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April 16, 2014

pregnancy test When you are trying to get pregnant, waiting to find out can be excruciating. Wouldn’t it be great if there were something that could tell you “Yes, you are pregnant” the moment you conceive? Well, unfortunately these things do not exist, so we rely on the home pregnancy test. These days, home pregnancy tests are extremely accurate, as long as you understand how they work and when to take them.

How Does a Home Pregnancy Test Work?

Home pregnancy tests are designed to detect Human Chorionic Gonadotropin (hCG), also known as the pregnancy hormone. The hormone is excreted as soon as the fertilized egg implants into your uterus, and your levels of this hormone double approximately every 48 hours from then on. Yet, they really are not high enough to detect in your urine until at least two weeks after conception.

Just to give you an idea of what the levels are like each week and how they increase, here is a guideline of hCG levels in weeks from your last menstrual period (LMP) :

  • 3 weeks LMP: 5 – 50 mIU/ml
  • 4 weeks LMP: 5 – 426 mIU/ml
  • 5 weeks LMP: 18 – 7,340 mIU/ml
  • 6 weeks LMP: 1,080 – 56,500 mIU/ml
  • 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
  • Non-pregnant females: <5.0 mIU/ml
  • Postmenopausal females: <9.5 mIU/ml

Remember that this is just a general guideline. As every women’s pregnancy is different, their levels of hCG can rise differently as well.

When to Take a Pregnancy Test

In order to get the most accurate result from an at home pregnancy test, read the instructions and follow them precisely. Many times they will tell you to take it first thing in the morning, as this is when your urine is most concentrated. As far as when into your cycle should you take a test, your hCG levels should be high enough to get an accurate result when you expect your period to start.

False Negative Pregnancy Test

Now that you have a better understanding how pregnancy tests work, I think you can figure out why false negatives are so common. In fact, it isn’t really even a false negative; it just means that your levels of hCG were too low at the time for the test to detect. So, if you think that you are pregnant and get a negative result, just try again a few days later.

As each brand of pregnancy test is different, and they each have a different calibration for detecting hCG  levels – some are more sensitive than others. The more sensitive ones would be able to give you a positive test earlier, and some brands even claim to detect pregnancy before your missed period.

Positive Pregnancy Test

It is extremely rare to get a false positive result on a pregnancy test, but it can happen. But usually, no matter how faint the line, plus sign, words, etc. may be, if you can see it at all, then it is likely a positive pregnancy test result. This would be the time to call your obstetrician or midwife and set up your initial prenatal appointment.

April 3, 2014

delivery roomAs the big day approaches, you have no doubt planned everything: your birth plan; your hospital bag; out of town guests secured; help for when you get home with the baby and travel plans to and from the hospital. Yet one detail that you may have overlooked is who you will have with you in the delivery room. Unless you are having a C-section where only you and the baby’s father are allowed in the delivery room – along with the medical staff – then this decision will take some consideration before the big day.

Selecting only a few individuals to be with you while delivering your baby does not mean that you are excluding everyone from coming to the hospital to experience this amazing event with you. Bear in mind that labor, typically speaking, is a long process. So, you may choose to  have visitors come in and out of the delivery room at your discretion throughout the entire time. You may want to ask that once you start pushing, these visitors respect your desire for privacy and wait in the waiting room until after the baby is born. Then, once you are comfortable, you may then want to welcome visitors back into the room to meet the new baby.

In the Delivery Room

So, who do you have with you? Truthfully, only you can answer this question. It’s a personal choice that is completely up to you. There are some factors you should consider to help decide:

Do you want someone there specifically to take pictures? The nurses and obstetrician/midwife are there to medically help you deliver your baby and care for your baby once he/she is born. If your significant other is there to support, you may want to include someone else to take photos.

Do you want to share this magical moment with extended family and friends? There is absolutely nothing that can compare to the first time you meet your baby, and this statement is also true for grandparents, aunts and uncles and friends. However, you need to decide whether you want this first meeting to be a moment that you share with just you and your baby’s father or if you want it to be the whole family. Frankly speaking, labor is not a time for you to worry about modesty. So, if you don’t want anyone other than medical professionals to see so much of you, then it might be a good decision to keep the delivery private.

Take time to think it over, but make sure you establish the rules before you get to the hospital so that everyone will know what to expect and you can have a more relaxing delivery.

If you have any questions about labor or your pregnancy, please call our office at 770-720-7733.

March 26, 2014

woman-consulting-doctorOnce you get the positive result from a home pregnancy test, the next step is making your first appointment with your obstetrician or midwife. While you will be visiting your doctor’s office many times throughout your pregnancy, the first appointment can be the most overwhelming, especially if this is your first pregnancy. So, Cherokee Women’s Health would like to walk you through your first OB appointment to give you a better idea of what to expect. The appointment should take about an hour to complete as there are many things to be done.


Once you check in, you will be given a packet of paperwork to fill out as well as be asked for your insurance card. Please take the time to read through everything thoroughly, and write down any questions that you might have for your doctor or midwife so that you won’t forget them.

First Prenatal Ultrasound

After the paperwork has been completed, the ultrasound technician will take you back to do your first ultrasound. In this early stage of pregnancy, we utilize a trans vaginal probe to get a good look at the baby. So, don’t be alarmed when the ultrasound equipment is not rubbed on your belly, like you see on television. In these early weeks of pregnancy, we can’t always get a clear picture. So, if you aren’t able to see anything, don’t worry; it just means it’s too soon and you’ll get a picture in a couple of weeks.

We use this initial ultrasound to help determine how far along you are and to determine your due date. Ideally, you will get a heartwarming picture of your little bundle of joy and get to bring it home. Lots of parents use this as a visual aid when they announce their pregnancy to family and friends.

Weight, Height, Blood Pressure and Urine Sample

From the ultrasound, a nurse will take you to check your weight, blood pressure and get a urine sample. You can expect that these three things will be done at every appointment throughout your pregnancy.

Meet the Doctor, Ask Questions, Pelvic Exam

Then, you will meet with your doctor or midwife. This is your opportunity to ask any questions that you may have about pregnancy. Do not be afraid to ask questions! We know that you have them, and we are here to help ease your mind of any concerns that you may have.

There will be a pelvic exam done following the consultation. Here, the doctor is checking to make sure your cervix is closed and ready for pregnancy and may do a pap smear if needed.

Goody Bag

You’re almost finished, and the good news is that you now get a goody bag filled with things like prenatal vitamins as well as important pregnancy literature, which you should take your time reviewing.

Blood Work

Finally, the last step before check out is to get some blood work done. We are just running some tests to ensure everything is going smoothly with your pregnancy.

Check Out, Make Next Appointment

Before you leave, stop by to check out and schedule your next prenatal appointment, which will be in two to four weeks.

Congratulations On Your First OB Appointment!

You are likely overwhelmed with information as well as emotions, but don’t feel like you have to have everything figured out already. Just take time to enjoy this exciting news while you navigate through your first trimester.

March 21, 2014

pregnancy boy or girlOne of the first questions others ask once you tell them that you are pregnant is “Do you know if it’s a boy or a girl?” No doubt, as you navigate your first trimester, you ask yourself this same question on a daily basis. The ultrasound to determine the baby’s gender, which is usually between 18 and 22 weeks, is still months away, and the anticipation is killing you. Isn’t there some way to find out if it’s a boy or girl before then? While there is nothing definitive, there are a myriad of characteristics of your pregnancy that suggest you may be carrying one gender versus the other. Cherokee Women’s Health has a list of these old wives tales for you compare:

It’s a Girl

  • You’re carrying high
  • Baby’s heart beat is higher than 140 beats per minute
  • You’re experiencing morning sickness
  • You’re craving sweet foods
  • Your hair is thinner and dull*
  • Your face is fuller and rounder than usual*
  • You’re experiencing acne during your pregnancy*
  • You are graceful during your pregnancy
  • Dad-to-be is gaining weight with you
  • When stringing your wedding ring over your belly, it moves back and forth

*Noticing a trend that suggests your pregnancy may not be too kind to your natural beauty? This is indicative that you are having a baby girl because she is stealing your beauty, or so the old wives tale goes.

It’s a Boy

  • You’re carrying low
  • Baby’s heart beat is below 140 beats per minute
  • You’re having little to no morning sickness
  • You’re craving salty foods
  • Your hair is full bodied and shiny
  • Your face is long and narrow
  • You are more clumsy during your pregnancy
  • Your feet get colder now than they did before your pregnancy
  • Your areolae have darkened
  • When stringing your wedding ring over your belly, it moves in a circle

Do your pregnancy symptoms favor one gender over the other? Well, these are all in fun and have not been proven to be an accurate indicator of your baby’s gender. Other than the second trimester ultrasound and an amniocentesis, the most accurate gender predictor is simply a mother’s intuition – 71% of the time, the mom-to-be knows the gender of her baby.

We hope that these fun gender predictors will help make the wait for your gender revealing ultrasound a little easier to bear. If you need to schedule a second trimester ultrasound, don’t hesitate to contact our office by calling 770-720-7733.


March 13, 2014

This is one of the first questions most moms-to-be ask when they reach 37 weeks and become full term. The big problem is that television and movies have led us to believe that labor begins when your water breaks, and then after a grueling hour, the baby is born. However, this is not an accurate portrayal of the labor process, and if you take yourself to the hospital at the first sign of labor, you will likely be sent home. So, how do you know when to go to the hospital?

Early Labor

pregnancy laborEarly labor can be difficult to determine. Once you understand what the difference is between Braxton Hicks and real contractions, you’ll know when real labor has begun. Yet, even if you have determined that you are in the early phase of labor, it is still not time to go to the hospital. Labor is a long process, so the longer you can spend in the comfort of your home, the better. During this phase, your cervix is effacing and dilating to about three centimeters. As this is a gradual process, the contractions are fairly mild and easily managed without the use of any pain management techniques. Use this time to get some rest because you are going to need it. This is also the time to enjoy a final meal since you won’t be able to eat or drink anything in the hospital until after the baby is born.

Active Labor

Once your contractions get to be about five minutes apart, you have successfully transitioned into the active phase of labor and this is when you want to go to the hospital. At this point in the labor process, the contractions have likely become more painful, making it uncomfortable to labor at home. We would love to be able to tell you that since you are now in the active phase of labor, the baby will be arriving shortly. However, this is not usually the case. While this phase of labor is much shorter than early labor, it can last up to eight hours or even more. As the pain has become more severe, it is during this phase when you will get an epidural, if you want one.

When Does My Water Break?

As far as the breaking of the water goes, it varies from person to person. Typically speaking, it will break when your cervix is almost fully dilated. It is funny that pop culture has portrayed the breaking of the water as something that signifies labor has begun, when in reality it is something that happens near the end of labor. Of course, there are circumstances in which the water does break before labor begins, and in these situations we recommend you call your obstetrician or midwife immediately for advice on when to go to the hospital. Since your water has broken, you do not need to wait until active labor has begun.

If you have any other questions about labor, do not hesitate to ask your midwife or obstetrician at your next prenatal appointment.

February 27, 2014

In slight continuation of our “Is it Safe to…” blog post from last week, one main question on lots of mamas-to-be minds is getting enough omega-3’s to help with baby’s development. Omega-3’s have been reported to help promote healthy fetal brain development, and reported benefits include fewer behavior problems, better verbal skills, and even higher IQ’s.

However, understandably, some pregnant mamas are concerned with the levels of mercury in certain fish, and knowing which fish to eat to gain this important nutrient and which to avoid can be tricky. Cherokee Women’s Health shares some important facts on which fish are safe to eat and which fish you should avoid until after your delivery.

Happy Fish, Sad Fish, Good Fish, Bad Fish

The FDA and EPA say pregnant women can safely eat up to 12 ounces of seafood a week. So which fish is best for pregnant moms? Ideally, you want to shop for or order fish low in mercury but high in omega-3’s. Salmon makes for an excellent choice in both categories (whether wild-caught or farm-raised). Herring, trout and sardines are are low-mercury, high-omega-3 options. Other safe choices include shrimp, pollock, catfish and canned light tuna, but you should limit albacore tuna and tuna steak to no more than 6 ounces a week.

The fish found to have higher levels of mercury include shark, swordfish, escolar, marlin, and orange roughy. Pregnant women are advised to limit these to twice per month.

Other Safety Guidelines Making healthy food choices during pregnancy

Of course, when eating any type of fish, you want to make sure it’s cooked to an internal temperature of 145 F. As a general rule, the fish is done with it separates into flakes and appears opaque throughout. For shrimp, lobster and scallops, cook until they’re milky white, and don’t eat any clams, mussels and oysters until their shells open. (And discard any unopen shells.) If you aren’t sure about the best way to prepare it, Pinterest has a ton of delicious-looking options that are sure to whet any pregnant mom’s appetite.

If fish has you thinking “yuck,” don’t worry – there are other ways to get omega-3 fatty acids. Flaxseed, walnuts, sunflower seeds, pine nuts and soybeans are all good sources of omega-3’s, and other foods have been fortified with this nutrient, including yogurt, milk, and eggs. Additionally, you can talk to your obstetrician or midwife about an omega-3 supplement at your next prenatal checkup.



February 25, 2014

Sometime between the 24th and 28th week of pregnancy, most women will come in for their glucose screening and glucose tolerance tests. These tests determine if you have gestational diabetes, a high blood sugar condition that some women get during pregnancy. If you have been diagnosed with gestational diabetes, Cherokee Women’s Health sheds some light on what it means for you and your baby.

What Causes Gestational Diabetes?

Gestational diabetes occurs as a result of hormonal changes during pregnancy. Increased levels of certain hormones interfere with the body’s ability to manage blood sugar. This condition is known as insulin resistance, and as the placenta grows larger during pregnancy, it produces more hormones, increasing the resistance to insulin. If a pregnant woman’s pancreas is unable to produce more insulin to overcome the effects of additional hormones in the body, blood sugar levels will rise, resulting in gestational diabetes.

Treatment for Gestational Diabetes

For women who test positive for gestational diabetes, there is extra treatment and doctor’s visits required, with the goal of making sure that blood glucose levels remain at a normal level. Treatment will most likely involve special care when it comes to diet and exercise, and checking your blood sugar levels daily. Monitoring gestational diabetes with healthy food choices

  • Diet – A registered dietician will be able to help you limit the amount of carbohydrates you eat to control blood sugar, as well as outline a healthy eating regimen. On average, a healthy weight gain during pregnancy is between 25 and 35 pounds, and your obstetrician or midwife will work with your dietician to recommend ways to monitor your overall weight gain.
  • Exercise – Aim for 2 hours a week or 30 minutes 5 times a week of moderate exercise to help your body use insulin better and help control your blood sugar level. Low-impact exercise such as walking and swimming are great options for pregnant women.
  • Checking blood sugar – Checking your blood sugar at home daily will help to make sure your level is within target range. Some women may require testing more than once a day, so it’s important to talk to your doctor about frequency during your routine prenatal visits.
  • Fetal monitoringYour doctor may want you to monitor fetal movements to let him or her know if your baby is moving regularly. You may also have more fetal ultrasounds to monitor baby’s growth, or a test known as the nonstress test to check how your baby’s heart responds to movement.
  • Insulin shots – If your blood sugar levels are still too high after making changes in diet and exercise routine, you may need insulin shots, which can lower your blood sugar without harming your baby. Or you can ask your doctor about pills such as glyburide or metformin that help regulate blood sugar.

If you’re diagnosed with gestational diabetes, it’s important to maintain regularly scheduled prenatal checkups. Your provider will check your blood pressure and test a sample of your urine, as well as discuss your blood sugar levels, your diet and exercise routine and how much weight you’ve gained. If you’re due for your next prenatal visit or are concerned about gestational diabetes, don’t hesitate to contact our office to schedule your next appointment.

February 21, 2014

Whether you’ve been trying to get pregnant for a long time or you discovered a happy accident, the moment a woman realizes she’s pregnant, she often begins to think of all the things she once did or likes to do, wondering if they’re still OK to continue during a pregnancy. The good news is, your list of pregnancy “don’ts” is much smaller than you might think, and there’s still a lot you can do during the next nine to ten months. Cherokee Women’s Health Specialists has compiled a few of our most asked “Is it safe?” questions here on our blog this week. Read up and know that you’ve got an exciting nine months ahead!

Is it safe to color your hair while pregnant? Woman thinking about questions to ask her doctor

Many women begin coloring their hair long before pregnancy, and often wonder if it’s still safe to do so once they see those two little lines. For these women, the good news is that very little chemicals in the hair dye are actually absorbed into your system, and as long as you’re coloring your hair in a well-ventilated area and using protective gloves (if you’re doing it yourself), you should be perfectly fine. If the idea of coloring your hair during pregnancy still concerns you, you can wait until your second trimester when baby is less vulnerable.

Is it safe to be around paint while pregnant?

One of the most exciting things for a pregnant mother can be decorating a new nursery. Naturally, selecting a wall color for baby’s room is one of the first steps in creating the mother’s ideal space, but what about painting it? The type of paint used is the key here. Latex, or acrylic paint, is the most common and is generally considered safe to be around while you’re pregnant as long as you’re in a well-ventilated area. If you start to feel sick or nauseous at all, get some fresh air and have someone else finish the job. It’s best if you avoid using oil-based paints on your own, but you can let someone else do this for you as long as you’re not around while they’re doing the work. Lead-based paints are a strict no-no, and if you have to have some removed, make sure you’re not home during the process. Afterward, you should be fine to return to the home.

How much caffeine consumption is OK?

If you’re used to waking up with a cup of coffee or have to have a soda in the afternoon to help with that afternoon crash, there’s no reason for you to give caffeine up entirely during pregnancy unless you’d like to. Experts have stated that moderate levels of caffeine have not been found to have a negative effect on pregnancy, with the definition of moderate varying between 150mg-300mg a day. For reference, there’s about 259mg of caffeine in a 16oz Starbucks House Blend Coffee. If you’re concerned about caffeine intake during pregnancy, you can always talk to your provider at your next prenatal checkup.

What medications are off limits during pregnancy?

Another concern of newly pregnant mothers is making sure that if needed, they’re taking only the medications that have been cleared by their doctor during pregnancy. At your first pregnancy checkup, your provider will send you home with a complete list of medications that are generally thought as safe to use, including treatments for pain like Tylenol, treatment for nausea, cough and cold, and other symptoms. If at any point in your pregnancy you’re unsure about a medication, it’s always best to ask your doctor before taking it.

While these questions are just a sampling of the many questions we hear from patients during prenatal visits, we urge our patients never to be shy about asking questions. Having an open communication with your doctor or midwife during your pregnancy is the key to having a safe and healthy pregnancy. To schedule a prenatal visit at either our Woodstock or Canton office, contact our office by calling 770-720-7733.





February 13, 2014

Bringing a new baby home is one of the most exciting exciting experiences new parents can have. Understandably, new parents may feel overwhelmed with all of the advice and information available, and trying to get a feel for what works best for you and your new family member can be daunting. In the spirit of Valentine’s week, the Cherokee Women’s Health team wishes to share some of the most helpful advice for new parents that we know to be true:

Quite simply, love each other, as this models a healthy relationship for your new child as they learn and grow.

Need a Relationship Pick-Me-Up? Couple with new baby's hands in a circle

If the upcoming romantic holiday has you thinking that your relationship (whether it involves a new baby or your children have flown the nest) could use a little pick-me-up, why not try one of these ideas that don’t have to end with Valentine’s Day:

  • Try something new together. Test out a new restaurant, sign up for a cooking or dancing class, or see if you can steal away a night from the kids in the Georgia mountains.
  • Laugh. Laughter is of the essentials to building a strong, healthy relationship. It brings people closer together, creates intimacy, and helps resolve conflict.
  • Eat healthy. A colorful diet full of fruits, veggies and plenty of protein will not only help you feel better, it might help put you in “the mood.” Common aphrodisiacs include oysters, figs, almonds, and avocados.
  • Take a walk. Exercising together, even if taking a quick 30-minute stroll, can help increase blood flow, which helps boost mood, reduces stress, and can lead to a bigger desire in the bedroom.
  • Remember that you’re a team. If anyone can attest to the trials and tribulations of family and marriage, it’s Dr. Litrel and his wife, Ann. Try to remember that you’re not alone in your struggles, and that if you can work as a team, your entire family will benefit.

If your family is growing this month, we hope that you have the love and support needed to help inspire your children to grow up and experience healthy relationships. If you’re done adding to your family, what other advice would you give to new parents about starting a family? Share with us by leaving a comment below.

Photo via FreeDigitalPhotos.net


February 6, 2014

For many women, their bodies post-childbirth are something they feel they have to “deal with.” Skin is sagging, they may have stretch marks, and if they had a successful vaginal delivery, they may feel that their vaginal opening is less-than what it was beforehand. Some women experience complications  related to other pelvic floor issues like incontinence and pelvic prolapse, and these issues can be embarrassing and hard to discuss. Knowing the specifics of what vaginal rejuvenation surgery can offer will allow you to make more informed decisions about whether or not the surgery is the right option for you.

Understanding the Types of Vaginal Rejuvenation

Vaginal rejuvenation surgery in the simplest terms is the tightening of the vaginal canal. Vaginoplasty is a procedure for women who want to firm up and reshape the tissue to gain a more youthful appearance and feel. With straight vaginoplasty, typically no other procedures are needed to reconstruct the tissues surrounding the vaginal opening.  Labiaplasty, another common procedure, is the reduction of the labia, usually done because they are too large.

Some women, depending on the severity of damage done during childbirth or another trauma, require reconstructive surgery to repair those same areas, often involving slings or mesh to reconstruct the gentle tissues that make up a woman’s anatomy. These types of procedures will repair the pelvic floor, addressing problems caused by a displaced organ, also known as pelvic prolapse. Pelvic prolapse afflicts over 3 million women in the United States.

What Does Insurance Cover?

Vaginaplasty and Labiaplasty

Both vaginaplasty and labiaplasty are considered cosmetic procedures. However, if a medical condition is diagnosed, a portion of your expenses may be covered by your insurance.

Medical Conditions

In the cases of women who have more severe damage to their pelvic organs and tissues, insurance does cover medical procedures for anterior and posterior repair, since they’re considered medical problems. Anesthesia and hospital care for the procedure are covered by insurance in this case as well. If you’re already considering talking to your doctor about reconstructive vaginal surgery and are interested in vaginoplasty or labiaplasty, you can add the cosmetic enhancements on top of your current procedure and pay for those separately.

The OB/GYNs at Cherokee Women’s Health Specialists understand that reconstructive surgery of the vagina is both a delicate topic and procedure. Our surgeons possess a combined experience of over 35 years performing vaginal rejuvenation procedures. Don’t hesitate to contact our female representative on her private and confidential line at 770-720-7733 ext. 2232 or you can contact us via our confidential contact form.







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“Dr. Litrel was a fantastic doctor. I had my first exam with him, although at first I was skeptical about a male doctor for my GYN. But after I met him I’m glad I kept an open mind, and I couldn’t have dreamed up a better doctor. He cares about you as a person and not just a patient. The front desk ladies and nurses were very friendly and it’s a great office, very clean and not intimidating. I highly recommend Cherokee Women’s Health.”
– Vicki