Ep. 4 | Ene Grace Morgan, MD, OBGYN, SGMC Health

Transcript

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- Welcome to another episode of "What Brings You in Today?"

- I'm Erika Bennett.

- And I'm Taylor Fisher.

- And today we are here with Ene Grace Morgan, MD, OB-GYN. Dr. Morgan, what brings you in today?

- Well, I'm here to talk about women's health, something I'm very excited about.

- Perfect. And you joined us not too long ago, but give us a little bit about your career path, journey and kind of what led you to women's health.

- Okay. So I grew up in Nigeria. My mom's a professor of ophthalmology and at the time that I grew up, my mom was very heavily invested in teaching. And so most of the people I knew growing up were doctors. 'Cause I grew up on the campus of a teaching hospital.

- Okay.

- So, you know, naturally I decided, "Oh, I want to be a doctor." And over the years it just became something I was very passionate about because I felt that I could really impact lives. And when it was time for me to go to college, I kind of sat down and thought about what is it that I really want to do? And I was at that time and still am very passionate about women. I've always felt that women give a lot of themselves, you know, they're always in serving positions. Even when they're in leadership, they're always thinking about how they can serve other people. And sometimes women's issues get pushed to the back burner. I knew I wanted to take care of women and I knew I wanted to do surgery. And so thankfully OB-GYN kind of combines both of those things. And that's how I found myself in OB-GYN.

- Very cool. And that is definitely, I think a rising theme that we're kind of seeing nowadays and it is starting to be talked about more is about the fact that women tend to put everyone else around them first and kind of neglect their own health and wellness. When does a woman need to start seeing an OB-GYN?

- So really you should be seeing an OB-GYN yearly. So I see patients upwards of, I've had as early as 12 years old, that's problem visits. But at the age of 18 or when a woman becomes sexually active, she needs to be seeing an OB-GYN, not only because we're talking about things like birth control, but because OB-GYNs are primary care doctors as well. So we can start to notice things like high blood pressure, if you have risk factors for obesity, we can look at those things. But also because you need to be having breast exams, we have to make sure that sexual health is something we're talking about because lots of people are not really paying attention to those things. So really as soon as you are sexually active and before then if you have any medical problems.

- So could you discuss why those routine exams are important? Like what do you look for and why is it important to get those every year?

- Okay. So there are a bunch of things we screen for, specifically OB-GYN, we're doing breast exams in the office. Most cases of breast cancer are found either just on routine examination or if you're over the age of 40 with routine mammograms. Lots of times when people have advanced stage breast cancer is when they'll start to see like skin changes or like a lump or something. Most cases are actually, if you are doing your screening, they're found when you don't have any physical manifestations. Additionally, we can go through a family history with you, see if there's anything in your family that puts you at higher risk for breast cancer or ovarian cancer. And we can start those screenings earlier on. Pap smears, so the guideline now is that we're starting Pap smears at the age of 21. So when I have patients come in and I ask them about Pap smears, they think that a pap smear is just a speculum exam. And I have to tell them, "Hey, when we're doing Pap smears, "what we're doing is we're checking if you have HPV, "which is an infection that is associated "with over 80% of cervical cancer "and we're also checking if you have any abnormal cells." So those two things alone are very important. And then we talk about sexual health. A lot of sexually transmitted illnesses you don't see manifestations of, you might have abnormal discharge here and there, but there are people just kind of walking around, you might have an STI and you don't know it. So for community health, if we test you and you're positive, then you're able to inform all of your sexual partners that, you know, they need to be tested as well because uncontrolled or untreated sexually transmitted illnesses can lead to infertility in the future for women and men as well. And then screening for things, like I said, high blood pressure, making sure that we're bringing you towards lifestyle modifications for healthy living as well.

- Mm-hmm. And I mean breast cancer, obviously there's a lot of education around that. There's these national campaigns and I do feel like I'm starting to see more and more cases in women, younger and younger. So definitely, you know, we always encourage everyone to make sure they're getting those annual visits.

- Right.

- And then, I think there's like genetic testing that they can even do now to help identify some of those. But moving to the fun stuff, the prenatal, the bringing a new life into this world. When should someone, I mean even if you're thinking about having children, right, it's recommended that they go ahead and start having these conversations with an OB-GYN prior to and kind of tell us about how that relationship works.

- Right. So we find that if you come into a pregnancy unhealthy or with chronic problems that are unattended to, then you tend to have a harder pregnancy. And so the goal of the preconception counseling is to find out if there are any areas in your health that need to be addressed. If you have high blood pressure, diabetes, we can talk you through the process of getting those numbers where they should be before you enter pregnancy. Also we have genetic testing for people so that they can know if they're carriers for diseases that are most common in the population. So things like cystic fibrosis, things like spinal muscular atrophy. Those are things that we can screen for before pregnancy. So we need to make sure that women are, you don't just, you know, show up when you're already pregnant, but you also need to make sure that as far as nutrition, your nutrition is where it should be and that you're taking prenatal vitamins. So those are kinds of things that we talk to people before they get pregnant

- In regards to prenatal care, in our area in particular, and I think in Georgia there is a high rate of mothers who maybe don't get prenatal care and they just come and deliver their baby. And what is the importance of prenatal care on the baby and then also on the health of the mother?

- I think that's a really good question because I do get patients who I'll see them later on in their pregnancy and I'm like, "Why didn't you come?" And they just don't know why. Thankfully, you know, most pregnancies will go well, but when they don't go well, bad things can really happen. And the importance of prenatal care, for me when I first meet a patient is I need to find out everything about your health, your habits. Are you a smoker? Do you have poorly controlled chronic problems? The reason being that whatever chronic problems you have prior to pregnancy can affect the formation of the placenta and so that it can affect the growth of the baby as well. Things like diabetes, for example, can affect baby's heart formation, it can lead to higher risk of things like cleft palate. So those are all things that we're looking at. So your initial prenatal visit is your physician sitting down, talking to you, finding out things about your health, figuring out if there are any high-risk conditions we have to pay attention to, seeing if you have to be on medication, seeing if we have to change your medications that are okay in pregnancy. And getting an ultrasound that says this is when you're going to have your baby. Later on in the pregnancy, we do things like the anatomy scan. And the anatomy scan is basically where we look at all of the baby's organs and see if there's anything that is abnormal that requires either additional intervention now or at the time of delivery. And then we do things like screening for gestational diabetes, specifically gestational diabetes is important because if it's poorly controlled it can lead to having very big babies which can lead to obstetric trauma. So moms who are afraid of things like tears, that's something we have to make sure that their sugar is well controlled. It can also, if poorly controlled, I have unfortunately had cases where babies can die because of bad sugar control. So that is one of the reasons we always tell you, "Hey, you guys should come in. "Let's talk about your health problems. "Let's see what we can do to make sure, "even though you were not "in the best health before pregnancy, "now we know about these problems, "let's treat them." And then moving forward, if you've had issues in pregnancy like gestational hypertension or gestational diabetes, those things do put moms at high risk of developing diabetes and high blood pressure outside of pregnancy. And so once we know it and we document it, then our surveillance for you is a little different from somebody else who didn't have it. As far as babies go, we have things like growth restriction, we have things like fetal anomalies. And when we are able to find those things in the pregnancy, we can then point you to the right people and the other doctors in the community that can help you. So we can point you towards whether or not we should deliver you in one hospital over another hospital. And so that's why the prenatal visit is very important.

- Very good. Thank you for sharing that. Because I think it's something that we just need to help educate our population on, right? So that we can keep everybody as healthy as we can.

- So we've talked about prenatal, let's talk about postpartum. What kind of postpartum care do you recommend for the wellbeing of not only the mothers but the newborns as well?

- I think a huge part of postpartum for many patients is just knowing what to do and what resources are out there for you. I think of myself as primarily like a source of credible information. Especially when, you know, we live in a society where anybody can get on Google, anybody can get on TikTok and there's all sorts of conflicting information there. So my biggest thing when I'm talking to my patients is don't be afraid to come to me and ask me questions. It might be the silliest question to you, but to me it's not because that's why I'm here. That's why I spend all of this time going to school to learn these things so that I can provide it to you and I can provide information that is specific to you as a patient. We, usually, what we do is, like I said before, if we notice that you're high risk for something in pregnancy, we have to make sure that we're paying attention to it outside of pregnancy, when you're done with the pregnancy too. So for example, monitoring of blood pressures can be important, is very important in the postpartum state, just to make sure that we are not having an exacerbation of something that already started in pregnancy. I think moms really should be leaning on their postpartum nurses. They should be leaning on us, healthcare providers. And one thing I've started doing that I find really helpful is I refer my patients to ACOG's website. So ACOG is the Committee of Obstetricians and Gynecologists. So they provide us with guidelines based of all the evidence they have been able to gather over years. So that's for us professionals, but for patients, literally any question that you can think of that is going to be asked is asked on the ACOG website. And then we'll have answers on there as well. So patients, I always tell them, "Hey, go to acog.org "because they can also answer your questions." And just leaning on the postpartum nurses, from the infant side of things, they can talk to you about how to lay a baby to rest when it's time to sleep, making sure that you're doing tummy time only when it's supervised. You know, putting baby on the back when it's time to sleep and kind of talk to you about things like how you shouldn't be sleeping with the baby in the same bed, knowing the kinds of cribs and the types of mattresses that are safe for a baby as well. So I think those are really, really helpful resources.

- What about mental health in postpartum?

- I have gotten, recently, so many patients with mental health issues and actually one in five people in the U.S. suffer from some sort of mental health issue. It could be anxiety, PTSD, whatever it is. And one of the things I'm seeing is patients thinking when they come into pregnancy, they're helpless because "Now I have to stop all my medication "and now I'm back to having all these symptoms." And it's a popular misconception that I hope that anybody who's listening to this can, you know, reeducate themselves on, yes, we want to work with you as your OB-GYNs to tell you what is safe in pregnancy. But we have lots of research with a lot of the older medications to say, "This is safe in pregnancy, "you can continue to use this in pregnancy." A lot of my patients, even when I tell them that are like, "No, no, no, I'm just not going to." And we know that moms who have health issues, mental health issues that are aren't well all taken care of tend to have poor outcomes. Number one, because they don't engage with healthcare as much. If you're depressed or if you're having anxiety, you're definitely not going to come see your doctor. So we need to make sure that that's under control. And if you're not coming to see your doctor, then we're going to miss things. We might miss your ultrasounds here and there. You might just show up in the hospital, nobody knows what's going on between the last time you've seen your doctor and now. So it's a huge issue for me. I'm constantly talking to my patients, trying to provide them with resources and also leaning on the other resources in the community. 'Cause I think therapy is also really important. I don't always necessarily have to give you medication, but I think you do have to have a way of coping with being pregnant. And also knowing that with the hormone changes that happen in pregnancy, there can also be changes in your symptoms as well.

- Right. Because I mean your hormone changes, that's not really anything that you can control, right?

- Right.

- I mean that's something happening within your body and just being aware and knowing that you have a partner in your health that can help you navigate that so you don't feel alone and just not feeling afraid to speak to somebody about that.

- Right.

- I think is important.

- And touching on misconceptions, are there any other popular misconceptions you see that you address frequently in your practice?

- I think the biggest one, just 'cause we're just in the flu season now, is that pregnant women can't get the flu shot. And actually it's the opposite. They should get the flu shot. Pregnancy is, we recognize it as what we call an immunocompromised state. So in order for you to be able to have a healthy pregnancy, your body has to lower some of its immune defenses. And that means that when you have some sort of infections, whereas when you're non-pregnant, your body's like, oh, let's fight this thing. Now you have lower immunity where a flu can be anything from just like a cold or runny nose to full-blown pulmonary disease that requires you to be on a ventilator. And I've seen that a few times too. So I always let my moms know, "Hey, the flu shot is something I recommend in pregnancy. "And it is good for not just you but also the baby." I think something patients don't know sometimes is that most of the vaccinations we give you also provide immunity for the baby either through your breast milk or some of these antibodies will travel through the placenta as well. And so you're not just doing it for yourself, but you're also doing it for baby as well.

- Yeah, I think

- Wow.

- of the unfortunate thing that we saw during COVID was that a lot of pregnant women would, you know, miscarry during that because their body was trying to fight, you know, couldn't fight the disease because it was protecting the child and that concept was definitely highlighted in that realm and something we want to prevent, so.

- I didn't know that. That's very interesting to me. So we have a question that was submitted from a listener that we were gonna ask. So it says, "Why is it that sometimes I pee a little "when I laugh or cough "and what can I do about it?"

- So that sounds like stress urinary incontinence. So in general, urinary incontinence is when you pee without intending to, and there are different forms of incontinence. This sounds like stress urinary incontinence. So if you think about your urethra, which is where you pee out of, as being some sort of tube and you think of the muscles of the pelvic floor as a valve. So the valves keep urine from coming out and they need your permission. So you as an individual say, "Hey, it's time for me to pee "and now I will, you know, relax my muscles and I'll pee." But what happens with stress urinary incontinence is over time, so it could be because of age and gravity, but it can also be because of trauma. And the biggest trauma we think of is childbirth. So there is trauma that happens to the pelvic floor during childbirth that is what we call occult. You might not see it with the bare eye, but it can't happen. And so those valves that are supposed to be holding everything in are now loose. So even when it's not time for you to pee, you sneeze and because there's more pressure in your abdomen, it just pushes out any urine that you have left in there. As far as things to do, there are many options. It goes from things like pelvic floor therapy where you retrain the muscles of the pelvic floor to something called a pessary, which is something that I provide in my office. So it's basically a plastic that goes in the vagina and provides support to the urethra, kind of like what, like, I explained the valves would do. And then there's also surgery and there are different surgical options as well. So there are options out there, you just have to talk to your doctor about it and then they'll probably send you in the right direction.

- It's probably one of those things that people don't really want to talk about, right?

- Right.

- That they're like, "No-"

- Or they don't know that there's any options

- Right.

- for it, so.

- Right.

- I know I feel like I've heard that from people before, especially when they're like, "Oh, I can't jump on that trampoline" or, you know, "I can't do anything "that would bring gravity around "because of that."

- Right.

- So they don't have to continue to live like that. You can, you know,

- Right. Right. consult a physician and see-

- And I would say that that's also one reason why you want to be seeing your OB-GYN too, because we have a list of questions we go through. Even if you don't tell me, I'm going to ask you about intercourse and if it hurts, I'm going to ask you if you pee when you sneeze or if you have any leaking of urine. It's not questions that other specialties might be asking you. But that's what we're trained to do

- As far as women's health, and you kind of spoke, well, you know, we talked about, you know, our tendency to put others first and then what have you seen as far as the health of communities? Because I've done a little bit of research just because it fascinates me too. But that... And what I saw is that communities that have healthier women have healthier communities because the women then translate that-

- Will push everything... Right. Right

- Yes.

- To their families.

- Right.

- So what are your thoughts on?

- I'm completely on the same page. I see that, I know that when women are there, especially, you know, when I have patients who are younger for example, and they come with their moms, I'll ask them questions and they'll be like, "Oh no, I don't have any problems." And their moms are like, "Remember, two years ago when this happened?"

- Yeah.

- And they're providing you with more information that can serve the patient's overall care. So I really do think that community health is a huge part of women's health. I think that providing access to care is a huge portion of improving the health of the entire community. You know, providing options where patients don't have to travel so far, 'cause imagine if you have to travel for two hours to see the nearest doctor, you're going to be discouraged, you know. So I think providing local things like health fairs, all those things provide people the opportunity to check things they otherwise wouldn't be checking.

- Mm-hmm. And you offer robotic surgery. So you had mentioned that you really enjoy surgery. So tell us a little bit about the surgeries that you might typically perform. I know obviously one might be a, one that comes to mind

- C-section

- is a C-section, but I know you probably do other things.

- Right.

- So just tell us a little bit about those, so that we...

- So like you said, I do C-sections when medically indicated, I also do hysterectomy, so that's the removal of the uterus. I take care of cysts. So cysts that have to do with the ovaries if they need to be removed. Hysterectomies can be open, so where you have like a big incision or robotic. And the thing I like about robotic surgery is that most of my patients get to go home the same day. You know, it's a major surgery just through four or five small incisions on your abdomen and then you get to go home the same day. So it's less time that you have to take off of work or it's less of an interruption to your life. And don't get me wrong, it's a big surgery

- Major surgery. and so you still have

- Yeah.

- to kind of pace yourself. But that's something I really enjoy. I do, right now, I'm very interested in pelvic floor work as well. So pelvic floor repair, there is obviously some limitation to my scope as I'm not a urogynecologist, so I do incontinence work as well, as well as prolapse repair. And then a lot of the stuff I'm doing are like DNCs, if you have a fibroid that can be removed through the cervix, that's something we can do easily for you. I deal heavily with heavy menstrual bleeding. We have options for patients including things just like a DNC where we just kinda remove the tissue, to things like an ablation, which is where we burn the, or I guess when I say burn it sounds a little... Use heat. You use heat to...

- We use heat. We use heat to treat the inside of the uterus. And that can significantly change, you know, the quality of life of people who are dealing with heavy menstrual bleeding.

- Yeah, and I think it goes back, again, it reiterates the importance of having a physician because I imagine so many people unnecessarily suffer because they do not just take that time

- Right.

- to get things seen about and be proactive, so.

- Definitely. Not only just having a physician, but we've talked about this, having physicians that reflect the community.

- Mm-hmm.

- So, how important do you think it is for your patients to have a physician, not only to be able to see a woman physician, but to see a physician that looks like them. So if you're a person of color wanting to see a person of color as your physician, do you find that that is important to have in the community?

- Yes, definitely. I think I find that my patients, sometimes I'll walk into the room and, you know, their faces will change and they'll tell me so much more than I would've anticipated, you know, prior to coming into the room. I think it's just a natural human instinct. You tend to relate to who looks like you, you want to go to who looks like you. It doesn't mean that anybody who doesn't look like you won't provide you good care. But I think there's also some cultural context there, where if a patient is a patient of color and they tell you something, you don't have to ask too many questions 'cause you kind of already understand the context that they're coming from. And I think it allows them to trust you more, to provide you with answers to questions that can impact their health instead of just, you know, keeping quiet and holding it all in.

- Yeah, and we're, I think from my perspective, finally blessed to start seeing a greater diverse group of physicians and more female physicians in our area. 'Cause for a long time, especially in South Georgia, I mean we just didn't, it was predominantly white men

- Right.

- and that's not to say that they can't provide good care, but it is proven that, I mean if you're especially having a baby or you're a woman, you kinda want someone that's maybe been through it before. But-

- Yeah, it's astounding that the statistics we were looking at recently, only 30% of physicians in the U.S. are women. And then when I looked at the physicians that were, you know, maybe African American, it was only like 3%

- Right.

- in the U.S. And I was like, we're so blessed to have so many women and, you know, African American women physicians and I think it's really a positive thing for our community.

- Yeah.

- And I think raising awareness too for young girls that, you know, it is an achievable career. So you grew up around medical providers, so you kind of were exposed to that, but a lot of people aren't. So I love the idea of our younger community members seeing our physicians

- That it's possible. and being like, "Hey, I can do that. "I can maybe do that."

- Yeah.

- And then being encouraged to-

- Girls can do it too.

- Girl power.

- Yeah.

- Definitely. Yes. I definitely... You know, I think there's a huge shift now where I trained in residency, we were 20 in the entire like residency class and they were... Not the class, the entire four years and there was only one guy. So

- Yeah, do think it's shifting now.

- It has shifted, like rather dramatically.

- Yeah. I've noticed,

- Yeah.

- and even in our residency program, there's more women, right?

- Yeah.

- I mean, and so I do see that shifting, which is definitely a positive thing because even Dr. Distler kind of hit on this in our cardiology podcast, but historically research was only done on men too. And so then that affects your treatment, your care, and we're starting to shift that. So really cool times. I mean, I'm glad to be a part of it. I'm glad that we have you here on our team. And so-

- Yes, definitely. Another topic that we wanted to talk about was maternal and infant mortality rates and what could be done to prevent these cases from happening. And what are you seeing in your practice? What have you seen in your training?

- Mm-hmm. I think it's really sad that we're still dealing with that. You know, even with all the advances in medicine that we're still dealing with that. I was looking at the CDC statistics and it has worsened even in the last 10 years. And when I look to see what the why was, there's a lot of research that shows that Black non-Hispanic women had the highest rates, even though they don't make up that much of the population. They're not the majority of the population. And that was traced back to some bias with the healthcare providers. We also see that some of the causes are things like pulmonary embolism, high blood pressure in pregnancy. So obstetric hypertensive diseases, postpartum hemorrhage. And when I sit down and I'm like, what is it that I personally can do? The biggest answer is to make sure that my patients are of optimal health before they're in pregnancy. And an early recognition because take for example, obstetrical hemorrhage, it's possible for you to start to see patients late in the third trimester who have low hemoglobin, you know, and what you want to do is kind of pump their hemoglobin stores so that by the time that they deliver, even when they lose blood, they're in a good position. So it's all about recognitions. A lot of these things are recognizing who's at risk for this, "Is my patient..." I talk a lot about obesity. I did a lot of research on obesity when I was in residency and we find that one in four women of reproductive age are obese. And what does that mean? It means that they're at higher risk of diabetes, they're at higher risk of high blood pressure, they're at higher risk of labor abnormalities and needing C-sections. And because they have more fat, it also means that they are at higher risk of wound complications. So what does that mean for my patients? For me it means talking to you, not shaming into thinking that, oh, this is your fault and, you know, you have to do something about it. But telling you, "Hey, "these are the resources I have for you." I'm happy that now we're talking about medication for the treatment of obesity. Because what I think we'll see in the next few years is that with treatment of obesity, high blood pressure will reduce, diabetes will reduce, and so we'll have more women coming into pregnancy healthier. But in the meantime it's talking to you about lifestyle modifications. And I think overall that's what is going to help us to reduce our mortality rates.

- And I think most, I don't know, I'm saying I think, but I have no idea. I think I just, when I was pregnant and I've had two children, you know, I trusted everything was gonna be fine. I really wasn't worried about anything happening during my delivery or anything. I'm like, well, so many people do it every day. Surely it's just gonna be fine. And it was, but it's a major event, right, for a woman.

- Yeah.

- And I mean it's important to be your best and then have the right team available. But I do think people underestimate what's happening

- Right. Right.

- in a delivery. And I mean, you're there,

- Yeah. Yeah.

- you see it all so how does it feel

- It is pretty life-changing

- for you as a physician? I mean, you're there at this most important time in someone's life. And what is that like?

- You know, it's really, I've had some situations where I'm saying bye to my patients after they've had their babies. And these are patients that I was seeing, you know, every week at the end of their pregnancy. And then I don't see you again. And it's actually really emotional for me, but being part of a moment where this child is brought into this world, I think it's just very special. When I first started, I used to cry in every delivery and I was like, nope, this is not sustainable. So it's honestly such a privilege and such an honor to be part of that whole process. But like you said, it's not a joke. You know, in the old days you either gave birth or you died in childbirth. They didn't have C-sections, they didn't have a lot of the interventions that we have now. So we should be thankful for that. But we shouldn't take for granted how life-changing and how every time you're pregnant your life is at risk, really.

- Yeah. Yeah.

- Yeah.

- It's so fascinating. So fascinating to me. What's the craziest, I mean, so people that don't find out their gender for their babies,

- Yeah.

- I didn't find out with my second one, and I thought that was the coolest thing because there's so little things that you can be surprised about in life like that, that are truly real exciting.

- Right.

- Most surprises may not be that exciting.

- Right.

- But that was super fun for me. But is there any kind of crazy thing that you've seen, a trend or anything of people doing with labor and delivery that's unique?

- That is hard for me.

- Yeah. I should ask you that. I didn't give you that question, heads up. I was just... My brain.

- I think I still, I just like it, you know, when they have their gender hidden and you like get the dad to be like, "What is it?" And then they announce it.

- Yeah,

- But you are right. I think it's the one thing that you can have somewhat control over. And I think it's nice when they do that. I can't think of anything else right now.

- Okay. That's fair. That's fair.

- Well, thank you so much for being here today. We're trying to get you on and we finally got you on here and I just was so excited to talk to you, someone in women's health because I'm passionate about it. I mean, not just as a woman, but because of all the things we talked about. And it's so important to have an advocate and have someone who looks like you. So we're glad that you're in our community.

- Thank you. Thank you for welcoming me. Thank you for having me. I love talking about this stuff, so this is nice for me too.

- Cool. All right, guys or ladies, you heard it here. If you have any questions or topics you wanna hear about that we didn't cover today, feel free to drop us some information in our forum below. And then make sure you subscribe and like our podcast so that you can get informed about your health and what's going on here around us and in our health system so that you can be your healthiest self. So thank you, Dr. Morgan, for joining us. Thank you, Taylor. And we'll talk to everyone else soon.