Top Doctor Susanna Magee Provides Circle-of-Life Care

The family doctor is present from beginning to end.

Photograph by Rupert Whiteley

How did you end up in Rhode Island?
I came here in 1998 for Brown University’s family medicine residency because it was well known nationally for family medicine/obstetrics training. The rest is history, so to speak. I’ve never left the Brown department of family medicine. They have a fellowship, which I completed and now run, and it’s been around since 1991.

Tell us more about the fellowship.
It trains family physicians to take care of high-risk pregnant women. Once they’ve finished their fellowship, they can do C-sections and take care of hypertension and diabetes in communities where there might not be an OB/GYN. This training is kind of visionary, and it’s happening right here in our state.

Did you go into family medicine with an eye toward birth services?
Yes. I love birth so much but I didn’t want to give up the babies. I wanted to care for whole families. Training in family medicine made that possible. It’s really the only specialty where you do all of that.

I’m picturing a doctor at the door with a leather medical bag.
Exactly. Even when I say I’m a family doctor who delivers babies, I picture [poet and pediatrician] William Carlos Williams, with his spectacles and bag, getting paid in twelve brown eggs. But there’s something really lovely about that.

So, in many cases, you care for a pregnant mom during prenatal visits, deliver her baby and provide care for both mom and baby postpartum?
Yes, and it’s super easy for me to recognize postpartum complications, because I’m seeing the babies and their moms four times before they’re six weeks postpartum. It’s the development of those family relationships that makes the difference. It’s an incredible honor to be a part of people’s families.
I joke that someday I’ll be a grand- doctor. I want to stay in it for that; that’s going to be a huge moment for me.

Do many other family physicians practice this model of maternity care?
Nationally, about 10 to 12 percent of family physicians provide birth services and that’s declined over the years. In the ’70s, when the specialty was first created, it was almost half. It’s following national trends about birth in all specialties — that careers for birth attendants seem to be shorter and shorter over time.

You also co-wrote the first paper that supported the safety of gentle cesarean births in the United States. Could you tell us more?
I didn’t invent that technique, but our program [at Memorial Hospital] was the first to popularize it in Rhode Island. It’s been done for decades overseas. Some of the most important health care changes happen because patients bring them forward, and this is an example of that. My colleague, John Morton, and I started looking at the data and the concerns about complications, which were unwarranted.

How is it different from a traditional C-section?
For a gentle C-section, a baby is born and, assuming the baby is vigorous, he or she goes skin-to-skin immediately. Assuming the baby remains with normal color, tone and breathing, he or she doesn’t leave mom’s chest at any time. They stay the rest of the operation with the pediatric provider right there to ensure the baby remains normal. Going skin to skin after birth is a physiological norm.

Gentle cesareans are standard practice at Memorial Hospital’s birthing center, however Care New England is moving to close the center. What will happen to the program?
To me, now, having developed this model, I’ll bring it with me wherever I go. And when people see the data, there’s less fear about problematic outcomes. The patients love it, and the people win every time.

What’s next for you?
I’ll be moving, with the fellowship program, to Landmark Medical Center [in Woonsocket] in August.
I really love working in under-served communities. It’s a patient population I want to continue to care for, and Landmark has the facilities and the desire to help me continue this training for interested and qualified family physicians. For the future, my goal is for this model to be available in every hospital in the state. There have been some organizations who have been incredibly helpful in publicizing this model, as well as my colleagues in nursing, midwifery, OB/GYN, pediatrics and anesthesia. And it’s all been word-of-mouth. The thing about Rhode Island is that it’s diverse, but it’s small enough where if you’re super motivated and you have an idea, you can be an agent of change.


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