Women Well Cared-for at Zuckerberg San Francisco General Hospital

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With this month’s opening of a new nine-story building that includes spacious rooms for labor, delivery, recovery, and postpartum care, Zuckerberg San Francisco General Hospital (ZSFG) combines well-designed facilities with highly committed physicians and impactful community programs that have served women and children from low-income and working-class families for decades.

“I think what makes us different from other hospitals is our ethos about supporting women and helping them make the choices that they want. We have a really good network of support services for patients, including social work and nutrition. It is often hard to get private insurance to cover these,” said Dr. Rebecca Jackson, chief of obstetrics, gynecology and reproductive sciences at ZSFG.

According to Jackson, approximately 80 percent of ZSFG’s patients are covered by Medicare or Medi-Cal. Five percent pay their own bills.  The remainder, including undocumented immigrants, are uninsured. Sixty percent of the hospital’s patients are Latino; many of whom speak only Spanish. ZSFG “meets patients where they are,” Jackson said, by having many staff members who are bilingual Spanish-English speakers, with cultural competency serving Latino populations.

“Many of our patients are immigrants, and quite a number of our mothers are isolated. They don’t have a lot of family members and friends around. Some had to come without their other children. It brings up a lot of conflicting emotions. We provide a lot of social support and care,” said Dr. Pooja Mittal, a family medicine physician at ZSFG.

According to a 2014 The New York Times article, ZSFG is women and children friendly. The hospital now features private, art-adorned lactation rooms and a large, open Intensive Care Unit for babies.  There are 19 beds and 14 rooms for expecting and new mothers on the old building’s fifth floor; the new structure contains 21 private rooms for this purpose on its second floor.

A 2014 California Office of Statewide Health Planning and Development study found that ZSFG’s approach to labor and delivery resulted in approximately 18 percent of mothers giving birth by Cesarean-section. The City and County of San Francisco averages a 21 percent C-section rate, California has a 29 percent average, with a 32 percent average nationally.   Vaginal births tend to result in no adverse outcomes to babies, and lower morbidity rate for women, according to a 2014 Pacific Business Group on Health report.

Margy Hutchison, a nurse-midwife who has worked at ZSFG for 25 years, said expecting mothers in a normal pregnancy can choose a nurse-midwife or a doctor as a primary caregiver. Women who choose a nurse-midwife are guaranteed that a midwife will be with them during the childbearing process.

As part of the Centering Pregnancy program, ZSFG’s nurse-midwives walk five blocks south to the Homeless Prenatal Program’s (HPP) 18th Street office, where they guide small groups of low-income pregnant women through prenatal support sessions. “I think the providers at ZSFG truly care. They make an effort to see that the poorest of the poor here in the City receive the same care that somebody who has tremendous means would also get,” said Martha Ryan, HPP’s founder and executive director. ZSFG staff regularly refer Black mothers-to-be to the San Francisco Black Infant Health Program, run by the City’s Department of Public Health, for group classes and support.

According to Dr. Melanie Thomas, a psychiatrist and health services researcher at ZSFG, effective and culturally-tailored mental health services are a critical component of treating women in Potrero Hill and the Mission District, the two neighborhoods the hospital straddles.

“The cumulative effects of chronic stress, which are increased with homelessness and other aspects of poverty, are often linked to mental health difficulties,” said Thomas. “Mental health services are undergoing a time of rapid change. Many of the shifts are driven by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act. We’re integrating behavioral health services into primary care. I think we are headed in the right direction.”

“For our homeless population, it’s clear that women and children are especially vulnerable,” said Dr. Melissa Nau, a UCSF faculty psychiatrist who focuses on women’s health at ZSFG. “We work as a multidisciplinary team to connect women in need to appropriate medical, mental health, and social services. Our leadership is committed to helping all providers continue to improve care delivery and find efficient and productive ways to meet our patients’ needs.”

Dr. Misa Perron-Burdick, medical director of ZSFG’s Women’s Health Center, said ZSFG offers more to women than an ordinary hospital because it provides specialty care on-site. “We have cancer specialists, a urogynecological clinic, high-risk obstetric services, and a clinic that examines abnormal pap smears on premises. Often (elsewhere) female patients must be referred out for these services,” said Perron-Burdick. 

Perron-Burdick added that ZSFG is establishing a Patients Advisory Council (PAC) for the Women’s Health Center, which will be in place by this summer. The council will provide opportunities for patients and their families to assist ZSFG staff improve clinic management and patient care.

ZSFG offers an open access clinic, where patients can call and get same-day appointments for such services as emergency contraception, sexually transmitted disease testing, breast problems, and pelvic pain. “We started that a couple months ago and now it’s really gaining traction,” said Perron-Burdick.

According to Jackson, transgender patients are welcome at ZSFG, where staff is committed to incorporating care and sensitivity into treatment for those who are transitioning. “They’ve struggled living their lives in a body that does not feel like their body. We’ve trained our staff to call them by the name of their choice and refer to them using the pronoun of their choice,” she said.

Onouwem Nseyo, a second-year resident at ZSFG, said she’s enjoyed her rotation at the campus. She believes female patients are well-served by close relationships with staff. “A lot of the advice we give our patients isn’t hot air. It is preventative medicine,” said Nseyo.

Nseyo added that at ZSFG she’s learned a focus on obstetrics means treating a new or expectant mother affects other people. “Working in obstetrics, you have an influence on the mom, the future baby, her marital partner, and his health,” said Nseyo.

Brent Andrew, ZSFG chief communications officer, said the new facility will benefit female patients in many ways. “The entrance is a welcoming space with a lot of light and color. The new emergency exam rooms take up more (space) so patients get more privacy. It’s also calmer and quieter in the ER pods. The Acute Care for Elders unit has a meditation garden, private rooms with natural light, and landscape paintings in the hallways. The labor, delivery, recovery, and postpartum rooms are private. They have space and furniture for family members to visit. They are designed to look as much as possible like a normal hotel room,” said Andrew.

“I think we offer the best care in the City,” said Mittal. “I think any of our providers who work here would have liked to come here for our own pregnancies if we could have. I can’t tell you how many times people have gone above and beyond their normal area of care. I’ve seen staff pool money to help a patient who is dying visit their home country. I saw a woman come in who had no family or friends, and the nurses all got together and threw her a baby shower. That is not unique. Zuckerberg San Francisco General Hospital is a place where people feel really cared for.”