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A natural birthing experience is desired by many expecting mothers…But what does ‘Natural Birth’ really mean?  For some women it means a vaginal birth with little or no medical interventions, for some it means a vaginal birth without pain medications (or without an epidural), for others it may mean any accomplished vaginal birth, and not a cesarean section.

 

Nearly a third of babies in this country are delivered by cesarean section. The more recent adoption of early skin-to-skin contact and intraoperative breastfeeding, not only benefit maternal-infant bonding, but also benefits the baby in terms of earlier success with breastfeeding.  It simulates a more ‘natural birthing’ experience, preventing the feeling of ‘disconnect’ for the parents of cesarean section babies, while separated from their baby in the operating suite.

 

As a practicing Ob/Gyn, I hold no strict or definite definition of ‘Natural Birth’.  I allow the patient to decide and define whatever ‘Natural Birth’ means to them.

 

 

Suzanne Hall, MD (@drsuzyyhall)

 

In discussing the concerns of Menopausal Hormone Therapy (MHT) with patients in the office, it’s evident that ‘the fear’ of developing breast cancer from hormone use, by far outweighs the benefits of use, for many women.  With breast cancer being the number one cancer diagnosed among US women, and the second leading cause of cancer-related deaths (second to lung cancer,) those concerns are certainly understandable.

 

Though concern for an association of breast cancer from hormone use have perplexed patients and the medical community for many years, in the last 10 years, that level of concern has escalated to nearly a level of fear.  Despite some public perception of hormones as the cause of breast cancer, the medical evidence does not support hormones as a cause for breast cancer.  Unlike the causal link between smoking and most cases of lung cancer, a causal link between hormone use and breast cancer has not been established.  In fact, the cause of breast cancer is still unknown.

 

 

Expecting and new mothers are faced with many decisions in preparation for the care of their newborn baby, the decision to breastfeed, being among one of the most important ones.  We’ve all heard the advice of family and friends that “breastfeeding is better for the baby”, but how true do we really know this to be?

The fact is, it is true.  Medical research has shown human breast milk, over formula feeding, to benefit the infant in several ways.  Some of those benefits include, improvement in gastrointestinal functioning, improvement in immune defenses, thereby reducing the occurrences of several acute illnesses, and enhancing the maternal-infant bonding, possibly reducing infant stress.  Because of the proven health benefits to infants, many national health organizations have recommended exclusively breastfeeding infants for the first 6 months of life (i.e., Academy of Pediatrics, the American Congress of Obstetricians and Gynecologist, The World Health Organization.)

 

Normal labor begins after 37 weeks. Your "due date" is set at 40 weeks. If labor begins before 37 weeks, it's too soon.....preterm labor. About 1 in 10 pregnancies in the U.S. have a premature baby.  But what about the patients that “don't feel good", may feel they’re “too big", or just “want the baby out".  A premature baby -or "preemie"- can suffer serious illness, both acute and chronic; some could even suffer insurmountable complications leading to death. The earlier a baby is born, the greater the chance of health problems. Preemies grow more slowly, and may have problems with their eyes, ears, breathing, and nervous system. Learning and behavioral problems are more common in children born premature.

John Knapp M.D.

 

As an Ob/Gyn physician, it’s not uncommon for me to hear the question from patients, “Am I actually ABLE to conceive?”  For some women who are planning  pregnancy, as well as for some others who’ve never had a pregnancy (intended or not)…the question, “Can I get pregnant?” may be a looming concern.

Other than actually attaining a ‘positive’ pregnancy test, there really is no other specific test allowing us to know IF a woman CAN actually achieve pregnancy.  What we do know is, that for the normal couple (those without risk factors/or a history of infertility, regularly sexually active,) the chances of conception are actually stacked in our favor.  In fact, for regularly sexually active couples, there is a 15-25% probability of pregnancy with each menstrual cycle!

It is expected that nearly 90% of sexually active couples, without contraception, would become pregnant (intentionally or not) within one year.  The one year mark is typically used in defining those couples with ‘infertility’…the inability to become pregnant, despite frequent, unprotected sex within one year.  An infertility evaluation by your health care provider may be initiated at this time, and even earlier (at 6 months) for those women over 35.

 

Suzanne Hall, MD (@drsuzyyhall)

Eastside Gynecology Obstetrics

 

An exciting time for expecting parents is the first sensation of fetal movement, medically termed ‘quickening’.  Though fetal movement can be seen by ultrasound as early as the first trimester, the perceived, physical sensation of fetal movement generally occurs by around the 20^th week of the pregnancy.  This sensation of fetal movement may vary among women, and among different pregnancies.  Some first-time moms may not perceive this movement until up to 22^nd-24^th week of pregnancy, while others may recognize the sensation of movement as early as 16-18 weeks.

This sensation of early fetal movement has been described as feeling like the fluttering of a butterfly, a tickling, or a light tap.  The differences in the timing of your perception of fetal movement may be based fetal/placental location, or the anatomy of your abdominal wall.  Initially, it may be hard to distinguish these movements from a feeling of gas or a hunger pang.  But once you recognize the sensation as fetal movement, you’ll most likely be reassured and happy with your baby’s activity!

 

You may be worried about first visit to the gynecologist.  Don’t worry, this is normal, and with a little preparation it can be an empowering and educational experience.  Let your doctor know that you are nervous and we can be more effective at walking you through the process.  The American Congress of Obstetrician and Gynecologists recommends young women make their first visit to the gynecologist between ages 13-15.  Your doctor will want to ask you questions regarding your medical and surgical history, menstruation history, sexual history, exposures to alcohol or tobacco, and review vaccinations you’ve received or may be due for.  If these topics seem too personal, or you are uncomfortable discussing them, remember your conversation with the doctor is confidential.  It may be helpful to go to the appointment with a parent or friend, but be sure some of the time is spent with you and the doctor in private, so you can voice concerns or questions that might be awkward to discuss around others.  You may want to write questions down before-hand, as this is an opportunity for you to gain knowledge regarding your health and well-being.

mind well-informed.

Would you describe your sexual response as ‘fireworks’…‘a budding flame’…or ‘not much at all’?  Despite our societal conditioning of the ‘typical’ female orgasmic response, not all women experience “fireworks” at climax (like in the movies,)…possibly leaving those women with a ‘less than typical’ response, left wondering…‘Is there something wrong with me?’

 

If you experience ‘fireworks’, that’s great!  But not all women experience ‘fireworks’ with climax (orgasm.)  In fact, less than a third of women even consistently experience orgasm with sex.  Like other sensory responses in our body, the frequency and quality of our individual sexual response vary amongst women (and often vary amongst experiences). Just like the ‘savor’ of chocolate cake, the ‘scent’ of spicy perfume, the picturesque  ‘vision’ of a floral garden bring different sensations to different women, so does our experience of sex.  Women vary in type, intensity and duration of orgasm, as well as in our level of satisfaction with the experience.

 

There is no ‘right’ answer for your response to sexual stimulation.  A ‘less than typical’ response, is only a problem if you see it as one, and desire more from your experience.

What is a Certified Nurse-Midwife?

More and more women in the US are choosing a certified nurse-midwife (CNM) for their pregnancy, birth, postpartum, and well-woman care. Certified Nurse Midwives are licensed health care providers educated in nursing and midwifery. They have master’s degrees in nursing, certified by the American Midwifery Certification Board, and are licensed to practice midwifery in the state of Michigan. National statistics show that in 2009 CNMs attended 11.9% of vaginal births, an all time-high. This trend has been discussed in newspapers such as the New York Times and in movies such as The Business of Being Born. As a leader and innovator in women’s health care, Eastside Gynecology and Obstetrics has committed to bring midwifery services to their clients, the only practice that does so in the area.

 

The midwives at Eastside Gyn/OB provide personalized, individualized care. We nurture each mother and her family with sensitive, holistic care. Our clients love that they get to know the person who will be taking care of them for their birth. We also have a commitment to promoting physiologic labor and birth, believing that labor works best when allowed to begin in its own time and progress at its own pace. At the same time, we are trained to recognize those situations where intervention is warranted and have the benefit of a close and supportive working relationship with the physicians in the practice when referral or consultation is needed.  As midwives, we aspire for you to have the birth experience that you desire. We promote mother-infant bonding immediately after birth, delayed cord clamping, breastfeeding, and childbirth classes such as hypnobirthing. We also desire for each birth to be a family experience for all who wish to be involved.

 

 

Heavy menstrual flow is a common occurrence affecting 10-35% of women, and a common reason for visits to the gynecologist.  Though the causes for heavy menstrual periods (menorrhagia) vary, the Novasure endometrial ablation procedure is an excellent treatment option for many women, when child-bearing is completed.

As an Ob/Gyn physician with greater than 10 years of experience performing the Novasure procedure (and with hundreds of satisfied patients having selected the procedure), I thought it may be helpful to discuss common questions from patients considering the procedure as their treatment of choice. Here are my answers to 5 common patient questions regarding the Novasure procedure:

 

1. How is the procedure performed?/What can  I expect from my menstrual flow after the procedure…lighter periods or no period?

The procedure is considered minimally invasive, performed through the vaginal aspect without surgical incisions.  The Novasure wand (containing a triangular mesh) is inserted within the uterus, where a short (less than 2 minute) cauterization of the uterine lining occurs.  The procedure may be performed in an outpatient surgical setting (with anesthesia) or possibly in your doctor’s office.  You should expect to be back to normal activities within a day or so.

Several research studies on the results of the Novasure procedure note over 90-95% patient satisfaction with the procedure.  Expected results range from notably lighter menstrual periods (for most patients)…to skipped/or absent menstrual flows (up to 40% of patients.)  It’s not possible to predict for patient’s what result they will get, but when questioned overall, most patients are (very) satisfied with the results achieved.

 

 

Suzanne Hall, MD, FACOG

Heavy menstrual periods (medically termed ‘menorrhagia’) is a common GYN concern, and a frequent reason for women visiting their doctors.  10-35% of women report heavy menstrual periods in population-based studies.  Though patients may not know the clinical definition of menorrhagia, I believe them when they report ‘heavy periods’… (based on relative changes in their flow compared to when their period was more ‘normal’…or based on their perception of the flow being ‘heavier than normal’.)

Menorrhagia is clinically defined as menstrual flow lasting longer than 7 days…or greater than 80ml (5-6 tablespoons) blood flow…but who really knows how to measure blood flow that way? Admittedly, for both patients and physicians, blood loss is difficult to quantitate by these measures.  More relevant descriptions of heavy menstrual flow may include

50%-90% of pregnant women experience symptoms of ‘morning sickness’ in the early months of pregnancy.  These symptoms can range from mild intolerance to certain odors or food, to more significant, daily nausea and vomiting (N/V).  Studies suggest that up to 25% of pregnant women experience nausea, 50% experience both nausea and vomiting, leaving only 25% of pregnant women unaffected.  In those affected, the symptoms usually manifest by the 9^th week of pregnancy.

 

Much is written and discussed about home/medical remedies for morning sickness, but much less is written/discussed about the (possible) causes for nausea and vomiting in pregnancy (NVP).  Though the cause of NVP has not been proven, it has been postulated that NVP is an innate mechanism, presenting as a ‘protection’ for the developing fetus (an inherent ‘aversion’ to substances that could be harmful to the fetus.)  Leading medical theories consider the adverse reaction of the ‘hormones of pregnancy’ as potentially causative (in the absence of other intestinal or medical problems that could present with N/V.)

At 15 years old I remember asking myself, “Is this what they mean by menstrual ‘cramps’?”  The term ‘cramp’ just seemed too mild to explain the horrid, 1 or 2 day experience, which regularly preceded the start of my monthly  period.  Back pain, ‘front’ pain, nausea, and sweats…felt more like a suffering from the flu…with an elephant stepping on my back!... than what I’d describe as menstrual ‘cramps’.  The usual ‘mother’s home remedies’ like a heating pad, hot tea, or over-the-counter pain reliever, hardly ever seemed to do enough, but I adhered to the regimen every month anyway…What else was I going to do?

 

As a Gynecologist, I now know the significance of the menstrual ‘cramps’.  In our rhythmic, monthly, hormonal cycle, and in response to the rise in our ovarian hormones (estrogen and progesterone), our ovaries form the ‘dominant follicle’, which releases the fertilizable egg for that month.  At the same time, the uterine lining develops a thick, shaggy layer (like a shag carpet) to enhance implantation of a fertilized egg (egg fertilized by a male sperm=pregnancy.)  On the other hand, if no egg fertilization occurs (no pregnancy), the ovarian hormones decline, allowing for release/shedding of the previously developed thickened uterine lining tissue (representing our ‘menstrual flow’), and the obvious sign of menstrual bleeding.

(cont'd)

Did you know that up to 10-15% of pregnancies are affected by hypertension? About 5% of those cases are in women previously known to have hypertension (termed ‘chronic hypertension’), prior to pregnancy.  Another 5-8%, develop hypertension within the pregnancy (termed ‘gestational hypertension’ or ‘pregnancy-induced hypertension’.)

 

Hypertensive disorders are characterized by blood pressures consistently ranging 140/90 or greater.  Women with chronic hypertension (existing before pregnancy, or diagnosed before 20 weeks of gestation) may require blood pressure medications to control their blood pressure, even throughout the pregnancy.  Those medications should be reviewed with your healthcare provider, to assess their safety in pregnancy, even before conception.

If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them.   With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’.  I counsel women on their risks nearly every day.

I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation.  I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age.  I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...

(press 'Continue Reading' to  finish)

Suzanne Hall, MD  (@drsuzyyhall)

On Teen Pregnancy Prevention...

A quote from a friend & middle-aged Mom--"So many of my friends had sex by age 17...but they refuse to think their daughters are having sex by age 17!"

According to the CDC's 2011 stats 47.4% of high school students have been sexually active. In my practice I see many parents struggle to balance between contraception for the (realistic) potential of sexual activity

& pregnancy prevention, while still, hopefully, advocating for abstinence as a choice. I try to reinforce with my teen patients the difficult position their parents may be in. In trying to 'protect' them from the 'possibilities', we want them to consider the consequences of unprotected sex....
And to remember, abstinence is still a choice.

Itching, redness, and discharge are common symptoms of genital infections, but a ‘Painful Sore’ usually raises the suspicion for Genital Herpes. Most people are unaware of how common the Herpes Virus infection actually is.  According to the CDC, 1 out of 6 people have the virus, though they may not be aware of it (i.e., never had an outbreak, or have never been tested for it.)  The risk of spreading the virus is greatest when an active lesion (a painful sore) is present.  Part of the reason for the high frequency of spread of this virus, is the fact that transmission of the virus can occur, even without visible signs of the infection (no sore present!) This is termed ‘asymptomatic shedding.’  Once exposed to the virus (by oral/genital skin contact during sex), infection may happen (the virus enters your bloodstream)…though, it may-or-may not, cause visible signs of infection.  1 out of 6 people would test positive for the infection by culture or blood test (even though they may not be aware of their previous exposure/infection.)

I’m glad you asked. There seems to be some confusion about the term, and how it’s used to define our reproductive state of being. First off, menopause is the permanent cessation of our reproductive hormones, and therefore, the end of our menstrual cycling. The average age of menopause is approximately 51yo in the United States, though some women may end earlier, and some later. For most women it’s not so much the ending of the periods that’s bothersome, but the symptoms that may go along with this “change"...

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There has been a lot of buzz in recent months about how often a woman should get their Paps.  Just to refresh everyone's memory, a Pap smear is a screen for cervical cancer and THAT IS IT!  It does not screen for breast cancer, uterine cancer or ovarian cancer.  It also does not screen for STD's or other gynecological issues.