As someone who grew up in rural Iowa, Abby Flannagan, D.O.’18, has always had a passion for rural medicine, particularly rural obstetrics.
Abby Stroeh, D.O.’18, was influenced by an older sister, Kim, a midwife who she says “set the stage for me to find a lot of joy in childbirth.”
Both graduates recently completed new fellowships in central Iowa – at UnityPoint Health and Broadlawns Medical Center, respectively – that represent steps in filling a big gap in service. Maternal death rates are higher in the U.S. than in any other developed nation, and access to care is shrinking. Only 46 of Iowa’s 99 counties have at least one open birthing center, and the state has the lowest number of obstetricians per capita in the country, according to the American College of Obstetricians and Gynecologists.
As a resident at UnityPoint Health, Flannagan seized every opportunity to train as a family medicine physician who was also experienced in obstetrics.
“I spent a lot of time on the OB floor,” she recalls. “On my free weekends, I’d ask the doctors, ‘Do you mind if I hang out with you?’”
When UnityPoint Health created a pilot for a new one-year surgical obstetrics fellowship at Iowa Methodist Medical Center in Des Moines, where she did her obstetrical training during residency, she jumped at the chance to advance her skills. As of late March, she had been the primary surgeon on 145 cesarean sections (the initial goal of the fellowship was at least 100), assisted with 120 more, and handled hundreds of vaginal deliveries.
“Her case numbers are so impressive and beyond what we could have imagined. Abby was the perfect person to start the fellowship,” says Joshua Rehmann, D.O.’06, a family medicine attending and the program director of UnityPoint’s Central Iowa Family Medicine Residency Program.
Meanwhile, John Pymm, D.O.’14, who had completed his family medicine residency at Broadlawns Medical Center, returned to Broadlawns after practicing in Storm Lake, IA, to oversee a new obstetrics fellowship there. It just so happened that Pymm had met Abby Stroeh near the end of her second year of residency in Sioux County, IA, during a health service trip in Honduras.
“She is extremely motivated. We wanted to make sure she had as much surgical experience as possible in the fellowship,” Pymm says.
For Stroeh, the fellowship is personal. Where she grew up in western Iowa, major hospitals were more than an hour away; she gave birth to her son at Broadlawns, where trained staff were readily available “if something went wrong.” In the fellowship, she’s performed more than 90 c-sections as the primary physician and assisted with more than 30 more.
Both Stroeh and Flannagan teach family medicine residents and medical students, including in obstetric simulation sessions at DMU. Rebecca Shaw, M.D., chair of specialty medicine at DMU, says the two fellows’ interactions with students are invaluable. “How do we staff the state of Iowa as fewer and fewer physicians provide obstetrics?” she says. “These two women were fortunate to be the trailblazers, our health systems are fortunate to have them and it’s wonderful for our students to talk with them.”
“Having a baby is such a life-changing experience, but it also can be really scary,” she says. “There’s a lot that can go wrong, so it’s important you’re at a place that’s equipped to handle that.”
When their fellowships conclude on June 30, Flannagan will enter practice with UnityPoint-Grinnell, IA; Stroeh plans to practice in Sioux County, IA. Both will continue meeting a critical need in the state.
“We have all these ‘desert’ areas where no one is doing OB. That sparked us to do something about it,” Flannagan says. “Our goals are to enable mothers to get care closer to home and ease the heavy caseloads on birthing centers in metro areas.”