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’.

Not uncommonly,  patients present with irregularities in their menstrual period, irritability or mood swings, bloating, fluid retention or weight gain, hot flashes, or decreased libido…wondering if their ‘hormones are out of balance’?  Unfortunately, there’s not always an easy answer to that question, but as Gynecologists, it does cause us to consider two common ‘hormonal’ conditions that could explain such symptoms:  Polycystic Ovarian Syndrome, and the Perimenopause.

 

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!

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.

As a practicing Ob/Gyn providing healthcare for female patients, I often get this question from mothers regarding their tween/teenage daughters.  Though the guidelines for requiring the first Pap smear have changed, to start at age 21, the American College of Obstetricians and Gynecologists (ACOG) recommends the first 'reproductive health visit' at ages 13-15.  This initial visit may not require a pelvic exam, unless your daughter is having menstrual difficulties (pelvic pain, menstrual cramping, abnormal/heavy periods) or is sexually active.  Contraceptive options, STD prevention, and the HPV vaccine may be discussed at this visit.

 

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)

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.

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.)