HJAR Mar/Apr 2024

Q&A 24 MAR / APR 2024 I  HEALTHCARE JOURNAL OF ARKANSAS   I think people now understand that it is a hard navigation of the postpartum period for women, and have given significantly more grace towards postpartumdepression, which has opened those conversations. Now, do I think there are pockets in communities that still don't talk about it? Absolutely. But as a community and as a nation, we're talk- ing about it more, which normalizes it, and patients don't feel quite so isolated. How good are we today at educating the new mom about how to be a mom and take care of that baby while their body's going through postpartum? Fifty, 60, 70 years ago, we had larger family units, and you can see that in certain commu- nities they have grandparents, parents, aunts, uncles, and other people that help within the household. We have become a much more isolated society. You don't get to reap the ben- efits of all the years of generations of helping as well as just helping with childbearing. "I need to go to a grocery store. Can you watch my kids for a few minutes so I don't have to take this child out to X, Y, Z?" On the flip side, we have education at our fingertips everywhere. We are a much more isolated society, but the access to quality edu- cation is significantlymore. I won't say every- one uses quality education.Alot of people get it fromTikTok or social media, and there are great resources in those places.There are also terrible resources in those places. We need to help people decipher between those two. What has changed most as you practice medicine since you finished your residency in 2007? The acuity of the patients that we see. I won't say I don't see something now that I've never seen before, but the frequency with which I see some of the very sick things and the very scary things is muchmore. I see obe- sity, chronic hypertension, diabetes, mental health illness — those diagnoses are so sig- nificantly more than they were before. Now, not necessarily inmy labor and delivery suite but throughout my institution, because of some illness. You have an increased inci- dence of getting sick in a hospital. There are more germs in a hospital. There are more people doing things. That can be good, espe- cially for new moms who need that support system and help with lactation, potentially social work, and all of these things that are in place; but if you could create a robust follow- up system for patients …we have anANGELS (Antenatal and Neonatal Guidelines, Educa- tion, and Learning System) program that calls every one of our delivering patients afterward and checks on them at two days. There's somuch that doesn't need to hap- pen in a hospital. Hospitals are so busy in our state.As I mentioned before, we've gone from 39 to 35 hospitals. We have a bigger book of business that we have to take care of, and we want tomaintain those doors being open for the next patient that needs our services. I think we have to be efficient and smart.There are people who definitely need to stay, but if we have highly motivated people who are doing well, and their baby is doing well, I don't think there's any reason not to do that recov- ery at home in your own world with a sup- port system around you. Postpartum depression — shine a little light on that for us. Postpartum depression, I think, has been under-reported for years. I had three kids. I'd be, again, remiss to say that it is not what I saw on TV. It is hard; it is overwhelming; it is anxiety driven; and if you have some of these underlying conditions already, it's definitely hard to navigate. We now are somuch better about doing depression screenings than we were before. We can now quantify what this looks like for patients. Is it what we call “post- partum blues”? Is this depression? Is this something really significant and this patient now needs an inpatient stay because I'm so worried about her? We are able to quantify that in better ways than we were before. It's talked about more too. It's not so taboo. You are expected to do everything well, but they're trying to do a C-section for fun and be able to get out of there. I think some- times they worry that if they sit on this and it becomes an obstetrical emergency, they can't move quickly enough tomake sure that that baby is okay. Do I think there are some C-sections that still happen at 5:00? Sure. I don't think it's with the frequency that it used to be. Lots of hospitals now have labor pro- grams as well where there's someone there 24/7 or someone there to take some of the unassigned calls so that burden of call is not as significant for physicians as it used to be. I truly think people see where our statistics are and want to make a difference. In the past, some mothers who have had C-sections have been told once you've had one, you always have to have another one. Is that current? No, that is not true. We do a lot of VBACs (vaginal birth after cesarean section) now, and we talk about this a lot. There are cer- tain places in the state that still can't offer it because you need to have anesthesia cover- age 24/7 because you just don't know when things are going to go bad, and you need to be able tomove quickly should that happen. But it is safe for most women, and it's certainly a discussion that needs to be had. ACOG has created VBAC calculators to plug in certain data and give you a predictive value of what the likelihood is that you will have a vaginal delivery. There are certainly diagnoses that preclude having a vaginal delivery after a C-section, but we offer it with significantly increased frequency than we did when I was a resident. Do you think that we release mothers and babies too quickly from the hospital today? I don't, and I think that could certainly be subjective, and that could be frommy obstet- rical point of view. You may get a pediatri- cian that says something very different. I think hospitals are not utopian. Hospitals are wrought with sickness. Most people are there,