After delivering roughly 4,000 babies, Heather Rupe, D.O., gets a little teary-eyed just thinking about the first one, in a tiny hospital in Oklahoma. After all, it’s not just about new life, but how her patients live life that is most important to her.
Dr. Rupe, a board-certified obstetrician-gynecologist with Women’s Group of Franklin and Williamson Health’s first female Chief of Staff, recently sat down with Health Talks: From the Inside Out to walk through the full scope of women’s health — from prenatal care to menopause and everything in between.
Here’s what she wants every woman in Williamson County to know.
Start Before You’re Even Pregnant
If Dr. Rupe could put one thing on a billboard for women who are pregnant or trying to become pregnant, it would be this: take your folic acid.
Ideally, those trying to become pregnant should start three to four months before trying to conceive. At least 400 micrograms a day of folic acid has been shown to reduce the risk of neural tube defects and other birth complications — and most prenatal vitamins contain it. The key is starting early, before a positive test.
She also advocates for preconception counseling visits — a sit-down with an OB-GYN before pregnancy to get the body in the best possible shape. For women with underlying conditions like high blood pressure, PCOS, or diabetes, that conversation becomes even more important. To help, Williamson Health offers a maternal-fetal medicine team of high-risk pregnancy specialists who work alongside OB-GYNs for more complex cases.
See the full episode of Health Talks with Heather Rupe, D.O. here.
What Obstetric Care Actually Looks Like
Once pregnant, patients are typically seen by their doctor between six and eight weeks, then monthly until the third trimester, and increasingly often as the due date approaches. The care extends well past delivery. Postpartum complications, including elevated blood pressure and postpartum depression, can emerge or worsen in the first weeks after birth, making follow-up care just as critical as prenatal care.
On postpartum depression, Dr. Rupe is particularly direct. Around 70 percent of new mothers experience some emotional shift in the first two weeks postpartum. But if feelings of emptiness, persistent crying, or urges to escape persist past that two-to-three-week mark, those are warning signs.
“If your blood pressure was elevated, you would take your blood pressure medicine,” she said. “Postpartum depression is a physical condition, and we have treatments for it.”
She points to newer medications that target the hormonal root cause as a meaningful development. Her message to any woman struggling: speak up, and if your provider isn’t listening, find one who will.
The labor and delivery unit at Williamson Medical Center reflects the same range of needs. Sixteen labor rooms, three caesarian section (C-section) operating rooms, seventeen postpartum rooms, and nine private NICU bays make up the recently expanded and renovated space. The unit accommodates low-intervention birth plans and epidural-on-arrival preferences equally.
Williamson Medical Center also holds one of the lowest C-section rates in the region, something Dr. Rupe attributes in large part to the nursing staff. “They really care and really go the extra mile,” she said.
The Annual Exam: More Than a Formality
Gynecological care typically begins at age 21, or earlier if there’s a specific concern or a patient is sexually active. The annual visit covers far more than a Pap smear. Dr. Rupe’s team screens for endometriosis, fibroids, cysts, PCOS, cervical cancer, and thyroid disease. Regular exams also ensure patients are up to date on mammograms, colonoscopies, and bone density scans.
A practical tip for self-exams: do a monthly breast self-exam the week after your period ends, when breasts are least tender. And if a Pap smear is uncomfortable or has been in the past, say something. Providers have options.
Perimenopause and Menopause: You Don’t Have to Just Push Through
Average menopause arrives around age 52. But perimenopause, the transition phase, can begin in the early 40s. Classic symptoms include hot flashes, night sweats, and irregular cycles. Less-talked-about symptoms like fatigue, brain fog, joint pain, decreased libido, and insomnia may also be hormone-related.
Treatment options have expanded considerably. Estrogen replacements are available in a variety of ways, including patches, creams, and pills. Testosterone and progesterone can also be evaluated. Non-hormonal approaches exist as well. The conversation, Dr. Rupe emphasizes, should start early.
“You don’t have to be miserable,” she said simply.
Her Second Billboard
If folic acid gets the first billboard, gynecology earns a second: you don’t have to live your life around your period and sex shouldn’t hurt.
Dr. Rupe regularly sees women who have restructured their schedules around painful or heavy periods. She does not believe canceling workouts, skipping plans, and maxing out ibuprofen have to be an accepted part of life.
“We are tough,” she said, “but we can be tough in other ways.”
Dr. Rupe sees patients through the Women’s Group of Franklin, one of two OB-GYN groups delivering at Williamson Medical Center. Information on both groups, as well as Williamson Health’s Maternal-Fetal Medicine practice, is available at WilliamsonHealth.org.
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