The debate over the safety of giving birth at home, both for the mother and for the infant, has continued for years. I’ve written about the issue myself. From time immemorial until about 75 years ago or so, most babies were born at home. Now it’s around 1 percent in the USA, although it’s much higher than that in many Western European countries. The shift to hospital births ...

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To put it simply, I’m scared by news headlines and conversations about the climbing rates of maternal mortality among Black women. I’m not surprised, however. As an internist, I regularly marvel at the advances that have been made in Western medicine, yet I pause and wonder why, in our profession, we continually get this mortality issue wrong. The conversation about the state of Black women’s health has reached a ...

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It’s that time of year when the weather outside is growing colder, the evenings seem to kick off way too early in the day, and the decorations around town remind all of us all of the fast-approaching holiday season.

But for many of us obstetricians, this can often translate into anxiety over how often we’ll be pulled away from long-scheduled holiday activities to rush to the hospital ...

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On January 22, 1973, Roe v. Wade established a woman’s fundamental right to abortion nationwide. Roe v. Wade should not be overruled because women having universal access to abortion services means women have the right to choose what is best for their health care. This is how health care should be in that if there is a viable medical option for the patient to pursue, the patient should have the ...

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I am a 38-year-old board-certified OB/GYN. I have been married to my husband for 12 years. I am the mom of two young boys. I drive a Subaru. In short, I am the complete opposite of the demographic that rules TikTok. Never heard of TikTok? It’s OK – until recently, neither had I. TikTok is the fastest growing social media platform that seems to have exploded overnight. The app, which is famous for ...

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I recently had a conversation with a new patient who was referred for surgery. As it happens, she discussed me with people she knew before her appointment. I like patients to look me up, talk to friends, find out who I am, and come with an expectation of what they will get in my clinic. We had a normal new patient visit, and per my typical workflow, I explained the agenda: ...

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When my obstetrician told me I was not going back to my clinic that afternoon due to severe preeclampsia, I was so indoctrinated that my first thought was of the inconvenience to my patients who would need to be rescheduled. Only a few minutes later did it register that I would be giving birth sooner than I had anticipated, and my new life as “working mother” would begin. I was due ...

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I did not want a baby.  As a 26-year-old third-year medical student who had quite recently ended a far from ideal relationship -- of this, I was certain. On vacation, in New York City, walking in Soho carelessly, I laughed with my friend Noelle over the fragility of condoms. “Trust me,” I said. “They break.” How many months in my sexually active life did I apprehensively count and recount the number of ...

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Why does the most expensive health care system on the planet do such a poor job protecting the lives of pregnant women? More important, what can be done about it? The United States continues to lead the world in health care spending yet it has the highest maternal death rate among wealthy nations. Researchers have found that maternal mortality in the United States 
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This past August, I attended the American College of Obstetricians and Gynecologists (ACOG) District VI meeting in Wisconsin. The theme of this year's meeting was "Bringing it Back Home," with a keynote presentation focused on developing the emotional habits to influence others and "embody the inner attitude of a leader." After a day of much self-reflection, I decided to stop by the poster presentations during a break between the major talks. ...

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In the recent book, Range: Why Generalists Triumph in a Specialized World, David Epstein makes a strong argument for exploring or sampling different interests and jobs before settling on a career of choice, a process that leads to “match quality,” which describes the degree of fit between one’s work and who they are. This idea flies in the face of our strongly held belief that early specialization, or ...

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As a profession, we’ve yet to standardize maternity leave and breastfeeding allowances for women. Given the length of medical training (seven-plus post-graduate years), timing (prime reproductive years) and slow increase in the ratio of female to male surgical residents, females choosing to start families during training are particularly afflicted. We just celebrated my son’s first birthday. I had him during one of the busiest years of my surgical residency, and it’s ...

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I am an experienced OB/GYN, well-versed in obstetrics, infertility, gynecology, surgery and — yes — menopause, or so I thought. So why was I so blindsided by my own menopause transition? I thought I was going through burnout, with anxiety, anger, mood swings, irritability, and depression. I was at a point in my career as an OB/GYN of 20-plus years that patients flocked to me because of my reputation and expected ...

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The field of teratology (also known as dysmorphology) is rapidly growing with daily innovations in prenatal medicine, genetics and preventive care that show its uniquely intersectional nature. But, the term teratology, and its derivatives teratoma and teratogen — derived from the ancient Greek root teras — do not do justice to the promising future of this field. I would like to see the field move away from this term for two reasons. First, ...

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When I walked into my first shift on labor and delivery as a brand new OB/GYN intern, complete with a freshly starched white coat, I was 33 weeks pregnant. As I listened to my chief resident effortlessly sign out the labor board, I was terrified. As the words pre-eclampsia, chorioamnionitis, and postpartum hemorrhage swirled around the room, I couldn’t get my heart rate under control. “They already hate ...

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It has been a savage few months for reproductive rights, with 12 states passing 26 bills to ban abortion, including measures that ban abortion as early as six weeks into pregnancy, as well as attempting to outlaw safe methods of abortion. In the face of this extreme, unprecedented wave of attacks, several states pursued an alternative route, passing laws that expand the scope of abortion providers to ...

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At the end of a long table covered with hors d’oeuvres and a birthday cake, I struck up a conversation with three primary care physicians.

I was hungry for their opinions. Inside the crowded apartment, we spoke for some 20 minutes about the systemic and cultural causes of burnout in primary care—a conversation that informed the first article in this series. As I was about to leave, I ...

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"You're 27-and-a-half weeks pregnant." As I lay on the exam table, time froze. How can this be? I wondered dazedly. I'm a second-year medical student. I've just completed a course in female reproduction and endocrinology. How could I have missed the signs? I attribute my obliviousness to the surgery I'd gone through only months before: the removal of a 27-pound, mucus-filled ovarian cyst. My lack of menstrual periods was nothing new; they'd been ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks' gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin. On physical examination, the patient is afebrile, blood ...

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On a beautiful spring morning, I found myself in an outpatient OB clinic, ready to begin the last rotation of my third year of medical school. My attending physician greeted me and patiently (but quickly) showed me the ropes. I spent the better part of the day using a doppler to detect fetal heart sounds, measuring fundal heights, reading ultrasounds, and learning how to do pelvic exams on my incredibly ...

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