The Intersection of CVD and Obstetrics

July 4, 2023
Guest: Stephanie Little, MSN, RNC-OB, C-EFM

Stephanie Little, MSN, RNC-OB, C-EFM, examines cardio-obstetrics, a growing field focused on the link of CVD in patients who are pregnant, post-partum or have had pregnancy-related health issues. The conversation also includes information about professional development throughout the nursing career and a review of the importance of nutrition on heart health.

 

Episode Resources

Welcome to Heart to Heart Nurses, brought to you by the Preventive Cardiovascular Nurses Association. PCNA's mission is to promote nurses as leaders in cardiovascular disease prevention and management.  

Geralyn Warfield (host): Welcome to today's episode where we're talking with Stephanie Little. Stephanie, I'm going to have you introduce yourself and then we'll get started with our conversation. 

Stephanie Little (guest): Absolutely. Thank you. My name is Stephanie Little, as she said. I am a Labor and Delivery nurse, originally, I've worked in labor and delivery since I graduated nursing school. I have now my Master's degree in Nursing Education, and I'm currently working through my PhD in, in nursing, focusing on health equity. 

Geralyn Warfield (host): Well, one of the things that our listeners may be interested in learning about is the trajectory of professional development as you continue through your career, whether or not you're new to the, to the field of nursing, or whether you've been in it for quite some [00:01:00] time and are more tenured. Can you talk a little bit from your perspective about professional development, maybe some resources that people can go to at every stage? 

Stephanie Little (guest): Yeah. I actually started my nursing career as an, as an Associate's Degree program because when I started nursing school, I had a five-year-old and a four-month-old.  

Geralyn Warfield (host): Oh my gosh. 

Stephanie Little (guest): So, I was in the very first evening weekend program of that community college, which worked out really well for me. And then I did my Bachelor's online and I didn't know that I wanted to do my Master's degree, so I waited a few years for that. 

And then my Master's in Education, but in the meantime, I also have done certifications in Inpatient Obstetrics. I always encourage our new nurses that there's so many certifications in all the different specialties. There's different, we have over a hundred different professional organizations that we can get involved in.  

That, I don't think anybody really teaches new nurses when, when [00:02:00] they're graduating, how important it is to be involved in these different organizations. Because a lot of that development, that professional development is going to come from your organization, which unfortunately is, unfortunately is very divided between different specialties in nursing, but, they have so many resources inside of those different organizations. Like Preventive Cardiovascular Nurses Association has all of the resources. 

Geralyn Warfield (host): Well, I understand that new nurses, and in fact all nurses, are so busy all of the time. How do you suggest that a nurse pays attention to the importance of professional development and how it fits into everything else that's happening in their lives?  

Stephanie Little (guest): Yeah. We are. I imagine, especially as a new nurse, that it was for, for myself, it was incredibly difficult to care, outside of the hospital, what was going on. 

I hope, in theory, a [00:03:00] lot of nurses work for the hospitals that care about their professional development and want to give them that time and those, those extra resources. I am very fortunate to work for a hospital that is not for profit, and that always gives nurses that, that time and even extra hours. 

I set up, personally, for the nurses in the maternal child areas, different educational opportunities for them. But even things like the Association for Women's Health, Obstetric Neonatal Nursing, they have, in my area, dinners that are just, it's a $10 dinner with educational opportunities that keeps them kind of up to date while still getting together with peers in the, the area. 

So, it's a couple hours out of your night in a three-month period that will help you. But even in downtime, in our downtime, [00:04:00] which is few and far between, but sometimes, you know, reading some of those journals that interest you. I think to not get overwhelmed with the amount of material, but just pick what you're interested in and really dive into it. 

Geralyn Warfield (host): So, nursing, like every career, has changed over time. And even a new nurse graduating, let's say this spring, might have a great breadth of information. But still, guidelines change all the time. And so, it sounds like we're encouraging our listeners to be active and involved so that they are providing the latest and greatest guidelines, guideline-based directed medicine. So that we are providing for our patients the, the best possible care, with the most current pharmacotherapies and those types of things. Is that an accurate statement?  

Stephanie Little (guest): That is an accurate statement. Things have changed so much just in [00:05:00] the time that I've been a nurse. And it’s small things too, but there are things that have changed that we've realized, science, that this is not the best practice and we should change this. And sometimes it's hard to want to change your practice, especially, “I just learned this, I just got comfortable with it”. 

But we do, we want to provide the best, most up to date care for all of our patients.  

Geralyn Warfield (host): We're here with Stephanie Little and we're going to take a quick break and be right back.  

 

Geralyn Warfield (host): Thanks to our listeners for coming back and joining our, rejoining our conversation with Stephanie Little. Stephanie, we're going to change trajectories just a little bit and talk a little bit about something I know is a passion of yours and that is obstetrics and the intersection of that in cardiovascular kind of care. 

And I'm wondering if you might think about your expertise and maybe consider a case or something that you would like our listeners to know about when it comes to that intersection of those two fields.  

Stephanie Little (guest): So, cardio, obstetrics specifically [00:06:00] is, is kind of a new growing niche area. But it's incredibly important because 70%--I may be misquoting the number—a lot of the percentages are, a lot of the, a lot of the cases of maternal mortality are related to cardiovascular disease. Whether it is obstetrically induced, because pregnancy, we're saying, is kind of the stress test on your heart, whether or not you can, you can handle that. 

There's a lot of underlying things that come up when you find out you're pregnant. Some women have never been to a provider prior to pregnancy. Pregnancy's the first time they're entering the healthcare system. So, they may have been hypertensive, they may have been diabetic, or it could be a pregnancy-induced situation. 

So maternal mortality is, is completely interrelated with this [00:07:00] cardiovascular disease process. It's, it's so important that we understand not just our very niche obstetric areas, or not just cardiovascular system. It's a whole person. So, getting to understand those processes and not feeling like if they have a cardiovascular issue, hypertensive disorder, that we don't have to pay attention. 

And in obstetrics, I think that we, we are very specialized. And so, we forget about the whole rest of the disease process. And even when people come in in postpartum heart failure, it's completely related to pregnancy, but when they arrive at the emergency department, they don't ask if you've had a baby in the last year. They'll ask you if you're pregnant.  

But as soon as you come in knowing that this woman has had a baby [00:08:00] in the last year, it changes how you should be viewing this woman and may change your diagnosis. Ultimately may get to your diagnosis faster because there's much more specific things related to the pregnancy that we're going to be looking for. 

Geralyn Warfield (host): Stephanie, could you give us a specific example of a case maybe where you saw this in action?  

Stephanie Little (guest): Yeah. We recently had a patient that had, she was an older first-time mom—and we are having babies much older than, than we did, but that comes with additional preexisting cardiovascular complications that your 19-year-olds may not have, where your 40-year-olds have the additional stress on your body. 

But she had a hemorrhagic stroke, flown into our hospital because we are a stroke center, and we have the appropriate obstetric care, which was new for our very small hospital [00:09:00] to have both of those situations at the same time. But she was taken care of appropriately, thankfully. 

I did have another person that was a student of mine that actually went into heart failure a couple weeks after having her baby. And she was a 30-ish-year-old Black female, which comes with all of those complications. And, thankfully, she had a provider that listened to her. There are providers out there, when you complain of being tired after just having a baby, you may be dismissed, unfortunately, and sometimes those things are missed.  

Another patient that was not in my area, it was one that a doctor talked to us about, that went into the hospital postpartum to the emergency [00:10:00] department, complained of headache. Her blood pressures were through the roof. They didn't ask her that important question about whether or not she had a baby in the last little while. And she had a seizure, and a stroke and died while in in CT.  

And just that one question, they could have had her on magnesium faster. Understanding that there's so much more going on than just what they're presenting with. People underestimate that postpartum period. 

Geralyn Warfield (host): So, it sounds like one of the other things that we can try and encourage our patients to do. And I realize that clinic settings, EDs, various locations, there's not even enough time to catch your breath, much less spend a lot of time in nurturing that provider-patient relationship, but really helping our patients learn how to advocate for themselves. 

If you're not getting the answer that you want, to [00:11:00] keep repeating yourself, to be incessant if you have to in your questioning or your types of information that you're trying to gather, so that you can be an advocate for your own health. And particularly for these women who are either going through pregnancy, or have just given birth, you know, if something doesn't feel right to keep on that. 

Stephanie Little (guest): Yes.  

Geralyn Warfield (host): Is that accurate?  

Stephanie Little (guest): Absolutely. Say something, speak up for yourself. I think that we don't do a good enough job, in general of, of letting patients know that they can advocate for themselves. The person with the healthcare degree of any sort may not always know best. We don't know what's going on in your body. 

And on the other side of that, we should be listening to people when they're trying to say, “This is what's going on. Something is wrong.” Oh, that's something that I teach my, my novice nurses, is to make sure that these women, when they come back into the hospital, if they come back into the hospital, they [00:12:00] speak up for themselves to say, “I just had a baby. This is what's going on. I think that something is wrong.”  

And making sure that they know that, even though the emergency department nurse isn't going to ask, because that's not on a lot of our electronic documentation, so it doesn't, there's not a trigger for them to ask, to be fair. But they need to know that they need to advocate for themselves and, and make sure that that nurse knows that this is what's going on, or that provider knows what's going on.  

Geralyn Warfield (host): Great suggestion, Stephanie. And speaking of being responsible for yourself, there's one thing that all of us can do, whether or not we are pregnant or have just given birth, and it has to do with our nutrition, and how that affects our heart. 

So, I realize that's a slight deviation from what we've been discussing, but it really does affect all of our listeners and all of our patients. I'm wondering if you could address that for us.  

Stephanie Little (guest): Absolutely. I, I really think it's interesting. I think we're learning so much more about [00:13:00] how even, even the very first thing that a baby eats sets up their microbiome for life. 

So, it changes how we develop, how, our hypertensive disorders, all of these things., I think that in American culture, we underestimate the effect of sugar and all these pro-inflammatory things that we eat. Other countries don't have these, as many cardiovascular diseases, as many diabetic problems. And I, I think it has to do with not just the quantity that we eat, not just the, the calories and, it's, it's what we eat, how it's processed. The sugar that we consume, which is very addicting and I understand [00:14:00] that.  

But I think if we set up our children, if we change our relationship with food. I did grow up learning that you clean your plate, because they grew up learning you have to clean…we worked hard for this food, you have to clean your plate. And that can be really difficult to talk yourself out of. That I do not have to finish every bit of food on this plate just because it's sitting in front of me. And that ‘this food is bad, and this food is good,’ sets us up for failure because we want that ‘bad’ food. So, everything in, in moderation and, and we don't need to have that ‘bad’ food because it's not a ‘bad’ food. It didn't do anything wrong.  

Geralyn Warfield (host): The other thing that's changed over time, if you look at portion size, for example, from the [00:15:00] 1970s to today, just the size of a hamburger at a particular location has doubled or sometimes tripled in size, and that's in diameter, not even including the two or three or four patties of beef. Those types of things.  

So, you are right. We have the deck sometimes stacked against us in terms of what we've been taught in terms of plate cleaning, in terms of portions that are available to us and issued at a single serving size, which, you know, 30, 40 years ago would've been three or four people's serving sizes. 

And you're right, that addictive property of sugar and other additives that we consume all the time that really make it tough for us to make good quality decisions about our, our diet. So, I think you and I both would agree that encouraging our listeners to maybe leave a bite or two on your plate today at your next meal and drink more water instead of sugar sweetened beverages. 

All those types of things, small steps, and that includes actual [00:16:00] physical steps can make a big difference in our overall health.  

Stephanie, is there anything else that you'd like to add that I did not ask you today?  

Stephanie Little (guest): One very small thing. Working in the hospital with novice nurses. I have had this group…until now, these groups haven't had clinicals because of the pandemic shut down there. Some hospitals allowed it, but a lot of areas didn't. 

Give these new nurses some grace, as they're learning, 

Geralyn Warfield (host): I think we all could use a little bit more grace in our lives. So, Stephanie, thank you so very much for taking time with us today. 

Thanks to our listeners for joining us, and this is your host, Geralyn Warfield, and we will see you next time. 

 

Thank you for listening to Heart to Heart Nurses. We invite you to visit pcna.net for clinical resources, continuing education, and much more. 

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