...how doctors keep people healthy during pregnancy and childbirth?

Ever Wonder? / July 7, 2021

...how doctors keep people healthy during pregnancy and childbirth?

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Dr. Kimberly Gregory interviewed on Ever Wonder? podcast

Dr. Kimberly Gregory

This summer, we opened a brand-new exhibit called Life! Beginnings in our World of Life gallery. Life! Beginnings invites our guests to discover how humans and all living creatures reproduce, develop, and pass on their genes in order to bring new life into the world.

Through interactive and immersive experiences, guests can explore the human journey from conception to birth, see how a mother’s body changes throughout pregnancy, and learn about reproductive health.

Do you ever wonder how doctors help keep people healthy during pregnancy and childbirth?

Dr. Kimberly Gregory is an OB-GYN and professor at Cedars-Sinai, as well as a scientific advisor for our exhibit Life! Beginnings. Dr. Gregory is on a mission to make childbirth a safer and more positive experience for everyone. She came on the show to tell us more about her work and share some useful advice for creating your own reproductive life plan.

Have a question you've been wondering about? Send an email or voice recording to the podcast team to tell us what you'd like to hear in future episodes.

Subscribe to our show on Apple Podcasts, Spotify, or Google Podcasts. To see a full list of episodes, visit our show’s webpage.

Transcript

Perry Roth-Johnson (00:06):

Hello! This is Ever Wonder? from the California Science Center. I'm Perry Roth-Johnson. This summer, we opened a brand-new exhibit called Life! Beginnings in our World of Life gallery. Life! Beginnings invites our guests to discover how humans and all living creatures reproduce, develop and pass on their genes in order to bring new life into the world. Through interactive and immersive experiences, guests can explore the human journey from conception to birth, see how a mother's body changes throughout pregnancy, and learn about reproductive health. Do you ever wonder how doctors keep people healthy during pregnancy and childbirth? Dr. Kimberly Gregory is an OB/GYN and professor at Cedars-Sinai, as well as a scientific advisor for our exhibit Life! Beginnings. Dr. Gregory is on a mission to make childbirth a safer and more positive experience for everyone. She came on the show to tell us more about her work and share some useful advice for creating your own reproductive life plan. Let's get into it. Dr. Kimberly Gregory, you are the Vice Chair of OB/GYN and a professor at Cedars-Sinai. You're also the Helping Hand Chair in Maternal Fetal Medicine—Kim, welcome to the show!

Kim Gregory (01:22):

Thank you for having me.

Perry Roth-Johnson (01:23):

Yeah. And Devin Waller, our cohost of the show, is back again. Hi Devin.

Devin Waller (01:27):

Hey Perry, great to be here. And hi Kim, thanks so much for joining us.

Perry Roth-Johnson (01:30):

Kim, we know you've done a lot of research on maternal health—what's working, what's not, and how to improve things—and I'm really excited to dig into that. But first, can we just start with some basics about your background and expertise for our listeners? Like, what is an OB/GYN, exactly? What do all those letters mean? And what do you do for patients who come to see you?

Kim Gregory (01:49):

So, OB/GYN is short term for obstetrics and gynecology. And obstetrics is delivering babies and providing all the care associated with that. And gynecology is taking care of the reproductive health parts of a woman from essentially adolescence till menopause. There's different specialties in OB/GYN. You can be a specialist which is OB/GYN as I've described, or you could do additional training and do high-risk OB. So that's what I do. That's the maternal fetal medicine part. There's also family planning. Uh, GYN-oncology, so people who have cancer of their reproductive system. REI, reproductive endocrine and infertility, so these are people who help you get pregnant. And, minimally invasive, so people who do the microsurgery with the robotics.

Perry Roth-Johnson (02:42):

Oh cool! But, but you were saying your focus and your specialty is on the first one.

Kim Gregory (02:48):

Yep. High-risk OB. After you have your baby, then I have to find another doctor for you.

Perry Roth-Johnson (02:53):

Okay. Got it.

Devin Waller (02:55):

Now Kim, you were a scientific advisor for the California Science Center's new exhibition called Life! Beginnings. The exhibit is about how humans and other living things reproduce. And in the exhibit, guests can learn all about pregnancy and how the body changes and about prenatal health and other things. And guests can also see real human fetal specimens inside of this big immersive experience that we've named the Womb Room—now say that three times fast. Now, from your perspective as an OB/GYN, why is reproduction and specifically maternal health and human development, an important topic to learn about?

Kim Gregory (03:34):

You know, I think that it's important to plan your pregnancy in the same way that you plan to graduate from high school, or you plan to be a doctor or a nurse or a rapper. You should plan when you want to have kids or if you want. So if you want to have kids, you want to be as healthy as you can before you get pregnant. Um, and if you don't want to have kids or you don't want to have kids right now, then you want to make sure that you're doing the right contraceptive technique for you.

Devin Waller (04:05):

It's sort of like a reproductive planning is part of life planning. The same way that you plan all of these other parts of your life, we need to plan the reproductive stage of our lives.

Kim Gregory (04:16):

Correct. That's true for both men and women, because you want to be as healthy as you can before you get pregnant. There's a whole field of medicine called the origin of adult diseases, which means that what happens in-utero during critical times can be predictive of what kind of diseases you have as an adult. So we want the mom to be as healthy as possible and we want her to take, if you're planning to get pregnant, we want you on prenatal vitamins with folate. If you have medical conditions such as diabetes, high blood pressure. Um, if you're overweight, we want you to lose weight. Um, if you're diabetic, we want your blood sugar to be as close to perfect as possible. Most medicines are okay, but there are a few that we would suggest you come off of and take a different type. Um, if you have any of the autoimmune diseases like lupus or inflammatory bowel disease, we want you to be in optimal health or in remission, ideally. Um, if not, we want to make sure that you're on the right medications for pregnancy. And then the one that gets overlooked but I want to make a point about is your mental health. People who have anxiety or depression, they may be on medications and I want to make sure that you know, that they're with the right, um, doctor and psychologist or psychiatrist so that if they need to stay on those medications, they're on the correct ones.

Devin Waller (05:45):

Yeah, it's very important. You know, something I didn't realize is that childbirth is the number one reason for hospitalization globally—over accidental injury or disease. So that really puts into perspective just how important it is that there be sort of like a national effort to make sure expectant partners get what they need. One of your missions is to make childbirth safer and more fulfilling experience for women while they're going through the process. Tell us more about that work that you, that you did, the research that you've done and what you've learned from it.

Kim Gregory (06:21):

Well, it's interesting. One of the things that I find the most fascinating about some of my work is, uh, and my team's work is how women are caregiving all the time. We did this survey where we asked people all across the country, what do they want for their childbirth experience? And then we went back and we asked ⅓ of them, "Did you get what you wanted and how important was it for you?" And we looked at the gaps and we use this to develop a model to predict hospital satisfaction. And one of the things that stood out to me as being very intriguing is women were likely to be dissatisfied if their partner wasn't given enough food or a proper place to lay down. So you think here this woman is, you know, laboring having a baby, but at the end of the day, if her partner wasn't happy, she wasn't happy. And it's important because those are things that hospitals can fix, right? You can get a nice chair that lays out so that the partner can relax. And we all know that hospital food could be improved to make it a more positive experience. I think the other thing that we found is that people want two things. They want to be told about the labor, what's going on. And then afterwards, they really want to talk about it and they want to, they want to talk about their feelings about it. And that's something that hasn't been part of our training. Um, you know, I always say, you know, if you tell somebody you're an OB/GYN at a cocktail party, you're going to hear somebody's birth story and it stays with you forever. And so we are now developing, um, opportunities to, to work in debriefing as part of our normal postpartum experience. I would say the last thing I'd want to share is that, um, there are things that people want that the hospital that they plan to go to doesn't do. And so if they don't do that service, you're not going to be satisfied. And so if you've had a prior C-section and you want to have a vaginal birth after cesarean, or if you want to have a tubal ligation after your baby's delivered, you need to make sure in researching to pick a hospital that do those two services.

Perry Roth-Johnson (08:35):

Just a stupid question. What is a tubal ligation?

Kim Gregory (08:39):

At tubal ligation is where they either tie your tubes or remove your tubes so that you can't get pregnant. It's a method of sterilization.

Perry Roth-Johnson (08:48):

Ah! Got it, got it.

Devin Waller (08:49):

Now, when you conducted the survey, are there things that just completely surprised you?

Kim Gregory (08:56):

Well, besides the partner issue, I think another big issue that comes up and it's kind of a disconnect, but we think that breastfeeding is really important. I guess that's another take home point. That it's great for the baby. It gives the baby the right bacteria and for their microbiome, um, it decreases the risk of infections, respiratory infections, colic, um, it decreases the risk of SIDS even, and it also increases their brain cognition, their brain development. But some women don't want to breastfeed and it's a hospital quality measure. The number of women who get discharged home with exclusive breastfeeding. So hospitals want to do really well at that. They want to, you know, they want 80%-90% of their women to go home and say that they're breastfeeding exclusively, but there's a certain percentage of women who don't want to breastfeed. And I think that, that after you have that discussion with them, you need to respect that because some will feel like they were harassed. And if they're asked about it, then they're not gonna say that they're satisfied with their birth experience because, you know, in a way we're making them feel guilty or, or they feel like they're being coerced when they feel that they've made an informed choice to not breastfeed. So I think that we have to be respectful of that. Um, but I still want to put in a plug for breastfeeding.

Perry Roth-Johnson (10:27):

Totally, totally. On the flip side, like, what are some things that you reconfirmed through your work that are working well, um, that the hospitals, like ,are already doing well for expectant mothers?

Kim Gregory (10:42):

Well, I think that we're doing a good job of educating the moms about, um, uh, how to handle the baby when they go home. Um, you know, there was this big push about the baby's sleeping position, putting the baby back to sleep. So you put the baby to sleep on their back. And that, that decreased the risk of sudden infant death. We do a good job of teaching women about following up with, um, vaccines for their baby and doing the well-baby care.

Perry Roth-Johnson (11:15):

Going back to, um, some of the things that still need to be improved, you know, uh, there's still significant racial disparities for expectant mothers, right?

Kim Gregory (11:24):

Yes.

Perry Roth-Johnson (11:24):

Uh, I think the stat that I've heard you point out and is getting wider attention in the media lately is that Black women are nearly four times more likely to die during childbirth than white women. Uh, I know our exhibit development team was surprised and saddened to hear that those disparities still exist. Uh, can you unpack for us, like, why these disparities exist?

Kim Gregory (11:44):

There's a lot that goes on with the structure of care. Um, you know, they talk about structural racism, and it starts with the social determinants of health and how you get access to care and, um, what type of insurance you have and the type of providers that you have. But you know, we're drilling down even more. And now we want to make sure that we're hearing patients when they have complaints and that we're working the complaints up to make sure that we can treat some of these conditions early, to try to prevent that. The leading causes of maternal mortality used to be hemorrhage and, um, hypertension disorders or preeclampsia, but now we standardize those protocols better. We're finding that, um, that we've gotten better at that. So now they're not the leading cause. And the leading cause is actually heart disease now.

Perry Roth-Johnson (12:38):

Oh, weird.

Kim Gregory (12:38):

And, um, and so as you standardize a treatment of hemorrhage and as you treat people more aggressively for hypertension, then because, um, those instances are going down, then other diseases become more prevalent—because it's still always equal to 100%, right? And so now heart disease is the leading cause. And some of it is unique to pregnancy, but some of it is associated with other comorbidities the woman may have—advanced maternal age, obesity, diabetes, and hypertension, all of which are things that Black women have a higher prevalence of. So I think that to the extent that we just take better care of ourselves and, um, exercise, eat right, and then pay attention to the symptoms. That's the other—you were asking, "What can we do better?" We're doing, we're much more aggressive about giving women the warning signs of what to come back for. And we're actually trying to make that a public health initiative. So that even you, as a friend, you know, when your friend calls you and says, "You know, I'm a little short of breath." And, you know, she just had a baby. It's like, "Well have you seen your doctor? Did you go to the hospital?" Um, and the campaign at the hospital side, um, supported by the CDC called, Hear Her. So if a woman comes in with complaints, pay attention to what she's saying, don't minimize these, even though they're common complaints in pregnancy, you want to minimize making something more severe.

Perry Roth-Johnson (14:18):

Yeah. And that program was called, Hear Her?

Kim Gregory (14:20):

Hear Her.

Perry Roth-Johnson (14:21):

Oh, okay. Yeah. It's, that's like the opposite of—I mean, like when I was growing up, you know, playing sports, you know, and you have like a common—this is not all equivalent. I don't know why I'm saying this, but you know they're like, "Ah, just walk it off. You'll be fine." Like, you don't want to tell that to a pregnant lady, who's having common [symptoms].

Kim Gregory (14:38):

Exactly. Exactly. Exactly.

Devin Waller (14:41):

You know, and I think to that point though, Perry. I think you have a point where it's like when you're pregnant, I think because your body, the woman's body is going through so many changes and experiencing so many new feelings, it probably could be easy for even the expectant mother to just say, "Oh, it's just part of pregnancy. It's just normal. I'm just going to let that go. It'll clear itself up on it on its own." And so I think it's an important point that needs to be heard all across the board from the expected mother to others, giving advice.

Kim Gregory (15:14):

Right. You know, like back pain, you know, back pain is so common, but for some women it's a symptom of preterm labor. So it's like if you're having back pain, it's not going away. I mean, it, you know, you try to teach, well, it comes and goes and comes and goes. But, you know, I always just say, go and let somebody tell you it's not contractions, you know?

Devin Waller (15:38):

Right.

Kim Gregory (15:39):

We will not get sick of seeing you just keep coming in and let us reassure you that everything is okay.

Perry Roth-Johnson (15:46):

What are some other strategies, uh, you think we should be doing more to lessen these disparities, uh, for expectant mothers? We talked about, you know, you need to have group support and more of like a public health mindset. Uh, is there anything else?

Kim Gregory (15:59):

I think it's important that the woman have a good relationship with her doctor, with someone that she trusts. Um, if you don't trust your doctor, then you're not going to tell them things. And, if you don't tell me, I don't know. For example, when I'm managing women with diabetes, I work with a nurse and I'm amazed at the things that she finds out that I don't find out. Now, maybe it's because too I'm busy or that, or because uh, she talks to the nurse more frequently. Um, but I'm grateful for the fact that we work as a team. And I tell the patients that from the beginning, and it is true that she has more time, but, you know, I am there to help and to support you. And, um, I think it's important for women to be with providers that they can trust.

Devin Waller (16:47):

So, Kim, what else would you like to share with us and what else would you like people to know?

Kim Gregory (16:53):

I think the main thing that I would like to share is reproductive life plan, plan your pregnancy, eat, right, exercise, prenatal vitamins, folate. Find a provider you trust and that they hear you. Like, you feel like what you're communicating to them, they heard. And that when you leave, you felt like you got what you needed and that you learned something from them. It should be a two-way street. And, um, and, and don't be afraid. This is a natural physiologic process.

Perry Roth-Johnson (17:25):

And just to follow up on that, like, what are some things people can do to educate themselves and be better advocates for their own reproductive health?

Kim Gregory (17:33):

Well, they get started with this museum exhibit! Check out all of the resources that they posted. Um, and then, you know, I would say, you know, everyone is doing Google searches. And, and the support groups are good, um, and there are good resources, um, but also try to make sure that you're reading medical versions for the lay person as well. Don't rely just word of mouth and, um....

Perry Roth-Johnson (18:07):

And free advice.

Kim Gregory (18:08):

Yeah, what Google docs says.

Devin Waller (18:10):

Yeah. That's important.

Perry Roth-Johnson (18:12):

Well, it’s been wonderful talking to you, Kim. Thanks for spending the time with us and joining us on the show today.

Kim Gregory (18:18):

Alright, have a great day.

Devin Waller (18:19):

Thank you, Kim.

Perry Roth-Johnson (18:20):

That's our show, and thanks for listening! Until next time, keep wondering. Ever Wonder? from the California Science Center is produced by me, Perry Roth-Johnson, along with Devin Waller. Liz Roth-Johnson is our editor. Theme music provided by Michael Nickolas and Pond5. We'll drop new episodes every other Wednesday. If you're a fan of the show, be sure to subscribe and leave us a rating or review on Apple Podcasts—it really helps other people discover our show. Have a question you've been wondering about? Send an email or voice recording to everwonder@californiasciencecenter.org, to tell us what you'd like to hear in future episodes.