GYNECOLOGY

Generally, your first screening mammogram should be done at age 40 unless you have a close family history of breast cancer. However, if you feel a lump or have any concerns prior to age 40, consult your physician. Remember to perform regular self-breast exams.

Generally, your Pap Smear should be performed annually. However, if you have had a history of abnormal paps, or your physician has instructed you differently, you may need to have a pap smear more or less frequently.

Yes. Pap Smears do more than screen for cervical cancer. They also measure the amount of hormonal activity in the vagina. They can also screen for vaginal cancer, and they can detect certain infections. Pelvic exams are necessary to detect other problems.

Our physicians can see only a certain number of annual exams every day to allow for problems and other types of visits. Therefore, we send out reminder cards or e-mails one month in advance of the time you are due for your annual exam. Please call as soon as you receive your reminder so that you can get the appointment of your choice.

Our nurse practitioners are available for most types of exams including pap smears, breast exams, obstetrical care, infections, birth control, etc. Our staff is available to assist you in making the appropriate provider selection. If your physician is unavailable, our nurse practitioner’s schedule may be a little more flexible.

Yes. It is okay to have any procedure done while you are bleeding. Ultimately, though, it is up to you. If you feel uncomfortable having anything done while you are on your period, them please call the office to reschedule your appointment.

The best time to examine your breasts is at the end of your period, when your breasts usually aren't tender or swollen. Every woman over age 20 should conduct a self-exam every month to check for lumps, thickening, dimpling of the skin, or any unusual discharge from the nipple. If you find anything unusual, contact us right away, so we can examine you and plan appropriate care.

Weight gain averaging 8 pounds per year, hair loss, depression, and spotting. Irregular and unpredictable vaginal bleeding is the number one side effect. Long term use is also associated with bone loss

It is usually recommended that a patient start her pills on the first Sunday after her next period begins. The advantage of this is that the next period should be during the week when it will be less likely to interfere with weekend activities.

What is HPV? Human Papilloma Virus (HPV) is a common virus. In 2005, the Centers for Disease Control (CDC) estimated that 20 million people in the U.S. had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people, the virus goes away on its own. When the virus does not go away, it can develop into cervical cancer, precancerous lesions, or genital warts, depending on the HPV type. The immunization helps protect against four types of HPV. Who is at risk for HPV? In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. Many people who have HPV may not show any signs or symptoms. This means they can pass on the virus to others and not know it. Who should receive the HPV vaccine? Girls and women 9 through 26 years of age. Will the vaccine help me if I already have HPV? You may benefit if you already have HPV because most people are not infected with all four types of HPV contained in the vaccine. How is the HPV vaccine given? HPV vaccine is given as an injection. You will receive 3 doses of the vaccine: your first dose, a second dose 2 months after the first dose, and a third dose 6 months after the first dose. Are there possible side effects of the HPV vaccine? The most commonly reported side effects include swelling, pain, itching and redness at the injection site and fever.

What is the pap smear? The pap smear is a screening test for cervical cancer. Usually done annually, it collects cells from the cervix which are then reviewed by a pathologist for evidence of abnormal cells. The pap smear is an ideal screening test because cervical cancer usually takes several years to develop so regular pap smears allow us to diagnose the pre-cancerous changes so that we can intervene before they develop into cancer. The results of your pap smear will be reported in several different categories: Negative (normal) Atypical squamous cells of undetermined significance (ASC-US) Atypical squamous cells suspicious for high grade intraepithelial lesion (ASC-H) Low grade intraepithelial lesions (LSIL). The LSIL category includes changes consistent with HPV, mild dysplasia, or CIN I (grade 1 cervical intraepithelial neoplasia). High grade intraepithelial lesions (HSIL). HSIL includes changes consistent with moderate or severe dysplasia, CIN II or III, and carcinoma in situ (CIS). Carcinoma Atypical glandular cells (AGC) may be endocervical, endometrial, or other glandular cells Endocervical adenocarcinoma in situ (AIS Adenocarcinoma What causes abnormal paps? The most common abnormal paps that we see are ASCUS and LSIL. The majority of abnormal paps are caused by an infection with a virus known as the human papillomavirus (HPV). HPV is the most common sexually transmitted disease. By age 50, over 80% of women will have been infected with HPV. The majority of people do not have any symptoms of the infection and will clear the infection on their own. There are over 100 strains of HPV and over 30 of them are involved with genital infections. The different strains are categorized into "low risk" and "high risk" groups. High risk strains cause abnormal paps and can lead to cancer of the cervix, vagina, vulva, anus or penis. Low risk strains can cause mildly abnormal changes in pap smears and also cause genital warts. How do we manage abnormal paps? Once you have an abnormal result on your pap smear, your doctor will probably recommend you undergo colposcopy. Colposcopy is a procedure done in the office during which your doctor will look carefully at your cervix with a colposcope (a kind of microscope for the cervix). If any abnormal cells are seen, biopsies will be taken. The procedure takes 15-20 minutes and does not require any anesthesia. You may want to take 600-800 mg of ibuprofen before the procedure to help with cramping. If the biopsy shows evidence of dysplasia, management may include simply repeating your pap in 4-6 months, cryotherapy (freezing of the abnormal cells on the cervix) or removal of the infected part of the cervix (a procedure called a LEEP or a cone). Your doctor will tell you which is the best choice for you after the biopsy results come back. You can also make some lifestyle changes that will help your body to clear the infection on its own. If you smoke, quit! Cigarette smoking helps the HPV virus to grow more quickly. If you are currently a smoker, quitting may be enough to return your pap smear to normal. Also, recent evidence suggests that increasing your folic acid to 800 micrograms a day may also help your body get rid of the infection.

The Food and Drug Administration issued a warning to users of Ortho Evra, a birth control patch. The warning notes that users of the patch are exposed to an estrogen dose that is up to 50-60% greater than initially thought. Ortho Evra was thought to expose users to a dose of estrogen equivalent to that of typical "low dose" oral contraceptive pills. Follow up data now suggests higher doses of estrogen are absorbed by patch users and MAY increase their risk of blood clots, stroke, heart attack, and death. The FDA warning follows news media reports including one from the Associated Press linking higher estrogen levels from the patch and blood clots. This was based on their review of reported adverse outcomes among patch users and not from a prospective clinical study. Katherine LaGuardia, MD, director of medical affairs for Ortho Women's Health notes, "The mortality rate associated with Ortho Evra use cited in the Associated Press story is misleading because it is based on spontaneous reports and inaccurate citation of clinical data. Spontaneous reports can come from various sources and there is a significant amount of uncertainty regarding the validity of their information." The company notes that there were no deaths reported during their clinical trials of Ortho Evra. Low dose combination birth control pill use results in 1 death per 200,000 women, and the Associated Press concluded that that rate may be three times higher in patch users or 3 per 200,00 women. Neither birth control nor pregnancy is without risk. The risk of dying from a pregnancy carried beyond 20 weeks is 20 to 25 deaths per 200,000 women or about 8-25 times more often than patch users. Some women, of course, should not take combination contraceptives such as the Ortho Evra patch. They include: Women who smoke cigarettes, especially for women greater than 35 years old Women with a previous or current blood clot either in the leg or a lung Some women with high blood pressure Women with markedly abnormal function of the liver Some women with diabetes Women who suffer prolonged immobilization, such as after major surgery Women who have just given birth. Hormonal contraceptives should be started no earlier than four weeks after delivery in women who are not breastfeeding. Women with a history of migraines with auras If you are an Ortho Evra patch user and are concerned about the increased dose of estrogen in your contraceptive, you should schedule a time to consult with your provider about the new data and review your contraceptive choices to reduce or eliminate estrogen use. There is no immediate need to discontinue patch use since it is effective to prevent, and much safer than, pregnancy

PMS can be defined as the monthly physical, behavioral, and emotional changes that typically take place two weeks before your period starts and ends dramatically within two days after it begins. PMS is related to hormonal changes during the menstrual cycle. Though the cause of PMS is unknown, it is attributed to an imbalance of female hormones. Physical symptoms include breast tenderness, bloating, weight gain, headaches and fatigue. Emotional symptoms include irritability, mood swings, crying, depression, sensitivity and hostility. Behavioral symptoms include insomnia, withdrawal and overeating. Various treatments include dietary changes, vitamin & mineral supplements, such as PMS Compose and exercise. Dietary changes suggested are eating frequent, but smaller meals and not skipping meals as hunger will exacerbate symptoms. Avoid refined sugars, caffeine, nicotine, alcohol and artificial sweeteners. Limit dairy products to two servings per day, limit red meats & saturated fats and lower your sodium intake. Eat foods consisting of mostly complex, unrefined carbohydrates such as green leafy vegetables, whole grains, cereals, legumes and fresh fruits. Vitamin and mineral supplements include magnesium (250 mg daily), zinc, vitamin E and vitamin B6. Natural supplements include evening primrose oil. Take 500 mg three times a day during the second half of your cycle (days 14 to 28.) One particular supplement, PMS Compose is a nutritional formulation designed to regulate and normalize the female reproductive system and cycle, thus preventing and managing symptoms associated with menstrual and reproductive dysfunction. PMS Compose contains chaste berry extract, dong quai extract, and alfalfa extract. Go to the Products page for more information or call the office to place an order. Regular exercise is very important and helps reduce symptoms in many ways. It increases our endorphins, the body’s natural painkiller, which in turn raises our serotonin levels. It is a stress reducer and therefore helps you sleep better. A daily exercise program such as brisk walking, biking, rollerblading, aerobics or yoga are all excellent ways to get the endorphins pumping.

The vagina contains various organisms which are necessary to keep it healthy. When the normal balance of these organisms is upset, one or more can multiply out of the usual proportions and cause an abnormal vaginal discharge. Three major organisms, bacteria, trichomonas, and monilia (yeast) cause vaginal infections. If you notice a change in the color, quantity, or odor of your usual discharge and/or develop itching, contact your doctor. Chemicals in commercial douches, vaginal sprays, and spermicidal foams, gels, or condoms can sometimes cause "noninfectious" vaginitis. Certain factors such as poor diet, lack of sleep, increased stress, oral antibiotics, or presence of another disease or infection may also make the vagina more susceptible to infection. Intercourse without enough lubrication and tight fitting clothing may also irritate the vagina and lead to infection. You can minimize the chances of getting a recurrence of your infection by completing all of your medication. More importantly, stop infections before they begin by following the rules of good hygiene: wear clean underwear, change sanitary pads often when menstruating and wipe from front to back after a bowel movement. Don’t use commercial douches, deodorant tampons or other perfumed products that can irritate the vagina.

Urinary tract infection (UTI) is an inflammation in the urinary tract. If left untreated, UTIs can cause permanent damage. A UTI is the result of bacteria that multiplies and spreads from the rectum to the urethra and to the bladder or kidneys. Your doctor will diagnose a UTI by reviewing your symptoms, examining you and ordering lab tests including urine analysis and cultures. Generally, your doctor will treat a UTI with antibiotics. Symptoms include: chills, fever, nausea and vomiting, perspiration, frequent need to urinate, strong-smelling urine, pain during sexual intercourse, blood in the urine, pain in the lower pelvis, abdomen, lower back or side, and pain or discomfort when urinating. Ways to prevent UTI’s include the rules of good hygiene (see) above in addition to the following: try not to postpone urination for long when you feel the urge, empty your bladder completely when you urinate, urinate after sexual intercourse, wear all-cotton or cotton-crotch underwear and pantyhose, drink plenty of fluids and avoid strong soaps, douches, antiseptic creams, and feminine hygiene products (sprays, powders.)

You will be escorted to an exam room in which to remove your clothing and put on an examination gown. A sheet is provided for added privacy. Before the exam begins, you will be asked to place your feet in the stirrups at the end of the table. The clinician will use a latex glove to manually examine your genital area then will gently insert a speculum device to hold open the vaginal canal. You will feel some pressure when the speculum is inserted, especially against the bladder, but the exam should not be painful. Once the speculum is opened, the wall of the vagina and the cervix will be visually examined and the clinician will perform a pap test. For best results, avoid the use of douches, vaginal creams or vaginal medications for at least 48 hours prior to your exam because these products can distort the appearance of the cells. Use a condom if you have vaginal intercourse less than 24 hours before your exam. Pap smears generally should be done when you are not menstruating. After removing the speculum, the clinician will do a digital examination. Two gloved fingers are inserted into the vagina and the other hand placed on the abdomen, applying slight pressure. The doctor may also insert a gloved finger into the rectum while applying slight pressure on the abdomen. This detects any growths, abnormalities, swellings, or areas of tenderness in the pelvic area. The entire exam takes only a few minutes.

Infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or the inability to carry a pregnancy to term. Couples who have known barriers to fertility, such as endometriosis, polycystic ovarian syndrome, male factor infertility, irregular cycles, etc., do not need to sit out the traditional "waiting period" to seek expert care for infertility.

Osteoporosis is one of the major health care problems of our time and still goes undiagnosed and unrecognized. If you are post-menopausal or have a family history of osteoporosis, you may be at risk for developing osteoporosis yourself. Osteoporosis is a disease in which the bones become fragile and more likely to break. Osteoporosis progresses without symptoms or pain and can lead to pain, disability, and in some cases, even death. Half of all women over age 50 will sustain an osteoporosis-related fracture in their lifetime. Regular exercise combined with a calcium-rich diet can build and maintain good bone health and may reduce your risk of osteoporosis. If you suspect you may be at risk for osteoporosis, consult with your physician during your annual exam about diagnostic testing (bone densitometry), diet, supplements, and educational material.

Douching is not recommended for overall gynecological health. Douching can also cause B-V or bacterial vaginosis.

No. Fibroids are benign tumors. This risk of cancer in a fibroid is estimated to be less than 1 in 500. There's in no evidence that benign fibroids will become cancerous.

Once fibroids are removed those particular fibroids cannot grow back. But fibroids are caused by mutations within uterine muscle cells. This process can over time create new fibroids. In addition, there can be tiny fibroids that cannot be seen or felt, and therefore cannot be removed. This is most likely to happen in someone who has many little fibroids. Recurrence is least likely in women with one or few large fibroids than with multiple small ones.

At least one in six clinical pregnancies ends in clinical miscarriage. Many more miscarriages may occur before a woman even knows she is pregnant. Most of these preclinical miscarriages are due to a random chromosome error.

Endometriosis is a common health problem in women. It gets its name from the word endometrium, the tissue that lines the uterus (womb). In women with this problem, tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas. These areas can be called growths, tumors, implants, lesions, or nodules.

Pain is one of the most common symptoms of endometriosis. Usually the pain is in the abdomen, lower back, and pelvis. The amount of pain a woman feels does not depend on how much endometriosis she has. Some women have no pain, even though their disease affects large areas. Other women with endometriosis have severe pain even though they have only a few small growths. Symptoms of endometriosis include: *Very painful menstrual cramps *Pain with periods that gets worse over time *Chronic pain in the lower back and pelvis *Pain during or after sex *Intestinal pain *Painful bowel movements or painful urination during menstrual periods *Heavy and/or long menstrual periods *Spotting or bleeding between periods *Infertility (not being able to get pregnant) *Fatigue Women with endometriosis may also have gastrointestinal problems such as diarrhea, constipation, or bloating, especially during their periods.

No one knows for sure what causes this disease, but scientists have a number of theories. They know that endometriosis runs in families. If your mother or sister has endometriosis, you are six times more likely to get the disease than other women. So, one theory suggests that endometriosis is caused by genes. Another theory is that during a woman's monthly periods, some endometrial tissue backs up into the abdomen through the fallopian tubes. This transplanted tissue then grows outside the uterus. Many researchers think a faulty immune system plays a part in endometriosis. In women with the disease, the immune system fails to find and destroy endometrial tissue growing outside of the uterus. Plus, a recent study shows that immune system disorders (health problems in which the body attacks itself) are more common in women with endometriosis. More research in this area may help doctors better understand and treat endometriosis.

There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes. Talk with your doctor about what option is best for you. The treatment you choose will depend on your symptoms, age, and plans for getting pregnant. Pain Medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include: ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may advise using stronger pain relievers available by prescription. Hormone Treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who don't have bad pain. Hormones come in many forms including pills, shots, and nasal sprays. Many hormones are used for endometriosis including: Birth control pills block the effects of natural hormones on endometrial growths. So, they prevent the monthly build-up and breakdown of growths. This can make endometriosis less painful. Birth control pills also can make a woman's periods lighter and less uncomfortable. Most birth control pills contain two hormones, estrogen and progestin. This type of birth control pill is called a "combination pill." Once a woman stops taking them, the ability to get pregnant returns, but so may the symptoms of endometriosis. Progestins or progesterone medicines work much like birth control pills and can be taken by women who can't take estrogen. When a woman stops taking progestins, she can get pregnant again. But, the symptoms of endometriosis return too. Gonadotropin releasing hormone agonists or GnRH agonists slow the growth of endometriosis and relieve symptoms. They work by greatly reducing the amount of estrogen in a woman's body, which stops the monthly cycle. Leuprolide (Lupron®) is a GnRH agonist often used to treat endometriosis. GnRH agonists should not be used alone for more than six months. This is because they can lead to osteoporosis. But if a woman takes estrogen along with GnRH agonists, she can use them for a longer time. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. But, usually the problems of endometriosis also return. Danazol is a weak male hormone. Nowadays, doctors rarely recommend this hormone for endometriosis. Danazol lowers the levels of estrogen and progesterone in a woman's body. This stops a woman's period or makes it come less often. Danazol also gives pain relief. But it often causes side effects like oily skin, weight gain, tiredness, smaller breasts, and hot flashes. Danazol does not prevent pregnancy and can harm a baby growing in the uterus. Since it can't be used with other hormones, like birth control pills, doctors recommend using condoms, diaphragms, or other "barrier" methods to prevent pregnancy. Surgery. Surgery is usually the best choice for women with endometriosis who have a severe amount of growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following: Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or destroy them with intense heat. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery. Laparotomy or major abdominal surgery is a last resort treatment for severe endometriosis. In this surgery, the doctor makes a much bigger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen. Recovery from this surgery can take up to two months. Hysterectomy should only be considered by women who do not want to become pregnant in the future. During this surgery, the doctor removes the uterus. She or he may also take out the ovaries and fallopian tubes at the same time. This is done when the endometriosis has severely damaged them.

OBSTETRICS

Most women can travel safely until close to their due date. For most women, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time. During pregnancy, many women have concerns about seat belts. There is no question that you are much better off wearing your seat belt during pregnancy. The baby is very well protected in the uterus from trauma, but car accidents are the most common source of trauma during pregnancy. The most common reason for fetal death is maternal death, and maternal death is much less likely in mothers who wear seat belts. Both lap and shoulder belts should be worn at all times. The lap belt should be worn low on the hips, not over the uterus. Also remember that after delivery, an approved car seat must be in you car in order to take your baby home from the hospital. We recommend you not sit with your legs crossed and that you get out to walk every two hours. People also have concerns about flying during pregnancy. In general, there does not seem to be an increased risk for women who fly during pregnancy. Any woman who sits for long periods of time without getting up for a walk is at risk for developing a blood clot in her legs. For this reason, on flights over two hours, you should get up, stretch your legs, and take a walk up and down the aisle. Because of this, an aisle seat is usually advisable. Our office recommends that patients do not travel at all in their ninth month, and restrict travel to within two to three hours from home during their eighth month.

Colds are miserable things, even at the best of times, but there are increased concerns during pregnancy. Many things can relieve symptoms at home, sometimes eliminating the need for an office visit. Use a cool mist vaporizer/humidifier at night. This moistens the air you breathe to keep secretions flowing. Saline gargles (one teaspoon of salt in ½ cup warm water) every four hours while awake will cut the mucus in the back of the throat and relieves mild soreness. Any brand of saline nose drops (NOT regular Afrin or Neo-Synephrine) at bedtime and on arising in the morning will help moisten secretions. Tylenol (plain) two tablets every four hours if necessary for aches (maximum of six tablets in 24 hours.) Preferably not during the first trimester and not at all for one week before your triple test. Take your temperature, orally, twice daily – call us if your temperature is greater that 100.4 Fahrenheit. Coughing can be relieved with one teaspoon of honey and 2-3 drops of lemon juice. Hold this in your mouth until the honey thins and then swallow. If coughing interrupts sleep or causes vomiting, call your doctor. You may try Robitussin DM, an over-the-counter cough medication, after the first trimester. Increase fluids (especially water) to two quarts a day. Get extra rest, if possible. Actifed or Sudafed may also be use for symptom of congestion when taken as directed on the package. It is preferable that you not take this in your first trimester of pregnancy.

Often pregnant women have concerns about the safety of hair dyes and permanents during pregnancy. There is no scientific data on this question, but it seems unlikely that these types of exposures are harmful.

The use of saunas, hot tubs, and tanning booths is not recommended in pregnancy. The extreme temperature could potentially damage the developing baby. Extremely hot baths are not recommended during pregnancy. Bath temperatures should be below 100 ° Fahrenheit.

The following suggestions may be useful in relieving nausea and vomiting: Remember, "any calorie is a good calorie" so eat what stays down for you. These foods may not be well tolerated: Greasy or fried foods, as they take longer to leave the stomach Very sweet foods Spicy hot foods Foods with strong odors Eat smaller, more frequent meals, that is six small meals and snacks. Drink fluids between meals, not with meals. Eat foods that are at room temperature or cooler. Hot foods may trigger nausea. Drink beverages chilled or cold. Decaffeinated soda is often well tolerated. Don't opt for diet soda, you need the calories right now. Eat slowly and rest after meals. It is best to rest sitting in an upright position for about one hour after eating. Dry toast, soda crackers, or dry pre-sweetened cereals may relieve periods of nausea. Keep track of when you feel nausea and what causes it. If continued vomiting occurs, do not eat or drink anything until the vomiting has stopped. As you feel better, try some small amounts of clear liquids (broth, Jell, apple, grape, or cranberry juice, and/or popsicles.) Tart or salty foods such as lemons or pickles may help decrease nausea. Avoid mixing hot and cold foods at a meal, as it may stimulate nausea. Ask your doctor about medicine to control nausea. Avoid eating in a room that is stuffy, too warm, or has cooking smells/odors that may disagree with you. Wear loose fitting clothing. To avoid the sight/smell of foods, eat meals out or have others bring prepared food to you. These are signs that you need to call your doctor: Unable to keep anything down for more than two days Fainting Vomiting blood Rib pain Jaundice (skin is greenish or yellow) Your weight drops more than five pounds within a week

Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of pregnancy. It may give you more energy and make you feel better. The type of exercise you can do during pregnancy depends on your health and how active you were before you became pregnant. This is not a good time to take up a new, hard sport. If you were active before, you can continue to be within reason. If, for example, you play tennis, you can still play unless you have special problems or feel very tired. A good "rule of thumb" is to limit exertion to about 2/3 of what you could do before pregnancy. Most of the time, a healthy woman with no complications in her pregnancy can keep working until the end of her pregnancy. Some may need to make some changes. If you are experiencing problems that you feel may be related to your job, please discuss this at one of your office appointments. Your family should be able to help you at home as fatigue increases at the end of your pregnancy.

A certain amount of swelling (called edema) is normal during pregnancy. It occurs most often in the legs. Elevating the legs usually makes the swelling less by the next morning. Swelling can begin during the last few months of pregnancy, and it may occur more often in the summer. Let your doctor or nurse know if you have swelling in your hands or face, because this may be a sign of another problem. A clue that your hands are swollen is that your rings are too tight. Never take medications (water pills) for swelling unless they have been prescribed for you. Elevate you legs when possible Rest in bed on your side Lie down with your legs raised on a small footstool or several pillows Do not wear stockings or socks that have a tight band of elastic around the legs. If you must sit a lot on the job, stand up and move around from time to time. Try not to stand still for long periods of time.

Most adults are immune to chicken pox, either from having the disease or by forming immunity from a mild exposure. If you have had chicken pox in the past, you and your baby are protected. If you are not sure, ask your doctor to check your immunity with a blood test. If this shows positive immunity, you are both protected. If it shows no immunity, an injection of a medicine called Varicella Immune Globulin (VZIG) may be given to prevent chicken pox. In order to be effective, this injection must be given within 72 hours of exposure.

Headaches are common during pregnancy. Usually headaches do not signal a serious problem. How often they occur and how bad they are may vary. It is important to discuss with your health care team which medications you can use for the headache. You should contact your doctor if your headache does not go away, returns very often, is very severe, causes blurry vision or spots in front of your eyes, or is accompanied by nausea. You may use Tylenol (acetaminophen) two regular tablets or one extra-strength tablet for headaches.

At least half of all pregnant women seem to have problems with constipation. One reason for this may be changes in hormones that slow the movement of food through the digestive tract. Sometimes iron supplements may also cause constipation. During the last part of pregnancy, pressure on your rectum from your uterus may add to the problem. Here are some suggestions that may help: Drink plenty of liquids – at least 6-8 glasses of water each day, including 1-2 glasses of fruit juice such as prune juice. Liquids (such as coffee, tea and cola) which make you go to the bathroom should not be drunk. They will tend to create a negative water balance in your body and thus make your stools harder and more difficult to pass. li> Eat food high in fiber, such as raw fruits and vegetables and bran cereals. Exercise daily – walking is a good form of exercise.

During pregnancy, the extra hormones in your body may cause your gums to swell and bleed. Floss and brush regularly, using a soft toothbrush, to keep your teeth in good shape. Having a dental checkup early in pregnancy is a good idea to be sure your mouth is healthy. Local anesthesia, if needed, does not pose a risk during pregnancy. Dental x-rays should only be done if necessary and with your abdomen shielded.

Some people worry about having intercourse during pregnancy. They may be afraid it will cause a miscarriage. For a healthy woman with a normal pregnancy, intercourse is safe into the last weeks of pregnancy. For your comfort, you and your partner may want to try different positions. Your doctor or midwife may advise you to limit or avoid sex if there are signs of problems in your pregnancy.

Very often pregnant women who are constipated also have hemorrhoids. Hemorrhoids are varicose (or swollen) veins of the rectum. They are often painful. Straining during bowel movements and having very hard stools may make hemorrhoids worse and can sometimes cause them to protrude from the rectum. Do not take drugstore cures while you are pregnant without first checking with your doctor or nurse. Hemorrhoids usually improve after the baby is born. Several things can help give relief or avoid the problem in the first place: Avoid getting constipated. Eat a high-fiber diet. Drink plenty of liquids.

Indigestion is commonly called heartburn, but it does not mean that anything is wrong with your heart. It is a burning feeling that starts in the stomach and seems to rise into the throat. It occurs when digested food from your stomach, which contains acid, is pushed up into your esophagus (the tube leading from the throat to the stomach.) Liquids that you drink also take up space in your stomach, so they may also add to the problem. Changes that take place in your body during pregnancy may worsen indigestion. Changes in your hormone levels slow digestion and relax the muscle that normally prevents the digested food and acids in your stomach from entering the esophagus. In addition, your growing uterus presses up on your stomach. To help relieve heartburn, try the following: Eat five or six small meals a day instead of two or three large ones. (A glass of fluid may be equal in volume to a small meal, so avoid drinking large amounts of fluids with meals.) Avoid foods that cause gas, such as spicy or greasy foods. Do not eat or drink several hours before bedtime. Wait two hours after eating before exercising. Antacids may be helpful, such as Maalox, Tums, or Gaviscon. Liquid will be more effective than tablets. If the problem is frequent and only briefly relieved by antacids, speak with your doctor or midwife.

It is not uncommon to develop a yeast infection during pregnancy. If such an infection does occur, it is safe for you to use over-the-counter products, such as Monistat. These are readily available at stores. However, if you are early in your pregnancy, before 12 weeks, it is important that the cream be used externally only. After 12 weeks, it is safe to gently use the applicator internally.

No, your prenatal vitamins should be the only supplement used during pregnancy unless your provider specifically directs you to use an additional product.

“Morning sickness,” which can occur at any time of the day, usually starts in the fifth to seventh week of pregnancy and disappears by the eleventh to thirteenth week of pregnancy. The two main culprits for morning sickness are extreme swings in blood sugar levels, which tend to be lowest in the morning, and hormones, which run rampant during pregnancy. To help minimize or avoid feeling queasy, eat small, frequent meals high in protein and fiber, get plenty of rest, keep healthy snacks with you at all times, drink plenty of water, and get plenty of fresh air and exercise. If your symptoms are severe, contact our office. You can quickly become dehydrated and may require IV fluids to replace fluids lost during vomiting.

You may feel the baby move around 18 to 22 weeks. If this is not your first pregnancy, you may feel movement earlier.

Three major federal laws protect the health, safety and employment rights of pregnant working women. If you are denied your rights, contact one of these agencies: Pregnancy Discrimination Act The Pregnancy Discrimination Act (PDA) requires employers to treat pregnancy as they would any other medical condition. That means they must offer the same disability leave and pay. If you have additional questions, contact the Equal Employment Opportunity Commission at 1-800-669-EEOC (3362) or the Woman’s Bureau of Department of Labor at 1-800-827-5335. Occupational Safety and Health Act The Occupational Safety and Health Administration (OSHA) requires employers to provide a workplace free from known hazards that cause, or are likely to cause, death or serious physical harm. If you have additional questions, contact OSHA at 1-202-576-6339. Family and Medical Leave Act The Family and Medical Leave Act (FMLA) requires employers with 50 or more employees to allow up to 12 weeks of unpaid leave during any 12-month period:

The American Diabetes Association strongly recommends that most pregnant women be screened for gestational diabetes between the 24th and 28th week of pregnancy. This coincides with about the sixth month of pregnancy and it is the time when the placenta has begun to make the hormones that can lead to insulin resistance. We test for gestational diabetes in the following manner: The day of your test you may eat normally, but try to limit your sugar intake as excess sugar may alter your test results. Forty-five (45) minutes prior to your appointment, drink the glucola over a five (5) minute period. The glucose tastes best if it’s cold, so pour it over ice or refrigerate it before drinking. Your blood needs to be drawn exactly one (1) hour after you began drinking the glucola. When you arrive for your appointment, please tell the receptionist what time your blood needs to be drawn.

The vaginal beta strep test is performed on all pregnant women to check for growth of bacteria and is performed between 34-36 weeks during your pregnancy.

You may take a TB skin test. We do not perform this test in our office and you must see your primary care physician for the test.

No. Pregnancy does not contraindicate the flu shot. You will have to see your primary care physician, as we do not give these specific injections in our office.

Your insurance usually covers only one basic ultrasound, which is usually performed at 18 weeks. If additional ultrasounds are deemed medically necessary, authorization from your insurance company must be obtained at that time.

At least one in six clinical pregnancies ends in clinical miscarriage. Many more miscarriages may occur before a woman even knows she is pregnant. Most of these preclinical miscarriages are due to a random chromosome error.

Our practice does not support home births because of the risks associated with them. We cannot assume the care for you through your prenatal course.