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And OB makes three: baby docs with notable histories have eyes on the future


May 29, 2018

From gentle C-sections and breech deliveries to gynecological surgeries and good old-fashioned family medicine, a trio of providers with more than 60 years of experience between them is making obstetrics in Newton and Jasper County more innovative and personalized than ever before.

Drs. Patrick Edwards, Esgar Guarin and Darryl Johnson are the three physicians now delivering babies at Skiff Medical Center. Dr. Edwards may be the most familiar face to many people, having worked at the hospital and Newton Clinic since 1987. He appears occasionally in local media for accomplishments of note, including running marathons, climbing Mount Kilimanjaro and being named the 2013 Iowa Family Physician of the Year by the Iowa Academy of Family Physicians. That award was more than well-deserved, according to his colleague Dr. Paul Ruggle, who once referred to him as “Jasper County’s gem.”

“He’s such a delightful guy, and great to work with,” said Dr. Guarin, who has collaborated with him on various cases. “He’s always willing to help and support, and to share the benefit of his many years of experience.”

Dr. Edwards noted that he has seen a decent amount of change in the practice of obstetrics during the past three decades.

“My dad was a family physician who delivered babies,” he said. “So that’s how I came to define family medicine: caring for all ages. These days, most providers aren’t going into family practice with the idea of doing OB. And a lot of the FP doctors who were delivering babies have gradually stopped.”

So why hasn’t he phased out that part of his practice? “Babies are cool,” he said with a grin. “I like doing obstetrics. It’s a joyous event for a family.”

He also feels his continued involvement is his way of supporting the growth of obstetrics in Jasper County. “We offer something unique here,” he said. “Most of the time, the doctor you see throughout your pregnancy is the one who will deliver your babies. So if you see me for nine months, odds are I’m the one who will deliver your baby. Same with Dr. Guarin and Dr. Johnson.”

Speaking of his fellow OB providers, he has nothing but the highest praise for both of them. “We are very fortunate to welcome Dr. Johnson,” he said. “He brings a whole new depth of experience and, as an OBGYN, he gives women another option that hasn’t been available locally for years. And having Dr. Guarin here has been a big benefit. He’s a charismatic guy – very enthusiastic, very caring, very thorough.”

Dr. Guarin’s local practice is relatively new compared to Dr. Edwards’ tenure, but he’s quickly making a name for himself as a popular OB doc. He started in autumn of 2015 and has built his practice to a level that he’s delivering nearly 100 babies every year. In 2017, he too received the prestigious Iowa Family Physician of the Year award, following nominations from several patients.

“Dr. Guarin is a special doctor in a way you don’t see every day,” said Mark Thayer, clinic administrator. “He has passion for working with pregnant moms and babies. He has a unique ability to connect with patients on a personal level.”

An emphasis on education is a particular hallmark of how Dr. Guarin runs his practice. His exam rooms feature display screens on the wall so he can show teaching materials during appointments, which are never shorter than 20 minutes, and go up to 40 minutes for brand-new patients.

“My appointments aren’t just ‘Come in, I’ll measure your belly, and then you go,’” Dr. Guarin said. “I need to know the patient and take the time to give them what they need. I have had patients who come in knowing nothing about pregnancy; that means they don’t just need maternal health care, they also need education. I refuse to spend too little time with patients.”

Another notable practice Dr. Guarin has brought to Skiff is known as the “gentle” c-section. In a traditional cesarean section, the mother’s midsection is draped, keeping the field of surgery out of sight, and when the baby is removed, he or she is handed off to fellow health-care providers to be cleaned, weighed and have other tasks completed while the mom remains on the surgical table.

Darrin Hansen, herself a registered nurse, had her first two children via standard c-section at large, metropolitan hospitals, and she found the experience to be detached and clinical. “I was never one of the first people to meet my children as they entered the world,” she said. “So many people held my babies before I did. That changed with the delivery of my third child, because I had it done at Skiff.”

In a gentle c-section, the drape is lowered as the baby is removed from the uterus, allowing the mother to watch her baby take its first breath and release its first cry. As long as the baby is not in distress, it is immediately placed on the mom’s chest. She is able to touch and cuddle her newborn, because at least one of her arms is free, as opposed to a traditional c-section, in which both arms may be restrained in a straight-out, “crucified” position.

“It’s a lot different when you get to see and hold your baby during the first few seconds,” said Carla Johnson, who has been an OB nurse at Skiff for more than 25 years. “Nothing is as important to a mom as loving on her baby.”

Fellow Skiff OB nurse Ashley Foster agreed, saying, “It brought tears to my eyes the first time I saw a gentle c-section.”

Dr. Guarin said the technical details of a gentle c-section aren’t a big departure from that of a traditional cesarean; rather, it’s a change in mindset. “While keeping respect for the surgery, we also take the time to remember what this really is: the birth of a child.”

The family-first attitudes both Dr. Guarin and Dr. Edwards express are shared whole-heartedly by Dr. Johnson, who joined the clinic in February. While he is the newest of the group, he is hardly new to medicine – he’s a board-certified obstetrician and gynecologist who estimates he’s delivered well over 4,000 babies in the more than 20 years he’s been in practice. His practice is split evenly between OB care and gynecological services, the latter of which includes incontinence/prolapse procedures, hysterectomies, and treatment of ovarian cysts and endometrial cancer.

Dr. Johnson said it’s not uncommon for an OBGYN to decrease their obstetrical services later in their careers, but that isn’t his plan. “Honestly, I’ve always liked OB,” he said. “Family is the most precious thing people have. Parents may have only two or three children total, so when you get to be part of that experience with them, it’s a privilege.”

“Dr. Johnson is very laid back, but also methodical,” Dr. Guarin said. “His experience, not just as an OB but as a pelvic surgeon, is a huge asset for the hospital.”

Prior to Dr. Johnson’s arrival, Newton and Jasper County had been without a permanent OBGYN for eight years. Filling that gap was important to Skiff President Laurie Conner. “We were well aware that women wanted the option of being seen by an OBGYN,” she said. “When Mercy was looking at partnering with Skiff, we reviewed a recent community needs assessment, which told us that recruiting an OBGYN was the No. 1 request from the community as far as physician needs.”

She went on to say that Dr. Johnson has been a fantastic complement to the OB model that was already in place. “He brings years of experience, and he has a very calming, confident and reassuring demeanor. Families will be very pleased and comfortable working with him to address their health-care needs.”

Thayer agreed, saying patient and staff feedback has already been overwhelmingly positive. “He is gentle, conservative with his care, explains treatment options to patients, and provides outstanding care. We’re extremely pleased to have him and his talents available to the citizens of Newton and Jasper County.”

Dr. Johnson, in return, speaks highly of the obstetrical staff he’s enjoying getting to know. “I’m impressed with Dr. Guarin’s surgical skills,” he said. “Both he and Dr. Edwards have excellent knowledge bases, and they are well-experienced, well-respected practitioners. As for Skiff, the hospital has good, good staff. They’ve gone out of their way to make sure I have the things I need.”

“Newton is fortunate to feature robust women’s and newborn services,” said Jan Myers, Skiff Clinical Services Director. “Collectively, the OB nurses have more than 175 years of experience, and we have our own dedicated board-certified lactation consultant nurse. We have great resources that not every hospital does. With the addition of Dr. Johnson as OBGYN, we are now able to offer a full range of services that allow women to stay close to home and receive the personalized care that our OB staff prides themselves on giving.”

Because of his lengthy history in the field, Dr. Johnson can offer services that aren’t necessarily provided by physicians currently training in obstetrics. An example of this is vaginal delivery of babies in the breech position (buttocks first, rather than headfirst). While only about 4 percent of full-term babies are in this position, the majority of breech presentations result in a c-section. This doesn’t always have to be the case, in Dr. Johnson’s mind.

“As long as we put the correct protocols in place and identify patients who are good candidates,” he said, “it can help avoid that initial c-section, which in turn helps avoid c-section necessity for subsequent births. It’s not for everybody, and you have to fit the decision to each patient. My default position is safety for mom and safety for baby.”

Dr. Johnson has other goals for local OB offerings, including infertility evaluation and treatment, along with additional exciting possibilities that are too early in the research process to even be named.

“The important thing for people to realize is that Skiff and Newton Clinic offer a wide range of options for pregnant moms,” he said. “If there is something you want, don’t assume we can’t do it. Give us a chance.”

Skiff Medical Center
204 N. 4th Ave E.
Newton, Iowa 50208
Phone: (641) 792-1273
Toll-free: (888) 792-1273

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Skiff Medical Center, a member of Mercy Health Network, is located in Newton, Iowa. We provide services to Jasper County residents in all major health areas, including general surgery, orthopedic surgery, radiology, obstetrics, emergency medicine, hospice, home care, laboratory, respiratory, audiology, physical therapy, occupational therapy and speech therapy. The Skiff Specialty Clinic hosts more than 20 physicians specializing in cardiology, dermatology, ENT, gastroenterology, nephrology, neurology, oncology, pulmonology and urology.
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