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The birth of a child is a time of joy and excitement, but for many new moms, it can also be a time of anxiety, stress, and inexplicable sadness. Postpartum mood disorders affect 10-15% of all new mothers. Postpartum depression can develop in the weeks after birth, and some begin women showing signs as late as 6 months post-labor. If you’re experiencing symptoms of postpartum depression, it’s important to realize that your feelings are valid. Reach out to get the help you need for the sake of you and your baby.

Signs You May Be Suffering From Postpartum Depression

The postpartum blues, or “baby blues,” are feelings of stress, depression, anxiety, and frustration that many mothers experience in the days after childbirth. The baby blues rarely last longer than 1-2 weeks, and don’t require medical treatment. Postpartum depression, however, is a more serious condition that usually requires medical care.

Signs of postpartum depression include:

  • Difficulty bonding with your newborn
  • Feeling overwhelmed by the responsibilities of motherhood
  • Withdrawing from your spouse, family members, and friends
  • Guilt about your shortcomings as a mother or feelings of shame and worthlessness
  • Loss of appetite or increased eating habits
  • Difficulty sleeping or sleeping too much
  • Fatigue and loss of energy
  • Feeling numb or disconnected from the world around you
  • Inability to enjoy activities you used to love
  • Cloudy thoughts and an inability to concentrate
  • Anxiety and/or panic attacks
  • Mood swings
  • Feelings of depression or suicidal thoughts
  • Thoughts of harming yourself or your baby
  • Fear that if you reach out, your baby will be taken away

Every mother experiences postnatal depression differently. Some women may have each of these symptoms at one point or another, while other mothers may experience only a few. If your symptoms last longer than two weeks or become a barrier to living life normally, don’t hesitate to contact your doctor. If you have thoughts of suicide or of harming yourself or your baby, seek immediate assistance.

Help is Available

If you think you may be experiencing postpartum depression, there is hope. Postnatal depression and anxiety are both temporary and treatable. Call Cherokee Women’s Health to schedule an appointment today.

Our patient Jacqui talks about her experience with infertility and her ultimate journey to motherhood.


Watch more GYN Problems videos below.

Adopting a Higher Quality Obstetrical Care Model for Women in the United States

Dr. Sara Bolden pic

Dr. Sara Bolden is a women’s health physical therapist, board-certified women’s health clinical specialist, owner of Women First Rehabilitation in Woodstock, GA and author of What a Girl Wants: The Good Girl’s Guide to Great Sex.

If you’ve ever had a baby, witnessed one being delivered or heard of someone’s detailed labor and delivery story, one thing’s for sure, there was pain involved. We’re not talking about a little discomfort here, folks. We’re talking about deep, intense, I-could-kill-the-man-that-did-this-to-me pain. Quite honestly, we’ve come to expect extreme bodily pain during a situation like this. It would be absolutely crazy to think otherwise. I mean, we’re talking about a small melon exiting out of an opening the size of a child’s sock. Yes, the sock will stretch, the melon will emerge, but not without some repercussions…sometimes big repercussions. Often, these consequences can be serious and have lasting musculoskeletal effects. So what’s a girl to do?

Physical Therapists are NOT Massage Therapists

Many would say, childbirth trauma is inevitable so proverbially “push” through the pain and try to get over it quickly. Unfortunately, this is frequently the default response to childbirth in the United States. There is little to no preparation of the pelvic floor muscles, the low back, the abdomen, nor education for proper breathing, delivery positioning, energy conservation or anything, for that matter, that adequately prepares the body’s musculoskeletal system for the delivery of a small human being. However, for many years now, international countries, such as England, Germany, Australia, Brazil and South Africa (to name a few), have taken proactive measures to assist women with labor and delivery and thus lower the risk of long-term musculoskeletal injuries or urogenital dysfunctions. One way they have elevated the standard of obstetrical care is to include physical therapists throughout pregnancy, during labor/delivery and for postpartum recovery. You might be saying to yourself, “physical therapists? Don’t they just give massages?” Brace yourselves…wait for it…no, they don’t. Physical therapists are not massage therapists. They are, however, musculoskeletal experts that have unique knowledge of the evaluation, assessment, treatment, disease/injury prevention and general wellness of the human body.

The Difference a Women’s Health Physical Therapist Makes

In other countries, the physical therapists that assist with prenatal and postpartum women are called obstetrical physiotherapists and have advanced skill and training in women’s health. In the United States, we call them women’s health physical therapists. I know, ingenious. They, too, have advanced knowledge and extensive training in women’s health; however in the U.S., their services have only been considered for the prenatal patient with abnormal or life-altering pain or for the complicated postpartum patient with pain and/or pelvic floor dysfunction (i.e. urinary incontinence, organ prolapse or pain with intercourse).

Higher Standards of Obstetrical Care

If the U.S. adopted a more comprehensive standard of obstetrical care, every pregnant women would be evaluated by a women’s health physical therapist. During the prenatal phase, she would get education and training on pelvic floor stabilization, core strengthening, body mechanics, birthing positions, perineal massage, breathing, relaxation and proper Valsalva for effective pushing, etc. Then, a women’s health physical therapist would be included in the delivery room to help with pain management, assist with birthing positions that open the pelvis and decrease risk of vaginal tearing, perform perineal massage to allow adequate room for the decent of baby, provide biomechanical support and coach the patient on the when’s and how’s of proper pushing…just like obstetrical physiotherapists are doing right now in other countries!

After the birth of the baby, postpartum women would follow up with their women’s health physical therapist to assess healing of vaginal and/or abdominal tissues, be educated on scar management and facilitated tissue recovery, learn mechanics for lifting baby as well as for breastfeeding and restoring pelvic strength. Of equal importance, women’s health physical therapists would help new moms get their bodies back in shape, set realistic goals and expectations of motherhood and restore her vibrant, sexual health. Yes, I said “vibrant!” Who wouldn’t want that?!

Good news! You belong to a cutting-edge OB/GYN practice and are hearing about women’s health physical therapists! I invite you to do a little research and see for yourself how effective this type of physical therapy is for pregnancy, labor, delivery and postpartum. Don’t be shy: ask your doctor to include physical therapy as part of your prenatal and postpartum experience.

Company Bio

Women First Rehabilitation is an elite healthcare practice devoted exclusively to treating individuals with pelvic pain, urogynecologic disorders and pelvic floor dysfunction in all phases of life. All of our practitioners are licensed women’s health physical therapists with advanced knowledge and training in women’s health. For more information, visit www.WomenFirstRehab.com.

What is diabetes mellitus?
How can pregestational diabetes affect my pregnancy?

How can pregestational diabetes affect my baby?
If I have diabetes and wish to become pregnant, is…
How can I control my diabetes during pregnancy?
How does my health care provider know if my blood…
Can pregnancy affect my glucose level?
How can my diet affect my pregnancy?
How can exercise help during my pregnancy?
Will I take medications to control my diabetes during…
How will diabetes affect labor and delivery?
If I have diabetes, can I breastfeed my baby?

What is diabetes mellitus?

Diabetes mellitus is a condition that prevents the body from properly using food to provide energy. Insulin is a hormone produced by the pancreas that removes glucose from the blood and into the body’s cells to use for energy.

Diabetes is caused by one of two problems with insulin:

  • The pancreas makes little or no insulin. This is called Type 1 diabetes.
  • The pancreas makes insulin, but the body does not respond to it correctly. This is called Type 2 diabetes.

As a result, glucose remains inside the bloodstream, which can create problems such as:

  • Heart disease
  • Kidney disease
  • Vision problems
  • Pregestational diabetes refers to diabetes that has been diagnosed before pregnancy.

How can pregestational diabetes affect my pregnancy?

Some problems that can occur in pregnant women with diabetes are:

  • Birth defects
  • High blood pressure
  • Hydramnios – Hydramnios means an increased amount of amniotic fluid within the amniotic sac that surrounds the fetus.
    This can cause preterm labor and delivery.
  • Macrosomia – Macrosomia is a term that is used to describe a newborn that is significantly larger than average (more than 8 pounds). This is due to the baby receiving too much glucose from the mother’s blood.
    Macrosomia can cause delivery to be more difficult, increasing the chance of having a cesarean delivery.

How can pregestational diabetes affect my baby?

Potential problems that may occur in the newborn:

  • Breathing troubles
  • Low glucose levels
  • Jaundice
  • Need for special care nursery.

You can prevent these problems with proper planning and maintaining control of your diabetes.

If I have diabetes and wish to become pregnant, is that safe?

Yes, it is safe, but controlling your glucose levels is important. High glucose levels can cause birth defects, which can happen before you even know you are pregnant. Controlling your diabetes may require modifications to your diet, medications, and exercise.

How can I control my diabetes during pregnancy?

You can control your diabetes with a combination of the following:

  • Taking medications as directed by your doctor
  • Proper diet
  • Exercising
  • Frequent prenatal appointment visits.

How does my health care provider know if my blood glucose levels are sufficient?

Your healthcare provider can check your blood glucose levels by performing a Hemoglobin A1C test. This test provides an estimate for how well your glucose levels have been over the past 4-6 weeks.

Can pregnancy affect my glucose levels?

Pregnancy can increase the likelihood of hypoglycemia in women with diabetes. Hypoglycemia refers to low blood glucose levels.

Contributing factors include:

  • Skipping meals
  • Not eating enough
  • Eating at odd times of the day
  • Exercising too much
  • Symptoms may include:Dizziness
  • Sweating
  • Feeling shaky
  • Weakness
  • Sudden hunger.

How can my diet affect my pregnancy?

For any pregnancy, a healthy, well-balanced diet is critical. The baby depends on the mother’s food supply for its growth and development. Diet becomes even more critical for those with diabetes. Not eating properly can alter your glucose levels, which can then affect the baby.

How can exercise help during my pregnancy?

Exercising helps to maintain glucose levels within the normal range. Exercising also helps in the following ways:

  • Weight control
  • Boosting energy
  • Sleep
  • Reducing backaches
  • Reducing constipation and bloating.

Will I take medications to control my diabetes during pregnancy?

  • If you were taking insulin before becoming pregnant, then insulin dosages will likely increase while pregnant. Insulin is safe to use during pregnancy and does not cause birth defects.
  • If you were using an insulin pump before becoming pregnant, then you most likely will be able to continue using it while pregnant, but you may be advised to switch to insulin shots.
  • If you normally take oral medications, then you may be advised to alter your dosage.

How will diabetes affect labor and delivery?

  • Labor could potentially be induced earlier than the expected due date, especially if problems during the pregnancy arise.
  • While in labor, blood glucose levels will be monitored closely (typically every hour).
  • If needed, insulin may be pumped through an IV line.
  • You may use an insulin pump during labor if desired.

If I have diabetes, can I breastfeed my baby?

It is highly recommended that women with diabetes breastfeed.

Benefits include:

  • Adequate nutrition for the baby
  • Shedding weight
  • Returning uterus to pre-pregnancy state.

What is a breech presentation?
What factors increase the chance of breech presentation?
How can my health care provider tell if my baby is…
What is external cephalic version (ECV)?
How is ECV performed?
When is ECV done?
Can ECV be done for all breech presentations?
How successful is ECV?
How are most breech babies born?
What are the risks of having a vaginal breech birth?

What is a breech presentation?

About 3-4 weeks before the due date, most babies will reposition themselves to have their head near the birth canal. If this does not occur, the baby’s feet or buttocks will be next to the birth canal. This is called a breech presentation. Breech presentation occurs in about 3-4% of full-term birth, and a cesarean delivery may be recommended.

What factors increase the chance of breech presentation?

Factors that increase the likelihood of breach presentation:

  • Having a previous pregnancy
  • Having a multiple pregnancy (twins or more)
  • Having too much or too little amniotic fluid in the uterus
  • Abnormal uterus shape or growths (such as fibroids)
  • Placenta previa (placenta covering all or part of the cervix)
  • Fetus is preterm.

How can my health care provider tell if my baby is breech?

A physical exam can be preformed to determine if the baby is breech presentation. By placing their hands on your abdomen and feeling where the baby’s head, back, and buttocks are, your doctor can tell the position of the baby. An ultrasound can be preformed to confirm the position.

What is external cephalic version (ECV)?

If the fetus is breech, your doctor may recommend external cephalic version (ECV), which is a procedure in which the baby is manually lifted and turned from the outside to increase chances of a vaginal birth.

How is ECV performed?

A health care provider places their hands at certain positions on your abdomen, then lifts and turns the baby.

When is ECV done?

Usually, ECV is only tried when you are at least 36 weeks pregnant. If the baby is too young, it may reposition itself again.

Can ECV be done for all breech presentations?

Your health care professional will consider your health and state of your pregnancy to see if ECV is the right option for you. There are certain conditions that may increase risks associated ECV, in this case an ECV may not be recommended.

How successful is ECV?

More than half of ECV attempts are successful. Sometimes, after an ECV, the baby will move back into a breech presentation, but if this happens an ECV can be tried again. It becomes harder to move the baby closer to the due date, because the baby has grown larger.

How are most breech babies born?

Most of the time, if the fetus is determined to be breech, your doctor will plan a cesarean delivery.

There are risks involved with a cesarean delivery, such as:

  • Bleeding
  • Infection
  • Problems resulting from pain relief medications.

However, it is not always possible to plan for a cesarean delivery because the baby may move into the breech position right before labor begins.

What are the risks of having a vaginal breech birth?

  • Vaginal breech birth increases the risk of harm to the baby.
  • It also increases the chance of a prolapsed umbilical cord (when the umbilical cord slips through the cervix ahead of the baby and can become pinched, stopping the blood flow to the baby).

One of the most exciting parts of the baby-planning process can be finding just the right baby shower theme to help celebrate your little one’s arrival. With the extreme success of Pinterest, soon-to-be Moms can plan out every single detail, including the color scheme, food served (cupcakes or cake pops, anyone?), games played and the overall theme of the event.

So without further ado, Cherokee Women’s Health Specialists has put together some of our favorite baby shower themes from Pinterest and a few other great internet sources: Baby Shower Theme - Duckies

Animals

Owls, giraffes, elephants and other wildlife have and will continue to be a huge trend in baby shower themes. Baby animals typically incite an uncontrollable “Awww” from even the manliest of men, and it’s no surprise that baby animals are a favorite for baby showers. Modern color combinations like aqua and soft pink and yellow and gray keep the theme updated and oh-so-cute. Birds have been a popular theme, with a play on words of “feathering the nest” for Mom and Dad.

Vintage

For vintage-themed baby showers, think a Radio Flyer wagon, a bright red tricycle or charming silhouettes of Mom and Dad on the invitations. You can get creative with vintage alphabet stacking blocks, spelling out the name of your new baby (if you’re not keeping the name a secret, of course!). Other options include just spelling out either “Boy” or “Girl,” or “Baby.”

Books

Did you have a favorite book as a child? Many expectant mothers are creating baby showers themed after their favorite books as a child. Favorites include Goodnight Moon, Where the Wild Things Are, and Green Eggs and Ham. You could even stay generic with a book theme, asking guests to bring a copy of their favorite childhood book with an inscription for the new baby in lieu of a card.

If you’re currently planning a baby shower for yourself or for a friend, what theme are you considering? Share with us by leaving a comment below!

 

By Michael Litrel, MD, FACOG, FPMRS

Michael Litrel, MD, FACOG, FPMRS

Why Are We Afraid?

It used to trouble me when a patient became nervous before surgery. Maybe she doesn’t think I will do a good job? Maybe I haven’t explained myself well enough? Maybe she doesn’t trust me? But after twenty years of being a surgeon, I now welcome a patient’s anxiety before she undergoes an operation.

Fear can be good for your health.

When my son Tyler was two years old, we took a family vacation to Jekyll Island, one of Georgia’s coastal isles that had been my wife Ann’s and my honeymoon spot a decade earlier. Tyler was thrilled at his first view of the ocean. The winter sun was warm as we slowly walked the sand to the water’s edge, and he grew more excited, pointing his chubby finger and saying “Water, water, water!!!” Tyler walked between Ann and me, and we each held one of his hands, swinging him high to prevent his feet from getting wet in the waves. But Tyler didn’t just want to get his feet wet. He fought to pull free of us, his intention clear: he wanted to walk into the ocean.

At first, Ann and were laughing as we enjoyed Tyler’s insistence that he be allowed to walk freely. But a spectacular temper tantrum soon followed, and our morning family stroll was ruined.

Tyler is now nineteen, finishing his first year of college, but in some ways things haven’t much changed. Three months ago, I taught him how to drive a manual transmission on my old 2004 silver Corvette; the car accelerates like a rocket ship. Tyler is a good driver. But when he asked to borrow the car to visit his buddies, my answer was an emphatic ‘no.’ There is no way I will put my son in a car that will go 160 MPH, so he can visit his teenage buddies. What good can come from that?

I’d just as soon let a two-year-old walk into the ocean.

Good Choices Can Cause Temporary Unhappiness

The reason parenthood is difficult is because that inexperienced human being you love more than life itself will do stupid things and hurt himself, if given the opportunity. Not only that, but when you rightfully say ‘no,’ he will express his anger adamantly – no matter that your heart and mind are in the right place.

The longer we are on this planet, the more we learn. If we look at the experiences we share as human beings, we see that each of us is born into this world as a helpless newborn, and a hundred years later – give or take – we die. In the process, we lose everything and everyone we love.

The truth is actually brutal. Anyone paying attention has a right to be terrified.

Surgery reminds us what we have to be afraid of. Every patient thinks about the same thing: “In a few moments I will be lying unconscious on a table while the surgeon cuts on my body! Who knows?!! I could die here today! ”

Yesterday my patient gave me a big smile before her operation. But I saw right through her poker face: her eyes clearly telegraphed her fear. I smiled at her, shook her husband’s hand, and asked her and her husband if they had any questions or concerns. They did not.

But it was obvious they did. We are all afraid of suffering. And although surgery always hurts, we know that when we wake up, there are narcotics and other drugs that will take care of the physical pain. Simply put, what we are really afraid of is not waking up.

What We Care About

I’ve had thousands of conversations with patients in the intense moments before an operation, and as I listen and try to comfort each patient before they go into the operating room, there is an additional truth my patients have shown me. We don’t want to say good-bye to the people we love.

In the moments when we brush with death, what matters to us is not our money, our home, our job or possessions – it’s the people we know and experience life with. Admittedly, they may sometimes annoy us – but they make our lives worth living.

Fear is good for our health because it serves as a spiritual reminder. God does not grant eternal biological life for any of us. As mortal beings, we lose all that is most important to us – our loved ones and our lives. So as experienced human beings who have suffered during our short time here, our spiritual lesson is fairly obvious – to love those around us more and more each day.

This is the path of a healthy life.

The more we love others, the more we understand the heart of God. This understanding brings us courage and comfort as we face the terrors of life. This courage is called faith. It is the understanding that true life is eternal.

I held my patient’s hand and said a prayer of gratitude. Together we asked God to be with my patient and her husband so their hearts were at peace, and with me and the other doctors and nurses and staff, so once again we would be blessed to witness the miracle of healing grace.

When I looked at my patient again, I noticed that now her eyes were smiling too. Already my prayer had been answered.

happy pregnant woman

For pregnant women, the symptoms of severe aches and pains, high fever, and inability to keep food down due to the flu virus is not an ideal combination with the already exhaustive symptoms of pregnancy. This is why it’s so important for pregnant women to get vaccinated for influenza. The flu vaccine is safe during pregnancy and protects both mother and the baby from the flu and its possible consequences.

Pregnant women are at a higher risk of complications from the flu because pregnancy affects their respiratory and immune systems. Pregnant women have a higher chance of being hospitalized with the flu and infections relating to influenza, which can increase their risk of preterm labor and delivery. Health complications from influenza, such as pneumonia, are very serious and can even be deadly.

The Good News

According to pregnancy experts March of Dimes, it’s not too late to get a flu shot. The flu season typically runs from late October through early March, and many insurance plans cover the vaccinations. Conducting a quick online search for locations in your neighborhood that offer the vaccine should allow you some options, as many pharmacies and grocery stores offer the vaccine  as well.

The CDC and FDA are monitoring the safety of seasonal influenza and other vaccines licensed for use in the United States in cooperation with state and local health departments, physicians and other partners. Monitoring the safety of the seasonal flu vaccine in pregnant women is part of this effort.

Extra Protection From the Flu

Of course, it never hurts to be more cautious during pregnancy when it comes to guarding yourself from the flu and other viruses. Limit contact with others who are sick and wash your hands with soap and water before and after touching others. Make sure not to share dishes, glasses or utensils with anyone to limit exposure to germs. If you do get sick, cough or sneeze into a tissue or an arm, and avoid touching your eyes, nose and mouth. Practicing healthy habits like getting plenty of sleep, exercise and a healthy diet can also aid in keeping you healthy throughout the flu season.

If you have questions or concerns about the flu vaccine during pregnancy, don’t hesitate to ask your physician or advanced practice provider questions during your next appointment.

 

1743574_10152171240838813_4319432320132342469_nDuring your pregnancy, you are no doubt taking every step to keep yourself and your baby as healthy as possible: you are abiding by the foods-not-to-eat list; you are not drinking any alcohol; you are limiting your caffeine; and you are making sure you are drinking plenty of water. So, what about being active? While this is not the time to start training for your first marathon, exercise during pregnancy leads to healthier moms and babies.

The Benefits of Exercising During Pregnancy

Exercise has already been proven to reduce the risk of gestational diabetes as well as improve the endurance of the mother, resulting in an easier delivery. Not to mention, you more likely to get back to your pre-baby weight faster than if you were not active. While we know that pregnancy fitness is beneficial for the mom, new studies indicate that maintaining a regular fitness regime during pregnancy will actually lead to a healthier baby, too.

Studies show that women who exercised regularly during the second half of their pregnancy were more likely to give birth to babies with a lower birth weight. While a lower birth weight might not seem preferable, it actually is healthier since a too high weight is an indicator of childhood obesity.

How to Exercise Safely During Pregnancy

Now that you know the many benefits to staying active during your pregnancy, you need to make sure you are not doing anything too strenuous that could result in injury. So, here are a few guidelines to safely exercising during your pregnancy:

  • Consult your doctor – It’s a great idea to discuss your fitness regime with your obstetrician and get his/her approval first. While it is healthy to continue exercising, your body is different now and some activities may not be conducive to your pregnant state.
  • Don’t Overdo It – This is not the time to try for a personal record in the upcoming 5K or to push yourself to tackle a new goal. You are growing a human being, and that takes a lot of effort. As a result, your body may need more recovery time in between workouts and you may need to reduce the intensity of your workouts – like switch to power walking or swimming instead of running.
  • Be Aware of Your Pregnant Limitations – Your growing belly comes with a few restrictions in regards to activity, like avoiding any exercises that require you to lie on your back. Also, your balance is not what it used to be, any activities that pose a high risk of falling, like rock-climbing and water skiing, are off-limits, too.

Cherokee Women’s Health encourages you to remain active during their pregnancy, as long as you get the go-ahead from your obstetrician. Don’t hesitate to contact our office with any questions you may have about exercising or pregnancy in general.

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