Scott Sullivan, MD, on increasing ER obstetrics training due to maternal care deserts

Building on his previous observations regarding the expanding specialty care gap in Virginia and trends occurring nationally, Scott Sullivan—MD, ob-gyn, division chief, Maternal-Fetal Medicine, Inova Health System; Professor, Medical Education, University of Virginia—described a shift in strategy necessitated by the permanent closure of local labor and delivery (L&D) units. This trend, unfortunately, continues, making care increasingly difficult to find, especially in rural settings.

Training the front lines of "drop-in" care

“Essentially, what we have gone to is training people who were not initially trained to do obstetrics, and that is mainly the ER,” Sullivan said. “ER doctors have to be masters of many things, but in their training, they really do not deal with obstetrics because most training centers have obstetricians.”

To address this, Sullivan’s team has implemented a program to visit hospitals without OB services, using simulation to train staff on basic emergencies.

“It is a growing problem,“ he added. “Now, we have a program essentially to go to hospitals without OB services to train their staff. It is not just the doctors; it is the nurses and the front desk staff who see someone come in. We train them to handle basic emergencies through simulation, and we also back them up.”

Does telemedicine help in obstetric care?

While telemedicine has been a success for behavioral health and remote consultations, its application in acute obstetric emergencies is more complex. Sullivan views it as a vital connection point between urban specialists and rural clinicians on the front lines.

“Telemedicine can do some things really well, like consultations or behavioral health,” said Sullivan. “It is really great because people can do it on their phones in their living rooms, and it really has been a success in some areas. Of course, as we pointed out earlier, you cannot deliver a baby or do surgery via telemedicine. We have tried it with imaging, sometimes remotely, and that has some applications, so it is better than nothing.”