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Cesarean Section Delivery isn’t Failure…It’s ‘Plan B’
If I had a nickel for the many times I’ve heard a laboring patient say, “I really don’t want a Cesarean Section!” In addressing their labor concerns, often times I try re-clarifying with them what they really mean in saying “I don’t want a Cesarean Section”. I believe what most of our patients really mean is:
“I’m really ‘hoping’ for a vaginal birth”…
“If I had a preference for delivery, it would be vaginally, rather than by Cesarean Section”…
“If circumstances arise for which a Cesarean Section would be better for the health and safety of my baby, I’d definitely agree to Cesarean Section delivery”…
Losing weight can be a challenge for many of us. For those of us that exercise regularly, further weight loss can also be frustrating. When beginning your commitment to a diet and exercise program to lose weight, it seems initially the weight does come off in manner that can be fairly satisfying.
But for those of us that have already been committed to healthier food choices, and regular exercise, the challenges of (further) weight loss can continue. It’s not uncommon to hear exercising women relate the difficulties of losing any more weight. And for me, like others, we may watch the scale actually start to ‘increase’ despite regular exercise and healthy food intake! I’ve had to reach back to my medical references to feel some sense of comfort for why this may be happening.
In our society today, women have a choice as to where to deliver their babies. Though home births have been on the slow increase (with some ‘popularization’ by certain celebrity backing,) we should be careful not to ‘over-glamourize’ the concept of home birth. Before considering the option of home birth, it’s vitally important for us to understand the risks of delivering a baby at home, even when those desires for home birth are based on concerns for a more private, comfortable, or ‘natural’ birthing experience.
Though the risk of neonatal death from a home birthing experience is (overall) considered low, findings from a new Cornell University study on home births show us that the risk of neonatal death is nearly 4X higher for babies delivered at home than those delivered in a hospital setting. According to lead author Dr. Amos Grunebaum, a professor of clinical obstetrics and gynecology at Cornell University's Weill Cornell Medical College, the predominant reason why “Home birth is more dangerous”, is that births occurring at home don't have the advantage of a hospital delivery, where immediate critical care is available for the baby if a complication arises. "There's insufficient equipment and personnel available [in the home] to address complications," Grunebaum says. Woman should know these risks before considering a home birth.
In the process of labor your baby’s normal fetal heart rate patterns assure us of the well-being of the baby, and it’s tolerance of the process of labor. During labor, the baby’s heart rate is monitored most commonly by a device called the Electronic Fetal Monitor. Many of you may be familiar with the device with the 2 Velcro straps wrapped across your belly. One of the circular sensors of the monitor laid across your abdomen picks up the fetal heart rate, while the other sensor measures the frequency of your contractions.
While we don’t intend for labor to be a ‘stressful’ condition for you or your baby, the reality is that the arduous process of labor can be a stress to both of you. While in labor, we monitor our Moms with vital signs, oxygen status, often IV hydration, and pain management when requested. Monitoring of the baby’s status during labor happens by our interpretation of the baby’s fetal heart rate patterns, using the Electronic Fetal Monitor. The monitor uses Doppler ultrasound wave forms (no radiation exposure) to record the fetal heart rate pattern, and is considered completely safe, posing no risk to your baby.
Though my career as a trained Ob/Gyn physician gives me expertise in Women’s Reproductive Health conditions, across the board, the most common medical condition I see regularly is obesity, and women struggling with weight loss management. In this 2014 upcoming year, I’ve decided to focus, both personally and professionally, on the emphasis, education, and support of weight loss, in my online work and with patients in the office.
According to the CDC, obesity affects nearly one third of all Americans, and is a known risk factor for common health conditions including hypertension, diabetes, and cardiovascular diseases. From a Reproductive Health perspective, we also know obesity to be linked with obstetrical complications, irregular menstrual cycles, and both breast and uterine cancers.
To know me, is to know the 'worker-bee'. My plate is usually quite full with the responsibilities of my career, a full-time Ob/Gyn physician, the ‘part-time’ role I play in assisting in the administrative duties of our practice, a Women’s health blogger, and Mommy, wife, sister, daughter and friend.
I’ve always enjoyed my work, never complaining about the dedicated additional time and energy it takes to build a high quality business that serves its public well. Though finding a healthy balance between my work life and personal/home life has been one of my perpetual challenges. (My Mom says I got the ‘work-a-holic’ gene from my Dad…She says she’s had “no problem” with knowing how to relax!)
Insurance changes, high deductibles, and faulty marketplace applicability are just a few of the burdensome changes invoked as a result of the ACA. Despite the many changes we’re sure to see in our insurance plans, keep in mind that many of the currently available preventive health screenings not only will continue to be available, but importantly, will be covered at no cost to you (no deductible and no co-pay,) by the ACA mandates. Annual Pap smear screenings, mammograms, contraception, and vaccinations will be covered by most insurance plans as a “No-fee Preventative benefit”, even if you participate in a high deductible plan.
Whether you find yourself needing to purchase insurance on the marketplace, or not, it’s possible that you may find changes in your current insurance coverage, such as the institution of higher deductibles. Studies show that participants of high deductible plans are less likely to utilize health services, even those services that are covered at ‘no cost’.
I'm hearing of women losing weight with the HCG injections, and I decided to look into it. While Dr. Sheri Emma, Creator of the Dr. Emma's HCG Protocol claims that this 'crash' diet allows you to loose weight while maintaining muscle, other researcher have shown the HCG injections to be no more beneficial than saline-water/placebo injections for weight loss. The HCG diet plan usually involves severe calorie restriction (500-1500 cal/day), and it's this significant caloric reduction that's likely responsible for the weight loss, rather than the HCG injections themselves. Dr. Emma quotes, "Remember, HCG does not make you loose weight - the diet makes you loose weight!"
Keep in mind, the safest and most healthy way to loose weight is still by moderate calorie restriction & Exercise! :)
Suzanne Hall, MD
Eastside Gynecology Obstetrics
Our busy lives as working women, mothers, wives, girlfriends, sisters, daughters and friends leave little time for ourselves. I'm trying to learn the importance of "Me Time", of which I'm learning to equate with a "balanced" life. I love being a "giver", but we can't forget to take time for ourselves, to rejuvenate and rest.
Check out my guest post on WhattoExpect.com on finding my "Me Time"...
Suzanne Hall, MD
In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.) This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth. (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.) In the U.S. 2.5% of births are performed by Cesarean section for this request. In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.
When is the right time to start ‘the talk’ with teens about sex-related issues…how to say No -or- how to protect themselves against pregnancy and STDs if they are, or considering, sexual activity? Some studies do suggest that parents may underestimate their teen’s sexually activity. According to the CDC, among U.S. high school students surveyed in 2011, 47.4% have already had sexual intercourse.
As the health providers in our practice, we want to provide health guidance regarding responsible sexual behaviors, for both teens who are and who are not sexually active. We’ve developed a new campaign in our office to encourage health habits for teens, called “i-ProMiss Health.” Our teen patients will receive a personal wallet-sized card –a ‘personal health promise contract’-to sign (and keep with them) after considering their own personal decisions regarding the health related issues of abstinence, condom use, healthy eating and exercise. The personal wallet card will be accompanied by an “i-ProMiss Health” rubber band bracelet as a personal reminder token.
Hopefully our teens (and parents) appreciate it!
In the recent several years, public health initiatives have been underway to increase public awareness of the prevalence of the HPV (Human Papilloma Virus) among the sexually active population, it’s health consequences of genital warts and cervical cancer, and the recommendations for Gardasil, one the available vaccines effective in the prevention of HPV. How much do you know/understand about HPV?
Test your knowledge of HPV here, with this simple quiz:
1. Of sexually transmitted infections, the most common is:
- – HPV (the Human Papilloma Virus)
- – HSV (the Herpes Simplex Virus)
- – HIV (Human Immunodeficiency Virus)
2. The HPV virus is spread by:
- Genital contact, most commonly through sex
- Oral-genital contact
- Straight and same-sex partners
- All of the above
3. The HPV is the cause of most cases of both genital warts, and cervical cancer?
4. The majority of cases of HPV infection cause no (visible) signs of infection at all, and are cleared by our body’s own immune system?
5. The HPV is a ‘newly’ discovered virus, linked with genital warts and cervical cancer?
6. The HPV vaccines are more than 90% effective in preventing genital warts and cervical cancer in femalefemafemifemales vaccinated before their sexual debut?
(See next page for answers...)
Have you had embarrassing episodes of leaking urine? This is actually not uncommon for women. I’d like to simplify the explanation of the 2 most common reasons for urinary incontinence. We’ll start first with the anatomy…
Imagine the bladder as a ‘balloon’ that holds our urine, located centrally just above the mid pubic bone. (It actually dwells right on top of the lower uterus.) This balloon has a short ‘straw’ that empties it (the urethra.) The urethra exits the bladder at about a 45 degree angle, in a ‘locked’ angle disallowing urine’s unexpected release. For urination to actually occur, a complex neurologic system connects the brain’s signal (which we mentally initiate) to the bladder to ‘command’ urination, with the bladder’s function of ‘contracingt’ to empty the urine, and the urethra ‘relaxing’, to allow the urine to actually release.
Have you avoided having a mammogram due to fear of ‘pain’ from the testing? This question came up on a recent vacation, while chatting with some of my (non-medical) girlfriends. They related knowing women who’ve avoided having a mammogram because of concerns of the mammogram being too painful. They suggested I write a post about it.
Having ordered many mammograms for women over the years (and having experienced a few myself), though the occasional woman may relate ‘pain’ with the mammogram, most women do not describe the test as “painful”. Uncomfortable and scary…yes. But then again, pain is a subjective matter. In a recent study polling 200 women on their level of pain with a mammogram, 72% rated the “pain” as that equal to a ‘tight fitting shoe’, or a ‘mild headache’. Which of us hasn’t pushed on through their day with a tight fitting shoe, or a mild headache?
Our breasts tend to be more full and tender the week before our menstrual period. If you’re concerned about pain with the mammogram, I’d suggest scheduling the test just after your menstrual period, and not the week or so before your period. Caffeine can cause breast pain as well, so avoiding caffeinated beverages the week or so before the mammogram may also help. An over-the-counter pain reliever taken prior to the mammogram is an option as well.
Apprehension about having a mammogram is understandable. Our breast on a metal plate, with a second plate coming down to compress it…is scary. But, in my opinion, not scarier than the possibility of a missed diagnosis of breast cancer.
Speak with your healthcare provider about scheduling your mammogram, as well as ways to make the testing more comfortable.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Offices in Roseville, Grosse Pointe, Macomb, Rochester, MI
Understandably, for many persons, a new diagnosis of genital herpes may lead to feelings of shock, shame, guilt or embarrassment. Often times, patients are unaware of how common this virus is among the general population. Some studies have shown up to 1 in 5 of sexually active people have been infected with the Herpes virus, whether they’re aware of it or not.
Genital herpes is a treatable condition. Aside from being sexually transmitted, much of the negative stigma around this infection seems to come from the fact that you don’t ‘get rid of’ it, and that recurrences can happen. Herpes is a viral infection (like HPV,) and though the symptoms (a cold sore in the case of oral herpes, or a genital sore in the case of genital herpes) can be treated, the virus itself remains present in our blood stream indefinitely. Even in its dormant state (no symptoms present,) the virus remains detectable by blood test, and can lead to partner-to-partner spread of infection (from asymptomatic shedding of the virus) when no detectable ‘sore’ is present. Gonorrhea and chlamydia, different from the Herpes virus and HPV, are bacteria or bacterial-like infections that are cured with treatment, with no detectable bacteria remaining after adequate therapy (unless the individual is ‘re-infected’.)
Though a diagnosis of genital herpes can be an embarrassing nuisance, it’s actually a newborn baby who’s at the most serious risks from a genital herpes infection. A newborn baby infected with genital herpes is at risk for multi-organ infection, that can be fatal if left untreated. If you are pregnant, with a known history of genital herpes, it’s important to let your healthcare providers know that information. Certain measures (anti-viral medications in the last month of your pregnancy, and performing a Cesarean section if active lesions are present at the time of labor) should be taken, to decrease the risk of spread of infection to your newborn baby.
Is this Depression or PMS? According to ACOG, "Depression and anxiety disorders are the most common conditions that overlap with PMS. About one half of women seeking treatment for PMS have one of these disorders. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. Women with depression, however, often have symptoms that are present all month long. These symptoms may worsen before or during their periods. Your health care provider will want to find out whether you have one of these conditions if you are having PMS symptoms." (posted 7/9/13 by @drsuzyyhall)
Breast/Nipple Discharge? Though most cases of nipple discharge (especially occurring with stimulation or expression of the breast) are benign (non-cancerous), an evaluation/exam by your doctor is usually warranted. (posted 5/28/13 by @drsuzyyhall)
Low Libido? Studies have shown Testosterone supplementation to be effective in treating low libido in menopausal women. While Estrogen Therapy may not directly effect libido, it does promote increased vaginal lubrication, improving vaginal pain with sex. Testosterone supplements are not approved by the FDA for treatment in women. Speak with your healthcare provider regarding safety concerns. (posted 4/3/13 by @drsuzyyhall.)
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)