SANSUM CLINIC BLOG

Having a baby is a positive and happy reason to need to visit the hospital. Expectant mothers and their visitors are generally excited and happy to be there for that occasion. The doctors and staff at Sansum Clinic Obstetrics and Gynecology Department appreciate the opportunity to bring joy into people’s lives and help them through the process. The professionals at the department are also prepared for complications and challenges that can occur during pregnancy and childbirth, and they treat and monitor a wide variety of conditions related to female reproductive health, providing age appropriate care to women from adolescents to older adults.

Doctors from the OB/GYN department rotate shifts at Santa Barbara Cottage Hospital to bring approximately 100 new lives into the world per month. They provide comprehensive health services for women at their offices on West Pueblo Street in Santa Barbara, and at Foothill Surgery Center at Sansum Clinic on Foothill Road in Santa Barbara.

David Raphael, MD, FACOG has been on staff at the department for twenty-eight years. He explains the services they typically provide. “The needs are mostly based on the age of the patients,” he says. “In the reproductive age group we help women with issues related to fertility, contraception, and disease prevention. And later, during menopause, we help with hormone deficiency symptoms.” Doctors and advanced practice providers at the department also perform routine procedures such as cancer screening, pap smears, pelvic exams, and pelvic ultrasounds. They treat uterine fibroids, which are noncancerous growths of the uterus that often appear during childbearing years. They also diagnose other benign and malignant tumors on the ovaries and uterus.

The team is well-trained when conditions require surgical intervention. “Women can become severely anemic due to abnormal bleeding and may be functioning with half their normal blood count,” Dr. Raphael continues. “That may necessitate a hysterectomy, which is removal of the uterus. Alternatively, we have an effective procedure called uterine ablation that can help patients avoid a hysterectomy. It’s an outpatient technique where we cauterize the lining of the uterus to stop any abnormal or menstrual bleeding without affecting the patient’s hormones.”

When a hysterectomy is required, doctors can leverage the latest advances in medical technology. Dr. Raphael and most of the other physicians at the department are skilled in robotic-assisted laparoscopic hysterectomy, which utilizes the da Vinci™ Surgical System. Interactive robotic arms hold graspers, scissors, 3-D cameras and other tools, and are controlled by the surgeon from a console. “The da Vinci system enables surgeons to perform with excellent precision and control, requiring only a few small incisions,” Dr. Raphael says. “The doctors in our department prefer it because it provides easier instrument manipulation and visualization while being minimally invasive. It has significantly changed our experience in the operating room.”

Ultrasound is another essential technology used by the department throughout pregnancy to diagnose growths on the ovaries and the uterus. If information or visualization is needed beyond what ultrasound can provide, the team can send patients to Sansum Clinic Radiology Department for an MRI or CT scan.

Heather Terbell, MD, FACOG says the OB/GYN doctors frequently assume the role of educator and counselor for their patients during clinical visits. “Often we need to help women through issues that may be difficult for them to talk about,” she explains. “Depending on their upbringing, some women are very familiar with how their bodies work, while others are ashamed, embarrassed, or don’t know their anatomy.”

Dr. Terbell says that while having babies is the most natural thing in the world, complications can occur during pregnancy and childbirth. “We are prepared for anything,” she says. “Things have gotten more high-tech, so computerized safety monitoring and record keeping are now standard. Also, advances in medical technology and knowledge have improved maternal and neonatal outcomes.”

Scientific developments reduce many risks in obstetrics, but they can introduce other challenges. Innovations in reproductive technologies enable older women to have babies. Older mothers have a higher possibility of pregnancy related complications. Procedures such as in vitro fertilization contribute to an increase in the incidence of twins, triplets, and other multiple-birth babies. Multiple-pregnancy babies have a higher risk of being born prematurely, having a low birth weight, and other problems. “The risks are shifting,” Dr. Terbell continues. “The goal is a healthy mom and a healthy baby.” Sometimes a mom will bring her teenage daughter in to discuss topics from first periods to first sexual encounters. “There are a lot of misconceptions about women’s health in mainstream culture, and we dispel them,” Dr. Terbell continues. “Patients trust us to provide accurate information and clarity. Women need to know how their bodies work and what their choices are. I want everyone to have a healthy body image and a healthy understanding.”

When Dr. Terbell was a student, she thought she would end up in the humanities as a theater major or an English major, but in college, she experienced a strong pull toward science. “My father had been sick my whole life, so I realized I wanted to be in a helping profession,” she shares. “In medical school, I planned to go into emergency medicine, as we see glamorized on TV, but in my first rotation as a third-year medical student, I delivered a baby all by myself, and I was hooked. Taking care of women is where my heart is now. I support women through some of the most exciting but also the most challenging parts of life.”

Dr. Raphael assumed he would be a pediatrician. “I had an interest in the sciences from an early age,” he says. “My mother was a social worker and helped people on a regular basis, and I saw how satisfying it was for her. I spent a lot of time working with kids through various community programs, and I intended to specialize in pediatrics. Then I had a phenomenal rotation experience with the required OB/GYN module, and I saw how satisfying and exciting it was to be involved in people’s lives when they were pregnant and giving birth. I really love the fact that the specialty involves a combination of medical activities for a wide range of patients.

Confidently Providing Care During Uncertain Times

Seven physicians anchor Sansum Clinic Obstetrics and Gynecology Department. Advanced practice providers, including three physician’s assistants and one nurse practitioner, perform some of the annual care exams and routine procedures.

Department office manager Rosa Booth directs logistics related to patient appointment flow, and she helped launch telehealth processes that enable the doctors to meet with patients without requiring in-person visits to the clinic. These practices have been crucial during the COVID-19 pandemic.

“The COVID-19 health crisis changed our workflow,” Dr. Terbell says. “People didn’t want to come to a medical facility where they feared people may be sick with coronavirus, and yet pregnancies continue and babies keep coming. Typically we see pregnant patients monthly so we can monitor the health of the baby and the mother. But we needed to pivot so we could provide the best care for people while following public health guidelines.

Changes at the department during the COVID-19 pandemic initially included rescheduling non-essential routine procedures and annual well-visits. “Previously we had an extremely busy practice,” Dr. Terbell continues. “At that rate of turnaround, there wasn’t time to thoroughly implement the extra sanitation protocols that health officials recommended to mitigate the spread of the virus. We made changes so we could keep the waiting room sparsely populated. I started my day earlier so we could space out the appointments.”

Dr. Raphael says there was a lot of uncertainty in early 2020 when the first wave of COVID-19 infections impacted the community. “It feels like a lifetime ago,” he says. “So much has changed and evolved. At first, we had to shut down for anything that was not an emergency. We did a fair amount of telehealth where we spoke with patients over Zoom video meetings. That has been helpful for maintaining a level of care and continuity with patients, but obstetrics is different from some other medical specialties. We need to be with the patient to listen to the fetal heartbeat, measure the mother’s abdomen, check blood pressure, and other things that can’t be done online.”

“Telehealth isn’t as well suited for our specialty as it is for others,” Dr. Terbell concurs. “However, sometimes the ability for a patient to simply check in with us on video can be very beneficial psychologically. It can also be helpful with follow-up appointments so we can ensure patients are feeling well after a procedure or that a prescribed medication is well tolerated and effective.”

Members of the OB/GYN team ensured safety measures were in place to prevent the spread of the virus, enabling the department to continue to provide health services to the community. “We created a safe environment so patients felt comfortable coming to our office,” Dr. Raphael says. “We implemented temperature checks, patient screening protocols, plastic partition barriers, and social distancing guides. We all wore N95 masks and spent longer sterilizing exam rooms.”

While these measures fostered a high level of confidence about safety at the clinic, the doctors initially felt less secure about conditions in hospital delivery rooms. Women in labor breathe hard, and doctors are in very close proximity to them when delivering a baby. “Patients giving birth are pushing and blowing intensely,” Dr. Raphael says. “In the early stages of the pandemic, nobody knew how safe that was going to be. There was no reference. We were learning on the job. We wore our N95 masks and gloves and we washed our hands, but we constantly worried about catching the virus. Some doctors slept in their garage to avoid potentially infecting family members. It was an extremely stressful time.”

Anxiety decreased as COVID-19 testing became standard for all patients and staff who entered Cottage Hospital. Thanks to protective measures, department staff remained healthy. “I don’t know of anybody in my office or at the hospital who contracted coronavirus while caring for our obstetrics and gynecology patients,” Dr. Raphael continues. “I believe mask wearing and testing were significant factors in prevention.”

Dr. Terbell describes other pandemic-related challenges at the hospital that emphasize the interactive personal component of the services the doctors provide. “When a doctor enters the waiting room after a medical procedure, friends and family of the patient always look at the expression on the doctor’s face to quickly get an indication about the outcome,” she says. “Before the pandemic, I always made sure I entered the waiting room with a big smile on my face. Now we are wearing N95 masks all the time, so it’s harder to convey the message that everything’s fine. In the past, we hugged visitors or shook their hands to congratulate on the happy occasion of a birth. Now we avoid close contact. Throughout this crisis, the quality of medical care we provide remains excellent.”

The Value of Personalized Care

Looking ahead in the field of obstetrics and gynecology, Dr. Terbell believes better understanding of risks associated with genetic makeup will help improve practices. “Genetics is a burgeoning area of study that is leading to more personalized medical care,” she says. “When we know genetics may place a patient into a high-risk category for a disorder, we can tailor the care we provide. Advances in the field of genetic research may lead to improvement for issues such as early detection of ovarian cancer.”

As she considers the events of the past year, Dr. Terbell believes the COVID-19 health crisis has transformed public appreciation for science and medicine. “Prior to the pandemic, I observed a lot of doctor shopping and Dr. Google,” she says. “People did their own research and chose information sources based on how well they liked the answers. Then the pandemic hit and suddenly people appreciated science and valued the knowledge of medical experts. It made me so proud to be a doctor. I felt grateful that I had a job where I was helping, in a time when circumstances made many people feel helpless. Patients thanked me for working during the pandemic. I think COVID has made us a little kinder as a society because we are all going through this together.”

Dr. Raphael reflects on twenty-eight years with Sansum Clinic. “I’m nearing the end of my career,” he says. “I have found it very satisfying. Sansum Clinic is a wonderful place to practice, and Santa Barbara is a phenomenal place to raise a family and have a great lifestyle. Delivering babies goes back thousands of years. Today sometimes technology helps, and sometimes it doesn’t. It comes down to the provider being involved in people’s lives at a momentous and joyous occasion. It’s that personal human connection that has made this career great.”

Photo caption: Physicians and Advance Practice Providers, Sansum Clinic OB/GYN Department