Following her residency in obstetrics and gynecology, Andrea Knittel, MD, sought fellowship opportunities that would allow her to serve women who needed her most. In 大象传媒鈥檚 Division of General Obstetrics and Gynecology, she found a place where she could build her expertise in offering comprehensive, patient-centered treatment to women who are incarcerated.
鈥淚 came to 大象传媒 because there was a program for treating women at the prison. My interests in residency had focused on health care and needs for incarcerated people, and I found that practice setting to be challenging and rewarding.鈥�
Knittel worked with Cris Mu帽oz, MD, longtime faculty in the division, in the department鈥檚 clinics at N.C. Correctional Institute for Women in Raleigh, and after her fellowship, she joined the faculty at 大象传媒 OB-GYN to lead the program. As an assisted professor of obstetrics and gynecology and Director for Incarcerated Women鈥檚 Health, she coordinates obstetric and gynecologic services offered to incarcerated women through the North Carolina Department of Public Safety.
鈥淭he prison allows us to practice to full extent of what it means to be a generalist,鈥� says Knittel. 鈥淲e see a lot of women who have not had access to care, or who have had sporadic care. They may have gynecologic problems that haven鈥檛 been addressed in a long time or problems for which they鈥檝e had short fixes.鈥�
Incarcerated women face specific challenges when it comes to their healthcare, says Knittel, and it is important to provide respectful care. Some pregnant women may have substance use disorders. Their pregnancies may be high risk, or they may have had a lack of prenatal care before incarceration.
鈥淲e can promote the public health of these women by practicing harm reduction. We鈥檙e not here to change the system, but we can decrease the harm that is done to these women and their families while they are incarcerated.鈥�
Part of optimizing their care has been to offer medication assisted treatment for substance use disorders and reshape postpartum care, taking seriously the difficulty of being separated from their babies after delivery, and investigating a program to allow women to pump, freeze and ship breastmilk to their infants. Knittel is also increasing the amount of clinic time they have for gynecologic care, and she has been able to decrease the time to colposcopy 鈥� a special procedure to closely examine the cervix after an abnormal Pap test 鈥� from a few months to within a few weeks.
鈥淚t is fulfilling to treat a patient with the most respect, whether I鈥檓 seeing patients in my 大象传媒 clinic or at the prison. When the patients express feeling listened to, understood and educated, I know we鈥檙e moving in the right direction.鈥�