BARDSTOWN In the midst of the COVID-19 pandemic, the general message has been to wait, to stay home, to be patient. Easier said than done, however, when a baby is on the way. There is no waiting until it’s safer. But there are ways to be maximize safety, to alleviate worries, and to welcome a newborn into a safe environment.
“As far as deliveries, it is business as usual in that we are still providing quality care for our patients. We are putting on our personal protective equipment and screening everyone at the entrance to the hospital,” says Carmen Folmar, MD, OB-GYN at CHI Saint Joseph Medical Group Obstetrics and Gynecology in Bardstown, Kentucky. “The patient and the support person are also wearing masks in the delivery room. We are still supporting skin to skin and breastfeeding which we know is important to our patients.”
Folmar says that fear and anxiety about having a baby during the pandemic is understandably high. That is one reason why one support person is allowed in the room with the mother.
“We have been doing a lot of counseling on COVID and what it means in pregnancy. Patients want to know what it is going to look like when they come to the hospital. Having that conversation has been really reassuring to our pregnant patients,” Folmar says. “We do allow one support person because we understand how important it is to have that person in the room with you.”
While deliveries continue, elective procedures have been postponed, and Folmar and her colleagues have made the transition to wider use of telemedicine. Folmar says telemedicine may persist as a preferred option for many patients even after the pandemic is over.
“We will have that subset of patients who find it hard to get to us whether it’s due to their work schedule or the distance they have to travel,” she says. “We can continue to see and manage them via a virtual visit. We like that we can provide that service to our patients. I don’t think that will go away after all this is over.”
Originally from Augusta, Georgia, Folmar is part of a medically inclined family, including her mother who is a retired lab technologist, a sister who is an occupational therapist, a cousin who is an anesthesiologist, and another cousin who is a dentist. Small wonder, then, that Folmar says she knew when she was 10 years old that she wanted to be doctor, often watching shows about physiology, pregnancy, and childbirth.
After attending Spelman College in Atlanta, Folmar completed medical school at the University of Louisville School of Medicine. She completed her residency at the St. Louis University Department of Obstetrics, then returned to Kentucky, joining CHI Saint Joseph Medical Group Obstetrics and Gynecology in 2016. The practice consists of two OB-GYNs and one nurse practitioner and serves a seven-county area, providing general obstetrics and gynecology care. In-office procedures include colposcopies and loop electrosurgical excision procedure (LEEP) for cervical dysplasia.
“We will treat some complications in pregnancy, including obesity, hypertension, gestational diabetes, and multiple gestations, but some of the more high-risk conditions we will refer to maternal fetal medicine,” Folmar says. Patients range in age from mid-teens to the 80s and 90s. “On the gynecology side, we perform annual exams, routine mammography, and manage common complaints like vaginitis and contraception. We provide conservative management of pelvic organ prolapse and treat abnormal bleeding and pelvic pain.”
Folmar and her colleagues also counsel their patients on HPV vaccinations to prevent cervical cancer. “We are counseling all who fall in that age group and have not been vaccinated to get that vaccine,” she says. “We have all seen the devastating effects of cervical cancer and know that this is something that can, for the most part, be prevented with vaccinations, routine visits and Pap smears.”
Communication and conversation are central to the quality of care the patient receives, Folmar adds. Patients might be uninformed or simply embarrassed or anxious to seek care. For example, she notes that many younger patients are hesitant to ask about birth control because they fear a pelvic exam will be required.
“That used to be how we practiced, but now our goal is to provide our patients with reliable contraception, and an exam is not required,” Folmar says. “When I tell them, ‘I don’t have to do an exam today,’ you can just see the relief on their face. All we are going to do today is talk and then decide what would be a good option for contraception for you.”
“In general, you have a conversation with the patient,” Folmar adds. “Many times, a patient will say, ‘You’re the doctor. You tell me what you think is best.’ I let them know that at the end of the day, they need to make a decision that they feel comfortable with and that is also safe.”
Unlike many of her colleagues who focus more on obstetrics or gynecology, Folmar enjoys both specialties. Furthermore, in a rural area with few subspecialists, the ability to provide both obstetric and gynecologic care is particularly important. Nonetheless, Folmar foresees that the trend to specialize will grow and may soon become part of the training process.
“There has been discussion for some time regarding how we are going to train future OB-GYNs,” she says, noting that some residency programs have begun experimenting with a system in which residents all do the same rotations the first two years. “Then they decide they want to practice just obstetrics or gynecology, and that gives them an opportunity to spend even more time in that discipline and field so they get even more experience. What we may see decades down the line is that you just don’t have one OB-GYN anymore.”
“As far as deliveries, it is business as usual in that we are still providing quality care for our patients.” — Carmen Folmar, MD CHI Saint Joseph Medical Group.
Regardless of what the future of OB-GYN holds, Folmar plans to continue delivering care and meeting the needs of her patients.