Maternal–fetal medicine

And this sort of interest comes from a really stimulating article that was published in the journal Paranatology.

Gets to a fundamental question, which is, are NICU admissions being accurately reported? Or is the utilization of NICU services actually much higher than some of the data says it would be? And if that's true, which data should we be relying on to actually assess how many babies need the care in the NICU? And how should policymakers at the state and federal levels decide the kinds of resources that they should devote to NICUs based on the data that is showing them what the burden of utilization is? And so this study, which was published in the Journal of Perinatology, used revenue codes in discharge data to assess whether infants had used NICU services.

And the top line finding is that almost 40% of the babies who are admitted to a NICU did not have a NICU admission on their birth certificates.

That sort of gap in the data on birth certificates was even more pronounced in certain subgroups.

Hello and welcome to TopMedTalk.

My name is Mike Grocott, co-editor-in-chief of TopMedTalk, and we're here at SOAP, the 58th annual meeting of the Society for Obstetric Anesthesia and Perinatology in delightful Montreal, Canada.

This is day three, I think I've said.

And it's a pleasure to introduce my wonderful co-host, a familiar voice on TopMedTalk, Desiree Chappell.

And I want to go back to you.

You, OBGYN, MFM, high risk, amazing specialist.

You saw some changes and some differences and that you were like, you know what? I'm not standing for this and I'm going to do better for my patients.

What made you make that, you know, pivot? And then I want to talk about the book and how that plays into everything.

Mm.

Any woman who has anything, like she's on thyroid medication, she needs to see the MFM.

Unbelievable.

That's, that's a change in training.

Yeah, I think obstetricians are truly afraid to p- uh, excuse the metaphor, but to pick their nose, uh-

Mm

... without consulting it with a, uh, MFM first.

Mm, right.

So I'm an REI, reproductive endocrinology.

You also have something called MFM, maternal fetal medicine.

So if you ever have a friend who gets pregnant, they say they have to go see a high risk OB doctor.

That's who they are.

Hardcore.

I don't know what your experience has been with sort of like the OB space, but something that I was so impressed by, you know, I saw MFM during my pregnancy and I felt like all of my OBs that I saw were so wonderful.

They're amazing.

Yeah.

I was like, oh my gosh, I tell you that I think something is wrong and you do not question me.

Because I was being seen at sort of this MFM clinic where I saw kind of a rotating group of providers.

So I would see a different person all the time, which to some people with chronic illnesses is like, no, please no.

I don't know if this person's going to be good.

Your career path, though, has really not been traditional, and I love that because neither is mine.

How did you end up in MFM?

Yeah, so the, the decision for maternal fetal medicine was, was not really where I thought I would go, per se.

Um, my mom was born with congenital hip dysplasia, so I kind of saw her go through a lot of struggles when I was younger.

Nice.

That's great.

Now, for our listeners, even though I think a lot of them kinda know or work with MFMs, but can you describe for us what an MFM does kind of day to day?

Yeah.

And I often start that in my patients.

I've actually had some people refer to maternal fetal medicine and they've come back on buspirone from MFM.

So that's a really great one and also a very favorable safety profile with lactation.

And then I want to emphasize the benefit of counseling.

Or you can go into something called a fellowship, which is basically a specialty on top of what you just specialized in.

So for example, for OBGYNs, you can do a specialty in something called MFM or maternal fetal medicine.

Those are the highest doctors.

It's an extra three years.

You have to go through that process of getting interviewed and applying to those places again, and you also have a match with them as well.

And once you go into MFM, then they're training you again.

You're actually ranked over the residents, so you kind of are in charge a lot of times of residents.

And then there's a fellowship program that is still training you in your area of expertise.