Centennial Stories: Obstetrical care focuses on women's health

In 1987, when an obstetrician left the Health Center of South County, that meant that South County women with Medicaid insurance could no longer deliver at South County Hospital.

“By that time I had stopped doing obstetrics,” recalled Dr. Joseph O’Neill, the hospital’s first board-certified obstetrician.

Dr. Robert Curhan and Dr. Martin Schwartz, meanwhile, had taken on a third doctor, Dr. Kimberly Hay, but – squeezed by low reimbursements and high malpractice insurance – they were not accepting Medicaid patients.

The situation, described in the press at the time as a crisis, put the hospital in the middle between an upset community and doctors struggling to maintain a solvent practice.

The state Health Department even became involved. Director H. Denman Scott was quoted in the Narragansett Times as saying, “The real shame is the hospital hasn’t stood up to these obstetricians.” He threatened a show-cause hearing to pull the hospital’s license.

The hospital, in fact, took a number of measures to resolve the impasse, including paying the malpractice insurance of two doctors and opening a clinic in Narragansett where Drs. Curhan and Schwartz were paid a salary by the hospital to treat Medicaid patients.

“The Health Department could holler all they want,” Dr. O’Neill noted. “The hospital couldn’t cut off their nose to spite their face” by rescinding the obstetricians’ medical staff privileges.

Ironically, all the negative press would have a positive consequence. Board of Trustees member Benjamin Sturges wrote a defense of the hospital that was published in the Narragansett Times, which caught the eye of Dr. Kate Cassin, who was visiting relatives in Matunuck in the spring of 1988.

A native of Providence who had graduated from Providence College and Brown Medical School, Dr. Cassin was working as an obstetrician/gynecologist in Springfield, Mass.

She contacted the paper and asked them to connect her with Sturges. By September, she was on the staff of the hospital as an employee of Curhan & Schwartz.

That brought the practice to four obstetricians, and they agreed to cover the Health Center of South County’s patients, resolving the problem.
That also launched a 30-year career for Dr. Cassin, who still practices gynecology at the hospital’s Center for Women’s Health. She remained with Curhan & Schwartz for five years before opening her own practice in 1993. After Dr. Schwartz left town to practice in Massachusetts, she began a partnership with Dr. Jeffrey Joseph, who had been hired by Curhan & Schwartz right before the practice dissolved.

Dr. Curhan, meanwhile, stopped delivering babies and paired up with Dr. Sheila Connery, whom Curhan & Schwartz had hired in 1992.
Although she was the second woman to practice obstetrics in South County, Dr. Cassin said her gender was not an issue. “I was happy and I never felt that I was treated differently. I always got along with my colleagues,” she said.

There was tension that led to her opening her own practice, however, and it may have been generational. “It was a different time,” she said. “It was a time when older established physicians had paid their dues and felt that young people coming up had to pay their dues.”

By the time Dr. Cassin opened her own practice, a shift also had occurred in the hospital’s approach to maternity care. The hospital was now delivering more than 600 babies a year, and it made a commitment to refurbish the maternity ward.

In 1992, the hospital opened the first of its all-in-one labor, delivery, recovery and post-partum care rooms (LDRP). Within two years the hospital had renovated eight rooms for this purpose, as well as seven rooms for gynecological surgical patients.

With convertible couches, rocking chairs and private bathrooms, the LDRPs gave families the comforts of home in a medical setting.
Beth Johnson, RN, started working at the hospital in 1994. The change to LDRP rooms made a big difference, she recalled.

“We had younger practitioners who were much more family-centered,” she said. “Family-centered means we focus on the family as a whole – we focus on the mother, the father, the baby and the siblings.”

This meant that the mother, not the hospital or doctor, would decide who would be in with the mother during and after delivery.

“When I first started practice at Women & Infants in the late seventies, fathers [in the delivery room] were a rarity,” Johnson recalled. “They had to go to classes. They had to have signed permission slips … for them to even set foot in the delivery area.”

Dr. Cassin recalled that while the LDRPs were welcomed by the obstetricians, they had the biggest impact on patients.

“It just was such a different environment for patients,” she said. “Just to be able to promote the privacy of it. To not have women laboring four to a room, or two to a room.”

The rooms were just one phase in a revolution in maternity care. In 1992, the hospital’s first midwife delivery occurred on June 24, when Deborah Drew delivered a baby boy to an Exeter couple. Besides childbirth classes for expectant parents, the hospital also began offering “We’re having a baby” programs for soon-to-be siblings.

In 2000, South County Hospital became the first hospital in the state to earn the Baby Friendly designation from UNICEF and the World Health Organization. Besides the LDRPs, this honor recognized the hospital’s efforts to prioritize breast-feeding as the healthiest alternative for mother and child.

Gone were the days when women would be sent home with a case of formula. Now, with two nurses certified as lactation consultants, the hospital made a concerted effort to educate and support breast-feeding mothers, who receive guidance while in the hospital and could call a “warm line” to ask questions after they were discharged.

In 2007, the state Department of Health designated the hospital a Breastfeeding-Friendly Workplace, one of only two in Rhode Island to achieve gold status.

The emphasis on women’s health could be seen in a popular new event held for the first time that year. Nearly 300 women turned out at the Dunes Club in Narragansett for the first Women’s Wellness Day.

When Westerly Hospital stopped delivering babies in 2013, South County became the regional center for maternity care in Washington County. The hospital now owns its obstetrical practice, the Center for Women’s Health, which employs five obstetrician/gynecologists, four midwives, and one gynecologist, Dr. Cassin.

The Center for Women’s Health tallies more than 30,000 visits a year, according to Dr. Lisa Rameaka, a gynecologist/obstetrician and the hospital’s vice president of medical affairs and chief medical officer.

The hospital has 11 LDRP rooms and delivers between 650 to 700 babies a year. In 2012, the hospital acquired a hydrotherapy tub as a pain management technique for mothers in labor.

Its gynecological services include pelvic floor surgery, laparoscopic hysterectomies, and some minimally invasive procedures that can be done in the office – such as hysteroscopy, which allows the doctor to view the cervix with a small camera.

As the hospital has grown, so has its ability to serve gynecological patients. Dr. Cassin noted that anesthesiologists now give and monitor epidurals for delivering mothers. Computer links mean that obstetricians can check fetal heart monitors from their office. A larger OR suite improved the facilities and backup for gynecological operations.

Through their mothers, Dr. Cassin still hears about many of her former obstetrical patients, including a boy who was born at 1 pound, 4 ounces and is now a strapping young man. She delivered her last baby, a boy, on April 30, 2004.

“The community has always welcomed me and treated me well, and patients have been faithful and stayed a part of my practice,” she said. “In all honesty, it’s only been good for me,” she said of the hospital. “I’ve always found the ancillary staff, from administrators to nurses, extremely helpful, friendly… I’ve always trusted that the people in charge have our best interest at heart. There have been a lot of challenges, and I think we’ve met them well.”

Photo caption: Dr. Kate Cassin, the second woman to practice obstetrics/gynecology at South County Hospital, recalls that women were a “hot commodity” in the field when she joined Curhan & Schwartz in 1988.