Dr. Shannon M. Clark, MD, FACOG
Appearances
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
People say just like what Kristen said, it's just as safe. Well, I cannot say that about where I work unless I have receipts. In the state of Texas, we have maternal levels of care and we have state guidelines that we have to meet in order to get designated.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Any place in the state of Texas that provides inpatient labor and delivery care has to have a designation, whether that be one, two, three, or four. We are a level four. We have to provide receipts in order to have that designation. That means a robust QAPI plan. QAPI is Quality Assurance Policy Improvement.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And that means we have certain triggers on labor delivery that are mandatory for case review. We chart audit thousands of charts per year. We are gathering data on a continual basis. We have levels of escalation, primary review of certain cases, secondary, tertiary, and beyond. This is something that I do daily with my colleagues. Why aren't birth centers required to do that?
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Because it's easy to say everything is okay when you don't have to provide receipts to prove it. So I agreed this should be done anywhere that is providing obstetrical care. They have to be able to back up what they're saying.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And they cannot do that if they're not collecting stats, if they're not reporting their outcomes, their transfer rates, their emergent transfer rates, their complications, the number of postpartum hemorrhages they have, anything like that. We have to have a way to find what those stats are for every birth center, just like I have to do for where I work. And a lot of hospitals do.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
This has been proven. to improve patient care and outcomes. The fact that it's that standard that birth centers are required to do that is a disservice to the community because they deserve to know what these stats are. Another thing to consider is if there is a complication in the birth center and they go to the hospital, that stat falls on the hospital.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
If there's a death or patient ends up in hysterectomy or X, Y, and Z, that's going to be on my stats. It's easy to not have to report it if it's not following on your stats. A lot of patients don't even realize that when they're looking at where they're going to give birth. And I'm not trying to throw birth centers under the bus.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I do think there is a role for them, but they should be required to do reporting just like we are because patients deserve to know all of those stats and they should be able to see the receipts. Changing medical records, that was another issue throughout. You can go back and change a medical record, but in our hospital system, if you change something, It's going to be known. Epic logs every edit.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
If somebody's requesting medical records, they're going to see that. There's an audit trail. One of the things about some of these systems, and I don't know if it was true in this situation, but when you do certain types of record keeping, they will charge for the number of users you have.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
So I don't know if it was at play in this situation that it was a way to cut costs, but depending on how many different usernames you're issuing, that is a cost. And I can tell you in a hospital setting, if you were to chart under somebody else's username or you were to go into a chart that you did not actually care for, that is grounds for dismissal, termination of your job.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I've heard of people getting fired because they went into somebody's chart or they did X, Y, and Z that was not their documentation. It happens.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I've actually talked about this a lot on my platform. When you look at worldwide mortality, we're actually very, very low. It's when you look at us compared to other higher income developed nations where we are not having a lower maternal mortality rate over the years. Ours is increasing yearly. And do I think we're in a crisis? Yes, I do. And I think there is a few reasons for that.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
The one's going to be a rise in maternal mortality. There has been a steady rise since around 2000. We've had a few peaks here and there. During COVID, we had a peak, which they're still trying to tease out the data on exactly why that happened. But we're not where we should be for a high-income developed nation. The other reason is because there are clear and proven racial disparities.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And we know that our black patients are disproportionately affected. Why is that? They're having consistently higher rates of maternal mortality compared to their white counterparts. And that is even if a black patient has a college education, they are still five times more likely to die in childbirth than a white counterpart. So even education isn't protective in that patient population.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
The next thing is going to be systemic issues. We have limited access to care. A lot of our patients don't get any care in between pregnancies. A lot of my patients don't get care until they're pregnant. And so then we're playing catch up with any pre-existing medical conditions they have while they're pregnant, which is not the ideal time to do that.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
We have a lot of social determinants of health that affect patient outcomes like Poverty, transportation issues, unstable housing, nutrition. Those are all affecting pregnancy as well. Mr. Delayed Diagnosis. And that's just because in general, anyone with a uterus isn't always taken seriously. And that's even from when they're not pregnant.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
If they're not pregnant and they're having a complication, oh, well, you know, they're just being dramatic. If they're pregnant, then, oh, it's just because you're pregnant. So there's always traditionally has been a tendency to downplay pregnancy. any concerns that a pregnant individual may have. So there's so many reasons why we are in a maternal mortality crisis. It's not where we should be.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
We can do a better job. And now that we're having laws that are affecting access to reproductive health care, there's going to be maternal health care deserts because people are going to leave those states. It's already happening. My residents are not going to get the training they need because they're in a state with restrictions and bans. Abortion bans and restrictions in the United States
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
It actually affects pregnancy care. So unfortunately, we are taking steps back in recent years, and it's only going to get worse. I'm in this every day. I don't see anything being done right now that's going to help the maternal mortality crisis in this country. And I don't see anything that's going to help improve health equity and equality for our patients of color.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Everything that's being done is doing the exact opposite. And it's something that I think about every day. It's something that I'm seeing the consequences of more. I've seen things in the past three years that I have not seen in my entire career.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
One of the things I teach medical students and residents, there's a difference between health equality and health equity. You walk onto a lever delivery unit and they say, everybody in rooms one through 10 get equal care. Everybody gets the exact same care. That's great. Nobody's going to get anything somebody else doesn't get.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
But that's not appropriate because a patient may walk into room three already at a disadvantage based on social determinants of health, based on the tone of their skin, based on other complications. So being equitable also applies, meaning you have to be able to allocate resources to the ones who need it the most. Giving just equal health care may not cut it for that patient in room three.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
They may need more. Being able to recognize what about that patient in room three is already putting them behind the eight ball. And fixing that is a place to start. But starting on labor delivery is not going to do a whole lot. It starts way back. It starts during the preconception period. It starts during pregnancy. We can't fix everything when they hit the doors for labor and birth.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
So we need to focus on equitable health care. We also need to focus on acknowledging the roles that social determinants have and the outcomes of our pregnant patients. The other important thing is we got to continue research and data collection. We got to keep researching this. We can't just keep saying we have a maternal mortality crisis and we can throw out stats. Well, why is that happening?
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And what are we doing to fix it? We need research on that. And if we keep cutting funding through the NIH, that's not going to happen. We have to acknowledge that racism in healthcare is an issue. We especially have to acknowledge it that racism in obstetrical care is an issue. And we have to start holding people accountable for that and doing more education.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And providers have to recognize both their implicit and explicit biases. And if we're not willing to do that, it's never gonna be fixed. It starts with the individual provider and then it balloons out from there. So we have to acknowledge that racism in obstetrical care has a huge impact on pregnancy outcomes and birth outcomes and neonatal outcomes. We have tons of stats to back that up.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
We need to fix it. Those are probably the top three things that I think really need to be addressed first.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Hi, yeah, I am Dr. Shannon Clark. I am a double board certified OBGYN and maternal fetal medicine specialist. That means after medical school, I did four years of OBGYN residency training. Then I decided to do more training to be a maternal fetal medicine specialist. So that is also known as perinatology or a high-risk pregnancy specialist.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I just wanted to commend you all for sharing your stories because I'm in the medical complex, if you will, and I'm a highly skilled physician. I've dedicated my life to this work.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And what I found since being on social media, and I'm sure you will understand when I say this, people are very willing to share their experiences with OBGYNs, whether it be either during their pregnancy care or postpartum. labor and delivery care or postpartum care when it's not what it should be. They're generally very open about it.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
But the same is not necessarily true for those who have chosen to do an out-of-hospital birth in a different setting. I do think there is a hesitation to talk about when things don't go right in those settings.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And I think for some people, there's a level of guilt about it, or they don't want the criticism saying, well, you should have given birth in a hospital, which I don't think is ever an appropriate thing to say to anybody, no matter what choices they made.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
All my patients are pregnant with either maternal fetal complications or both. I've been a faculty in maternal fetal medicine and OBGYN since 2007. And now I'm a professor at a large academic institution. institution. That's my day to day. And I'm actually right now, I'm post call. So I've been up since about four o'clock yesterday morning.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Coming forward and talking about this on such a public forum is very commendable because you guys will give other people a voice and maybe prompted them to share their stories as well. Things can happen in any setting, but it's expected at hospital birth settings that things should be right. And they fit in that perfect Instagram square and they have the beautiful pictures and all that.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And things don't always go right. We just don't see it. And you guys are bringing it to light. So I hope you know that as difficult as it may have been for you to do this, you are going to change somebody's life and you are going to change somebody's outcome by helping them better make informed choices.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I've talked about this a lot on my social media platforms. I have readily acknowledged that the obstetrical traumas that can happen in a hospital setting, whether that be pregnancy trauma, birth trauma, postpartum trauma, at the hands of providers is real. I know it's happening.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
autonomy being taken away, no explanation about what's being done and why it's recommended, no follow-up, having a traumatic birth and then going home with questions about what happened because nobody actually explained what happened. I understand the role that all that plays in patients choosing out-of-hospital birth.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Yeah, I mean, I've been doing it forever. I'm older now and I can tell you the recovery is not as smooth as it once was. We do the 24 plus hour shifts and that's just the lifestyle at this point.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
So if there's any obstetrical care provider listening to this, we have to do better because we are, as a profession, one of the reasons why patients are making this choice and why they may be willing to make a choice for an out-of-hospital birth before being fully informed because they don't want to go back to that hospital that caused them trauma.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Trauma can happen at the fault of no one, but we can also add to it or we can cause it. We should never be adding to or causing trauma. And we have to acknowledge that that does happen and we need to do a better job as a profession of stopping that.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Going to an out-of-hospital birth is not the answer to experiencing in-hospital trauma if we can't ensure that the care is going to be what it should be and that birth centers have receipts. The people doing the home births have appropriate credentials to manage complications because it can still happen there. So it starts with us in the hospital setting.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
We have to make sure the patient is a part of their care and the decisions being made. Just sitting someone down and explaining you had this postpartum hemorrhage because of X, Y, and Z, and this happened and not sending them home where they just don't have answers. That goes a long way. Yes, it takes time, but we have to do it.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
When I hear about patients choosing an out-of-hospital birth because of things that happened to them in the hospital, to me, that's not the answer, but I understand why they do it. Knowing that some of these patients go to birth centers like the one talked about on this podcast and that they're not placed in better hands, that's even more alarming to me.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And I know it just doesn't happen in Dallas. It happens all across this country.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Yes. Since 2000 was when my first year of residency, I've always worked alongside midwives on a labor and delivery unit. Where I work, it's a little bit of a different model. Maternal fetal medicine specialist staff labor and delivery 24-7. But we also have midwives there to take care of patients. But they're on the floor with us. And if they need us, they let us know. If they don't, they don't.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
But we're there. It's still a hospital setting. But if something goes wrong, they have what they need. I love that model. I wish we had midwifery care on all labor delivery units. I wish we had doula services available on labor delivery units. So that's another place to focus on is what can we do on labor delivery units to get the best of both worlds?
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
The first thing is what exactly is physiological birth? What's the definition? Because there is no one definition. It's pretty much going to be according to whoever's talking about it. If you think about it, maternal physiology is what the body does during the course of birth.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
The physiological changes in the blood volume, the uterine blood flow, the elevation of the diaphragm, all that still happens in a hospital birth. Managing labor and delivery by having a spontaneous vaginal delivery, that's still physiological birth. There are a lot of OBGYN practices who are very hands-off. They do interventions when they need to. It's hit or miss.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I'm not going to pretend that it's an option for everyone. I know that it's not. But there is a very common misconception that if you want to have a physiological birth, you need to be in an out-of-hospital birth setting. And that's simply not true because we really don't even know what that means. I think interventions should be done when they're indicated.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
If something is recommended, it should be explained to the patient. The most important thing is a good maternal and fetal neonatal outcome, whatever that looks like. If a cesarean section is needed, that's what's needed. If pitocin augmentation is needed, that's what's needed. I've talked about this on my platform.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Honestly, I don't think I have a cutoff point because I think that as physicians, especially those of us that are in a surgical specialty like OBGYN and as a high risk pregnancy specialist, we can be on at the drop of a hat. And while we're on call, we may have a chance to rest if things are kind of quiet. I can go from sleeping 30 minutes to being in the OR with someone hemorrhaging.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I actually even made a video in response to one of the episodes for this season about physiological birth and what that means. I wish we could say physiological birth is X, Y, and Z, but we simply cannot. So it can look a lot of different ways.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And so I don't want anyone who's listening to this podcast think that there is one way to have a physiological birth and that's it because it's simply not true.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
No, that should not happen. Keep in mind how I work. I don't have my own patients. I have them for the time that they're here, either admitted antepartum or they're delivering in a postpartum. I don't have my own patient schedule, but I've had patients who have reached out to me on social media and I don't respond because it's inappropriate.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I feel like there is this thought or feeling both on some providers and also on patients that we are supposed to be friends. I'm not your friend. Can I be friendly to you? Absolutely. Can I be cordial? Can I be respectful? Can I be empathetic? Yes. But being friends and being on that kind of level is not appropriate because you will lose your objectivity in order to take care of that patient.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And that cannot happen. And it's an expectation sometimes on the provider's part and on the patient's part. Just remember, you want your doctor or your provider to always be objective and do what standard of care is based on what's indicated for you and not because they're friendly with you and they know your family or you guys just had lunch or you guys are friends on social media.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
That's not how it's supposed to be. And it shouldn't be that way. I hope that doesn't make me sound like I'm not being a nice person, but there is a line that can be crossed.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I can't say that I've ever really felt that I couldn't function appropriately after being on call or being up because we just turn it on. It's the skill set we develop over years of doing this.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I can tell you, I don't belong to any Facebook groups, whether it's for personal reasons or medical reasons. Groups like that can be problematic at baseline. Reddit groups can be problematic at baseline because there's a lot of confirmation bias and quite an echo chamber there. So that has to be taken with a grain of salt. I've chosen to educate on social media the way I do. And that works for me.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
But I think it should be a red flag. It's unprofessional. But as Kristen said, it's borderline unethical. And it could definitely be problematic.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
48 hours is a lot. I've done 48 hours as a resident back in the day. Not so much now, but I will say it's not only just the lack of sleep, it's being out of your home or being away from your family or being in that high intensity environment for that period of time. Even if you're able to step away and go to your office or go to the call room and take a nap.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
you're in a hospital setting or a birth center setting. So I can imagine having someone cover for that period of time in a birth center or in a hospital will take a toll. The most I will do now is probably about 36 hours. And that's very, very rare. But it's not always that I'm clinically active, taking care of patients on labor delivery.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
You have to be careful in what you're doing as far as what your call shifts are going to look like. There are some surgical specialties or even medical specialties where they may be on call from home for the weekend, but they're at home. So it's a little bit different. I can imagine being in a birth center setting or a hospital setting for two to three days. That's a lot.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I don't know that I could do that.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
It was hard to listen to. It's almost like watching a medical TV drama and you're screaming at TV. But this was real life. And listen, I'm not here to say that giving birth in a hospital is perfect and we have no issues. We do. But my overall feeling is that being in a birth center is for patients that are lower risk. And that means throughout their pregnancy, all the way coming up to delivery.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And if they're getting care in pregnancy that's maybe not what it should be, and then they're delivering in a birth center setting, that just compounds on the potential for complications. With a couple of these stories, I saw red flags in their antenatal care and their prenatal care. And then now they're in a birth center.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I wish that some things had been picked up earlier on and they could have gotten those medical consults earlier on in their pregnancy that were needed. Maybe things could have been avoided. If they're not getting all the information they need, or full transparency, that's not allowing them to make an informed decision. And I feel like that was what was at play as well.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
We are choosing to give birth to our babies in this setting. We should be able to trust that what we're being told is the truth and that they're telling us everything we need to know. That's whether it's in a birth center or a hospital setting. But in a birth center setting, the risk are higher because if something goes wrong, time is everything.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
Whether it's a maternal complication or a fetal or neonatal complication,
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
so i just wish that there was more transparency on the providers who are taking care of the survivors i have a lot of feelings about this but again i want to emphasize that i'm not doing this just so that i could say well giving birth in a hospital is perfect and there's no issues there i'm not saying that at all but when someone chooses to be in a birth center and they are considered to be low risk they should actually be low risk because that's what a birth center is for
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I want to say that I am not anti-midwifery model of care, as long as it still applies to the patient. They may walk in at point A, being low risk, where the midwifery model of care completely applies. But pregnancy is a dynamic state. You have a lot of physiological changes, anatomical changes. A whole new being is being grown inside of someone's body. And we have to respect that.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And I say this all the time. A lot of things have to go absolutely perfectly for there to be no complications. And there's a lot of room for error just innately by being pregnant. We can't dismiss those, as Kristen said, red flags. And red flags develop, not in every pregnancy, but in a lot of them.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I feel like the stories that I heard on this season, they were being forced into that box where they were low risk. And even though red flags kept popping up, they weren't willing to acknowledge that they're starting to move out of that low risk box. As physicians, we get criticized all the time for dismissing patients.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
It also happens in a free model of care, just as it has happened with us OBGYNs who deliver in a hospital setting. We have to understand and respect pregnancy for what it is. There is a lot of room for things to go wrong. We have to listen to red flags when they pop up.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
We have to appropriately evaluate them and do what we need to do to manage them in order to ensure the best outcome for both the patient and the fetus in neonate. If we keep trying to dismiss them so that they stay in that low risk box, that's going to do a huge disservice to the patient and their care.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
I am an OBGYN and high-risk pregnancy specialist. I do all high-risk pregnancies. So I am in a different setting dealing with a different acuity of care at baseline with my patients. But shit happens, right? There's a saying that says meconium happens. But we can't dismiss meconium and just say, oh, well, it happens because there are a lot of consequences to meconium.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
It's associated with abnormal fetal heart rate tracings, meconium aspiration syndrome, increased admission to the NICU for the neonate, need for neonatal ventilation. In really bad scenarios, it can even lead to hypoxic ischemic encephalopathy of the neonate. It can cause an increased risk of cesarean delivery for the patient, infection, fever.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
The consequences of meconium aspiration syndrome or having HIE are so significant and profound that we can't dismiss it When we start seeing meconium, the first thing we need to do is once a patient in labor starts showing signs of meconium passage during the course of their labor, we need to let the neonatal resuscitation team know, hey, patient in room 321 has meconium.
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
If you don't have a neonatal resuscitation team, how can we put them on alert? Because they have to be ready in case when the neonate is born, there are complications. One of the other things that can happen is having an abnormal fetal heart rate tracing. Well, if we're not doing continuous fetal monitoring, how are we going to pick up that there's an abnormal fetal heart rate tracing?
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
And having done this for a gazillion years, I could tell you there are certain signs in a fetal heart rate tracing that can tell me that there's meconium there and that there could be a complication if we continue laboring in this patient. So I look at the big picture and say, how close is she to delivering?
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
If she comes in at two centimeters and I'm already seeing some issues, I'm not going to wait until she's completely dilated. There's a lot of clinical nuance at play with the individual. So we need to consistently document what the meconium looks like because it can evolve over time. There's a lot of things we need to do. What protocols does a birth center have?
Something Was Wrong
S23 Ep14: S23 Roundtable with MAMA founders Kristen & Markeda and Dr. Shannon M. Clark, MD, FACOG
If there is meconium noted during labor and delivery, that's a question that they should be able to answer. And if they just say, oh, well, meconium happens, that's not a good answer, in my opinion, because they should have protocols on what to do.