Having a baby in America is risky. Will a new model of postpartum care work better?

Women’s health providers are gearing up for their annual meeting in Austin, Texas, this week. Here’s a smattering of what you can expect on the ground. And join the conversation using #ACOG18.

How doctors should address postpartum care will be a big issue.

It’s been pretty well documented that the United States, which spends more on medical care than any other country, has the worst maternal mortality rate in the developed world.

The American College of Obstetrician-Gynecologists is now calling for a new model that includes outreach to new moms in the crucial early weeks after childbirth as well as making postpartum care an ongoing process.

The group released its new guidelines just days ahead of its annual meeting, which starts today. The guidelines recommend an initial check-in no later than three weeks after someone gives birth, and advises healthcare providers to address a host of issues including physical recovery, emotional health and even monitoring chronic diseases like high blood pressure or diabetes.

“The ob-gyn is the primary care provider for women in their reproductive years,” said Dr. Sandra Carson, ACOG’s vice president for education.

The previous guidelines called for a single postpartum visit within the first six weeks after delivery and the group estimates that as many as 40% of new moms never even have that.

ACOG will be addressing the new guidelines in a panel discussion during Friday’s opening ceremonies, and topics will range from how many postpartum visits are appropriate to the best way to address non-reproductive health concerns during the exam.

While the guidelines aim to address the risk of life-threatening complications that can occur in the immediate postpartum period, taking a more holistic approach to care will also help women with all the other changes that are occurring during those early weeks and months.

These include issues like breastfeeding concerns, anemia, sexual health and emotional disorders.

"Quality of life issues are really paramount," Dr. Michael Krychman, owner of the Southern California Center for Sexual Health and Survivorship Medicine. "How do we maintain postpartum health and help the couple transition back to quality of life?"

(Read another ob-gyn's perspective on this topic here.)

Ob-gyns are burnt out and work-life balance will be discussed heavily.

Ob-gyns score high when it comes to job dissatisfaction, with 51% of respondents in a 2016 MedScape survey reporting some degree of burnout, placing them in the top 10 among specialties.

More doctors are leaving small group practice to join hospital networks or multispecialty medical groups. And an increasing number of hospitals are bringing in ob-gyn hospitalists (sometimes referred to as laborists) who attend to women in labor but don’t have their own office practice. The system provides back-up to doctors in private practice who don’t have to drop everything when one of their patients is admitted.

Hospitalists like the model because it allows them to have set hours, like shift work, said Dr. Rob Olson, who is both a practicing hospitalist in Washington State as well as a consultant to hospitals interested in setting up their own programs.

Olson gave the first lecture on ob-gyn hospitalists at an ACOG meeting less than 10 years ago, but says there’s a growing acceptance from ACOG leadership that the model will become the new standard of care. This year’s meeting will feature a session and a three-hour course on the educational impact of a hospitalist program (the Society of Ob/Gyn Hospitalists is a co-sponsor of the latter.)

Demand for these programs has exploded, he said, noting that when he started consulting in 2007, he was aware of just 15 of them. Now that there are about 300 medical centers employing hospitalists, and he estimates that four to six programs are added each month.

New drugs and other innovations will be on display.

The theme for this year’s meeting is “Medical and Surgical Innovations in Health Care,” and there will be a number of opportunities for doctors to see live telesurgeries and learn new surgical technique, ACOG’s Carson said.

The exhibit hall will include what ACOG is calling an “innovation rodeo” where doctors can play educational games, learn the best ergonomic practices during surgery or perform a hysterectomy using virtual reality.

Attendees say they’re excited to see new drugs and medical devices in a field where there hasn’t been a lot of innovation and where there’s no shortage of untested treatments offering false claims and fake hope.

Krychman, of the Southern California Center for Sexual Health and Survivorship Medicine, is presenting four posters this year. He is also presenting on Solosec, a drug from Symbiomix (a company acquired last year by Lupin) that was approved in September for bacterial vaginosis. The drug represents a new delivery system, an oral granules formulation that can be sprinkled on a food like applesauce or yogurt and taken as a one-time oral dose.

“I think BV is a condition that was kind of forgotten for some time,” he said. “There haven’t been many new drugs in a while. It’s been pretty static.”

There are also a number of products undergoing clinical trials for sexual health, a market where many treatments never undergo stringent regulatory testing, Krychman said. These include lubricants and radiofrequency, the latter of which is also showing promising results in early proof-of-concept studies for its ability to improve urinary stress incontinence.

Should nitrous oxide be offered in labor? This issue will be up for debate, among others

Ob-gyns, somewhat uniquely, are on the frontlines of many public health debates in medicine and this year’s meeting will address many of them.

These include debates on:

-whether the U.S. c-section rate (which currently stands at almost one out of every three births) can be further lowered

-whether all women should be offered genetic screening for diseases like breast cancer

-whether nitrous oxide should be offered to women in labor, like it is in other countries

There will also be sessions on transgender health and achieving gender equality by 2020, Carson said.