Q&A with Courtney Allen Cowardin

Associate Medical Director of Women’s Health Courtney Allen Cowardin, CNM, and her team make sure their patients feel respected, heard and cared for. This Women’s Health Month, let’s learn more about how they do it.

Can you tell me what drew you to women’s health, and why did you get into this field?

I started as a nurse, and was working at Methodist Hospital at their gynecology and oncology hospice. And there I was with mainly women. I was also working at OneWorld at the same time, which was called the Chicano Health Center back then. Just kind of by chance really, I got put with the OB clinic. Everything happens for a reason, and I’m glad that I was, because I just realized that I was drawn to women’s health.

I’ve always been a feminist my whole life, just the way I was raised. Everyone has ability and should have access to everything. That was kind of my upbringing.

But seeing [pregnant] patients – although it’s a happy time, it’s a vulnerable time in their life. Our patients here especially need a little extra care. Some of them have never been cared for during pregnancy, physically or emotionally, and so being able to provide that for them was really neat. From that grew my desire to then also work in labor, delivery and postpartum at [the now-closed St. Joseph’s Hospital]. I would see some of the patients at the clinic in the hospital just because I would be their nurse in the hospital as well. That was bringing it full circle.

Then that led me to realizing the next step would be to become a midwife. And so I left and went to the University of Washington, knowing that the plan was always to come back here and be a midwife. I didn’t want to stop taking care of these women in particular.

I’ve been working as a midwife for 20 years. I really like focusing on women’s health, number one, because I am a woman, and I have a daughter and I have a mom and I have females in my life that I love and want to make sure that their health is taken care of. But also because I think just historically, we need to have more people taking care of women in a way that is appropriate and safe and kind and respectful. It hasn’t always been that way. I thought if I’m not the person who could change everything, I can do my part to make sure that women I come in contact with get treated well.

And hopefully the people that I train, I train them to also treat people well. It’s just a passion of mine to make sure that, when a woman comes in to see me or comes into this building that they’re kind of given the red carpet. Their needs are met, they’re listened to, they’re helped in the best way that we can. They’re empowered, maybe they’re taught a few things health-literacy-wise. They leave and they feel like they have better knowledge about their body and feel like they have control over things, that they have choices.

What are some of the frequent reasons that patients are coming into the OneWorld Women’s Health Clinic? Along with that, what are some key areas of education that you do as providers?

The vast majority I would say falls in three sections. One is, prenatal care. One is birth control or reproductive health. And then the other one would be a mix of everything else: menopause, earaches, depression, vaginal symptoms, stuff that I would maybe put in gynecology, but also not focusing on family planning or anything like that.

We do a lot of education about birth control and demystifying some of the things about it. Safety is one of them. We try and talk to people about safety. People come with preconceived notions or hear stories of what I think birth control probably was like 50 years ago, maybe not so safe. But it’s better now.

What was taught and passed down from generations to generations is hard to undo. [Birth control] doesn’t affect your fertility in the future. You don’t have to have a period – that’s really OK as long as we know why. And we talk about fertility, as far as when you can become pregnant in your cycle and when you can’t.

We do a ton of talking about the HPV virus. A lot of it is trying to calm people down. You notify them that they have HPV and they immediately think that their partner cheated on them, and/or they have cervical cancer. And so trying to back that up a little bit and helping them not be as afraid, but also be empowered to then talk to their partner about something if they think it’s necessary. Also to not be embarrassed. It’s one of the most common things in the world that people have. I tell people you probably passed 85 people in the car today that had HPV and you didn’t even know.

There’s anatomical education that goes on too. It’s not just our patients. Anywhere, talking about your body, I think it’s taboo for a lot of people. Bringing things up in the review of systems – you know, if you’re having any problems with X, Y and Z – opens the door to talk about something that they had never thought about, or they’ve been too embarrassed, or that they’ve been ashamed of talking about before. We give them the option and the opportunity to talk about something in a safe place.

Are there other things that come up a lot or other things that you wish patients knew more about?

Yeah, my team and I are kind of on a menopause education train right now, partly because a lot of us are going through it, but also because that was something that was taught to a lot of us: that you don’t treat menopause because it’s deadly to treat menopause. That’s been debunked. I was taught that if you give a woman hormone replacement therapy she’s going to have a heart attack and she’s going to die. We know now that because the way the study was done and presented that it’s not true anymore. Undoing those decades of fear of hormone replacement therapy is turning out to be really hard. For the providers too, it’s hard to unthink that I’m doing harm to somebody when I’m prescribing something. We’re slowly but surely getting women to actually talk about it. For so long I know it wasn’t brought up because we couldn’t do anything about it, because everyone was too afraid to do anything.

So now, we can help you with that. You don’t have to suffer through X, Y and Z. Just because you’re not having hot flashes doesn’t mean you’re not having other symptoms of menopause. We’re bringing an awareness of what they’re feeling. Instead of just, “here’s some medication for your depression,” let’s treat your menopause symptoms that maybe are making you depressed, and then help with that. It’s a whole new world that shouldn’t be a new world, but it is. Now we know how safe and actually protective it can be for the right person to give them hormone replacement therapy. I think that’s big on everyone’s brain right now, trying to make sure all the patients that we’ve inadvertently missed in the past decade to, if they show up again, to get them something if they need it, or at least get them to talk about it or not feel like they’re alone.

In thinking about different points in a woman’s life span, when do you recommend coming in, or why do you recommend coming into women’s health for the first time?

For the first time, ideally it would be to come in for what we call the well woman exam. Maybe that includes a pap smear if you’re old enough – and talking about breast exams, knowing your body, normal feelings and physical symptoms, cycles and protecting yourself from things. Ideally, with a teenager, it would be lovely to see them before they’re sexually active. If not, at least trying to help them get through that safely.

Also with vaccines, we don’t do a whole lot of that because by the time we see them, their vaccines are mainly caught up. Mental health is a lot of people – I wish they would have come in sooner for some mental health things. I would say it’s starting with the well woman exam, to just take a baseline of, “how are you doing, and is there anything we can help you with?”

So thinking about a teen specifically, do you work with the teen clinics? How does that interaction with other departments work too?

We have two clinics that are dedicated to teens and young adults, which is lovely. The providers there know what they’re doing, and they’re so good at that. If for whatever reason the patient doesn’t go there and they come here, oftentimes, it’s a referral from the pediatrician because they’ve maxed out on the things that the pediatrician is comfortable doing or talking about, so they’re now transitioning to us.

I have a lot of patients that I’m seeing their daughters. I’ve known them for 10, 15, 20 years and now I’m seeing their daughters as they’re coming up in age. It’s kind of fun to do that. I think like anything in any town, especially kind of a smaller town, word of mouth is big. People know what OneWorld is and that we’re here, and they can walk into the women’s clinic and get an appointment.

For a patient who’s coming in for the first time, what are some of the things you might invite her to discuss with a provider at Women’s Health?

If she is able to become pregnant, it’s talking about her plans for pregnancy in the future, or lack thereof, and how she wants to make sure she can complete that plan. We talk about protecting them from future problems, by getting tested for STIs and talking about protection from STIs. 

A healthy weight is a good thing. We all know that obesity is an epidemic and the effect that has on your lifelong health. We talk about that kind of thing as far as, do you have some exercise in your life? If you do, that’s step number one, that’s awesome. Mental health, we know that has repercussions later on if it’s not treated, or it’s not diagnosed.

Bring with you anything that you want [to talk about]. For the next 40, 50 years of your life, what are your goals and how can we help with that health-wise? We can talk to you and help prepare you for pregnancy if that is your desire, or prevent pregnancy until/if/when you are ready.

Is there anything else that you want to make sure to highlight?

We have a very large group of women’s health providers, a huge concentration of us, that have dedicated our profession to women’s health. We all speak Spanish and we’re all here for the mission. I think that’s a pretty unique thing.

I’m so glad that the people who are here, are here, because I know that they will take just as good of care of the patients as I would. I know it’s so important to them to make sure these women feel important, safe, heard, capable and all the things that anyone might not hear enough. We want them to be healthy.  

 

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