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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.

 

September 18, 2018
Midwife Susan Griggs, APRN, CNM photoWe often receive questions from expectant mothers about the different members and roles of our team throughout the pregnancy and delivery process. If you are wondering what the differences are between a midwife and an OB-GYN, you are not alone. Let’s take a closer look and break down what distinguishes an OB-GYN from a certified nurse midwife.

What Type of Education Does a Midwife and OB-GYN Have?

Both OB-GYNs and certified nurse midwives have extensive training to support you throughout your birthing experience. No matter which option you choose, you’ll be in good hands.
  • OB-GYN: An OB-GYN is a doctor who has studied 4 years of medical school, plus 4 years of residency and 3 more years of specialization.
  • Certified Nurse Midwife: A certified nurse midwife is a Registered nurse with an advanced Master’s degree in nursing and a certification by the American Midwifery Certification Board. Typically they study for 2-4 years (Bachelor’s degree), plus another 2 years (Master’s degree).

What Types of Care do Midwives and OB-GYNs Provide?

The most important thing is that you do what makes you feel the most comfortable and safe. It does not necessarily need to be an either/or decision; it is perfectly acceptable to see both a midwife and an OB-GYN. Ultimately, we encourage you to consider what you feel is best for you and your baby.

OB-GYN

  • Can assist with hospital births and any surgical procedures including cesarean sections
  • Able to prescribe medication
  • Able to prescribe contraception

Certified Nurse Midwife

  • Can assist with home births, birth center births, or hospital births
  • Able to prescribe medication
  • Able to prescribe contraception

What is the Focus of a Midwife Versus an OB-GYN?

These two types of care providers are separate but complementary professions. They may also work together on a team to provide effective patient-centered care. When choosing your main care provider, it really boils down to what you feel you need.

OB-GYN

  • OB-GYNs work in teams at Cherokee Women’s regardless of if you’re expecting a child or are coming for a routine gynecology check-up.
  • Trained to manage high-risk pregnancies, complications and perform surgery if needed (for example cesarean sections), offer epidurals or use instruments such as forceps and vacuums to facilitate delivery.
  • OB-GYNs are not typically present for the entire labor, as they are attending to more than one patient at a time.
  • Focus on prenatal care, surgical prenatal care, childbirth, surgical childbirth, women’s health, postpartum care, menopause care.

Certified Nurse Midwife

  • Midwives rely on clinical experience to provide expert care in normal pregnancies. They see birth as a normal, natural process, intervening only when necessary and not routinely.
  • Certified nurse midwives are present for labor support, often using more natural approaches such as breathing techniques and hydrotherapy.
  • Focus on prenatal care, childbirth, women’s health, postpartum care, transitional counseling (ex. nutrition and exercise, breastfeeding, emotional changes post-partum)

Things to Consider Before Making Your Decision

You may want to speak with family, friends and other health care professionals. Ask them about their own experiences and recommendations. Next, ask yourself some of the following questions in order to help you decide:
  • Is vaginal birth your priority?
  • Would you like a natural or medicated birth? Do you think there is a good chance you will want an epidural?
  • Do you want your caregiver with you during labor?
  • What are your plans for pain management?
  • What are you hoping will happen at the hospital?
  • Do you wish for more support and advice for your transition to parenthood?
  • Are you considered high-risk or do you have any complications such as diabetes?
  • What does your instinct tell you?

Final Thoughts

At Cherokee Women’s we are pleased to be able to offer flexible labor and delivery options. Our practice has two certified nurse midwives on staff. If you wish to have a midwife as a caregiver we do our very best to work with you to offer this type of care. We cannot guarantee that a certified nurse midwife will be available at the exact time of your delivery, but we will ensure that you and your baby are provided with the most competent, compassionate and safe care possible.
If you have any further questions, please do not hesitate to contact us or make an appointment at 770.720.7733. We are happy to help you to be more informed and feel as comfortable as possible throughout your pregnancy.
May 21, 2018

An interview with Air Force veteran Dianna Hornes, third-time mom and our OB “Cover model” for this spring’s AroundAbout magazines.

 

“I joined the Air Force after high school to get as far away from home as possible,” Dianna opens her story. “And they sent me from Phoenix to Las Vegas!” She laughs. “My friend and I joined at the same time. She wanted to be as close to home as possible – and they sent her to Guam! Go figure.”

Dianna’s new baby Matthew is the first child of her second marriage to Dennis, a Woodstock policeman. As she already had two daughters from her first, we suspect that her journey from military through family life may not have been smooth.

Q: So, first off – you’re married to a Woodstock policeman and fellow veteran, you have two little girls from your first marriage and now a newborn, Matthew. Would you mind just telling us a little bit about your story?

I was born and raised in Phoenix, AZ. I am the oldest and have 4 sisters and 2 brothers. As I said, I joined the Air Force after high school to get as far away from home as possible…

But the military experience was wonderful, in fact, one of the best experiences ever! I got to travel the world and see everything. I experienced life on a different level, and it made me more appreciative. From my first marriage I have Madison and Kayla … and now with Dennis I have little Matthew, as you know.

Q: How did you meet Dennis?

We are one of those Match.com success stories. It’s funny too, because I reached out to him first. After I divorced, I waited a year before I considered dating again. I had two daughters, Kayla and Madison, from my first marriage. At around a year, I created a Match.com profile. One day I was scrolling through all the profiles, specifically looking for matches who were interested in someone with kids. I came to Dennis’ profile, and his just happened to say “no”. 

But I was looking at pictures and I thought, “He’s a good-looking dude, you know what, screw it. I’m just going to send the message.” I’m very straightforward, and I believe you don’t need to sugar coat things or hide things from folks.

If you change your mind, message me. If not, have a nice life.”

So, I sent him a message saying, “Hey, you seem like a good-looking, nice guy. I have two daughters, I know you said you’re not interested in someone with kids, but if you change your mind, message me. If not, have a nice life.” And it took a couple of weeks, but he responded, and we went on our first date to Starbucks. Starbucks seemed like a safe bet in case things didn’t work out. Surprisingly, our first date was nine hours long. We met for coffee and stayed there for a few hours. Then we went to a restaurant, and we closed the restaurant down. After that, we drove home and continued to talk on the phone for like, 2 hours. We had a lot in common—he was in the Army, I was in the Air Force, and we connected and teased each other about which branch was better. The Air Force, of course! 

Q: What made you decide to marry Dennis?

He makes me want to be a better person for me and for everybody else. I couldn’t believe people when they said they met their true love or that they were in love with their best friend. It just didn’t seem real to me. I suppose I was a bit jaded from my divorce. Then I met Dennis. He makes me laugh, he’s someone who appreciates me, loves me and makes me feel good, and I realized, this is how it’s supposed to feel. I’m very much in love with him. He’s my best friend.

“I couldn’t believe people when they said they met their true love… It just didn’t seem real to me.”

Q: Did you have any concerns about starting over or creating a blended family?

Yes, I was very much against starting over and starting another family. My husband was also married before, but he didn’t have children with his ex.  It took me dating him for 4 months before I introduced him to the girls. I didn’t want them to meet this random person, and I didn’t know how dating would be for me. 

When we first started dating, and the first few months after being married, I wasn’t sure if I wanted more children. He was okay with that. He loves them very much, and he is very much their parent. People find it hard to believe that they aren’t his biological girls. He’s a natural with them.

Though, I could see how happy he was with being a father to the girls I knew he wanted to have a baby of his own. And that’s when I realized that when you love someone, their wants and needs become your wants and needs. I wrapped my head around that and am very much in love with him. I realized I wanted to have that connection with him forever, so that’s when we started trying to have a baby.

“When you love someone, their wants and needs become your wants and needs.”

I had a Mirena and decided, “it’s time we took this bad boy out.” When I told him that I was ready to start a family with him, the look on his face was just love and excitement and joy. And then when we were pregnant the first time it was, oh my gosh, it was the most amazing feeling in the world to have created a life with him. But the last two pregnancies (and miscarriages) were just horrible to go through.

But they made us stronger as a couple, and we also appreciate every moment that we have with Matthew. 

I want my husband to experience every little moment with his son and have all the input he wants on what we do day-to-day. I have already experienced caring for the girls, making a big deal about decorating their rooms, etc. So, every chance I get, I’ve put my husband’s wants and input into things. My husband is a huge Star Wars fan. To the point that we even had a Star Wars themed wedding. So, Matthew’s room is a Star Wars theme. We even had infant pictures taken with a little Yoda hat.  

Q: How are things with a newborn?

Things are great. Exhausting, but great. We’re supposed to take it easy for the first six week, but after Matthew’s birth, I just couldn’t. I’m a real estate agent and the market is insane right now. I was out going on appointments and showing houses with Matthew in tow. I think by the third week I had shown around 75 houses. Since we couldn’t take him to daycare because he was still so young, it has been quite the struggle. 

But my husband is very supportive and helps out any way he can. He works nights with the City of Woodstock Police, so our schedule has been challenging to say the least. Juggling a newborn, a 10y/o & 6y/o with both of our careers and life has its stresses, but it’s very rewarding at the same time. I am just thankful I have a really good support group surrounding me. 

Q: How was your pregnancy this go around?

This pregnancy was very good. I have practically been pregnant for two years. We had two previous miscarriages, so Matthew is our rainbow baby. During this pregnancy I took a lot of things very slow and very easy because the two times before were very hard, gut-wrenching and emotional. I didn’t want to go through that again. Each time we made it to the end of the first trimester then lost our babies. It was just a very, very sad experience. So, for this pregnancy it was tough in the beginning. You want to fall in love once you see that you’re pregnant with the positive pregnancy test, but you’re scared to let your emotions go. It’s hard to believe that it’s actually happening; that the baby is gonna stay. 

We had two previous miscarriages…you’re scared to let your emotions go.”

After the first trimester it was starting to feel real. I was able to wrap my head around the fact that this pregnancy was going to be successful. I was very fortunate to only have mild aches and mild nausea. The third trimester was great. I felt huge and as you can tell I had a big’ole moon belly! 

Q: How are the girls reacting to the new baby?

They love him. They absolutely adore him, and even fight over him. They want to hold him constantly. Since he is being breastfed I started pumping to give them an opportunity to help feed him with a bottle. They’re so wonderful with him. Kayla, the youngest, she calls him Moo-Moo. He eats a lot of milk and the “M” is for Matthew, so, yeah—Moo-Moo.

Yeah, the girls love to play with him and show him off. They love being big sisters. 

Q: What are you most looking forward to in your new relationship and family?

I’m looking forward to creating memories and just taking it all in. It’s weird, when I had the girls I was in a different place mentally and emotionally, and I don’t think I quite took in as much as I should have. I would say just being more in the moment and appreciating the moment.

Q: If you could give advice to other women based on your experiences, what would you tell them?

I would tell them that life is too short to not be happy. If your gut tells you you’re not happy, if something inside of you says, “There might be something else for me,” then there is something else for you. Life is too short to be unhappy. There will always be someone to love you. There will always be someone who will have their heart open, and if you have kids from a previous marriage, there will always be somebody out there for you who will welcome you and your family in and love them just like their own. Don’t settle; never settle. You are stronger than you realize.

“If your gut tells you you’re not happy…never settle!”

Q: What life lessons would you hope to instill in your children?

Always respect yourself and respect the person that you’re with. Also, never settle. Know your self-worth and know that you’re capable of… and this is going to sound so cliché… so much, and I know that if they were to apply themselves, they can do anything that they set their minds to. It’s a mental game, and they’re really strong. They can do whatever they want to do.

Q: Anything else you’d like to add to the interview?

I also want to say that Dr Gandhi and Jordan and both offices and all the women at Cherokee Women’s: I freaking love them. They’re awesome. You know, I can’t say enough about how pleased I am with everything. The emotional part; just being there for us and being silly with us, meant so much. Even when we were delivering via c-section, Dr. Gandhi was amazing and funny! I wasn’t excited about having to have a c-section, I really wanted a VBAC, but Dr. Gandhi is a doctor for a reason… She knows best!

My husband and I always feel comfortable enough to be able to joke around with her and with Jordan – they made our experience better. I’d would jokingly say, “I’m going to have a VBAC.” And Dr. Gandhi would reply, “Sooo, when we’re having the c- section…”. 

We did asked for a “gentle c-section”. It’s where we were able to have the blue tarp removed and replaced with a clear one to see pretty much everything. I’m weird like that. When we were taking pictures at the end, Dr. Gandhi was being silly and fun, and it made the entire experience very lighthearted and not so stressful or scary.

Dr. Gandhi is so funny and so amazing. I love that I can joke with her, then turn around and ask serious questions. Jordan is also hilarious, and easy to talk to.

So definitely, yes, it’s been a blessing to be with this practice and I’m just so thankful that I was able to use my VA benefits here.

Lots of medical practices do not like working with the VA as their payments can take a while to be sent. After researching doctors and practices, Cherokee Women’s was up on the list. I talked to the billing department and they were able to accept the VA’s payment. I was able to get great care and fell in love with Dr. Gandhi and nurse Jordan. They’re both great women, and I couldn’t have been happier with all of this.

“Everything happens for a reason!”

– We’re so happy that you ended up here and that you had an amazing experience with Dr. Gandhi.

I’m so blessed. I am beyond blessed. I must have done something right in another life because I don’t know what I did to deserve a wonderful husband and healthy daughters, a healthy son and great doctors to look after me. I truly am, and I believe it from inside my soul that I am very blessed with everyone that in my life right now.

May 3, 2018

Have you decided that it’s time to make your family of two an official family of three or more? The decision to start trying to get pregnant is exciting, but it’s easy for hopeful mamas to get discouraged after a few months without seeing those two little lines. Studies have shown the link between stress and a woman’s ability to conceive, so the first step in trying is an easy one – relax and enjoy the process.

Preconception Counseling Visit preconception appointment

Next, visit your doctor for a pre-pregnancy checkup. Also referred to as a preconception counseling visit, this appointment is your opportunity to discuss your current lifestyle, weight, medications and medical history with your doctor. Together, you discuss how all these factors affect your chances of getting pregnant. He or she can also recommend changes you can make to help you get pregnant faster.

Here are some additional steps you can take to get pregnant sooner:

  • Start taking a prenatal vitamin with folic acid. Start taking prenatal vitamins at least a month before you officially start trying to conceive. Most prenatals contain the 400 micrograms of recommended folic acid, but check the label just to make sure. Folic acid is also naturally found in leafy green veggies, citrus fruits, beans and whole grains, so doubling up is always a plus.
  • Improve your diet. Healthy babies start with healthy moms. Try to avoid junk food and load up on fresh fruits and veggies, which will aid in both helping you maintain a healthy weight and give you the energy to maintain a baby-friendly exercise plan.
  • Start limiting your caffeine intake. If you’re a 2-or-more-cup a day gal, it’s best to start cutting back, as the recommended daily intake of caffeine is 200 milligrams while pregnant.
  • Have your teeth cleaned. A rise in hormones causes gums to bleed more often than usual during pregnancy, causing what’s known as pregnancy gingivitis.
  • Get to know your cycle. Knowing when you ovulate will increase your chances of timing intercourse, which should be during the three to four days around your most fertile time of the month. There are lots of ways to track, including free apps for your phone or the good ‘ol fashioned way – with pen and paper.

Quick Conception Numbers

Overall, around 70% of couples will have conceived by 6 months, 85% by 12 months and 95% will be pregnant after 2 years of trying. Only about 8% to 10% of couples get pregnant within a one-month time frame, and the ‘per month’ rate for a normally fertile couple is around 20%.

With all these facts and figures, it’s important not to stress out to give it time and try to relax and enjoy the time you have alone with your partner. By meeting with your physician during a preconception counseling appointment before you start the process of trying to conceive, you can ensure that every possible precaution is taken to prevent future problems throughout gestation, labor, delivery and even afterwards.

Your peace of mind combined with our experience experience and expertise is our ultimate goal so that you may enjoy a safe and healthy pregnancy. For any additional questions or concerns, or to schedule your preconception counseling appointment, call us at 770-720-7733.

 

 

January 24, 2018

If your doctor looked at your face discoloration that has been worrying you and quickly murmured the word, ‘melasma’, you have nothing to fear. It is not only treatable but oftentimes, it is temporary and in no way a health risk.

What is Melasma?

Melasma is a skin issue that most often affects women, but men can experience it too. Brown or brownish-gray blemishes, or inflamed, red patches (erythrosis pigmetosa faciei) begin to appear in a typically recognizable configuration and hue that physicians can easily identify in areas such as:

  • The jawline (mandibular pattern)
  • The cheek (lateral cheek pattern)
  • Nose, cheeks, upper lips and forehead (centrofacial pattern)
  • Nose and cheeks (malar pattern)
  • Upper arms and shoulders (acquired brachial cutaneous dyschromatosis)
  • The sides of the neck, usually after the age of 50 (poikiloderma of civatte)

What Causes Melasma? Melasma is a common skin condition during pregnancy

The cause is unclear, but there is speculation that hormonal factors, combined with heat, sun, and light exposure, may create an imbalance of cells in the body called melanocytes. These melanocytes normally create the skin pigmentation, melanin, which decides the uniform color and shade of your skin. When melasma occurs, it is thought that the confused melanocytes sense some sort of disruption and command the melanin to generate more pigment. This results in patches of off-color skin.

Who Gets Melasma?

Melasma is completely impartial. Anyone, male or female can get it, but it is more commonly found in:

  • Pregnant women: This form of melasma is known as ‘chloasma’ or ‘the mask of pregnancy’.
  • Women taking contraceptives: Because progestin and/or estrogen found in birth control pills fool the body into believing it is in a state of pregnancy, women taking these medications are also prone to chloasma.
  • Women taking hormonal replacement drugs or steroids
  • Women using intrauterine devices or other implants
  • Women using certain medications for cancer and other problems that may make them more vulnerable to solar rays (photosensitivity)
  • Women using essential oils or certain toiletries, hygiene, and cosmetic products such as soaps, deodorants etc. that may result in skin reactions (phototoxicity) when exposed to the sun’s rays.
  • Darker skin-toned women such as females of Middle Eastern, North African, Latin, Mediterranean, Asian, and Indian descent
  • Women whose backgrounds may include a family history of melasma
  • Women between the ages of 40 to 60 and beyond who have been regularly exposed to the sun.
  • Women suffering from hypothyroidism or other medical issues
  • Women suffering from stress.

How is Melasma Diagnosed?

Melasma is easily identifiable and usually only requires a visual diagnosis, especially if you are obviously pregnant, or if any of the abovementioned criteria apply to you. However, if there is any doubt on the part of your doctor, certain tests can be performed.

One is called a Wood’s lamp examination. This lamp emits a particular light that, when scanning a targeted mottled section, can enable your physician to evaluate the depth of skin affected by the suspected melasma. Treatment would then depend on those findings.

Once the number of skin layers affected by melasma is determined, the Wood lamp results are usually categorized into one of these three classifications:

  • Epidermal melasma which responds very well to treatment
  • Dermal melasma which can be difficult to treat
  • Mixed melasma which can be treated partially.

If the doctor is still not positive that you are presenting with melasma, an additional procedure of removing a small skin sample for further analysis (biopsy) may be required.

Is Melasma Dangerous?

Not at all. Melasma poses no physical health risks whatsoever. It is purely a visual cosmetic issue. Its impact is more emotional and psychological due to the fact that it is predominantly a facial discoloration that is always noticeable. Women with severe melasma often suffer from low self-image, social discomfort and even depression depending on the severity of the condition.

Is There Any Treatment For Melasma?

Absolutely! With pregnancy-related melasma, the condition often disappears by itself after giving birth. Drug modification or complete cessation of medication containing steroids, hormones, or other melasma triggers can eliminate the problem as well.

Minor cases can be addressed through home remedies made with items found in your pantry or spice rack that contain natural bleaching or exfoliating properties. Many recipes are available online and include such ingredients as:

  • Turmeric
  • Papaya
  • Oatmeal
  • Apple cider vinegar
  • Almonds
  • Onion juice
  • Horseradish
  • Lemon juice
  • Sandalwood
  • Aloe Vera gel
  • Mulberry extract

Over the counter preparations can help too. Your doctor may prescribe oral medications or creams containing medicinal ingredients.

For more stubborn or resistant melasma, there are other, more aggressive options that your doctor may discuss with you such as:

  • Dermabrasion
  • Microdermabrasion
  • Topical glycolic or acid peels
  • Fractional lasers
  • Intense pulsed light (IPL)

Does Melasma Always Go Away Completely?

Unfortunately, not all the time. Usually, the gentler interventions mentioned are enough to eliminate the problem altogether or lighten it to a more acceptable level. Some cases of melasma, however, are difficult to correct. They may require several treatments, and even ongoing care to minimize large or extremely dark blemishes. Every case is different and only a specialist can determine your unique needs.

Is There Anything I Can do to Make Sure I Don’t Get Melasma?

There are definitely precautions you can take to lower your risk of getting melasma. You can:

  • Wear SPF 30 or higher sunscreen daily, reapplying it every 2 hours
  • Select make-up that also includes sunscreen
  • Avoid extreme exposure to the sun
  • Wear a wide-brimmed hat, and make sure your neck, shoulders, and arms are covered or protected outdoors
  • Discuss all medications you are taking with your physician to see if any of them may make you more prone to developing melasma. Sometimes a simple adjustment can prevent the condition from occurring.
  • Avoid rough or abrasive cleansers and soaps
  • Apply moisturizer regularly if your skin is dry

 

If you have already been diagnosed with recurring melasma, or have been unable to eliminate all traces of it, there are now excellent camouflage cosmetics available that greatly reduce the appearance of darker discolorations. As well, if you are experiencing psychological repercussions that often accompany more severe cases. It may be to your benefit to join a support group that can help you share and possibly overcome these issues.

Cherokee Women’s Health Specialists Can Help You if You Have Melasma

At Cherokee Women’s Health Specialists, our doctors can diagnose most cases of melasma. Honest, open, confidential dialogue regarding all your concerns allows us to give you the best possible attention and discuss treatment options you deserve.  We can help you. Melasma can be treated and controlled, and we are available to make that happen.

To book an appointment to discuss melasma with one of our doctors, call 770.720.7733.

January 15, 2018

Disturbing statistics show that, after previous years of decline, premature births are now on the rise in Georgia. Reports state that, in 2016, there was an 11.2% increase. Though this is partly due to lack of funding and, consequently, the shutting down of many medical facilities in Georgia, it is also happening nationwide.

Babies born before 37 full weeks of gestation are considered premature. Many maternal factors can contribute to preterm deliveries, and some of these include:

  • Diabetes
  • High blood pressure (Hypertension)
  • Pregnancies occurring within 6 to 18 months of each other
  • Racial and ethnic factors: Premature births to African American mothers surpass Caucasian ones by 50%
  • Malnutrition
  • Poverty hindering regular prenatal care
  • Drug or alcohol abuse
  • Smoking
  • Limited access to prenatal care for women living in rural areas
  • Reproductive system irregularities such as a malformed uterus, short cervix, or closed cervix (incompetent cervix)
  • Placenta previa
  • Previous or existing infections and STD’s
  • Mothers who are obese or underweight
  • Multiple births, whether natural or through in vitro fertilization
  • Pregnancy before the age of 18 or after 35
  • Fetal abnormalities
  • Overwork, excessive standing
  • Uterine rupture
  • Previous fibroid removal
  • Blood clotting irregularities
  • Injury from domestic violence or abuse
  • Stress or recent traumatic life experience
  • Pollutant or chemical exposure
  • Previous abortion or miscarriage
  • Rapid hormonal changes
  • Prior birth by C-section (Cesarean)
  • Epilepsy
  • Mental illness

Premature babies often suffer from both short and long-term health complications, neurological issues, and developmental delay concerns such as:

  • Hypothermia
  • Infections
  • Underdeveloped lungs and breathing problems
  • Cerebral palsy
  • Hearing and/or vision problems
  • Higher incidence of Sudden Infant Death Syndrome (SIDS)
  • Cardiac irregularities
  • Blood pressure complications
  • Brain hemorrhage and/or brain fluid buildup (Hydrocephalus)
  • Gastrointestinal difficulties
  • Jaundice
  • Anemia
  • Metabolic issues
  • Lowered immune system
  • Dental problems
  • Learning disabilities
  • Reduced cognitive skills
  • Psychological and/or behavioral problems

If you are not yet pregnant but may potentially give birth prematurely, prenatal counseling and testing are usually advised.

Is Your Pregnancy High-Risk?

If your pregnancy classifies as high risk with a danger of premature birth, you should find a fully accredited physician who is both familiar with and can treat complications associated with these pregnancies, as you will probably need extra monitoring throughout gestation.

Any medications, vitamins or supplements you are taking will be evaluated and possibly stopped or modified. Your diet might be adjusted to create a more nutritious and beneficial plan. Additionally, you will be provided with a list of any danger signs that may point towards a premature birth.

Prenatal Care for All Pregnancies 

At Cherokee Women’s Health Specialists, we offer you exceptional prenatal service. All of our professionals possess up-to-the-minute knowledge in their fields of obstetrics, gynecology, surgery, midwifery, cosmetic surgery, nutrition, medical assistance, nursing, holistic medicine, and equipment technology. They are committed to putting your well-being and that of your child first.

Unlike many OB-GYN facilities, we conveniently deliver multiple women’s health services to meet your needs under one roof. Our priority is to prevent as many premature births as possible by providing you with these broad amenities.

Along with being voted “Best OB/GYN in Towne Lake, Woodstock, and Canton, we are affiliated with Northside Hospital Cherokee, the nation’s leader in maternity services. We have unlimited access to their state of the art equipment, test center, and birthing center. Their Neonatal and NICU facilities have the most advanced technology to ensure that your baby is given every possible opportunity to fight against the challenges it might face due to a premature birth.

At Cherokee Women’s Health Specialists, we offer you exceptional prenatal service. Drs. Gandhi, Haley, and Litrel were among the first doubly accredited specialists in America to meet the high standards necessary to achieve certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This enviable distinction is only given to qualified individuals after years of training, education, and experience, and adheres to the stringent criteria demanded by the American Board of Medical Specialties (ABMS). Their expertise enables them to administer superior care throughout your pregnancy. Additionally, Drs. Hale, Crigler and Clay and our certified nurse midwives, Susan Griggs and Ruth Roser, complete our provider team and help us offer the best obstetrical care in Cherokee County.

Not all premature births can be foreseen or prevented, but at Cherokee Women’s Health Specialists, we try to do everything within our scope of expertise to deliver one healthy baby at a time.

Whether naturally or through in vitro fertilization, the number of women who are getting pregnant after 50 is increasing. Celebrities such as Gwen Stefani, Sophie Hawkins, Kelly Preston, Geena Davis, Janet Jackson, and Halle Berry were well into their 40s and early 50s before giving birth.

As more women wait to secure careers and stablize incomes before starting a family, their decision can come with the following drawbacks to both mother and child:

  • Miscarriage
  • Delivery by Cesarean
  • Difficulty in getting pregnant
  • Premature delivery
  • Gestational hypertension leading to preeclampsia
  • Gestational diabetes
  • Death during pregnancy or childbirth
  • Greater possibility of stroke in later years
  • Lung development problems in babies
  • Stillbirth
  • Low birth rate
  • Birth defects such as Autism or Down syndrome
  • Infant predisposition to overweight and diabetes

Because of these possible complications, pregnancies occurring later in life are considered high risk and therefore should be monitored more carefully. If you are considering getting pregnant after 50, you owe it to yourself and to your baby to choose an accredited OB-GYN whose experience, training and credentials encompass the entire spectrum of requirements and problems that could arise- one who will closely follow your progress throughout your entire nine-month gestational period. Prompt recognition and treatment of any complications that may occur from their onset are vital to both your health and that of your baby. 

Unless you conceive naturally, which is rare for women over the age of 50, you would probably have to become pregnant via in vitro fertilization, using either your own stored eggs or those of a donor. Preconception and fertility counseling might be recommended to inform you of both the risks and benefits that may arise with starting a family later in life. Your entire pregnancy should be monitored from beginning to end with regular ultrasounds, checkups, and prenatal testing. If you are overweight, wish to maintain an already healthy weight, or want additional advice regarding the best food and exercise plan during your pregnancy, it may be wise to consult a dietitian. Finally, if you prefer a more holistic approach and opt for a midwife, finding one that is familiar with pregnancies occurring after 50 is as important as any physician you would choose.

Cherokee Women’s Health Services not only offers all these amenities under one roof, but we offer them with a superlative degree of excellence. Our physicians and staff are trained to meet all your needs. Drs. Haley, Litrel, and Gandhi possess double accreditation in the field of Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Receiving this credential requires years of additional education, skill, and training, not to mention meeting the strictest guidelines set forth by the American Board of Urology. Their 40 combined years of knowledge and proficiency ensure you will have optimum care during your mid-life pregnancy.

Our entire staff of OB-GYNs, counselors, and board certified midwives possess stellar credentials. They diligently remain abreast of the most advanced scientific breakthroughs in women’s health, thus offering you the finest obstetric care modern medicine has to offer. They work as a team, making sure you receive every advantage to make your prenatal experience as safe as possible.

Practitioners at Cherokee Women’s Health Services are affiliated with Northside Hospital-Cherokee and all babies are now delivered at its new location which opened earlier this year. Their birthing center provides a comfortable and modern environment with access to the latest technology only steps away should any last minute problems arise.

Our Patient Philosophy at Cherokee Women’s Health

Our basic philosophy at Cherokee Women’s Health Specialists is a simple one–to treat every woman who walks through our doors with no less than the same consideration, understanding, and respect we would expect for any woman in our lives. This tenet is one of the many reasons that our full-service facilities were voted both “Best OB-GYN in Towne Lake, Woodstock, and Canton” and “Mom-Approved OBs” by Atlanta Parent Magazine readers. We take pride in these recognitions and make sure to pass the expertise that earned them on to you, the patient.

As we see more and more women get pregnant after the age of 50, we strive to keep ahead of all the improvements in medicine in regard to your special needs so that you and your baby can have a trouble-free pregnancy, safe delivery and can go on to enjoy the wonderful rewarding pleasures motherhood has to offer.

Call today to schedule an appointment with one of our OBs at 770.720.7733.

On May 6, 2017, the new Northside Hospital-Cherokee opened its doors to the public. That occasion was monumental, in that it was the beginning of providing the residents of Cherokee county with the most up-to-date, outstanding patient care and services available today. This modern full-service institution is prepared to provide the community with some of the most advanced technology known to medicine including top maternity, neonatal, and level II NICU facilities.

If you are a woman in Cherokee County who is planning to have a baby, you  can receive preconception counseling to help you determine if you are not only ready for motherhood, but to thoroughly investigate any possible genetic, hereditary, medical, physical and psychological history that may hinder the mental and physical futures of both you and your child.

If you are already pregnant, you can benefit greatly from Northside Hospital-Cherokee’s top prenatal, perinatal and neonatal services. This means that the health, safety, and well-being of both you and your baby can be monitored from conception to post-delivery, ensuring that any problems that may occur can be detected and treated as early as possible.

(For clarification, prenatal and perinatal care are the similar but with a slight overlap. Prenatal begins from conception to birth, while perinatal care commences at 154 days (22 weeks) of gestation and continues for a week after birth occurs.)

Because each woman is unique, every pregnancy varies in its needs and the level of attention necessary to insure the safest possible outcome. Depending on your medical history, you will be classified as normal, moderate risk, or high risk. Northside Hospital-Cherokee is prepared to expertly handle your pregnancy throughout all three.

Prenatal Care 

Regular prenatal care is one of the most important steps in making sure your baby is given every advantage possible. By going to all your appointments, following directions, taking the vitamins and supplements prescribed, and having all the tests suggested to make sure your child’s size, weight, progress and development is progressing well and on schedule, you are doing everything you can to ensure he or she is getting the best and healthiest start in life.

Northside Hospital-Cherokee will do its part in making all that happen while your baby is still in the womb and until he or she is safely nestled in your arms. From your first appointment, you will be given basic testing, blood work, urinalysis, and ultrasound at the correct time during gestation. They also offer noninvasive cell-free DNA testing, and were in fact pioneers- the first in Atlanta- to introduce most of these prenatal services, along with fetal echo and diagnostic radiology.

As your pregnancy moves forward, you will be carefully and regularly monitored, especially if you have been classified as high risk. Northside Hospital-Cherokee has the latest diagnostic and imaging equipment, operated by highly trained professionals and technicians to vigilantly follow the progress of you and your baby, keeping careful watch over even the smallest irregularity so that protective intervention is swift and immediate.

Once your baby is ready to come into the world, you will have access to individualized care in a private labor-delivery room until the birth, after which he or she will be taken to a full service newborn nursery.

Post-Birth Recovery

While recovering, you will have access to the lactation center if you choose to breastfeed. If this is your first experience with it, trained consultants will take the time to guide you through the process. You will also be offered additional assistance if needed, and be invited to attend a weekly support group.

Cherokee Women’s Health Specialists is proud to be closely affiliated with Northside Hospital-Cherokee and have collaborated with this institution for years. Our unlimited access to their technology, equipment and testing centers, along with our close association with many colleagues on its staff have enabled us to give our patients the quality care and service they deserve. The amenities they offer at their new location are among the best, most current and innovative in the nation. The medical advantages they have always shared with us have bettered untold lives and have enabled us to safely deliver over 10,000 babies over the years to mothers in Cherokee County and its surrounding areas. Their newest, top neo-natal facilities will guarantee that we will continue to deliver many more.

For more information on Northside Hospital-Cherokee’s facility, visit their website.

November 22, 2017

Cervical cerclage is only done in a small percentage of pregnancies.

It is the placement of stitches in the cervix to hold the area closed to prevent preterm labor or pregnancy loss for women who have a weak or incompetent cervix.

Cervical cerclage can be done as early as 12-weeks as a preventative measure for women who have had miscarriages due to a weak cervix. It can also be done as an emergency measure after the cervix has dilated. Typically, this procedure is not done after the 24-week mark.

When is Cervical Cerclage Recommended?

This procedure is recommended for women to prevent pregnancy loss or premature birth. Stitches are used to close the cervix around the second-trimester and typically removed no later than week 37.

Your doctor may suggest cervical cerclage if you qualify as a high-risk pregnancy.

During pregnancy, your cervix gradually softens, decreases in length, and begins to dilate in preparation for your baby. However, in rare cases, your cervix may open too soon putting you at risk for premature labor.

Your healthcare provider will assess your risk level based on the following circumstances.

  • If you’ve had one or more 2nd-trimester pregnancy losses related to dilation.
  • If you have had cervical cerclage during previous pregnancies.
  • If you have been diagnosed with painless cervical dilation during your second-trimester.

Generally, cervical cerclage is done through the vagina (transvaginal cervical cerclage). But, in some cases, it can be done through the abdomen (transabdominal cervical cerclage). Ask your doctor what is better for you and your baby.

Cervical cerclage and high-risk pregnancyIs Cervical Cerclage Right for You?

Your doctor may discourage cervical cerclage for any number of reasons. You may want to reconsider this procedure if you have vaginal bleeding, preterm labor, an intra-uterine infection, a rupture in the amniotic sac, or are carrying multiple babies.

Risks Associated with Cervical Cerclage

There are many side effects associated with cervical cerclage. Having the procedure doesn’t always prevent premature birth.

Women who experience premature dilation of the cervix during the second-trimester may have one or a number of these problems whether they opt for cervical cerclage or not.

Here are a few side effects that are occasionally associated with a cervical cerclage procedure. Consult your doctor about your risk factor based on previous pregnancies and what you can do to minimize side effects.

  • Infection
  • Vaginal Bleeding
  • Tear in the Cervix
  • Leakage of Amniotic Sac (Prior to week 37)
  • Miscarriage
  • Preterm Labor or Birth

If you experience bleeding or leakage after your cerclage procedure, seek medical attention immediately. In such cases, your OB-GYN may recommend the removal of stitches early.

Closing Thoughts

Cervical cerclage is not for everyone. Talk to your healthcare provider to learn more about the options available to you. Ultimately, it’s up to you to make the right decision about what’s right for you and your baby.

Whether you’d like a second opinion about your cervical cerclage recommendation or have other pregnancy-related questions, don’t hesitate to contact us today. Here at Cherokee Women’s Health, we offer a full range of services to help you along the way.

November 11, 2017

Placenta accreta can be discovered in the third trimester.When blood vessels and other parts of the placenta attach too deeply to the uterine wall during pregnancy, you have what’s known as placenta accreta.

As many as 1 in 2,500 pregnancies experience this condition.

Placenta accreta is a serious pregnancy condition that can cause serious blood loss after childbirth.

This condition can also be called placenta increta, or placenta percreta depending on the severity of the and deepness of the placenta attachment.

Symptoms Associated with Placenta Accreta

Generally, there are no symptoms or signs of this condition early on. During the third-trimester, some women who have placenta accreta may experience vaginal bleeding.

If you do experience bleeding, consult your doctor to discuss your risk level. If bleeding is severe, seek immediate medical care.

Who is at Higher Risk?

Placenta accreta is thought to be caused by abnormalities in the lining of the uterus. These abnormalities can be caused by a number of things such as scarring due to a past C-section or other uterine surgery.

You may at a higher risk for placenta accreta if you have any of the following risk factors:

  • Older than 35. Women above the age of 35 are more likely to have placenta accreta.
  • Previous childbirth. Your risk factor increases with each birth.
  • Past uterine conditions. Uterine conditions such as fibroids can cause scarring or damage to the uterine wall.
  • Previous C-sections. If you’ve had a C-section or other uterine surgery in the past, you’re more at risk for placenta accreta.
  • Placenta position. When the placenta is partially or totally covering your cervix, the risk factor for accreta increases. Placenta accreta is also more common when the placenta sits on the lower portion of the uterus.

If you suspect you may be at risk for this serious medical condition, ask your physician about your risk factor.

How is Placenta Accreta Diagnosed?

Fortunately, some indicators of this condition can be spotted early on during initial ultrasounds.

If your doctor suspects you may be at higher-risk for placenta accreta, they will schedule a follow-up visit to discuss the condition and form a plan to manage it.

A follow-up visit may also include:

  • An MRI (magnetic resonance imaging): Your doctor can better see how your placenta is attached to the uterine wall through an MRI.
  • A Blood Screening: Through a simple blood test your physician tests the levels of alpha-fetoprotein in your blood. A rise in these levels has been linked to placenta accreta.

Your doctor may suggest a scheduled C-section as early as 34 weeks to avoid an emergency premature birth.

How Can Placenta Accreta Affect Delivery?

After normal childbirth, the placenta typically detaches from the uterine wall. However, with placenta accreta part of the placenta remains firmly attached.

Women with this condition can experience severe blood loss after the birth of their child. Placenta accreta can also cause premature birth.

If you’ve been diagnosed with placenta accreta, your physician may recommend an early C-section.

You may also need a hysterectomy (the surgical removal of the uterus).

Final Thoughts

Placenta accreta can be a scary medical condition. Maintaining an open dialog with your doctor throughout your pregnancy can help alleviate some of your fears. Together you can develop a plan for a safe delivery.

Don’t hesitate to contact us with any questions or concerns regarding placenta accreta or any other pregnancy-related condition. A trained staff member will be happy to answer any questions or schedule a consult.

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

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