woodstock ob gyn

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Anterior and Posterior Repair Education, Mesh Education, Pelvic Organ Prolapse Education, Urogynecology

What is Prolapsed Bladder?

Prolapsed bladder, also known as fallen bladder or cystocele, is a condition where the bladder drops down from lack of support. A concave dome-shaped group of pelvic floor muscles and tissues hold the bladder and other organs in place. Due to a variety of reasons, these muscles and tissues can weaken over time. This causes the bladder to descend from its fixed position and slip downwards into the vagina, much like a big toe begins to rub, then protrude through an old, worn sock. In more severe cases, the bladder may dangle completely outside of the vagina. What Causes Prolapsed Bladder? What are the Symptoms? In cases where the bladder prolapse is mild, women may not experience any symptoms at all, and the condition may only be discovered during a routine examination. When Should You See Your Doctor? If you notice that you may have any of these symptoms and suspect a prolapsed bladder, you should see your doctor immediately. This condition often means that other pelvic organs may also be prolapsed, as the same muscles and tissues hold the uterus, cervix, vagina, rectum, and intestines in place as well. This is not a condition that repairs itself. It usually worsens over time, but it can be fixed thanks to many modern methods available today. Diagnosis and Tests In obvious cases, an examination of the pelvis and genitalia can visually confirm prolapsed bladder. If less evident, the doctor may use something called a Voiding Cystourethrogram to confirm diagnosis. This is a sequence of x-rays taken while the patient is urinating so that the physician can see the bladder shape and what may be causing flow problems. He may also request additional x-rays of different abdominal sections to eliminate other theories, after which he may test muscles, nerves and the force of the urine stream to conclude his diagnosis and recommend treatment. Additional tests, if necessary are: Treatment If tests confirm prolapsed bladder, your doctor will categorize its degree as mild, moderate, severe or complete. If it is mild, it usually requires no immediate treatment other than to refrain from heavy lifting or exertion.For more serious cases, depending on health, age and other factors, some non-surgical treatments include: Surgery Should you need surgery, one of the following may be recommended: Types of Reconstructive Surgery What Can You Do? Make an Appointment Today Prolapsed bladder and its effects can be uncomfortable, restrictive, and inhibit a normal lifestyle. Our board-certified OB/GYNs can address these issues so you can get back to living the life you deserve. Call and make an appointment today at 770.720.7733 or schedule an appointment online.

vaginal discharge square
Well Woman

Vaginal Discharge – Should You Be Worried?

What is Vaginal Discharge and What Causes It? The vagina is similar to a corridor that leads from outside of woman’s body to her inner reproductive organs. The vagina and cervix contain tiny internal glands that create and secrete fluids. The purpose of these fluids is to wash away bacteria and dead cells. This natural cleansing process protects the vagina, and prevents infection, much the same way a kitchen sieve holds strawberries while a good rinsing flushes away harmful dirt, grit and anything else those berries might have been lying in as they grew. While vaginal discharge can be annoying, often staining and occasionally ruining those favorite, overpriced panties, it is a perfectly natural bodily function and should not be tampered with unless problems arise. If something interferes with the delicate balance of vaginal secretions, uncomfortable, painful and even serious infection may occur. What is Normal, Healthy Vaginal Discharge? Color: The color of healthy vaginal discharge can range from clear to milky white, the latter usually occurring during ovulation. It may also be clear with white stringy flecks. When dry, white discharge may turn yellow on underclothing.A bloody discharge is also perfectly normal during a woman’s period and is no cause for alarm. At times, droplets of blood can be mingled in with discharge between menstrual periods and this is known as spotting. Unless excessive, or accompanied by discomfort, this is also normal. Amount: The amount can vary anywhere from 20 mg to 60mg a day (yes, it feels like much more!) This can increase to about 600mg during ovulation. Increase in discharge can also occur during exercise, breastfeeding, contraceptive use, sexual arousal and even emotional stress. Vaginal discharge decreases at menopause due to lower estrogen levels. Consistency: The texture of normal discharge also fluctuates. During ovulation, it can be thin and watery. This texture is Nature’s way of enabling sperm to pass into the uterus allowing a better chance of fertilization. At other times, it is thicker, more acidic, and less hospitable towards sperm. This is temporary, just like a mild marital spat. Discharge texture varies depending on the body’s levels of the hormones estrogen and progesterone, both found in birth control pills. This is why women who take oral contraceptives produce thicker discharge, thus preventing unwanted pregnancy. During pregnancy, a thick mucus plug (operculum) forms inside the cervical canal. Containing antibacterial properties, its function is similar to that of a cork or safety seal for the uterus, protecting it from uterine fluid leakage or pathogen invasion. When dilation begins to occur before childbirth, the plug loosens and drops out, resembling discharge tinged with blood. Odor: Discharge odor can vary depending on medication, menstrual cycle, diet, activity, personal hygiene, pregnancy, lubricants, and hygienic cleansing products, but usually a slight musky, though not unpleasant odor is normal. Receiving oral sex can sometimes produce a different odor. When Should You See Your Doctor? Although vaginal discharge is vital in maintaining optimal health of the reproductive organs, the delicate Ph balance can sometimes be compromised leading to infection. Infections may occur at any time, but are more likely to happen when the Ph balance is less acidic, right before or during menstruation. If you experience any of the following symptoms, see your doctor. These can possibly be indications of infections or sexually transmitted diseases such as Bacterial Vaginosis, Yeast Infection(Candida), Pelvic Inflammatory Disease, Human Papillomavirus, Trichomoniasis, Gonorrhea, or Chlamydia –to name a few: • Pain or inflammation accompanying discharge• Redness in vulvar or vaginal areas• Strong unpleasant smelling discharge immediately after intercourse• Burning or itching• Rash• Burning while urinating• A cottage cheese like texture.• Thick, lumpy, or pasty discharge• Foul smelling green, yellow, grey, or cloudy discharge• Excessive or recurring brown or bloody discharge, especially when not on your menstrual cycle• Strong, foul, fishy odor• Watery discharge• Any unusual discharge accompanied by abdominal pain, uncommon fatigue, fever, sudden weight loss, and increased urination.• Blisters or sores in the vaginal or vulvar area.• Painful intercourse Treatment After a brief medical examination which is usually enough to identify the problem, your doctor may request additional tests to analyze skin, cervical or discharge samples. When the problem is identified, most vaginal discharge abnormalities can be treated with prescription medications such as antibiotics, creams, antifungals, or suppositories. These should always be taken for the full amount of time prescribed by your doctor, no matter how much better you feel. In some cases, it may be necessary to treat both the patient and her sexual partner, and both may be asked to refrain from sexual intercourse until treatment is successfully completed. If symptoms persist after medication is completed, a follow up visit may be necessary. Over the counter medications are available for common yeast infections, but should be avoided if pregnant unless approved by a physician. Abnormal discharge may be indicative of some cancers, but this is rare. How You Can Help Prevent Problems • Use condoms, especially with new sexual partners.• Have an annual pap smear to screen for possible cancer. It’s only uncomfortable for a minute• Keep the genital area dry and clean with regular bathing, showering and gentle wiping from front to back after urination or defecation.• Avoid harsh soaps, feminine sprays, powders, chemicals or douches around the vaginal area. They can may upset the Ph balance and kill important bacteria. Being field flower fresh can sometimes do more harm than good• Avoid deodorized pads and tampons, especially those discount store brands that can be smelled before you enter a room.• Wear absorbent cotton underwear, and save the sexy, synthetic ones for special occasions unless they have a cotton crotch piece.• Be vigilant when you wear tampons. Anyone can forget, especially near the end of a period when there is little or no blood. It happens more often that women think.• Use products designed specifically for vaginal lubrication. Avoid petroleum jelly or other household lubricants your grandmother suggested.• Eat a healthy, well balanced diet and drink plenty of fluids. Yogurt containing live cultures

OB

Why Is Breastfeeding So Hard?

Breastfeeding is probably the first most intimate bond a mother will ever create with her child, but sometimes it can take a little while to get it right—both for mother and baby. Much like picking up rice with chopsticks for the very first time, breastfeeding requires patience, practice, time and effort. Although babies are born with a natural instinct to suckle, and mothers usually produce the colostrum and milk they need immediately, sometimes getting the two natural occurrences to cooperate with each other can be difficult. Apart from the time and discomfort needed to recover from childbirth, baby’s constant demands for food, cuddling, changing– not to mention possible colic- the first few days can be overwhelming on a new parent. Lack of sleep can also cause impatience, which in turn is something a baby can easily sense. No matter how many decibels you attempt to lower your voice after drowsily walking into walls during that three o’clock feeding, your baby will still pick up on your irritability and react accordingly with fussing, flailing or crying. Compounding all this with a difficulty to breastfeed could easily leave the mother experiencing feelings of failure, shame and anxiety. Rapid hormonal changes on her part add to the melting pot of emotional stew. Latching Problems Breastfeeding can be a painful, uncomfortable experience during the first few postpartum weeks. Although hungry newborns may not have teeth, their gums can certainly clamp on well enough to make a new mother wince, even yelp at times. Until tender, engorged nipples become accustomed to the sensation, it can be highly unpleasant for the first little while. If pain persists after this adjustment period, however, it may possibly be caused by a bad latch. A bad latch may occur for a number of reasons, such as cradling the baby’s head at an improper angle, positioning your breast incorrectly, flat or inverted nipples, or an infant who hasn’t quite yet grasped the intricacies of sucking and getting tasty results. Learning to latch may take time. If you look down and see that your areole or nipple are visible, your baby may not be latching correctly. Both serve a purpose similar to a bull’s eye on a target. Baby needs to zone in and clamp on the center to achieve proper suction. The sensation of the nipple, and in some cases the tiny bumps surrounding it on the areole serve as a type of braille to baby’s sensitive mouth. Nursing pillows may facilitate finding the correct angle, thus gently coaxing your child to a better position. If you can’t resolve the latching problems on your own, there is no need to get frustrated or to feel badly about it. At your next appointment, ask your obstetrician or certified nurse-midwife for information on overcoming breastfeeding problems. They are familiar with the problem and will gladly help to make breastfeeding a more enjoyable nurturing time for you and your infant. Inverted or Flat Nipples 1 to 3% of all women have flat or inverted nipples which can create a challenge when breastfeeding. Speak to your obstetrician about breastfeeding with inverted nipples. Some methods he or she may recommend would be to pump before breastfeeding to stimulate milk flow, or using a silicone shield to help your baby latch. Some women with flat or inverted nipples may require the help of their spouses to get a good latch going. In a way, this can also be a pleasant bonding time for their partners. Breast milk provides babies with vital nutrients to help them grow and develop into healthy, strong little people. It is recommended that mothers try as much as possible to introduce their infants to not only this beneficial form of nourishment, but the resulting closeness and warmth both mother and baby can derive from it. For more information on lactation, Northside Hospital-Cherokee has a center dedicated to lactation and their website offers lots of great tips.

breastfeeding
OB

Common Breastfeeding Problems

Apart from providing valuable colostrum and vital nutrition for babies, breastfeeding can create an intimate bond between a mother and newborn. Another plus is that breastfeeding requires more calories than pregnancy, Mother Nature’s way of rewarding a new mother by giving her a jump start on the road to ‘baby weight” loss. Breastfeeding Doesn’t Always Happen Naturally At first, however, to the dismay of many new parents, it isn’t always the warm fuzzy experience they imagined it would be. Breastfeeding does not always happen naturally. The milk is in the mother’s breast, and the baby instinctively makes sucking motions looking for food, but the act of successful breastfeeding itself is a skill that requires a little practice on both parts. Motherhood can be challenging and intimidating enough, especially for first time moms who want to do the very best job possible. Even the sweetest, undemanding baby can be intimidating due to lack of experience, let alone a colicky fussy child. Encountering breastfeeding problems can raise stress and anxiety levels at the very best of times, and this frustration may result in abandoning breastfeeding altogether. Most breastfeeding difficulties, however, are easily remedied with minor position adjustments or a few timeless suggestions from your OB-GYN. Solving Common Breastfeeding Problems Low milk production: Many moms underestimate their milk levels, especially when first learning to breastfeed. But a few tricks can increase your supply: ensure your baby latches well and drains both breasts at each feeding, drink plenty of water, use a breast pump between feedings, and nurse at night when milk production hormones surge. You can also ask your doctor to modify your diet to include foods that encourage healthy milk production. Latching pain: Latching pain is expected for new moms, but it shouldn’t last. If latching pain lasts longer than a minute, reposition your baby to an asymmetrical latch, where his mouth covers the nipple and the lower part of the areola. Cracked nipples: A common result of latching problems, improper pumping, or thrush, cracked or bloody nipples can cause serious anxiety in new moms. But a little blood won’t harm the baby, and the solution is simple: lanolin cream. Other remedies include repositioning your baby’s latch, breastfeeding more frequently for shorter intervals, and letting some milk air dry on your nipples. Thrush: A yeast infection that may develop in infants’ mouths, thrush can spread to the breasts, causing itching, soreness, and sometimes a rash. See your doctor, who will provide an antifungal cream to be applied to both your nipple and the baby’s mouth. Every woman faces her own challenges during pregnancy and postpartum. We encourage our patients to take advantage of the rich resources in our health community, including the Lactation Program at Northside Hospital-Cherokee, where we deliver all our moms. If you have concerns about breastfeeding, schedule an appointment with us today.

OB

Healthy Weight Gain During Pregnancy

Every woman gains weight during pregnancy. For some, this is a positive experience: the healthy glow and rounded figure are a badge of honor, broadcasting her good news to the world. For others, it’s a struggle: dealing with the stress of weight fluctuation on top of the other body changes pregnancy brings. But all moms share the same question: how much pregnancy weight gain is too much? Healthy Weight Gain During Pregnancy The amount of weight gained during pregnancy isn’t an abstract question. It can affect the health of both mother and child during gestation. Gaining too much weight contributes to postpartum weight retention, but gaining too little leads to inadequate birth weight of your infant. If you’re worried about weight gain, discuss it with your obstetrician or CNM. Your physician can give you an individual assessment to make sure you gain a healthy amount of weight during pregnancy. To get you started, here’s a handy chart from the American Congress of Obstetricians and Gynecologists. For underweight mothers (BMI of 18.5 or less), the recommended gain is 28-40 lb For average weight women (18.5-24.9 BMI), there’s a recommended weight gain of 25-35 lb For overweight (25-29.9 BMI) moms, doctors recommend a 15-25 lb weight gain For obese mothers (30 BMI and higher), the recommended weight gain is 11-20 lb How to Control Weight During Pregnancy If you’re gaining too much or too little weight during pregnancy, ask your obstetrician about a personalized nutrition plan. Not only will a proper diet improve your weight gain, it will also provide necessary nutrients to you and your baby. Moms-to-be can also begin a pregnancy exercise routine to improve health and decrease the discomforts of pregnancy. Some conditions make exercising during pregnancy unsafe, so always speak to your doctor before starting a new fitness regimen. Want to learn more about nutrition, fitness, and healthy weight gain during pregnancy? Visit Northside Hospital-Cherokee or make an appointment with one of our physicians or advanced practice providers today at 770-720-7733. 

woman with bladder prolapse
GYN Problems, Urinary Incontinence Education, Urinary Incontinence Treatments Education

Leaky Bladder Symptoms and Remedies

One in five women endures the symptoms of leaky bladder, or urinary incontinence. Yet often, a suffering woman does not acknowledge it as an issue. She may be self-conscious about mentioning the condition to her doctor, or she may assume it’s a normal part of being a woman. Two of the most commonly accepted situations are incontinence after pregnancy and incontinence during exercise. The truth is, although urinary incontinence is common, it is not considered normal. Needing to urinate frequently, as well as urinary urgency, are signs that one may be dealing with a leaky bladder. Fortunately, for a woman experiencing these symptoms, she can find both surgical and non-surgical options in treatment to minimize or even eliminate these symptoms permanently. What is Urinary Incontinence? Weakening of the pelvic floor can affect bladder control and urethra function, causing issues with urination. Women suffering from urinary incontinence find themselves running to the bathroom frequently. Strong urges to use the restroom, even after urinating, is another sign that a woman may be dealing with urinary incontinence. It is important to not brush off the occasional leak experienced while exercising or shifting position, because there are treatments available for women dealing with urinary incontinence. Types of Urinary Incontinence One important step in the diagnosis process is identifying the type of urinary incontinence, in order to find the best treatment option. Stress Incontinence This type of incontinence occurs when urine leaks out of the bladder during certain strenuous activities. Jogging or other exercising can cause urine leakage. Coughing and laughing can also bring on an unexpected leak. More severe symptoms of stress incontinence may include urine leakage during low stress activities such as changing position or walking. Many pregnant women can experience stress incontinence as the growing uterus puts pressure on their relaxed pelvic floor and the organs shift to make room for baby. Sometimes the symptoms are dismissed as an annoying pregnancy symptom, but if they do not subside after delivery, they may need medical assistance to prevent symptoms from worsening. Urge Incontinence Commonly referred to as overactive bladder, or OAB, urge incontinence is a continued sensation of needing to urinate. This sensation is often an overwhelming, powerful urge which sends women dodging for the nearest restroom. Urge incontinence is different from stress incontinence in that it occurs suddenly, without pressure on the bladder from strenuous activity. In addition to strong urges to urinate, women with urge incontinence may find themselves waking up at night to use the restroom, interfering with a full night’s rest. Sometimes, there may be an underlying condition that is causing the undeniable urges to urinate. An honest discussion about symptoms with a doctor can help them determine any underlying conditions so they can better treat you. Preventing Urinary Incontinence Many situations can result in urinary incontinence. There are some factors that do make a woman more prone to the condition, including pregnancy and childbirth. Women who want to lessen the chance of experiencing urinary incontinence can follow the advice below: Leaky Bladder Remedies Don’t be ashamed or embarrassed to mention your symptoms to one of our double board-certified FPMRS specialists. Treatment options will be chosen based on the severity of the symptoms but can include:

pregnant woman checking blood pressure
OB Education

Recognizing Preeclampsia During Pregnancy

Because preeclampsia only affects women during pregnancy and the postpartum period, many first time mothers are unaware of the effects and symptoms of preeclampsia. Proper prenatal care with an OB/GYN is typically enough to catch the early signs of preeclampsia; however, new mothers should be aware of the symptoms and notify their doctor about any changes in their health.  What Is Preeclampsia? Preeclampsia is pregnancy induced hypertension that affects mothers and infants during late pregnancy. Symptoms typically develop after week 20, and can show up as late as 6 weeks postpartum. Researchers have yet to isolate the cause of preeclampsia, but the disorder affects 5-8% of all pregnancies. Preeclampsia is most common in first time mothers. It is one of the leading causes of illness and death in mothers and infants, but identifying the problem in its early stages allows for the best possible outcome. Recognizing the Problem Although some women show few symptoms of pregnancy induced hypertension, preeclampsia is typically characterized by high blood pressure and protein in the urine. Your obstetrician will monitor your pregnancy for signs of preeclampsia, but it’s important to tell your physician if you’re experiencing any symptoms. Symptoms of preeclampsia may include: Preeclampsia develops rapidly, so it’s important to notify your doctor as soon as you experience symptoms. But with early detection and proper care, your physician can provide the best possible outcome for you and your baby. To learn more about preeclampsia or to schedule a prenatal appointment with one of our board-certified OB/GYNs, call us today at 770.720.7733 or schedule an appointment online.

pregnant women exercising
OB

Fitness During Pregnancy

Regular fitness is one of the best ways for women to stay healthy during pregnancy. Staying active during pregnancy can improve mood, reduce pregnancy pains, and boost overall health. If you’re training for a marathon, you’d better leave it for your baby’s first birthday. Otherwise, it’s time to get active! Regular Fitness During Pregnancy Staying active keeps both mom and baby healthy and strong Decreases the risk of gestational diabetes and long-term obesity Reduces backaches, bloating, and swelling Contributes to faster postpartum recovery Improves energy levels Increases endurance, strength, and muscle tone Improves posture How to Stay Active While Pregnant Whether you’re a CrossFit champion or a full-on couch potato, it’s important to find the right level of fitness for your pregnancy. The American Congress of Obstetricians and Gynecologists recommends moms-to-be exercise for at least 30 minutes most days. For fitness newbies, this can work just as well broken into three 10-minute sessions throughout the day. Try a brisk walk after each meal (don’t forget to give yourself time to digest). Other safe pregnancy workouts include: Swimming: Water makes your body feel lighter, so it’s easier for pregnant moms to get moving. Bonus: swimming can help reduce nausea, swollen joints, and sciatic pain. Running: Hardcore runners don’t have to go from 60 to 0 when they get pregnant. Speak to your obstetrician about adjusting your training during pregnancy. But pay close attention to what your body tells you; pregnancy loosens joints, increasing risk of injury. Low impact aerobics: Don’t be afraid to sign up for that dance fitness class. Just don’t ignore your body when it says, “Ok, enough is enough!” Indoor cycling: A good workout that’s easy on the joints, indoor cycling adds stability during a time when a growing stomach makes balance a daily struggle. Weight training: Choose lighter weights and increase your reps to weight lift safely with a baby on board. To protect yourself from injury, consider using a weight machine, which limits your range of motion. Pilates and prenatal yoga: Both exercises improve flexibility and strength while promoting relaxation. They also improve posture, which relieves back tension from a burgeoning belly. As you grow, ask the instructor to modify moves and make certain poses safe for you. And whatever you do, avoid Bikram yoga (commonly known as hot yoga). It’s important that pregnant women listen to their bodies when finding the right pregnancy fitness routine. Use common sense – if the exercise makes you feel energized, it’s likely healthy. If the activity results in discomfort, it’s more likely unhealthy! If you have further questions about the right kind of exercise during your pregnancy, call Cherokee Women’s Health at 770.720.7733 or simply schedule an appointment online.

pregnancy pain
OB

Pregnancy Pain

If your pregnancy pains incite panic, you’re not alone. Moms are hardwired to protect their babies, and it’s easy to jump to the worst case scenario when experiencing unexpected pregnancy pains. But pregnancy means your body is stretching to accommodate new life, and sometimes those internal gymnastics result in some less than pleasant feelings. It’s not always fun to be a human trampoline! So when is pregnancy pain something to get concerned about? Common Pregnancy Pains Pregnancy pains are nothing new. Between the uterus expanding and infant elbows jutting into your internal organs, pregnant mothers undergo a lot. The most common causes of sharp pain during pregnancy are uterine cramping, gas and bloating, constipation, and second trimester round ligament pain. Home remedies will typically alleviate these discomforts. Try: Pregnancy safe stretches Walking or light exercise Breathing exercise Experimenting with sleeping positions and sitting positions. When to Call Your Obstetrician While many pregnancy pains are nothing to worry about, they can be a warning from your body that something isn’t right. Contact your obstetrician immediately if: You experience bleeding, chills, fever, or you are leaking fluid Pain lasts longer than several minutes or fails to abate after resting or adjusting The pain makes it difficult to move, breathe, or speak Sharp pain is localized on one side of the abdomen or uterus The pain comes and goes in cyclical fashion and increases in intensity Your midwife or obstetrician is with you for every step of your pregnancy. If you have concerns about pregnancy pain you’re experiencing, call us today at 770.720.7733 or request an appointment online.

heart health in women
Well Woman

The Number One Killer: Know the Signs!

Did you know heart disease is the No. 1 killer of women, causing 1 in 3 deaths each year? That’s approximately one woman every minute so it’s important to know the symptoms and how you can take control of your risk factors. The Most Common Heart Attack Symptoms in Women Shortness of breath Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. Nausea, vomiting, cold sweat or lightheadedness Pain or discomfort in any of the following: jaw, neck, stomach, arms (one or both). Lifestyle Changes to Help Prevent Heart Disease There are many things you can do to control heart disease and with the right information and care, heart disease in women can be treated, prevented and even ended. Studies show that healthy choices have resulted in 330 fewer women dying from heart disease per day. Don’t smoke Manage your blood sugar Get your blood pressure under control Lower your cholesterol Know your family history Stay active Lose weight Eat healthy Trust your gut Women are less likely to call 9-1-1 when experiencing symptoms of a heart attack themselves so trust your gut. If you aren’t feeling normal or are experiencing any of the symptoms above, call 911 or head to your local emergency room.

OB

Raising the Bar For OB Care

  Dr. Sara Bolden is a women’s health physical therapist, board-certified women’s health clinical specialist, owner of Women First Rehabilitation in Woodstock, GA and author of What a Girl Wants: The Good Girl’s Guide to Great Sex. Adopting a Higher Quality Obstetrical Care Model for Women in the United States If you’ve ever had a baby, witnessed one being delivered or heard of someone’s detailed labor and delivery story, one thing’s for sure, there was pain involved. We’re not talking about a little discomfort here, folks. We’re talking about deep, intense, I-could-kill-the-man-that-did-this-to-me pain. Quite honestly, we’ve come to expect extreme bodily pain during a situation like this. It would be absolutely crazy to think otherwise. I mean, we’re talking about a small melon exiting out of an opening the size of a child’s sock. Yes, the sock will stretch, the melon will emerge, but not without some repercussions…sometimes big repercussions. Often, these consequences can be serious and have lasting musculoskeletal effects. So what’s a girl to do? Physical Therapists Are NOT Massage Therapists Many would say, childbirth trauma is inevitable so proverbially “push” through the pain and try to get over it quickly. Unfortunately, this is frequently the default response to childbirth in the United States. There is little to no preparation of the pelvic floor muscles, the low back, the abdomen, nor education for proper breathing, delivery positioning, energy conservation or anything, for that matter, that adequately prepares the body’s musculoskeletal system for the delivery of a small human being. However, for many years now, international countries, such as England, Germany, Australia, Brazil and South Africa (to name a few), have taken proactive measures to assist women with labor and delivery and thus lower the risk of long-term musculoskeletal injuries or urogenital dysfunctions. One way they have elevated the standard of obstetrical care is to include physical therapists throughout pregnancy, during labor/delivery and for postpartum recovery. You might be saying to yourself, “physical therapists? Don’t they just give massages?” Brace yourselves…wait for it…no, they don’t. Physical therapists are not massage therapists. They are, however, musculoskeletal experts that have unique knowledge of the evaluation, assessment, treatment, disease/injury prevention and general wellness of the human body. The Difference a Women’s Health Physical Therapist Makes In other countries, the physical therapists that assist with prenatal and postpartum women are called obstetrical physiotherapists and have advanced skill and training in women’s health. In the United States, we call them women’s health physical therapists. I know, ingenious. They, too, have advanced knowledge and extensive training in women’s health; however in the U.S., their services have only been considered for the prenatal patient with abnormal or life-altering pain or for the complicated postpartum patient with pain and/or pelvic floor dysfunction (i.e. urinary incontinence, organ prolapse or pain with intercourse). Higher Standards of Obstetrical Care If the U.S. adopted a more comprehensive standard of obstetrical care, every pregnant women would be evaluated by a women’s health physical therapist. During the prenatal phase, she would get education and training on pelvic floor stabilization, core strengthening, body mechanics, birthing positions, perineal massage, breathing, relaxation and proper Valsalva for effective pushing, etc. Then, a women’s health physical therapist would be included in the delivery room to help with pain management, assist with birthing positions that open the pelvis and decrease risk of vaginal tearing, perform perineal massage to allow adequate room for the decent of baby, provide biomechanical support and coach the patient on the when’s and how’s of proper pushing…just like obstetrical physiotherapists are doing right now in other countries! After the birth of the baby, postpartum women would follow up with their women’s health physical therapist to assess healing of vaginal and/or abdominal tissues, be educated on scar management and facilitated tissue recovery, learn mechanics for lifting baby as well as for breastfeeding and restoring pelvic strength. Of equal importance, women’s health physical therapists would help new moms get their bodies back in shape, set realistic goals and expectations of motherhood and restore her vibrant, sexual health. Yes, I said “vibrant!” Who wouldn’t want that?! Good news! You belong to a cutting-edge OB/GYN practice and are hearing about women’s health physical therapists! I invite you to do a little research and see for yourself how effective this type of physical therapy is for pregnancy, labor, delivery and postpartum. Don’t be shy: ask your doctor to include physical therapy as part of your prenatal and postpartum experience. Company Bio Women First Rehabilitation is an elite healthcare practice devoted exclusively to treating individuals with pelvic pain, urogynecologic disorders and pelvic floor dysfunction in all phases of life. All of our practitioners are licensed women’s health physical therapists with advanced knowledge and training in women’s health. For more information, visit www.WomenFirstRehab.com.

Dr. Litrel's Blog

The Marriage Thermostat

For ten years, without fail, Ann and I kept our razors side by side in the shower. Then I switched to the Mach 3 triple blade razor, and suddenly the ever-present disposable pink lady razor disappeared. I didn’t give it much thought at the time. I figured such a sissy razor was an embarrassment beside my macho marvel of modern technology. The truth was more horrific. One morning I walked into the bathroom while Ann was in the shower, and I discovered that my Mach 3 triple blade marvel was being used to shave her legs. It didn’t take much to surmise that it might be getting some time under her arms, too. I kept my mouth shut until our morning coffee. “Doesn’t it repulse you,” I said calmly, “to know that the razor you’re using under your arms is the same one that I’m using on my face?” Ann laughed, and then quickly reached for my hand. “Sometimes…” she replied with a serious voice. “But love is a strange and wonderful thing.” She gave me an angelic smile. All was forgiven. Disagreement between a husband and wife occurs in the best of marriages.  Sometimes this manifests as open argument.  Other times, marital conflict can be more subtle, an unspoken tension permeating the relationship for years, like an uncomfortable humidity. When I met Ann at that fraternity costume party, she was supposedly dressed as a Greek goddess, in a skimpy toga no father would have permitted his daughter to wear in public. I fell in love. After our three years apart, there was nothing I looked forward to more than marriage and spending my life with Ann. My attraction to her was more than just her physical beauty; I admired her talent, kindness, intelligence and discipline. I still admire her. But after twenty-five years of marriage, the intelligence and discipline thing sometimes gets on my nerves. Ann has tendencies towards frugality that do honor to her Scottish heritage. She also endeavors to be environmentally aware. These two qualities are evidenced in the temperature settings Ann prefers for the household thermostat. During the hot Georgia summer the air conditioning is set at 80. During the cold of winter the heat is set at 65. In January when I am cold, Ann tells me to put on a sweater. In July when I am hot, Ann tells me to take my sweater off. Last year it was another hot, humid summer. So one day when Ann wasn’t looking, I sneaked to the thermostat and deftly dropped the temperature five degrees. It didn’t take Ann long to notice. “Who turned the air conditioning so low, Michael?” “Those kids,” I responded, shaking my head disapprovingly. I was not lying. I was simply making a declarative statement designed to misdirect. “The boys say they didn’t touch the thermostat, Michael.” “Those kids,” I repeated, shaking my head disapprovingly. Ann laughed and moved the thermostat back to “where it belongs.” I didn’t argue. I could understand her perspective: why burn fossil fuels to lower the temperature of my house just so I could be a tad bit more comfortable? But sometimes it was annoying. It was like I was married to Al Gore, and every time I touched the temperature control I was sinking an axe into the trunk of the last giant redwood. Over the years, Ann had successfully colored our “thermostat decision” in spiritual terms. With artful language she conveyed to me sophisticated thoughts about the needs of the body versus the needs of the soul. Essentially, her argument boiled down to this: Jesus didn’t have air conditioning, so why don’t you spend more time praying for strength, and less time whining about the heat? One summer Ann left town to visit her sister for a week. It was like Dorothy’s house had plopped down in Oz, and ding dong, you-know-who was dead! I ran to the thermostat like an unsupervised teenager and lowered it not five degrees, but ten. I was going to get all the air conditioning that compressor could muster. That night my house was so cold I needed another blanket from the closet. Immobilized by comforters, I slept like it was the dead of winter. Condensation covered all my windows when I awoke. I shivered when I sat down to my morning coffee. Now this was what July in Georgia should feel like!  I thought about getting out that dang sweater. Maybe I should light a fire too? But after an hour of reflection, I simply turned the air conditioning off. I missed Ann. Morning coffee was more fun with her. It’s far better to have a home that is too hot in the summer and too cold in the winter than to suffer again through the fires and chills of a long distance relationship. A prescription for tolerance is an occasional few days apart. In our human struggles, we can sometimes fixate on small problems. Absence gives God a chance to direct our focus on the big picture – Love. Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812

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