Ep. 37 | Kimberly Cross, MD, OBGYN

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- Welcome to another episode of What Brings You in Today. I'm Taylor Fisher. And I'm

- Kara Hope Hanson.

- And we just wanna thank all of our listeners for tuning in, subscribing, and leaving reviews for the podcast.

- And if there's any topics that you're interested in hearing more about or any special guests you'd like us to have on, you can let us know at sgmc.org/podcast.

- So today we're here with Kimberly Cross, MD, obgyn. So what brings you in today, Dr. Cross?

- So I'm actually here today to talk a little bit about women's health and what I do every day.

- Good. Good. We're really excited to have you. Can you share a little bit about your background and how you got into obstetrics and gynecology?

- Sure. So I'm originally from, believe it or not, small town in Cleveland, Mississippi. If you ever heard of the Delta, that's where I was born. I moved to Chicago right outside the outskirts of Chicago when I was three or four. And that's where I grew up. My family was military, my dad was in the Army after Chicago. I went to Xavier University of Louisiana in New Orleans, and that's where I obtained my bachelor's degree in biology. And it's funny, I just talked to my mom yesterday. I said, how old was I when I really said I wanted to be a doctor? And honestly, from at a very young age, like three or four was when I knew I wanted to go into medicine. Wow. So I was super young. I loved my pediatrician. Her name was Dr. Berger and I was fascinated by her lipstick and Dr. Right. But she worked hot pink lipstick and I always thought it was the coolest thing. She's a very jazzy lady, but also she taught me a lot just as a young girl about being a woman in medicine and definitely empowered me from a young age. And so I went on to work for a little bit after college. Excuse me. I wasn't sure what I really, really wanted to do. And I wanted to make sure that medicine was for me. And I went to back to Chicago and worked in pharmaceuticals for a couple of years, so I'm not gonna give away my age. And I did a, a Master's of Public Health at the same time. And at that point I kind of knew this is what I wanted to do and so applied for medical school and I jet set it to DC and I completed my MD at Georgetown University School of Medicine. And I stayed there for residency as well.

- Okay. You've been in a lot of, I've been every different places everywhere. Yeah. Yeah. So a lot of people associate OBGYNs with just pregnancy, but there's so much more to it than that. Can you kind of touch on some of those other key health areas in, in women's health that you are involved

- In? Yeah, sure. So Abso, you know, absolutely. I say we're, you know, 50% obstetrics most of the time and 50% gynecology, which a lot of people do forget. So obstetrics, you know, again, is just taking care of, you know, a woman from the onset of her pregnancy until delivery. But what I love is that we do also gynecology and what, you know, you don't really realize, but take care of a lot of women from sometimes the, their first period right. Until they have a baby. And then when they go through menopause and sometimes, you know, throughout, you know, that time. And so the gynecology piece deals more with menstrual period sexual health, you know, a lot of mental health concerns as well. So I think we're kind of a hodgepodge of many things combined into one. But typically most OBGYNs do 50 50. We also do lots of surgical procedures. So with our obstetrics, you know, C-sections and with gynecology, we do lots of hysterectomies, you know, other minor procedures as well.

- And for some women, you know, women are very busy. That may be the only time they go to the doctor is their annual visit or when they're pregnant. So y'all also kind of act a little bit as primary care Absolutely. For women as well. And I know there's a lot of screenings and preventative things you can do. Can you talk a little bit about some of those key preventative steps and screenings?

- Absolutely. So for most women, you know, I do encourage women to, you know, at least consider coming into gynecologist around 16 to 18 is a good time. Not in particular for screens, but it's good to come in to kind of understand, you know, your health, your health as a woman. But your first screening is really at the age of 21. And so years ago we used to do your first pap smear after you were either active intimately or you know, wanting to start birth control. But that is not the case and it has not been the case for a very long time. So a pap smear is just a cervical cancer screen and is recommended to have your first pap at the age of 21. We see women every year. So we do recommend an annual exam. Pap smears are no longer every year. And if you read the new guidelines for screening, we do pap smears every three years. There are some caveats to that can also range to every five years for women in their thirties. But the next kind of big screening is, and you're at 40 and so that's when every woman should have her first mammogram. If you have a family history of breast cancer, depending on that history and how old that you know, mother or family member was, we would recommend mammograms possibly at an earlier age. There are certain immunizations that are important as well to, but I know we're kind of, you know, geared towards screenings in your late, you know, fifties, early sixties for post-menopausal women, it is recommended to have a DEXA scan, which is a bone density scan. And that checks for osteoporosis or osteopenia, which is low bone mass. I did kind of skip your colon cancer screen. And so the new guidelines for colon cancer screening is actually 45 for all women used to be 50. And so those four, you know, big screens are very important. And

- What are, and we can talk about immunizations if there's any important ones that you wanna talk about.

- Absolutely. Definitely for younger girls. So you know, you may not necessarily come to the gynecologist for those screens, but the first vaccination from a women's health perspective is the Gardasil. And you guys may have heard of that. We start that at nine years old and that would be at their pediatrician. You can actually have the Gardasil vaccine, which is the HPV vaccine up until 45. And that's a new extension in age. It used to be 26 and then it was 44 and now it's 45. But it's a three shot series for younger girls and a two shot series for older women. And that would be kind of the first vaccination. You know, there's obviously other vaccines that typically would happen with your primary care physician, but your flu vaccine can be done honestly at this point. Any age. And your COVID-19 boosters. For our pregnant patients, we do recommend if it's in the flu season, that they have a flu shot during the flu season. RSV is another important vaccine and it's a newer vaccine that is important for our pregnant patients. And that is usually recommended between 32 and 36 weeks. And in addition for our pregnant patients, the TDAP and that's the tetanus diptheria and the pertussis vaccine, that's for the whooping cough. And we can do that starting at 28 weeks. Yeah,

- I think I'm due for that one.

- And I got the Tdap at the request of my sister-in-law and brother. Very good because, you know, they were having newborn babies, you know, I wanted to be there to hold her. So just be an extra safe. Good. How will you approach topics like birth control, menstrual health and sexual wellness with patients who might be a little bit nervous since those can be kind of awkward or uncomfortable topics for some,

- Yeah, those are, you know, they are uncomfortable conversations. I think for some women at any age I try to leave, you know, I, I use kinda those call nonverbal cues. So it's very important I think as a physician in any specialty, kind of watch, you know, a patient's, you know, physical signs and you kind of can tell where to take the conversation. I use a lot of open-ended questions, so I try not to do a lot of yes no answers because it kind of closes a woman in on what she can say. For example, if I wanna talk about, you know, sexual health, I'll say instead of are you sexually active, what are your thoughts on, you know, do you have any questions about your sexual health? And that then opens up sometimes Pandora's box or you know, but yeah, you know that you don't know where the conversation will lead. But it does start to at least give, just make a woman feel comfortable in that setting. I do also kind of like to normalize the conversation. I think we make some, you know, some women feel very embarrassed, but this is what I do. Yeah. So this is the place to talk about it. You know, so I may try to, I joke a lot, you probably hear me laughing down the halls all the time. But I try to make patients feel that this is normal, this is what we are here to talk about. And I think that that also helps to ease that conversation as well.

- And full disclosure, Dr. Cross is my OB, GYN, and I can attest to how comfortable she makes you feel in the room. Even topics like birth control, you know, it's like, oh, have you ever thought about, you know, this option? Rather than like, you know, what are your thoughts on like, let's just do this. Yes. You know, making it a two-way conversation. Well, thank you.

- I think it's very important. 'cause I mean, even as a woman in my thirties, I mean, it's still a bit awkward sometimes, but if you have that physician that you're comfortable with and you know, like this is literally their job. Like whatever question I ask is not gonna be the craziest thing you've ever heard. Absolutely. Like they've heard it all, we've heard it or heard and seen it all. Absolutely. So what advice would you have for a young woman who's coming in for her first gynecological visit and she, what should she expect? And you know, everything like that.

- Sure. I remember that being terrifying. Like the very first one, when you're, when you're younger,

- It is scary, you know, I think just to be, you know, it is, it's normal to be uncomfortable. And I think that is one of the things that, it's kind of the hallmark of any appointment with any patient of mine. You don't have to put on airs for me. You don't have to pretend like you're comfortable. It is okay to be uncomfortable. That's normal. It's not a comfortable exam. Yeah. You know, it's, I, I do recommend sometimes if you feel better with someone with you, that's always a good idea. Sometimes you're so nervous for that first exam, a lot of information kind of slides past you. And so it's okay to bring a family member, your mom, you know, whoever brings that sense of comfort. Also know that you are in control of that visit. And so no physician ever should force anyone or make anyone feel uncomfortable with an exam. If it's something that is so terrifying and so uncomfortable or so scary, we don't have to do it. We can always come back. I do that all the time. And so, you know, it can just, it can be whatever you want it to be. Know that with your first, you know, exam, if you are 21, likely you will get a pap. But you have that option to say, I don't know if this is, you know, if I'm ready for this. And just kind of mentally being, you know, in a space to prepare for that. I think it's a good idea to write things down. A lot of my patients do. Yes.

- Sometimes. Sometimes you get there in the room and you have all these questions maybe you've been thinking about, but you forget. Yes. And it's like, it's just good to have that note of like, oh yeah,

- I meant to

- Ask her

- About this one thing. I say, you know, I always say women, we're so busy, We do so many things, we take care of everybody else. And it's, you know, I know, you know, my patients, sometimes it takes months to get an appointment and so you're in this room and you may not be able to come back, you know, write any, you could be in the car, you know, sir, however you have to do it, you know, tell someone to write it down for you. But it's good to come in with a list of things. Sometimes we may not have time to cover those things, but at least if there's something that you wanna talk about, you have it with you. Absolutely. Yeah.

- So one thing we wanted to touch on is we have a partnership with Life South Cord Blood Bank about core blood donation. It's like an option that delivering moms can, can donate their cord blood. And if for somebody who doesn't know what that is, can you just explain

- It a little bit more? Absolutely. So cord blood, it's just the blood that comes from the baby's umbilical cord. And we usually will collect that at delivery for various reasons. But this is something that patients can decide if you want to privately keep that cord blood or you can do what's called public cord blood banking. And that's to donate the blood to families in need. In that cord blood, we have what are called everyone here is about stem cells. It's kind of hard to know what, you know, what is a stem cell? It's just a cell that can evolve into other things. Stem cells are early cells that can, you know, potentiate or differentiate into different things. So different types of blood cells, different types of immune cells. And the cord blood can be given to people that may be dealing with things like leukemia, sickle cell disease, that need bone marrow transplants. You can, so again, if you have a family member, I've had patients that have sickle cell and they're, you know, concerned that maybe their child will have sickle cell anemia. They can bank the cord blood on their own. It's kind of like life insurance. You know, you can hold onto it when you, until you think you need it. But you can also donate that. And when women present to labor and delivery here, they're asked if they would like to donate their cord blood. And we can certainly, it's a very simple process. They just literally sign a form and that blood gets donated to a family in need. That's awesome.

- That's very, very important. And I'm glad we have that option here. So switching gears to a little more of obstetrics, how do you help your patients prepare emotionally and and physically for delivery and labor and all of that? Do you have any

- Words of wisdom? Like, buckle up? No, I'm just kidding. I love my patients and I, you know, I, I try to keep some continuity. I think it's very important, you know, I know it's frustrating for some women in pregnancy when you see, you know, four or five different providers and you don't know who's delivering you. And I think from the beginning that having a sense of comfort and some continuity in under knowing who your providers are is key. I think that one of the things, and the nurses may not love me for this sometimes, but I encourage birth plans. I do. I think the birth plan is really to open up a conversation and a dialogue about what your options are. There's lots of things that, you know, it's hard to educate a couple on all of the things. Pregnancy, it's just so much. And a birth plan, you know, there are multiple segments of a birth plan that starts a conversation about do you want skin to skin? What is skin to skin, what is delayed cord clamping? You know, all of these things. Do you want an epidural? You know, patients can then decide if they want a natural labor. Maybe we've never really talked about that before. Monitoring, you know, what is that? And, oh, I didn't realize I can have, you know, the monitor and I can walk around a cordless monitor. And so I, we usually, I think education is key. I'm all about being prepared. I think the more prepared you are, the better. But there are things that you will not be prepared for. And sometimes the more you plan things don't always go according, you know, to that plan. But yes, I definitely try to add some sense of comfort and recommend, you know, just being educated on what to expect.

- Yeah, definitely. And I'm expecting, so we have childbirth classes here at the hospital and I recently took one of those with my husband and it covered basically all from the beginning to end, you know, to postpartum. And that was definitely eye-opening. So I'm definitely diving into the, into the education, listening to podcasts, and just trying to be as prepared as I can because I'm anxious about it. Absolutely. And I wanna know what to expect. So I'm sure my doctor will start to go over those things with me as well. But I'm trying to be prepared. Absolutely. Yeah.

- You're gonna do great. And touching on that mental health too, I, we briefly mentioned it earlier, but I mean, how do you support patients' mental health? Especially, you know, maybe postpartum depression or anxiety?

- That's a great question. You know, so there's, you may hear about postpartum depression, postpartum blues. So postpartum blues is really, it's common probably every woman experiences that. And that's, you know, usually happens very early in the postpartum window about one to three days after delivery up to two weeks. And that can just be, you know, due to cry, you know, crying spells, not feeling you're enough, you know, anxious, but

- Not getting much sleep. Not getting much

- Sleep, you know. But usually with postpartum blues, the difference is that you can still function. So you can still do the things that you need to do every day to take care of your baby. What happens with postpartum depression, usually kind of, it's a lingering kind of postpartum blues that then becomes to the point where you can't continue to do those day-to-day tasks. You know, isolation, crying much more than normal, you know, feeling, you know, defeated. One of the obviously big concerns is the suicidal or homicidal idea, ideations, feeling like you may want to hurt your baby. Things to that nature. And when it gets to that point, you know, we do try to educate our, our moms on things to look for and our, our parents, you know, or the couple to, you know, their partner and other family members on what to look for. You know, women that have a history of anxiety pre-pregnancy or depression, they are at huge risk for postpartum depression. If they're on medications, a lot of times, you know, it's not the best to stop those medications in the pregnancy. So, you know, you wanna talk to your doctor about what is safe for pregnancy and definitely, if not continuing them in your pregnancy, postpartum certainly would be important to start those medications away right away.

- I was gonna ask that about like certain anxiety medications that, is it better to just stay on it if it, as long as it's safe for baby?

- I think that there are times where, you know, it's, it's scary a lot of times to know, you know, do you keep a woman on a certain medicine? Do you stop that medicine? But if you read all the literature, it is not good. It's best to continue someone on their medications for their mental health. If you abruptly stop a mental health medication on someone that's, you know, in need, that can cause, you know, can definitely cause mom to spiral, which then puts baby at risk. And so it's actually more important if that medication is safe, you know, and you wanna use your mental health providers or psychiatrists to really help intervene and talk with your obs and just to confirm that those medications are okay.

- And that kind of leads to my next thought, which was you hear about maternal mortality rates and maternal health, everything and our rates are kind of high. Yeah. So in Georgia. In Georgia, yeah. Could you touch a little bit on what that means and what could be done? 'cause I think a lot of that is preventable, correct? Absolutely. That people are educated.

- Absolutely. So we have one of the highest rates of maternal mortality in the country, and about 85% of those of the deaths that we have seen are preventable. That's huge. Yes. 85% what we see are collectively some mental health is one of the biggest, you know, causes of maternal mortality next to heart disease. And so these are things that we definitely need to, you know, make sure that we're encouraging our patients to continue. Either we talked about medications, talked about, you know, making sure, do they have a mental health provider? Is there someone that they're locked in with that can kind of follow them through their pregnancy and make sure and check in with them. Are you doing okay? Do we need to change your medications? One thing that happens in pregnancy, you know, your, your kidneys can filter a little bit faster. Certain medications start to become less functional. And so you may have to up those doses. So being, you know, ahead of the game is important. But education is key. And I know that it, you know, it does start with us as OBGYNs, all of our, you know, women's health providers, making sure that we are educating our women on that. It's super important.

- And I've also heard about, you know, when you go home from the hospital that there are certain signs you need to watch out for that sometimes as women we might brush off, you know, and we're trying to take care of this new baby, but they're like crucial things to watch out for. Yes. Can you talk about those a little bit?

- Absolutely. So you wanna watch for, especially with, you know, mental health, we talked a little bit about that. The postpartum blues and postpartum depression from a cardiac standpoint or your heart health, you know, if you feel any chest pains having headaches, you know, that don't go away. You know, you can take a Tylenol or what have you or ibuprofen and it doesn't resolve having any shortness of breath. Right. Upper quadrant discomfort is a indicator of some liver concerns. These are all signs of either postpartum hypertension or what's called postpartum preeclampsia is, you know, some people think, oh, I have the baby and I'm good. Yeah, I wish it were like that. So that's not necessarily the case. Your body still thinks it's pregnant for six weeks after you deliver. And so you're still at very high risk for hypertension, preeclampsia, what's called eclampsia, and that's seizures. And so all of those things can occur if you have swelling, you know, anything if you just say, I don't know, but I don't feel right, call your doctor.

- Yeah. Yes. Yeah. And don't brush those things off. Absolutely. 'cause that is something they spoke about, which I'm glad they did in the childbirth class, was, these are the things you need to look out for because maternal mortality doesn't just mean a pregnant woman. It, it's like up to a year after you give

- Birth. Yes.

- I think that absolutely. That still counts in that statistic. So

- Do you have any special patient stories that stand out to you that, that are meaningful?

- You know, I, I really do, when you ask me that, I think every patient, it's hard to, to have any particular question, any story. I feel like I have stories with every patient. I love, you know, sometimes being in a small town because I see patients, you know, everywhere and it kind of then brings, you know, you see them in the supermarket with their baby and you think, gosh, you know, two years ago we were, they were trying to get pregnant and we were crying in the room. And then I came in with a, you know, a pregnancy test and everyone was, you know, happy. And I said, look, it's gonna happen. You know, or the woman that was bleeding and, you know, wearing diapers that now is so energetic and happy 'cause we did a hysterectomy and, you know, she feels better. It is hard for me to pinpoint any particular patients because I have so many patients that we have so many stories that it is a little difficult. I will say I have one patient that they had been trying to conceive and the first time around they had seen another provider and then kind of saw me and her, you know, she was maybe a couple days late, not much. And I said, let's just check a test. And, you know, we were, I was almost in tears in the office with her and trying to figure out what to do and, and I said, well, I've had it in a little baggy. I said, well, guess what? I don't think we need to figure it out anymore. You're pregnant. I kid you not. They had the baby the next year they had been trying to conceive for a year. She ends up coming in to see me to talk about fertility. And I said, let's just check our pregnancy test. I kid you not again. So I didn't get to deliver her first baby, but I said, I have to deliver this next baby. Aw. And that always, you know, comes to mind. Yeah. I have wonderful patients that have, you know, had, you know, we call 'em rainbow babies and have lost babies and, you know, definitely one in, sorry, I have, I have stories. No, we love it. One in particular that, you know, wasn't having a cycle for years and thought she was menopausal, you know, and we found out that there was a cyst on her ovary causing her her periods to be suppressed. Took it out, got pregnant, lost their baby, However, got pregnant again and she had a beautiful baby girl. And I get pictures all the time of her baby. And so, so many stories like that. It, it's definitely a rewarding, rewarding job I have to say.

- Absolutely. I would think so too. Yeah. I mean, I'm sure at times it can be, you know, a lot to deal with emotional and emotional good and bad. I just think if I were to ever go into medicine, which I never will, that would be one area. Never say never. I can't do blood. There's so many things I can't do. But I, I think it is probably a really rewarding and beautiful job to be there from the beginning to the end. You know, the whole life of a, a woman's health. What is one thing if that you can think of just one thing that you wish every woman knew about their own health or any piece of advice like

- That? I think this goes back to that first appointment where, you know, we talked about how you take control of that appointment. You, you are in control of your health and everyone should feel some autonomy. Meaning it is your body, it is your health. Women go through so much in our lives and our bodies go through so many changes that we're so in tune when a woman comes to me and says, gosh, you know, this is something's hurting on this side. And it's been two weeks and you know, I decided to come in today. Trust your intuition. Know that, you know, for women, I think we are some of, some of the most amazing species on this earth. I think our instincts are beyond, you know, and trust that trust that if someone tells you no, get another opinion. And so you are in control of your health and of your body.

- Yeah. I think advocating for yourself

- Absolutely

- Is one of the most important things anyone can know about their health and men and women. But I feel like, especially as women, sometimes you feel like maybe you're not being taken as seriously as you think you should. Yeah. Because we do know, I mean, we are in tune with our body from the time that we are like 13, 14, and have that first menstrual cycle and you just know when something is wrong.

- So, you know, you just know when you know.

- Well that's, that's about all the time we have. But I have one more question.

- Okay.

- This is our favorite question to ask all of our guests. I'm sure that you're here a lot all hours of the day and we like to know what your favorite meal to eat here in the hospital is. I don't think

- Cafeteria is not watching. Yep. The cafeteria or the allspice. Okay. Yeah. All spice is, I have to say my favorite. And now I'm to the point where you walk down and they make this particular meal. 'cause they know what I like. It's the sausage, egg, and cheese breakfast sandwich.

- I love that.

- So

- I bet you are here a lot of early morning. Yeah. Yeah. Absolutely. Well, thank you so much for being here today. You're so welcome. Thank y'all for having me. This has been a great conversation. Thank you to all of our listeners for always tuning in for subscribing. And please continue to rate, review, and submit your questions at sgmc.org/podcast. Thank you. Thank you.