Voted "Best OB-GYN" in Towne Lake, Woodstock and Canton Voted "Mom-Approved OBs" by Atlanta Parent magazine readers
May 9, 2019
grateful woman

One in ten women suffer with a combination of PCOS and endometriosis, and often go undiagnosed. Such is the case with our patient, Tiffany. She was a healthy middle school girl who was very active in sports, but when she began to menstruate, things started to change. Her cycle was always irregular, and sometimes she wouldn’t have a period at all. She wasn’t overly concerned though, and attributed these changes to her active lifestyle. However, by the time she entered high school, her situation worsened.

Painful Symptoms

Tiffany began to experience a great deal of pain and would sometimes bleed three weeks of the month. Things progressively got worse and lasted for years. She had no idea what the problem was. Tiffany’s mom, and other close family members, had been diagnosed with PCOS, or polycystic ovary syndrome, a hormonal disorder common among women of reproductive age. The symptoms include pain and irregular periods, among other things. Weight gain is sometimes associated with PCOS due to an increase in male hormones. Since Tiffany never gained any weight, and her mom and relatives all gained quite a bit of weight, she never thought that she could have PCOS.

One night, when Tiffany was 21, the pain and bleeding were so severe that she had to go to the emergency room. An ultrasound was performed, and it was discovered that she had a cyst the size of a tangerine on one of her ovaries. She was also told that a smaller cyst had likely ruptured and that was probably the cause of her severe pain. The emergency room doctor recommended that she follow up with a gynecologist.

Diagnosed with PCOS and Endometriosis

Tiffany made an appointment with Dr. Litrel of Cherokee Women’s Health Specialists. After gathering her history and performing his own ultrasound, he diagnosed her with PCOS and recommended laparoscopic surgery to remove the large cyst. During the surgery, Dr. Litrel discovered that Tiffany also had endometriosis, which he treated during the procedure. Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus known as the endometrium, grows outside your uterus. 

Dr. Litrel told Tiffany that she may have a hard time conceiving, although it wasn’t impossible. He advised her not to wait too long to try to conceive as her situation was severe. Tiffany shared that her mom had to have a total hysterectomy at the very young age of 24, and that her aunt had one at a young age as well. She also had a few first cousins with PCOS and endometriosis. 

Feeling Relief After Treatment

After the surgery, Tiffany had relief for the first time in years. She began to have regular cycles, her pain lessened, and she had energy again. Dr. Litrel performed ultrasounds on her every 3-6 months. After about a year or so, her symptoms would begin to return, and she eventually needed two more surgeries.  Her symptoms improved greatly.

“Dr. Litrel helped me so much,” Tiffany says with gratitude. “He is not only an excellent doctor but a Godly man who prayed with me before my surgeries. I loved that!”

Dr. Litrel continued to monitor her and perform follow-up ultrasounds. It was during one of those appointments that Dr. Litrel had the pleasure of telling Tiffany she was pregnant. She and her husband were ecstatic! 

Tiffany’s son Kru was born a few years after her first surgery. Kru is now 11 months old and about to become a big brother. Her baby girl, Remington, whom they will call Remi, was due at the end of April, 2019.

“Dr. Litrel helped me so much,” Tiffany says with gratitude. “He is not only an excellent doctor but a Godly man who prayed with me before my surgeries. I loved that! Feeling respected and not like a number, I know he really cares about me. He made me, and my problems feel unique, though I know he had a lot of other patients. He always listened to me. The whole practice is wonderful. Each provider I have seen has treated me well and has shown me they care. I recommend Cherokee Women’s Health to all my friends.” 

Help is Available

Tiffany’s struggle with PCOS and endometriosis may sound familiar. Many women just live with the symptoms and don’t seek a diagnosis or treatment. As Tiffany’s story proves, help is available and you don’t have to suffer in silence. If you experience any of the symptoms listed above, seek help. Call us today at 770.720.7733.

May 2, 2019

by Peahen Gandhi, MD, FACOG, FPMRS

woman with pelvic pain

“My insides are falling down,” explained my patient Mandy, who came to see me for her annual GYN exam. A young mother with three children, she’s not one to complain, so when I first asked her how she was doing, she politely said, “Fine!”

But as she answered questions during her exam, her real story came out.

Three Babies and a Leaky Bladder

Ever since delivering her third child, Mandy’s bladder has been leaky. She used to love tennis, but can’t play anymore because of the stress it puts on her bladder. She also admitted that she constantly has the uncomfortable feeling that her “insides are falling down.”

Mandy has pelvic health issues.

Like many women, she has accepted the changes in her body and has given up on activities that used to bring her happiness, like tennis and aerobics.

The fact is, one-quarter of women face poor pelvic health issues.

Pelvic Health Risk Factors

Pregnancy/childbirth – Childbirth puts strain on the pelvic area during delivery.

Menopause – Pelvic floor muscles weaken in menopause, leading to pelvic organ prolapse (POP).

Heredity – Having a mother or sister with PFD (Pelvic Floor Disorder) puts a woman at higher risk.

Obesity – Overweight or obese women have increased pressure on the bladder and frequently lack strength in their bladder muscles.

Other risk factors for poor pelvic health include:

  • Constipation/chronic straining
  • Diet
  • Smoking
  • Heavy lifting/exertion
  • Lung conditions/chronic coughing
  • Nerve injuries
  • Other health conditions.

Signs of a Healthy Pelvic Floor

The key foundation for pelvic health is the “pelvic floor” — a versatile set of muscles that works 24/7 — supporting the uterus, cervix, vagina, bladder and rectum. Pelvic health encompasses four broad categories:

1. Normal functioning of the bladder, and the portion of the digestive system that includes the bowel and rectum.

2. Well supported reproductive organs. A woman with good pelvic health will have no uncomfortable feeling of sagging, pressure or “falling.”

3. No significant pain or dysfunction in the pelvic area, whether from aging, childbirth or past injuries due to surgeries or accidents.

4. Good sexual function and sensation.

Pelvic Health Treatment

Pelvic health treatments can include:

  • Medications
  • Lifestyle changes
  • Physical therapy
  • Noninvasive procedures
  • Pelvic reconstructive surgery.

Enjoy Life Again

Complete pelvic health diagnosis and treatment can best be addressed by a specialist known as a Urogynecologist: an OB/GYN who is board-certified in the subspecialty of Female Pelvic Medicine and Reproductive Medicine (FPMRS).

With treatment, Mandy was able to enjoy life again. You can too. If you experience problems with bladder or fecal leakage, pelvic pain, the sensation of your insides “falling down” or impaired sexual function, call us to make an appointment with one of our FPMRS physicians.

Endometriosis occurs when the endometrial tissue grows and attaches itself in different places outside of the uterus where it doesn’t belong. It impacts 11% of women in the U.S. alone and often goes undiagnosed for years. That is what happened to Chelsea, a patient of Cherokee Women’s Health.

endometriosis pain photo

Chelsea’s Story of Endometriosis

Chelsea began to experience severe pain in her lower abdomen in 2013. The pain progressively got worse and eventually became constant. She describes it as the worst pain she has ever had. Having not experienced any previous gynecological issues, she made an appointment with her primary care physician.

Unsure of what it could be after Chelsea explained her pain, her doctor decided to run a battery of tests — including blood tests, G.I. tests, and even an MRI — but still, there was no answer. Chelsea felt confused and discouraged.

Dr. Hale Believed Me

A year had nearly passed and Chelsea was still in severe pain so she made an appointment with her OB/GYN, Dr. Hale of Cherokee Women’s Health Specialists. During the visit, Chelsea explained what she had been going through and how she felt that no one believed how bad her pain was. Dr. Hale not only believed her but immediately said that it sounded like endometriosis. She explained that the only way to be sure was to schedule surgery to confirm. Chelsea agreed, anxious to find an answer and hopefully alleviate the pain.

“As long as Dr. Hale and Cherokee Women’s Health is here, I will never go to anyone else.”

During the surgery, Dr. Hale discovered that while the right side of Chelsea’s pelvis was clear, her left side contained Stage 4 endometriosis — the most severe stage. She also found that Chelsea’s left ovary had attached to part of her intestines. Dr. Hale treated the endometriosis, freed the ovary from its attachment, and did a full sweep to make sure all else was clear.

Five years later and Chelsea still feels great and has had no reoccurring pain. She credits Dr. Hale’s expertise and for believing her when no one else did. She stated, “As long as Dr. Hale and Cherokee Women’s Health is here, I will never go to anyone else.”

In fact, Chelsea is now seeing Dr. Hale for another reason — she’s trying to conceive. She knows if anyone can help her achieve this dream, it’s Dr. Hale.  

April 30, 2019

Premature birth, also known as preterm birth, occurs in roughly 12% of women in the United States. Any birth before 37 weeks is considered premature. The earlier the delivery, the higher the risk for the baby. Though now, with modern information and technology, babies born as early as 23 weeks and weighing just one pound, one ounce have been successfully saved.

Krystina, a patient of Cherokee Women’s Health, was all too familiar with premature birth. Two of her grandparents were born premature, as well as multiple family members. Her own mother was also a preemie. And yes, Krystina herself was born premature. 

Krystina’s mom delivered her 7 weeks early and almost died in the process. Krystina weighed in at only 3 lbs. 3 ounces. She burst both of her lungs immediately following delivery and spent a couple of months in the NICU (neonatal intensive care).  At 11 months old, Krystina only weighed 11 pounds.

Preemie Mom Gives Birth to Preemie Babies

Fast forward over 30 years and Krystina is a healthy adult who now has had two preemies of her own. Her first baby, her son Augustus, who is now 4 ½ years old, was delivered by Cherokee Women’s Health’s Dr. Gandhi. He was 4 weeks early and delivered via emergency C-section.

Her most recent birth of her daughter, Aurelia, happened even earlier. Krystina had a textbook pregnancy with her son up until the last trimester, when she developed high blood pressure. Because of this, she began monitoring her blood pressure at home while pregnant with Aurelia. Once again, all was fine — until the 3rd trimester when her blood pressure started rising again. 

Developing Pre-Eclampsia

Krystina woke up early one morning feeling strangely so she took her blood pressure. It was much higher than before. She called Cherokee Women’s Health, who of course had been monitoring her closely as well, and was told to go to the hospital. Once there, she was diagnosed with pre-eclampsia (a condition that only occurs during pregnancy, and usually after 20 weeks, and can be very dangerous for the mom and baby. High blood pressure is one of the signs). It was decided that she should be admitted but the hospital’s NICU was full, so she was transferred to a different hospital in anticipation of the baby coming early.

The next 9 days were very hard on Krystina. She was in a hospital further from home, she hadn’t gotten to say goodbye to her son, and she was very worried about her new baby making an early entrance.

Thankfully, the doctors were able to stabilize her blood pressure and after a few days, she was sent back to her local hospital. But once there, her blood pressure elevated again so the decision was made to deliver her baby.

Going Home Without Her Baby

Dr. Crigler of Cherokee Women’s Health performed a C-section and Aurelia was born 7 weeks early and weighed only 3 lbs. 8 oz., just 5 ounces more than Krystina had weighed when she was born. Aurelia spent the next 13 days in the NICU due to needing oxygen and being a little jaundiced. Overall though, she was strong and doing well. Krystina was also doing well and was released after 2 days. Going home without her baby was one of the hardest things she has ever done.

Grateful Parents

Today Aurelia is a beautiful and healthy 10-month-old daddy’s girl. She is a great eater and has quickly grown to almost 20 pounds. Krystina says, “Both Dr. Gandhi and Dr. Crigler played such a crucial role in making sure my babies were fine. They are both fantastic. Dr. Crigler’s calm demeanor really helped me to relax. He was so supportive.”

Krystina and her husband are so grateful that both of their preemies are doing so well.  Those babies, and Krystina herself, are great examples of how premature babies can go on to live happy, healthy lives.

Preemie baby Aurelia Before Pic
Aurelia 1 Day Old
Preemie baby Aurelia After Pic
Aurelia 10 Months Old
April 2, 2019

A miscarriage often makes women feel alone and as though no one else understands. Janie, a medical assistant here at Cherokee Women’s Health, understands this feeling all too well.

Photo of Janie's rainbow baby after her miscarriage
Janie’s Rainbow Baby, Carter

Janie and her husband starting dating in high school and were married in November of 2015. They always knew they wanted children, so they tried to conceive after only a year of marriage. One year later, Janie was pregnant. Their excitement was short-lived, however, when Janie suffered a miscarriage at 6-1/2 weeks.

Like so many couples, Janie and her husband were devasted. Along with the physical pain, Janie also dealt with the emotional pain of feeling “like a failure” as a woman, which is also a common reaction after a miscarriage.  

A few months later, Janie and her husband found out she was pregnant again. When she first saw the two lines on the pregnancy test she was terrified. She wanted to be excited but she and her husband both were so nervous and scared

Janie wasn’t sure if they could handle it if they experienced another loss.

Leaving it in God’s Hands

They decided not to do early bloodwork or ultrasounds, but to leave it in God’s hands. They had their first ultrasound at 7 – 8 weeks and were amazed when that saw the heartbeat, although they were still nervous. After a few more weeks and a few more scans, they were finally ready to share the news. 

Janie’s pregnancy and delivery went smoothly with no complications. She and her husband now have Carter, their beautiful baby girl — their rainbow baby. (A rainbow baby is a baby born after miscarriage or early loss of a child).  

Dr. Gandhi Was a Huge Support

After suffering the loss of her first baby, Janie now realizes many women have gone through what she has and that she was not alone. Janie’s doctor, Dr. Gandhi, was a huge support for both her and her husband and was there to deliver their little miracle. She feels that she may never completely heal from that loss, but having faith, family, and Carter makes it easier.

Though miscarriage is a painful topic, Janie now knows that talking about it can help. She hopes other women can find someone to confide in if they experience this type of loss. As a medical assistant, she hopes to be that person for all the patients that come through the office, even on their worst day. She wants to share her experience and let them know they are not alone.

March 13, 2019
Board-certified urogynecologists
Drs. Litrel, Gandhi and Haley are double board-certified in Female Pelvic Medicine

Pelvic health problems affect almost one-quarter of women, and the incidence increases with age. Most women leave pelvic health issues to their general OB/GYN. But in fact, complete diagnosis of these issues is complex, and sometimes can only be fully addressed by a specialist known as a Urogynecologist: an OB/GYN who is certified in Obstetrics and Gynecology as well as Female Pelvic Medicine and Reproductive Medicine (FPMRS).

Cherokee Women’s Health is the only Southeast OB/GYN practice with three physicians double board-certified in Female Pelvic Medicine, drawing in women from all over the country – 27 states in 2018! Cherokee Women’s is THE resource in the Southeast for women with pelvic health issues – before, during, and long past the child-bearing years.

Cherokee Women's Health national patient map
Women travel from all over the country to visit Cherokee Women’s Health

What is Pelvic Health?

Pelvic health includes the functioning of every organ and structure in the pelvis, and encompasses four broad categories:

  • 1. Normal functioning of the bladder, and the portion of the digestive system that includes the bowel and rectum.
  • 2. Well-supported reproductive organs. A woman with good pelvic health will have no uncomfortable feeling of sagging, “falling,” or pressure.
  • 3. No significant pain or dysfunction in the pelvic area, whether from aging, childbirth or past injuries due to surgeries or accidents.
  • 4. Good sexual function and sensation.

The key foundation for pelvic health is the “pelvic floor” — a versatile set of muscles that works 24/7, supporting the uterus, cervix, vagina, bladder and rectum.

Almost one-quarter of women face pelvic floor disorders. Certain risk factors indicate that a woman should be on the lookout for needing further diagnosis and treatment.

Pelvic Health Risk Factors

  • Pregnancy/childbirth
    Childbirth puts excessive strain on the pelvic area during delivery.
  • Heredity
    Having a mother or sister with PFD (Pelvic Floor Disorder) puts a woman at higher risk for developing pelvic health problems. Caucasian women are more likely to develop prolapse and to have bladder leakage. African American women are more likely to have leakage related to urgency.
  • Obesity
    Overweight or obese women have increased pressure on the bladder and frequently lack strength in their bladder muscles

Other risk factors include:

  • Constipation/Chronic Straining
  • Diet
  • Smoking
  • Heavy Lifting/Exertion
  • Lung Conditions/Chronic Coughing
  • Nerve Injuries
  • Other Health Conditions


Treatments can include medications, lifestyle changes, physical therapy, noninvasive procedures or pelvic reconstructive surgery.

If you experience problems with bladder or fecal leakage, pelvic pain, the sensation of your insides ”falling down,” or impaired sexual function, seek treatment from a specialist in pelvic health: a board-certified Urogynecologist in Female Pelvic Medicine and Reconstructive Surgery Specialist (FPMRS). Call us today at 770.720.7733.

March 6, 2019

A father’s grief after a miscarriage is often overlooked. Miscarriage and subsequent pregnancies often center on the emotions of the mother only: the grieving and anxiety of losing a baby, and the nerve-racking experience of becoming pregnant again with a “Rainbow Baby”. A Rainbow Baby is a baby born after a miscarriage, thus becoming the “rainbow after the storm.”

Rainbow Baby Cayson and Mom Mariah – An Interview, Learning To Live With Grief and Joy

Sharing Grief With the Husband and Learning To Live With Grief and Joy

Fathers often feel they have to be “strong for the mother,” so they may put their grief on the back burner, all while silently suffering alone. But solitary grieving can take a toll on a marriage, especially during stressful times, like losing a baby.

“Rainbow Mom” Mariah Foster and her husband lost their unborn daughter, Raelynn, late in Mariah’s pregnancy, from a cord accident. She shares their experience and the words of advice from their doctor, who told her to pay attention to how the experience affected not only her, but also her husband and their relationship as a married couple.

“After I lost my daughter, Dr. Litrel asked to see us so he could see how we were doing. His advice was not to try to cover up our grief with antidepressants. He told us to go ahead and scream, yell, even be mad at God – but especially to learn how each other grieves.”

Miscarriage is Hard on Men Too

Mariah said Dr. Litrel told them that the father’s grief is often overlooked, and that he had seen couples divorce after losing a baby because neither understood how the other grieves. “He told me to pay attention to my husband during this time of being sad. He said it’s hard for the man, too – and they grieve in a different way from the woman.

“That conversation opened our eyes. And honestly, the grieving process built on our communication and compromise skills.”

Mariah shares that Dr. Litrel also advised them to ‘talk about our daughter and use her name’, telling us to take time to enjoy each other, so we could accept the loss better and go on with the marriage. He didn’t want us to lose what we had.

He also didn’t want us to try to have another, but just to ‘let it happen’, so he did not prescribe birth control for me.

Smiling at the baby beside her in the stroller, Mariah says, “Eleven months later we ended up having our wonderful Rainbow Baby, Cayson Charles. Cayson means ‘Healer’ in Gaelic,” she explains.

Getting Pregnant Again is Nerve-Racking

Mariah comments that becoming pregnant after a miscarriage is not the purely joyful experience everyone assumes it will be.

“You know, everyone’s excited when you’re pregnant with a Rainbow Baby, but it’s a lot harder. I was nervous. When I hit nine months and said, “I need to be induced!” I finally ended up having a C-section — and the most beautiful Rainbow Baby.

“During the pregnancy, Dr. Litrel had us on a strict schedule of seeing doctors and also the specialist. By 29-30 weeks, we were going to the doctor every week.

“Pregnancy with a Rainbow Baby is nerve-racking. You want to feel him every second of the day. When he’s not moving, you’re panicking.”

“The scariest time was at one point, when I slipped and fell at work. I thought at that point I was going to lose him. Dr. Litrel and really, all the medical staff, did everything for us. “They gave me a Doppler (a hand-held monitor) so I could check on Cayson, and seeing him on the screen helped me so much with my anxiety.

“Pregnancy with a Rainbow Baby is nerve-racking. You want to feel him every second of the day. When he’s not moving, you’re panicking. You lay on your left side, you drink ice water, you try all the tricks the doctors tell you. There were times I went to Northside Hospital and just said, ‘Hey, I just need you to do an ultrasound. I can’t find my baby on the Doppler.’ They were great and really supportive during the entire pregnancy.”

TheGrieving Process

“Losing Raelynn was hard for my husband, and sometimes it still is. He’ll take a picture of Cayson, which is his way of grieving. He’ll say, ‘I want to be with him so much, because sometimes he fills that void.’

When Cayson was crawling at six months, my husband was excited to see him, and he’d say, ‘Wow, Raelynn, look what your little brother is doing!’

Mariah wipes away a tear. “It’s hard to explain how it feels because the grieving never stops. “We actually planted a tree for my daughter, and we watch it grow, and talk about it all the time. We got a bird feeder and all the birds come so we can feed them. It’s really sweet.

Getting Support

“The grievance counselors at Northside are really great and so supportive. On Facebook, there’s a group called Rainbows of Atlanta. When you’re having a hard time — when that anniversary comes up and it’s the week you lost your baby — you can get on that group and post at 4 a.m., and you know someone is going to comment. Someone will be there. It’s so rewarding to see women back each other up. They give advice, and they’re just there.”

Mariah smiles and gives her Rainbow Baby Cayson (aka the Healer), a kiss. Her eyes glisten, but there is happiness there, too.

After Miscarriage – Stories of Hope

Reading stories of hope from others who have experienced what you’re going through can help you feel not so alone. Here, we share stories from patients who suffered from miscarriage and how they got through it.

Sheila suffered many miscarriages so we sat down with her to get her story and learn what she had to overcome to eventually have three Rainbow Babies.

Jamie shares her story of hope and what helped her keep going.

Miscarriage Resources

The following resources are available to help you with the grieving process:

H.E.A.R.T. Strings Support Group – Hope, Empathy, Alliance, Resources and Teamwork

Perinatal Bereavement of Palliative Care. Email them at northsidepnl@gmail.com or call them at 770.224.1817.

January 2, 2019

“A Ticking Time Bomb” – The Doctor’s Perspective

Dr. Peahen Gandhi delivers a baby.

You are giving life to someone who is helpless, and it requires ALL of your attention…you just can’t have a bad day. You just can’t. – Dr. Peahen Gandhi

Dr. Peahen Gandhi and her Medical Assistant Jourdan worked together for years at Cherokee Women’s Health Specialists. Jourdan also saw Dr. Gandhi for her annual OB/GYN care, as Jourdan and her husband planned to start a family.

When Jourdan became pregnant with twins, it was Dr. Gandhi who gave her the surprise announcement and who began Jourdan’s pregnancy care. Jourdan’s perspective as a young woman with a high risk twin pregnancy is told in her video interview here.  Yet for Dr. Gandhi, from the moment she diagnosed Jourdan’s pregnancy, her friendship and working relationship with Jourdan became something much more complex –

Jourdan was now a high risk patient under Dr. Gandhi’s direct care.

Danger at 28 Weeks: “Something Was Off”

As it turned out, Jourdan’s pregnancy would not be an easy one. Early contractions at 22 weeks sent Jourdan to Northside Hospital Cherokee, where she was treated and the contractions eventually stopped. But at 28 weeks came the most dangerous moment of the pregnancy. Jourdan came in for her check-up having contractions. Medication could not stop them. And she was already dilated.

Dr. Gandhi knew that Jourdan’s tiny twin boys were not yet ready to survive outside their mother’s body. She shares the experience from a doctor’s perspective:

“Jourdan is my medical assistant. She’s seen me practice for many years now – we’ve worked together for a really long time. She knows exactly what to say to me to not worry me.

“But that morning something was off. She didn’t feel well that day. She said she was feeling some pressure – and that’s not uncommon. For our pregnant patients, we sometimes put them on the monitor to see if they’re having contractions.

“But when patients have twins, we’re a little extra careful. Because they don’t have the typical symptoms. Sometimes they may not have contractions but they could still be dilated.

“So I asked her to get an ultrasound and examine her.”

Ultrasound Shows Contractions and Growing Dilation

Dr. Gandhi describes the next moments, when it became that things were not going well. “During the ultrasound, Brenda, our ultrasonographer who’s been with us many years – twelve-plus years – said, ‘You know Dr. Gandhi, I’d like to you to come in here and take a look at this.’”

Dr. Gandhi smiles a bit. “And that’s never a very good sign when she asks me to do that.

“Looking at the ultrasound, I could tell that there was only a very thin layer between the presenting part of the baby and the cervix. This means that the cervix has either started to dilate or shorten – there is now very little distance between the bag that holds the baby and the cervix.

“I did a speculum exam and I was able to see right away that she was dilated.”

Dr. Gandhi pauses to consider her personal relationship with Jourdan. “Of course, if this is someone you know very well, you don’t want to worry them… I took the speculum out and I told her, ‘I think we’re going to send you to the hospital for some observation.’ And she looked at me, kind of worried, and I said, ‘Oh yeah, it’s probably going to be fine.’”

Balancing Clinical Objectivity with the Personal Relationship

Dr. Gandhi confides that at this point she viewed Jourdan’s pregnancy as “a ticking time bomb.” Every decision she would make for Jourdan’s care was weighed to give her and her babies the best chance of a safe and successful delivery. At 28 weeks, the contractions and dilation were life-threatening for the babies.

“In the back of my mind, I know what all this means. She’s very early, she’s only 28 weeks, she’s already 2 centimeters dilated and she is having twins – which is all  a package – it’s kind of like a ticking time bomb.

“You have to be kind of conservative because the babies are early, but you don’t really know how much time you have in order to make sure that the babies have the best chance of surviving, to do well should they be born early. And at the same time you have to make sure you’re taking the precautions needed to get her to the right facility and be around the right pediatric care.”

Dr. Gandhi called the ambulance and had Jourdan taken directly from the office to Northside Hospital, where Dr. Gandhi met her shortly afterward.

“Her whole family was there – she has a very large, loving family – and of course she’s having twins, so they’re all very excited – but NERVOUS…”

“As her physician, I have to talk to her, be objective and explain the things that can go wrong – but at the same time make her feel comfortable. And that’s very hard to do – especially when you’re dealing with babies that are not even two pounds, advising her about the risks of them being born early – you’re trying to stop her contractions and also make her feel calm.

“I did send her to Northside Atlanta, where they have a NICU that’s equipped to handle very early care like that. We will now have the ability here at Northside Cherokee to handle preemies – as early as 32 weeks.

“So we called the ambulance. I was in contact with her the whole time.”

Pre-Term Labor With Twins

Dr. Gandhi pauses a moment to talk about the clinical aspect of twin pregnancy and pre-term labor. “Pre-term labor happens in 11-12 per cent of pregnancies – and it’s scary because sometimes – many times – it’s a false alarm.

“But when it does happen, and it when it happens that early, it is so important to recognize it, and to intervene as quickly as possible. We want to give the baby – or potentially babies – enough time to get prepared so that the pediatric staff and the NICU staff have the best chances of providing great survival.”

In this instance of pre-term labor at 28 weeks, Jourdan’s contractions were eventually stopped and she was able to go home. Dr. Gandhi ordered Jourdan on strict bedrest. As her physician, she remained watchful and called Jourdan every day, knowing that her medical judgment could be the critical factor keeping Jourdan and her babies safe for the remainder of the pregnancy.

Finally Jourdan went into labor at 33 weeks. Dr. Gandhi relates that she safely delivered her twin boys by C-section. The babies were cared for in the NICU at Northside Hospital Cherokee for several weeks until they were breathing and eating on their own, and finally able to come home.

“The way technology is now,” Dr. Gandhi explains, “we have the capability of take care of these very, very premature babies in the NICU. But each moment the mom is away from the baby – because the baby is in the nursery – it’s heartbreaking. I sympathize with women who have to go through this. Not only because I’m an OB/GYN but because Jourdan is a very close friend –

“And I saw her through THAT side – not just the medical side.”

Obstetrics – Joy and Emergencies

As the interview concludes, Dr. Gandhi reflects on caring for patients in the specialty of Obstetrics. “As obstetricians, we have the JOY of delivering babies and everything is going fine, everything is normal and everybody is excited…

“But we get to see emergencies, too, and it’s so hard because you are giving life to someone who is helpless, and it requires ALL of your attention. And you have to  – well, you just can’t have a bad day. You just can’t.” Her voice is serious.

“The patients rely on you –  and the baby relies on you.”

Then Dr. Gandhi relaxes a bit and says with her characteristic smile, “Well, it was a little intense. But in the end it all worked out – Jourdan was completely stabilized. She ended up delivering at 33 weeks. And they did great – her boys, Briar and Wyatt.”

She fights through a hint of emotion and finishes with a smile. “It’s such a blessing to have someone in our own Cherokee Women’s family have a great outcome like that – and me being a part of it –

“It’s just a huge privilege.”

Read more on this story here: Premature Twins Part 1 – – A Young Mother Rides the Emotional Roller Coaster

Obstetrician delivers a baby in the hospital
Dr. Gandhi holds her Medical Assistant Jourdan’s twin boys.
November 28, 2018

mother and twin babies

“Nothing in the world can prepare you for going home without your children.”

Jourdan Adams is calm as she describes her high risk pregnancy, the birth of her tiny twin boys as “preemies,” and the long weeks they stayed in the Northside Hospital Cherokee NICU (Neo-Intensive Care Unit).  The emotional ups and downs will sound familiar to any mother who has given birth to a premature baby.

“The pregnancy was good – up until about 22 weeks. That was the first time I had to go to the hospital.”

Jourdan and her husband Tyler had been trying to get pregnant for a couple years, so when Jourdan’s home pregnancy test read positive, she went to the OB right away.  Jourdan’s choice of a doctor was simpler than it is for many women. As a medical assistant for an OB/GYN practice, Jourdan made an appointment with Dr. Peahen Gandhi, the physician with whom she had worked so closely over the past few years.

“We came in super early – and then again at 5 weeks, when we saw 2 sacs! And that was how we found out we had twins.”

She admits the twin pregnancy came as a shock. “I just remember looking at my husband and saying, ‘Oh my gosh – what are we going to DO?!’ And my husband was so good, he just said to me, ‘Babe, we’ve got this.’

“But I was thinking, ‘No, you DON’T!!! You have no CLUE what we’re in for!”

Pregnancy of Hospital Trips and Bedrest

Jourdan relates that early on in the pregnancy she had a small bleed, which – she quickly adds – is “not unusual. ” But at 22 weeks the real trouble started.  “I was feeling kind of weird at the office one day. Dr. Clay gave me an ultrasound and put me on the monitor – and they realized I was having contractions. She sent me to the hospital.”

At Northside Cherokee, Jourdan saw her high-risk specialist, who put her on fluids and sent her home, anticipating that the contractions would settle down once she was off her feet.

“But the next day I was still having contractions, regular – every 10 minutes. I went back to the hospital, and got three injections of terbutaline.”

Jourdan confesses, “Well, it was so early, I just wasn’t worried. I was thinking, ‘They’ll fix it… this is just normal, right?’ I never really felt super fearful they were coming.

“Then I was put on bedrest until 24 weeks – because that is viability. At that point I was allowed to work for three days.”

But at Jourdan’s next check-up, an ultrasound by Dr. Gandhi revealed a troubling development. “We realized my cervix was shrinking. After that, I was on bedrest for the rest of my pregnancy.”

 An Emergency Ambulance Ride to Atlanta

At Jourdan’s 27 week appointment, there was more trouble. “I was dilated, my cervix was shrinking further. They sent me to Northside Hospital Cherokee. The monitors showed I was having regular contractions – that I wasn’t feeling. They gave me more terbutaline – and then magnesium, which made me feel really sick. It was horrible.

“Dr. Gandhi came to check on me when got out of surgery. She took a look, and then she sent me straight to Atlanta [Northside Hospital Atlanta] – because she was afraid the boys were coming.”

Jourdan admits this time she was scared. “Dr. Gandhi said she was transferring me and I didn’t know she meant I needed to go by ambulance. It was terrifying. I was hooked up to all these machines – IV, catheter…We got there and I filled out all the paperwork. There I was, a at 27 weeks, looking at birthing my twins.

“But after a few hours at the hospital, I got settled and the contractions stopped. They let me go home again. And after that I was on bedrest until 31 weeks.

Waiting Alone, the Dog By Her Side

Jourdan describes the final weeks of bedrest as lonely.

“I was sitting by myself all day. I came down from my bed every morning. Tyler had to work of course – he was saving up his sick days for when we had the babies. He would help me downstairs, make my breakfast, and then he was gone the rest of the day. At lunch, my mom, or his mom, would come over to make me lunch and sit with me a while.

“I sat and I felt very hopeless. Dr. Gandhi called me every day to make sure I wasn’t going crazy. My husband was very supportive. But I felt so hopeless. I couldn’t do anything.”

Jourdan smiles when she mentions her dog. “We have a bulldog. And he sat with me every day. I made sure to put his bed right beside me, so I had him with me. He really did help me.

“My brother offered to get him and take care of him so I wouldn’t have anything to worry about – and I said ‘No – You can’t! He’s the only company I have all day long!’”

Jourdan made it to 33 weeks. And that’s when her boys decided to come.

 Early Labor – A Rush To C-Section

Jourdan recalls the morning of the day the twins were born. “I told my dad, ‘I feel weird, I just feel off.’

“I went to the High Risk Specialist, and I was feeling my contractions in the waiting room. That was the first time I’d ever felt them. Then Dr. Gandhi came in to evaluate me – I was already at 4 centimeters. Dr. Gandhi announced, ‘We’re going to do your C-section within the hour.’

“All of a sudden it seemed like I was surrounded with so many nurses. I looked over at my husband and he was getting fully scrubbed in.  I thought I had prepared myself, but it happened so fast. Our families got there really quick and they were able to say ‘hi and bye’ to me – and then I was taken back to the OR.”

Jourdan was admitted to the hospital at 7 pm. And by 9 pm her twins were born, at just 33 weeks. Briar John was 4 pounds, 10 ounces, Wyatt Graham, only 4 pounds, 5 ounces.

Jourdan describes the uncertain moments after the delivery, wondering, Would her babies be okay?

The Cry Of Her Babies

“Dr. Gandhi showed me the boys right away, and I heard them cry. I had been anticipating that moment for so long, and I was so scared, so to hear them cry, I was like, ‘Okay I can breathe. They are okay.’

“I had two separate NICU teams. They were doing a full evaluation, and that was hard to wait for them to finish to hear how the boys were. My first baby, Briar, had to be put on a C-PAP [a device providing Continuous Positive Airway Pressure] – because his lungs weren’t fully developed. It was helping him breathe. So when I first saw him, he had the tubes stuck up his nose, and around his face. He just looked horrible. And I could only see him for a second, and then they had to take him upstairs.

“And then my second baby, Wyatt, he was fine. And he was the smaller one! And I got to see him for a little bit. They laid him on my chest. – and in that moment, everything just stopped for me – nothing else mattered. I didn’t hear anything, I don’t remember Dr. Gandhi sewing me back up… none of it! I just remember him being on my chest, and we were able to sit like that for just a few minutes. And then they took him to the NICU.”

Jourdan remembers being in the recovery room for a few hours, where the Neonatologist came in to talk to her about her boys, and that Briar would be on the C-Pap for 2-3 weeks.

“Dr. Gandhi sat with me the whole time, and then they took me to my room. And I remember them telling me, ‘Normally after a C-section you can’t get up for 12 hours.’

“But I had hardly seen my babies!!! And I just said, ‘THAT’S NOT going to happen. I’m going to get up, and you get whoever you need to, because I’m getting UP!!!’ So I got up about 4 hours after my surgery and I went up to the NICU and I was able to see my boys for a little bit.”

Northside NICU, Close To Home – “A Blessing”

Jourdan sits now with her twin boys beside her, each sound asleep in a car seat. She looks bright and well-rested. No one would guess that she has recently had a dangerous pregnancy, or even that she is the mother of infant twins born just 3 months ago.

We ask her, “How did you handle the waiting period before the boys could come home?”

“I didn’t anticipate, obviously, how everything went. It was hard to see them in the NICU, especially Briar, because he was doing this whimpering thing – they said he wasn’t in pain, that he was just getting adjusted to the C-PAP.

“I stayed in the hospital as long as I could – I stayed 4 or 5 days. And then they were like, ‘You need to leave. You cannot stay here any longer – you are fine, GO HOME!’

“I was anticipating that day, having to leave them – which was the hardest thing. And I had other moms tell me, you are going to be heartbroken. And I had tried to prepare myself for it, but nothing in the world can prepare you for going home without your children.

“Luckily, we only live 5 minutes from Northside Hospital, so we were there every single day, all day long. We got there every morning and only left for lunch. The boys had feeding tubes for the first week and a half, and we wanted to hold them while they were being fed so they would associate food with Mommy and Daddy. And after that we were working on bottles.

“The NICU team was so wonderful. The boys had their own room – so it was really nice.” She laughs. “We could kind of spread out.

“It was a blessing that we were in Cherokee County. I couldn’t imagine them being in Atlanta, and having to drive THAT every day. It was exhausting to be there all day long, and still recovering from surgery. It takes an emotional toil.”

Advice for Mothers of Preemies

We ask Jourdan: Do you have any advice or words of experience you would share with mothers of premature babies?

“I would get up in the middle of the night and pump in their nursery, and I had this song I would play for myself, by Darius Rucker, “It Won’t Be Like This For Long.” And I just played that over and over, and told myself, “It won’t be like this for long. The boys will be home one day.

“And I would just picture what their lives were going to be like – us on the baseball field, or whatever they will want to do – and I just dreamt about THAT. Instead of thinking about them in the NICU and everything they were going through.

“And also I put blankets under the boys in the hospital – the nurses did this for me – and they allowed me to take those home with me so I could smell them when I was at home. It kind of gave me that comfort – that they were there with me.

“In the NICU, I was trying to be very hands-on. I was always changing diapers, giving them baths, feeding them. I wanted to do those things, like I was at home. And it made me feel like I was somewhat normal. We also had a lot of people come visit them – which helped me, too. Because I kind of felt like I was able to show them off, like it was NORMAL – because usually people come to visit them when they come home. So I really liked that I could show them off, and tell people how good they were doing, and all their improvements.”

Jourdan concludes, “It is hard, so hard – but they DO come home!”

She smiles, her healthy twin boys now right beside her.

November 21, 2018

Young woman having abdominal painEndometriosis is the third leading cause of infertility in women of childbearing age. This disease affects 1 in 10 females from the ages of 15 to 44. It impacts more than 11% of women in the U.S. alone and is often times not diagnosed until a woman is in her 30’s or 40’s, so they may have it and not even know.

What is Endometriosis?

The inside of your uterus (womb) has a lining of tissue called the endometrium. This is similar to that thin layer of skin-type material attached to the shell you sometimes see when you peel a hard-boiled egg.

When you have a normal menstrual cycle, this uterine lining thickens to get your uterus ready to house a baby. Its purpose, if fertilization occurs, is to keep an embryo latched on to itself for nine weeks, providing nourishment until the mother’s blood supply through the placenta can take over the job.

If pregnancy doesn’t happen that month, menstrual blood sloughs away that barrier and your body begins to rebuild a new one in preparation for the possibility of pregnancy the next time.

With endometriosis, endometrial tissue grows and attaches itself in different places outside of your uterus where it doesn’t belong. Like the one in your womb, this tissue is stimulated during the menstrual cycle, but it doesn’t break down. Instead, it remains, causing pain, irritation, and possible scarring which can eventually lead to adhesions, a type of scarring that can cause different organs to fuse together.

Endometrial tissue can be found in:

  • The pelvic cavity lining
  • Ovaries
  • Fallopian tubes
  • Uterine support structures
  • Outer uterine surface
  • Rectum
  • Bladder
  • Bowels
  • Cul-de-sac (a space that is located behind the uterus)
  • Outer uterine surface
  • Peritoneum

In very rare cases, it has even been found on skin, and in the lungs and brain.

What are the Symptoms of Endometriosis?

Many women have none. Others may suffer a little discomfort, while yet others may experience extreme, debilitating effects. Symptoms include:

  • Moderate to crippling pain during menstrual cycles that worsens over time
  • Bloating
  • Sexual discomfort felt deep in the pelvic area both during and after intercourse
  • Constipation
  • Lasting, chronic pain in pelvis and lower back
  • Intestinal pain
  • Digestive problems, especially during menstruation
  • Nausea
  • Diarrhea
  • Infertility

What Are the Heath Risks of Endometriosis?

Although endometriosis is neither contagious nor cancerous, left alone it can continue to expand in places where growths should not appear. Unchecked, this may lead to the following problems:

  • Swelling and pain: Because these implants of endometriosis are appearing internally where they don’t belong they cannot be expelled from the body. They can cause tenderness, inflammation, swelling, irritation, and even excruciating pain depending on their location.
  • Infertility: Adhesions or scar tissue involving the fallopian tubes may block access to eggs, or damage both the sperm and egg during ovulation. Adhesions that have formed may also make pregnancy difficult or impossible.
  • Cysts: If endometrial tissue grows in the ovaries and traps blood, painful, blood filled sacs called cysts may develop.
  • Intestinal and bladder problems: Continual, unchecked growths in these areas can result in major health issues.

Who Can Get Endometriosis?

Any female who has begun to menstruate can get endometriosis. In the past, women were often not diagnosed until 30 or 40 years old. Now, doctors know to be on the lookout much earlier, starting in the teens to 20’s. Although endometriosis is not overly picky about which woman’s body it chooses to inhabit, you have a greater likelihood of suffering from it if you have:

  • Had short menstrual cycles of 27 days or less
  • Breast or ovarian cancer
  • Never had children
  • Difficulties or health problems preventing you from expelling regular menstrual flow
  • Allergies
  • Sensitivity to certain chemicals
  • A female relative diagnosed with endometriosis
  • Prolonged periods that exceed one week.
  • An autoimmune disease like lupus, multiple sclerosis, hypothyroidism etc.
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Asthma

 What Causes Endometriosis?

No one really knows although research is intense and ongoing. Some theories include:

  • Genetics: Women in the same family are often diagnosed with the disease, so it is assumed that genetics play a role.
  • Hormones: Estrogen spurs endometrial tissue production, so there is a hormonal link.
  • Menstrual flow problems: Referred to as ‘retrograde menstrual flow’, this means that, since tissue is expelled through the fallopian tubes into the pelvis, it can end up in other parts of the body. This is the most popular theory
  • Compromised immune systems: A weakened immune system may not be able to perceive or fight off the growth of endometrial tissue. Endometriosis has been found in that many women with certain cancers and lowered immunities.
  • Invasive surgery: Transfer of endometrial tissue during certain abdominal surgeries is a possibility.
  • Transportation of cells: Some experts think that endometrial cells ‘hitchhike’ with tissue fluids and blood cells to other parts of the body.

How is Endometriosis Diagnosed?

The only way endometriosis is diagnosed is that it must be seen at the time of surgery. When someone presents with symptoms of endometriosis, initial workup may entail:

  • Complaints you are experiencing
  • Family and your own medical history
  • Evaluating all medications, herbs and supplements you are taking
  • Blood and urine tests if needed
  • A pelvic exam
  • Ultrasound

Surgery is then performed as necessary.

Is There a Cure for Endometriosis?

There is no cure, but endometriosis can be treated and managed. Options depend on your particular issues and symptoms, and whether you still want to become pregnant. They range from medication to surgery.

What Are the Treatments?

Your doctor will most likely try the following:

  • If pain is your major complaint, over the counter anti-inflammatory medications might work, or stronger prescriptive medication may be dispensed if needed. If you are averse to those, meditation, acupuncture, chiropractic help, and certain supplements may be beneficial.
  • If you are not trying to get pregnant, you may be prescribed a birth control pill minimizing menstrual occurrence or eliminating periods altogether. Another option is insertion of a long-term intrauterine device (IUD) to prevent pregnancy for up to five years. It may not, however, reduce bleeding and endometrial pain for its complete duration.
  • If you want to get pregnant, there are medications that may help. They stop the hormones that prod the body into ovulating, putting your body into a temporary state of menopause for a few months to control endometriosis growth. When this medication is stopped, menstruation resumes, allowing you a better chance of success for pregnancy.
  • If a possible fallopian tube blockage is suspected, a test called a hysterosalpingogram (HSG) may be performed to confirm obstruction. Surgery may follow to correct the problem, or another bypass method to achieve pregnancy, such as insemination or in vitro fertilization (IVF) may be recommended.
  • Laparoscopy is the mainstay of treatment. When the implants of endometriosis are found, they are treated or removed so that they no longer are active.
  • As a last resort for unbearable pain and extensive growth, a hysterectomy may be performed, removing the uterus and ovaries entirely, along with all visible endometrial tissue. Hormone therapy is then started immediately to stave off additional formation. There is still a chance that endometrial development may continue, but this usually solves the problem.

How Can I Make Sure I Don’t Get Endometriosis?

There is no way to prevent endometriosis, but there is a possibility of reducing your odds by using estrogen-lowering birth control, limiting caffeine and alcohol which raise estrogen, exercising regularly, and maintaining ideal body weight.

How Can Cherokee Women’s Health Specialists Help Me?

Our entire practice focuses solely on women and their unique biology. We are trained in every aspect of women’s health care and have three board–certified, doubly accredited urogynecologists holding certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This means that we can diagnose, understand, and treat all feminine problems with the most up-to-date knowledge and innovations known to modern medicine.

To book an appointment to further discuss endometriosis, call 770.720.7733.

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