Q&A with the Scholars: Practicing Maternal and Fetal Medicine
Steve Calvin, M.D., is an Associate Clinical Professor in the Clinical Scholar track in the Department of OB/GYN and Women’s Health at the University of Minnesota, where he served as co-chair of the Program in Human Rights and Health from 2000 to 2016. Dr. Calvin is board certified in Obstetrics and Gynecology and the subspecialty of Maternal-Fetal Medicine. Dr. Calvin has 35 years of experience in caring for mothers and babies with the entire range of pregnancy concerns. Dr. Calvin is one of our nearly 40 associate scholars. In this interview, he discusses his experience working in maternal-fetal medicine.
You are an OB/GYN who subspecializes in Maternal-Fetal Medicine. What constitutes a high-risk pregnancy, and how does maternal and fetal care differ in those situations from the normal course of care?
Dr. Calvin: Pregnancies are the most momentous event in our lives—both for those who are born and for those who become mothers, when they give birth. Pregnancy is most often a normal life event. But even normal pregnancy and birth can become complicated and can lead to harm to the mother and the baby. The challenge is to provide care that recognizes these two realities.
When medical interventions are used unnecessarily there is a risk of iatrogenic (medically caused) harm. On the other hand, if naturally developing complications are not recognized, tragic outcomes can occur. Over the last 100 years dramatic improvements have been made in maternal and newborn care.
A walk through most cemeteries in the United States shows a disturbing number of hundred-year old tombstones with names of young mothers and infants—sometimes buried side by side. There are thousands of sad stories behind those names.
In 1916 the risk of maternal death was about one in every 125 pregnancies. In 2016 the risk of maternal death has decreased to one in every 3,500 pregnancies. The risk of infant death in the first year of life in 1916 was one in 10. It is now about one in 200. The chance of a mother or baby surviving pregnancy, birth, and the first year of life has improved by more than 20 times in the last century.
Those advances have come with the availability of better-trained birth attendants, safe cesarean section, anesthesia, blood transfusions and antibiotics, as well as improved public health and sanitation. The dramatic outcome improvements for mothers certainly came well before 1973 and the regrettable Roe decision.
High-risk pregnancies are characterized by a wide variety of complications for mother and baby. Sometimes mothers have poorly controlled diabetes or a congenital heart malformation that can be life threatening. Mothers may develop preeclampsia, a common but sometimes severe reaction to pregnancy that is only curable by delivery. Sometimes babies have serious congenital anomalies. Sometimes babies are born weighing less than one pound, near the threshold of viability.
Though these severe complications are present in less than 5 percent of pregnancies, they keep obstetricians, maternal-fetal medicine specialists, and neonatologists busy. I spent more than 20 years of days (and nights) in this kind of work.
Based on your three decades practicing medicine in this area, what can you say about the claim that in some cases it is necessary to take actions that lead to the death of the child in the womb in order to save the life of the mother? What are examples of such difficult medical situations, and is induced abortion ever necessary?
Dr. Calvin: Some of the situations I describe in the previous answer are life threatening to a mother if the pregnancy continues. In very rare instances the difficult decision may be made to end a pregnancy to save a mother’s life. These are exceedingly rare circumstances. During my career I can remember less than a dozen mothers who faced this horrendous choice.
One was a mother who was bleeding from a placenta that covered her cervix and was bleeding profusely many weeks before her baby could survive outside the womb. Another was a mother whose bag of waters had ruptured weeks prior to viability and an overwhelming infection had developed. In both of these instances the risks and benefits were discussed and the mothers chose to have me end the pregnancy.
In those tragic situations my intention was to save the life of the mother. The inevitable death of the baby, due to premature delivery or other medical intervention, was not my intention. This is clearly distinct from the objective of those who perform direct, induced abortions. These heartbreaking cases only strengthened my resolve to oppose elective abortion and to provide life-affirming options.
You were the first doctor in Minnesota to open a freestanding birth center—the Minnesota Birth Center. What is a freestanding birth center, and what motivated you to take this step? Is there a discernible trend across the country towards these models?
Dr. Calvin: I am personally optimistic about healthcare reform. In 2012, midwife colleagues and I launched a maternity and newborn care practice in independent birth centers integrated with physicians and hospitals. We did so because we believe that reform should start where we all did—with pregnancy and birth.
More than 1,000 low-risk mother and baby pairs have received care in a model that is safe, satisfying, and cost-saving. Though we were initially seen as a competitive threat, we are now working with our hospital and physician partners to provide comprehensive care for a single price. My commitment to this team model of maternity care is not just professional. It is personal, as five of our nine grandchildren were born with the midwives at the birth center.
What is the BirthBundle model? How does it differ from the status quo of health care for pregnant mothers? Is this a model for healthcare reform that can be extended into other areas of health care, and what are the benefits for patients? For medical personnel?
Dr. Calvin: If you paid an electrician remodeling your house by the number of outlets installed you would get many more outlets than you need. Unnecessary medical care has a similar cause. The better alternative is to pay for well-defined “packages” of care. A package might be sold as a year of comprehensive primary care, or all of the care for a specific healthcare episode like a pregnancy, a joint replacement, or cancer care. This new model of a single price bundle will drive collaboration and get us much better care at a lower price.
Why are you pro-life? If you had 60 seconds to explain to someone why you have pursued the work that you have throughout your career, what do you tell them?
Dr. Calvin: For more than three decades I have been privileged to care for thousands of mothers and babies. I have seen joyful triumphs and unexplainable tragedies, but through it all I have seen the love that mothers have for their babies. Since I believe that every member of the human family is created in the image of God, I am obligated (and happy) to do what I can to empower mothers and to do everything that I can do to help them to bring new life into the world.
Dr. Calvin’s full biography can be found here.
