Women’s and Children’s

For more than 30 years, we have been a leading provider of outsourced women's and children's services, specializing in acute inpatient care and treatment of infants and children. We continue to expand our services into pediatric intensive care, pediatric hospitalist programs and pediatric emergency medicine.

Through our demonstrated commitment to clinical excellence, we are also motivated to be an integral part of your community. We develop collaborative working relationships with community obstetricians, pediatricians, hospital nursing staffs and administration.

PremiEHR™, our proprietary EMR, captures medical information relevant to care provided in the NICU, nursery and delivery room. We also offer a turnkey, universal newborn hearing screening program called Healthy Hearing™.

Led by our dedicated on-site medical director, our locally based teams are comprised of full-time, board-certified or board-eligible physicians and ARNPs. Learn more about our women's and children's services management.

Read our posts related to women's and children's:

21 February2017

Research Recommends Continued Breast Cancer Screening Mammography for Older Women

New research about the appropriate age limit for breast cancer mammography screenings, presented at the Radiological Society of North America’s annual meeting late last year, challenges current conventional recommendations. While the U.S. Preventive Services Task Force (USPSTF) recommends that women undergo screenings every two years until age 74, researchers from the University of California at San Francisco assert this age limit may be arbitrary after finding that the precision of breast cancer mammography screening, and thus the rate of cancer detection, increases significantly as women age.

Pulling from the American College of Radiology National Mammography Database, the research team examined 5.7 million mammography screenings from 2.6 million women 40 years or older. The team found the average national cancer detection rate to be 3.74 per 1000 screenings, while the average recall rate of screenings leading to a call-back for additional workup was 10 percent. Further, the rate of cancers found in cases recommended for biopsy was 20 percent, and the rate of cancers found in women who underwent biopsy was 29 percent.

Next, researchers stratified the data into five-year age groups to identify any trends. They found that the recall rate decreased progressively every decade and that detection rates increased progressively with age. The team concluded that doctors should continue to recommend mammography screenings for women 75 years and older if it is medically appropriate based on preexisting conditions and life expectancy.

This conclusion coincides with growing evidence of high breast cancer incidents in older women. A similar study published in the May 2015 edition of the American Journal of Roentgenology found a significant detection of carcinomic and invasive breast cancer tumors in women 75 years and older at a rate of 5.9 per 1000 screenings. While detection rates for older women seem to have recently decreased, as the American Cancer Society states in its 2015-2016 report, almost 58 percent of all breast cancer deaths occur in women older than 65. Within this same group, women 80 years or older make up 46 percent of all deaths. 
Ultimately, at a time when the medical community is questioning the effectiveness of screening mammography, research still supports the necessity of continued, quality preemptive care for all – and especially older – women.

16 February2017

No Link Between Maternal Influenza and Increased Autism Risk for Children

Current research by the Center for Disease Control and Prevention estimates that autism spectrum disorder (ASD) affects about 1 in 68 children in the United States. While the exact causes for ASD are not yet known, previous and now widely discredited scientific research contributed to the popular belief that vaccinations can cause the disorder. Despite new research that increasingly disproves any potential link, this belief continues to linger. To further investigate a possible connection, a recent study published in JAMA Pediatrics examined the association between maternal influenza vaccination during pregnancy and an increased risk of ASD for children.

For this cohort study, researchers from Kaiser Permanente Northern California examined the mothers of 196,929 children born at Kaiser Permanente between Jan. 1, 2000 and Dec. 31, 2010. Influenza was diagnosed in 0.7 percent of the women with a gestational age of at least 24 weeks, and 23 percent of these women received an influenza vaccination during the remainder of their pregnancy. After adjusting for covariates, the team found there to be no substantial link between a mother’s vaccination for influenza during her pregnancy and the subsequent development of autism in her child. 

Overall, only 1.6 percent of children in the study were diagnosed with ASD. However, in a trimester-specific analysis, there was a slight correlation between first trimester influenza vaccination and an increased risk of ASD for children. While the researchers ultimately determined that this correlation could be due to chance, the possible increased risk in the first trimester suggests additional research is needed. 

Based on their findings, the research team has not called for any changes to influenza vaccine policy or practice for pregnant women. Their research supports current medical recommendations that all women receive the influenza vaccine when pregnant, as the weakened state of a pregnant woman’s immune system increases a child’s susceptibility to short- and long-term risks such as premature birth, low birth weight and illness in early life. Further, studies show that maternal infections that occur and are not treated during pregnancy can increase the risk of ASD for children. 

7 February2017

Grand Strand Medical Center Adds Neonatology Program

Grand Stand Medical Center in Myrtle Beach, South Carolina has launched a new neonatology program that has been in the works for about a year. The hospital is working to recruit two permanent, local neonatologists. Until those positions can be filled, neonatologists from other counties in South Carolina are working at the hospital, making Grand Stand Medical Center the only hospital in Horry County to have a neonatologist either in the hospital or on-call at all times.

Dr. Art Shepard, the Sheridan neonatologist who worked on staff at the hospital during the first week of the new program, told local ABC News affiliate WPDE that the hospital delivers about 1,000 babies a year, and that 8-10 percent of all babies need specialty neonatal care. “If babies need respiratory support or prolonged tube feeding, for example, because they're early those babies would ordinarily have to go to [a NICU in] Charleston or Florence, and so that's about a hundred babies a year that have to leave just for those reasons," Shepard said. Because Grand Strand has a level II nursery and not a NICU, he explained, some seriously ill babies will still need to be transported to either the Florence or Charleston NICUs.

"We can take care of babies as young as 32 weeks gestational, so about 8 weeks early, we can take babies that are as small as 1500 grams at birth, which is about 3 1/2 pounds, and we can maintain babies on mechanical ventilation for as long as 24 hours,” he continued. “If babies are smaller than that, less mature than that, or require more respiratory therapy than that, they still need to go to the regional perinatal center."

Both Shepard and OB/GYN Dr. Tracey Golden are excited that more babies will be able to be treated locally, near their mothers and families. "We are looking forward to the opportunity to keep those babies here. Keeping babies and moms together is so important. It's important to facilitate breast feeding, we want to encourage that. And keeping families together is the best way to get a family off to a healthy start," Shepard said. Golden added, "It's priceless, because unfortunately the NICUS are at least an hour and a half to two hours from this local region, and for many families that means they're taken away from their other children or their support network."

Emerald Rabon, who has a high-risk, complicated pregnancy, is comforted by the availability of a neonatologist at the hospital. “I'm going to be delivering really early, and she's going to be super small and not as developed, so that's even more scary," she told WPDE. After meeting with Dr. Shepard, she was reassured to learn that even if her baby girl arrives weeks early, there’s a good change she will be able to remain in Myrtle Beach. "You think of a pregnancy and the baby just pops out and they're doing great and mine is going to be hooked up to machine and tubes going in and out of her. It's scary," she said. 

31 January2017

Learning Health System (LHS) Pilot Saved Nationwide Children’s Hospital $1.36 Million in 12 Months

Researchers from Nationwide Children's Hospital and The Ohio State University (OSU) found that a learning health system (LHS) pilot program at Nationwide combining tailored electronic health records system entry, care coordinators and evidence-based clinical data and research reduced total inpatient days by 43%, reduced inpatient admission by 27%, reduced ER visits by 30% and reduced urgent care visits by 29% during the first year. Per a recent article in HealthLeaders Media, those reductions generated an impressive $1.36 million savings in health care costs during the 12-month period in 2010 and 2011.

The National Academy of Medicine’s Learning Health System Series defines a learning health system (LHS) as a system in which “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.”

The findings by the team of Nationwide and OSU researchers were published by the journal Developmental Medicine and Child Neurology. The study authors said they “developed, implemented, and evaluated a model of EHR-supported care in a cohort of 131 children with cerebral palsy that integrated clinical care, quality improvement, and research, entitled ‘Learn From Every Patient’ (LFEP).“ A multidisciplinary team of key stakeholders was recruited for this pilot program, which was designed to fully integrate research, clinical care and quality improvement. 

The findings were also cited in an editorial published in JAMA, which said the LFEP pilot included initial standardized care for all patients, both evidence-and expert opinion-based; routine clinical data collected in the EHR as discrete data fields and data elements (categories and choices within those categories, respectively); physician-inspired research data collection in the EHR; content-specific quality control of EHR data entry; and provision of standard care coordination. Per the HealthLeaders Media article, special data entered into the patients' EHRs was used to coordinate care, with the goal of reducing treatment duplication and errors. LFEP data were extracted into an Epic Clarity enterprise data warehouse, which also housed billing information, and providers used clinical documentation templates created in Epic that presented them with a prioritized list of research questions designed to drive specific improvements in clinical care.
The HealthLeaders Media article also said the total cost of implementing the pilot program, including care coordination services, was about $225,000 during the first year; but since that represented only 16% of the reduced health care costs during that same year, the program yielded savings of roughly $6 for every $1 invested. And the study authors believe that similar programs could yield even greater potential healthcare system savings in adult patients, since the chronic conditions of the children with CP resemble those of chronic multi-symptom conditions in adults.
For hospitals and health systems considering investing in learning health systems, the National Academy of Medicine discussion paper “Generating Knowledge from Best Care: Advancing the Continuously Learning Health System” provides strategies and examples of operational and research collaborations within U.S. delivery system settings.

24 January2017

Strategies to Provide Neuroprotection for Preterm Infants

Neuroprotection for preterm infants can be one of the most important aspects of care provided to preterm neonates, yet it is sometimes overlooked because the providers are focused on other health issues. It is also essential that neuroprotection for preterm infants be done correctly to avoid causing lifelong struggles for both the babies and their families. A recent article in Neonatal Network, “Neuroprotection of the Preterm Infant,” co-authored by Sheridan Doctor of Nursing Practice (DNP) and Neonatal Nurse Practitioner (NNP) Abby Kaspar, offers simple strategies that providers and nurses can use to provide effective neuroprotection for premature infants.

The article defines neuroprotection as “strategies or interventions…used to prevent cell death and promote normal development.” This is done by supporting the developing brain or by facilitating the development of new connections and pathways for functionality and by decreasing neuronal death. These strategies are necessary to prevent intraventricular hemorrhage (IVH) and other brain injuries in very small, immature infants who are born preterm. Preterm infants who develop a severe IVH have an increased chance of mental retardation, cerebral palsy, seizures and/or hydrocephalus, and even preterm infants with milder IVH can have developmental difficulties. Since most IVHs occur within the first 24-48 hours of life, neuroprotection should be provided as soon after birth as possible. 

Fetal and Neonatal Neuroprotection Strategies

Neuroprotection strategies, which can be implemented during the prenatal or postnatal period and include organizational, therapeutic and environment-modifying measures, may protect fetuses and newborns from developing IVHs and cerebral ischemia.

One fetal neuroprotection strategy the authors recommend is administration of betamethasone to the mother at least 24 hours before preterm delivery. Betamethasone is a corticosteroid that protects the development of blood vessels in the germinal matrix of the infant’s brain or inhibits prostaglandin synthesis. It also helps an infant’s lungs mature, which can reduce the incidence of respiratory distress syndrome (RDS). If the mother tolerates it, continuous magnesium sulfate infusion during the same can decrease the likelihood that the infant will have an IVH.

Routine caregiving activities (e.g., diaper changes, endotracheal tube repositioning, other minor manipulations) performed on critically ill preterm infants has been shown to be associated with major circulatory fluctuations that can lead to IVH. The authors recommend supine positioning of preterm neonates and midline positioning of their heads, a position that favors cerebral venous drainage, prevents an elevation of cerebral blood pressure and increased flow, and may increase cerebral oxygenation. Another recommendation is keeping the head of the bed either flat or slightly elevated and keeping the infant’s head midline, which has been shown to decrease intracranial pressure.

Other recommendations for neuroprotection of preterm infants:

  • Keep the baby’s hips and legs lower than his or her head during diaper changes to avoid increasing intracranial pressure and maintaining a neutral thermal environment, since hypothermia has been associated with IVH.
  • Keep lighting and noise levels low and handle the infant as little as possible to minimize stress and overstimulation, which can increase blood pressure and, consequently, cerebral blood flow, which can lead to IVH.
  • Provide swaddling and pain medication to minimize crying, which can impede blood return from the brain, increase cerebral blood flow and decrease cerebral oxygenation.
  • Infuse fluid boluses or hyperosmolar solutions slowly or dilute the solution to avoid potential swelling, thinning and/or fluid reduction in the vessels in the fragile germinal matrix that can cause them to rupture, eventually leading to IVH.
  • Limit endotracheal tube suctioning, which can increase cerebral blood flow and intracranial pressure and has been associated with increased incidence of IVH.
  • Maintain a partial pressure of carbon dioxide (PC02) greater than 30 mmHg, keep peak inspiratory pressures (PIP) less than 30 cm H20 and keep the mean airway pressure (MAP) less than 12.5 cm H20.

19 January2017

Integrating Telemedicine Responsibly

Providers and patients alike view telemedicine as an increasingly important healthcare delivery modality. Per a recent article in Medical Economics, “How to balance telemedicine advances with ethics,” the American Telemedicine Association (ATA) reports that more than half of all U.S. hospitals use some form of telemedicine; and IHS Technology predicts the number of patients using telehealth services will jump from fewer than 350,000 in 2013 to 7 million in 2018.

But this modality can also be challenging to implement responsibly.

Telehealth Benefits

The dramatic growth of telemedicine is driven by its ability to further the goals of the “quadruple aim” framework for value-based care.

More Efficient Care

The recent American Hospital Association (AHA) issue brief on telehealth cited several examples of significant telehealth-driven savings, including the Veterans Health Administration’s “nearly $1 billion in system-wide savings associated with the use of telehealth in 2012.” A major contributor was the dramatic decrease in hospitalizations.

In addition, doctors who offer telehealth services can spend more time caring for additional patients – time that otherwise would have been spent traveling between offices or facilities.

Better Outcomes

The AHA brief also describes the efficiencies and improved outcomes resulting from the innovative Hospital at Home (HaH) care model developed by Johns Hopkins researchers. HaH is being used effectively to provide hospital-level care at home in place of acute hospital care for older adults. Per the brief, “When a patient is treated at home, clinical staff travel to the home as needed to provide treatment, while telehealth is used to monitor the patient’s condition and enable daily meetings with the physician.” According to the program’s website, HaH patients experience better clinical outcomes, higher patient and family satisfaction, reduced caregiver stress and better functional outcomes compared to similar hospitalized patients.

Expanded Access to Care

Traveling to medical facilities can be a hardship for people who are physically challenged/housebound, live far from the nearest medical center or cannot afford to take time off from work. The ability to meet with a clinician remotely via a secure audiovisual device or application can mean the difference between those patients seeking – and getting – the care they need versus going without.

More Convenient Care

While it’s early days yet, “virtual visits” are beginning to be offered for more and more types of medical care. For example, St. Vincent Heart Center in Indianapolis is piloting a telecardiology program, per a recent article in Cardiovascular Business.

There is also increasing demand by health care consumers for “at home” virtual visits. A recent ATA-WEGO Health survey of active health care users found that consumers are very interested in using telehealth to complement (or even replace) their in-person care, primarily because of convenience. Other commonly cited reasons included scheduling conflicts and issues with transportation. 

Expanded Access to Specialized Clinical Expertise

Many small or rural hospitals often don’t have the budget or volume to support staffing a range of staff specialists or subspecialists. Even hospitals that have the budget may be in areas that make it difficult to recruit those types of physicians.

Dr. Lynn Palmeri, National Medical Director of Telehealth for Sheridan’s Women’s and Children’s Division, explains that telehealth carts can allow doctors at these facilities to consult remotely with specialists or subspecialists as needed. For example, an obstetrician may see an expectant mother with high-risk findings that require her to be referred out to see a perinatologist. Rather than having the mother drive three or four hours to the nearest perinatologist – potentially putting her and her baby at even greater risk – the obstetrician could have a remote telehealth consult with the subspecialist to determine whether the mother can be given appropriate care locally with the help of follow-up telehealth consults with the perinatologist.

Telemedicine is equally valuable in emergency medicine. Physicians in the adult emergency department (ED) at Jupiter Medical Center consult remotely with neurologists at the Cleveland Clinic using a telehealth cart approximately 10–30 times per month, most often to expedite implementation of tissue plasminogen activator (tPA) therapy for stroke patients.

Sophisticated telemedicine robots can allow remote specialists and subspecialists to perform much more in-depth examinations. Dr. Palmeri says “there are robots with sensors that can, for example, allow a neonatologist to remotely inspect a patient, auscultate bowel, breath and heart sounds, examine a neonate’s eyes for retinal findings, and even palpate to see if there is abdominal pathology or edema. These patient care modalities augment the in-person physical examinations by the nurse and neonatal nurse practitioner at the bedside.”

Radiology’s many subspecialties make it a prime candidate for expanding access to highly specialized clinical expertise remotely while also increasing efficiency. For example, Sheridan’s distributed teleradiology network includes hundreds of the country’s best radiology subspecialists who can provide hospitals of any size with affordable, 24/7/365 coverage and faster turnaround times for final reads. 

Challenges to Responsible Implementation

The promise of telemedicine is exciting, and pertinent logistical and quality matters will be ensured prior to its implementation and expansion.

Protecting Patient Privacy

Maintaining patient confidentiality is a cornerstone of ethical medical practice. Telemedicine systems will be HIPAA-compliant and hospitals must make data security a top criterion when selecting robot cart and software options.

Maintaining Care Quality

The same standards of care must be maintained regardless of the delivery modality, and that’s a key challenge of telemedicine. The American Medical Association (AMA) released its Guidance for Ethical Practice in Telemedicine in June. In the policy announcement, AMA Board Member Jack Resneck, M.D. said, "Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions. The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians' fundamental ethical responsibilities do not change.” The AMA also released its Principles to Promote Safe, Effective mHealth Applications in November. 

Telemedicine can make continuity of care challenging, especially when patients seek care from doctors who are not affiliated with their primary care physicians or who use different EHRs. But in some situations telehealth can improve care continuity. “In a pediatric unit, for example, an attending physician might see the baby during morning rounds, but by the time the parents can come to the hospital that evening after work that physician’s shift may have ended and the parents may not speak directly to that same doctor,” explains Dr. Palmeri. “Telemedicine has the potential to overcome those types of scheduling conflicts so that parents can speak with the doctor ‘face-to-face’ through the telemedicine robot screen whenever needed.”

Telehealth will play an increasingly important role in care delivery and physicians will carefully adopt remote care technology in a manner that ensures patient safety and privacy.

17 January2017

Study Identifies Risk Factors for Congenital Heart Disease in Infants

A study in the Canadian Medical Association Journal identified the chronic conditions that may predispose women to give birth to infants with congenital heart disease, also known as congenital heart defects or CHD.

The study reviewed the Taiwan Maternal and Child Health Database’s records of 1,387,650 live births from 2004 to 2010. The researchers investigated three data sets including:

  • Birth Registrations data on the sociodemographic characteristics of live births
  • Birth Notifications data on prenatal care and the lifestyles of pregnant women
  • Medical claims data from Taiwan’s National Health Insurance program

The researchers found that several maternal chronic diseases were associated with higher rates of CHD in babies. These conditions include type 1 and type 2 diabetes, hypertension, CHD, anemia, connective tissue disorders, epilepsy and mood disorders. Pregnant women who are identified as at risk can receive preconception counselling and developing fetuses can be more closely screened for CHD via fetal echocardiography. Early recognition of CHD can additionally help clinicians optimize the care of both women and infants.

That said, there are some limitations to the study. The detection period for the study was restricted to the first year of life. Potential cases of CHD may have developed in later years; however, under-identification should be minimal, given the high frequency of prenatal care and health checkups for infants under National Health Insurance coverage. Additionally, researchers noted that maternal lifestyle factors, including smoking and alcohol consumption, were likely to be underreported in the Birth Notifications data set.

About CHD

CHD affects nearly 1 percent of births per year in the United States and is a leading cause of birth defect-associated infant illness and death, according to the CDC. About 25 percent of babies with CHD have a critical CHD and generally require surgery or other procedures in their first year of life.

Although a few states track CHD among newborns and young children, no tracking system exists for older children and adults with heart defects. A study published last July estimates that approximately 2.4 million people – including 1.4 million adults and one million children – were living with CHD in the U.S. in 2010. Nearly 300,000 of those individuals had severe CHD.

Research projects like the review published in the CMAJ continue to improve care for people affected by CHD. Improved counseling and screening procedures for CHD have the potential to both reduce the prevalence of CHD and its resulting fatalities.

5 January2017

Our 10 Most Popular Blog Posts of 2016

The most-read posts on the Sheridan blog in 2016 focused on key topics – ranging from the challenges involved in the transition to value-based care and this country’s physician burnout epidemic to exciting technology innovations and trends in clinical practice.

The 10 most popular posts from the past year are:

  1. How to Manage the Burdens of Change on Physicians and Health Care Practitioners, a summary of Chief Quality Officer Dr. Gerald Maccioli’s presentation at the 2016 Health:Further Summit about the overwhelming burdens on providers created by current and planned changes to the U.S. health care landscape and strategies for managing them.

  2. Sheridan’s 2016 Leadership Conference Recognizes Eight Outstanding Clinical Leaders: Dr. Mike Adkins, Anesthesia Services Chief of the Year; Dr. Joseph Toscano, Emergency Medicine Chief of the Year; Dr. Frank Seidelmann, Radiology Chief of the Year; Dr. Mitchell Stern, Women’s and Children’s Chief of the Year; Dr. Adam Blomberg, Diamond Award Winner; Cindy Houck, CRNA, Platinum Award Winner; Dr. Gary Gomez, Innovation Award Winner; and Dr. Jonathan Katz, Innovation Award Winner.

  3. Six Physician Communication Strategies to Increase Patient Engagement and Improve Outcomes, including encouraging patients to talk about psychosocial factors that might be related to their conditions, tailoring communications to each patient based on his/her culture, values and beliefs to avoid inadvertent offense or mistrust, educating patients on care best practices and about responsible antibiotic stewardship, providing compassionate, personalized care and reassurance, and providing online information resources to educate patients and set appropriate expectations.

  4. Technology Innovations That Will Transform the Future of Radiology, including the groundbreaking work of the IBM Watson Health medical imaging collaborative, in which Sheridan and its chief of teleradiology, Dr. Glenn Kaplan, are playing a key role.

  5. Five Medical Practices That Soon May Be Outdated, including hospitals advising doctors not to apologize, prescription labels that don’t include what condition the drug is treating, monitoring handwashing by hospital staff, doctors spending more time on paperwork than on patient care, and making it difficult for patients to get their medical records quickly.

  6. The AMA’s New Tools to Ease MACRA Transition for Physicians, including the MACRA Assessment (aka Payment Model Evaluator), new MACRA-focused modules in the AMA STEPS Forward interactive, online practice transformation series, and the Inside Medicare’s New Payment System ReachMD podcast series.

  7. The Physician Burnout Epidemic, Part 1: Root Causes of This Alarming Trend, which looked at the factors fueling the increase in U.S. physician burnout. Part 2 offered strategies physician leaders can use to help combat burnout.

  8. Career Advice from Sheridan’s Chief Medical Officer for Radiology Services, Dr. Frank Seidelmann, including being proactive in managing your career, embracing technology and investing in your professional development and of the physicians you lead. 

  9. How Video Laryngoscopy Is Shaping the Future of Anesthesiology, which highlighted a discussion by Regional Medical Director Dr. Joseph Loskove, Chief Quality Officer Dr. Gerald Maccioli and National Education Director, Anesthesiology Division, Dr. Adam Blomberg in their Anesthesia News article, The Shift Toward Video Laryngoscopy: The Good, the Bad, and the Future.

  10. Pain Management Boosts Patient Satisfaction, which addressed the significant impact of addressing patients’ and caregivers’ concerns and setting their expectations appropriately – as well as treating patients’ physical pain – on their satisfaction with their pain management and overall care. 

3 November2016

Sheridan CRNA Jobina Ruiz Featured on AANA Journal’s October Cover

Sheridan is proud that the cover of the AANA Journal’s October issue features a photo of Sheridan Certified Registered Nurse Anesthetist (CRNA) Jobina Ruiz setting up for an obstetric fistula repair surgery in Rwanda. Ruiz participated in a global anesthesia immersion experience in Rwanda with the International Organization for Women and Development (IOWD) at the beginning of this year, when she was a student registered nurse anesthetist at Northeastern University. The IOWD is a non-profit organization that, among other things, provides free treatment and care to Rwandan patients suffering from obstetric fistulae, gynecologic and pelvic floor disorders. Ruiz, who was invited to participate in the mission at the invitation of her instructor, made the trip at her own expense.

Her 16 days in Rwanda with the IOWD was a valuable and eye-opening experience. For the first few days, she worked with the gynecological surgical team on general anesthesia cases and had the opportunity to watch those patients over an extended period of time. For the rest of her stay, she worked primarily on less invasive fistula repair cases and cystoscopies under epidural and spinal anesthesia. 

Working with the IOWD volunteers and local clinicians in Rwanda was both challenging and exciting. It provided Ruiz with many new learning opportunities, for example, administering anesthesia drugs such as halothane and sodium thiopental that are no longer used in the United States. Language barriers sometimes made communication challenging, and learning about the cultural differences between Africa and the U.S. was fascinating but also could be frustrating, such as the local cultural bias against using extreme measures to save the lives of critically ill neonates. But Ruiz fell in love with Africa and the people she met there – especially the women whose pain she helped manage during obstetric fistula repair surgeries. 


Jobina Ruiz draws blood from a Rwandan woman’s anti cubical vein as an anesthesiologist places an epidural to administer a blood patch

Fistula, a hole in the wall between a woman’s bladder and vagina, is a terrible condition found in women who have experienced a prolonged and obstructed labor without medical assistance, or sometimes as a result of injury to the bladder during a difficult surgery. This hole causes constant urine leakage. If the rectal wall is also affected, the woman also has no control over her feces. Ruiz learned that Rwandan women with untreated obstetric fistula are ostracized by their husbands and shamed by society, becoming social outcasts.

These women were incredibly grateful for the help of the surgical team volunteers, looking at them with eyes filled with hope and saying in their native language, “You’re going to fix me!” Ruiz said she’s equally thankful for having had the opportunity to meet and help them. “I helped these women,” she explained, “but in return they taught and helped me so much more! I am a better person because of them and this experience, and I am extremely grateful I was able to go.” She also appreciates the experience of having to make do with very limited supplies, equipment and drugs: “It taught me what I’m capable of.” Ruiz, who is well traveled, said she is anxious to return to Rwanda, next time with her husband.

She joined Sheridan in early September, immediately after passing her CRNA exam, and works at Memorial Regional Hospital in Hollywood, Florida. Prior to returning to school to earn her graduate degree and CRNA certification, she worked as a critical care registered nurse at the Mayo Clinic in Scottsdale, Arizona and NYU Langone Medical Center, Beth Israel Medical Center, New York-Presbyterian Hospital and Midtown Surgery Center in Manhattan, New York.

She hit the ground running at Memorial Regional, becoming a preceptor for nursing students after just two weeks. Her favorite thing about being a Sheridan CRNA is the strong sense of community. “It’s like being welcomed into a family.”

1 November2016

What Can Be Done About the Rising U.S. Maternal Mortality Rate?

As featured in The New York Times, several recent studies have revealed that the maternal mortality rate in the United States increased by nearly 22 percent between 2000 and 2015. This is a surprising finding, given that this increase defies current global trends. For most countries, maternal mortality has declined by a third over the last 15 years. Meanwhile, the U.S. is one of just 24 countries, including South Sudan and Democratic Republic of Congo, where the maternal mortality rate has increased.

Not only does America now have a higher rate than poorer countries such as Iran, Vietnam, Russia and Romania, but the U.S also stands as a notable outlier among wealthy countries. Data show that increased maternal mortality rates are incredibly unusual for rich countries, and this disturbing upward trend is particularly surprising in a country known for its robust health care system and dedication to improved care. Nevertheless, American maternal deaths have increased from 23 to 28 deaths per 100,000 births, and per the Institute of Health Metrics and Evaluation, the maternal death rate has increased by roughly half since 1990.

What’s Behind the Rise in U.S. Maternal Deaths

The rise in maternal mortality in the U.S. may be attributed in part to an increase in heart problems and some chronic medical conditions. One possible explanation is cardiovascular disease, which despite a declining mortality rate is still the leading cause of death overall and particularly for women. Diabetes, a diagnosis that has increased sharply and now affects 21.9 million Americans as of 2014, is considered another chronic cause. Obesity is also believed to have influenced maternal mortality rates, with more than one-third of Americans categorized as obese. It makes sense that the continuous physical strain of heart disease, diabetes and obesity, added to that of a pregnancy and subsequent childbirth, have contributed to the increase in maternal mortality in the U.S.

The health care community has yet to determine the definitive origin of America’s increase in maternal mortality. Previous research focused on isolating certain factors that might affect the data – such as poor public health in the African-American community and the rise in pregnancy among older women – but the results have been inconclusive. While maternal mortality rates varied among socioeconomic groups, every group experienced a rise in maternal death. 

Reversing the Trend Will Require More Accurate Tracking, Actionable Analysis

Further research has proven difficult as tracking maternal deaths accurately is a challenge. Maternal death is defined as complications from pregnancy or childbirth that may affect a woman up to a year after giving birth. However, in some cases the immediate cause of death may not be attributed back to the recent pregnancy and, instead, might be considered isolated and unrelated ailments. The longer the interval between the child’s birth and the mother’s death, the harder it can be to accurately attribute the death to the pregnancy or childbirth.

More accurate tracking and analysis of maternal mortality in this country is needed to better understand the causes and, potentially, reverse the upward trend. The World Health Organization (WHO) has encouraged global adoption of the Maternal Death Surveillance and Response (MDSR) approach, tracking maternal deaths, conducting expert investigations and using the findings to recommend policy changes that could reduce preventable deaths. Australia, Britain and a number of other European countries have implemented national maternal review boards. But although the MDSR working group includes representatives from the United States Centers for Disease Control and Prevention, a national maternal review board does not yet exist in this country. Half of U.S. states have set up state-level review boards, but more progress is needed. Implementing a national MDSR system could be an important step toward driving down U.S. maternal mortality. 

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