This is a question we get asked from time to time and it really is quite tricky. What one person will love in a health care provider is just the thing another woman will not like. But there are some ways to narrow down your search for an obstetrician to find one who will be a good match for you.
1. INSURANCE
Let's start off with the most practical things first. You will need to make sure that the physician accepts your form of insurance or payment. You can find this out usually with a simle phone call to their office. Next you want to find out if the hospital(s) to which the physician goes also takes your form of insurance or payment. This is important too, because if the hospital doesn't take your insurance, but you still want your physician to deliver you at that institution, you may need to pay your account before the baby is even born. Each institution is a little different in how they like to handle these situations, but it is best to know as much about what to expect from the physician and the hospital before you ever have that first contraction!
2. GENDER
For most women, the gender of their health care provider is strictly a preference. I have spoken with women who have only had men physicians, and in fact describe being cared for by a woman as something they would find very odd or discomforting. I have also spoken with women who would never go to anyone except a woman. Personally, I have had both. I like the fact that for the most part a female care giver can have some firsthand understanding about pregnancy, labor, birth and postpartum. But realistically, it is all very subjective. If her experience was blissful and mine extremely stressful, she still can't really relate to what I am going through. If she had vaginal deliveries and I have C-Sections (or the other way around), she can't fully relate to my experience either.
Some women express anxiety and embarassment at being examined by a male obstetrician and I can tell you that is only enhanced when you have to work side by side with them every day! However, I have had male obstetricians whose bedside manner was so professional and gentlemanly that they immediately put you at ease and made you feel confortable. For me, the bottom line is that I find I can talk to a female about female issues easier than I can talk to a man, I feel less inhibited in the discussion and I feel more likely to bring up issues that need to be dealt with.
3. AGE/EXPERIENCE
Age is probably not the word we are looking for here as much as the word, experience. Would you prefer a physician who has been in practice for a long time, has delivered thousands of babies and knows exactly what he's going to do before he even walks in the room? Or would you prefer a younger physician, someone who has recently finished residency and is fresh with the latest techniques and tips, and may be more open minded about what you may want to do?
While there is great benefit in having learned the latest and best recently, (and many physicians do all they can to keep current with trends, standards and techniques), there is also something to be said for that intuition which comes with having watched hundreds and thousands of babies on fetal monitor tracings, or having seen every emergency situation so many times that you don't have to think about what to do.
One advantage of the younger physician is that often, while starting a practice, they have more time to spend with each patient, so you may feel as if you are getting more individualized care. Older physicians may already have a full practice and schedule of patients to be seen each day and time for each appointment may be more limited.
Another thing to consider is where are you in your child-birthing cycle? Is this your first baby, and do you plan to have a few more? Do you plan to space them out over many years? Are you just about at the end of having babies and you might be finished after this pregnancy?
If you are just beginning to start your family, you may want a physician who will be available for you for all your pregnancies. An older physician who may be planning on retiring in a year or two, may not be the optimal choice for you. If you are finishing your family then the age of your obstetrician may not be so much of an issue.
4. CREDENTIALS
Don't be afraid to ask for your physician's credentials. Of course a physician should have graduated from medical school and completed a residency in obstetrics/gynecology. (In some states a graduate from medical school can actually get a license to practice medicine with only one year of residency.)
It is also advantageous if they areBoard-Certified by the American Board of Obstetrics and Gynecology. This means that they have passed a written test, demonstrating that he or she has obtained the special knowledge and skills required for medical and surgical care of women. They must demonstrate that they have experience in treating women's health care and then they must pass an oral examination. This oral examination is given by a group of well-respected national experts. The exam covers the physician's skills, knowledge and ability to treat different conditions. Physicians must be retested periodically to keep this certification updated.
4. PERSONALITY
This is where no one can tell you what you like or dislike, but you! Do you want a physician who is has more bedside manner, or one who is more "straight from the hip"? Do you want someone who is going to bring topics up gently or do you want your physician to just bring the topic up and discuss it boldly? Do you like a quiet person or a more talkative person? Maybe you don't even know!
Most physicians are willing to schedule a "consultation" appointment with you. This is usually an appointment where you can go and meet the physician and ask questions and get a basic feel for his or her personality. This should tell you alot about whether or not you like this individual. If you don't like them during this visit, or for any reason they make you uncomfortable, then this isn't the obstetrician for you.
5. PERSONAL BELIEFS
During a consultation appointment is a good time to ask your prospective obstetrician some questions about their personal beliefs that may impact your care or your birthing experience. You may want to ask how they feel about unmedicated deliveries and are they generally supportive of that. How do they feel about labor inductions, and what percentage of their OB patients are induced. How do they feel about breastfeeding and are they supportive of that. How do they feel about epidurals and when do they allow them to be given. How do they feel about visitors in during the birth. What is their current C-Section rate? Anything that you can think of that would be important to you for your delivery would be a good thing to ask at this appointment.
You will want to notice the general attitude of the physician as they answer these questions. Are they truly interested in what you are asking and are they respectful in their answers? Then you may find that they are interested in you and about whether the issues are important to you. Are they generally flippant or dismissive about the questions? Are their answers disrespectful or frivolous? Then you might find that they may be dismissive and frivolous about other issues that are important to you as well. If you leave the consultation appointment feeling as if someone really took time with you, cared about what you had to say and made you feel special, you might be on your way to choosing an obstetrician.
6. SOLITARY OR GROUP
Most women don't think about this issue until they begin realizing that delivery is just around the corner and by then it's too late. Is your prospective obstetrician in a solitary practice, meaning that he or she is the only physician in the group, or is he or she in a group with other physicians?
This may not seem to make much difference as you go to visits monthly, or even toward the end of pregnancy when you begin to go weekly. But one visit to Labor & Delivery with a run of false labor can show you the importance of this question.
If your physician is in a solitary group, then chances are pretty good your physician will deliver your baby. Now even in a solitary group, your physician will have a physician from another group (usually another solitary physician) to take call on some weekends, or if he/she has to go out of town, or on (don't say it!) vacation. But still, most of the time they deliver their own babies.
If your physician is in a group with other physicians, they usually rotate the calls, both nights and weekends. The more physicians in the group, the fewer the chances are that your physician will actually be the one to deliver your baby.
7. AFTER THE CHOICE IS MADE
After you have chosen your obstetrician, if you find for some reason it was not the right choice for you, you can change physicians. However, it is recommended you do so very early in the pregnancy as many physicians will not take a new pregnant patient later in pregnancy. You might find your physician's nurse can help you with the issue if you take a few minutes to talk with her, or leave your number with her and have her call you during a slow spot in her day.
If you have gone the whole pregnancy and still are not happy with your choice of obstetrician, there is no reason for you to continue with a physician with whom you do not have a good relationship. Women change physicians all the time. Just make sure you change after your last postpartum checkup and in time for your next scheduled checkup.
If you have found the perfect obstetrician for you then by all means, tell everyone! The greatest compliment you can give your physician is to spread the word to every woman you know of the wonderful job he or she is doing!
Saturday, December 31, 2011
Wednesday, December 28, 2011
Preterm Labor -- Signs
Yesterday I admitted the sweetest couple who needed to be treated for Preterm Labor. I was very impressed with one of the statements the physician made to the couple regarding preterm contractions. The mother had been relating the fact that she had been feeling tightening for awhile, but having read about Braxton-Hicks contractions, she felt this was normal.
The physician told them that whenever a pregnancy is earlier than 37 weeks (which is considered term), contractions do not have to be considered painful to be effective. She added that by the time these contractions are painful, labor can be too far progressed to stop.
The truth is, there are many signs of preterm labor that may actually be ignored or not even noticed by the mother until preterm labor is much too advanced to be stopped. Some signs of preterm labor are:
There are a few things you can do to minimize your chances of preterm labor:
- sharp burning and pain when urinating
-the urge to urinate more frequently than usual
-a strong urge to urinate that can't be delayed
-soreness in the back and sides
-small amount of blood when urinating
If you do experience any signs of either preterm contractions, or urinary tract infections, notify your health care provider as soon as possible.
Next we will discuss how preterm contractions are treated.
The physician told them that whenever a pregnancy is earlier than 37 weeks (which is considered term), contractions do not have to be considered painful to be effective. She added that by the time these contractions are painful, labor can be too far progressed to stop.
The truth is, there are many signs of preterm labor that may actually be ignored or not even noticed by the mother until preterm labor is much too advanced to be stopped. Some signs of preterm labor are:
- Contractions (which may only feel like "tightening" or the "baby knotting up", which occur more than five times in an hour
- Change in vaginal discharge, leaking fluid or spotting
- A dull, low backache
- Cramps that feel like menstrual cramps or gastrointestinal cramps
- Pelvic pressure, the feeling that the baby is pushing down
There are a few things you can do to minimize your chances of preterm labor:
- Be aware of the signs and symptoms of preterm contractions
- Keep all your scheduled visits with your health care provider
- Keep yourself well hydrated
- Be aware of the signs and symptoms of urinary tract infections (a major cause of preterm contractions)
-the urge to urinate more frequently than usual
-a strong urge to urinate that can't be delayed
-soreness in the back and sides
-small amount of blood when urinating
If you do experience any signs of either preterm contractions, or urinary tract infections, notify your health care provider as soon as possible.
Next we will discuss how preterm contractions are treated.
Saturday, December 24, 2011
Dr. Santa and the Reindeer Scrub Nurse
Throughout my career I have worked many Christmas Eve nights. The first was my first year in Nursing School – with barely enough nursing knowledge to justify receiving a paycheck.
I had volunteered to work 11-7 Christmas Eve. I don’t know to this day what prompted the decision, it just seemed like a good idea at the time, and it was. I had a nice night with nurses who were surprised to have an extra pair of hands to lighten the load and an heart that was willingly working with them. As I took vital signs that night and again early that Christmas morning, I enjoyed being the first one to wish the patients a cheery and heart felt “Merry Christmas”.
The vantage point of the unit on which I worked allowed me to watch the sunrise from a nearby window. While I might have been awake before sunrise on Christmas before, I believe this was the first time I ever watched a Christmas sunrise. It was as if the full meaning of Christmas rose with the sun inside my heart that morning.
At the end of my shift, my mother and I went to my sister’s to watch her children open their presents. Somehow I felt as if I had already been given the greatest present of the day.
For years later I would volunteer to work night shift on Christmas Eve. When our children were young, I would make arrangements with “Santa” about what needed to go where and when I came home, Christmas would begin.
A couple of years ago, I volunteered to work with Tammye and Denise. All of us have children that are either older or grown and we had worked together the previous Christmas Eve. That year we had each brought food for Christmas dinner and because our unit was empty – Santa was bringing no babies that night – we ate our middle of the night Christmas dinner and watched Christmas movies all night. We got paid holiday pay for it, too!
That is exactly what we had planned for this time as well, but Santa had a baby on his delivery list. Denise was the patient’s nurse. I was the scrub nurse for the night and Tammye was the “free” nurse, which means she ran around and did everything else.
It wasn’t a calm night in the manger. The patient was progressing rapidly and it was all we could do to keep up with her. . .get an IV started, get lab work drawn, call anesthesia for an epidural, get her bladder emptied. In the meanwhile, the baby would have times when it concerned us. Not bad enough to do a C-Section. . .just enough to keep Denise on the edge of her chair and us on our toes.
I went to set up a sterile delivery table and remembered I had worn a pair of reindeer antlers to work. Still in the holiday spirit, I didn’t want to take them off, so I made holes in my scrub hat so the antlers could poke through them. On went the hat over the antlers and I finished setting up the table. Just in the nick of time too, the patient was pushing and the table called for.
Image via WikipediaThe baby delivered easily, thanks to Dr. Santa, and as the doctor was trying to sew the episiotomy, with me standing beside her to assist her, we kept noticing shadows that would move along the area. It took awhile for us to realize the bright delivery lights were creating shadows from my reindeer antlers.Looking back on it, I realize that was my last time to ever work with my dear friend Denise. Fighting cancer these last six years, her body is now too weak to work with us though that is exactly where her heart remains.
Tammye, too, gave us a scare by having a major heart attack and then open heart surgery. She is well now and her bright smile greets me in the morning when I arrive to work.
That night, Santa didn’t just deliver a baby to a mother, he delivered precious memories to three friends who love each other, loved to work together and will cherish the memories of our Christmas Eves together, reindeer antlers and all.
Wednesday, December 21, 2011
Round Ligament Pain
I have to confess, for years I was not nearly sympathetic enough with patients who came in complaining of Round Ligament pain. Then, with my third pregnancy, I experienced it for the first time and immediately, I was more sympathetic!
The good news about Round Ligament pain is that it isn't a serious condition as far as your health or the baby's health is concerned. The bad news is that it can be extremely painful. It can be hard to believe that something that painful isn't a sign of something seriously wrong.
The non-pregnant uterus is the size of a pear. It is suspended in place in the lower abdomen with ligaments that begin at the top sides of the uterus and continue all the way down to the labia.
As the uterus begins to grow, in both size and weight, these ligaments begin to be stretched and tensed. This causes resulting pulling on surrounding and attached nerve fibers, causing pain.
The pain from Round Ligament Syndrome can present in any different ways. Most often it is a one-sided, sharp pain frequently noted when changing positions or rising from a seated or lying position. It is more common on the right side that the left because the uterus has a natural shift to the right. Some women can also complain of a sensation of great weight and heaviness in their labia, this is also a result of pulling of the round ligament, which ends in the labia.
There is nothing you can do to make Round Ligament Pain go away, however, there are a few things you can do to be more comfortable:
You should always report any pain to your health care provider. Also report if you have any fever, pain upon urination, severe nausea and vomiting or bleeding.
One encouraging thing is that Round ligament pain often seems to improve once the uterus is totally out of the pelvis.
The good news about Round Ligament pain is that it isn't a serious condition as far as your health or the baby's health is concerned. The bad news is that it can be extremely painful. It can be hard to believe that something that painful isn't a sign of something seriously wrong.
The non-pregnant uterus is the size of a pear. It is suspended in place in the lower abdomen with ligaments that begin at the top sides of the uterus and continue all the way down to the labia.
As the uterus begins to grow, in both size and weight, these ligaments begin to be stretched and tensed. This causes resulting pulling on surrounding and attached nerve fibers, causing pain.
The pain from Round Ligament Syndrome can present in any different ways. Most often it is a one-sided, sharp pain frequently noted when changing positions or rising from a seated or lying position. It is more common on the right side that the left because the uterus has a natural shift to the right. Some women can also complain of a sensation of great weight and heaviness in their labia, this is also a result of pulling of the round ligament, which ends in the labia.
There is nothing you can do to make Round Ligament Pain go away, however, there are a few things you can do to be more comfortable:
- If you are past the first trimester, a very warm bath or heating pad may give some comfort to the area.
- Speak to your health care provider about taking acetaminophen according to package directions, but do not take ibuprofen, it is contraindicated in pregnancy. Do not take any medication without your physician's recommendation.
- Change positions slowly, giving the stretched ligaments time to adjust.
You should always report any pain to your health care provider. Also report if you have any fever, pain upon urination, severe nausea and vomiting or bleeding.
One encouraging thing is that Round ligament pain often seems to improve once the uterus is totally out of the pelvis.
Sunday, December 18, 2011
How Does it Feel to Get an Epidural?
I was helping to admit a young woman the other day and she confessed that she was more scared of the needle of the epidural than of delivery. I was able to tell her that most women who receive and epidural, after the procedure is complete, say, "That wasn't as bad as I thought it would be."
Image via Wikipedia
Because each woman is unique and each anesthesiologist is unique, I can't tell you exactly how it will feel for you. I can tell you however how it felt for me, and how many of the women I have cared for say it felt for them.
Some women find having to curl around their baby while having contractions a somewhat uncomfortable. Also, having to remain still while the epidural is being placed frightens many women, but usually there is a nurse right at your side to help you and hold you in your position.
The sterile prep which the anesthesia doctor uses is often cold and is applied with a scratchy feeling sponge. The doctor usually then numbs the skin and deeper tissues with an injection of Lidocaine. This is very similar to the numbing shot one receives at the dentist in that it is a stick and then a burn. It only lasts a few seconds however and within ten to fifteen seconds you should not feel that anymore. At this point, you would only feel pressure as the doctor feels your back for landmarks.
When the catheter is placed into the epidural space, it can brush across a nerve root. This causes a momentary "shock" feeling similar to when you hit your "funny bone", only this shock sensation will occur in your back and run down one leg or the other. It only lasts for two or three seconds.
When the anesthesiologist injects medication into the catheter, there can be a slight cramping feeling in the back and the medication will feel cold. It isn't cold, but the room temperature medication is going into a warm place, making it feel cold by comparison.
As the epidural begins to take effect, your feet and legs will begin to feel warm and tingling, then you will become numb. Some women will still be able to move their legs, some will not. Much depends upon the medication used, the concentration of the medication used and the dose of the medication given.
The majority of women feel quite comfortable throughout their labor, though some may have a "hot spot", an area where the medication did not take effect, or some may need additional injections of medications into the catheter (called a redose) throughout labor.
If the epidural placement is more difficult, the woman may find the procedure more difficult as well, but most of the time the woman feels as if the placement of the epidural was much easier than what she would have imagined it to be.
Image via WikipediaBecause each woman is unique and each anesthesiologist is unique, I can't tell you exactly how it will feel for you. I can tell you however how it felt for me, and how many of the women I have cared for say it felt for them.
Some women find having to curl around their baby while having contractions a somewhat uncomfortable. Also, having to remain still while the epidural is being placed frightens many women, but usually there is a nurse right at your side to help you and hold you in your position.
The sterile prep which the anesthesia doctor uses is often cold and is applied with a scratchy feeling sponge. The doctor usually then numbs the skin and deeper tissues with an injection of Lidocaine. This is very similar to the numbing shot one receives at the dentist in that it is a stick and then a burn. It only lasts a few seconds however and within ten to fifteen seconds you should not feel that anymore. At this point, you would only feel pressure as the doctor feels your back for landmarks.
When the catheter is placed into the epidural space, it can brush across a nerve root. This causes a momentary "shock" feeling similar to when you hit your "funny bone", only this shock sensation will occur in your back and run down one leg or the other. It only lasts for two or three seconds.
When the anesthesiologist injects medication into the catheter, there can be a slight cramping feeling in the back and the medication will feel cold. It isn't cold, but the room temperature medication is going into a warm place, making it feel cold by comparison.
As the epidural begins to take effect, your feet and legs will begin to feel warm and tingling, then you will become numb. Some women will still be able to move their legs, some will not. Much depends upon the medication used, the concentration of the medication used and the dose of the medication given.
The majority of women feel quite comfortable throughout their labor, though some may have a "hot spot", an area where the medication did not take effect, or some may need additional injections of medications into the catheter (called a redose) throughout labor.
If the epidural placement is more difficult, the woman may find the procedure more difficult as well, but most of the time the woman feels as if the placement of the epidural was much easier than what she would have imagined it to be.
Wednesday, December 14, 2011
Infection? What is Group B Strep?
A friend of mine recently came to me concerned about his daughter. Due to deliver 
Image via Wikipediawithin a few weeks, she had just told him she was positive for Group B Strep and would need antibiotics during labor. He had never heard of this and wanted my thoughts. He wanted to know if there was any danger for her or for her baby.
Group B Strep is one that frequently puzzles and concerns many people. Group B streptococcus (GBS) is a type of bacteria that is found in 25-30% of pregnant women. Most women do not have symptoms or become sick, but they carry the bacteria in their bodies, hence they are called "carriers". Adults can have GBS in the bowel, vagina, bladder or throat. Most of the time the bacteria poses no threat to the woman at all. However, if her baby comes into contact with the Group B strep bacteria during birth, the baby can become very ill. In fact, according to the CDC, Group B Strep is the most common cause of life-threatening infections in newborns. It is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid surrounding the brain) in newborns.
How Do You Get Group B Strep - Is it a Sexually Transmitted Disease?
The bacteria that causes GBS normally lives in the intestine, rectal areas of men and women, and also lives in the vagina of women. Colonization of the bacteria is not a sexually transmitted disease. GBS may come and go in people's bodies without symptoms throughout their lives.
How Do I Know If I Am Group B Strep +?
Most health-care providers will use a screening test late in pregnancy to determine if you carry Group B strep. Most health-care providers will test between 35-37 weeks of pregnancy.
The test is simple and painless. A sterile swab (Q-tip) is used to collect a sample from the vagina and rectum. It is then sent to a laboratory to be tested for Group B strep.
What if My Test Comes Back Positive?
If your test comes back positive, it will be noted on your prenatal record. You should also be aware of it and inform your care givers as soon as you arrive in labor. You will receive intravenous (IV) antibiotics throughout your labor.
Why Can't I Be Treated As Soon As My Test Comes Back?
Even if treated with antibiotics as soon as your test results were available, it is highly likely the bacteria would return by the time you were in labor. The goal is to keep the baby from coming in contact with the bacteria, so treating the GBS during labor is the best way to accomplish that. In fact, since the early 1990's, the onset of newborn GBS disease has decreased by 80%, due to the treatment of mothers in labor.
Is There Any Risk to Me Being Treated for GBS?
There is a rare chance (about 1 in 10,000) of having a severe allergic reaction to the antibiotic which would require treatment. Penicillin is most often given, but if you are allergic to Penicillin, there are other antibiotics that can be substituted.
By being treated in labor, you reduce the chances of your baby developing newborn GBS disease from 1 in 200 to 1 in 4000!
Is GBS the same as a Yeast Infection? Or the same as Strep Throat?
Yeast infections are caused by yeast and not bacteria. Taking antibiotics can often increase the liklihood of developing a yeast infection because killing the bacteria normally found in the vagina gives yeast more of a chance to grow.
Strep throat, while caused by a streptococcus bacteria, is caused by Group A streptococcus. Group A and Group B streptococcus are two different kinds of bacteria each belonging to the same family, but of different species.
Once I am GBS +, Will I Always Be?
GBS can come and go in people's bodies without our knowing it. If you have had one pregnancy that was GBS+, your health-care provider may not even test you with
Image via Wikipediasubsequent pregnancies, but decide to treat you as positive instead.
The most important thing about GBS to remember is that it is common, it is not a sexually transmitted disease and that it is easily treated to help prevent a dangerous infection in your baby.
Image via Wikipediawithin a few weeks, she had just told him she was positive for Group B Strep and would need antibiotics during labor. He had never heard of this and wanted my thoughts. He wanted to know if there was any danger for her or for her baby.Group B Strep is one that frequently puzzles and concerns many people. Group B streptococcus (GBS) is a type of bacteria that is found in 25-30% of pregnant women. Most women do not have symptoms or become sick, but they carry the bacteria in their bodies, hence they are called "carriers". Adults can have GBS in the bowel, vagina, bladder or throat. Most of the time the bacteria poses no threat to the woman at all. However, if her baby comes into contact with the Group B strep bacteria during birth, the baby can become very ill. In fact, according to the CDC, Group B Strep is the most common cause of life-threatening infections in newborns. It is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid surrounding the brain) in newborns.
How Do You Get Group B Strep - Is it a Sexually Transmitted Disease?
The bacteria that causes GBS normally lives in the intestine, rectal areas of men and women, and also lives in the vagina of women. Colonization of the bacteria is not a sexually transmitted disease. GBS may come and go in people's bodies without symptoms throughout their lives.
How Do I Know If I Am Group B Strep +?
Most health-care providers will use a screening test late in pregnancy to determine if you carry Group B strep. Most health-care providers will test between 35-37 weeks of pregnancy.
The test is simple and painless. A sterile swab (Q-tip) is used to collect a sample from the vagina and rectum. It is then sent to a laboratory to be tested for Group B strep.
What if My Test Comes Back Positive?
If your test comes back positive, it will be noted on your prenatal record. You should also be aware of it and inform your care givers as soon as you arrive in labor. You will receive intravenous (IV) antibiotics throughout your labor.
Why Can't I Be Treated As Soon As My Test Comes Back?
Even if treated with antibiotics as soon as your test results were available, it is highly likely the bacteria would return by the time you were in labor. The goal is to keep the baby from coming in contact with the bacteria, so treating the GBS during labor is the best way to accomplish that. In fact, since the early 1990's, the onset of newborn GBS disease has decreased by 80%, due to the treatment of mothers in labor.
Is There Any Risk to Me Being Treated for GBS?
There is a rare chance (about 1 in 10,000) of having a severe allergic reaction to the antibiotic which would require treatment. Penicillin is most often given, but if you are allergic to Penicillin, there are other antibiotics that can be substituted.
By being treated in labor, you reduce the chances of your baby developing newborn GBS disease from 1 in 200 to 1 in 4000!
Is GBS the same as a Yeast Infection? Or the same as Strep Throat?
Yeast infections are caused by yeast and not bacteria. Taking antibiotics can often increase the liklihood of developing a yeast infection because killing the bacteria normally found in the vagina gives yeast more of a chance to grow.
Strep throat, while caused by a streptococcus bacteria, is caused by Group A streptococcus. Group A and Group B streptococcus are two different kinds of bacteria each belonging to the same family, but of different species.
Once I am GBS +, Will I Always Be?
GBS can come and go in people's bodies without our knowing it. If you have had one pregnancy that was GBS+, your health-care provider may not even test you with
Image via Wikipediasubsequent pregnancies, but decide to treat you as positive instead.The most important thing about GBS to remember is that it is common, it is not a sexually transmitted disease and that it is easily treated to help prevent a dangerous infection in your baby.
Saturday, December 10, 2011
Is it a Boy or a Girl?
Most pregnant women are curious to know the sex of their baby before it is born. Only an amniocentesis can give that information with 100% certainty, although ultrasounds continue to become more and more accurate with each advancement of technology.
Some women want to know, however, how to choose the sex of their baby even before it is conceived. At first this may sound like an impossibility, and there are certainly no guarantees, but it is really a matter of environment, timing, number and temperature.
Let's settle one thing first of all. It is the man who determines the sex of the baby.
Women present XX chromosomes to the party, men can present sperm that are either XY or XX. In the case of humans, a single gene on the Y chromosome acts as a signal to set the developmental pathway towards maleness. So if the XX sperm meets the XX ovum, a girl baby ensues. If the XY sperm meets the XX ovum, you have a bouncing baby boy!
But why do the XY sperm or the XX sperm make it to the ovum? That is a very interesting thing. It is a long journey for the little sperm and the environment plays a big part of the picture.
ENVIRONMENT
Sperm are very sensitive to their environment, from temperature to the pH, or whether their surrounding is acidic or alkaline. In fact, XX sperm prefer an environment that is acidic and XY sperm prefer a more alkaline environment. To further complicate things, women can naturally have a more acidic or more alkaline vaginal mucousa. There are some who recommend a woman douche with water and vinegar immediately before intercourse if she prefers a girl or use water and baking soda if she prefers a boy.
Also, female orgasm is said to increase the alkalinity of the vaginal mucousa, so if a woman wants a boy, she should orgasm prior to the man's ejaculation. If she wants a girl, she should avoid orgasm.
Environment isn't the only factor involved, however. The sperm themselves are different between XX and XY. XY sperm are bigger and faster swimmers, however they have a shorter life span. XX sperm, while slower and smaller, live longer, so timing is an important issue.
TIMING
The mobility and life span of sperm has a big impact upon when intercourse should occur depending upon which sex baby you desire. If your desire is to have a boy, then you should have intercourse as close to ovulation as possible, since the XY sperm are the fastest and strongest swimmers.
If you desire a girl, having intercourse three or more days before ovulation increases the chances to conceive a girl, because the faster sperm with the shorter life spans will have died off, leaving a greater quantity of the XX sperms when the egg is released.
HOW MANY INVITATIONS TO THE PARTY
When it comes to conception, and especially gender selection, sperm count matters. A low sperm count, of course, doesn't favor fertility at all. A high sperm count favors boy babies.
If you are desiring a boy, abstain from intercourse 3-4 days before your ideal date, a day or two before ovulation.
If you are desiring a girl, have intercourse daily from day 1 until 3 days before ovulation.
X MARKS THE SPOT
While trying to maximize the mobility of the sperm, the position of intercourse and depth of penetration during intercourse is important.
The closer the entrance to the vagina, the more acidic the vaginal canal. Avoiding ejaculation close to the entrance would then enhance the likelihood of conceiving a boy. It is recommended that to conceive a girl, the missionary position should be used and to conceive a boy, the rear-entry position.
TEMPERATURE
Sperm are very sensitive to the temperature around them. If you want to conceive a boy, it is recommended that the man wear boxer shorts exclusively. This will reduce the heat that can destroy sperm. The opposite is not recommended for a girl however, as the heat can lower the sperm count. What is recommended if you wish to conceive a girl, is immediately before intercourse the man take a hot bath. This can destroy some of the faster XY sperm, leaving more of the XX sperm to fertilize the egg.
ENHANCEMENT AIDS
Once you have the timing, the position, the temperature and the environment right, another suggestion is for the man to drink a nice cup of caffeinated coffee immediately before intercourse (perhaps while he is sitting in that hot bath) if you desire a boy baby.
CONCLUSION
Hopefully with this information you can begin to skew the statistics a tiny bit in the direction of the gender for which you are hoping.
n all organisms, however, there are those that out-perform and out live their expected parameters. So you may have an XX sperm that is a "Michael Phelps" type swimmer, or an XY sperm that will set the Guinness World Book of Record for sperm longevity. There are no guarantees. Personally, I believe the Lord puts each sperm and egg together to make just the person He wants.
To make all the details a little easier to remember, I've condensed them into this table. I wish you all, Happy Swimming!
Some women want to know, however, how to choose the sex of their baby even before it is conceived. At first this may sound like an impossibility, and there are certainly no guarantees, but it is really a matter of environment, timing, number and temperature.
Let's settle one thing first of all. It is the man who determines the sex of the baby.
Women present XX chromosomes to the party, men can present sperm that are either XY or XX. In the case of humans, a single gene on the Y chromosome acts as a signal to set the developmental pathway towards maleness. So if the XX sperm meets the XX ovum, a girl baby ensues. If the XY sperm meets the XX ovum, you have a bouncing baby boy!
But why do the XY sperm or the XX sperm make it to the ovum? That is a very interesting thing. It is a long journey for the little sperm and the environment plays a big part of the picture.
ENVIRONMENT
Sperm are very sensitive to their environment, from temperature to the pH, or whether their surrounding is acidic or alkaline. In fact, XX sperm prefer an environment that is acidic and XY sperm prefer a more alkaline environment. To further complicate things, women can naturally have a more acidic or more alkaline vaginal mucousa. There are some who recommend a woman douche with water and vinegar immediately before intercourse if she prefers a girl or use water and baking soda if she prefers a boy.
Also, female orgasm is said to increase the alkalinity of the vaginal mucousa, so if a woman wants a boy, she should orgasm prior to the man's ejaculation. If she wants a girl, she should avoid orgasm.
Environment isn't the only factor involved, however. The sperm themselves are different between XX and XY. XY sperm are bigger and faster swimmers, however they have a shorter life span. XX sperm, while slower and smaller, live longer, so timing is an important issue.
TIMING
The mobility and life span of sperm has a big impact upon when intercourse should occur depending upon which sex baby you desire. If your desire is to have a boy, then you should have intercourse as close to ovulation as possible, since the XY sperm are the fastest and strongest swimmers.
If you desire a girl, having intercourse three or more days before ovulation increases the chances to conceive a girl, because the faster sperm with the shorter life spans will have died off, leaving a greater quantity of the XX sperms when the egg is released.
HOW MANY INVITATIONS TO THE PARTY
When it comes to conception, and especially gender selection, sperm count matters. A low sperm count, of course, doesn't favor fertility at all. A high sperm count favors boy babies.
If you are desiring a boy, abstain from intercourse 3-4 days before your ideal date, a day or two before ovulation.
If you are desiring a girl, have intercourse daily from day 1 until 3 days before ovulation.
X MARKS THE SPOT
While trying to maximize the mobility of the sperm, the position of intercourse and depth of penetration during intercourse is important.
The closer the entrance to the vagina, the more acidic the vaginal canal. Avoiding ejaculation close to the entrance would then enhance the likelihood of conceiving a boy. It is recommended that to conceive a girl, the missionary position should be used and to conceive a boy, the rear-entry position.
TEMPERATURE
Sperm are very sensitive to the temperature around them. If you want to conceive a boy, it is recommended that the man wear boxer shorts exclusively. This will reduce the heat that can destroy sperm. The opposite is not recommended for a girl however, as the heat can lower the sperm count. What is recommended if you wish to conceive a girl, is immediately before intercourse the man take a hot bath. This can destroy some of the faster XY sperm, leaving more of the XX sperm to fertilize the egg.
ENHANCEMENT AIDS
Once you have the timing, the position, the temperature and the environment right, another suggestion is for the man to drink a nice cup of caffeinated coffee immediately before intercourse (perhaps while he is sitting in that hot bath) if you desire a boy baby.
CONCLUSION
Hopefully with this information you can begin to skew the statistics a tiny bit in the direction of the gender for which you are hoping.
n all organisms, however, there are those that out-perform and out live their expected parameters. So you may have an XX sperm that is a "Michael Phelps" type swimmer, or an XY sperm that will set the Guinness World Book of Record for sperm longevity. There are no guarantees. Personally, I believe the Lord puts each sperm and egg together to make just the person He wants.
To make all the details a little easier to remember, I've condensed them into this table. I wish you all, Happy Swimming!
Boy Baby | Girl Baby |
Alkaline environment | Acid environment |
Faster swimmers | Slower swimmers |
Short life | Long life |
Rear entry position | Missionary position |
Less frequent intercourse | More frequent intercourse |
Abstinence 3-4 days before | No abstinence before |
Female orgasm prior to ejaculation | No female orgasm |
Target date 1-2 days before ovulation | Intercourse everyday from day 1, stop 3 days before ovulation |
Boxers only | No change |
No hot baths | Hot bath for man immediately before intercourse |
Caffeinated coffee imediately before intercourse | No caffeine immediately prior to intercourse |
Tuesday, December 6, 2011
Did My Water Break?
Apart from trying to determine if their contractions are labor, the question of "Did my water break?" is often the most perplexing for many pregnant women.
The amniotic sac surrounding the baby contains approximately a quart of fluid. This fluid is comprised mainly of baby's urine, baby's skin cells and fluid created from the placenta. Since most of baby's waste products are transported through the umbilical cord to the mother's circulation and filtered through her kidneys, baby's urine is not like ours at all. That explains why amniotic fluid is usually clear, or a very pale color.
When a woman's amniotic sac ruptures, or her "water breaks", it usually occurs in one of two ways. It's either a big gush, or a steady trickle.
THE BIG GUSH
Image by roychung1993 via Flickr
If your water breaks with a big gush, its going to be pretty easy to tell what happened. Water will be everywhere. It will run down your legs; when you get into the car, it will be in the seat of the car. Everywhere you go, you will leave a trail of water.
Don't try to use a towel to keep up with the flow. Go to your baby's nursery and grab a diaper. They are the perfect hour-glass shape, they are lined with plastic and extremely absorbent. Put one between your legs and you can be on your way!
THE STEADY TRICKLE
If you have a steady wetness, it is much harder to know if it is definitely your amniotic fluid. Many women have a thin, whitish discharge toward the end of pregnancy which is can be normal.
If you are a steady discharge that requires you to wear a pad, you need to notify your health care provider. Don't try to diagnose it yourself at home.
HOW TO KNOW FOR SURE?
If you have a the "big gush" usually it is very obvious and there is nothing else that needs to be done to determine that your water has broken. If however you had small gush and then no more fluid leaked out, or if you are having a continual trickle of discharge, your health care provider will need to determine definitely if it was your amniotic fluid.
The first test performed is often to test the pH of the amniotic fluid. This is a simple litmus test done either with a swab or a strip of paper. A more definitely test involves viewing the amniotic fluid under a microscope.
This is usually done by obtaining a sample of the fluid with a small swab through a speculum. The higher salt content of the amniotic fluid causes it to create a pattern of ferns, like a Boston Fern, on the slide when observed through the microscope.
WHEN WILL MY WATER BREAK?
Many new mothers are concerned about when their water will break, especially the thought of if it should happen in a public place. I usually ask them to think about all the times they have been in the grocery store, out shopping or at the theater. Have they ever been there and seen someone's water break? The answer has always been "No".
Only 10% of women rupture their amniotic sac before labor begins. Of those 10%, rupturing your membranes is usually a private thing, even if you are around many people. It is very rare for it to be something for everyone to see and notice.
WHAT DO I DO WHEN MY WATER BREAKS?
When your water breaks, notify your health care provider immediately. Most will want you to come to the hospital or birth center so they can verify that your water has been broken. Do not put anything into your vagina -- it is now EXIT ONLY! That means no douches, no tampons, no body parts.
The membranes serve as the last guardian against infection for your baby. The normal bacteria that live in your vagina will begin the slow, steady trek upward toward your uterus and your baby. Anything introduced into the vagina will help spread those bacteria along their way.
Take a deep breath and remember that having your water break means that your baby will soon be here. The moment you have been awaiting for so many months is just around the corner. Congratulations!
The amniotic sac surrounding the baby contains approximately a quart of fluid. This fluid is comprised mainly of baby's urine, baby's skin cells and fluid created from the placenta. Since most of baby's waste products are transported through the umbilical cord to the mother's circulation and filtered through her kidneys, baby's urine is not like ours at all. That explains why amniotic fluid is usually clear, or a very pale color.
When a woman's amniotic sac ruptures, or her "water breaks", it usually occurs in one of two ways. It's either a big gush, or a steady trickle.
THE BIG GUSH
Image by roychung1993 via FlickrIf your water breaks with a big gush, its going to be pretty easy to tell what happened. Water will be everywhere. It will run down your legs; when you get into the car, it will be in the seat of the car. Everywhere you go, you will leave a trail of water.
Don't try to use a towel to keep up with the flow. Go to your baby's nursery and grab a diaper. They are the perfect hour-glass shape, they are lined with plastic and extremely absorbent. Put one between your legs and you can be on your way!
THE STEADY TRICKLE
If you have a steady wetness, it is much harder to know if it is definitely your amniotic fluid. Many women have a thin, whitish discharge toward the end of pregnancy which is can be normal.
If you are a steady discharge that requires you to wear a pad, you need to notify your health care provider. Don't try to diagnose it yourself at home.
HOW TO KNOW FOR SURE?
If you have a the "big gush" usually it is very obvious and there is nothing else that needs to be done to determine that your water has broken. If however you had small gush and then no more fluid leaked out, or if you are having a continual trickle of discharge, your health care provider will need to determine definitely if it was your amniotic fluid.
The first test performed is often to test the pH of the amniotic fluid. This is a simple litmus test done either with a swab or a strip of paper. A more definitely test involves viewing the amniotic fluid under a microscope.
This is usually done by obtaining a sample of the fluid with a small swab through a speculum. The higher salt content of the amniotic fluid causes it to create a pattern of ferns, like a Boston Fern, on the slide when observed through the microscope.
WHEN WILL MY WATER BREAK?
Many new mothers are concerned about when their water will break, especially the thought of if it should happen in a public place. I usually ask them to think about all the times they have been in the grocery store, out shopping or at the theater. Have they ever been there and seen someone's water break? The answer has always been "No".
Only 10% of women rupture their amniotic sac before labor begins. Of those 10%, rupturing your membranes is usually a private thing, even if you are around many people. It is very rare for it to be something for everyone to see and notice.
WHAT DO I DO WHEN MY WATER BREAKS?
When your water breaks, notify your health care provider immediately. Most will want you to come to the hospital or birth center so they can verify that your water has been broken. Do not put anything into your vagina -- it is now EXIT ONLY! That means no douches, no tampons, no body parts.
The membranes serve as the last guardian against infection for your baby. The normal bacteria that live in your vagina will begin the slow, steady trek upward toward your uterus and your baby. Anything introduced into the vagina will help spread those bacteria along their way.
Take a deep breath and remember that having your water break means that your baby will soon be here. The moment you have been awaiting for so many months is just around the corner. Congratulations!
Saturday, December 3, 2011
Is it Baby Blues. . .or More?
Image by moominmolly via FlickrYour little bundle of joy has arrived and you couldn't be happier! Or at least you thought you would be happy, but you don't feel happy. In fact, you feel sad, very sad.You may be one of as many as 80% of mothers who experience some type of Postpartum Depression.
Sometimes referred to as "Baby Blues", many women just feel sad, for no specific reason. One woman described it perfectly to me the other day, "I just wasn't me anymore." Some women feel upset, afraid, alone or unloving toward their baby, their partner, or both.
The Baby Blues
The Baby Blues is a period of more sensitive emotions - similar to that experienced in the first trimester of pregnancy - but accentuated with the exhausted and sleep deprivation of caring for a newborn. This occurs in approximately 50% of all postpartum women and may last from a few days to a couple weeks after delivery, peaking within 3-5 days of delivery. Symptoms of Baby Blues may include:
- Crying for no apparent reason, or more easily than usual
- Difficulty sleeping even when tired
- Feeling irritable, or "on edge" emotionally
One of the key factors in determining if what the new mom is experiencing is Baby Blues or something more serious is Baby Blues will not interfere with the mom's ability to care for herself and her baby. Also, for most women the symptoms remain mild and go away on their own.
More Serious Than Baby Blues
For another 10-20% of mothers, Postpartum Depression can be more than just "Baby Blues", it can be a more severe form of emotional distress, sometime called Postpartum Non-psychotic Depression. This usually occurs within a few months of delivery. Risk factors include:
- Previous major depression
- Previous Postpartum depression
- Psychosocial stress
- Inadequate social support
- Previous premenstrual dysphoric disorder
- Sad mood, frequenct crying; crying easily
- Inability to find pleasure in things that were once pleasurable
- Trouble sleeping, even when fatigued
- Anxiety, extreme worry over the baby's safety or her own safety
- Changes in appetite, either not eating or over-eating
- Fatigue
- Feelings of inadequacy as a parent
- Decreased interest in sex
- Inability to concentrate
- Feelings of rejection
- Suicidal thoughts or expressions
- Inability to properly care for the baby
The Most Extreme Cases
Rarely, an extreme form of postpartum depression known as postpartum psychosis develops after childbirth. This is the most serious of all the Postpartum Depression categories and usually manifests itself within three weeks of giving birth, but can last for much longer. Thankfully, it is rare, but it requires immediate attention. A woman with Postpartum Psychosis may have periods of seeming well, and may even appear to have recovered. Women who have thoughts of hurting their babies are more likely to act upon those thoughts if they are suffering from Postpartum Psychosis. If untreated, postpartum psychotic depression has a likelihood of coming back after the postpartum period and after the birth of other children.
If you have experienced any form of Postpartum Depression you need to know when to seek immediate help:
- Inability to sleep more than 2 hours per night
- Thoughts of hurting yourself or killing yourself
- Thoughts of hurting your baby or other children
- Hearing voices or seeing things
- Thoughts that your baby is evil
During an evaluation, you can expect your health care provider to ask you about your symptoms, what they are, how long they have lasted and how bad they are. It is important to be as truthful as possible to these questions. You will also be asked about any risk factors you may have for depression, such as a family history of mental illness, drug and alcohol usage, family, marital or financial problems. To help with your diagnosis, your health care provider may use the Edinburgh Postnatal Depression Scale. In this questionnaire, 10 questions help to indicate your probability of having postpartum depression.
How is Postpartum Depression Treated?
The plan of care for Postpartum Depression will depend upon the severity of your depression, based upon the answers you have given your health care provider. There may be several aspects to your care, including referral for psychological help, individual and/or group therapy, medications, marriage counseling, support groups and financial counseling. There are also some things which you can do to aid the therapies suggested by your health care provider.
- Don't be afraid to ask for help, especially in caring for the baby
- Surround yourself with supportive family members and friends
- Take care of yourself.
- Get as much rest as you can -- rest when the baby naps.
- Try not to spend much time alone.
- Spend some time alone with your husband or partner.
- Take a shower and get dressed every day.
- Get out of the house. Take a walk, see a friend, do something you enjoy. Get someone to take care of the baby if you can; if you can't, take the baby with you.
- Don't set unrealistic expectations.
- Don't worry too much about the housework. No one is a Super-Mom. Ask friends and family for help.
- Talk to other mothers. You can learn from each other, and their experiences can be reassuring.
Other Support References Depression After Delivery
- (800) 944-4PPD National Women's Health Information Center -
- (800) 994-9662 Postpartum Support International (PSI) -
- (805) 967-7636 American College of Obstetricians and Gynecologists Depression
- After Delivery Postpartum Depression Postpartum Support International
- http://www.mamalove.org
- http://postpartumdadsproject.org/
- www.postpartum.net
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