Women’s health care in crisis: Is Guam a ‘maternity care desert?’ | Guam News

Editor’s note: This is the first story in a series looking at women’s health care on Guam.

A maternal health care crisis has existed on Guam for several years, according to Dr. Hoa Nguyen, a family provider, who said the state of health care for women and pregnant mothers today is “worse.”

“We are now in the worst time for pregnant patients and (gynecology) patients who might or might not have cancer,” Nguyen, who practices at American Medical Center, told The Guam Daily Post. “We might have to declare another crisis. This is really worse than 2022. At that time, there was the COVID-19.”

Nguyen stressed that one of the reasons Guam’s maternal fetal mortality rate is among the highest in the nation is inadequate or lack of prenatal care.

“What people don’t understand is it starts when you conceive. Prenatal care is the most important thing of them all. We have a lot of high-risk patients here that have high blood pressure and diabetes, so when they get pregnant they become high-risk,” he said.

What’s changed in two years that has stressed the women’s health care system?

Nguyen said, “If you look at the (landscape) now, back in 2022 we had more (obstetrics) doctors on the island. Right now, on the private side of the community, Dr. (Teresa) Underwood is an (obstetrics and gynecology specialist). She left (the) island recently. She left for good. Dr. (Annie) Bordallo, she practices a little bit on the outside, but she retires (in March 2025). Who’s left for the whole island for OB-GYN? Dr. Tom Shieh,” Nguyen said.

However, Shieh, who is close in age to Bordallo, no longer accepts new patients except by special referrals and indications.

“I get calls from doctors and families at times, and I will accept on a case-by-case basis. (It’s a) small island. It’s not easy to say no,” Shieh told the Post.

He provides care to his patients at Dr. Shieh’s Clinic alongside Dr. Greigh Hirata, who comes to the island once a month to take care of high-risk pregnant mothers.

“We are doing what we can. Both of us are board certified, and we continue to make a positive difference for Guam. We remain committed,” Shieh said.

Dr. Sylvia Cruz, who works as a board-certified OB-GYN clinician at Todu Guam Health and Wellness Center, provides limited services.

Guam Memorial Hospital Authority spokesperson Cindy Hanson confirmed, “She is not on our active provider roster.”

That means she does not perform deliveries.

“She has the ability to do surgeries and other (gynecology) procedures,” former Sen. Dennis Rodriguez, Todu Guam founder, said. “She is also credentialed with all insurances. Additionally, Todu Guam offers a sliding fee discount program for eligible self-pay patients.”

That puts Cruz on the roster only for prenatal care and women’s health.

“Right now, what’s left is Dr. Shieh. That’s the only one on (the) island that can do high-risk, … no one else. You have (Dr. Mariana Cook-Huynh) and Dr. Jen (Linden). They’re family practice like me, but they just do OB. They’re really not qualified to do high-risk OB. In cases (where) they have to do an emergency (cesarean section), they cannot, they have to have an OB backup in order to help with (a) C-section,” Nguyen said.

At GMHA, Bordallo, although retiring, continues to take calls for deliveries, according to Hanson, who also confirmed that Dr. Jonathan Sidell, who recently retired, also “occasionally” covers shifts when needed and provides support to Linden and Dr. William Vercio, who handle labor and deliveries.

More often than not, when an expectant mother goes into labor and heads to the delivery room, it’s a first-time encounter with GMHA’s on-call OB-GYN, who helps bring their child into the world, Nguyen said.

“When we talk about the hospital OB on call, that’s the end point. Those guys, when they see you, they have no idea who the heck you are. They don’t know if you’re 36 or 40 weeks (pregnant). They don’t know if you have diabetes or high blood pressure. They don’t know. Their job is just catching the baby. That’s why the (Neonatal Intensive Care Unit) is so full all the time because they catch the baby and the baby’s in trouble because they don’t know the history,” Nguyen said.

Nguyen, however, contends that the crisis “is not about GMH OB doctors on call. It is about prenatal care on island from a qualified OB doctor.”

“Really, when we talk about the maternal fetal mortality, we talk about the care before you deliver. That’s the most important,” he said.

He noted that AMC, which has about 20 family care physicians, may issue a community notice to high-risk pregnant mothers.

“Just to say hey, we really recommend that if you are diabetic, have high blood pressure, you really have to have a passport ready on standby,” Nguyen said. “We lost quite a few babies because of complications. As a primary care provider, we see what’s going on because we are fully engaged in the health care system on Guam.”

He added that Guam also lacks neonatologists who provide care to preterm babies.

While Post files show that it’s been recommended that family practitioners, midwives and doulas help augment the shortage of OB-GYNs, Nguyen said, realistically, limitations in care must be considered.

“They cannot. They are not providers. Midwives will still need the OB because they could get in trouble. They need the OB to be there with them. Midwives are not qualified to manage high-risk prenatal care. At AMC, we can provide prenatal care, but we know we are going to get people in trouble because we will miss all of the abnormalities that a certified OB like Dr. Shieh will pick up,” Nguyen said. “We know our limitations. Can we do that and make money? Yes, we can, but money is not worth a baby’s life.”

The ideal situation for an expectant mother is to have the OB-GYN who provided her with prenatal care in the delivery room.

“But I see women who, when they deliver, they are like. ‘Who are you?’ That’s not good because there’s no continuum of care,” Nguyen said.

With prenatal care in a state of crisis, Nguyen stressed that losing OB-GYNs to retirement and difficulties with recruiting exacerbate the issue.

Across the nation, “maternity care deserts” or areas where maternity care resources are difficult to find are becoming increasingly common. The March of Dimes 2024 report, Nowhere to Go: Maternity Care Deserts in the U.S., revealed in the states that over 35% of counties are considered maternity care deserts.

“Our data confirms that women living in maternity care deserts and counties with low access to care have poorer health before pregnancy, receive less prenatal care and experience higher rates of preterm birth,” The March of Dimes 2024 report said.

The report focused on premature babies born in these areas.

“Our analysis revealed an excess of over 10,000 preterm births among those living in maternity care deserts and limited-access counties in 2020-2022. These findings affirm that U.S. systems, policies and environments are failing moms and babies,” the report said.

While Guam is not on the list as a maternity care desert, similar circumstances on the island, namely a shortage of OB-GYNs, exist and the closure of women’s health clinics are an issue.

Post files show that Sagua Managu ended 22 years of service to the community as the island’s only birthing center on Dec. 24, 2022, and SaguaMPG (Marianas Physicians Group), which provides prenatal and women’s care, will permanently close at the end of February 2025.

That narrows options for prenatal care and leaves GMHA as the sole civilian birthing center on the island.

With recent developments to build a new hospital in Mangilao, Shieh said he believes Guam could one day go “down that deserted road.”

“Currently, 100% of all maternity providers lives in Tamuning. This also includes 100% of our anesthesia providers. To ask them to run 30 minutes or more up past (the) Eagles Field area is placing mothers and babies’ lives at risk. Remember, current GMH-employed OB hospitalists’ average age is over 65 years of age already. (The) governor’s plan to build a hospital in six to eight years, maybe longer? OBs’ age will be well over 70 years … by the time her unreasonable desires come to fruition. We can’t find providers who will be willing to stay inside the hospital 24 hours a day as well, 7 days a week as a group,” Shieh said.

Shieh has stood in strong opposition to a new hospital being built outside Tamuning and has often butted heads with Gov. Lou Leon Guerrero.

The governor’s response will be presented in a follow-up report.