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Labor pains: Guam’s birth rate declines but maternal care crisis looms

Updated: Jan 10




 By Ron Rocky Coloma 

 

Every first of January, photos of the New Year baby from Dr. Thomas Shieh’s clinic are the traditional front-page visuals of local media outlets, heralding a new life and fresh hope for Guam. But for Guam Memorial Hospital, 2024 is emerging to be yet another year of challenges. This time, the government hospital grapples with a shortage of doctors in the field of obstetrics and gynecology. The looming crisis, though already previously identified, was highlighted anew by the recent passing of Dr. Jeffrey Gabel.

 

Besides Sagua Mañagu, GMH is the only civilian facility that delivers babies on island. Guam Regional Medical City shut down its maternity unit in 2018. While the U.S. Naval Hospital provides maternity care, it only serves military personnel.

   

According to data from the Department of Public Health and Social Services, total births remained constant, averaging about 3,300 births annually during the past decade. Total number of births, however, dropped slightly to 2,938 in 2020. According to the Guam Bureau of Statistics and Plans’ 2017 data, GMH reported a total of 1,913 deliveries, GRMC reported 705, and Sagua Mañagu reported 302. This brought the 2017 total to 2,960 baby deliveries.


In the mainland U.S., birth rates increased following the 2022 reversal of Roe v. Wade, which rendered abortion less accessible, if at all. Abortion remains legal on Guam. But while the latest data for Guam is not currently available, the most recent numbers showed no link between birth rate and lack of abortion services. Guam’s birth rate declined since the island’s sole doctor who performed abortions retired in 2018.


 Dr. Thomas Shieh said on average, about 2,000 babies are delivered at GMH each year, with additional patients for non-pregnancy-related issues. Dr. Jon Sidell’s estimate is 2,500 births per year.


Despite the declining birth rate, the island’s medical sector noted the urgent need to address the shortage of OB-GYNs on Guam.


Shieh expects to deliver 40 babies in June alone. Sidell delivers 500 babies per year. In the states, Sidell said, the average number of patients per doctor is 150 a year.


There are conflicting numbers as to the number of OB-GYNs at GMH.


“There are four private doctors, and three public doctors. It does not include Navy doctors who work at the Navy Hospital,” Sidell said.


According to a statement from GMH, there are currently 15 providers with privileges who deliver babies. “This includes 11 full- and part-time OB/GYNs, three midwives and one family practice doctor with credentials and experience delivering babies,” GMH said.

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“Privileges” means a physician and/or midwife has been vetted and meets the criteria to admit patients and practice medicine at GMH. Initially, the healthcare provider is given privileges for one year. If the doctor continues to meet the necessary criteria to practice, their privileges are renewed for two years and renewed every two years for the same length  of time as long 

as the physician continues to possess a Guam medical license and meet the qualifications. 


But GMH’s claims are “misleading,” according to Shieh. “The reality is we really have just 6.5 OB/GYNs on Guam,” he said, emphasizing the difference between those with privileges and those actively involved in patient care.


This number will further dwindle with the retirement of some OB/GYN doctors including Sidell. “I have been working double shifts for 20 years and I'm tired,” he said. “I worked both as a public doctor for GMH and had a private practice. I have no idea what they will do, but I'm replaceable just like anyone else. I'm not special but they need to find a body.”


GMH officials said privileges are extended to doctors working full- or part-time,

doctors who are not physically in Guam on a full-time basis but travel from the mainland and practice while here, and doctors from the private practice sector who deliver their patients’ babies at GMH but do not work there. “There are five part-time OB/GYNs and one who is based in the mainland but will take shifts when in Guam,” GMH said.


“GMH vigorously recruits to bring more OB/GYNs on staff. However, we face challenges due to the higher wages and packages offered by other hospitals,” said Perez-Posadas. “We are competing against higher wages and benefits offered elsewhere.” 


A report by the Association of American Medical Colleges projects a national shortage of up to 124,000 physicians, including OB/GYNs, over the next decade. This shortage is attributed to an aging physician workforce and a growing population.


While there may be a national shortage, Sidell said “Guam is worse because of historically low pay, and insurance companies not willing to pay stateside rates will be way worse if they build (a new) hospital away from Tamuning.”


The situation would get worse if all current OB/GYNs decide to either leave Guam or retire. It would not be an easy decision to make, he said. “No one wants to sell their house, practice, then put their kids in new schools,” he said. “At that point, it’s just easier to relocate. The governor does not seem to care.”


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Perez-Posadas said, “Regardless of the circumstances, we focus on ensuring the safe delivery of babies and the continuity of care for mothers and newborns.” 


The shortage of obstetricians and gynecologists on Guam is a significant issue, which reflects a broader national trend, but also includes unique challenges specific to the island.


The shortage of OB-GYNs in Guam is partly a reflection of a wider national trend. The American Congress of Obstetricians and Gynecologists has projected a nationwide shortage of OB-GYNs, estimating up to 9,000 obstetricians and gynecologists could be in shortage by 2020, with the number expected to grow to 22,000 by 2050. 


The situation is compounded by the fact that OB-GYNs are a unique specialty that requires significant investment to employ, and the existing workforce is aging, with fewer younger OB-GYNs entering the field. 


This national trend affects various regions in the United States, indicating that Guam's situation is not an isolated case.


The OB-GYN shortage in Guam is aggravated by several local factors. For an island with a population of approximately 154,000, there are only seven working OB-GYNs, and most of them are nearing retirement age, with only three working full-time.  This scarcity poses a significant risk, especially since losing even one specialist can significantly impact healthcare delivery on the island.


Additionally, the conditions of GMH’s maternity ward are a contributing factor, Shieh said. The maternity ward still uses a 40-year-old layout, which requires mothers in labor to move through multiple rooms, a situation described by Shieh as "inhumane."


The lack of modern facilities and the state of disrepair of existing ones make it challenging to attract and retain OB-GYN specialists.


In an earlier interview with K57, Dr. Hoa Nguyen of the American Medical Clinic said the shortage of OB-GYN doctors is linked to various adverse outcomes, such as high infant mortality rates.


According to the U.S. Department of Health's 2023 report, between 2017-2021, 161 Guam infants died before their first birthday, an average of 32 infants per year. The mean infant mortality rate for the five years was 10.71 per 1,000 live births. Guam's infant mortality rate is higher than the Healthy People 2020 Objective of 5.8 infant deaths per 1,000 live births, according to the report. (With additional reports from Mar-Vic Cagurangan)




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