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women's health
So much attention goes into preparing for labor and delivery. I'd like to take a minute and focus on the next important period: the postpartum period. With forethought, preparation and help, the postpartum period can be made enjoyable and smooth.
First you needs to know what to expect in the postpartum period. Next, you needs to know how to prepare for it. Finally you need to know when to reach out about concerns and questions.
Two thirds of American women will delivery vaginally. It varies, state by state from a high of about 40% to a low of about 23%. What accounts for this? Although the matter is complex, suffice it to say it is all about the labor. When we follow the course of a labor, we are following many things: cervical dilation in cm, effacement, and the descent of the baby into the pelvis. We are also tracking the contraction pattern as well as the fetal heart tracing and maternal vital signs.
To learn more about Labor and delivery, Click HERE.
There are all kinds of peculiar myths about breastfeeding. You may have heard that it is difficult and painful. You may feel too bashful to do it. But I would like to encourage everyone to give it strong, evidence based consideration, because I think it is one of the most gratifying aspects of having a young baby. It does take a little learning, and a little getting used to, but it is more than worth effort. Most first timers take about 7-10 days to get used to it and then they have it down. It is best for babies nutrition, immunity, brain development, teeth, etc etc. For mom, it helps with minimizing post partum blood loss. It hastens return to pre pregnancy weight. Finally, it is convenient and cost effective.
Click HERE for a introduction to what you will want to know.
Induction of labor is a hot topic. Some patients are dead set on avoiding it and some are begging for it. Induction of labor simply means using medicinal or mechanical means to start labor before it has on its own.
Inductions may be elective (by choice) or medically indicated. They may be accomplished by a variety of medicines and techniques. Induction of labor is an important tool in the Obstetric tool box.
Get a balanced perspective on induction of labor HERE.
Blood Pressure. We all know it can be a concern. But what is it really? Why is it such a concern in and out of pregnancy ?
Our entire body is fed by a system of pipes from large to tiny, which is pressurized by the pumping of the heart. Plumbing is a good analogy until you realize these aren't ordinary pipes. Most of these pipes are capable of changing their diameter, and thus their pressure within, in response to fine chemical signals. And they are pipes, which like ordinary plumbing, can build up sediment and develop blockages. They can even weaken and leak. Blood pressure is the pressure of the blood flowing in these pipes.
Fluid balance, hormone, and immunologic changes of pregnancy have great sway of the blood pressure of a pregnant woman. If she happens to have the type of body which has tense stiff vessels even outside of pregnancy, that is, if she has chronic underlying hypertension, so much the worse. She will be prone to conditions like preeclampsia, also called toxemia.
Click HERE to learn more about this fascinating and important area of Obstetrics .
Whether a baby is large or small depends on two things : the innate qualities of the baby and the maternal enviroment in which he or she grows. The growth rate and specific size measurements of the baby tell us a great deal, which is why we are continuously tracking them by exam and by Ultrasound. Major deviations in any direction are a source for concern.
Click HERE to learn more.
I recently finished and published the website's pages on Infections in Pregnancy. At the bottom of those pages, I have added that much again in a new section called "Other infections of Perinatal Significance". Now this may sound way too scientific and unrelated to daily life, but nothing could be further from the truth. These are the big time everyday infections we hear of each week: Pertussis (whooping cough), Bacterial Vaginosis, Toxoplasmosis, Influenza, Herpes, Chicken Pox, and more. Learn more about these common infections and how they pose special risks to pregnant women. Learn what you can do to protect yourself and those around you.
And, also coming tomorrow, will be a special section on Preterm Labor. Learn the facts and figures as we know them, and how we handle Preterm Labor today. Hint: It is not how we handled it even 5 years ago.
Thanks for all your well wishes. I am making a good recovery.
We bring you back to your regularly scheduled programming (Old time radio announcer voice here) , "Gestational Diabetes".
My suspicion that we see more of this every year is substantiated. Gestational or pregnancy-related Diabetes (GDM) is on the rise. It seems to track right along with the obesity epidemic. However, it is a cloud with a very silver lining. In many cases, the women I see who receive a diagnosis of GDM see me as their primary doctor, and, like many others, come in regularly only when they are pregnant. As such, it is golden opportunity for effective lifestyle intervention.
GDM patients receive a whole package of nutritional, fitness and lifestyle advice, treatment and monitoring which I think, in the final analysis, will add years to their lives. They learn about the pleasure and ease of good nutrition, about personal organization, and about optimizing health. They do this through learning to craft meal and snack plans with the diabetic educator and my office. They learn to structure their days to a very high degree as a result of having to have blood sugar checks, medication and meals and snacks at just the right time. They are also introduced to mild regular exercise or at least physical therapy, which they uniformly enjoy. They report weekly for monitoring and feedback. Most of the time they achieve great results and feel good about themselves.
And here's the cherry on top: If patients keep up the nutrition and exercise after baby is born, their weight and body composition drift naturally toward the optimal. And that's worth its weight in gold.
Learn more HERE on our page about Gestational Diabetes Mellitus.
You've no doubt heard of or gotten a prenatal lab panel. The panel includes a number of tests for infections that might have an effect on mother or baby during the pregnancy.
For most common infectious diseases, like the flu, you know you have it almost right away. Others can be carried silently for years, and what we test includes them. If we know about them, we have a chance at treating them before they can cause harm to mom or baby. Learn more HERE.
Did you know pregnancy has an effect on the health of your mouth and teeth? Did you know good dental health has a measurable effect on your lifelong general health? The connection isn’t immediately obvious, but what goes on in your mouth relates intimately with your whole body. Check out our new page on Dental Health in Pregnancy to learn more.
When I was a little girl in the 1960s, pregnant women wore loose billowing clothes in futile efforts to hide their pregnancies. The round silhouette of the pregnant belly was considered too suggestive for public presentation. Pregnant women were encouraged to stay home out of sight and rest.
Fast forward to 2015 and not only are women wearing yoga pants in public, but pregnant women are too, complete with body conscious form fitting exercise tops in bright colors. They are out and about flying that pregnancy flag and getting fit. I love it. Do you exercise ? Would you continue your exercise in pregnancy? Review the facts on the subject here on my page on Exercise and Pregnancy.
Mother Nature considers pregnancy the height of her achievement. Because of this, she will throw all your bodily resources toward the cause. It's no wonder we feel like pregnancy takes over our bodies and, by full term, uses up most, if not all, of our strength. The rapid growth and development of not only the baby but of our own bodies is not without its dramatic and sometimes uncomfortable sensations. To learn more about these and how to deal with them. Click HERE.
Prenatal Vitamins are a standard part of prenatal care. But did you know they should be started at least three months before pregnancy ? And did you know that 50 % of all pregnancies are unplanned ? Given these two facts you could make an argument for all women of childbearing age to take prenatal vitamins all of the time.
What makes prenatal vitamins so special ?
Mayo Clinic recommends that a prenatal vitamin include at least the following :
Consider folic acid. This is given to prevent defects of the baby's brain and spinal cord, what we call neural tube defects. These defects form in the first 28 days after conception, so often times the woman does not even know she's pregnant. This is why it is ideal for women to be on them in the three months before pregnancy. As soon as a woman decides to try to become pregnant she should start a prenatal vitamin.
Prenatal Vitamins are not always easy to take. I recommend taking a gummy prenatal vitamins if nausea is a problem. I also recommend taking them with food in the evening. Sometimes they cause constipation. Of course that is best dealt with by fluids, fiber, fruit and vegetables, but stool softeners can be used .
Pregnant women need more of just about every nutrient. This also includes calcium and iron, in addition to folic acid. Calcium is necessary for building bone. Iron is necessary for manufacturing red blood cells which carry oxygen to mom and baby. A deficiency of iron results in anemia, which is suboptimal for both mom and baby. Personally, I think Calcium taken separately from the Prenatal vitamin or iron causes them both to absorb better. It is also good to note that Calcium citrate is the most easily absorbed type of Calcium. Additionally, calcium should be paired with vitamin D. Most over the counter calcium supplements do just this.
Newer data also indicate that it is beneficial for pregnant women to ensure that they are consuming at least 200 milligrams of DHA (docosahexaenoic acid) in addition to their prenatal vitamins. This seems to be beneficial for the development of unborn baby's brain. It is available by supplement or incorporated into a prescription prenatal vitamin.
But vitamins are not the whole story. I have prepared a page devoted entirely to preparation for a planned pregnancy. You might be surprised to see some of the things that it contains. Have a look HERE.
Trouble with incontinence can cause problems with body image, self esteem and confidence. It can also interfere with a woman's social life and her ability to stay fit. Incontinence is common, and should not be a source of shame. It should come out of the closet and be subject to evaluation and treatment.
Learn more on the newly completed page about Urinary Incontinence.
Please note that the entire section of Gynecology is now done !
Baby shower cake: champagne cake with raspberry filling, courtesy of MISS PATTY CAKES of Kalispell, Montana
Here's a problem that besets 1/3 to 1/4 of all US women, and that is rarely discussed. The risk factors are common and it greatly affects quality of life. This blog post will lead you to a newly completed page on this very important topic.
To learn more on this fascinating and important condition that affects so many, click HERE.
And just so you know, this post is serving both as your Structure Sunday and Medical Monday posts for two reasons:
1. It required quite a bit of time and research
2. On Saturday I threw a baby shower for our daughter Echo, who will have our first grandchild in May : )
Many thanks for your patience,
Dr. Gina
More and more of us will be in menopause as time passes by. Our lifespans are increasing along with the quality of our health care and our knowledge about fitness, nutrition and health in general. So get rid of old stereotypes about menopause and menopausal women and learn the facts HERE.
Tubes and ovaries rarely enter one thoughts or conversation. However, pain in the low pelvis catches everyone' attention. To understand more about this life impacting and very important area of the female body, click HERE.
As complementary health practices go, meditation seems to be the one with which Americans feel the least comfortable. The CDC reports that in 2012, nearly 18 % of people used non vitamin non mineral supplements. Eight percent use chiropractic manipulation, 8 % use yoga, but only 4% use meditation. And yet, among the many alternative or complementary approaches, it is one which is amply supported by data.
Is it religion ? Is it philosophy ? Is it just exercise ? What does it even do ?
Read HERE to learn more.
Hysterectomy is a topic that is highly politicized in our media and in our culture. It is the most common operation that women have except for Cesarean section. The reasons or indications for hysterectomy are fairly well defined. And yet there is debate about when to do them and how to do them. The good news is that the quality of our research and the quality of our surgery is improving by the day. Our decision making processes regarding treatments, our ways of discussing options with patients, and our methods of surgery are far better than they used to be.
Click HERE to learn more.
In the " olden days" all surgery was done through open incisions, meaning an incision large enough to see and get at whatever you were operating on. During my Ob/Gyn specialty residency training in the years 1990-1994, our profession made a big transition to laparoscopy. Instead of large 14 cm incisions for a hysterectomy for example, we made a 1-2 cm incision tucked discreetly under the belly button and two others out to either side of the same size. We would use instruments on sticks in the side ports to do the surgery. Most recently we have a adopted the use of the multi-armed Da Vinci Robot for laparoscopy which confers numerous advantages to surgeon and patient alike.
One a warm evening in 1992 in a synagogue in Boulder Colorado, I had the pleasure of meeting an elderly Russian man and his family. His wife was a cardiologist and his adult children a variety of scientific professionals. They were recent refugees to the States. Despite their education and experience, they could only find work at McDonalds.
The old gentleman himself had been Chief of Surgery in a large Russian hospital. Since his children spoke English, I decided to chat with him though a translator about what surgery we were doing at the University Hospital. I described the new laparoscopic technique, from the small incisions, to the use of CO2 gas to elevate the abdominal wall, and the positioning of the patient with her head down, to get the bowel out of the way of the pelvic organs. I described the long straight tools which we inserted in the two side ports, one cautery, and one grasper, and how we could switch out for a scissors which rotated at the end. There we sat at a festive dinner table after services, with good food, and these amazing people, discussing the latest advances in surgery. I had to suppress my eyes from getting misty when I contemplated all they had been through. I thought he would be so proud and pleased.
He listened thoughtfully but his face was very grave. I feared he had not understood me. He seemed restless. I finally had to ask his daughter what was the matter, and she measured her words in a thick Russian accent. He did not believe me. He said it was impossible. He thought I was mocking him. Despite my best efforts, he gathered up his family and left.
I wish I could have a chance to show him all that I have presented for you in the latest section of my website: Laparoscopic and Robotic Surgery. Click HERE to see it.
