Bridging gaps: Transforming obstetric medicine from silos to solutions

Serena Gundy is an associate professor in the Department of Medicine at McMaster University and a full-time obstetric medicine physician at McMaster University Medical Centre, specializing in the care of medically complex pregnancies. Gundy is part of leading-practice work in the postpartum period through the Post-Partum Vascular Clinic, a women’s health clinic focusing on post-partum medical care and risk factor modification for hypertensive disorders of pregnancy (HDP), such as pre-eclampsia.

A proud graduate of both McMaster undergraduate and postgraduate medical programs, Gundy discovered her passion for obstetrics in her fourth year of internal medicine training—a discovery that would shape the course of her career. Since joining McMaster faculty seven years ago, Gundy has remained committed to one goal: to expand and enhance every facet of the obstetric medicine program. Her vision includes broadening clinical services across Hamilton, expanding the program’s academic impact, and deepening its involvement in research.

The challenges of silos within medicine

Gundy’s passion for hypertensive disorders in pregnancy stems from a key discovery: complications like pre-eclampsia, which involve high blood pressure and organ damage, are often viewed as purely obstetric issues. Gundy points out that while many patients recover quickly after delivery, long-term health risks remain. This leaves patients at a higher risk of future medical complications, including hypertension, heart disease, dementia and kidney problems. “Despite data showing a fourfold increase in the risk of cardio-metabolic diseases after hypertensive pregnancy disorders, most patients and care providers are unaware,” Gundy explains. As a result, early screening and treatment are often missed. She adds, “As with so many other areas in women’s health, the lasting impact is frequently overlooked, even though millions of women worldwide are affected each year.”

The impact of missed opportunities

What are the consequences of overlooking these hypertensive pregnancy disorders? Gundy answers this using pre-eclampsia as an example: “You’re 50 per cent more likely to die or experience severe complications in the postpartum period than during pregnancy. And even if most people recover well, the risk of dying from cardiovascular disease later in life is up to 70 per cent. There are steps you can take to reduce this risk, but gaps in care, knowledge, and communication prevent that from happening,” Gundy explains. She attributes this to insufficient physician education and a lack of coordination between obstetric and medical care providers. “My role in postpartum care is to bridge these gaps, which often don’t fit neatly into one specialty. Pre-eclampsia is a clear area where we can make an immediate impact.”

A catalyst for change in maternal medical health

Pre-eclampsia is just one of many pregnancy-related complications, and according to Gundy, maternal medical morbidity rates in Hamilton are rising notably higher than the national average. “Pregnancy can be a canary in a coal mine,” says Gundy, noting that it offers important insights into broader health trends in the city. She points to the lack of comprehensive data surrounding this disparity and underscores the need for research. Many of her colleagues in Obstetrics, Psychiatry, Midwifery, and Nursing are actively investigating the causes and seeking solutions. At the Postpartum Vascular Clinic, where Gundy and her team have treated over 500 women with pre-eclampsia since 2019, patients are eager to contribute to research, having experienced the condition’s effects firsthand. Many of her patients have played a key role in advancing the clinic’s research and co-designing its approach. Gundy emphasizes that the postpartum period is a time of significant vulnerability and requires a practical, collaborative approach that is continuously evolving.

Transforming obstetric medicine

Gundy notes that this field does not just require more care providers with an interest in medical complications of pregnancy—it demands a fundamental shift in philosophy that makes care integrated, accessible and effective for all individuals in the region. Progress is being made through interdisciplinary collaboration and knowledge-sharing between learners and trainees. A recent example is the McMaster Women’s Health Review “Obstetric Medicine Update Day” in June 2024, which brought together clinicians, trainees, patients, and community organizations to share best practices and learn from one another. Gundy boldly states, “We don’t fit in a box, and while that can be frustrating at times, it’s actually a good thing.” She explains that while traditional academic divisions do not apply to their work, this makes way for innovative solutions to complex problems. The Post Partum Vascular Clinic embodies this by fostering high-quality, interdisciplinary care. “My hope for this program is to deliver world-class standards while delivering comprehensive and compassionate care to those in our community who need it most,” Gundy concludes.