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October 7, 2014

rollercoaster-picI love the twists, turns and rapid descents of roller coasters. Do you remember the first roller coaster you ever rode? Nope, it wasn’t at Six Flags or some other awesomely fun amusement park. It was while you were maneuvering through the birth canal. That’s right, the process of being born is very much like riding a roller coaster.

Cardinal Movements

The journey an infant takes and the adaptations made while being born is referred to as the cardinal movements. The first cardinal movement is called descent. Just as you feel when your stomach drops as the roller coaster rushes down full speed, down into the valley, securely positioned into your seat by the tight lap bar, an infant’s head is pushed deep into the pelvis.


Next is flexion. Do you remember trying to raise your head in the coaster while diving into the valley at high speed? This is similar to an infant’s chin that’s secured onto the breast bone as they prepare for the tight fit. Just as you can’t raise your head, neither can a baby.


Engagement is next. This is the moment you catch your breath before the next thrill, the next turn.
This is when an infant’s head reaches the pelvic inlet. The infant now undergoes a sharp internal rotation, sometimes at a 90 degree angle, in order to accommodate your pelvis. And just as the coaster comes out of its last turn, the infant extends its head, only to take one last turn before applying the brakes.

External Rotation

Next is external rotation. This is the this final turn that allows for the infant to line its head up to its back to allow for the final step, which is expulsion. And finally, the screams. All at once, the cries of excitement and relief converge.

Season Passes

Just as you might have a season pass for an amusement park, some women open up admission to allow for riders every season! Two, three, four or more deliveries later, these season passes can take a toll on a woman’s equipment.

Can you imagine the CEO of Six Flags complaining because they’ve sold too many tickets for the roller coasters and are now making too much money? Well that’s kind of how women view it when they come to see me about pelvic complaints. After all, what right do they have to complain about the wear and tear on their equipment when the birth of a child makes them so rich with love and blessings?

We Are Human

It’s this very notion that I try to absolve. Urinary incontinence, pelvic organ prolapse, and suffering obstetric lacerations are not a rite of passage. It simply reveals how vulnerable our bodies are to trauma. It simply makes us human. Thankfully, our ability to repair our bodies makes us sustainable.

The miracle of birth does not need to be altered but the recovery can be optimized. When I see a woman and discuss these very personal issues, I keep in mind this notion she came with and value her beauty as a mother. I also try to reassure her and offer solutions to restore her beauty as a woman as well. After all, being a woman and a mother are two of the most beautiful things on this planet and they deserve to be treasured.

-Dr. Peahen Gandhi

September 11, 2014

We understand that discussing heavy bleeding can be embarrassing to talk about. You may not even realize that what you experience each month is abnormal because your periods are normal to you. However, it is critical to recognize what defines heavy bleeding as it may be a symptom of other issues that require further medical attention.

What are the causes?
There are many factors that can cause heavy bleeding. In young women who have just started having regular periods as well as premenopausal women, heavy bleeding is often due to a hormonal imbalance between the estrogen and progesterone levels. This hormonal imbalance may also be caused by a malfunction of the ovaries.
Fibroids may also be a cause of heavy bleeding. Fibroids are non-cancerous tumors inside the uterus, they are most common in women who are within their peak child-bearing years as this is when hormone levels are at their highest.

woman with headache

photo via freedigitalphotos.net

What are the symptoms?
 The symptoms may seem difficult to identify because they may seem normal to you. The average period only produces about two to three tablespoons of blood and lasts about four to five days, if you are soaking through a tampon or pad hourly for many consecutive hours you may have heavy bleeding. Other symptoms include severe cramps, periods that last longer than seven days, and passing clots larger than a quarter. You may also experience fatigue and shortness of breath. These symptoms are signs of anemia which can be caused by severe blood loss.
Are you still unsure about your symptoms? To take our Heavy Bleeding Quiz, please click here.
How is it treated?
Treatments vary depending on what is causing the heavy bleeding. Options may include simple over the counter medicines, low-dose birth control pills or hormone therapy. In some cases, your bleeding can be treated with ablation. Ablation is a new treatment that can be done in our office in about ten minutes. Check with your physician to see which is right for you.
There is no reason your life should be on hold each and every month. If you find that your monthly period is taking a toll on your lifestyle, schedule an appointment to talk to your physician about treatment options and getting your life back on track without monthly interruptions.

September 2, 2014

pregnant woman getting flu shotIf you’re pregnant, a flu shot is your best protection against serious illness from the flu. Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the immune system, heart and lungs during pregnancy make pregnant women more prone to severe illness from flu, which can lead to hospitalization or even death. A pregnant woman with the flu also has a greater chance of serious problems for her unborn baby, including premature labor and delivery.

The Flu Shot is the Best Protection against Flu Getting a flu shot is the first and most important step in protecting against flu. When given during pregnancy, the flu shot has been shown to protect both the mother and her baby (up to 6 months old) from flu. The flu shot is safe to get at any time while you are pregnant, during any trimester. (The nasal spray vaccine should not be given to women who are pregnant.) An additional way to protect the baby is for all of the baby’s caregivers and close contacts (including parents, brothers and sisters, grandparents and babysitters) to get vaccinated against the flu.

When to Receive the Flu Vaccine It is particularly important that women who are or will be pregnant during the flu season receive an inactivated flu vaccine as soon as it is available. The inactivated flu vaccine can be given to women at any point during their pregnancy. Live, attenuated flu vaccine is available as an intranasal spray and is not recommended for pregnant women, but is safe for use in women in the postpartum period. In the United States, the influenza season typically occurs from October through May. The preponderance of data overwhelmingly demonstrates the safety of flu vaccination during pregnancy.

The Flu Shot is Safe for Pregnant Women Flu shots are a safe way to protect pregnant women and their unborn children from serious illness and complications of flu, like pneumonia. The flu shot has been given to millions of pregnant women over many years. Flu shots have not been shown to cause harm to pregnant women or their babies. It is very important for pregnant women to get the flu shot.

Early Treatment is Important for Pregnant Women  If you get sick with flu-like symptoms, call your doctor right away. If needed, the doctor will prescribe an antiviral medicine that treats the flu. Having a fever caused by flu infection or other infections early in pregnancy can lead to birth defects in an unborn child. Pregnant women who get a fever should contact their doctor as soon as possible.

More Facts to Support the Importance of Flu Shots The Center for Disease Control and Prevention (CDC) recommends that all adults get vaccinated for influenza. This is especially true for woman who are pregnant. According to a study conducted by American College of Obstetricians and Gynecologists (ACOG), the number of pregnant women who are vaccinated has gone up since last recorded in 2010. However, it is still important that this number continues to increase.

If a woman is – or may become pregnant – during the height of the influenza season, it is critical that she get vaccinated as quickly as possible. Flu season is usually between October and May. It is recommended that pregnant women receive the inactivated flu vaccine as it has been proven to be safe throughout the gestation period. Different immunization options are available for women who are postpartum so be sure to check with your physician about which options are right for you.

In addition to the benefits and protection provided by being vaccinated, a recent randomized trial found that the children of vaccinated women had fewer instances of getting the flu as well as fever and respiratory illness as opposed to children whose mothers were not vaccinated. Studies have also shown that some of the antibodies may be passively acquired by the baby in utero when pregnant women are vaccinated. This helps babies fight any threat to influenza after they are born. Newborns up to six months of age cannot receive the influenza vaccine.

Where to Receive the Flu Vaccine At Cherokee Women’s Health Specialists, we are committed to making sure you are well-informed so you may make the healthiest decisions for yourself and your families. To make it as easy as possible for you to receive a vaccination, following is a list of places in the Canton and Woodstock areas that offer flu shots:

Rite Aid

August 28, 2014


incontinence types and treatments blog

Photo via: Freedigitalphotos.net

Urinary incontinence is not an uncommon problem. In fact, 1 in 5 women struggle with it. Incontinence itself is not a disease but rather an indication that there is something else going on inside the body. It’s important to speak to a doctor to ensure that your incontinence is not a symptom of a more serious medical issue.

Incontinence can be caused by various factors. Some of your day-to-day activities could be causing what is known as temporary urinary incontinence. Different foods, drinks, diuretics and even medication may be causing you to feel a seemingly constant urge to use the bathroom.  If you regularly consume caffeine, artificial sweeteners, sodas, alcohol or highly acidic beverages, this may also be a factor. Temporary urinary incontinence may also be a symptom of a urinary tract infection or constipation.

Persistent urinary incontinence is a side effect of many natural changes women experience. From childbirth to aging, there are several natural factors that can affect the severity and frequency of your symptoms.

The muscles surrounding your bladder and pelvic floor experience many changes throughout the course of your life. When women are pregnant and then deliver vaginally, bladder muscles are weakened and there is also a possibility for nerve damage. As women continue to age, bladder muscles get weaker. When a woman reaches menopause, estrogen levels begin to decrease. Estrogen is  responsible for maintaining the health of your bladder and urethra tissues. As the health of those tissues decline, this can add to the severity of a woman’s incontinence.

In preparing for your appointment to address urinary incontinence, keep a list of your diet, medications and how many times you are using the restroom. This added information will be very helpful to your physician in addressing your symptoms.

All forms of incontinence are treatable.  Pelvic floor exercises are a great way to help rebuild the strength in those critical muscles after childbirth.  In addition, there are several prescription medicines and minimally invasive surgeries available. Be sure to talk to your physician about which options are right for you and your needs.

Women are affected by incontinence at all stages of life. It’s important to not let it go untreated and to understand that you are not alone. At Cherokee Women’s Health Specialists, we’re committed to giving you the answers and treatment you need while also making sure that you are comfortable. To make an appointment, please contact us here.



August 21, 2014

The choice to work with a  Certified Nurse-Midwife (CNM) or an Obstetrician (OB) is a personal one that should not be taken lightly, nor should you feel any pressure to choose one over the other. When considering your choices, keep in mind your expectations, personal beliefs and healthcare needs.


photo via freedigitalphotos.net

photo via freedigitalphotos.net

Nurse-Midwifery is commonly practiced across the United States. CNMs are registered nurses; many complete a Master’s degree in Midwifery which includes clinical training. In order to become licensed by the American College of Midwife Nurses, practitioners must first pass the American Midwifery Certification Exam. If you choose to work with a CNM, you can be confident that he or she has been trained to identify conditions that require the attention of an OB.

Your Relationship

Your CNM will work with a physician throughout your pregnancy. In addition to being present at the delivery of your baby, CNMs can provide annual gynecological exams, prenatal and postpartum care. They advise on screenings, diagnostic testing,  vaccines and order blood work. Midwifery as a practice places a great deal of emphasis of your psychological well-being, education and guidance throughout the entire duration of your pregnancy.

Many women who chose to work with a CNM do so because they would like to experience a natural birth. Your CNM will train and guide you throughout your pregnancy so you can go into delivery feeling empowered and prepared. Midwifery as a practice endorses natural methods of coping with the pain associated with childbirth. This includes breathing techniques, visualization, relaxation techniques and various body movements and positions.

Pain Control

Not every CNM is against the use of pain medication. It is best to discuss your preferences when you have your first preconception appointment to ensure that you and your CNM agree on your preferred pain management methods. If you are delivering your baby in a hospital, OB-GYNs and CNMs can administer pharmaceuticals as well as order an epidural for a patient; however, an epidural must be administered by an obstetric anesthesiologist. 

As a mom-to-be, it’s important that your beliefs and preferences are addressed so that you feel comfortable and confident throughout your pregnancy. At Cherokee Women’s Health Specialists, our entire team is here to support you through pregnancy, and beyond. For more information about choosing a Certified Nurse-Midwife,  please contact us here.

August 14, 2014

Having a baby can present a lot of firsts for women. It’s important to be prepared and educated on what to expect on the birth day of your new addition. Being prepared will give moms-to-be a sense of confidence when getting ready to head into the delivery room. A good place to gain the confidence and knowledge is to choose a birthing class.

Choosing a class that best suits your time constraints is a good place to start. You can find courses that range from one-day workshops to weekly classes. Look at your schedule and pick something that easy to commit to.

Regardless of which class you choose, you should pick something that highlights the following:

photo via Freedigitalphotos.net

photo via Freedigitalphotos.net

  • Signs of labor
  • What happens during labor and delivery
  • How to cope with pain and anxiety
  • How your partner can be involved in making you comfortable
  • When to alert your midwife or doctor


Lamaze classes are a popular choice for women who are planning on having an all natural birth. Lamaze instructors teach natural coping and breathing strategies that are easily done during labor and delivery; they also teach various positions and movements to promote comfort. In addition to these coping mechanisms, Lamaze classes also teach women to trust their intuition and to make informed decisions, particularly when it comes to consenting to medicine during the delivery. You can check out their website here, they even offer online classes!

The Bradley Method  

The Bradley Method promotes the partner’s role as a coach during the delivery. In these classes, you and your partner will learn how to best prepare for labor and delivery of your baby throughout your pregnancy. There is an emphasis on everything from your diet during pregnancy to physical and breathing exercises to make you strong enough for an all natural birth. Like Lamaze and other classes available, The Bradley Method classes also offer help for adjusting to postpartum life.

Other Options  

While Lamaze and The Bradley Method classes are popular choices among moms who are planning natural births, there are many other options available. Hypnobirth is a choice among many mothers as it promotes relaxation, visualization and self-hypnosis during labor. While the practice promotes natural birth, it is also popular for mothers who will be receiving medical intervention during labor and delivery.

Prenatal yoga classes focus on relaxation and strength while delivering your baby. If you already do yoga,this may be a great choice for you as it includes various yoga poses and breathing techniques to strengthen you for delivery. You can contact any certified yoga instructor about different prenatal options.

At Cherokee Women’s Health Specialists, we are committed to helping you make the best choice for you and your growing family. If you have questions regarding childbirth class options, please contact us here.



August 7, 2014

It’s August, which means it’s Breastfeeding Awareness Month. Breastfeeding can be a beautiful way to bond and spend time with your baby. It can also present its fair share of challenges from midnight feedings to getting your baby to latch on. Here are a few tips that might help along the way!

Get in the GrooveID-100104726
Nursing is about getting in sync with your baby’s schedule. Most babies nurse about every two to three hours for the first few weeks.  If you think your baby might be hungry, some signs to look for include restlessness, sucking and lip motions. Your baby should nurse from your breast for about 20 minutes or until it is soft. From there, you can try burping your baby and switching breasts if they still appear to be hungry.

It’s in the Latch
Achieving the correct the latch early on is a critical part of breastfeeding to ensure that your baby is getting enough milk.  There are many people who can help you while you’re still in the hospital, whether it is your doctor, midwife or a lactation consultant. Of course, your loved ones are great people to ask for advice too.You may want to hold off on introducing a pacifier until your baby is well established in breastfeeding; a pacifier may interrupt the muscle memory your baby has learned.

Get a Tool Kit
There are many products on the market to help you with your breastfeeding needs:

− Nursing Pillows: Since you will be spending many hours a day nursing, it’s important to be comfortable. There are many pillows on the market to help give your baby assisted access to your breast while remaining comfortable. A very popular brand is Boppy, but there are many on the market.

− A Breast Pump: There are many models of breast pumps available. These pumps can help you create a supply of milk in case you are unable to nurse your baby. If your little one favors one breast, you can use a pump to relieve the other side and save the milk for later.

− Nursing Pads: While nursing, it’s very common for breasts to leak. Nursing pads are a lifesaver when it comes to preventing unwanted moisture on your bras and clothes.

Breastfeeding your baby is a special time just for the two of you to bond. While it can present its challenges, our team at Cherokee Women’s Health Specialists is here to help and cheer you on. If you have questions regarding breastfeeding, contact our office to make an appointment.


August 1, 2014
photo via freedigitalphotos.net; Ohmega1982

photo via freedigitalphotos.net; Ohmega1982

July was Group B Strep Awareness Month. Group B strep can be a deadly disease if left undetected or untreated. It’s our goal at Cherokee Women’s Health to arm our moms-to-be with as much information as possible so they can have peace of mind during pregnancy.

What is Group B strep?

Group B strep disease (GBS) is a bacteria that is carried by one in four pregnant women and is not threatening to women who are not pregnant. Most women who carry GBS never feel any symptoms. If left untreated or undetected, GBS can be responsible for meningitis, sepsis and in some cases, pneumonia in babies. Premature babies as well as babies that are delivered long after the water has broken (up to 18 hours) are at greater risk when the mother is a carrier.

There are two kinds of group B strep, early-onset and late-onset. Babies with early-onset could potentially show symptoms as early as birth and into the first week of life. Early-onset is the more common type of GBS. Babies that have contracted late-onset can begin developing symptoms months after they are born. Symptoms for both early and late-onset include irritability, grunting, difficulty feeding and fever.

In extreme cases, babies may be permanently impaired by the disease and develop cerebral palsy or other developmental problems.

How can it be prevented?

The best way to prevent group B strep is for all pregnant women to get tested during the final weeks of pregnancy (usually at 35-37 weeks). The test is very simple and minimally invasive. Your doctor will swab the vagina and rectum to be tested for the bacteria, in some cases you can even do the swab yourself with instruction from your doctor. The swabs are then tested and results are usually given within two days. If the test comes back negative, no further measures will be necessary unless otherwise instructed by your physician. Testing positive does not mean your baby will have GBS.

About one in every 200 babies born to carrier mothers will show symptoms. Antibiotics will be given during labor through an IV to further ensure that the baby does not catch it. There are no antibiotics that can be given beforehand as the baby will be most likely to contract the disease during the birthing process when it is exposed to the mother’s fluid.

The Center for Disease Control and Prevention (CDC) recommends that women get tested with each pregnancy. If you have further questions about GBS testing and prevention please contact our office at 770.720.7733 to make an appointment or contact us here.


July 22, 2014

It’s a common misconception that women don’t need an annual checkup from their gynecologist each year. In fact, women do need an annual checkup each year, especially for a pelvic exam and breast exam. Cherokee Women’s Health sheds some light on the difference between a pap smear and a pelvic exam and why they’re so important to maintaining your overall health.

Pelvic Exam vs. Pap Smear

A pap smear and a pelvic exam are not the same thing. A pap smear is a brushing of cells from the cervix, or opening of the uterus. These cells are evaluated by a laboratory to look for signs of precancerous diseases of the cervix, which if successfully treated, can prevent cervical cancer. Sexually transmitted diseases can also be diagnosed and treated through information gained from a pap smear. Pap smears do not test for uterine or ovarian cancer.

A pelvic exam usually occurs after a pap smear at your annual checkup. This is when your healthcare provider examines the skin of the vulva, vagina and cervix, looking for any suspicious lesions, which could indicate skin cancer or vulvar diseases. He or she will also perform a bi-manual exam using their hands to feel the pelvic organs and check for masses or inconsistencies. During this process, your doctor will gently place two fingers inside the vagina and use the other hand to gently press down on the area he or she is feeling. In doing this, your doctor is noting if the organs have changed in size or shape, and it allows them to feel the uterus, the ovaries, the bladder and the rectum. If your doctor determines that your uterus or other organs feel enlarged, he or she may order an ultrasound to check for fibroids, cysts, or other inconsistencies.

Do I need a Pap Smear Every Year? Happy female patient and doctor at office

The American College of Obstetricians and Gynecologists (ACOG) suggest that certain women do not require a pap smear every year. If you are over the age of 30, in a mutually monogamous relationship and have never had an abnormal pap smear, you may not need a pap smear each year. If you’ve ever had a hysterectomy that was not done for an abnormal pap smear and you fall into any of the above categories, your doctor may suggest you only need a pap smear every three to five years. However, any changes to menstrual cycle, abnormal bleeding, or vaginal pain or discomfort should warrant a call to your gynecologist.

Do I need a Pelvic Exam Every Year?

Annual pelvic exams in addition to your yearly well-woman exam are essential for maintaining your overall health. It is imperative that you do not skip your annual pelvic exam, even if you have had a hysterectomy with removal of the uterus and ovaries. Your annual well visit not only includes a pelvic exam but a breast exam, as well as an opportunity to talk to your doctor about birth control options, weight, cholesterol, blood pressure or any other concerns.

If you have questions regarding the recommendations of when to get a pap smear or a pelvic exam, contact our office speak to one of our healthcare providers or to make an appointment.


July 18, 2014

While new mothers have a ton of new things on their minds after giving birth to a baby, one of the most important things they need to keep in mind is the importance of self-care, particularly the tightening of pelvic muscles to prevent further decline. For many women, practicing pelvic floor exercises can help repair their pelvic muscles and speed up recovery time.

Tighten Your Pelvic Floor with Kegels Woman sitting on exercise ball

Kegels, or pelvic floor muscle training, can be especially helpful for women who may be experiencing urinary incontinence due to pregnancy or childbirth. The great thing about Kegels is that you can do it discreetly, and just about anywhere or anytime. To make sure you have the right muscles, stop urination midstream. If you succeed, you have the right muscles. (However, be sure not to do this often, as doing Kegel exercises while emptying your bladder can actually weaken the muscles.) Once you identify your pelvic floor muscles, follow these tips to help tighten them:

  • Empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
  • Maintain your focus on your pelvic floor muscles only. Be careful not to flex the muscles in your abdomen, thighs or buttocks, and avoid holding your breath. Focus on breathing freely during the exercises.
  • Repeat times three. Once you feel comfortable flexing and relaxing your pelvic floor muscles, aim for at least three sets of 10 repetitions a day.

Pelvic Reconstruction Surgery

While Kegels can be helpful in repairing pelvic floor muscles, it’s not a solution for every woman. The uterus, vagina, bladder and rectum can be injured during childbirth, resulting in uncomfortable symptoms for women after they give birth. These symptoms include pelvic pain, pelvic heaviness, back pain, bladder leakage, pain during intercourse, sexual dysfunction, and many others, and can be difficult to talk about. Sometimes, pelvic reconstruction surgery is necessary depending on the level of discomfort of the symptoms. The physicians at Cherokee Women’s Health are expertly trained in surgery to repair a woman’s reproductive and pelvic organs. If you are suffering from pelvic floor problems due to pregnancy, childbirth or age, don’t suffer silently. Contact us today to schedule a consultation to speak to one of our doctors.

Photo via Flickr.



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