St. Bernards’ Serena Vance, DO, discusses innovation, challenges in OB/GYN
By MELANIE KILGORE-HILL
Serena Vance, DO, OB/GYN, is changing the future of women’s health in Northeast Arkansas and Southern Missouri. As Medical Director of the Obstetrics and Gynecology Department at St. Bernards Medical Center, she's offering hope to women across the continuum of care, from fertility concerns to childbirth and menopause symptom management.
A native of Republic, Missouri, Vance received bachelor's degrees in secondary education and biology from the University of Missouri-Columbia before earning her Doctorate of Osteopathic Medicine from Kansas City University of Medicine and Biosciences. She went on to complete a residency in obstetrics and gynecology at Akron City Hospital in Ohio before joining Ascension St. Joseph Medical Center in Joliet, Illinois. In 2015 she and her husband, electrophysiologist David Vance, MD, made their way closer home to Jonesboro.
An early interest
For Vance, the road to healthcare was paved early. “I was always interested in medicine, and when I was 16 my dad and stepmom decided to have a baby,” she remembered. “That pregnancy and delivery just sparked an interest.” Vance also took advantage of a high school-hospital partnership that encouraged students to explore healthcare careers. “What I really like about OB/GYN is that it’s varied between clinic time, labor and delivery and surgery,” she said. “Sometimes they run together and it can be harder to manage time, but I like that I’m not in one place every day. It keeps the job interesting and there’s always something new.”
St. Bernards Healthcare
Vance is particularly interested in prolapse surgery and is comfortable treating higher-risk obstetric patients with chronic conditions such as diabetes, thyroid disease or hypertension. As the only NICU east of Little Rock, St. Bernards welcomes more than 100 babies each month and is able to accommodate the majority of higher risk pregnancies. The independently owned health system also includes St. Bernards Five Rivers Medical Center in Pocahontas and CrossRidge Community Hospital in Wynne, along with several specialty, surgical and primary care outpatient clinics throughout Northeast Arkansas. Vance said working for a smaller, locally owned health system has tremendous advantages. “Physicians and administrators here work well together toward having a successful system, as well as really great patient care,” she said. “They take care of things quickly and administrators listen to staff and physicians. That’s hard to come by.”
Innovation in OB/GYN
Vance credits advances in minimally invasive procedures for better outcomes in obstetrics and gynecology, offering patients more options, quicker recovery times and shorter hospital stays. “We’re able to get patients back to daily activities so much faster,” said Vance, who uses the Da Vinci Robotic Assisted Surgical System to perform once complicated procedures. “In the gynecological world that’s been the greatest innovation over the past decade.” Advances in obstetrics include more options in pain management for maternal comfort, including use of nitrous oxide as a noninvasive alternative to epidurals. “The gas is only active when inhaling and has a short half life, so it takes the edge off laboring and still allows mom to walk around or sit on a labor ball,” Vance said.
She’s also seeing more women turn to weight management medications to combat infertility triggered by polycystic ovary syndrome and metabolic disorders. “We know that dropping 15 percent of your body weight significantly boosts fertility, so I work with patients who are trying to lose weight in order to get pregnant,” she said. Combine that with the number of women waiting until their 30s to start a family, and the risk of fertility problems further increase. “We’re seeing more and more women affected by increased maternal age, obesity and health concerns, especially in the American south,” she said, citing baseline hypertension, diabetes and thyroid disorders as now common diagnoses affecting conception. “In the fertility world we try hard to help with what we can, then try medications to improve a woman’s odds while increasing the chances of a healthy pregnancy.”
Vance also works to combat misinformation among patients about the role of hormones in women’s health. “There’s a misconception that hormone levels provide physicians with a clear understanding of what's going on with a patient, but levels vary so significantly through each woman’s cycle,” Vance explained. “I also can have two menopausal women the same age with the same low hormone levels but with completely different symptoms. That’s why we treat symptoms and not lab numbers.” Pills, patches, creams and vaginal rings all provide relief, while many menopausal patients use a newer class of medications that affect the thermoregulatory part of the nervous system. Vance said the recent popularity of telemedicine also is a game changer for older women, who often need a conversation rather than a physical exam.
Pap smears and yearly exams
Vance said evolving pap smear screening guidelines often cause confusion - and apprehension - among patients and providers alike. While today’s five-year screening guidelines make some uncomfortable, there’s often confusion between pap smears and yearly exams. “There’s still a lot of education that needs to happen,” said Vance. “I tell patients I don’t need to scrape their cervix every year, but that they still need to have their wellness exam. Overall, women are much more aware of the need for screenings, including mammograms, and will let us know if they find something that’s concerning.”