770.720.7733
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October 26, 2016

Bring your birth control questions to the providers at Cherokee Women's Health.The responsibility of Family Planning has never been easier with all of the options available to meet a patient’s health and lifestyle needs.  While the choices may seem overwhelming, a doctor can help to find the right contraception method to meet each patient’s needs. Below are some things to consider before scheduling an appointment with a care provider:

  • Disclose Complete Health History- It is especially important to be honest and thorough when disclosing health history because of any risks associated with contraception methods. This is a critical step in finding a birth control that will work for any health conditions a patient may have. Furthermore, there are certain birth control types that are contraindicated for those with genetic conditions or predispositions such as breast, uterine, or ovarian cancers.
  • Ask about options-it is best to make an informed decision about birth control, so start by asking what types are available. Choices range from pills, implants, and injections to more permanent options such as sterilization for women or men. While considering all of the options, it is important to plan for the future. For patients looking for long-term or permanent birth control, it is advantageous to ask about the reversibility of the method. Plans change, and patients should know if their birth control can be easily reversed.
  • Inquire about the Efficacy of Birth Control-Different methods hold different rates of effectiveness and a doctor can help compare methods that will work best for each patient’s needs. Find out what types of back-up or emergency birth control can be used to bolster effectiveness, prevent failure, and protect against sexually transmitted diseases. Additionally, ask if any supplements or antibiotics will interfere with the effectiveness of birth control and if there are back-up birth control options that should be used.
  • Evaluate the Cost-Some birth controls will cost more out-of-pocket than other types. Doctors can assist in finding a solution that fits into the budget. Contacting insurance is another suggestion to see what options are covered under a patient’s health plan.
  • Compare the Side-Effects and Benefits-Ask for a run-down on the types of side effects that can occur on birth control. Some patients may want to adjust their method based on their level of comfort with the side effects they experience. A doctor can answer any questions about switching methods or reducing symptoms or side effects.
  • Lifestyle Considerations-Depending on a patient’s lifestyle and individual menstrual cycle, there are contraceptive methods that may be the most optimal choice. For patients who travel often, they may find that they need a method that does not require weekly updating, or monthly prescription renewals. Those with irregular periods may want to consider something that regulates their cycle, such as birth control pills. Doctors can help pinpoint a method that accommodates lifestyle needs.

More than Protection– Proven benefits of taking contraceptives include regulating periods, reducing heavy bleeding, and clearing up skin conditions such as acne. Endometriosis is another condition that can be helped with the right birth control method, eliminating pain associated with the disorder. Women suffering from PMS, or PMDD should ask their doctor about a birth control method that can also help eliminate or lessen these irritable symptoms. Mention any symptoms experienced prior or during a menstrual cycle such as:

  • Mood changes or Anxiety and Depression
  • Severe pain
  • Sleepiness or Insomnia
  • Social Dysfunction
  • Weight gain and water retention

Birth control is not a one-size-fits-all method. If a particular type of birth control does not meet a patient’s needs, they should discuss any issues with their doctor and find other suitable options. Cherokee Women’s Health want to help take the guess work out of choosing a birth control. The first step in finding a contraception method is making an appointment with one of our health professionals, today!

October 19, 2016

Routine prenatal care is not a luxury or indulgence. It’s something both you and your baby deserve, and it’s a service that we excel at and are happy to provide.

Just as a gardener waters, nurtures, and cares for the seeds that he planted in rich, fertile soil, your baby, who is even smaller at conception than those seeds, needs the same dedication and attention to insure its prenatal growth and development in the womb. We help make that happen.

Whether this is your first pregnancy, or you’re already familiar with the whole process of giving birth, the importance of prenatal care can’t be emphasized enough. No matter how typical your pregnancy is, or how little risk your baby is exposed to health-wise and genetically, proper vigilance from conception to safe delivery is vital.

routine prenatal care exam photoOur specialists are trained in every facet of women’s health. We excel in the fields of fertility, obstetrics, gynecology and pelvic surgery. Not only do we offer optimum prenatal care, but we treat you, the patient, the same way we would treat our own mothers, sisters, daughters and all other females in our lives. Having successfully delivered over 10,000 babies, our priority is to safeguard not only your continuing well-being, but that of your baby. We offer every advantage currently known to women’s medicine, all with a compassionate and dedicated approach.

What Can You Expect From Us?
From your very first prenatal care visit, we treat you with the utmost care and respect, beginning with the initial pleasant greeting you receive the moment you walk through our doors. We’re professionals, but first and foremost, we’re human, just like you. We want you to feel as comfortable as possible so that you can establish a trusting relationship with your physician, and with his or her assisting staff.

How Can You Prepare For Your First Visit?
Bring your medical history and background. They’re important. That information gives us an idea of how closely we need to scrutinize your progress. It can help us decide what tests we should run during your first few prenatal care appointments. Your information and subsequent test results, if merited, determine whether your pregnancy should be considered high risk, moderate risk or risk free. No matter what the results, we are qualified to treat all levels.

What Happens During Routine Prenatal Care Appointments?
Our standard examinations during each visit include the following:

  • Blood tests
  • Blood pressure monitoring
  • Listening to your baby’s heartbeat
  • Urinalysis
  • Abdominal measurement to verify normal fetal growth
  • Pelvic examinations when necessary
  • Addressing any patient concerns.

When you’re ready for your first ultrasound, our prenatal care physicians are among the few who are fully accredited in the use of the most modern up-to-date 4D ultrasound. This procedure allows you to see your growing baby in full detail. It also lets our trained specialists evaluate your baby’s progress, detecting any potential problems that might occur as it matures from embryo to fetus, and finally to the infant you’ll cradle in your arms.

What Other Routine Prenatal Care Services Are Available?
We check for gestational diabetes, anemia and any genetic abnormalities. By conscientiously monitoring both your baby’s development along with your own, we want to relieve you of any stress or worry. When you leave after an appointment with us, we want you to do so with complete peace of mind.
We also offer the following prenatal care services:

    • Nutrition and diet: Our experts will help you maintain a healthy weight throughout your pregnancy, insuring a less complicated delivery. We provide information on regular, vegetarian, gluten free, vegan, and holistic nutrition. We take every precaution to insure that you and your baby receive the proper nourishment you need to sustain a trouble-free pregnancy.
    • Physical therapy: On-staff professionals will guide you in preparing your body for labor. Their recommended prenatal exercises and fitness regimens will minimize any possible trauma your body might experience during delivery, such as perineum damage, pelvic organ prolapse, or urinary incontinence. Their expertise has been proven invaluable, reducing previously unavoidable pelvic injury while giving birth.
    • Midwifery: You may be more comfortable with a nurse-midwife to assist you during delivery. We will partner you with a highly skilled nurse midwife, who has decades of experience. As long as your pregnancy is uncomplicated and progressing within normal guidelines, this practitioner is available to you.
    • Counsel and advice: No topic or concern you wish to broach regarding your pregnancy is trivial to us. We’re happy to address any subject, including such topics as breastfeeding, natural childbirth, having participants in the delivery room, umbilical cord blood banking, signs of postpartum depression, or circumcision if you are having a boy. You might be strongly opposed to routine afterbirth procedures, like a nurse washing your baby instead of leaving that first bath to you, or allowing it to have a pacifier in your absence. If it’s important to you, it’s important to us. We’ll answer your questions, dispense guidance as you need it and accommodate you to the best of our ability.

Getting you through your pregnancy with as little stress and complication as possible is our primary focus. We accomplish this goal successfully during every routine prenatal exam by treating you as the important and unique individual you are.

To schedule an appointment, please call us at 770.720.7733. For more information on prenatal care, visit Northside Hospital Cherokee.

Midwife-attended births have doubled in the United States since 1990, and the numbers continue to rise every year. In fact, the demand for them is beginning to far outweigh their availability. We are proud that our staff of these professional caregivers is among the very best, and prouder still that they manage to find the time in their busy schedules to help ensure that their numbers continue to grow by mentoring, educating and indoctrinating future midwives to fill the fast growing gap of need.

What Exactly Do Midwives Do?
Our midwives have accumulated years of learning, experience and training in women’s health in order to receive their certification. They hold the highest degree possible in their field CNM (Certified Nurse Midwife). Their primary focus, however, is on providing care to women and their families during their pregnancy, delivery, and the following postpartum period. They are also qualified to:

  • Provide prenatal care
  • Dispense medication
  • Recognize any potential problems that may arise during pregnancy or delivery
  • Conduct annual women’s examinations
  • Administer birth control
  • Give pre-pregnancy counseling
  • Diagnose infections
  • Provide postnatal care to mothers and newborns
  • Advise on nutrition and diet
  • Arrange for all routine prenatal testing
  • Make limited medical decisions within their scope of training and expertise
  • Deliver routine pregnancy babies
  • Prepare women for delivery with relaxation and breathing techniques
  • Discuss breastfeeding and its options
  • Provide parenting education.

Why Would I Choose a Midwife Instead Of a Doctor?
Many women prefer to opt for natural childbirth in a more subdued, comfortable setting. Midwives approach childbirth as a holistic, rather than medicinal, experience. They concentrate on alternative drug-free methods to bring your child into the world, such as breathing and relaxation techniques, massage, comfortable positioning, and advice to help you cope with contractions as they become more intense.

midwife-photoAlthough our midwives encourage non-anesthesia delivery, you will not be refused medication if you should happen to change your mind during labor. In fact, if your midwife recognizes that you are in too much painful distress, she will urge you to accept relief so that the birthing process does not become a traumatic memory.

Our midwives also develop a more intimate bond with their patients, something physicians and surgeons are not always able to provide due to time constraints. Though all our doctors strive to answer all your questions and concerns, taking whatever time is necessary to put your mind at rest during your prenatal appointments, midwives offer more availability. Since they usually have less patients at one time than an OB-GYN, this allows them to concentrate more fully on each individual pregnancy.

By questioning and getting to know you better, our midwives will learn exactly what your preferences are during your natural birth process and will do their best to accommodate those wishes.

I’ve Already Had a Caesarean but Would Really Like to Give Birth Naturally This Time. Can I Still Ask for a Midwife or Natural Birth?
In many cases, absolutely! You’ll have to be evaluated by one of our OB-GYNs to make sure there is no risk to you or your child, of course. Your health and safety, along with your baby’s, are our primary concern at all times, but once we’re confident that a natural vaginal birth is possible, one of our staff nurse-midwives can take over your prenatal care, and often your labor and delivery.

Should any problems arise at any given time, our midwives are trained to immediately notify a physician for help and support.

Midwives are our respected colleagues, and we rely heavily on their knowledge and sound medical training to alert us to step in at any time we are needed to assist if they encounter a problem outside their scope of expertise.

Childbirth is one of the most memorable experiences in a woman’s life. A midwife is proficient in extracting the inner strength and determination you may not even be aware you have to give birth naturally and still revel in the whole process.

For more information on midwifery, visit Northside Hospital -Cherokee. To make an appointment with us, call us at 770.720.7733.

October 12, 2016

If your pregnancy has been defined as high risk, there is no need to panic. The truth is, all pregnancies on some level are high risk; to grow another human being inside your body is a significant event! A high risk pregnancy status is a precautionary determination to make sure that any pre-existing risk factors you have, along with any you may develop during your pregnancy, are monitored closely to ensure both your baby’s safety and yours.

Our obstetrics team has successfully delivered over 10,000 babies, many of those deemed high risk. We’re trained to detect and evaluate situations hazardous throughout gestation, and equipped with the technology to do so.

Most of all, our tenet is to treat every pregnant patient the way we would want our loved ones treated.

What Is Considered a High Risk Pregnancy?
There are many factors that can designate a pregnancy as high risk. Some medical, physical or genetic influences may predispose you to being susceptible to certain problems. These are:

    • High blood pressure
    • Being overweight or underweight
    • Diabetes
    • Cancer
    • High blood pressure
    • Heart, lung, or kidney disease
    • Epilepsy
    • Alcohol or illegal drug usage
    • Age (under 17 or over 35)
    • Multiple births
    • History of miscarriage
    • Family member or previous child with Down syndrome
    • Infections such as HIV, chicken pox, rubella, toxoplasmosis, hepatitis C, syphilis
    • Certain medications
    • Chronic health issues such a lupus, asthma, rheumatoid arthritis, heart valve abnormalities or sickle cell disease
    • History of preterm labor or preeclampsia.

What Can You Do For Me If I Have Any of These High Risk Pregnancy Markers?
The first step is to establish a trusting relationship with you, taking the time to answer all your questions and concerns.

In many cases, just a few lifestyle modifications can ensure a safe, healthy pregnancy. Some of these changes can be as simple as speaking to our diet and nutrition experts, who will counsel you on a food and supplement regimen appropriate for your specific needs. We may schedule more frequent prenatal visits so that we can carefully monitor your progress, taking immediate steps to treat whatever problems might occur.

high risk pregnancy photoYour blood pressure will be watched closely. Blood and urine tests will be taken during every prenatal visit, along with any physical examinations or scans that may be indicated.

Our high risk obstetric specialists will evaluate any medications you might be taking, making adjustments as necessary to protect you and your child. If you suffer from pre-existing chronic conditions, we will work with you to minimize any arising difficulties.

We may monitor your pregnancy more frequently with ultrasounds and fetal monitoring.

Finally, we screen for genetic abnormalities, providing information, counsel, and advice if required.

If My Pregnancy is Normal, With No Pre-Existing Conditions, Will it Stay That Way?
Usually, but not always. This is why prenatal care appointments are so important for both you and your baby. You can develop complications at any time, placing you into a high risk pregnancy category. Again, don’t become alarmed. Our specialists have combined decades of experience and training to deal with that if it happens, and the earlier we detect something, the better. Here are some of the things we look for:

  • Gestational diabetes mellitus (GDM or gestational diabetes): High blood sugar sometimes develops during pregnancy, causing headaches, depression, high blood pressure, hydramnios (increased amniotic sac fluid), and birth defects. It can also increase the danger of preeclampsia and premature labor. Babies can grow too large, resulting in a need for a caesarean, and they may suffer from jaundice and low blood sugar after birth. We screen for this between your 24th and 28th week- earlier if your history warrants it.
  • Preeclampsia: Preeclampsia causes persistent high blood pressure which can lead to organ damage and seizures, possibly requiring medication and/or early delivery. Routine urine testing at every prenatal visit can detect this, alerting us to rigidly monitor your progress.
  • Rh factor: Rh is an inherited protein found in some blood. If yours differs from your baby’s, difficulties may arise. We routinely test for this incompatibility to safeguard the well-being of the fetus.
  • Bleeding: Though not all bleeding is dangerous, if you’re deemed a high risk pregnancy, we follow up to make sure there is no jeopardy to you or your baby.
  • hCG: (human chorionic gonadotropin): This substance not only confirms pregnancy, but analyzing levels regularly can indicate if you are at high risk for ectopic pregnancy, possible miscarriage, or a Down syndrome baby.
  • Placenta previa: Sometimes the placenta covers the cervix, causing bleeding during delivery. Transvaginal ultrasound tests warn us beforehand if a caesarian is necessary.
  • Fetal problems: Our 4D ultrasound and other equipment can detect complications or abnormalities before they become a problem.
  • Premature labor: We can’t always predict if your baby will thumb its little nose at our calculated due date, but a previous history of early labor, a shortened cervix, or certain infections alert us to be vigilant of that possibility.
  • Placental abruption: When the placenta separates or peels away from the uterine wall, the situation may become detrimental to both mother and baby. We always look out for this and other potential dangers.

Our hospital partner, Northside Hospital Cherokee, opens its new facility in early 2017, continuing to handle a full range of services for our patients with high risk pregnancies. Since 1993, Cherokee Women’s Health has delivered more babies at Northside Hospital Cherokee than all other OB practices combined.

Whether yours is a routine or high risk pregnancy, our highly qualified, expert providers pride themselves on giving you the best individual prenatal care necessary to ensure a safe and healthy pregnancy.

For an appointment, call us at 770.720.7733.

October 4, 2016

Vegans can have healthy pregnancy without adding animal products to their diets.A healthy pregnancy requires that mothers-to-be eat foods rich in vitamins and minerals to help support their growing baby. One of the first prenatal appointments with an obstetrician will include a discussion about what foods to eat or avoid in order to provide optimal nutrition for fetal growth. The American Congress of Obstetricians and Gynecologists suggests that pregnant women eat a well-rounded diet which should consist of fruits and vegetables, whole grains, dairy, and meat. However, for those whose diets stray from the five food groups, such as vegans, or vegetarians, they simply need to find other foods or supplements that will provide adequate nutrition for themselves and their babies.

Veganism is a dietary lifestyle which completely abstains from the consumption of animal products. A vegan’s diet eliminates: eggs, meat, dairy, honey, etc. It is not imperative for a vegan mother-to-be to include these food items in her diet because a 100% plant-based diet can include all the required nutrition a mom and baby need. A fundamental step is making sure to find alternative sources for the all-important vitamins and minerals needed to foster healthy development and less pregnancy complications.

Iodine:

No matter her dietary lifestyle, iodine is one of the essential minerals that a pregnant woman must consume. Iodine is important for proper thyroid function, and critical during pregnancy for fetal neurological development. The recommendation for pregnant women is 220 micrograms of iodine a day. Even a small deficiency can have a major impact on fetal development, which is why sources of iodine need to be included in consumption. Due to its use in the milking process, dairy can often be a main source of iodine intake for women. Instead of dairy, a vegan mother can add iodine to her diet by taking iodine supplements, eating fortified foods, or using iodized table salt.

Iron:

Iron is a mineral often found in red meat. Iron deficiency anemia is a concern for pregnant vegans, unless they can find alternative sources for the mineral. The body requires at least 30 milligrams of iron daily during pregnancy to increase blood supply and foster a healthy fetus. In addition to possibly adding in iron supplements, pregnant vegans should be eating green leafy vegetables, whole grains, and dried beans daily to ensure necessary iron levels.

Calcium:

For vegans, sufficient calcium intake will be more tedious to acquire than simply drinking milk. 1,000 mg. are needed during pregnancy to help build healthy fetal bones and teeth. Vegans can turn to kale as a large source of calcium to add to their diet. Other top vegan calcium sources include: almonds, bok choy, turnip greens, or fortified foods such as soy milk, cereal or orange juice.

Vitamin B12:

When it comes to vitamins, one vitamin vital to pregnancy is Vitamin B12. Vegans do not naturally consume as much B12, because they abstain from eating animal products which are rich sources of the vitamin. Plant products do not contain a considerable amount of B12, but foods such as cereal are often fortified with the vitamin. Pregnant women are recommended to take 2.6 mcg. of B12 a day, and even slightly more when breastfeeding. B12 deficiency is life-threatening, so pregnant and breastfeeding vegans need to ensure that their levels are appropriate for pregnancy.

Vegan mothers should bring up any questions or concerns to their doctor when it comes to meeting the crucial vitamin and mineral intake during both pregnancy and breastfeeding. It is always recommended to not begin taking any additional vitamins or supplements without consulting a physician first. If a mom-to-be is struggling to reach these nutritional values, she may be put in touch with a nutritionist, who can assist in planning a suitable diet for the duration of pregnancy and breastfeeding. Having a baby changes everything; but moms don’t have to completely adjust their dietary lifestyles to keep themselves and their baby healthy.

 

A pap smear is a simple procedure which tests for abnormal cervical cells. The test is performed on an exam table and is generally a painless and quick procedure. The doctor uses a speculum to open the vagina so that a sampling brush can be guided in to gather cells from the cervix. This sampling brush is then sent to the lab for study and results will be communicated to the patient after the lab examination is complete.

Ask your doctor if it is time for you to get a pap smear.If abnormal cervical cells are present, follow-up testing using the DYSIS colposcopy technology can reveal whether the abnormality is related to Human Papillomavirus (HPV) or cervical cancer. Pap smears are a critical component of a well-woman’s health exam. In recent years, the American Congress of Obstetricians and Gynecologists created new guidelines for the time frame between each pap test. The new guidelines were instituted following research that revealed that yearly pap smears were no more likely to catch cervical cancer than tests performed every 3 years. Previously, the pap test was generally conducted at every annual well-woman examination, but currently ACOG suggests the following:

  • Women under 21 do not require a screening
  • Women aged 21-29 should have a pap smear every 3 years
  • Women ages 30-65 years should have a pap test and an HPV test completed every 5 years, or a pap smear every 3 years
  • Women aged 65 or older do not require testing if they have had three negative pap tests in a row

These are current guidelines, but they have proven controversial, and as new data emerges, it is likely these will be changed yet again. Many doctors are concerned that these guidelines are too liberal, and that cancers will be missed. It is important to note that well-woman visits are still just as important even though the pap test guidelines have changed. Women should still have an annual visit with their gynecologist for reproductive health and for any other concerns related to women’s health.

Prevention is key in cervical cancer screening.

Having a monogamous relationship, limiting the number of sexual partners, and using condoms are paramount to a woman’s health. Doctors advise that women receive the HPV vaccine, as well as pap tests, which will help to screen for any abnormalities and catch any precancerous cells (dysplasia) before they spread.  Women who are found to have cervical dysplasia can receive treatment to prevent the cells from turning into cancer. Usually, this is removal of the abnormal cells. If cervical cancer is found to be invasive, surgery, radiation therapy, and chemotherapy may be required to treat the cancer.

Cherokee Women’s Health uses cutting edge DYSIS technology to assist in diagnosing and treating cervical issues including dysplasia and cancer. With proper screening and prevention, cervical cancer diagnoses can continue to decrease.

pregnant womanThe third trimester begins in the 28th week of pregnancy and ends when your baby officially becomes a newborn. This is a bulkier, less comfortable time, but will soon be over. At the end of this trimester, the fetus will be 17 to 23 inches long, fully formed, and weigh anywhere from 6 to 10 pounds.

What Happens Now?
Some new symptoms may appear, and familiar ones may intensify. They might include:

  • Restless Leg syndrome (RLS) and leg cramps: These can occur at any time. RLS is common in about 15% of pregnant women. Support hose, moderate exercise, less caffeine, and more fluids during the day may alleviate discomfort.
  • Nasal congestion and snoring: Estrogen increases blood flow throughout the body, including nasal membranes. Nasal strips and saline drops often help. So can elevating the head during sleep. If snoring becomes intense, your obstetrician may want to rule out sleep apnea.
  • Abdominal aches: The fetus is becoming more active. Growth is accelerating, widening the uterus so that it presses against your bladder, diaphragm and other organs. Discomfort is usually minimal.
  • Fatigue: Finding a comfortable position in bed sometimes becomes difficult. It’s recommended that you not sleep on your back now, as the growing uterus can press on the main vein (vena cava) which pumps blood from your heart to the lower part of your body. Try sleeping on your left side, using pillows as props.
  • Insomnia and/or bad dreams: Anxiety and overactive hormones may rob you of rest. Moderate exercise, a warm bath, massage, cutting caffeine and lowering the bedroom temperature helps enable sleep.
  • Heartburn: Hormones and pressure from the uterus pushing the stomach upward can trigger indigestion. Consult your obstetrician before trying any remedies.
  • Stretch marks: These may become itchy and more prominent. A good moisturizer can help.
  • Varicose veins and hemorrhoids: Extra blood pumping through your body now can make these appear. Both usually diminish or disappear after birth.
  • Clumsiness: Rapid body shape and size changes can make you misjudge distances and bump into surroundings. Try moving slower. This minimizes injury both to yourself and the fetus.
  • Pregnancy fog and distraction: Forgetfulness and distraction are attributable to brain function changes during pregnancy. Research actually shows that women pregnant with females experience pregnancy fog more than those carrying males. This haziness disappears a month or two after birth. Until then, keep to-do lists on hand to jog your memory.
  • Lack of bladder control/ frequent urination: Extra weight and pressure on the pelvic floor can result in leakage and constant bathroom visits. Do your Kegels and wear panty liners.
  • Backache: A growing stomach pulls your center of gravity forward, triggering backache. Elevating your feet, a warm bath, and gentle massage can ease pain. If it’s intolerable, however, your doctor may want to rule out injuries like sciatica.
  • Breast leakage: Your body is preparing for breastfeeding. Nursing Pads aid in preventing staining.
  • Lightening: At about week 36, you might notice your shape changing. Your stomach will drop lower and you could start waddling. Your baby is changing position to prepare for birth. Your breathing will be easier, heartburn may diminish, but urination may become more frequent.
  • Mucus plug: A clear gelatinous plug may detach from the uterus weeks or immediately before labor. This means the cervix is softening and preparing for delivery.
  • Braxton Hicks: These irregular contractions are often mistaken for the real thing by first time moms. They can occur intermittently weeks before you actually go into labor.
  • Bloody show: Pink or brown tinged mucous indicates that you are effacing and dilating. Labor is close at hand, but it can still be several days to a few hours away. Blood should not be bright red or excessive though. Call your doctor if it is.
  • Water breaking: The amniotic sac has ruptured and labor is approaching. If steady contractions have not begun within 24 hours, labor might be induced to avoid infection.
  • Contractions: These are regular and stronger than Braxton Hicks and will not diminish. Your doctor will advise you as to how long to wait before leaving for the hospital.

What Precautions Can I Take During This Time?
You can continue to do exactly what you’ve been doing all along- take care of yourself and your baby. Eat well but watch your weight. Rest when necessary, but avoid becoming inactive. Moderate exercise will make your labor and delivery easier. Avoid strenuous activity or heavy lifting. If you are uneasy about anything or notice radical symptoms that worry you, consult your doctor.

Fetal Kick Counts
Your baby’s movement may provide information that help us care for you during this pregnancy. During a convenient hour each day, after eating and emptying your bladder, please lie down (on your side is best) and concentrate on your baby’s movement. Note each movement. Smoking may interfere with the movements and should be avoided during pregnancy. Count the number of movements for thirty minutes. Your baby should move at least five times in that thirty minutes. If your baby moves less than five times during that thirty minutes call your physician or go to the hospital.

Call your doctor if you experience: 

  • Decreased fetal movement
  • Rupture of membranes (water breaking)
  • Contractions every 2-5 minutes (more than five per hour)
  • Cramps in the lower abdomen with or without diarrhea
  • Low, dull backache felt below the waistline
  • Temperature over 100 degrees
  • Vaginal spotting or bleeding.

Helpful Hints: 

  • Be sure to drink at least 8-10 glasses of water every day (in addition to anything else you drink).
  • Eat small frequent meals to avoid heartburn.
  • Use Tylenol for minor aches and pains.
  • You may take warm baths or showers, place a heating pad on your back using low heat setting and rest with your feet elevated.

What Tests are Performed During the Third Trimester?
By this time, most precautionary tests have been completed, and only these regular routine tests are done during prenatal visits

  • Urine test
  • Blood pressure check
  • Fetal heartbeat check
  • Measuring of the uterus.

You could possibly require a pelvic exam to check that the cervix is changing the way it should, along with a test for group B streptococcus, a bacterium that approximately 30% of women can transfer to their babies during delivery. If results are positive, an antibiotic will be administered during labor.

Additional tests may be warranted, especially if:

  • You are having a multiple birth
  • Your baby is growing slowly
  • You have chronic problems
  • You are past your due date.

Each trimester has its own unique milestones, and our doctors have the knowledge and expertise to make sure that your pregnancy is progressing safely and well. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

September 1, 2016

Vulvodynia is persistent, inexplicable pain anywhere in the vulva. The discomfort associated with this condition can be so severe that any sexual activity may be impossible. Even sitting can become intolerable.

Vestibulodynia (Vulvar vestibulitis syndrome or vestibulitis) is another condition which is very similar to Vulvodynia except that pain is situated at the entryway just outside the vagina inside the labia (vestibule).

Though it is not known exactly what causes Vulvodynia, doctors speculate that there may be several triggers:

  • Allergies or sensitive skin that can be easily irritated
  • Hormonal changes or hormonal contraception
  • Injures to the vulvar area’s surrounding nerves
  • Sexual abuse
  • A predisposition to yeast infections
  • Pelvic floor dysfunction
  • Past history of anxiety and/or depression
  • Muscle spasms
  • Frequent antibiotic use.

Vulvodynia has also been associated with several other chronic pain-related conditions, meaning that there is a higher likelihood of Vulvodynia if a woman has any of the following:

  • Interstitial cystitis: (An inflammatory condition that causes moderate to severe pain or pressure of the bladder and surrounding pelvic area).
  • Fibromyalgia: (A chronic disorder causing widespread muscular, joint and tendon pain).
  • Irritable bowel syndrome: (Recurrent abdominal pain, diarrhea and constipation).
  • Endometriosis: (A painful disorder where tissue that is similar to the kind growing in the lining of the uterus (endometrium) grows outside of the uterus instead).
  • Chronic fatigue syndrome: (An unexplained ailment with symptoms of fatigue, fever, tenderness and depression, usually following a virus).

In most cases, however, there is no absolute known cause, and the reasons for Vulvodynia remain a mystery. Investigation of this disorder is still in its medicinal infancy because it was previously thought to be a purely psychological issue.

What are the Symptoms?

  • Itching
  • Throbbing
  • Burning
  • Stinging
  • Painful intercourse (dyspareunia)
  • Soreness
  • Rawness
  • Redness
  • Irritation.

These symptoms can be sporadic or constant. They can last for weeks, months or even years. They may also appear suddenly, and disappear just as abruptly. This discomfort can be centralized in one area such as the vaginal opening, or spread throughout the entire vulvar zone. This area may appear swollen or irritated, but often looks completely normal.

Vulvodynia can seriously impact a woman both physically and mentally. Inability to engage in sexual activity may jeopardize relationships. Chronic pain can also lead to irritability, anxiety, sleeping difficulties, social withdrawal, and low self-esteem. Vulvodynia, and the negative emotions that ripple from the condition, can disrupt quality of life and eventually activate full-blown depression.

How Is Vulvodynia Diagnosed?
There is no actual test for vulvodynia. Diagnosis is made by ruling out any other possible ailments that might mimic the symptoms of this disorder, such as:

  • Skin conditions
  • Diabetes
  • Yeast or bacterial infections
  • Cervicitis or inflammation of the cervix
  • Endometriosis.

A medical history will need to be provided, especially past infections in the pelvic region. Any current drugs you are using, specifically hormonal replacement or contraception should be mentioned.

Female pain photoYou will be asked pertinent questions in order to determine the problem. A pelvic exam will be done, both internally and externally to see if there is a possibility of a present infection. Even if the genitals show no visual signs of any infection, a cell sample may be taken to rule out bacterial vaginosis or yeast infection. Finally, to check for vulvodynia, a swab that has been moistened will be used to gently dab at and probe the vulva and surrounding area to determine the exact locations of your pain.

What Happens if I Have Vulvodynia? Can I Be Helped?
Yes. There are several treatments that can minimize pain or discomfort:

  • Antihistamines can calm itching, steroids, anticonvulsants, and antidepressants can subdue chronic pain.
  • Numbing creams or ointments containing a local anesthetic applied before initiating sex may provide temporary help, but may also cause your partner to experience numbing upon physical contact with these creams.
  • Biofeedback therapy can train you to relax, in turn decreasing suffering. You can be taught how to control your body’s responses to vulvodynia symptoms. If the human body anticipates pain, it involuntary contracts to avoid it, causing the very pain it tries to ward off. In time, this pain becomes chronic. Biofeedback can help with this vicious circle, allowing the pelvic muscles to relax and minimize this innate tightening and the subsequent discomfort.
  • Nerve blocks that are injected can help with chronic pain.
  • Pelvic floor therapy reduces muscle tension in the pelvic floor muscles. These muscles are a support for the bladder, uterus and bowel, and relaxing them can provide vulvodynia relief.
  • Surgery that removes tissue and skin affected by vulvodynia or vestibulodynia (vestibulectomy) can effectively relieve pain in many women.

Is There Anything I Can Do At Home in the Way of Self-Help?
There are some simple measures you can take to decrease some of the uncomfortable symptoms:

  • Sitz bath soaking, which is sitting in cool or lukewarm water for 5 to 10 minutes two or three times a day can soothe symptoms.
  • Avoid those hot tubs and long soaks in scalding water. They contribute to discomfort and itching. Chlorine pools exacerbate the problem as well.
  • Save the control top pantyhose and sexy synthetic panties for special occasions. They restrict airflow to the genitals, causing the temperature down there to rise and trap moisture that can cause irritation. Try to find cotton substitutes that promote dryness through absorption, and that encourage healthy, necessary ventilation to the delicate genital area. If you’re comfortable with it, go ‘commando’ at night and skip underwear altogether.
  • Cold compresses placed directly on the affected area can help itching and pain—especially after sex.
  • Whenever possible, try to avoid any activity that may put pressure on your vulva, such as horseback riding or biking.
  • Treat your lady parts gently. Avoid douches. Wash the area with plain water using your hand, then lightly pat it dry. Avoid soap when possible. Even residue scented laundry detergent and fabric softener in clean towels or facecloths can irritate sensitive tissue. You might even wish to put on a natural emollient without additives or preservatives after washing. Petroleum jelly creates a soothing barrier.
  • If you’re able to tolerate intercourse, a lubricant can greatly help, preferably a water soluble one.
  • Antihistamines before bed can stop itching and provide a restful sleep.
  • Unscented white toilet paper can make a difference. So can tampons and sanitary napkins that don’t smell like they’ve been dragged through a perfume factory. Contraceptive creams and spermicides can also irritate vulvodynia.
  • Harsh, irritating urine caused by certain foods and drinks like citrus beverages, beans, nuts, chocolate, berries, etc. may cause burning upon voiding. Rinsing the vulvar area after urination with cool water helps.

It is important to note that vulvodynia is NOT a sexually transmitted disease. It is not contagious, and is in no way an indication of any kind of cancer.

There is no cure for vulvodynia, but different remedies can ease the symptoms for different women. It may take time to find the combination that works best for you, but our doctors will work with you to help provide a comfortable, better quality of life. To schedule an appointment, call 770.720.7733.

August 30, 2016

What is Vaginal Shortening and is Vaginal Lengthening a Solution?
Vaginal shortening, or iatrogenic vaginal constriction, is a condition that occurs in women usually as a result of undergoing gynecological surgery. After removal or correction of organs within the pelvic area, post-surgical tweaks are always necessary to close any internal incisions, suture tissue together, and to restore the vagina back to its previous corridor-like shape.

Depending on the extent of the surgery, sometimes it’s necessary to stitch together a great deal of a woman’s remaining tissue, leaving the vagina shorter—the same way gathering fabric to repair a hole in the toe of a sock would alter its size. Subsequent scarring in the area over time may also contribute to narrowing and reduction. Unfortunately, though vaginal tissue is extremely elastic and stretchable, a substantial shortening may result in uncomfortable and even painful intercourse, especially during the natural penile thrusting stage of a sexual encounter.

What Conditions and Their Aftermath Cause Vaginal Shortening to Occur?
Most surgeries that involve the removal or correction of vaginal organs may contribute to this problem. Some of these include:

Vaginal mesh surgery – A transvaginal surgical mesh that may have been used to repair a woman’s urinary stress incontinence or pelvic organ prolapse (POP) can cause future problems. Mesh is sometimes used to support ligaments and organs that have slipped out of place. Its purpose is to reinforce the pelvic floor or weakened vaginal wall. Sometimes the mesh can cause infection, fuse with organs and tissue, or perforate its surrounding structures, making removal necessary. Much like cement sticking to the webbing used to adhere stucco to walls in home construction projects, tissue and organs may have stuck to the transvaginal mesh, making is difficult to remove without causing damage. When this damage is extensive, additional tissue is needed to repair the vagina, thus shortening it even more.

Bladder tack surgery/bladder suspension surgery – This procedure is used to minimize or correct stress incontinence in women by creating a hammock shaped sling made of a mesh tape. The material is different from transvaginal mesh, but with similar complications. If rejection, fusion, or infection arise, the methods used to correct these post-surgical problems may result in vaginal shortening.

Anterior repair/posterior repair (colporrhaphy) – Anterior repair surgery tightens the front wall of the vagina when the bladder has drooped or fallen out of place (cystocele or dropped bladder). Posterior repair surgery tautens a rectum that has sagged or dropped (rectocele or rectal prolapse). Though both procedures are minimally invasive, complications may occur that require surgical attention and subsequent suturing, in turn shortening the vagina.

Enterocele repair – This reparation is necessary when intestines (small bowel) bulge through the weakened tissue at the top of the vagina. As with anterior or posterior repair, risks are uncommon but may occur, needing attention that might impact vaginal proportion.

Sacrospinous ligament/vault suspension – This procedure lifts the top of the vagina and holds it in place after complete vaginal prolapse. As with several of the previous surgeries mentioned here, postoperative stitches are necessary using a woman’s available tissue. This can minimize the original size of the vagina.

Hysterectomy – In a hysterectomy, all or part of the uterus is removed. In some cases, it may also be necessary to extract the ovaries, cervix and/or fallopian tubes. The more radical the procedure, the more internal trimming and stitching may be necessary. Hysterectomy is possibly one of the biggest causes of vaginal shortening.
Cervical or uterine cancer: Due to removal of cancerous organs, and scarring that can occur as a result of follow up radiation, both vaginal capacity is usually reduced.

Can Vaginal Shortening Be Repaired?

Often, following surgery, the vagina may simply feel shorter due to swelling, inflammation, tenderness, bruising, and the presence of stitches. Vaginal tissue is very elastic, and though it may feel tight immediately after your operation, size often returns to normal after a short recovery time.

If actual shortening has occurred, repair can sometimes be complicated, depending on the extent of the surgery or cause of the diminishment.

Though it is possible to approach correction by using more drastic measures such as muscle flaps, biological animal grafts, skin grafts, or even a woman’s own bowel tissue, these methods can cause further complications and we prefer to avoid them. Instead, we opt for the least physically intrusive methods first. Several of these options are:

Pelvic floor massage – Internal and external massage can relax tenderness, muscle tightness and trigger points that cause pain, gently stretching or tightening the pelvic floor muscles and connective tissue.

Pelvic floor physiotherapy – These exercises stretch and strengthen the pelvic floor muscles.

Vaginal dilators – Plastic tubes that gradually increase in size are inserted to gently stretch the vagina over time.

If these procedures prove to be ineffective, laparoscopic surgery, which is minimally invasive and generates less blood loss, scarring, and a quicker postoperative recovery time may be beneficial.

Whatever the reason for vaginal shortening, we can recommend the safest and most effective approach to try and correct the problem. To make an appointment, call us at 770.720.7733.

What is Libido?
Libido, very simply put, is sexual desire or sex drive. Just as there are multiple shades in a color spectrum, levels of libido are unique to each woman, and these levels can rise and fall monthly throughout a woman’s lifetime depending on many biological and psychological factors.

What are the Different Levels of Sexual Desire?
Intensity can vary. Sexual desire may range from heightened – where a woman may want sex one or more times a day (hypersexuality), to several times a week, once a month, once every few months or year, (hyposexuality) or not at all (asexuality).

What is Considered ‘Normal Libido’?
There are no standards for ‘normal’ libido, especially if a couple is sexually compatible and comfortable in their mutual need for intimacy. Often, however, this is not the case. Women frequently tend to have a lower libido than men. In fact, it is estimated that 1 in 10 women suffer from low sexual desire in the United States, meaning that 16 million women have what is referred to as hypoactive sexual desire disorder (HSDD).

A female’s low libido can have a huge negative impact on a relationship. Once the brilliant shine of newly-found lustful love wears off, couples may find their physical needs are drastically different. The apathy of the less ardent woman may lead to conflict, suspicion, hurt, infidelity and even complete collapse of the relationship. The woman herself may also suffer feelings of inadequacy, self-doubt, and frustration, emotions that might send her into an emotional depression, worsening the situation.

Mass media today slants sex to appear as if anything less than constant bedroom activity is abnormal, often convincing a woman with a perfectly healthy sexual appetite that she is some kind of freak if she doesn’t engage in a passionate encounter at every opportunity. For one who suffers from a lower sex drive, the impact may be even more devastating. The inner turmoil of a dwindling self-image and shattered self-esteem can compound the problems already complicated by sexual dysfunction.

low libido photoWhat are the Causes of Low or Waning Libido?
There can many causes for low sexual desire, and they can be either physical or psychological.

The following are some of the physical reasons for a low libido:

  • Hormonal imbalances: The three hormones that impact a woman’s sexual function, desire and reproductive organs are estrogen, progesterone and testosterone.
  • Testosterone is the primary hormone responsible for a healthy libido in women. Yes, ladies, we all have testosterone, just as all males produce estrogen! The amounts just vary for each gender. Testosterone is what enables a woman to fantasize, piques her interest in sex, and aids in lubricating the vagina to prepare for comfortable, pleasurable intercourse. A woman’s testosterone levels begin to rise just before she ovulates, piquing a day or two before, and reaching maximum strength at ovulation. This is Mother Nature’s way of preparing the body for reproduction by plumping the uterine wall, which in turn stimulates sensitive nerve endings, encourages lubrication and heightens sexual motivation. Immediately afterwards, the amount of this hormone in her body diminishes. A low testosterone count hampers the possibility of a satisfying sexual experience by minimizing enthusiasm, sensitivity and arousal.
  • Estrogen is the main hormone responsible for the development of the female sex organs. It regulates the menstrual cycle and is crucial in thickening the uterine lining in preparation for pregnancy. As women age and enter the premenopausal stage (perimenopause), estrogen begins to significantly decrease until the levels are so low that menopause occurs. Vaginal tissue becomes thinner, less elastic, drier and more fragile. As with testosterone, natural lubrication diminishes with less estrogen, and this decrease affects sexual desire.
  • Progesterone is another female hormone that is vital in thickening both the uterine wall and endometrium to protect the egg during the process of fertilization, conception and pregnancy. Levels normally rise immediately after ovulation. If fertilization does not occur, levels drop, and the uterine walls become thin again, allowing the unfertilized monthly egg to pass as menstruation. Progesterone also regulates a woman’s menstrual cycle. As with estrogen, levels decline with age. Research is still being done, but it is believed that progesterone’s role in waning libido is just as important as those of testosterone and estrogen.
  • Menstrual cycle: Irregular or absent menstruation (secondary amenorrhea) can wreak havoc on natural hormonal processes, causing libido to become equally sporadic.
  • Age: Testosterone, progesterone and estrogen levels diminish as women age and enter menopause, causing lowered sexual interest, loss of muscle mass, compromised skeletal health, and vaginal dryness that can lead to painful intercourse. As these hormone levels decrease, so does libido.
  • Antidepressants: Sexual dysfunction, low lido and even genital numbness may be attributed to some currently prescribed antidepressants which are referred to as selective serotonin reuptake inhibitors (SSRI’S).
  • Drugs: All recreational or prescription drugs have side effects. They can inhibit hormonal functions, dull physical and mental sensations, dehydrate the body’s natural secretions and lubrications, or interfere with sexual desire. Blood pressure medications, tranquilizers and antihistamines are just a few. Always give your doctor a complete list of medications you are currently using.
  • Lack of restful sleep: Drowsiness, irritability and fatigue can dampen anyone’s mood for lovemaking.
  • Birth control: Some patches and oral contraceptives fool the body into believing it is pregnant by neutralizing the very hormones that enhance libido. If you notice a sudden disinterest in sex after beginning birth control, speak to your doctor.
  • Alcohol, smoking or drug abuse: Smoking restricts blood flow to the body. The clitoris, labia and vagina become engorged with blood during sexual arousal, just like a man’s penis, so restricting this flow also restricts sensation and response to physical stimulation. Alcohol is a depressant. It dehydrates the body, dulls sensitivity, and causes loss of vaginal lubrication.
  • Giving birth: Immediately after giving birth, a woman’s hormones are causing an uproar inside her body. Physical trauma to the vaginal area, possible postpartum syndrome, and the exhaustion and stress of caring for a newborn amplify sexual indifference. Luckily, these issues usually only last a few weeks, but if libido remains low or non-existent for longer, consult your doctor.
  • Genital abnormalities or problems: Pelvic organ prolapse(POP), muscle mass and tissue deterioration due to aging (urogenital atrophy), fecal incontinence, urinary problems, dryness, atrophy, and a small vaginal opening are only a few of the physical problems that can decrease libido.
  • Surgery: A hysterectomy with or without compete removal of the entire reproductive system (Oophorectomy) decreases or completely eliminates the hormones necessary for sexual gratification.
  • Major health conditions: Cancer, high blood pressure, neurological disorders, hypothyroidism, diabetes, arthritis, infertility, and coronary artery disease, along with the medications and procedures necessary to correct these issues are just a few disorders that can weaken female libido.
  • Anemia: Low iron levels caused by heavy periods can result in anemia. Anemia reduces red blood cells and compromises a protein called hemoglobin whose job is to push oxygen from your lungs to all your body parts, including the pelvic area. Since blood is vital to the labia, clitoris and vagina to enhance erotic sensitivity, anemia can greatly subdue bedroom pleasure and cause fatigue, weakness, and sexual apathy.

Psychological factors that can cause low libido are:

  • Low self-esteem or body image: If a woman is overweight, underweight, lacks self-confidence, or feels inferior in other ways, she may shy away from physical contact, robbing herself of the gratification of a healthy sex life.
  • History of sexual abuse: Rape, assault, and molestation can have a devastating effect on the psyche. Without counselling, the aftermath of these experiences can leave lifelong psychological scars, and it is understandable that a woman may avoid any future sexual encounters.
  • Religious and moral issues: Deep rooted personal beliefs can sometimes be detrimental to a healthy libido. Entrenched convictions about sex, religion, moral taboos and behavior can prevent a woman from truly enjoying an intimate relationship, causing her to view a physical union as repulsive or simply a ‘duty’ to get out of the way.
  • Trauma: Psychological trauma such as post-traumatic stress disorder (PTSD) can follow any highly disturbing event. Just as with sexual abuse, the repercussive emotions following the death of a loved one, a divorce, violence, being the victim of a crime, etc. may lead to sexual dysfunction and a damaged libido.
  • Relationship problems: Constant tension and conflict with a loved one can slowly chip away at even the strongest relationships. Anger, disillusionment and unresolved issues ultimately make their way into the bedroom, negatively impacting any activity that is still, or no longer, going on there.
  • Depression or anxiety: Either of these emotional conditions can affect performance or pleasure by causing disinterest, especially if medication is being used to control the issue.
  • Lifestyle: As the world becomes more and more fast paced, a busy lifestyle and the responsibilities that come with it can succeed in putting any romance on the back burner, lowering the flames of passion and eventually putting them out altogether.
  • Stress: Worries about health, finances, or other everyday problems cause physical and mental tension. If a woman is unable to relax and enjoy sex, orgasm is impossible and frustration inevitable, causing her to lose interest altogether.
  • Anxiety: Anticipation of sex is not always viewed favorably. Many women dread intercourse when they feel it’s expected or demanded of them. Some worry that they may not fulfill their partner’s expectations, or that they might be urged to perform acts that they’re not comfortable with to please their mate, especially in a new relationship.
  • Environmental stress: Distractions such as bright lights, lack of privacy and extreme noise can hinder a woman’s ability to relax and enjoy intimacy. For instance, visiting or living in a mother-in-law’s home, or listening to a neighbor’s loud, thumping music can impede full enjoyment of sex or orgasmic achievement.
  • Poor communication: Optimal sexual performance does not come naturally. It’s a learning process for both partners. Many couples avoid telling each other what pleases them in the bedroom. Whether it is because if shyness, fear of shock, or ridicule, women sometimes avoid telling their mates what they prefer and, in time, come to dread intimacy altogether.
  • Latent sexual orientation: Denial of gender preference can raise feelings of guilt and suppress the pleasure that comes with an open, honest, relationship.

Is Help Available?
YES!!!! There is no reason to go through life with lowered libido. Women can enjoy a satisfying sex life at any age, and with today’s resources and modern technology, we are usually able to effectively treat the problem.

Diagnosis and Treatment
In order to pinpoint the root of this dysfunction, frank honest discussion is necessary, as well as a list of any medications you are currently taking. Your doctor will ask pertinent questions to find out whether the problem is physical or emotional.

After an examination of the genital area, blood tests may be required to determine hormonal levels.

Once a diagnosis is made, your doctor will move forward to correct the problem. It may be as simple as a change or alteration in medication or a new prescription. If surgery is indicated, most physical corrections are minimally invasive, can be done in our clinic, and the recovery time is usually short.

If the problem is psychological, resources to help are available. For an appointment, call us at 770.720.7733.

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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.”
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