical complication of pregnancy and need to be delivered, you know, falsely induced or have a C-section. We are the surgeons who do C-sections when, you know, labor arrests or there's an emergency that arises. Um, and we are often the end point of transfers of care. So, you know, in situations where providers who do only vaginal birth have an emergency, we are there to be the backup to do, you know, vacuum deliveries, forceps deliveries, C-sections, those things.

Maggie, RNC-OB:

Great . And then what are the, like if you can speak to what professional organizations that help to kind of, you know, guide or you know, kind of lead your practice as, as an OB?

Abby, MD:

Sure. I mean American I guess they call themselves the Congress now or college of OB GYN. ACOG is really the national sort of governing bodies of OB GYN. We're very lucky; it's a very well organized group that you know, provides literature and guidelines, really helps obstetricians practice well. Um, and they practice, they're hand in hand with American board of OB GYN , which is the governing body that makes sure that we know the things we need to know to practice and they take care of making sure that the obstetricians are certified. I think those are probably the biggest organizations; within family physicians who deliver babies, there's American Academy of Family Physicians. It also is just a very wonderful group that provides a lot of evidence based information to physicians.

Maggie, RNC-OB:

Yeah. And then, so, you know, do they have kind of, you know, I know as a nurse, like there's code of ethics or kind of mission guiding principles, you know, like how do they, how do you feel like that kinda gets pulled together for, you know, OBs to kind of feel like they're practicing kind of in concert with, you know, a larger idea? Or is that not present as much? I mean , it is, I think really just jumping back when you graduate from medical school, I think there's a real expectation and obligation that all of us practicing evidence-based, compassionate care and that you're always doing what's in the best interest of your patient, which can be sometimes a complicated thing to figure out. Yeah, absolutely. Um, and then, you know, during, you talked about during birth the role you play, but how does your role play out during pregnancy and then in the postpartum period?

Abby, MD:

So during pregnancy we do multiple visits with patients where, you know, we do exams and counseling about what to expect and same postpartum. Um, there's been an effort for more postpartum care in the past few years, which is great. Because right now I think a lot of postpartum, I think we could step up how much postpartum medical care is provided to patients and support is provided just to new parents as they transition. Y.

Maggie, RNC-OB:

Yeah. I think that's something we're definitely seeing, you know, internationally, but especially I think here in the US there's a lot of groups that are starting to really work, you know, focus on that, that fourth trimester period and how we can, you know, across several different disciplines, really come together to provide a better, a better postpartum experience. You know, for people that's more than just kind of a few touchstones, you know, here and there. All right. And so what do you, what do you feel is the most challenging piece, you know, for your role?

Abby, MD:

Sure. I think I struggle a lot with time. I struggle with , um, having enough time with patients too . You know, not only make sure that I'm examining them and making sure their prenatal labs are right and that kind of stuff, but making sure that I'm really educating them, helping them make the best decisions , um, as those decisions relate to childbirth and time to build the relationships that we need , um, to make sure that we get patients' trust going into the process of childbirth. That last one comes up a lot when we accept transfers of care as obstetricians. I think , um, you know, I am sometimes the recipient of a patient who has been managed by their beloved midwife an entire pregnancy and then things aren't going well and it's very hard to step in and you know, gain trust and get people to really believe that I'm making the next steps in care that are, that are necessary. Um , especially when things aren't going as planned.

Maggie, RNC-OB:

Yeah, obviously it's a very, that's a challenging situation, you know, to be in for, for everyone involved. And I think again, you know, in the magic theoretical world, it would be great to have, you know, have people know, kind of who the backup provider might potentially be. So you would have a chance to kind of already have a little bit of a, you know, established relationship when people aren't in a scary situation, in pregnancy when something's going awry or in labor when you know, if things have changed quickly. Um , cause it is a hard headspace for, you know, for the birthing person to all of a sudden just kind of pivot. And be accepting and trusting of someone else kind of coming into such a personal experience. And I wanted to see, you know, what do you wish, you know, the birth community knew about, about OBs you know, if you could kind of clarify, you know, misconceptions or, you know, something that you sometimes hear as, you know, issues that people have. What do you think?

Abby, MD:

Most of us absolutely love what we do. Most of us love delivering babies. Many of us had one or two delivery experiences that, you know , sort of sealed our fate and made us realize that, you know , we really wanted to do this going forward. Um, probably really important to point out that we also don't like love doing C-sections. That's not really how most of us get our jam. That's all.

Maggie, RNC-OB:

Yeah . That's great. And then what do you see kind of like the future of this role? You know, do you see anything changing with it over the next, you know , several years? Why would someone want to kind of pursue becoming an OB at the time ?

Abby, MD:

Yeah, I don't know. I'm not going to be surprised if at some point there obstetricians and gynecologists, people that um , practice one or the other. Um, but I don't see the field changing tremendously. I am hopeful that within the field we are able to move forward and make some changes that allow us to still be providing really safe and evidence based care for patients. And also, you know, make changes so that we are able to reduce morbidity and mortality, which is far too high in obstetrics and in this country. I'd like us to see, I'd like to see us cut down our C-section rate and I think this podcast will probably hopefully, you know , at some point go into the sort of why, why that is.

Maggie, RNC-OB:

Yeah, absolutely. I think, you know, OBs, you know, are responsible for, is it 95%? of births in our country [editors note: physicians were responsible for 91% of US births in 2018]. You know, obviously the vast, vast majority are cared for by OB-GYNs. Um, and then, you know, smaller amounts by, you know, family physicians and midwives , from there. But I think obviously because of that, you know, there's this, this great platform with tons of exposure, you know, to making changes, you know, to helping to solve some of these issues that we, you know, we continually see , um, are ending up with, you know , outcomes that aren't as desirable and, you know, higher morbidity and mortality rates then we want to see. And so I think, you know, coming together so that you can, you know, highlight some of your experience and as we, you know, get into some of these topics and we're bringing in guests and other people who have, you know, experience within that to share kind of, you know, best practices and what you're seeing that has worked, you know, to help mitigate some of those issues and how we can kind of help, you know, spread and make some change.

Abby, MD:

And I think it's important to acknowledge that there's not an easy or necessarily a universal fix to some of these problems.

Maggie, RNC-OB:

And that's the hard part, right? It would be awesome. We would all love to have like the one thing we could do that just like, yes, that would , that would turn this on its head and everything. You know, everyone would have great, you know, experiences and everything would just be, you know, just flow. But we also know that, you know, that's not life, you know, because things constantly come up and birth is certainly, you know, one of the most unpredictable, you know , pieces of that. That's, you know, things are going to, you know, change throughout pregnancy and birth at that alter from kind of what the goal or the hoped planned for was.

Abby, MD:

It's the first exercise in parenthood, right?

Maggie, RNC-OB:

Right, exactly. It's true. And you know, there's, there's so much we could do in terms of providing support to people while they're in birth though and , and to each other. Cause this is hard. It's hard work to be involved in and it's hard to constantly deal with something that is, that is changing and so much out of our, our control that has such high stakes at the same time attached to it. So I look forward to kind of seeing, hearing more from you and you know, other OB colleagues, to kind of share, you know, share your experiences and make moves.

Abby, MD:

I'm excited to be part of this .

Maggie, RNC-OB:

Thank you so much for sharing. I appreciate it. Abby . Thank you for tuning in to Your BIRTH Partners. We love to talk birth and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter, we're Your BIRTH Partners on all platforms, or comment on our show notes blog at yourbirthpartners.org. We would especially love to hear from any of our OB colleagues out there about their experiences and challenges that they're facing, and we would also love to have particular questions you have about interacting with OBs during birth care. Till next time.