We’re growing! VWC Health Care Job Fair | Wednesday, November 14

If you have the desire to begin, grow or seek a new direction in your career, while working with some of the best OB/GYNs in RVA, Virginia Women’s Center is the place for you!

We’re growing. Which means we need to add to our incredible team of nurses, medical assistants, ultrasonographers and patient coordinators.

We offer competitive pay, excellent benefits, health insurance that starts on the first day of the month following your date of hire, financial and retirement planning support, and much more.

We’re looking for compassionate and committed team players who want to live a life of purpose.

If this sounds like you, we hope to see you on Wednesday, November 14th , 4:30 – 6:30 PM, Health Care Job Fair

Virginia Women’s Center – Short Pump
Community Room – 2nd floor
12129 Graham Meadows Drive
Richmond, VA 23233

If you can’t attend the job fair, feel free to apply online.

Questions? Email jobopenings@vwcenter.com.

Talk soon!
Virginia Women’s Center

Postpartum Incontinence: What You Need to Know.

You sneeze, and—oops. A friend makes you laugh, and—oops. You run after your rambunctious dog, and—oops.

Experiencing occasional incontinence is one of those post-pregnancy side effects that takes women by surprise. Many women just accept it (and try to avoid triggering it), but you don’t have to. We spoke with Richmond urogynecologist Dr. Tovia M. Smith, of Virginia Women’s Center, about common misconceptions around incontinence and treatment options.

I can’t talk to my doctor about postpartum incontinence—it’s so embarrassing!

Many women are embarrassed about incontinence, or they don’t know who to turn to, Dr. Smith says. That’s why “here at Virginia Women’s Center, we really make a point to ask about it.”

Incontinence is one of those post-pregnancy side effects that takes many women by surprise. It’s totally normal and expected, Dr. Smith reassures her patients. “Many women don’t seek care because they aren’t that bothered by it,” she says, and that’s OK. At the same time, if postpartum incontinence is affecting your quality of life, it’s time to talk to your doctor.

Incontinence will go away on its own in a few months—right?

After childbirth, your body needs time to recover and function normally. If you’re not nursing, your period usually returns around the third month postpartum. If you are nursing, you may not get your period for several months.

Having regular periods means “your body’s back to its new normal, hormonally speaking,” Dr. Smith explains, and that means episodes of incontinence should decrease: “The majority of women do improve, to the point where it’s no longer a major quality-of-life issue.” But if you’re still leaking six months postpartum (and not nursing), it may be time to seek advice from your doctor.

If I’d had a C-section, I wouldn’t have problems with incontinence now.

Having a C-section does not necessarily prevent it, Dr. Smith says. While prolonged pushing (2+ hours) or having a forceps delivery are associated with an increased risk, postpartum incontinence is caused by many factors.

Number one is hormones. During pregnancy, progesterone levels are elevated, which relaxes muscles such as the esophagus (leading to reflux) and the urethral sphincters, which control the flow of urine from the bladder. “I call it the loosey-goosey hormone,” Dr. Smith says.

Another factor is pregnancy-related trauma to the nerves that run through the pelvic floor to the urethra. The weight of carrying a baby for nine months, plus the trauma of childbirth, can damage nerves and impair the brain-to-bladder connection. “I don’t know when I have to pee anymore,” women tell Dr. Smith.

Other causes are simply environmental. New moms may be drinking a lot of water if they’re nursing, but they’re so busy caring for their newborn that they often forget to go to the bathroom.

Incontinence is a problem for me, but there’s nothing I can do about it. 

When postpartum incontinence is persistent and affecting a woman’s quality of life, there are several treatment options. The first is Kegel exercises, which aren’t as simple as women think they are! Dr. Smith recommends working with a physical therapist on muscle training to strengthen the pelvic floor and improve biofeedback to “really make that brain to pelvic connection.”

Another option is a pessary, a small device that increases the resistance in the urethra. Dr. Smith shows women how to put it in place and take it out. A pessary is completely removable and reversible.

When incontinence persists, Dr. Smith asks two questions: “Is this bothersome enough to you to take a surgical step? And are you done with childbearing?” If the answer to both is yes, she may recommend a urethral sling, which lifts the urethra and exerts pressure to help control the flow of urine.

For many women, the biggest relief they feel is simply knowing they’re not alone in dealing with postpartum incontinence. The first step toward a solution is making an appointment by calling 804.288.4084.

 

 

 

We’re changing to better care for you.

We’re changing women’s health care—for the better. We’re partnering with Privia Women’s Health to give caring for women the prominence it deserves. But don’t worry…

  • We did not sell our practice!
  • We’ll care for you—like we always have.
  • You’ll still see your doctor or nurse practitioner at the location of your choosing.
  • You’ll still be able to see VWC specialists as needed.

Our new partnership provides us with patient-centered technology that helps us to efficiently and thoroughly address your needs.

  • EHR.  We are upgrading our electronic health record system. Our new EHR is a great tool to help us manage your medical information faster and more efficiently. You’ll be asked to provide a photo ID along with your insurance card at your next appointment.
  • Patient Portal. We’re upgrading our patient portal, too! You will be able to do all of the same things you were able to do in our old patient portal. but it’s easier to navigate. At your next appointment, you’ll be asked to confirm your email address and mobile number and given a new portal registration link.
  • Online Scheduling. We are converting to an enhanced scheduling system that will allow you to schedule your appointments—including specific date, time and visit type—using your phone, tablet or computer, wherever you are. Appointment availability will be displayed in real-time!
  • You’ll start seeing the Privia logo on invoices, explanation of benefits (EOB) our website, and a few other places. But don’t worry, as always, we’re here to answer any questions you may have.

“It was extremely important that we did not compromise the integrity and all of the work we have put into growing Virginia Women’s Center into what it is today,” said Kay Stout, MD, President, Virginia Women’s Center.”

“The biggest advantage of this strategic alignment with Privia is our ability to remain independent while experiencing the benefits of a larger, more well-equipped network where the patient is paramount and healthcare is local.”

 

FDA Concerns about Laser Devices

Virginia Women’s Center offers the MonaLisa Touch® procedure to patients suffering from vaginal atrophy that results in painful intercourse, vaginal dryness, burning, and itching.

You may have heard that the FDA recently contacted the manufacturer of MonaLisa Touch and other similar devices, with concerns regarding the accuracy of their marketing messaging.

Years ago, the FDA approved the use of the MonaLisa Touch for general gynecological indications including incision, excision, ablation, vaporization, and coagulation of body soft tissues. However, the FDA has not specifically approved the device for vaginal rejuvenation in the United States. At Virginia Women’s Center, we take patient safety very seriously. However, we also know it’s important to keep on the cutting-edge of technological advances to best serve our patients.

Virginia Women’s Center is committed to providing women with the personal care they deserve. Since 2015 we have successfully treated hundreds of women suffering from menopause-related vaginal symptoms using the MonaLisa Touch, without any serious side effects. We believe this is a safe, effective treatment option for women who can’t take or don’t want hormone containing therapies. If you have questions about the FDA’s warnings, please reach out to Virginia Women’s Center’s Drs. Kristin Schraa or Peter Wilbanks, 804.288.4084.

Below is a list of studies supporting the efficacy and safety of the MonaLisa Touch for use in managing the symptoms of vaginal atrophy.

https://www.ncbi.nlm.nih.gov/pubmed/29286986

https://www.ncbi.nlm.nih.gov/m/pubmed/29726916/

https://www.ncbi.nlm.nih.gov/pubmed/29795970

https://www.ncbi.nlm.nih.gov/pubmed/28881431

https://www.ncbi.nlm.nih.gov/pubmed/28866727

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584900/

https://www.ncbi.nlm.nih.gov/pubmed/28056209

https://www.ncbi.nlm.nih.gov/pubmed/27823733

https://www.ncbi.nlm.nih.gov/pubmed/27170261

https://www.ncbi.nlm.nih.gov/pubmed/27558459

https://www.ncbi.nlm.nih.gov/pubmed/27404032

https://www.ncbi.nlm.nih.gov/pubmed/27648595

https://www.ncbi.nlm.nih.gov/pubmed/27383297

https://www.ncbi.nlm.nih.gov/pubmed/25333211

https://www.ncbi.nlm.nih.gov/pubmed/25596815

https://www.ncbi.nlm.nih.gov/pubmed/24605832

https://www.ncbi.nlm.nih.gov/pubmed/28843942

https://www.ncbi.nlm.nih.gov/pubmed/26536212

https://www.ncbi.nlm.nih.gov/pubmed/29492713

Surviving Morning Sickness

Suffering from morning sickness? Midlothian OB/GYN Dr. Elisabeth McGaw walks expectant moms through the options.

How to Survive Morning Sickness

For many women, the joy of pregnancy is soon eclipsed by the misery of morning sickness. They’re constantly nauseous. Nothing tastes good. Aromas of cooking chicken or bacon or even a certain soap, have you running to the bathroom with your hand over your mouth.

The good news is that morning sickness typically gets better after the 12th or 13th week of pregnancy. But if you’re feeling terrible, don’t assume you just have to put up with it! “There’s no reason to suffer,” says Dr. Elisabeth A. McGaw, an OB/GYN in the Midlothian office of Virginia Women’s Center. Morning sickness remedies are available that can offer some relief.

Here’s what you need to know about surviving morning sickness.

How can I reduce the symptoms of morning sickness?

Unfortunately, there is not one simple remedy that works for everyone. The first thing Dr. McGaw recommends is making some changes to your diet:

  • Eat small, frequent meals.
  • Try to eat high-protein foods, if your stomach allows it.
  • Otherwise, eat bland foods like crackers, pretzels, bananas, rice, applesauce or toast — just as if you were recovering from a gastrointestinal virus.
  • Try products containing ginger, such as ginger candies and teas, which can soothe the stomach.
  • To stay hydrated, try drinks that are cold, clear, carbonated or sour, such as ginger ale and lemonade. Whole-fruit popsicles work, too.
  • Are there effective morning sickness medications that are safe for baby?

For first-line treatment of nausea and vomiting of pregnancy, the American College of Obstetricians and Gynecologists recommends a prescription medication called Diclegis. Rated Pregnancy Category A, the highest safety rating possible, it’s a delayed-release medication that functions to prevent nausea. That means Diclegis doesn’t provide instant relief, but can reduce symptoms of nausea and vomiting the next day if taken at bedtime. Check with your insurance carrier to determine the cost of Diclegis.

An over-the-counter alternative is taking vitamin B6 in conjunction with Unisom, an antihistamine sleep aid. (These two medications are the same medications found in Diclegis.) This remedy is often taken at night because it causes drowsiness. Your provider can give you details on dosages.

If morning sickness symptoms don’t get any better, a patient may be prescribed a medication like Zofran (ondansetron), which relieves nausea within 30 minutes. Zofran and similar medications are considered Category B; that means no studies have shown they cause birth defects, Dr. McGaw explains, but the studies evaluating their safety in pregnancy are limited.

If acid reflux is contributing to morning sickness, over-the-counter medications such as Zantac or Tums can be added for further relief.

When should I be concerned about morning sickness symptoms?

The main question to ask yourself, Dr. McGaw says, is “How is this affecting my quality of life?” Can you still go to work and do everything you need to do? Or is the nausea really hampering your ability to function?

Severe morning sickness may be hyperemesis gravidarum, a serious pregnancy condition with symptoms that include excessive, persistent nausea and vomiting; weight loss; dehydration and electrolyte imbalance. You may remember from the media, this condition struck Kate Middleton especially hard during her first pregnancy.

Some women can still feel very sick and still not have hyperemesis. “If they’re ever unsure, they should always come to the office and let the doctor examine them,” Dr. McGaw says. The doctors at Virginia Women’s Center can do lab work to further evaluate them.

Nominated as one of Best OB/GYN in Richmond

We’re honored to be nominated as one of the Best OB/GYN practices in RVA. Thank you readers of the Richmond Times-Dispatch! If you love your VWC provider, please share that love and vote for us. Voting closes August 5th.

Pregnancy Brain: Is it Real or a Myth?

Mechanicsville OB/GYN Dr. Rachel Kreis, of Virginia Women’s Center discusses the experience of “pregnancy brain”: What it feels like, why it occurs and how expectant moms can cope.

You keep losing track of your keys. You forget that one important thing you wanted to buy at the store. You open the fridge and stare at the shelves, unable to remember what you wanted, or you struggle to find the word for… water.

Feeling strangely absent-minded during pregnancy? You’re not the only one — and you’re not imagining your symptoms. “Pregnancy brain” usually manifests as a feeling of easy forgetfulness, difficulty focusing, or lapses in short-term memory, explains Dr. Rachel N. Kreis, an OB/GYN who practices at Virginia Women’s Center’s Mechanicsville location.

Is it normal to experience pregnancy brain?

Yes, Dr. Kreis tells moms-to-be. “Fifty to 80 percent of patients report feeling like this,” she says, “but not that many patients bring it up at doctor visits, so their concerns are likely going unaddressed.” If you’re concerned about symptoms (or your spouse/partner is!), talk to your VWC doctor.

What causes pregnancy brain?

The condition may be caused by a combination of factors, Dr. Kreis says: stress, lack of sleep, changes in hormone levels (estrogen, progesterone, oxytocin), and the mental shift toward preparing for baby’s arrival.

Some research suggests that pregnancy causes long-term changes in the brain that improve emotional intelligence, better preparing moms for parenting. “The structural renovations wrought by pregnancy appear to overlap almost perfectly with the brain regions that play a key role in how we understand and interpret the actions, intentions and feelings of others,” the L.A. Times reports.

Does pregnancy brain affect intelligence? 

No! It’s important to know that there is no decrease in actual cognitive ability or IQ associated with pregnancy. “If a patient is asked to take a test, she likely will do just as well as if she’s not pregnant,” Dr. Kreis explains.

How can mothers-to-be deal with pregnancy brain? 

 Dr. Kreis recommends some simple coping strategies:

  • Write things down, and keep a detailed calendar or day planner.
  • Simplify your daily routines, and make them consistent.
  • Get organized! Try to make a habit of putting things back in the same place every time. (This will also help you deal with the chaos a newborn introduces to the household.)
  • Get more sleep and exercise.
  • Ask for help from family and friends. This is a good habit to practice in pregnancy, as you’ll need support once baby arrives.

How long does pregnancy brain last? 

The structural changes in the brain of a first-time mom may remain for at least two years after birth, recent research suggests. Symptoms should improve after delivery, but may last longer if stressors and lack of sleep persist.

If you experience significant difficulty focusing after childbirth, and also feel overwhelmed or sad, it could be depression rather than just pregnancy brain, Dr. Kreis says. That’s why it’s important to discuss any symptoms or concerns you feel with your doctor. The providers at Virginia Women’s Center can help if you’re struggling with postpartum depression, anxiety, or stress. Searching for compassionate women’s healthcare in Richmond? Schedule an appointment by calling 804.288.4084.

Give yourself some love, too.

Guidelines for Pap smears and cervical cancer screening have changed over the last few years. But that doesn’t mean you should skip your annual GYN exam —your wellness visit. Your annual check-up is more than a pelvic and breast exam. It’s about checking in on your overall health.

Before you find yourself sitting on the exam table, put some thought into what you want to get out of your visit. Did anything happen since your last wellness visit that worried you slightly but not enough to prompt a visit to the doctor’s office? This is your chance to talk to your provider and share what’s new in your life. An opportunity to discuss changes in your body, period and sleep patterns. Are you experiencing pain during sex? Leaking when you run, jump or laugh too hard? Have your birth control or hormone replacement needs changed?  Based on your conversation, you and your provider can decide if there are any screenings or tests you might need.

Your annual wellness visit includes a physical exam and health assessment which can help detect problems like high blood pressure, diabetes, thyroid issues, bone density loss, cervical, uterine, breast and colon cancer, anemia and more. And, it’s your chance to address your emotional well-being, too. Are you taking life’s challenges in stride? Or are you constantly feeling overwhelmed and exhausted? What about abuse – partner or substance?  Your provider can’t help you if you don’t share what’s going on in your life, body, and mind.

If you’re like many women, your annual wellness visit is the only time you take out of your hectic schedule to see a doctor. Make the most out of it. Be honest and open so that they can help keep you healthy, catch problems early, start treatment and prevent long-term issues.

If you have trouble remembering when your last check-up was, or difficulty remembering when to set up the next one, schedule it during your birth month. Think of your annual exam as a gift to yourself – the gift of health and well-being. And, put yourself on top of your to-do list. You’re worth it. And, your family and friends will thank you for taking care of yourself.

About Virginia Women’s Center

At Virginia Women’s Center, every medical decision we make — together with you — is based on what is best for you. Our goal is to educate and empower you so that you can actively manage and maintain your health, no matter where you are in your life journey. We provide comprehensive care — mind and body. Our dedicated, knowledgeable team is here for you, from adolescence to menopause and beyond.

In addition to gynecologic care, we offer urogynecology,  complete breast health services,  in-office procedures, bone health and psychology services in the comfort and convenience of our offices. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Birth Control Packaging Error Leads to Recall – May 2018

On May 24, 2018,  Allergan voluntarily recalled one lot of Taytulla® sample birth control packs due to pill sequencing concerns. The first four days of the pack included non-hormonal placebos instead of active pills.  As a result of this packaging error, contraceptive failure and unintended pregnancy may occur.

If you received a sample(s) of Taytulla, check the lot number.  If you have an affected sample, lot #5620706., please return it to our office for replacement, and use another form of birth control in the meantime.

To view the details of the recall, visit the FDA’s website at www.fda.gov/safety/recalls and click on the Taytulla link.

If you have further questions, please do not hesitate to call us at 804.288.4084.

News you can use

A bone density test measures the amount of bone mineral content and density at specific sites (mainly the hip and the spine) that are most susceptible to fracture. The test compares your results to an established norm.

PerimenopauseAt Virginia Women’s Center, we use a technology called DXA (dual-energy X-ray absorptiometry) to measure bone density. DXA scans are performed in two of our office locations, often at the same time as your annual exam and mammogram. Learn how to prepare for your DXA scan here.

Why should I have a bone density test?

  • Prevention
    • You can learn if you have weak bones or osteoporosis and take steps to prevent breaking a bone in the future
  • Tracking
    • You can see if your bone density is improving, getting worse or staying the same
    • You can measure your response to osteoporosis treatment
  • Diagnosis
    • If you have already broken a bone, you can determine if you have osteoporosis

 

Who should have a bone density scan?

 

What do the results of my bone density test mean?

The results of your bone density test are reported in two numbers: a T-score and a Z-score. A T-score shows your bone density compared to that of a healthy 30 year old adult. T-scores are in units called standard deviations where a healthy 30 year old adult has a score of 0. The more standard deviations your bone density is below 0, the lower your bone density and the higher your risk of fracture.

Based on your results, your health care provider can determine if any treatment is necessary for you to prevent your risk of breaking bones in the future.

  1. Normal bone density = Your T-score is within one standard deviation of the young adult mean (+1 or -1). Your bone density is considered normal.
  2. Low bone density or osteopenia = Your T-score is between -1 and -2.5 standard deviations from the young adult mean. Your bone density is below normal and you have a greater chance of developing osteoporosis. Most women in this category do not require medication – only Calcium, Vitamin D and weight-bearing exercise.
  3. Osteoporosis = Your T-score is -2.5 standard deviations or below from the young adult mean. Your bone density indicates you have osteoporosis. Medication should be considered to reduce the risk of fracture.

 

A Z-score, also measured in standard deviations, compares your bone density to what is normal for someone your age and body size. In older adults, the Z-score can be misleading since low bone mineral density is quite common. For younger individuals, the Z-score can be helpful in determining if there is an underlying disease or condition that is causing bone loss.

Learn more:

 

About Virginia Women’s Center 
Virginia Women’s Center is a full-service women’s health care provider specializing in obstetricsgynecologyurologyhigh-risk obstetricsobstetrical genetic counseling, ultrasound, in-office proceduresmammographybone healthpsychologynutrition and clinical research. The practice sees patients in four locations in the Richmond area and has additional offices in Kilmarnock and Tappahannock. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

New Partnership Empowers Women’s Health Providers

Virginia Women’s Center is partnering with to Privia Health to form Privia Women’s Health, focusing on providing women with exceptional healthcare.  

RICHMOND, VA (May 10, 2018) Virginia Women’s Center, Inc. (“VWC”) announced today a strategic alignment with Privia to form Privia Women’s Health, designed to provide women with enhanced access to genuine, accurate, and authentic care. Privia Women’s Health will be completely physician-led and governed with the sole focus of providing better support and economic outcomes that providers need in order to holistically treat their patients.

“It was extremely important that we did not compromise the integrity and all of the work we have put into growing Virginia Women’s Center into what it is today,” said Kay Stout, MD, President, Virginia Women’s Center. “The biggest advantage of this strategic alignment with Privia is our ability to remain independent while experiencing the benefits of a larger, more well-equipped network where the patient is paramount and healthcare is local.”

Privia Women’s Health will be uniquely positioned to allow women’s healthcare providers to continue to own their own practices while gaining the support and infrastructure of a team of experts who will secure optimal payer contracts in both fee-for-service and value-based arrangements. This model reduces administrative burden and provides patient access to ancillaries and revenue cycle support, among other services.

“We are thrilled to announce our arrangement with Virginia Women’s Center, as we could think of no better partner to make a significant difference in how women are cared for,” said Lauri Rustand, President, Privia Medical Group – Mid-Atlantic. “Our reality is that healthcare is a confusing industry and we need to preserve the importance of the provider/patient relationship between women and their care providers.”

Questions, contact marketing@vwcenter.com

 

Maintaining Strong Bones: Who Needs Calcium?

While certain factors can increase one’s risk for Osteoporosis, there are some measures that all women can take to help prevent the development of Osteoporosis. One of these measures is to make sure you are getting enough Calcium in your diet. This infographic will explore how much Calcium women need throughout the different stages of their lives as well as some good sources of Calcium.

For more information about the symptoms, risk factors and ways to detect Osteoporosis, read this blog post. To learn more about the different ways to prevent Osteoporosis, check out this blog post.

 

Check Your Eggs – 208 Million Eggs Recalled Due to Suspected Salmonella

Salmonella poisoning can cause abdominal pain, diarrhea, fever and chills, nausea and vomiting, dehydration, and headaches. Not fun!

Most of the time, the risks of salmonella to expectant moms are minimal. It usually just runs its course and isn’t of specific concern. But if a mom-to-be becomes really sick and the infection gets into the bloodstream, it can cause sepsis. Additionally, there are reported cases of preterm labor and miscarriages as a result of the illness. Although these cases are exceedingly rare, it’s best to avoid getting salmonella poisoning in the first place.

Please check the eggs in your fridge to make sure they are not part of this recall.  The federal Food and Drug Administration reported that eggs from the affected farm were distributed to nine states—including Virginia.

https://www.fda.gov/Safety/Recalls/ucm604640.htm

Postpartum Incontinence: What You Need to Know

Postpartum Incontinence: What You Need to Know

You sneeze, and—oops. A friend makes you laugh, and—oops. You run after your rambunctious dog, and—oops.

Experiencing occasional incontinence is one of those post-pregnancy side effects that takes women by surprise. Many women just accept it (and try to avoid triggering it), but you don’t have to. Richmond urogynecologist Dr. Tovia M. Smith, of Virginia Women’s Center shares common misconceptions around incontinence and treatment options.

I can’t talk to my doctor about postpartum incontinence—it’s so embarrassing!

Many women are embarrassed about incontinence, or they don’t know who to turn to, Dr. Smith says. That’s why “here at Virginia Women’s Center, we really make a point to ask about it.”

Incontinence is one of those post-pregnancy side effects that takes many women by surprise. It’s totally common and even expected, Dr. Smith reassures her patients. “Many women don’t seek care because they aren’t that bothered by it,” she says, and that’s OK. At the same time, if postpartum incontinence is affecting your quality of life, it’s time to talk to your doctor.

Incontinence will go away on its own in a few months—right?

After childbirth, your body needs time to recover and function normally. If you’re not nursing, your period may return around the third month postpartum. If you are nursing, you may not get your period for several months.

Having regular periods means “your body’s back to its new normal, hormonally speaking,” Dr. Smith explains, and that means episodes of incontinence should decrease: “The majority of women do improve, to the point where it’s no longer a major quality-of-life issue.” But if you’re still leaking six to 12 months postpartum (and not nursing), it may be time to seek advice from your doctor.

If I’d had a C-section, I wouldn’t have problems with incontinence now. 

Having a C-section does not necessarily prevent it, Dr. Smith says. While prolonged pushing, having a large baby and having a forceps delivery are associated with an increased risk, postpartum incontinence is caused by many factors.

Number one is hormones. During pregnancy, progesterone levels are elevated, which relaxes muscles such as the esophagus (leading to reflux) and the urethral sphincters, which control the flow of urine from the bladder. “I call it the loosey-goosey hormone,” Dr. Smith says.

Another factor is pregnancy-related trauma to the nerves and muscles that run through the pelvic floor to and around the urethra. The weight of carrying a baby for nine months, plus the trauma of childbirth, can damage nerves and tear the pelvic muscles. “I don’t know when I have to pee anymore,” women tell Dr. Smith. Others say that they can’t really feel themselves squeezing when trying to stop the urine stream.

Other causes are simply environmental. New moms may be drinking a lot of water if they’re nursing, but they’re so busy caring for their newborn that they often forget to go to the bathroom.

Incontinence is a problem for me, but there’s nothing I can do about it.

When postpartum incontinence is persistent and affecting a woman’s quality of life, there are several treatment options. The first is Kegel exercises, which aren’t as simple as women think they are! Dr. Smith recommends working with a physical therapist on muscle training to strengthen the pelvic floor with the help of biofeedback to “really make that brain to pelvic connection.”

Another option is a pessary, a small vaginal device that increases the resistance in the urethra. Dr. Smith shows women how to put it in place and take it out. A pessary is completely removable and reversible.

When incontinence persists, Dr. Smith asks two questions: “Is this bothersome enough to you to take a surgical step? And are you done with childbearing?” If the answer to both is yes, she may recommend a urethral sling, which lifts the urethra and exerts pressure to help control the flow of urine.

For many women, the biggest relief they feel is simply knowing they’re not alone in dealing with postpartum incontinence. The first step toward a solution is making an appointment by calling 804.288.4084.

 

 

Dr. Smith is as passionate about giving women time and space to discuss their symptoms as she is educating women on their conditions and treatment options. With all treatments, she aims to help women of any age regain an improved quality of life.

As a urogynecologist, Dr. Smith uses non-surgical approaches as well as advanced technologies, such as minimally invasive surgery and the daVinci® Surgical System, to reconstruct the pelvic floor for women who suffer from pelvic organ prolapse, urinary incontinence and fecal incontinence. In addition, she is skilled in repairing fistulas and complications from third and fourth-degree tears following vaginal childbirth.

Dr. Smith earned her bachelor’s degree from Yale University, where she played varsity field hockey as an All-American for the Bulldogs. She earned her medical degree from the University of Virginia, where she was elected to the Gold Humanism Honor Society for compassion in medicine. Dr. Smith trained in obstetrics and gynecology at the University of Virginia. She then pursued a specialty fellowship in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology) at the University of Michigan in Ann Arbor, an ACGME Accredited program.

Strong From The Inside Out

Strong From The Inside Out: Osteoporosis Prevention in Every Decade

It doesn’t hurt. You can’t feel it.
And by the time you have symptoms, it’s too late to reverse it.

Osteoporosis—a condition that thins and weakens bones, making them more likely to fracture — is thought by many to only affect women who are 70 or older. The truth is, bone loss begins well before then, and osteoporosis prevention should too.  “It’s an important part of women’s health, thinking about bone loss after the age of 20,” says Dr. Karin W. Buettner, an OB/GYN in the Short Pump office who is Virginia Women’s Center’s resident expert on osteoporosis. Here’s what you should be doing to reduce your risk.

Osteoporosis prevention in every decade

In your 20s. your bones are as strong as they’ll ever be. Bone mass usually peaks in a woman’s mid-20s, so young women should try to eat a calcium-rich diet and start a lifelong habit of exercise, especially weight training. Maintain a healthy weight, because being underweight is a significant risk factor for osteoporosis.

In your 30s. your bones are already losing calcium. “Bone loss definitely gets accelerated as you’re getting older, and you need to think about protecting your bones,” Dr. Buettner says. Maintain that exercise habit and high-calcium diet. Also, check your multivitamin, Dr. Buettner says, to see if you’re getting enough vitamin D. She recommends 800-1000 IU per day, starting in the 30s. She sees a fair amount of vitamin D deficiency even in Richmond, Virginia, where most people get adequate sun exposure.

In your 40s, Dr. Buettner says, you should begin having a conversation about osteoporosis prevention with your doctor. She reviews women’s medical history and prescription medications to see if they’re at risk. And “I give them homework to see how much calcium they’re getting in their diet daily,” she says. The good news is that most women are getting enough, or close to it—“it’s pretty amazing.” Yogurt and cheese contribute a lot of calcium, as do nuts and greens.

In your 50s, it may already be time to do a bone density test. Menopause is a risk factor for bone loss, and if you have certain medical issues, Dr. Buettner may even recommend getting the test pre-menopause. “It’s pretty amazing how we do actually find significant bone loss before 65,” she says.

In your 60s and beyond, continue with weight-bearing exercise, vitamin D, a calcium-rich diet as well as any recommended medications.

What is a bone density test?  

Bone density tests are quick, and the procedure doesn’t hurt at all. At Virginia Women’s Center, we use dual-energy absorptiometry (DXA) to measure your bone strength, vulnerability to fractures and risk for osteoporosis. In the 15-minute test, you lie on a cushioned bed while a mechanical arm scans your lower spine and hips, which are the two areas most likely to break because of osteoporosis. It’s a more accurate test than an ultrasound scan of the heel, Dr. Buettner says, and radiation levels are extremely low—even lower than airport security screening machines. Bone density testing is offered at our Mechanicsville and Short Pump locations.

If you find out that you have a higher risk of osteoporosis, or if you develop osteoporosis, Dr. Buettner and the other VWC providers can help! Treatment recommendations may include dietary changes, exercise and medications. Make an appointment today by going online or calling 804.288.4084.

 

 

Dr. Karin Buettner practices at the Short Pump location of Virginia Women’s Center.  She’s passionate about helping women of all ages, and emphasizes individualized medical care, by getting to know the unique qualities of her patients. Dr. Buettner takes into account not only the physical changes taking place but the emotional ones, too.  If you’d like to make an appointment with Dr. Buettner, you may do so online or by calling 804.288.4084.

Strong From The Inside Out: Osteoporosis Prevention in Every Decade

Strong From The Inside Out: Osteoporosis Prevention in Every Decade

It doesn’t hurt. You can’t feel it.
And by the time you have symptoms, it’s too late to reverse it.

Osteoporosis—a condition that thins and weakens bones, making them more likely to fracture — is thought by many to only affect women who are 70 or older. The truth is, bone loss begins well before then, and osteoporosis prevention should too.  “It’s an important part of women’s health, thinking about bone loss after the age of 20,” says Dr. Karin W. Buettner, an OB/GYN in the Short Pump office who is Virginia Women’s Center’s resident expert on osteoporosis. Here’s what you should be doing to reduce your risk.

Osteoporosis prevention in every decade

In your 20s. your bones are as strong as they’ll ever be. Bone mass usually peaks in a woman’s mid-20s, so young women should try to eat a calcium-rich diet and start a lifelong habit of exercise, especially weight training. Maintain a healthy weight, because being underweight is a significant risk factor for osteoporosis.

In your 30s. your bones are already losing calcium. “Bone loss definitely gets accelerated as you’re getting older, and you need to think about protecting your bones,” Dr. Buettner says. Maintain that exercise habit and high-calcium diet. Also, check your multivitamin, Dr. Buettner says, to see if you’re getting enough vitamin D. She recommends 800-1000 IU per day, starting in the 30s. She sees a fair amount of vitamin D deficiency even in Richmond, Virginia, where most people get adequate sun exposure.

In your 40s, Dr. Buettner says, you should begin having a conversation about osteoporosis prevention with your doctor. She reviews women’s medical history and prescription medications to see if they’re at risk. And “I give them homework to see how much calcium they’re getting in their diet daily,” she says. The good news is that most women are getting enough, or close to it—“it’s pretty amazing.” Yogurt and cheese contribute a lot of calcium, as do nuts and greens.

In your 50s, it may already be time to do a bone density test. Menopause is a risk factor for bone loss, and if you have certain medical issues, Dr. Buettner may even recommend getting the test pre-menopause. “It’s pretty amazing how we do actually find significant bone loss before 65,” she says.

In your 60s and beyond, continue with weight-bearing exercise, vitamin D, a calcium-rich diet as well as any recommended medications.

What is a bone density test?  

Bone density tests are quick, and the procedure doesn’t hurt at all. At Virginia Women’s Center, we use dual-energy absorptiometry (DXA) to measure your bone strength, vulnerability to fractures and risk for osteoporosis. In the 15-minute test, you lie on a cushioned bed while a mechanical arm scans your lower spine and hips, which are the two areas most likely to break because of osteoporosis. It’s a more accurate test than an ultrasound scan of the heel, Dr. Buettner says, and radiation levels are extremely low—even lower than airport security screening machines. Bone density testing is offered at our Mechanicsville and Short Pump locations.

If you find out that you have a higher risk of osteoporosis, or if you develop osteoporosis, Dr. Buettner and the other VWC providers can help! Treatment recommendations may include dietary changes, exercise and medications. Make an appointment today by going online or calling 804.288.4084.

 

 

Dr. Karin Buettner practices at the Short Pump location of Virginia Women’s Center.  She’s passionate about helping women of all ages, and emphasizes individualized medical care, by getting to know the unique qualities of her patients. Dr. Buettner takes into account not only the physical changes taking place but the emotional ones, too.  If you’d like to make an appointment with Dr. Buettner, you may do so online or by calling 804.288.4084.

Postpartum Incontinence: What You Need to Know

You sneeze, and—oops. A friend makes you laugh, and—oops. You run after your rambunctious dog, and—oops.

Experiencing occasional incontinence is one of those post-pregnancy side effects that takes women by surprise. Many women just accept it (and try to avoid triggering it), but you don’t have to. Richmond urogynecologist Dr. Tovia M. Smith, of Virginia Women’s Center shares common misconceptions around incontinence and treatment options.

I can’t talk to my doctor about postpartum incontinence—it’s so embarrassing!

Many women are embarrassed about incontinence, or they don’t know who to turn to, Dr. Smith says. That’s why “here at Virginia Women’s Center, we really make a point to ask about it.”

Incontinence is one of those post-pregnancy side effects that takes many women by surprise. It’s totally common and even expected, Dr. Smith reassures her patients. “Many women don’t seek care because they aren’t that bothered by it,” she says, and that’s OK. At the same time, if postpartum incontinence is affecting your quality of life, it’s time to talk to your doctor.

Incontinence will go away on its own in a few months—right?

After childbirth, your body needs time to recover and function normally. If you’re not nursing, your period may return around the third month postpartum. If you are nursing, you may not get your period for several months.

Having regular periods means “your body’s back to its new normal, hormonally speaking,” Dr. Smith explains, and that means episodes of incontinence should decrease: “The majority of women do improve, to the point where it’s no longer a major quality-of-life issue.” But if you’re still leaking six to 12 months postpartum (and not nursing), it may be time to seek advice from your doctor.

If I’d had a C-section, I wouldn’t have problems with incontinence now. 

Having a C-section does not necessarily prevent it, Dr. Smith says. While prolonged pushing, having a large baby and having a forceps delivery are associated with an increased risk, postpartum incontinence is caused by many factors.

Number one is hormones. During pregnancy, progesterone levels are elevated, which relaxes muscles such as the esophagus (leading to reflux) and the urethral sphincters, which control the flow of urine from the bladder. “I call it the loosey-goosey hormone,” Dr. Smith says.

Another factor is pregnancy-related trauma to the nerves and muscles that run through the pelvic floor to and around the urethra. The weight of carrying a baby for nine months, plus the trauma of childbirth, can damage nerves and tear the pelvic muscles. “I don’t know when I have to pee anymore,” women tell Dr. Smith. Others say that they can’t really feel themselves squeezing when trying to stop the urine stream.

Other causes are simply environmental. New moms may be drinking a lot of water if they’re nursing, but they’re so busy caring for their newborn that they often forget to go to the bathroom.

Incontinence is a problem for me, but there’s nothing I can do about it.

When postpartum incontinence is persistent and affecting a woman’s quality of life, there are several treatment options. The first is Kegel exercises, which aren’t as simple as women think they are! Dr. Smith recommends working with a physical therapist on muscle training to strengthen the pelvic floor with the help of biofeedback to “really make that brain to pelvic connection.”

Another option is a pessary, a small vaginal device that increases the resistance in the urethra. Dr. Smith shows women how to put it in place and take it out. A pessary is completely removable and reversible.

When incontinence persists, Dr. Smith asks two questions: “Is this bothersome enough to you to take a surgical step? And are you done with childbearing?” If the answer to both is yes, she may recommend a urethral sling, which lifts the urethra and exerts pressure to help control the flow of urine.

For many women, the biggest relief they feel is simply knowing they’re not alone in dealing with postpartum incontinence. The first step toward a solution is making an appointment by calling 804.288.4084.

 

 

Dr. Smith is as passionate about giving women time and space to discuss their symptoms as she is educating women on their conditions and treatment options. With all treatments, she aims to help women of any age regain an improved quality of life.

As a urogynecologist, Dr. Smith uses non-surgical approaches as well as advanced technologies, such as minimally invasive surgery and the daVinci® Surgical System, to reconstruct the pelvic floor for women who suffer from pelvic organ prolapse, urinary incontinence and fecal incontinence. In addition, she is skilled in repairing fistulas and complications from third and fourth-degree tears following vaginal childbirth.

Dr. Smith earned her bachelor’s degree from Yale University, where she played varsity field hockey as an All-American for the Bulldogs. She earned her medical degree from the University of Virginia, where she was elected to the Gold Humanism Honor Society for compassion in medicine. Dr. Smith trained in obstetrics and gynecology at the University of Virginia. She then pursued a specialty fellowship in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology) at the University of Michigan in Ann Arbor, an ACGME Accredited program.

The SMART Way to Shed Holiday Stress

Family photo. Holiday cards. School concert. Friends’ cookie swap. Neighbors’ progressive dinner. Work holiday party. Client gifts. Hosting dinner for 20.

Are you having fun yet?

Most domestic duties and merry-making activities and tasks are handled by women,  says Dr. Mary E. Polce, a licensed professional counselor and developmental psychologist with Virginia Women’s Center. That’s why self-care and a healthy dose of “no” are vitally important. Here’s Dr. Polce’s SMART method for coping with holiday stress.

S.   Share the holiday work as well as the joy.

“Smart women know it is not possible to fit all the shopping, wrapping, baking, decorating, entertaining, corresponding with cards, etc. into a four-week window, Dr. Polce says. “So ask for help and accept the reality that everything may not get done exactly as you would do it.” Ask spouses, family and children to help. Buy cookies from a bakery; order the apps or entrée from your favorite deli. While browsing locally owned boutiques is great, sometimes you need to power-shop online—and services like Shoprunner, which give you free two-day shipping at hundreds of stores, can be well worth the membership cost.

 M.   Monitor your basic needs. 

Protect your power sources: food and sleepAdhere to your sleep routines, Dr. Polce advises, and pay attention to your nutritional needs. “Most ‘mommy meltdowns’ are no different from toddler tantrums,” she says. “Everyone has a shorter fuse when tired, hungry and stressed!” Ways to practice self-care include:

  • Take time for you. (No one will give it to you… especially the kids.)
  • Maintain your usual sleep and exercise routines, despite the chaos of the holiday calendar.
  • Make a cup of tea or pour a glass of cold water just for you. Sit and enjoy it, daily.
  • Prioritize the practices that help you de-stress, such as yoga, meditation or prayer.

A.   Always let your yes mean yes, and your no mean no. 

When you don’t want to do something stressful during the holidays, say no. “Practice saying no without adding a litany of reasons why you’re not a superhuman being,” Dr. Polce says. She calls it “the Netherlands no,” after the Dutch custom of politely declining without bending over backward to apologize. Feel like you really need a reason? Try saying, “We’re simplifying this year,” or “No, not this year.” Your response may model healthy boundaries for others.

However, when you say “yes,” do so wholeheartedly. “If you agree to host 35 people, it doesn’t make sense to say ‘yes’ and then later complain about it,” Dr. Polce says. Instead, let the work be a gift from your heart, and enjoy it.

R.  Realistic expectations keep you sane and happy. 

To ward off holiday stress, make time to connect with one of your friends who has a gift for maintaining a healthy work-life balance. Have a conversation about what’s going on in your lives, and try to get a reality check. Can everything be homemade? No. Will every event go perfectly? No. Can you do every single thing you want to do? No. Try to adjust your expectations and do the best you can. Give thanks for all that goes well, and develop a sense of humor for what doesn’t.

 T.  Take time to enjoy the moments.

When you look at photographs of past holidays, are you rarely present because you’re always holding the camera? It’s time to change that. Put yourself in the picture this year. One way to do that is to reduce screen time by cutting back the hours you lose on Instagram or Pinterest. “If you know you’re the person who gets lost in technology, perhaps don’t start it,” Dr. Polce suggests. Practice self-discipline, or use tools like blockers to put on the brakes. Remember what’s important: “You will only experience this holiday once in your life. Show up. Be present and take it all in… the faces of loved ones, laughter, hugs, tears, scents, and lights. And, of course, if you have a faith tradition let it guide your moments and priorities.”

Remember that your mental health is just as important as your physical health. Psychologists at Virginia Women’s Center can help if you’re struggling with anxiety, stress and depression, loss and grief, relationship challenges or other life transitions.

High Risk for Breast Cancer? Here’s What You Can Do.

When you come to Virginia Women’s Center for a mammogram, you get much so much more than just breast cancer screening. You get an expert medical team dedicated to learning about your risk factors and health concernsa team that uses state-of-the-art 3D technology to review your breast tissue layer by layer in 1mm slices. And, every woman who comes in for breast screening also receives a preliminary assessment of her risk of developing breast cancer in her lifetime.

We use the Tyrer-Cuzick model (sometimes called IBIS) to determine your risk of developing breast cancer. “It’s not a perfect test, but it’s one of the best ones available,” says Dr. Katherine Czyszczon (pronounced sizz-ZON) or Dr. “C” as most of her patients call her, an OB/GYN in our West End office. The Tyrer-Cuzick assessment tool considers not only family history, but other variables such as BMI (body mass index) and personal medical history.

The average woman’s lifetime risk of breast cancer is 12 percent. So what happens if you find out that your breast cancer risk is high—20 percent or more?

First steps when you have a higher breast cancer risk 

Don’t panic. “One in 11 women is going to face breast cancer sometime in her life,” Dr. C says. “The wonderful news is, in this day and age, it’s an incredibly treatable disease, and very often curable—when we find it early.”

If you learn that you have an intermediate or high risk of breast cancer, you can discuss it with a breast cancer risk specialist at Virginia Women’s Center. Your doctor can talk about increasing surveillance and may recommend genetic testing, six-month exams, and possibly even a screening MRI.

Another possibility is genetic testing, which can reveal whether you have hereditary gene mutations, such as a BRCA mutation, that would increase your risk of having certain cancers. “There are certain patterns in a family history that would justify screening for genetic predisposition,” Dr. C explains, “but genetic testing isn’t useful for everyone.”  High-risk patients may carry genes that modern medicine hasn’t found yet.

Breast cancer prevention: How to reduce your risk

 Your doctor will also talk to you about breast cancer prevention. Most of the actions you can take to reduce your risk are “the normal things that encourage general health and well-being,” Dr. C says, and it’s never too late to make a difference in your life and in your health.

  • Regular exercise lowers breast cancer risk by about 10 to 20 percent, according to research compiled by the Susan G. Komen Foundation.
  • Maintain a healthy weight, especially after menopause. But don’t obsess over the number on the scale, Dr. C says. “Take one day at a time, and try to do your best. There’s no way you won’t succeed.”
  • Eat a healthy, 80% plant-based diet (fruits, vegetables, whole grains, legumes and nuts) with the other 20% from “real foods” such as healthy fats, fish, etc.  Stick to the outer edges of the grocery store when shopping.
  • Quit smoking. Recent studies suggest a link between smoking and breast cancer risk, especially in premenopausal women.
  • Cut back on alcohol. Studies have consistently found an increased risk of breast cancer as alcohol intake increases, according to the National Cancer Institute. Limit yourself to less than one drink a day, as even small amounts increase risks.
  • Limit hormone therapy. “Anyone who’s considering hormone replacement therapy for menopause symptom relief should consider the pros and cons,” Dr. C says, and consider alternative or non-hormonal treatments first.
  • Breastfeed, if possible, if you’re a new mom. Emerging evidence says breastfeeding may play a role in breast cancer prevention. The longer you can do it, the better.
  • Be vigilant. You know your body better than anyone. If you notice a lump, bump, skin change or discharge, or if you just don’t feel right, call us.

To make an appointment for your annual well-woman visit, or schedule a mammogram, call 804.288.4084.

Dr. Katherine Czyszczon is a much-loved provider who practices at the Virginia Women’s Center West End location on Forest Hill.  When she’s not caring for women, she enjoys running, cooking and spending time with her family and new puppy.

Virginia Women’s Center offers complete breast health services, including state-of-the-art 3D technology which allows the radiologist to examine your breast tissue layer by layer. Instead of viewing all the complexities of your breast in a flat image, fine details are more visible, no longer hidden by the tissue above or below.  The radiologist is able to view 1mm slices of your breast tissue at a time. If anything of concern is found, diagnostic mammograms, ultrasounds and biopsies are performed right here at Virginia Women’s Center. And depending upon the findings, we have a team dedicated to educating and helping you navigate any next steps required.

Healthy Holiday Eating Tips

Skipping lunch before a big holiday dinner. Forgetting to drink water all morning because you’re so busy rushing around. Diving into the buffet at a party—and then feeling guilty for days.

The holiday season is full of pitfalls for people who are trying to maintain healthy eating habits. “They are worried about how to stay on track,” says Valerie Pulley, RDN, Virginia Women’s Center’s registered dietitian. “They don’t want to give up on healthy behaviors they’ve worked so hard on. They’re worried about temptation and how to mindfully deal with it.”

Pulley can help. She offers some strategies to help women eat sensibly (and not stress too much) during the holiday season.

Tips for avoiding holiday overeating 

Pulley’s advice can be summed up in a word: Plan. It’s hard to make mindful eating decisions when you’re hungry, thirsty, rushed and running. During a busy Saturday spent shopping, you may suddenly realize you’re starving—“and there’s the new Cook Out! With milkshakes!”

Planning means always having a high-protein and/or high-fiber snack in your purse or car, so you can replenish your energy. Popcorn is a popular choice or trail mix with little or no added sugar. “I love the one I have in front of me right now,” Pulley says: a balsamic herb-flavored mix of crispy fava beans and peas from The Good Bean. Other ideas: mixed nuts, pumpkin seeds, roasted chickpeas and whole grain crackers with natural nut butter.

Planning meals is also crucial when you’re traveling. Instead of pulling into the first fast-food spot you see, research your route, look up nutritional info and choose your lunch ahead of time, Pulley says. Also, bring a cooler packed with snacks like string or Babybel cheese, hummus or avocado cups, veggies, fruit and hard-boiled eggs.

And don’t forget to stay hydrated! When women come to see Pulley and she starts talking about the importance of water, they often say “Oh! You’re right – I haven’t had any water today.” She goes straight to the water cooler and brings them a cup.

Tips for healthy eating at holiday gatherings

Here’s a secret about holiday potlucks: People want you to bring a healthy dish.

Sure, they might say, “Oh, I hope you make your peppermint bark!” or “Your meatballs last year were amazing.” But in their hearts, they’re wishing for better options.

Pulley hears this in her office all the time. “People want to be able to go to parties, and they want to have healthy choices,” she says. “Especially at work parties.” That doesn’t mean you have to bring the standard plate of raw veggies — consider a Mediterranean mezze platter, smoked salmon, or creatively displayed fruit. “Take your favorite nutritious, healthy option that you love,” Pulley says.

And when other people’s decadent dishes tempt you? Pulley offers some useful tips:

  • Don’t go hungry. Eat a healthy snack beforehand.
  • Don’t stand right next to the food.
  • Begin by filling your plate with salad.
  • Be the last in line at a buffet, because the picked-over food won’t look as appealing.

We can help you stay on track

Women get discouraged when they fail to stick to their healthy routines. It’s all right, Pulley reassures them: “Don’t give up. OK, that happened, but that doesn’t mean you have to give up all the goals and healthy behaviors you’ve established. Forgive yourself and move on.”

Virginia Women’s Center now offers our patients a wellness program that incorporates weight management. Approaches include nutrition education, medication and psychological counseling, and all are medically supervised by a board-certified specialist in weight loss. Best of all, it can be covered by your insurance. An initial consult with Dr. Peter Wilbanks or Nurse practitioner Kelly Yeong is required to enter the program.  Let us help you be the best possible you.

Breast Changes and When to Call Your Health Care Provider

Women’s breasts are always changing, often in response to hormonal changes that occur during the menstrual cycle, pregnancy, breastfeeding and menopause. While many of these changes are normal, problems can also arise. Practicing breast self-awareness can help alert you of any changes in your breasts.

When you know what is “normal” for you, you are better able to identify new changes when they occur. See your health care provider right away if you notice the following:

  • A lump, hard knot or thickening in or near your breast or under your arm
  • Swelling, warmth, redness or darkening
  • Change in the size or shape of the breast
  • Dimpling or puckering of the skin
  • Itchy, scaly sore or rash of the nipple
  • Pulling in of your nipple or other parts
  • Nipple discharge (fluid that is not breast milk)
  • New pain in a spot that does not go away

 

It is important to note that if you experience the symptoms above, it does not necessarily mean you have breast cancer. There are other breast problems that can occur, some of which are fibrocystic breast changes, breast cysts, fibroadenomas and mastitis.

Fibrocystic breast changes are most common in women in their childbearing years. This condition is characterized by breasts that are swollen, lumpy and tender. Breast cysts are small, fluid-filled sacs that may cause pain or tenderness. Breast cysts occur most often in women ages 25-50. Fibroadenomas are most common in young women and are characterized by solid, well-defined lumps. Mastitis is when an infection occurs in the breast tissue, most often in women who are breastfeeding.

In addition to breast self-awareness, regular screening mammograms and clinical breast exams are tools we have that can help detect breast cancer before it has progressed. We know that breast changes can be alarming. If you notice any of the changes listed above, or something else that is new for you, never hesitate to make an appointment with your healthcare provider.

Preparing for College: The Five Hs You Need to Know

So you’re going to college—that’s awesome! Overwhelming AND awesome, we should say. As you’re rushing around looking for extra-long sheets and shoe organizers, make time for one last checkup at with your doctor. It’s not just about vaccinations and lectures on safe sex; we’re here to answer the questions you can’t ask anyone else—no matter how unsure or embarrassed you may feel.

VWC’s Dr. Karen W. Jefferson loves working with teens and will put you at ease. For her, the pre-college checkup is a chance to cover all the things you need to know, from mental health to sexual health. “Sometimes you don’t know what you need to know, and don’t know what questions to ask,” she says. That’s OK. Here are the five Hs you need to think about as you head off to college.

HPV Vaccine

If you never had the opportunity to get the Gardasil vaccine against the human papillomavirus (HPV) when you were younger, or if you didn’t complete the three-shot vaccine series, now is the time.

The HPV vaccination decreases your chance of getting life-threatening cancers, specifically cervical and anal cancers. It also decreases your chances of genital warts and precancerous cells.  It is important for young women under the age of 27 to discuss getting the vaccine with your physician. If you’re not sure if you got the vaccine, our VWC team can help you request your medical records so you can find out.

HPV isn’t the only sexually transmitted disease to worry about, of course. If you choose to be sexually active, it is much better to be protected than affected by the many potential sexually transmitted infections. Practice safe sex. If you’re not sure what your options are, ask! Don’t be embarrassed—that’s why we are here.

HEALTH  Center

Your college’s health center is your on-campus resource not only for common medical concerns but also for those personal problems that you may not want to share with anyone else.

Mental health issues, irregular cycles, and unexplained changes, if serious, are important to address as they occur—don’t wait to come home for the holidays! If your college is close by, we are happy to help you navigate many of these issues. If you’re further away, seek help at your college’s health center. The important thing is to get the care you need.

Maintaining a healthy lifestyle—a good healthy diet, regular exercise, enough sleep and stress management—is very important during the college years.

  • Eating a healthy diet can help boost your immune system and help you maintain a healthy weight. Walking to class is an easy way to fit exercise into your busy college schedule. Most schools have incredible fitness centers, intramural sports, and offer exercise classes—at all hours of the day!
  • Try not to make pulling all-nighters a habit. Treat college as you “job” get up at a regular time, study during the day and in between classes. Then you can enjoy college and social activities at night.
  • Try to get eight hours of sleep each night.
  • Learn to manage your stress. The college years are an exciting time—and they can be stressful with roommate challenges, classes, projects, exams and more. Finding time to relax and have downtime is important to staying healthy. If you find yourself panicking while studying or taking an exam, breathe slowly and deeply.

Sometimes, when young women live around other young women, they begin to compare themselves. In rare cases, obsession with body image can overtake thoughts and daily activities. If this happens, it’s important to seek professional help— right away.

HELP  against sexual assault/harassment

Colleges and universities are working to make campuses safer by providing extra security, encouraging group travel and making security escorts available for late-night travels. But, it’s important for you to know where you’re going (it’s hard to be aware of your surroundings if you’re following a map app on your phone!) and where your school’s campus safety office is. Take extra precaution at night and walk with a friend or group, lock your dorm room and bike, and keep your wits about you. Be wary of excessive drinking, drugs and “special” drinks that might alter your judgment. Beware of date rape. No means NO.

HYGIENE

At school, you’re going to be sharing your personal space, so it’s really important to respect others in the bathroom, dispose of sanitary products discreetly, and don’t leave hair in the sink. If you’re an athlete, make sure you’re diligent about washing your clothes, so your room doesn’t get that sweaty funk. “Keep your part of the world as tidy as you can,” Dr. Jefferson says, “and you’ll keep the peace with roommates and friends.”

HAPPINESS

As a college student, you’ll have to create a balance between work and play, apply for internships and jobs, and manage your budget along with many other “adult” responsibilities. But, being happy should be on your to-do list, too!  “Don’t let college stress wreck your health; make time for exercise you enjoy and mindfulness—whether meditation or just quiet ‘you’ time. Remember, self-care is not selfish.”

In life, communication is key. “Don’t bottle things up and then explode,” Dr. Jefferson says. Instead, share when something’s bothering you. Talk to your friends, your RA/RM or a counselor if you’re feeling anxious or depressed. Stay in touch with family members and friends you can confide in.

You may become best friends with your roommate, you may not. You’re not stuck with them all four years. Branch out, make friends in class, at work, or by joining a club. If you’re feeling lost, volunteer. Giving back is a great way to meet people with similar values and goals, and get perspective on life.

This is your time—your time to explore, to learn and to shine. Trust yourself, work hard, and take a few leaps of faith. Revel in your college experience. Treasure every precious moment—and remember them on the hard days. You’ve got this.

 

 

 

Virginia Womens’ Center, Dr. Jefferson and her team of nurse practitioners at our Short Pump location have a passion for helping teens navigate life. They have a special interest in helping them learn about the unique situations women experience as young adults. They enjoy helping young women learn about birth control options and irregular cycles. Throughout every age and stage Virginia Women’s Center encourages preventative care and living a healthy lifestyle.

If you would like to be seen at any of our other locations, we have teen specialists available there as well. Just let our patient coordinator team know when you call to make an appointment.  804.288.4084

Karen W. Jefferson, M.D.

Catherine D. Douglas, W.H.N.P.-B.C.

Elizabeth R. Compton, W.H.N.P.-B.C

Kelly L. Yeong, W.H.N.P.-B.C.

Teen Development: What’s Normal, Anyway?

Dr. Amie Miklavcic’s first experience visiting the gynecologist as a young teenager was frightening and confusing. “I remember holding the nurse’s hand and saying, ‘Is it almost over?’” But the memory of that traumatic visit now guides her compassionate approach to adolescent care, because she wants her patients to have a better experience than she did.

“I think a lot of times that first visit is really awkward, and they’re scared to death,” Dr. Miklavcic says. Often, she tells her patients, they’re just going to talk about what’s going on and how they feel. Here are a few of the topics she covers.

Periods

“A lot of times they don’t know what normal is,” Dr. Miklavcic says of her younger patients. Some think it’s normal to miss school days because of their periods, and they don’t know that they can get help for heavy and/or painful periods. On the other side of the spectrum, some teenagers worry because they haven’t started their period yet, and it seems like everyone else has.

Dr. Miklavcic starts with the basics. Are they using pads or tampons? If they’re using pads, do they know how to use a tampon? “There’s always that hesitation if they haven’t tried one,” she says, so she demonstrates how to insert a tampon properly.

Dr. Miklavcic also explains how the menstrual cycle works. “I think very few women understand their period cycle at all,” she says. They don’t understand that a normal cycle can last between 21 and 32 days, and may be shocked that they get a period twice in one month. Young girls also don’t realize their periods will be irregular for the first year because they’re not yet ovulating and “it takes a while for their hormones to catch up.” Stress, illness and travel all can cause abnormal periods, too.

Puberty

There’s no getting around the awkwardness of puberty, but knowing what to expect—and that there’s really no such thing as normal—makes it easier. Girlology has some excellent, conversational resources on puberty that cover the typical hormone-related changes:

  • Breast development
  • Vaginal discharge
  • Pubic hair
  • Acne
  • Body odor
  • Growth—both height and new curves.

Doctors can also offer help for certain physical problems that arise at this time. One young patient reported feeling really uncomfortable every time she wore a swimsuit; the reason, Dr. Miklavcic says, was a septate hymen, which could easily be corrected with minor surgery.

Privacy

While a parent can be an important ally and advocate for a daughter’s health, it’s also important for young patients to retain their privacy. If a patient’s mom comes with her into the exam room, Dr. Miklavcic speaks with both of them about confidentiality. “I make sure the patient knows that anything we discuss is between her and me, and will not be shared with Mom unless she gives me permission to, or if there’s an immediate danger to her or someone else,” Dr. Miklavcic says.

“I always encourage them to share things with Mom, because she was a teenager too,” Dr. Miklavcic says. But she wants young patients to know that they can call her anytime with questions and that anything they talk about will remain confidential. She also asks moms to step out of the room during the exam, “just from a privacy standpoint,” unless a patient wants her mother to stay. Girls also can come in on their own, Dr. Miklavcic says, particularly if they’re sexually active, concerned about STDs or birth control.

Looking for caring and compassionate adolescent care in the Richmond area or the Northern Neck? Dr. Miklavcic sees teenagers—and women of all ages—at the Virginia Women’s Center’s Mechanicsville and Tappahannock locations. Make an appointment today.

 

Dr, Amie Y. Miklavcic believes in a patient-centered approach to care—a team approach with input from patients on their goals and options for treatment.

Dr. Miklavcic’s practice spans the full spectrum of women’s health care including routine and high-risk pregnancies, laparoscopic gynecologic surgery and ambulatory gynecologic care including the evaluation of Pap smears, helping women with Polycystic Ovarian Syndrome (PCOS), and menopause management. She has a particular interest in pediatric and adolescent gynecology. Another area of interest for Dr. Miklavcic is her recent research and presentation on over-the-counter contraceptives.

The Benefits of Minimally Invasive Surgery

Large uterine fibroids can be a debilitating condition, causing intense pain, heavy bleeding and abdominal swelling. Many women with large fibroids think open surgery is the only solution. But as amazing as this seems, says Dr. Andrew Moore, laparoscopic surgery often proves effective. “Four small incisions, and they’re able to go home the same day,” he says. “You’re changing their life.”

Dr. Andrew Moore is an OB/GYN in Midlothian, practicing at the St. Francis Medical Pavilion office of Virginia Women’s Center. Dr. Moore did his residency at the University of Louisville — “a premier training program for minimally invasive surgery,” he says — and performs around 100 surgeries each year. We asked him what women should know about this type of surgery.

What is laparoscopic surgery?

Instead of making a large incision, as in traditional surgery, a few small incisions are made and then plastic ports are placed in the incisions. Then, a camera and surgical instruments enter through the ports, allowing the surgeon to see inside a patient’s body and perform delicate operations.

Laparoscopic surgery is recommended for a range of gynecological and urological conditions, such as:

• Fibroids
• Endometriosis
• Pelvic organ prolapse
• Ovarian cysts/tumors
• Ectopic pregnancies
• Hysterectomies
• Pelvic pain

Minimally invasive surgical procedures can also be used for risk-reducing surgeries, Dr. Moore explains, in which women with a high hereditary risk for ovarian cancers may choose to have their ovaries removed. “As we learn more and more about hereditary cancers, we’re being more and more proactive,” he says.

The benefits of minimally invasive surgery

Minimally invasive surgery is characterized by less of everything: less scarring, less pain and less bleeding. Almost all of Dr. Moore’s patients are able to go home the same day after a laparoscopic procedure, he says, although “everybody’s recovery’s a bit different. We all have different pain thresholds and different reactions.”

Being able to recover at home isn’t just more comfortable — it can also speed recovery. The risk of infection is lower, and patients are happier when they can manage their own care, Dr. Moore says. While nurses and hospital staff provide attentive care, there’s nothing like going to your own fridge to make a sandwich when you’re hungry. Getting up and moving around decreases the risk of blood clots after surgery. Not only that, but both pain levels and bowel function improve more quickly at home, Dr. Moore says.

One additional advantage of minimally invasive surgery is cost. The procedure itself is typically less expensive, because it’s outpatient and no hospital stay is required. One overlooked benefit, Dr. Moore says, is that women are usually able to return to work quickly, allowing them to use less FMLA or personal leave.

Have questions about minimally invasive surgery? Make an appointment at Virginia Women’s Center to speak with Dr. Moore or another of our surgeons.

 

 

Dr. Moore enjoys caring for patients throughout the spectrum of women’s health including both low- and high- risk pregnancies. In addition, he is skilled in caring for women who experience diabetes or hypertension in pregnancy and has special interest in pelvic pain management as well as minimally invasive and vaginal surgery for gynecologic conditions.

Having grown up in Richmond, Dr. Moore is happy to be back in his hometown. In his spare time, he enjoys traveling, playing golf, watching live music and sports as well as spending time with his wife, Christy, their dog, Solomon, and other family members and friends.  Dr. Moore is active in his church and enjoys medical missions work. He served in Togo, Africa in 2011 and looks forward to future mission trips.

May Is National Maternal Mental Health Awareness Month. Knowledge Is Powerful.

Maternal mental health issues affect many mothers.
More than you might think.

There is a vulnerability associated with pregnancy when it comes to mental health. Lack of awareness or unnecessary stigma often prevents expectant mothers from preparing for all of the hormonal, physical, situational and psychological changes that occur in the months leading to and after delivery. Even women who seemingly had it all together before pregnancy can find themselves struggling to adjust to their  “new normal” of a messy world order—and exhaustion—that come with a baby.

Symptoms* can be successfully treated with education, stress management, counseling, medication, or a combination.

  • Depression/Anxiety during pregnancy  15-21% of pregnant women experience moderate to severe symptoms of anxiety or depression during pregnancy. Depression symptoms can include sadness, guilt, irritability, hopelessness, lack of motivation. Anxiety symptoms can include chronic worrying, restlessness, physical panic, and intrusive thoughts. Proper treatment can prevent related postpartum symptoms.
  • “Baby blues” 60 to 85 percent of mothers experience the baby blues which typically lasts four to nine days. Symptoms include feeling stressed, lonely, sad, anxious, exhausted and weepy.
  • Postpartum depression (PPD)  Approximately 21% percent of new mothers experience persistent feelings of anxiety, inadequacy, guilt, irritation, sadness and restlessness. Symptoms last for more than two weeks. PPD is often characterized by not attaching or bonding with the baby, and in some instances, PPD moms may have thoughts of suicide.
  • Postpartum anxiety Approximately 11% of mothers may experience anxiety (increased worry or obsessions, physical panic, and intrusive thoughts). A smaller percentage of women, who experience a traumatic birth experience, can have Post Traumatic Stress Disorder (PTSD)  symptoms which can include anxiety and depression symptoms and flashbacks.
  • Postpartum psychosis is very rare and must be treated immediately. It is characterized by racing thoughts, mania, depression, severe confusion, paranoia, hallucinations, and paranoia. Symptoms begin suddenly, usually in the first two weeks after delivery and can last up to three months.

*Note: postpartum symptoms are not limited to the first few weeks/months. They can emerge during the course of the first year.

If you are experiencing any of these symptoms, it’s important to tell someone—a family member, friend or healthcare professional.  Know that you are note alone.

Maternal mental health symptoms are not your fault and do not reflect your character or will. Strong mothers face many of these mental health challenges and wonder if they will ever feel like themselves again. The answer is a definite yes!  

Practicing self-care—eating regularly, getting enough sleep, and establishing a support network—is critical to positive mental health.

At Virginia Women’s Center, we treat the whole woman—body, and mind. With two clinical psychologists on staff, Drs. Mary Elise Polce and Lisa Cuseo-Ott, we’re able to offer support in the comfort of surroundings already familiar to our patients.

We offer a weekly postpartum support group, led by Dr. Lisa Cuseo-Ott, on Mondays, from 5-6 pm at our Short Pump location—free of charge.  Additionally, we offer a monthly Miscarriage and Infant Loss Support Group, led by Dr. Mary Elise Polce, on the first Wednesday of every month, from 5-6 pm, at our West End office. This important support group is offered free of charge as well.

If you need to talk to someone urgently, we offer individual counseling, and the cost is typically covered by insurance.

Let us help.  804.288.4084

You’re Not Alone. Virginia Women’s Center Offers Help for Miscarriage and Infant Loss.

Grief is not a noun, Dr. Mary E. Polce says.

Grief is a process. Grief is work. And experiencing the devastating loss of a baby is the hardest work of all.

Shock, denial, anger, sadness and guilt are all normal feelings associated with grieving, says Dr. Polce, a licensed professional counselor and developmental psychologist with the Virginia Women’s Center. “The work of grief is to let the feelings come, experience them, and let them gowithout any judgment,” she says. Often grief comes like ocean waves: A powerful sadness washes over you, and then it passes.

“There’s no right or wrong way to grieve,” she tells moms and dads who have lost a baby. But there are ways to help the grieving process, which parents can learn at Dr. Polce’s free monthly miscarriage and infant loss support group.

How the Compassionate Caring: Miscarriage and Infant Loss Support Group can help

“When a parent is grieving after a miscarriage, they are mourning the loss of their baby,” Dr. Polce says. “It is a real loss. It is a real grieving process.” But not everyone understands this.

Friends, family members and strangers may say hurtful things that are meant to be comforting, such as “Well, you can always try again.” Others may ignore or minimize the loss. “Everyone just wants you to feel better. But feeling better takes time.” Dr. Polce says.

In the group, people support each other without expecting you to feel better. Everyone is experiencing their own grief process, but everyone understands what loss is like. And, Dr. Polce says, it’s an empowering process. Moms and dads discover that they can both offer and receive help, as well as learn comforting coping tools.

Strategies for coping with the loss of a baby

Know that moms and dads grieve differently. While both parents feel the heavy burden of loss and grief, there’s a biochemical aspect unique to the mother in the grieving process, because she’s experiencing postpartum hormonal changes. This means moms may have fewer inner coping resources to help manage their grief. These biochemical changes will lessen over time, Dr. Polce explains; some may require medication to help reset biochemistry.

Set aside time to talk. Partners need to talk to each other about their grieving, but that can be hard to do. Instead of avoiding the topic, or talking about it all the time, Dr. Polce suggests setting aside a specific time to check in with each other. This, she says, can “give the grief some walls, or a container.”

Find a way to honor your baby’s memory. Dr. Polce encourages moms and dads to begin with their values: religious beliefs, cultural traditions or family traditions. That can help guide them to a meaningful way to honor the precious memory of their baby.

Make self-care a priority. When mourning the loss of an infant, it’s absolutely crucial to protect your sleep. “Sleep is one of the primary biochemical resets for all of us,” Dr. Polce says, and when grieving parents don’t sleep, it can even make it hard to cope with normal daily challenges. Sometimes short-term medication is needed to restart the sleep cycle, she says. Other self-care strategies include developing a nurturing, compassionate inner voice; eating healthfully; and doing any kind of physical activity, such as yoga, fitness classes or simply walking.

The Miscarriage and Infant Loss Support Group meets from 5 to 6 p.m. on the first Wednesday of every month at the VWC West End office located in the Forest Medical Plaza building, 7611 Forest Avenue, Suite 200. The workshop is offered free of charge to VWC patients and their partners. Call 804.288.4084 to reserve your place.

For patients who prefer an individual or couples’ counseling, this can be scheduled by calling the same phone number and is usually covered by health insurance.

Four Surprising Things You Should Know About Menopause

Menopause can feel really weird. And that’s okay.

That’s the number one thing Richmond gynecologist Dr. Kristin Schraa wants menopausal women to know: What they’re experiencing is normal. “They’re not crazy, they’re not falling apart, this is just a transition, and they’re going to be fine,” Dr. Schraa says. Here are four other things women going through menopause need to know:

1. Mood changes may surprise you.

Most women know that mood changes are a common part of menopause, but few are prepared for the wild emotional ride. Dr. Schraa has seen it all: really bad PMS that precedes menopause, depression, irritability, and “just feeling like you’re crawling out of your skin.” Some women even lose interest in activities they once loved, which is called anhedonia.

You don’t have to just accept mood changes or depression, Dr. Schraa says. She advises patients to try exercise and meditation, and if problems persist, she may recommend an SSRI such as Wellbutrin or Prozac. As a side benefit, these have been clinically proven to help with hot flashes without the cardiovascular/cancer risks of hormone replacement therapy.

2. You can gain weight for no reason at all.

“I haven’t done anything differently at all, and I’m gaining weight!” women tell Dr. Schraa. It’s not fair, but it’s normal—just like the freshman 15. With menopause, women’s metabolism slows, and we don’t metabolize starches and sugars as well as we used to, she says. Active women who have always been able to eat a plate of spaghetti carbonara without gaining weight suddenly find they can’t do that anymore. Dr. Schraa delivers some tough love: “In all honesty, there is little to no nutritional value in pasta, bread, rice and soda, all that stuff. So they’ve got to cut that out.” She also recommends increasing the intensity of exercise routines and adding strength training, depending on each patient’s needs.

3. There is help for painful intercourse and vaginal dryness.  

Decreased estrogen levels can cause the walls of the vagina to get thinner, in addition to vaginal dryness. As a result, intercourse can become painful, and women may experience chronic vaginal or urinary tract infections. But there’s good news: there are several simple ways to treat vaginal dryness/atrophy, including over the counter moisturizers/lubricants, or prescription intravaginal estrogen. For many patients, Dr. Schraa recommends MonaLisa laser therapy, which targets the vaginal mucosa and triggers the body’s natural healing response to generate new collagen and elastin. It’s a series of five-minute procedures that are uncomfortable but not painful, and no sedation is needed. “They’re up and at ‘em immediately,” Dr. Schraa says. “It’s actually miraculous. It works great.”

4. The craziness of menopause doesn’t last forever.

Aggravating symptoms like hot flashes and mood swings are transient, Dr. Schraa reminds her patients. She reassures them that they’re just experiencing a transition—and that there’s light at the end of the tunnel. Plus, there are upsides to menopause: “Not having to deal with periods anymore, and soon, no need for birth control!” she says.

Most importantly, Dr. Schraa wants every woman facing menopause to know “there are a lot of women out there that are feeling the exact same way that they are. They’re not alone.” And she’s on their side.

Experiencing symptoms of menopause or perimenopause? Schedule an appointment with Dr. Kristin Schraa.

The Heart of a Young Doctor: Dr. Rachel Love

Midlothian OB/GYN Rachel K. Love, M.D. joined Virginia Women’s Center in 2015. She’s known for her warm and compassionate approach to care. Dr. Love passionately cares for women from their first period to their last hot flash and beyond.  But, there are three elements of her practice that are especially close to her heart.

Building deep trust with all her patients, especially teens

The most rewarding part of her work as an OB/GYN, Dr. Love says, is the relationships she builds with her patients. “No matter whether it’s relieving someone from their fibroids or delivering a baby after a couple struggled with infertility or prior miscarriage, it’s absolutely the personal bond and the connection that you make,” she says. Patients feel like they can share their concerns, their fears and their hopes with Dr. Love.

A big part of Dr. Love’s practice is treating teenagers.  “I love working with adolescents because it’s such an impressionable time tin their life,” she says. “I may be one of their first doctor’s visits other than a pediatrician.” And if that first visit is a positive one, it lays the foundation for a lifetime of care. Dr. Love wants her young patients to feel respected, empowered about their reproductive health, and comfortable talking about sensitive topics, such as managing heavy or painful periods. “Hey, I was there once,” she says. “I remember those days.”

Serving as a Spanish-speaking OB/GYN in Richmond

While a resident at Virginia Commonwealth University School of Medicine, Dr. Love delivered babies for several patients who had received prenatal care at CrossOver Healthcare Ministry, a nonprofit clinic that serves low-income, uninsured patients. CrossOver cares for a primarily Hispanic and Middle Eastern population that has no other way to access healthcare. Dr. Love, who speaks medical Spanish, helped put frightened patients at ease by enabling them to talk about their health in their native language.

Dr. Love enjoyed working with the CrossOver patients so much that in 2016, she began volunteering at the clinic. One current patient had suffered years of pain from an ovarian cyst and needed surgery. With the help of the Access Now program, Dr. Love was able to get the patient’s procedure covered. At last, she was able to get the surgery she needed. “It feels good when you can help someone who otherwise wouldn’t be able to gain access to medical care,” Dr. Love says.

Volunteering with Midwives for Haiti

Most overseas medical missions follow the same format: volunteer doctors arrive, work feverishly for a few weeks seeing patients, then depart. Dr. Love was looking for something different—an overseas program that offered continuity and created meaningful, long-lasting change. She found that opportunity in Midwives for Haiti, a Richmond-based nonprofit that trains Haitian midwives and birth attendants. Since 2006, the organization has trained 124 skilled birth attendants—about 17 percent of the total skilled providers working in Haiti. The eventual goal, Dr. Love explains, “would be that they don’t need us anymore.”

In 2016, Dr. Love made her first volunteer trip to Haiti. She was called on to perform one C-section while a handful of Haitian students watched. At the end, they giggled, Dr. Love recalls.  She asked why. “Because you were a woman,” she was told, “and you did a good job.” They had never seen a female surgeon before — but after that, they knew it was possible.


Dr. Love cares for patients at our Midlothian office located at 13801 St. Francis Boulevard, Midlothian, VA 23114. Call 804.288.4084 to schedule an appointment with her. At CrossOver and Midwives for Haiti, Dr. Love volunteers alongside numerous other Virginia Women’s Center providers and staff.

 

Comprehensive Care. Every Visit. Every Time.

When pregnancy doesn’t go as expected, it’s important to have a team of medical professionals who can provide compassionate, comprehensive care at every visit, every time.

Winter Pregnancy Tips

The weather outside may get frightful later this week.

Here are a few tips to keep you safe and warm while pregnant.

  • Wear flats whenever possible. You don’t want to risk slipping on ice or snow.
  • Dress in layers so that you can stay comfortable between frigid outdoor temps and blasting heat indoors.
  • Get enough calcium. Odds are you aren’t spending that much time in the sun.
  • Stay active. Gaining weight during the holidays and winter months happens all too often. If you are pregnant, gaining too much weight can cause pregnancy and birth complications.
  • Do everything you can to stay healthy. Getting the flu shot is highly recommended. But don’t use a nasal spray vaccine as they contain “live” or activated influenza.
  • Get fresh air. It’s amazing what a 30-minute walk can do for your physical health, and mental outlook.

Enjoy your increased internal thermostat, now. And, look forward to warm spring and summer walks with your baby.

RVA summer pregnancy survival tips

For most of us, RVA in the summer is uncomfortable due to the high heat and humidity. But if you’re pregnant, the mere thought of venturing out may make you wilt! There are countless stories about pregnant women who are hot no matter how high the air conditioning is turned up. And tales of pregnant women who sleep on top of the covers with the ceiling fan on high while their husbands wear sweatshirts and sweatpants shivering under piles of covers. Hearing these stories along with weather forecasts for heat indices of 100+ can make you afraid to leave your house.

Pregnancy raises your body temperature. In fact, it’s one of the first hints that you’re pregnant. Combine an already elevated core temp with hot, muggy weather and the effect is intensified. Heat stress can cause hyperthermia and can – in extreme cases – harm your baby’s development. And, dehydration can decrease the amount of blood available to your baby and cause preterm contractions. But with a little planning and a few extra precautions, you can survive – and thrive – being pregnant in the summer in central Virginia.

Tips to help you stay safe and beat the heat this summer.

  • Wear light-colored, loose, comfortable clothing that breathes – cotton, linen or man-made wicking materials.
  • Drink plenty of fluids. Keep water with you at all times and drink throughout the day. If you start to feel faint, dizzy or fatigued, you probably aren’t drinking enough. Your urine should be the color of pale straw or light yellow.
  • Try to stay indoors whenever the heat index – combination of heat and humidity – is over 90.
  • Avoid the hottest part of the day – 11:00 am to 4:00 pm.
  • Stay cool in the water. There’s nothing like a dip in a swimming pool to cool you off. If you don’t have access to a swimming pool, put a cool, wet washcloth on your neck and run cold water over your wrists, or take a lukewarm or cool shower. But be careful, cold showers can actually overchill your body and cause it to generate more heat.

Swelling of the legs, feet and hands is another common pregnancy side effect. And, summer temps can exacerbate your puffy extremities. If you notice that swelling doesn’t go away with rest, or it’s associated with a severe headache or pain on your right side, call your provider, immediately. But most of the time, following these simple guidelines will help reduce water retention and manage the swelling:

  • Lie down and put your feet up for at least thirty minutes during the day. And, when you sleep at night, prop up your feet with a pillow.
  • Wear comfortable shoes, or go barefoot. If none of your shoes fit and barefooting isn’t an option, try shoes that are one-half to a whole size larger.
  • Pay attention to your fingers. If your rings are getting snug, take them off. Putting them on a necklace in the final months of pregnancy is preferable to having them cut off.

When pregnant, your hormones change drastically. Increased estrogen stimulates a temporary increase in your body’s production of melanin, and increased melanin means heightened sun sensitivity. Even short periods in the sun will cause existing freckles and moles to darken, and new spots to pop up. Roughly 50 to 75 percent of pregnant women develop blotchy areas of darkened skin call the “mask of pregnancy,” or melasma. These splotches can show up on your forehead, nose, cheeks, upper lip and arms. Pregnancy mask typically lingers past birth and fades over time – although in some cases the changes never completely disappear. To reduce pregnancy-related skin darkening:

  • Wear a hat with a wide brim.
  • Apply sunscreen of SPF 30+ at least 15 minutes before heading outdoors. To adequately protect against the sun’s ultraviolet rays, use 1.5 fluid ounces (roughly the size of a shot glass) or more of sunscreen lotion to cover your body. Reapply sunscreen throughout the day.
  • Take your prenatal vitamins and eat dark, leafy greens, broccoli, citrus fruits, beans, peas, lentils, avocados, whole-wheat bread and cereal. Hyperpigmentation can be related to a folic acid deficiency.

RVA summers are tough. By taking a few of these simple actions you’ll feel better, have more energy, keep your —cooland —enjoy your summer pregnancy.

High-Risk Pregnancy and Maternal-Fetal Medicine Specialists

Pregnancy is typically a time of great joy and excitement. However, for some women, certain preexisting medical conditions can increase the potential for complications during pregnancy. For others, unexpected complications can arise that require the expertise of a specialist.

Maternal-fetal medicine specialists are obstetrician gynecologists who have completed an additional two to three years of maternal-fetal medicine fellowship following their residencies. They specialize in caring for women who are experiencing high-risk pregnancies and are experts in the various obstetrical, medical and surgical complications that can arise during pregnancy. At Virginia Women’s Center, we understand that complications during pregnancy can be unsettling. That is why we have three maternal-fetal medicine specialists, Dr. Jessica DeMayDr. Rodrick Love and Dr. Lisa Troyer, who work closely with our obstetricians to care for patients who are experiencing high-risk pregnancies.

Having to consult with a maternal-fetal medicine specialist is not necessarily a cause for alarm. Most often, maternal-fetal medicine specialists will monitor a patient closely so that the appropriate precautionary measures can be taken to ensure a healthy mom and baby.

Depending on a woman’s medical history and/or conditions, she may only consult with a maternal-fetal medicine specialist at the beginning of her pregnancy. Other women might need continuous monitoring throughout their pregnancies. It is typically recommended that maternal-fetal medicine specialists care for women who have the following medical disorders:

  • Heart disease
  • High blood pressure
  • Preeclampsia
  • Diabetes or other endocrine disorders
  • Kidney or gastrointestinal disease
  • Infectious diseases

 

In addition, the following circumstances will increase a woman’s risk for complications during pregnancy:

  • Abnormal AFP (alpha fetoprotein) blood test
  • Multiple gestation (twins, triplets or more)
  • Recurrent pre-term labor and delivery
  • Premature rupture of membranes
  • Recurrent pregnancy loss
  • Suspected fetal growth restriction (baby not growing enough)

 

As many new moms will tell you, pregnancy, labor and delivery often go differently than they had envisioned. For Virginia Women’s Center patients who encounter complications during pregnancy, they can rest assured that a maternal-fetal medicine specialist will collaborate closely with their obstetrician to provide quality and compassionate care. Not to mention, having your appointment with a maternal-fetal medicine specialist at the same time and office as your obstetrician can help save you time and gas money (and we can benefit from that!).

Why Your OB-GYN Cares About Your Weight

At Virginia Women’s Center, we value the complete health of women. We believe it is important to look at each

woman as a whole – physically and emotionally. While it may seem that your weight is insignificant to your OB-GYN, it can be a telling sign of your overall health as certain signs and symptoms in one area of your body can often signal problems in other areas. Your weight can also alert your OB-GYN to other conditions or diseases for which you may be at risk.
Being overweight or obese can increase your risk of disease and health problems including:

  • Cancers, including breast cancer and several gynecologic cancers
  • Cardiovascular disease, high blood pressure or high cholesterol
  • Gallbladder disease
  • Diabetes
  • Urinary leakage and incontinence

For women preparing to conceive, it’s important to try to achieve your normal weight before getting pregnant. Obesity can affect ovulation, menstrual cycles, and pregnancy rates and outcomes. Obesity during pregnancy can lead to complications such as:

The recommended first step in treating excess weight or obesity is to make lifestyle changes – nutrition and exercise are foundations for a healthy life and important first steps in improving your health. The need for good nutrition and regular exercise changes as you advance through the different stages of your life. Healthy eating and regular exercise during childbearing years can help support fertility and a healthy pregnancy. As you advance through menopause and beyond, healthy eating and regular exercise will help maintain a sharp mind and strong bones.

Eating healthy and reducing calories is essential to losing weight. Start by eating smaller portions, planning your meals in advance, eating fruits and vegetables with every meal, and limiting fats, fried foods and sugars. Increased physical activity helps you burn calories, increase muscle, decrease stress and depression, and gives you an overall sense of well-being. Start slowly and try to exercise at least 30 minutes five days a week. In addition, work to turn your daily activities into exercise – take the stairs, park far away, do yard work, and clean your house.

While our OB-GYNs can provide basic guidelines on dietary or physical activity changes you can make to improve your health, they may also recommend you consult with other local resources and weight loss specialists. Achieving a healthy weight, or even decreasing your BMI by a small amount, can make a big difference in your overall health.

Additional Resources:

About Virginia Women’s Center 
Virginia Women’s Center is a full-service women’s health care provider specializing in obstetricsgynecologyurogynecologyhigh-risk obstetricsobstetrical genetic counseling, ultrasound, in-office proceduresmammographybone healthpsychologynutrition and clinical research. The practice sees patients in five locations in the Richmond area and has additional offices in Kilmarnock and Tappahannock. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Skin Changes in Pregnancy

While most moms-to-be look forward to the “glow” of pregnancy and dread the coming of stretch marks, there are other skin changes that are equally common. Just as many parts of the body change during pregnancy, the skin is no exception. Many of the skin changes below occur because of shifting hormone levels and the changes to circulation and the immune system. The good news is that many of these changes will clear up once the baby is born – or within a few months after delivery.

  • Stretch marks: Stretch marks can occur on the belly, breasts, buttocks, thighs or hips. They often start as red, brown or purple, but typically fade after delivery. Stretch marks are caused by changes in the elastic supportive tissue that lies just under the skin. While many products tout their ability to prevent or reduce stretch marks, there are no medically proven solutions.
  • Acne: While many women thought they said goodbye to acne in high school, it is common to have an increased number of breakouts during pregnancy. Washing a few times daily with a mild cleanser should help. If acne is especially bothersome, pregnant women should talk to their health care providers.
  • Darkening skin: During pregnancy, the body produces more melanin, which is the pigment that gives color to the skin. In addition to a darkening of the nipples, some women also notice brownish marks around their eyes, noses and cheeks. This is called chloasma, or the “mask of pregnancy.” Many women also have a line darken from their belly buttons to their pubic bones. This is called the “linea nigra” and typically fades after delivery. Exposure to sun can make these dark patches even darker. Wearing a hat, putting on sunscreen, and limiting sun time can help prevent further darkening.
  • Itching: Many moms-to-be feel that their skin is itchy during pregnancy, especially over their expanding abdomens and breasts. In addition to moisturizing, staying hydrated is key to reducing itching. A small percentage of women will develop an itchy and bumpy rash during the third trimester of pregnancy. Commonly called PUPPP, this rash typically starts on the belly, but can also spread to the thighs, buttocks and arms.

The joy of pregnancy and parenthood cannot be experienced without some of the above discomforts and annoyances. Fortunately, many of them are temporary and resolve after delivery. Others of them may remain, but will serve as reminders of the amazing work that took place during pregnancy and childbirth.

Additional Resources:

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

What to Expect during Your First Mammogram

You may be anxious when your health care provider suggests you have your first mammogram. We hope this post will help you know how to prepare and what to expect, giving you peace of mind as you schedule your first mammogram. Above all else, remember that a screening mammogram is an important aspect of preventative medicine and can help detect breast cancer when it is most treatable.

The American College of Obstetricians and Gynecologists (ACOG) recommends that women over age 40 have a mammogram annually. As always, there are certain circumstances or family history that might warrant earlier or additional screening. One-on-one with your health care provider is the best way to determine what you need and when.

Screening mammograms use low-dose x-ray to create an image of the breast tissue. Mammograms can help detect lumps that are often too small to be felt. Screening mammograms are for women who:

  • Have never had breast cancer
  • Do not have symptoms of breast problems (i.e. lumps; mild breast pain is okay)
  • Have not had a recent abnormal mammogram

 

Preparing for your mammogram:

  • If you are still having regular periods, try to schedule your mammogram for immediately after your menstrual cycle. This may help you avoid the breast tenderness that can occur at other times in your cycle.
  • On the day of your mammogram, avoid perfumes, powders, deodorants, lotions or any other substance that you may put under your arm or on your breasts. They contain ingredients that can interfere with the clarity of the image.
  • It’s best to wear a two-piece outfit to your mammogram appointment. Then, you will only need to remove your top at the time of the exam.
  • If you have had a prior mammogram at a different office, request that the films be sent to the new facility you have selected. This will help the radiologist compare studies over time.

 

What to expect at your mammogram:

  • Your appointment will last 20 to 30 minutes, but each breast compression only lasts 20 to 30 seconds.
  • You will be given a gown and asked to remove your clothes from the waist up.
  • Your will stand in front of the x-ray machine and the mammogram technologist will help place your breast on a small platform. A clear plastic plate will press down on the breast for several seconds. Many women find the pressure uncomfortable and some women may find it painful. The compression allows the breast tissue to spread and flatten. This ensures a clear view of the breast tissue and reduces the amount of radiation needed to make an image.
  • The technologist will take several pictures of the breast.
  • A radiologist will review the x-ray pictures to see any changes and/or abnormalities.

 

After your mammogram:

  • You must be notified of your results within 30 days, but we will notify you much sooner.
  • It’s not unusual for radiologists to need additional views to complete a screening mammogram. It’s important to remember that if you are called for further screenings, it does not necessarily mean you have cancer. Suspicious findings can come from cysts, dense tissue or an unclear image. You may need another mammogram or a breast ultrasound to evaluate.

 

About Virginia Women’s Center 
Virginia Women’s Center is a full-service women’s health care provider specializing in obstetrics, gynecology, urogynecology, high-risk obstetrics, obstetrical genetic counseling, ultrasound, in-office procedures, mammography, bone health, psychology, nutrition and clinical research. The practice sees patients in five locations in the Richmond area and has additional offices in Kilmarnock and Tappahannock. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Regain Control: Definitions, Causes and Treatments for Fecal/Anal Incontinence

What is fecal/anal incontinence?

Fecal incontinence is the inability to control solid or liquid stool. Anal incontinence is the inability to control gas and mucous in addition to the inability to control stool. Symptoms can range from mild – occasionally leaking stool while passing gas – to severe – a complete loss of bowel control. No matter the severity of symptoms, it’s embarrassing to not be able to make it to the bathroom in time! For this reason, many individuals do not share their symptoms with a health care provider. Instead, they tend to withdraw from work and social activities for fear that they’ll have an accident outside of the comfort of their homes. They often suffer in silence, not knowing that help is available.

What causes anal incontinence?

While anal incontinence can affect all ages and both men and women, it most commonly affects middle-aged and older women. Approximately one out of thirteen women under the age of 60 and one out of seven women over the age of 60 has anal incontinence.

There’s often more than one underlying cause for anal incontinence. Some of them include:

  • Frequent diarrhea or constipation
  • Injury, weakness, or nerve damage to the sphincter muscles (the muscles that are responsible for continence)
    • The sphincter muscles can be injured during childbirth, past rectal surgeries, or other trauma
    • The sphincter muscles weaken with age
    • Certain medical conditions, like diabetes, can cause nerve damage to the sphincter muscles
  • Rectal scarring from ulcerative colitis or Crohn’s disease
  • Surgical removal of the rectum
  • Prolapse
  • Fistula

 

How is anal incontinence treated?

An appointment with your health care provider can help you determine the best course of treatment based on your individual health and medical history. The treatment plan will often be determined after a series of tests to determine the cause of your incontinence. Treatment may involve a combination of the following:

  • Dietary changes
  • Exercises to help restore muscle strength
  • Physical therapy
  • Medications that change the consistency of the stool or reduce the frequency of bowel movements
  • Surgery

 

At Virginia Women’s Center, our urogynecologist, Dr. Tovia Smith, and her staff work to find the best individualized treatment plan for women who are suffering from anal incontinence.

 

Additional Resources:

 

About Virginia Women’s Center 
The Pelvic Health and Continence Institute at Virginia Women’s Center offers state-of-the-art evaluation and treatment of female urogynecologic issues including urinary and fecal incontinence, chronic infections and pelvic organ prolapse. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Vaginal Birth After Cesarean: Am I a Candidate?

If you had a cesarean delivery with a prior pregnancy, you may be wondering what that means for your future pregnancies. For a long time, women were told “once a c-section, always a c-section.” While for some women that remains true, many women now have two options: scheduling a c-section or attempting a vaginal birth after cesarean (VBAC).

Why might I consider a VBAC?

In addition to the fact that you may simply wish to experience a vaginal birth, VBAC can also help you avoid a c-section and the risks associated with this major abdominal surgery. Compared to a c-section, a vaginal birth has a shorter recovery time, a shorter hospital stay, a lower risk of infection, and less blood loss. Sixty to eighty percent of women who attempt a trial of labor after cesarean (TOLAC) go on to have a successful vaginal birth.

Why might I not consider a VBAC?

A VBAC is not without risk – namely, the risk of uterine rupture. Uterine rupture is very rare, occurring in less than one percent of women who attempt a VBAC, but very serious for both you and your baby. Uterine rupture occurs when the uterine scar from your prior c-section tears open.

Who’s a good candidate for a VBAC?

Not all women are good candidates for a VBAC. The following factors are important to weigh when considering a VBAC:

  • Type of incision in your prior c-section: A low transverse (side to side) uterine incision is the most common incision used and has the lowest chance of rupture. A high vertical (up and down) uterine incision has the highest chance of rupture and precludes you from attempting a VBAC.
  • Number of prior vaginal deliveries and number of prior c-sections: A previous vaginal delivery increases your risk for a successful VBAC. On the other hand, two or more c-sections lower your chance of a successful VBAC.
  • Your health and your baby’s health: If you’ve had a healthy, problem-free pregnancy then you may be a good candidate for a VBAC. Certain problems in pregnancy or medical conditions could make a VBAC risky. Also, consider the reason you had a c-section in your prior pregnancy. If that reason is not a factor in this pregnancy, you’ll have a higher likelihood of a successful VBAC. A prior uterine rupture prohibits you from a VBAC.
  • The number of children you wish to have: If you’re planning on having more children, there can be complications associated with multiple c-sections.
  • When you go into labor: You will have a higher chance of a successful VBAC if you go into labor naturally on or before your due date.

 A VBAC is not for everyone and it is not without risk; it’s important that you do your own research and speak with your health care provider to determine the option that is right for you and your baby. Also keep in mind that your plan may need to change. If you decide to attempt a VBAC, your plan may need to change to keep you and your baby safe. Likewise, if you decide to schedule a c-section but go into labor beforehand, a VBAC may be recommended.

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Healthy Weight Gain During Pregnancy

Weight gain during pregnancy can be a sensitive and stressful subject. How much is too much and how much is not enough? It’s easy to compare your weight gain to another woman’s and unfortunately, it’s all too common for others to comment on how “big” or how “small” you are. Although your pregnancy weight gain is a personal topic that does not need to be discussed with your family, friends or complete strangers, it is an important measure for you and your health care provider. Your health care provider will track your weight gain at every prenatal appointment and may give suggestions for how to boost calories or cut back depending on how much you’ve gained.

Gaining too little or too much during pregnancy can affect both you and your baby. Women who gain too few pounds have a higher risk of having a low birth weight baby, which may lead to health problems after birth. Gaining too much weight during pregnancy can increase your risk of developing gestational diabetes and high blood pressure. In addition, gaining too much weight can increase your risk of having a baby that is too large or a premature baby.

How much weight you should gain during pregnancy often depends on how much you weigh when you get pregnant. Body mass index (BMI) calculates whether you are at a healthy weight for your height. The general guidelines for weight gain during pregnancy are based on BMI and are below. If you’re expecting multiples, it is likely that the recommended weight gain would increase.

BMI Recommended Weight Gain in Pregnancy
BMI less than 18.4

(Underweight)

28-40 pounds
BMI between 18.5 and 24.9

(Healthy weight)

25-35 pounds
BMI over 25

(Overweight)

10-15 pounds

 

It is common for most of your weight gain to be in the second and third trimesters. Most women will gain between two and four pounds in the first trimester, but some may even lose weight due to morning sickness. In the second and third trimesters, you should gain weight gradually, approximately a pound a week for a healthy weight woman. To achieve the recommended weight gain, the majority of women need only about 300 extra calories per day.

With the average newborn weighing between seven and eight pounds, where does the rest of the weight go?

  • Amniotic fluid = 2 pounds
  • Placenta = 1.5 pounds
  • Uterus = 2 pounds
  • Breasts = 2 pounds
  • Body fluids = 4 pounds
  • Blood = 4 pounds
  • Maternal stores of fat, protein and other nutrients = 7 pounds

Eating a well-balanced, healthy diet when you’re expecting and getting regular exercise are two of the best things you can do for yourself and the health of your baby.

Additional Resources:

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Preparing Your Daughter for her First Visit to the Gynecologist

While only you and your daughter can determine the right timing for her first visit to the gynecologist, the American College of Obstetricians and Gynecologists as well as the physicians at Virginia Women’s Center recommend an initial reproductive health visit between ages 13 and 15. Of course, if your daughter is having discomfort with her periods, recurring yeast infections, asking lots of questions, or considering sexual activity, she may need an appointment before this age.

The goal of this first visit is to build the foundation for a trusting relationship between your daughter and her health care provider. It can help your daughter get comfortable with her health care provider and make her aware that he or she, in addition to you, is a trusted resource to answer her questions.

Many girls are anxious or frightened about their first visit to a gynecologist. By assuring your daughter, empowering her and providing her with practical tips, you can help ease her anxieties about her appointment:

  1. Educate her on her family history. Your daughter should know her own medical history and the medical history of close relatives. This information can help her gynecologist know whether she needs certain preventative screenings and how frequently she might need them.
  2. Encourage her to write down her questions. This can be helpful for patients of all ages. Writing down a list of questions, in order of priority, ensures she gets the answers she needs. It allows her time and space to think about what her questions are and helps her to remember them if she gets flustered or nervous. Of course, if she thinks of other questions after the fact, encourage her to make a phone call or send a message on our secure patient portal.
  3. Let her know what to expect. Many girls are most apprehensive about Pap tests and pelvic exams. Current guidelines recommend the first Pap test at age 21, therefore, this initial visit often does not need to include a pelvic exam. Her health care provider will discuss topics such as puberty, hygiene, diet, exercise, vaccinations, sexual orientation, substance abuse and prevention of pregnancy and sexually transmitted infections (STIs). Her health care provider may also perform a visual exam of her breasts and external genitalia.
  4. Determine your role at the visit. Before the visit, ask your daughter if she wants you to come into to the exam room with her or if she would prefer you wait in the waiting room. Since the goal of this appointment is to encourage open communication, it can be helpful for you both to be part of the visit. However, it’s important to let her know that there will be a few minutes where her health care provider will want to speak with her alone.
  5. Encourage her to be honest. While some girls will be open and eager to discuss their health, others may be sensitive and embarrassed. Remind your daughter that even though some questions may be uncomfortable, it’s important she is open and honest with her health care provider so that he or she can provide the best care for her.

Your daughter’s first visit to the gynecologist can help set the stage for a lifetime of good health. It can also help her learn the important skill of taking care of her body and advocating for her own health. Yearly visits can help her build a relationship with her health care provider as well as answer any questions she might have or address any problems she may be experiencing.

Additional Resources:

About Virginia Women’s Center 
Throughout each phase of your beautiful life, we’re here to help you LIVE HEALTHY. In addition to gynecologic care, we offer urogynecology, gynecology, in-office proceduresmammographybone health and psychology services in the comfort and convenience of our offices. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Birth Control Options While Breastfeeding

In between diaper changes and middle of the night feedings, one thing a new mom needs to consider is what method of birth control she will use. It is recommended that women wait at least a year after the birth of one baby before becoming pregnant with the next. Not only does this allow the body time to heal, but it also helps lower the risk of complications in the next pregnancy such as miscarriage, low birth weight and preterm birth.

BirthControlA longtime abounding myth is that you can’t get pregnant if you’re breastfeeding. We’re here to tell you that you can; breastfeeding is not an effective form of birth control! Women’s periods return at different times after delivery. Some women may not have a period until they begin weaning their babies and/or introducing solid foods. Keep in mind that even if you have not had your period, you can still become pregnant. It’s important to select an effective form of birth control before you have intercourse for the first time after delivery. This may or may not be the same form of birth control you used before you were pregnant and here’s why.

When determining what medications are safe to use while breastfeeding, we always look at two factors. One, will the medication have an adverse effect on the baby if it passes through the breast milk? And two, could the medication hurt the mother’s milk supply?

Many of the available birth control options contain estrogen. While studies have not found estrogen to be harmful to the baby, it has been shown that estrogen can decrease a mother’s milk supply. For that reason, the following progestin-only contraceptive options can be considered:

  • “Mini pill,” progestin-only birth control pill
  • Birth control injection
  • Hormonal Intrauterine device (IUD)
  • Implantable Hormonal Contraceptive

In addition, the following non-hormonal birth control methods can be considered:

  • Non-hormonal Intrauterine device (IUD)
  • Condoms
  • Spermicide
  • Diaphragm
  • Contraceptive sponge
  • Cervical cap
  • Natural Family Planning
    • Please note: natural family planning is more difficult than normal because your period may not be consistent while breastfeeding.

Learn more about the positives and negatives of each birth control method here. Women who are certain that they do not wish to have any more children may be interested in learning about the options for permanent birth control. It’s important to remember that there is no perfect method for all women – that’s why there are so many options! Before your baby is born, we recommend you take the time to weigh the positives and negatives of each method with your partner and your health care provider in order to make the decision that is right for you.

Additional Resources:

Packing Your Bag for the Delivery Room

As you get within a month or two of your due date, it is a good idea to pack your hospital bag as well as install your baby’s car seat. Below are some suggestions of what to pack for yourself, your baby and your partner or birth coach, as well as a few items that you may find helpful during labor and delivery.

 

 

 

 

 

VWC_infograph_packingfordeliveryroom2

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Bone Density

Staying healthy as we age means keeping bones strong. Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks.

If you already have osteoporosis, or know you’re at risk, you can live actively and comfortably by seeking proper medical care and making some adjustments to your lifestyle. Your physician may prescribe a diet rich in calcium and vitamin D, a regular program of weight-bearing exercise and medical treatment.

Learn more about osteoporosis and bone density testing in the infographic below.

 

Understanding Preeclampsia in Pregnancy

May is Preeclampsia Awareness Month. While preeclampsia only occurs in a small percentage of pregnancies, it is a serious condition. It is important for expectant moms to know the symptoms of preeclampsia and to seek regular prenatal care. At every prenatal appointment, your health care provider screens for preeclampsia by tracking your blood pressure and checking your urine for protein.

What is preeclampsia?

Preeclampsia is a serious blood pressure disorder that can affect all the organs in a woman’s body. Typically, preeclampsia occurs in the second half of pregnancy and most often, in the third trimester. However, it is possible for preeclampsia to occur in the postpartum period as well. While there are no guaranteed ways to prevent preeclampsia, you should work with your health care provider to keep medical conditions, such as hypertension or diabetes, well-controlled.

What are the signs and symptoms of preeclampsia?

While it is possible for preeclampsia to develop without any symptoms, the most common symptoms include:

  • Increased blood pressure
  • Excess protein in your urine or other signs of kidney problems
  • Swelling of the face or hands
  • Severe headaches
  • Changes in vision – temporary loss of vision, blurred vision, light sensitivity
  • Pain in the upper abdomen or shoulder
  • Nausea and vomiting
  • Sudden weight gain
  • Shortness of breath or difficulty breathing
  • Reduced urination

 

What causes preeclampsia?

The exact cause of preeclampsia is unknown. However, the following individuals appear to be at increased risk for developing this condition:

  • Women who are pregnant for the first time
  • Women who have a personal or family history of preeclampsia
  • Women who have chronic hypertension, kidney disease, diabetes, thrombophilia or lupus
  • Women who are 40 years of age or older
  • Women who are pregnant with multiples
  • Women who are obese
  • Women who had in vitro fertilization

 

What does preeclampsia mean for me and my baby?

Preeclampsia can range from mild to severe and can progress slowly or rapidly. The more severe the preeclampsia and the earlier it occurs in pregnancy, the greater the risks for you and your baby.

  • If you are 37 weeks or further along in your pregnancy, it is likely that your doctor will decide to induce labor to deliver your baby.
  • If you are less than 37 weeks along in your pregnancy, your doctor may be able to treat preeclampsia until your baby has developed enough to be safely delivered.
    • If you have preeclampsia, your doctor may recommend bed rest, careful observation, medication or continued blood and urine testing.
    • If you have severe preeclampsia, your baby may need to be delivered immediately as preeclampsia can affect many organs and cause serious or even life-threatening problems.

 

As many new moms will tell you, pregnancy, labor and delivery often go differently than they had envisioned. For Virginia Women’s Center patients who encounter preeclampsia or other complications during pregnancy, they can rest assured that a maternal-fetal medicine specialist will collaborate closely with their obstetrician to provide quality and compassionate care.

 

Additional Resources:

  • High-Risk Pregnancy and Maternal-Fetal Medicine Specialists

 

About Virginia Women’s Center 
Our care team – comprised of OB-GYNs, high-risk pregnancy specialists, nurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Debunking the Myths: Who Can Get Breast Cancer?

Myth: I’m too young to get breast cancer.

One of the risk factors for breast cancer is advancing age, which means that breast cancer is more common in older women. However, even young women in their 20s or 30s can develop breast cancer. It’s important for all women to get regular clinical breast exams and practice breast self-awareness. In addition, women should begin annual mammograms at age 40.

Myth: None of my relatives have had breast cancer, so it is impossible for me to get it.

One of the factors that increases a woman’s risk for breast cancer is a family history of the disease. However, the majority of women who are diagnosed with breast cancer do not have any family history of the disease.

Myth: Only women can get breast cancer.

While the majority of breast cancers are found in women, men can develop it as well since they have breast tissue. Overall, the risk of a man getting breast cancer is very low.

Myth: I eat healthy and exercise so there is no way I can get breast cancer.

Maintaining a healthy weight, getting regular exercise and cutting back on alcohol are some ways to help lower the risk of developing breast cancer. While these things can be controlled, there are other things that cannot be controlled that could increase one’s risk.

In many cases, it’s not always clear what causes breast cancer in an individual. There are some individuals who develop breast cancer even though they have very few risk factors. On the other hand, there are individuals who have several risk factors who never develop breast cancer.

What symptoms should I look for?

If you notice any of the following symptoms, it’s important that you see your health care provider right away.

  • A lump, hard knot or thickening in or near your breast or under your arm
  • Swelling, warmth, redness or darkening
  • Change in the size or shape of the breast
  • Dimpling or puckering of the skin
  • Itchy, scaly sore or rash of the nipple
  • Pulling in of your nipple or other parts
  • Nipple discharge (fluid that is not breast milk)
  • New pain in a spot that does not go away

 

About Virginia Women’s Center 
Virginia Women’s Center is a full-service women’s health care provider specializing in obstetrics, gynecology, urology, high-risk obstetrics, obstetrical genetic counseling, ultrasound, in-office procedures, mammography, bone health, psychology, nutrition and clinical research. The practice sees patients in five locations in the Richmond area and has additional offices in Kilmarnock and Tappahannock. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Get to Know Your Pelvic Floor

Pelvic organ prolapse occurs when the connective tissue of the pelvic floor muscle is weakened allowing one or more of the organs in the pelvis to drop down. In some women, this downward descent can result in the protrusion of the vagina, uterus or both.

Pelvic organ prolapse affects approximately half of the women who have had children by vaginal delivery. Other factors that can contribute to prolapse include advancing age, obesity, hysterectomy, chronic straining and abnormalities of the connective tissue.

Learn more about the symptoms and treatment solutions for pelvic organ prolapse in the infographic below.

About Virginia Women’s Center 
The Pelvic Health and Continence Institute at Virginia Women’s Center offers state-of-the-art evaluation and treatment of female urogynecologic issues including urinary and fecal incontinence, chronic infections and pelvic organ prolapse. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter

I was just diagnosed with gestational diabetes. What’s next?

What is gestational diabetes?

When diabetes starts during pregnancy, it is called gestational diabetes. Women with diabetes (diagnosed before or during pregnancy) need special care during their pregnancies.

Diabetes is a condition that prevents the body from processing food properly. The body receives its major source of energy from a sugar known as glucose. Insulin, a hormone manufactured in the pancreas, must be available for glucose to be used in the tissues. During pregnancy, some of the hormones produced by the placenta have a blocking effect on insulin. Gestational diabetes occurs when the pancreas produces its maximum amount of insulin, yet that is not enough to overcome the effect of the placenta’s hormones.

All moms-to-be are routinely screened for gestational diabetes, typically around 28 weeks of pregnancy. The screening involves an oral glucose tolerance test. If this test is abnormal, a more extensive oral glucose tolerance test is often performed. Women are diagnosed with gestational diabetes if two or more of the glucose levels in the additional test are abnormal.

 

What changes can I begin to make once I’ve been diagnosed with gestational diabetes?

At Virginia Women’s Center, if you are diagnosed with gestational diabetes, you will meet with one of our health care providers for a diabetic counseling visit. At this visit, your health care provider will help you learn what diet and exercise changes you may need to make to manage gestational diabetes. He or she will also educate you on how to test your blood glucose levels.

From the time you are diagnosed with gestational diabetes to the time you have your diabetic counseling visit, you can begin to incorporate the following changes in your diet:

  • Replace sugary beverages (i.e. sodas, juices) with water
  • Stop eating anything that has concentrated sweets (i.e. cookies, desserts, ice cream)
  • Try to eat more protein (i.e. eggs, meat, peanut butter, cheese) and green vegetables
  • Begin to reduce your overall carbohydrate intake, avoiding foods that are made with white flour (i.e. pastas, rice, breads, tortillas); substitute whole grains for white flour wherever possible

 

How can I prepare for my diabetic counseling appointment?

In preparation for your diabetic counseling visit, we encourage you to:

  • Come with questions. You may find it helpful to bring a friend or family member to your appointment to help you remember something that you may forget or miss.
  • Share any symptoms you are experiencing with your health care provider.
  • Record everything you eat in a food diary for three days. This can help your health care provider make specific recommendations on areas for improvement.
  • Be open to making healthy dietary changes. Remember, these changes are important for your health and your baby’s health!
  • Don’t be afraid – the diet isn’t that bad!

 

Most women who develop gestational diabetes will have more frequent prenatal visits. These visits will be important for monitoring your health and your baby’s health as well as for discussing your diet and exercise routine. Following the diet recommendations and getting regular exercise should help maintain your blood glucose levels. For some, however, this is not enough. Some women may need to take a medication or use daily insulin injections to help control their blood glucose. Your physician or nurse practitioner will carefully monitor your levels throughout your pregnancy and advise if this is necessary.

 

Additional Resources:

  • Diagnosing Gestational Diabetes
  • Frequently Asked Questions on Gestational Diabetes
  • Healthy Weight Management

 

About Virginia Women’s Center 
Our care team – comprised of OB-GYNs, high-risk pregnancy specialists, nurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Preventing and Treating Urinary Tract Infections

urinary tract infection (UTI) is a common infection caused by bacteria in the urinary tract. This can occur in the kidneys (pyelonephritis) or in the bladder (cystitis). Women have a much higher prevalence of UTIs than men due to the position and shorter length of their urethra. This makes it far easier for bacteria to gain access to the urethra, and once there travel the shorter distance to reach the bladder.

Who has an increased risk of developing a UTI?

  • Postmenopausal women, as they lose the protective effects of estrogen
  • Women who are sexually active
  • Women who use diaphragms or spermicidal foam, or whose partners use condoms
  • Women with diabetes
  • Women who have anatomical abnormalities of the urinary tract

 

How can UTIs be prevented?

If you have UTIs often, you may find that some of the following suggestions may help:

  • Drink plenty of water to flush out bacteria. Drinking cranberry juice or taking cranberry extractmay also help prevent urinary tract infections.
  • Wash your genital area every day with mild, unscented soap, then rinse and pat dry with a clean, soft cloth. Wash the skin around and between the rectum and vagina. Washing before and after sexual intercourse may decrease your risk of a UTI. Avoid using douches or feminine hygiene sprays.
  • Change sexual positions to ones that cause less friction on the urethra.
  • Use enough lubrication during sex. Try using a small amount of lubricant before sex if you’re a little dry.
  • Urinate at least every three hours, even if you feel as though you do not need to. Urinate before and after sex.
  • Wipe from front to back after bowel movements.
  • Consider using a different birth control method, especially if you use diaphragms, spermicidal foam or condoms. Ask your health care provider about other choices.
  • Keep your blood sugar under control if you are diabetic.

 

Who can treat UTIs and when should I see a specialist?
If you believe you have a UTI, give us a call at 804.288.4084. Same-day appointments are available. UTIs can be treated by any of our OB-GYNs or urology experts. However, the following individuals should consider seeing Dr. Lonny Green or Dr. Tovia Smith, both who specialize in the treatment of UTIs:

  • Women who have had recurrent UTIs (three UTIs in the past 12 months or two UTIs in the past six months)
  • Women who have structural or functional abnormalities of the urinary tract
  • Women who are diabetic
  • Women who have had prior urinary tract surgery or trauma
  • Women with incontinence requiring the use of pads or liners

 

About Virginia Women’s Center 
The Pelvic Health and Continence Institute at Virginia Women’s Center offers state-of-the-art evaluation and treatment of female urogynecologic issues including urinary and fecal incontinence, chronic infections and pelvic organ prolapse. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Five Ways to Prepare for a Natural Birth

The term “natural birth” is used to describe a spontaneous, unmedicated vaginal birth. No matter how a child is born, it’s important to remember that each pregnancy, labor and birth is unique and special. If you hope to have a natural birth, you may find these tips helpful as you prepare.

What are some things I can do to prepare for a natural birth?

  1. Read up.
    • Learn what options may be available to you during labor, delivery and your postpartum stay in the hospital. Determine which options are important to you and which ones are not.
    • Take advantage of the many books and online resources that are available to help moms prepare for a natural birth.
    • Talk with other women who have had natural births and ask what they found helpful.
  2. Create a birth plan.
    • After you have done your research, write down your wishes in an easy-to-read, concise format.
    • Discuss your birth plan with your health care provider about a month before your due date.
    • Pack a few copies of your birth plan in your hospital bag so you can share your wishes with your nursing team, physician and birth partner.
  3. Prepare during pregnancy.
    • Stay healthy throughout your pregnancy. Make healthy eatingregular exercise and prenatal care part of your pregnancy routine.
    • Take labor and delivery classes that are specific to natural birth. There are many different techniques you can choose from including The Bradley Method® of Natural Childbirth, Lamaze® and HypnoBirthing®. These classes can help you prepare mentally and physically for the birth of your baby.
    • Learn about different techniques to help you relax through your contractions and manage the pain of labor. Get any supplies that you may want, such as a birthing ball, ahead of time.
  4. Choose a supportive birth partner.
    • As in all births, your birth partner plays an important role.  Determine who you would like with you during labor and delivery.
    • Make sure your birth partner is on board with your birth plan. Have him or her attend classes with you so he or she can learn the different pain management and relaxation techniques you would like to use.
  5. Be flexible.
    • At Virginia Women’s Center, our first priority is always a healthy baby and a healthy mom. Unexpected emergencies can quickly arise and medical interventions may be necessary to ensure a healthy delivery. A birth plan is good to have, but realize that it may need to be changed in order to meet our first priority.
    • Every labor and birth is different. What worked for one mom or for one pregnancy, may not work for this delivery. It is best to have an arsenal of techniques to try, but also realize that you may decide to alter your birth plan in the midst of labor and delivery – and that’s okay!

Additional Resources:

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Additional Testing After an Abnormal Pap Test

What is a Pap test and why do I need one?
A Pap test, commonly referred to as a Pap smear, is a simple screening test that helps detect abnormal cells on a woman’s cervix. A Pap test allows for early diagnosis and treatment so that the abnormal cells do not become cervical cancer. While for many women, Pap tests are no longer needed every year, they still play a vital role in a complete health program.

What does an abnormal Pap test mean?
An abnormal Pap test means that cell changes were found on your cervix. However, this rarely means that you have cervical cancer. The majority of cell changes are caused by human papillomavirus (HPV). The cell changes may be classified as minor or serious. Many minor cell changes, also called low-grade, will resolve on their own over time. Serious cell changes, also called high-grade, may need to be removed so that they do not develop into cancer.

What follow-up will I need to have after an abnormal Pap?
If you have an abnormal Pap test, your health care provider will determine any necessary follow-up based on your age and the severity of the abnormal cells. Some of the follow-up testing options include:

  • HPV testing – your health care provider may be able to run a HPV test on the cells that were collected at your Pap test in order to determine if the cells have HPV.
  • Colposcopy (with or without a biopsy) – your health care provider will look at your cervix through a magnifying device called a colposcope. If abnormal cells are found, your health care provider may remove a small piece of tissue from your cervix so it can be further examined. This is called a biopsy. Colposcopies can be performed in a health care provider’s office.

If the results of the follow-up testing indicate precancerous cell changes, you may need treatment to remove the abnormal cells. You will then see your health care provider for follow-up visits to ensure all the abnormal cells are gone and that they have not returned.

Additional Resources:

About Virginia Women’s Center 
Throughout each phase of your beautiful life, we’re here to help you LIVE HEALTHY. In addition to gynecologic care, we offer urologyin-office proceduresmammographybone health and psychology services in the comfort and convenience of our offices. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

What Does it Mean if Your Baby is Breech?

Throughout much of your pregnancy, you will feel your baby move around in your uterus as he or she assumes a variety of positions. However, after approximately 36 weeks, the majority of babies will turn in a head-down position to prepare for delivery. Once a baby turns into this position, he or she will likely stay there until delivery.

However, in approximately four percent of pregnancies, the babies will not turn and are considered to be in a “breech” presentation. A breech presentation means that the baby’s feet, buttocks or both will be in position to come out first. There are three different types of breech positions – a frank breech, a complete breech and a footling breech. In a frank breech, the baby’s buttocks are aimed at the birth canal and his/her feet are straight up, near the baby’s head. In a complete breech, the baby’s buttocks are aimed at the birth canal and his/her legs are folded at the knees. In a footling breech, one or both of the baby’s feet are pointing towards the birth canal.

While the majority of the time, it is unclear what causes a baby to be in the breech presentation, these factors may increase the likelihood:

  • The mother is having multiples
  • The mother has had more than one pregnancy
  • The baby is preterm
  • The uterus has too much or too little amniotic fluid, or it has an abnormal shape or abnormal growths
  • The mother has placenta previa, where the placenta covers all or part of the opening of the uterus

As you get closer to your due date, your health care provider will be able to determine whether your baby is in the breech presentation through a physical exam. If he or she suspects that your baby is breech, an ultrasound will likely be performed for confirmation.

If you are a candidate, your physician may recommend a procedure called an external cephalic version (ECV). Your physician will try to lift and turn the baby from the outside with the goal of moving the baby to the head-down position. If the version is not successful or if you are not a candidate for the procedure, some physicians may recommend other at-home or natural techniques to try to get the baby to turn itself.  If your baby does not turn from the breech presentation, your physician will most likely recommend you have a C-section to reduce the risk of complications for you and your baby.

Additional Resources:

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Letting Your Baby Pick the Delivery Date

In honor of Prematurity Awareness Month and World Prematurity Day, we’re joining with organizations around the world to bring awareness to the prevalence of preterm labor and birth. Preterm labor is when an expectant mother goes into labor before her 37th week of pregnancy. About one in nine babies born in the U.S. is considered preterm. A premature birth can put the baby at greater risk for medical and developmental problems down the road. While some preterm births cannot be avoided, many “elective,” early deliveries can.

For many years, it was not uncommon to have expectant moms schedule the birth of their baby – often a few weeks before their due date. These deliveries are referred to as elective deliveries and from the 1990s to the mid-2000s, there was a large increase in the number of elective deliveries that occurred. The medical community has since learned the significant growth and development that babies undergo in the last few weeks of pregnancy. While there may be some babies that are fully developed at 37 weeks, the majority are not.

There are many reasons why scheduling an elective delivery is appealing. Much of pregnancy involves planning and preparing for your new arrival. For logistics sake, it can be convenient to know the day your baby will arrive. Additionally, the last few weeks of pregnancy can become increasingly uncomfortable and many women (and their health care providers) sought to alleviate these discomforts.

Now, since we have learned just how important those last few weeks of pregnancy are to your developing baby, we encourage mothers to wait until the onset of labor, whenever possible. During the last few weeks of pregnancy, your baby is growing and developing:

  • Important organs, like your baby’s brain, lungs and liver are still developing
  • The likelihood of your baby having vision and hearing problems after birth continues to decline
  • Your baby is gaining weight, which means he or she will have an easier time staying warm
  • Your baby is learning to suck, swallow and stay awake long enough to eat after he or she is born

Because of these reasons and others, elective inductions have declined significantly and we do our best to support women going into labor on their own.

All this to say, there are times when medical reasons require labor to be induced or a cesarean delivery to be performed prior to 39 weeks. In the case of these medically-indicated deliveries, your health care provider has determined that the benefits of having the baby early outweigh the potential risks. If mom and baby are both healthy, then the risks of inducing labor early do not outweigh the benefits and for this reason, it is encouraged that you stay pregnant until at least 39 weeks.

 

About Virginia Women’s Center 
Our care team – comprised of OB-GYNs, high-risk pregnancy specialists, nurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to help you LIVE HEALTHY during your pregnancy. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Leaking? When and How to Discuss Incontinence with Your Health Care Provider

This week is Bladder Health Awareness Week and the National Association for Continence (NAFC) reported in this infographic that nearly two thirds of women with urinary incontinence have not discussed their symptoms with a health care provider. In addition, NAFC reported that on average, women wait six and a half years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problems.

There are several reasons that cause women to delay seeking treatment for urinary incontinence and we’ll discuss two of the most prevalent reasons here. First, breaching the subject with any one, let alone a health care provider, can be embarrassing! It’s important to remember that this is something that physicians talk about daily. To us, it’s science and your bladder health can be a telling sign of your overall health. Another reason why women delay seeking treatment is because, for too long, they have been told that incontinence is just an unfortunate part of aging, something they had to deal with. Over the past several years, the number and variety of treatment options for incontinence have greatly increased and that myth couldn’t be farther from the truth.

When to Seek Treatment

If you only experience the occasional leakage, you may not need to or you may not be interested in seeking treatment. However, if you’re experiencing the symptoms below, we recommend you make an appointment with a health care provider:

  • You are embarrassed about the symptoms you are experiencing
  • You are avoiding certain social or physical activities for fear that your symptoms will strike
  • You often rush to the bathroom, but you don’t always make it in time
  • You are going to the restroom more often than you used to (this may or may not include getting up in the middle of the night)
  • You feel like you are not emptying your bladder completely when you use the restroom
  • You feel like your urine stream has gotten weaker
  • You are experiencing pain while urinating
  • You have had a recent surgery (i.e., hysterectomy or C-section) and are experiencing leakage
  • You are unable to urinate

 

Preparing to Talk with a Health Care Provider

Before you visit with a health care provider, we recommend you consider the following questions. Knowing the answers to these questions can help ensure you have a fruitful conversation.

  • When did your symptoms start?
  • What symptoms are you experiencing?
  • How frequent are your symptoms?
  • Are there certain conditions or events that lead to your frequency, urgency or incontinent episodes?
  • What strategies are you currently using to cope with your symptoms?

 

Just like any medical condition, an appointment with your health care provider can help you determine the best course of treatment based on your individual health and medical history. Don’t just assume the problem you are experiencing is a “normal” part of aging or something that women just have to “deal” with. At Virginia Women’s Center, our urologist, Dr. Lonny Green, our urogynecologist, Dr. Tovia Smith, and their staff work to find the best individualized treatment plan for women who are experiencing leakage.

 

About Virginia Women’s Center 
The Pelvic Health and Continence Institute at Virginia Women’s Center offers state-of-the-art evaluation and treatment of female urogynecologic issues including urinary and fecal incontinence, chronic infections and pelvic organ prolapse. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Kegel Exercises

Millions of individuals experience some degree of urinary incontinence or involuntary loss of urine. Stress incontinence, one of the four types of urinary incontinence, is more common in women. Women suffering from stress incontinence experience the leakage of urine when they cough, sneeze, laugh or engage in any activity that increases the pressure on the bladder and/or the supporting tissue. Kegel exercises (or kegels) are at-home exercises you can do to help improve bladder control. When performed daily, these exercises strengthen the pelvic floor muscle that supports the bladder.

  • Learn how to do the exercises by using one of these techniques to identify the pelvic floor muscle:

Start to void. Once the stream has started, try to stop it. If the flow of urine stops, even slightly, you have found the correct muscle. Note: once you identify the muscle, do the exercises only when you are not voiding.

Another technique is to squeeze the muscle in your rectum (not your buttocks) that would prevent you from passing gas. If you feel a pulling or tightening sensation, you are using the correct muscle.

A woman can also identify the muscle by inserting a finger into the vagina and tightening the vagina around it. If you can feel the tightening, you have identified the correct muscle.

  • Once you have identified the correct muscle, be sure you are not using the stomach or buttock muscles when doing your kegel exercises. As you practice the exercise, place your hand on your stomach to make sure you are not contracting it. If you feel your stomach muscle move, you are using that muscle. The same goes for your buttock muscle.

 

  • Be sure to breathe! The tendency is to hold your breath while concentrating. Remember to breathe!

 

  • Each exercise consists of squeezing and then relaxing the pelvic floor muscle. Squeeze the muscle for five seconds and then relax it for 10 seconds. Practice them in a lying, sitting and standing positing. Do not do the exercises when you are voiding!

Do 40 exercises every day, divided into four sets of 10 exercises each. Set aside some time in the morning, at lunch time, in the evening and at bed time to perform the exercises. Finding time to do them each day is very important. Like any kind of muscle training, these exercises take time to work, so don’t get discouraged. There is seldom much improvement seen before four to six weeks.

  • Attempt to squeeze the muscle just before you know a stress is coming, like sneezing, coughing, laughing, lifting or bending.

 

Kegel exercises are one of the many non-invasive treatment options that women experiencing stress incontinence can try first. However, for some individuals, non-invasive therapies may not completely eliminate the symptoms of incontinence. These individuals may be good candidates for minimally invasive surgeries that take as little as a few minutes to perform.

 

Additional Resources:

 

About Virginia Women’s Center 
The Pelvic Health and Continence Institute at Virginia Women’s Center offers state-of-the-art evaluation and treatment of female urogynecologic issues including urinary and fecal incontinence, chronic infections and pelvic organ prolapse. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

How do I know I’m in menopause?

Menopause is a stage of life, not unlike adolescence, that affects every woman around the world. However, women’s physical and mental experiences during “the change,” as it’s often called, vary within and across cultures. With knowledge and attention to self-care, menopause can mark the beginning of an exciting new chapter of life for all women.

Perimenopause

Perimenopause is a time of life when a woman’s body changes in preparation for menopause. Women enter perimenopause at different ages. Typically, women will begin to notice symptoms in their 40s, but some may experience them sooner, some as early as their 30s. Perimenopause can last as short as two years or as long as 10 years.

The physical symptoms below will signal the nearing of menopause. Some women will experience all of the symptoms and some women will only experience a few. One of the most common symptoms is a change in menstrual periods. Many of the symptoms below are caused from hormonal changes.

  • Irregular periods or skipping periods
  • Periods that are heavier or lighter than usual
  • Vaginal dryness, which can cause painful intercourse
  • Urinary tract changes
  • Hot flashes
  • Trouble sleeping
  • Emotional changes – irritability, mood swings, mild depression

It’s important to note that pregnancy is still possible during perimenopause; the potential for pregnancy only goes away after a woman has not had her period for 12 consecutive months.

Menopause

Menopause is defined as the time in a woman’s life when she stops having menstrual periods; thus marking the end of her reproductive years. In the United States, menopause occurs on average at age 51; however, it can happen anytime within the age range of 40 to 58. Women aren’t considered to be through menopause until they have had 12 consecutive months without a period.

Post menopause

After menopause, the remainder of a woman’s life is considered postmenopause. Because estrogen levels continue to decrease, vaginal dryness and hot flashes may persist. Even after menopause, annual exams with a women’s health care provider are still recommended to address the many aspects of women’s health that are unique to this age. Some considerations after menopause include bone densitybreast healthurinary incontinence and pelvic floor health.

About Virginia Women’s Center 
Throughout each phase of your beautiful life, we’re here to help you LIVE HEALTHY. In addition to gynecologic care, we offer urologyin-office proceduresmammographybone health and psychology services in the comfort and convenience of our offices. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Understanding Interstitial Cystitis

Interstitial cystitis (IC) is a chronic bladder condition that results in recurring pressure, discomfort or pain in the bladder and surrounding pelvic region, urinary frequency and urgency. IC may also be referred to as painful bladder syndrome (PBS), bladder pain syndrome (BPS) and chronic pelvic pain. IC is more common in women than in men; approximately eight in 10 of those diagnosed are women. It is estimated that three to eight million women in the United States may have IC. That is about three to six percent of all women in the U.S. Many people are diagnosed in middle age, but IC can be diagnosed in teenagers and senior citizens as well.

The symptoms of IC vary from person to person and even in the same individual, they can change over time. Symptoms can be mild or severe, occasional or constant. Women who have IC may experience the following symptoms:

  • Discomfort, pressure, tenderness or pain in the bladder and pelvic area
  • Urgency – the urgent need to urinate
  • Frequency – the frequent need to urinate
  • Pain during vaginal intercourse

 

While there is not yet a cure for IC, there are treatments available that can help relieve symptoms. There is no single “correct” treatment for any given person; treatment is tailored to the individual. Treatments can include self-help strategies, medications, bladder instillations, physical therapy, complementary and alternative therapies, bladder distention and nerve stimulation.

Some individuals also find relief by making changes to their diets. Alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, artificial sweeteners, high-acid foods and foods with potassium are often the culprits for worsening symptoms. Eliminating various items from your diet and then reintroducing them one at a time may determine which, if any, affect a person’s symptoms.

In addition to physical symptoms, IC can also lead to emotional concerns. We recommend you learn as much as you can about IC and play an active role in your treatment and self-care. Studies have shown that people who learn about the disorder and become involved in their own care do better than those who do not. Emotional support of family, friends and your health care team is very important in coping as well.

At Virginia Women’s Center, our urologist, Dr. Lonny Green, our urogynecologist, Dr. Tovia Smith, and their staff work to find the best individualized treatment plan for women who have IC.

Additional Resources:

 

About Virginia Women’s Center 
The Pelvic Health and Continence Institute at Virginia Women’s Center offers state-of-the-art evaluation and treatment of female urogynecologic issues including urinary and fecal incontinence, chronic infections and pelvic organ prolapse. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

True Labor versus False Labor

It is common to experience “false” labor pains before you have “true” labor pains. False labor pains – also called Braxton Hicks contractions – are common in your third trimester and may start as early as your second trimester. Braxton Hicks contractions feel like your abdomen is tightening. They often serve as your body’s way of getting you ready for “true” labor by softening and thinning your cervix. They are normal and nothing to worry about.

If you’re already having false labor pains, how will you know when you are really in labor? There are a couple ways to identify whether you are having Braxton Hicks contractions or true labor contractions:

 

In addition, here are other tell-tale signs of labor:

  • Feeling like the baby has dropped
  • Increase in vaginal discharge (clear, pink or slightly bloody)
  • Rupture of membranes (your water breaking)

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to provide care that revolves around you. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Is Your Diet Making Your Bladder Symptoms Worse?

While you may consider your bladder health an embarrassing subject to breach with close friends, let alone your health care provider, remember that it’s something that physicians talk about daily. To us, it’s science and it can be a telling sign of your overall health. Frequent urination – or having to use the restroom more than eight times in 24 hours – could be a symptom of a greater problem or it could be the problem. Either way, there are treatment options available and you can regain a normal life.

Women who are experiencing frequent urination without additional symptoms might be suffering from overactive bladder. Overactive bladder affects an estimated 17 to 53 million Americans. We do not know why the condition occurs and it is unclear whether childbirth has any relationship to it. In addition to frequent urination, other symptoms include waking up more than two times per night to urinate; urgency, or a sudden and strong desire to urinate; and urge incontinence, or accidentally wetting yourself due to not getting to a bathroom in time.

The foods and beverages we consume play a critical role in our body’s functioning and our bladder habits. There are some simple diet modifications you can try that may improve your bladder control. These techniques can be used before you seek other treatment options, such as medications or surgery, or in combination with them. Sometimes, diet modifications may be enough to treat your problems.

Potential Dietary Irritants to the Urinary Tract

What causes bladder irritation can vary from person to person, but here are some common foods and beverages that can irritate your bladder or contribute to leakage of urine.

Acidic foods to be avoided:

  • All alcoholic beverages
  • Apples
  • Apple juice
  • Cantaloupe
  • Carbonated drinks
  • Chilies/spicy foods
  • Citrus foods/juices
  • Coffee
  • Cranberries
  • Grapes
  • Guava
  • Lemon juice
  • Onions
  • Peaches
  • Pineapple
  • Plums
  • Strawberries
  • Tea
  • Tomatoes
  • Vinegar
  • Vitamin B complex

Other Possible Bladder Irritants

  • Spices, especially hot ones
  • All wheat, rye, corn, oats, barley and their derivatives
  • Grain alcohols
  • All vegetable fats, except olive oil
  • Bean family including ground nuts and cocoa beans (chocolate)

If these foods and beverages are regular parts of your diet, try eliminating them for 10 days. This should bring significant relief. Once you are feeling better, you can begin to add these items back into your diet, one thing at a time. This way, if something does cause your symptoms, you will be able to identify what it is. As you add items back into your diet, make note of any changes in urinary urgency, frequency or incontinence. It is also crucial that you maintain significant water intake throughout this process. Water should be the majority of what you drink every day.

There are a variety of other treatment options available for patients suffering from overactive bladder and run the gamut to include exercises, lifestyle modifications, medications and in-office procedures like Botox.

About Virginia Women’s Center 
The Pelvic Health and Continence Institute at Virginia Women’s Center offers state-of-the-art evaluation and treatment of female urogynecologic issues including urinary and fecal incontinence, chronic infections and pelvic organ prolapse. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

What is a Urogynecologist?

Urogynecologists are physicians who have completed a residency in either OB-GYN or urology as well as a two to three year specialty fellowship in Female Pelvic Medicine and Reconstructive Surgery. The fellowship training provides these physicians additional expertise in the evaluation, diagnosis and treatment of conditions that affect the pelvic floor.

The pelvic floor is a set of muscles, ligaments and connective tissue in the lowest part of the pelvis that supports a woman’s internal organs, including the bowel, bladder, uterus, vagina and rectum. Weakened pelvic muscles or tears in the connective tissue can occur when excessive strain is put on the pelvis through childbirth, repeated strenuous activity or pelvic surgery. Other factors that can increase the risk of pelvic floor disorders include repetitive heavy lifting, menopause, chronic disease, tobacco use and family history.

What conditions can a urogynecologist treat?

  • Pelvic organ prolapse: One or more of the organs in the pelvis drops down causing a sense of pressure or a bulge in the vagina. It may also cause urinary incontinence, pain or constipation.
  • Stress urinary incontinence: Leakage of urine with coughing, sneezing, laughing or any other activity that increases the pressure on the bladder and/or the supporting tissue.
  • Overactive bladder syndrome: Frequency, urgency (a sudden and strong desire to urinate that is bothersome) and nocturia (waking up more than once at night to void) with or without urge incontinence (accidental urine loss associated with a sudden and strong desire to urinate).
  • Anal and fecal incontinence: Involuntary leakage of gas and/or stool.
  • Fistulas: An abnormal connection between two organs (i.e. bladder and vagina or vagina and rectum)
  • Complications from third and fourth degree tears following vaginal childbirth

What treatment options are available?

There are a variety of non-surgical approaches as well as surgical options that can help relieve the symptoms associated with pelvic floor disorders. After consultation, you and your physician will work together to find the solution that works best for you, your lifestyle and your overall health.

Why should I see a urogynecologist?

While many of the symptoms and conditions listed above are very common, it is important to know that these are not a normal part of aging or something that women need to put up with. Consulting with a urogynecologist will provide you with specialized expertise to help determine the best way to relieve your symptoms and restore your quality of life.

We’re excited to welcome our first urogynecologist, Dr. Tovia Smith, to Virginia Women’s Center. Dr. Smith will work with female urologist Dr. Lonny Green to care for women whose qualities of life are being affected by bladder and pelvic health issues.

About Virginia Women’s Center 
Since 2006, Virginia Women’s Center has been dedicated to helping women with urinary incontinence and other bladder problems find solutions to restore their quality of life. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Getting Your Body Ready to Have a Baby

Every mother wants her baby to be as healthy and strong as possible. The best way to do that is to start at the very beginning: before conception. Preconception care can improve your chances of getting pregnant and of having a healthy pregnancy and a healthy baby. Since some habits are harder to break and some health issues take longer to address, preconception care ideally begins at least three months before you get pregnant. Below are some things to consider as you plan for pregnancy.

 

 

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Tips for Getting Good Sleep During Pregnancy

While moms-to-be anticipate getting up several times a night after a new baby arrives, many do not realize that some of the changes that occur during pregnancy can make it difficult to get a good night’s sleep before the baby arrives. As a follow-up to last week’s blog post on making room for sleep, this post will cover specific tips for getting good sleep during pregnancy.

While experiences can differ from woman to woman and pregnancy to pregnancy, the following changes can cause sleep disturbances:

  • Urinary frequency
  • Heartburn
  • Constipation
  • Hunger
  • Vivid dreams
  • Anxiety or worry
  • Difficulty getting comfortable
  • Leg cramps
  • Back aches
  • Increased heart rate
  • Shortness of breath

Listed below are a variety of suggestions that can help reduce the number of sleep disturbances you may experience during pregnancy. Try a variety of them and find the ones that work best for you.

Diet:

  • Eat a healthy and nutritious diet.
  • Avoid caffeine in all forms or consume it in the morning or early afternoon only.
  • Drink plenty of water; 64 to 80 ounces per day is recommended. However, try to taper off your water consumption in the evening to avoid waking up to use the restroom multiple times.
  • Avoid eating heavy meals within two hours of going to bed. You may wish to have a light snack – something with protein and carbohydrates – to help stave off hunger. An evening snack may also lessen any nausea you may be experiencing. Avoid sugary snacks as they can give you an energy boost.

Get comfortable:

  • Keep your bedroom cool. If the weather is appropriate, try opening your window to get some fresh air.
  • Practice relaxation exercises prior to going to bed. There are many options, including: deep breathingmindfulness, meditation or yoga.
  • Choose a comfortable position. It is recommended that you sleep on your side, especially as pregnancy progresses. However, do not worry if you wake up and find yourself on your back. Trust that your body will find the best positions to sleep.
  • Use lots of pillows for support. It can be helpful to put one between your legs and one under your abdomen.

Other suggestions:

  • Exercise regularly, but not too close to bedtime. Exercising during pregnancy can help alleviate other common ailments as well.
  • Taking 30 to 60 minute naps during pregnancy can help with fatigue. Avoid napping too close to bedtime.
  • Leave a night light on in the bathroom instead of turning on an overhead light. Exposing yourself to bright lights can make it more difficult to fall back to sleep.
  • Enroll in a childbirth class and educate yourself about labor and delivery to help ease some worry and anxiety.
  • Practice some of the other sleep hygiene practices found in this post.

Know that it is normal, especially in the last few weeks of pregnancy, for it to be difficult to sleep and get comfortable. Make yourself as comfortable as possible and try to get a few hours of rest whenever you can.

About Virginia Women’s Center 
Our care team – comprised of OB-GYNshigh-risk pregnancy specialistsnurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to provide care that revolves around you. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on FacebookPinterest and Twitter.

Talking to Your Daughter About her Period

While it’s not as dreaded as the birds and the bees talk, talking to daughters about periods is not usually high on the list of parenting milestones that moms look forward to. Take a deep breath and read through these tips to help prepare you for this exciting time in your daughter’s development. 

While the exact timing depends on your child and your family culture, it’s important that you start talking about puberty and menstruation before your daughter begins her period. You’re likely to see other signs of puberty – developing breasts, pubic hair and/or vaginal discharge – appear before her period. When you start noticing these changes, it is time for you to bring up the subject if you haven’t already.

On the other hand, many girls begin asking questions at a fairly young age. If your daughter asks questions, be open, honest and age-appropriate.  Start fairly generic and add more details as she gets older. Try having many smaller conversations instead one tell-all session. If your daughter is resistant, don’t force the subject that day, but don’t give up! Having honest and encouraging conversations with your daughter can help pave the way for open communication down the road.

On average, girls will start their menstrual cycles between the ages of 11 and 13. However, some can start as early as eight or as late as 16. While it is important to provide accurate biological information about what happens in her body (diagrams are helpful!), your daughter will likely be more interested in the practical side.

Many girls are anxious or frightened about their periods. Some may come with several questions, but others may be afraid to ask them. Ask what your daughter has heard and correct any misinformation. Assure her, empower her and provide practical tips so she knows what to expect. Some common concerns are:

  • What if I get my period when I’m at school? Be proactive. Suggest she carry supplies with her in her purse or backpack or keep them in her school locker.
  • How do I use a pad/tampon? Explain how to use and the difference between pads, tampons and panty liners. Provide several options so she can choose what she is most comfortable using. Empowering her to make her own decision, rather than trying to impose your own bias, helps her feel like the woman she is. No matter her choice, stress the importance of changing pads and tampons every three to four hours.
  • Am I normal? Assure her that there is no normal and what she is experiencing may be different from her best friend. There is a wide range of ages when girls can start their periods and not all periods are the same. It may take several months for her cycles to become regular.
  • Will it hurt? Assure her that it will not hurt, but that some women do experience symptoms like cramps. Most of the symptoms can be eased with over-the-counter medicines or heating pads. Learn more about menstrual cramps and other PMS symptoms.
  • Will I gush blood? Most girls will only have light spotting for their first periods.
  • Will everyone know I’m on my period? Make sure she knows that pads and tampons are not visible through clothes. She will be the only one who knows that she’s on her period.

Most of all be positive, open and encouraging. Let your daughter know that being a female is a blessing, not a curse, and that this is an exciting milestone and not a reason to feel ashamed or upset. Enjoy the time you can spend together and encourage her to come to you with any questions. Let her know that you are here for her, no matter what. How you embrace and lead her through this transition will lay the groundwork for how she feels about her body, health and femininity.

Additional Resources:

About Virginia Women’s Center 
Virginia Women’s Center is a full-service women’s health care provider specializing in obstetricsgynecologyurologyhigh-risk obstetricsobstetrical genetic counseling, ultrasound, in-office proceduresmammographybone healthpsychologynutrition and clinical research. The practice sees patients in four locations in the Richmond area and has additional offices in Kilmarnock and Tappahannock. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

Reducing Your Risk of Preterm Labor

In honor of Prematurity Awareness Month and World Prematurity Day, we’re joining with organizations around the world to bring awareness to the prevalence of preterm labor and birth. Preterm labor is when an expectant mother goes into labor before her 37th week of pregnancy. About one in nine babies born in the U.S. is considered preterm. A premature birth can put the baby at greater risk for medical and developmental problems down the road.

While the exact cause of preterm labor is often unknown, there are some risk factors that increase a woman’s chance of having preterm labor. It is important to remember that preterm labor can happen to anyone and many women who experience a premature birth have no known risk factors. While there is no guarantee that preterm labor can be prevented, there are some changes you can make to have a healthy pregnancy and reduce your risk of having a premature baby:

  • Quit smoking, drinking alcohol or using street drugs.
  • Talk to your health care provider about how much weight you should gain during pregnancy and do your best to get to a healthy weigh before you get pregnant.
  • Talk to your health care provider and come up with a plan to manage any chronic conditions you have.
  • Make your first prenatal appointment when you find out you are pregnant. Go to all of your prenatal appointments, even if you are feeling well. Prenatal care helps your health care provider make sure you and your baby are healthy.
  • Eat a healthy diet, exercise and take prenatal vitamins.
  • Reduce your stress; ask for help from family and friends.
  • Protect yourself from infections.
  • Know the signs of preterm labor and alert your health care provider if you’re experiencing them.
  • Talk to your health care provider about how long you should wait before having your next baby.

At Virginia Women’s Center, we have three maternal-fetal medicine specialists who collaborate with our OB-GYNs in the care of high-risk pregnancies. Our maternal-fetal medicine specialists partner with women who have a higher risk of preterm labor and work to reduce that risk.

Remember, it’s Worth the Wait!

The last few weeks of pregnancy can be challenging. Not only are you anxious to meet your new addition, but you also may feel increasingly uncomfortable. However, because your baby is still developing, it’s best to stay pregnant until at least 39 weeks. Please note: If there is a medical indication, your health care provider may recommend delivery before 39 weeks.

Here’s why your baby needs 39 weeks:

  • Important organs, like your baby’s brain, lungs and liver, have time to fully develop.
  • Your baby is less likely to have vision and hearing problems after birth.
  • Your baby has more time to gain weight in the womb, which means he or she will have an easier time staying warm.
  • Your baby can suck, swallow and stay awake long enough to eat after her or she is born.

Pregnancy Nutrition Facts: Eat This Fish, Not That

Fish and shellfish are an important part of a healthy diet. They are a great source of protein and heart-healthy omega-3 fatty acids. However, for women who are nursing, pregnant or may become pregnant, it is important to consider the quantity and type of fish and shellfish before you eat it.

Mercury is a metal that can harm the brain of your unborn baby, even before it is conceived. Unfortunately, almost all fish and shellfish contain some mercury. Mercury mainly gets into our bodies by the fish we eat. However, different kinds of fish and shellfish have varying levels of mercury. Fish is still an important part of your diet, but it is necessary that you avoid certain types of fish and limit your portions of others.

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You can eat one serving (six ounces) per week of:

  • Tuna steaks
  • Canned albacore or chunk white tuna

You can eat two servings (12 ounces) per week of:

  • Shrimp, crab, clams, oysters, scallops
  • Canned light tuna
  • Salmon
  • Pollock
  • Catfish
  • Cod

Fish to avoid:

  • Swordfish
  • Tilefish
  • King mackerel
  • Shark
  • Raw or uncooked fish or shellfish (e.g. clams, oysters, scallops)
  • Refrigerated uncooked seafood (labeled nova-style, lox, kippered, smoked or jerky)

If you eat fish caught locally, you should check local advisories from your state health department about any mercury or other pollution warnings. Local fish advisories can also be found on the Web site of the U.S. Environmental Protection Agency. If you’re unsure about the safety of a fish from local waters, only eat six ounces per week and don’t eat any other fish that week.

Debunking the Myths of Mammography

Women’s breasts are always changing. They change during the menstrual cycle, pregnancy, breastfeeding and menopause. Many lumps, tenderness and other changes are benign, normal and simply the result of these hormonal changes. Along with these normal changes, problems can arise. It is important for you to be aware of any changes in your breasts. Tools such as screening mammograms and clinical breast exams, which are procedures that are performed by health care professionals at facilities like Virginia Women’s Center, can help detect breast cancer before it has progressed.

There are many reasons why some individuals choose to delay or avoid having a mammogram. Check out the infographic below to learn why some of the myths you may hear are simply not true!

 

Your Third Trimester in Pregnancy

Congratulations on your pregnancy! Whether you’re a first-time mother-to-be or experienced in pregnancy, our team at Virginia Women’s Center will be with you every step of the way. We believe that children are among life’s greatest blessings and it is a privilege to help bring them into your family. Each pregnancy and birth is just as special and unique for our medical family as it is for yours – we are excited and honored to begin this journey with you.

Understanding that pregnancy can be a time of combined excitement, anxiety and confusion, we hope that this infographic will help you know what to expect during your third trimester.

 

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The Tdap Vaccine: Frequently Asked Questions

Please note: this post was originally posted on January 8, 2013. It has been updated with new guidelines on May 28, 2013.

If you are currently pregnant, Virginia Women’s Center recommends you receive the Tdap vaccine. The Tdap vaccine can help prevent pertussis, also called whooping cough.

If you are currently pregnant, your health care provider will offer you the Tdap vaccine at an appointment at or beyond 28 weeks gestation. Even if you have received the Tdap vaccine before, it is recommended you receive it during each pregnancy so that the antibodies can be transferred to the infant.

What is pertussis?

VaccinePertussis, also called whooping cough, is a highly contagious disease that causes severe coughing. People with pertussis may make a “whooping” sound when they try to breathe. In newborns, pertussis can be a life-threatening illness. It can be prevented with a vaccine called Tdap.

Who should receive a Tdap vaccine?

  • Women who are pregnant should receive it at or beyond 28 weeks gestation in each pregnancy. The Tdap vaccine will protect the mother and baby from serious illness and the complications of pertussis.
  • Women who did not receive the vaccine during pregnancy and have never received it before should receive it immediately after the baby is born.
  • Women who are breastfeeding and who did not receive the vaccine during pregnancy, immediately postpartum or ever before, should receive it as soon as possible. Patients with an unknown or uncertain Tdap vaccination status are considered unvaccinated and are therefore eligible to receive the vaccine.
  • Family members and/or caregivers of newborns who have never received a Tdap vaccine should receive it at least two weeks prior to having contact with a baby.

What are the risks of pertussis in infants?

In 2010, 27,550 cases of pertussis were reported in the United States; 3,350 of those cases were in infants younger than 6 months of age – 25 of those infants died. Studies have shown that when the source of pertussis was identified, 30 to 40 percent of infant infections occurred because the disease was transmitted from mother to infant.

Pertussis can cause serious and sometimes life-threatening complications in infants, especially within the first six months of life. In infants younger than one year of age who get pertussis, more than half must be hospitalized. The younger the infant, the more likely treatment in the hospital will be needed. Of those infants who are hospitalized with pertussis, about one in five will get pneumonia and one in 100 will die.

How can pertussis be prevented in infants?

There are currently no pertussis vaccines licensed or recommended for newborns at birth. The best way to prevent pertussis in a young infant is by vaccinating the mother during pregnancy. When a mother is vaccinated with Tdap during pregnancy, her infant will gain pertussis antibodies during the most vulnerable time – before three months of age. Infants are able to be vaccinated against pertussis at two months of age.

Diagnosing Gestational Diabetes

What is gestational diabetes?

When diabetes starts during pregnancy, it is called gestational diabetes. Women with diabetes (whether or not it is classified as gestational diabetes) need special care during pregnancy.

Diabetes is a condition that prevents the body from using food properly. The body receives its major source of energy from a sugar known as glucose. Insulin, a hormone manufactured in the pancreas, must be available for glucose to be used in the tissues. During pregnancy, some of the hormones produced by the placenta have a blocking effect on insulin. Gestational diabetes occurs when the pancreas produces its maximum amount of insulin, yet that is not enough to overcome the effect of the placenta’s hormones.

What are the risk factors for gestational diabetes?

Gestational diabetes is more common in women who

  • are overweight or obese
  • are older than 25
  • have had gestational diabetes in a prior pregnancy
  • are African American, American Indian, Asian American, Hispanic, Latina or Pacific Islander
  • have a family history of diabetes
  • have previously given birth to an infant that weighed more than 10 pounds
  • had excess amniotic fluid in a prior pregnancy
  • had an unexplained stillbirth or miscarriage in a prior pregnancy

 

How is gestational diabetes diagnosed?

At Virginia Women’s Center, we screen for gestational diabetes at 28 weeks of pregnancy. You will have to drink a syrupy glucose solution and then have your blood sugar level measured one hour later. If your blood sugar level is higher than normal, you will have to do a follow-up glucose test. The follow-up test involves drinking another glucose solution and having your blood sugar level checked every hour for a three hour period. If at least two of the blood sugar readings are higher than normal, you will be diagnosed with gestational diabetes.

What if I am diagnosed with gestational diabetes?

If you are diagnosed with gestational diabetes, you will work closely with our nurse practitioners to create an individualized food plan. You will not have to give up foods you love, but you may have to limit them or eat them with other foods so that your blood sugar isn’t negatively affected. During pregnancy, you will have to manage your blood sugar so that it stays in the optimal range and reduces your risk for complications. Usually, this can be done through diet and exercise. You will also work closely with our physicians and may need additional testing to monitor the baby’s health and reduce the risk of complications throughout your pregnancy.

For most women, once the baby is delivered, gestational diabetes will go away. You will be tested again at your postpartum visit. If it does not go away, it is reclassified almost always as type II diabetes. Women who had gestational diabetes are at high risk of having diabetes later in life. Choosing to pursue a healthy lifestyle by eating nutritiously and exercising regularly may help prevent or postpone diabetes.

Additional Resources:

 

Knowing the Risk Factors and Signs of Preterm Labor

A full term pregnancy lasts 40 weeks. Preterm labor is when an expectant mother goes into labor before her 37th week of pregnancy. Ideally, it’s best to stay pregnant until at least 39 weeks because the last few weeks of pregnancy are an important time for the baby’s growth and development. However, about one in 10 babies born in the U.S. is considered preterm. A premature birth can put the baby at greater risk for medical and developmental problems down the road. Sometimes, there will be medical indications and health care providers may recommend delivery before 39 weeks. In the case of preterm labor, early labor typically begins unexpectedly and on its own.

While the exact cause of preterm labor is often unknown, there are some risk factors that increase a woman’s chance of having preterm labor. However, it is important to remember that preterm labor can happen to anyone and many women who experience a premature birth have no known risk factors. Some of the risk factors include:

  • Preterm labor or preterm birth in a previous pregnancy
  • Being pregnant with multiples (twins, triplets or more)
  • Certain problems with your uterus, cervix or placenta
  • Having little or no prenatal care
  • Smoking or drug use
  • Abdominal surgery during this pregnancy
  • Too much amniotic fluid
  • Bleeding or infection while pregnant
  • Being underweight or overweight

 

A preterm labor typically begins unexpectedly. The signs of preterm labor are often no different from regular labor, except that they happen before the 37th week of pregnancy. If you experience any of the warning signs listed below before your 37th week of pregnancy, call your doctor. Sometimes, preterm labor can be stopped. However, there are certain situations and complications that make an earlier delivery safer for the mother or baby. The warning signs for preterm labor include:

  • Contractions, where your abdomen tightens like a fist, every 10 minutes or more often
  • Change in vaginal discharge, such as a watery, mucus-like fluid leaking from the vagina, or bleeding
  • Pelvic pressure; the feeling that your baby is pushing down
  • Low, dull backache
  • Cramps that feel like your period
  • Abdominal cramps with or without diarrhea

 

Women who are at risk for preterm labor may be advised to take certain steps to prevent preterm birth. At Virginia Women’s Center, we have three maternal-fetal medicine specialists who collaborate with our OB-GYNs in the care of high-risk pregnancies.

The InTone Device: A New Treatment for Urinary Incontinence

Urinary incontinence is something many individuals consider to be a normal part of aging – rightly so, as it affects as many as 17 to 25 million Americans, approximately 85 percent of whom are women. While urinary incontinence is very common, what many women don’t realize is that it is not usually something that they have to “put up” with; there are many treatment options available.

There are four types of urinary incontinence: stress, urge, mixed and overflow. Depending on the type of urinary incontinence you have, the treatment options can range from non-invasive therapies to minimally invasive surgical procedures. The InTone device is a new treatment option for women who suffer from stress, urge or mixed incontinence. By combining gentle muscle stimulation with pelvic floor training exercises, the InTone device can stop bladder leakage without medication or surgery. The InTone device is used on a regular basis in the comfort and privacy of your own home.

The InTone device helps strengthen your pelvic floor in two ways: gentle muscle stimulation and voice-guided pelvic floor exercises. Gentle muscle stimulation strengthens the pelvic floor by helping stop the spasms of the bladder muscle. If you have a strong pelvic floor, you can do things like cough, sneeze, laugh or run without leakage. Calming spasms of the bladder muscle allows you to “hold it” longer and avoid frequent trips to the bathroom.

The muscle stimulation will be customized under your physician’s supervision to ensure proper muscle activation. The muscle stimulation delivers a gentle electrical current directly to your pelvic floor muscles and has been proven to be an effective treatment for bladder leakage.

The InTone device also features voice-guided pelvic floor training exercises. The InTone device will talk you through your entire 12 minute session. The pelvic floor exercises are performed by contracting your muscles as directed. The InTone device uses an illuminated bar graph so that you know the strength of your contractions. The bar graph will also help guide you toward doing your exercises correctly.

Dr. Lonny Green, urologist and director of Virginia Women’s Continence Center, specializes in treatment for urinary incontinence and he is also a Certified InTone Specialist. Scheduling an appointment with Dr. Green is the first step in determining whether the InTone device is an appropriate treatment solution for your incontinence. If you’re interested in learning more about the InTone device or the other treatment options for incontinence, we recommend that you schedule an appointment with Dr. Green through our secure patient portal or by calling 804.288.4084.

Preventing Osteoporosis

Last week’s blog post focused on the symptoms, risk factors and detection of Osteoporosis. While certain factors can increase one’s risk for Osteoporosis, there are some measures that all women can take to help prevent the development of Osteoporosis.

Weight-bearing exercises and muscle-strengthening exercises can help women increase bone mass before menopause and slow bone loss after menopause because bones are strengthened when muscles pull on them. The National Osteoporosis Foundation has some great information about what types of exercises are good for your bones.

In addition, it’s important that women get enough Calcium. Calcium helps slow the rate of bone loss. It can be obtained by eating foods that are rich in Calcium and through Calcium supplements, if necessary. This chart that shows the amount of Calcium a woman should get throughout her lifetime:

Age

Calcium intake/day

11-18 years old

1500 mg

18-50 years old

1000 mg

Perimenopausal

1200 mg

Postmenopausal

1500 mg

Vitamin D is necessary to ensure that Calcium is adequately absorbed and incorporated into your bones. Vitamin D can be obtained through your diet (particularly certain kinds of fish) and is activated in the skin by sun light. In general, adults should obtain 1000 units of Vitamin D daily. Vitamin D supplements and/or therapy might be recommended for individuals who are not getting an adequate amount.

Here are some simple ways you can boost your intake of Vitamin D:

  • Drink at least 2 cups of Vitamin D3-fortified milk a day
  • Use milk instead of water in making hot chocolate, soups and sauces
  • Choose Vitamin D-fortified yogurts and cheeses whenever possible
  • Check labels and choose breakfast cereals that are fortified with Vitamin D
  • Flake tuna on top of a salad for a hearty lunch or make tuna salad sandwiches
  • If you drink soy beverages, choose a Vitamin D-fortified brand
  • Grill or bake salmon for a Vitamin D rich meal once a week

 

In addition to performing weight-bearing and muscle-strengthening exercises and ensuring you are getting enough Calcium and Vitamin D, eating a balanced diet, not smoking and limiting alcohol can help prevent the development of Osteoporosis.

To learn more about how we incorporate bone health into the care we provide at Virginia Women’s Center, visit our Web site.

Managing Back-to-school Stress

Ah, back-to-school! Whether or not you are sending little ones off to new classrooms this year, the anticipation of fall leaves and cooler temperatures signal a fresh start for many of us. While we often look forward to back-to-school routines and schedules, we also must acknowledge the stress and anxiety that can accompany this time of year. As activities gear up and the days begin to get shorter, we may question how we will be able to get everything accomplished in the little amount of time we have. While stress is a good and necessary part of our lives, there are healthy behaviors that can help us all learn to better cope with stress.

  • Practice healthy stress management skills:
    • Develop good sleep hygiene (e.g., practice sleeping and waking at a regular time, avoid watching TV in bed and avoid drinking caffeine close to bedtime).
    • Practice good nutrition (e.g., eat regular meals, eat in moderation and eat foods that are as close to nature as possible).
    • Exercise 30 to 60 minutes per day.
    • Practice relaxation techniques:
      • Deep breathing is an exercise that helps bring your focus to the present moment and promotes being centered even in the most challenging situations.
      • Muscle relaxation is an exercise where you focus on slowly tensing and then relaxing each muscle group.
      • Guided imagery is an exercise where you envision yourself in the midst of the most relaxing environment you can imagine and try to engage all of your senses. There are guides that can be purchased or downloaded to facilitate this exercise.
  • Let go of perfectionistic thinking (e.g., “shoulds” and “oughts”) and strive for excellence rather than perfection.
  • Set realistic expectations for life and for yourself. For example, instead of telling yourself “I must make a home cooked meal every night,” consider making meals some nights of the week and eating leftovers the other nights.
  • Nurture yourself. Healthy relationships with others begin with a healthy relationship with yourself. Learn more by reading this article.
  • Nurture relationships with your partner (if applicable), family and friends. Take time to play and show your family and friends how important they are to you.
  • Set your priorities and determine the things that need to be done. Write them down and enjoy the satisfaction of completing one at a time. At this time of year, it is natural for moms to want to be active with their children’s school activities. Make sure you do not overschedule yourself; don’t be afraid to say ‘no’ to commitments that do not fall in line with your priorities.

 

Because stress can have significant effects on your body, behavior, thoughts and feelings, it’s important to find the stress management and relaxation techniques that work best for you. That way, during the back-to-school frenzy and throughout the rest of the year, you can manage your stress symptoms and ultimately, better protect your health.

Additional resources:

Packing Your Hospital Bag for Delivery

As you get within a month or two of your due date, it is a good idea to pack your hospital bag as well as install your baby’s car seat. Below are some suggestions of what to pack for yourself, your baby and your partner or birth coach, as well as a few items that you may find helpful during labor and delivery.

Keep in mind that you won’t be able to leave the hospital if your baby’s car seat is not properly installed. We recommend you do this a month before your due date, just in case he or she decides to arrive early. Some car dealerships as well as police or fire stations offer free car seat inspections. You may wish to see what’s available in your community before your baby arrives.

Essentials for mom:

  • Your photo ID, insurance card, any hospital papers you may need and your birth plan (if you have one)
  • Bathrobe, slippers and/or non-skid socks, for walking around the hospital
  • Headband or ponytail holder to pull your hair back during labor
  • Toiletries including glasses an d contact lenses, if you wear them
  • Cell phone and charger or a prepaid calling card for using the hospital phone
  • Nursing bras and breast pads to absorb leakage
  • A loose and comfortable outfit to go home in

Essentials for baby:

  • Hat
  • Blankets for swaddling
  • Mittens to protect your baby from his or her long fingernails
  • An outfit for going home
  • A rear-facing car seat that has been properly installed

Essentials for partner/birth coach:

  • Money for food and change for the vending machines
  • A change of clothes as well as comfortable clothes for sleeping
  • A camera or video camera as well as the charger/extra batteries
  • A list of people to call and their phone numbers

Other items you may wish to bring:

  • Your own nightgown or pajamas; if you plan to breastfeed, make sure the gown opens in the front
  • Your own pillow with a bright pillow case so it isn’t mistaken for a hospital pillow
  • Comfortable, full-coverage underwear
  • Flip flops for showering
  • Music, iPod, DVDs, magazines
  • Back massage aids
  • Lip balm (lips can get very dry during labor)
  • Mints, lollipops or sugar-free hard candies may be helpful during labor
  • Sanitary pads (will be supplied, but you may wish to bring your own)
  • Nursing pillow
  • Baby book
  • Paper and pen

We’d love to hear your thoughts on what you found helpful during your stay at the hospital. What essentials have we forgotten? Or, what’s something that you brought, but didn’t use?

Perimenopause: What’s Normal and What’s Not

Puberty, pregnancy and you guessed it – another life transition that starts with a ‘p’ – perimenopause. While you are probably familiar with the term menopause, what many women don’t realize is that there are several years prior to menopause that are defined as perimenopause. Just like other life transitions that you’ve already gone through, the symptoms and length of perimenopause can vary from woman to woman, so your experience may differ greatly from the experiences that other women have had.  

What is perimenopause?

Perimenopause is a time of life when a woman’s body changes in preparation for menopause. However, it can be a lengthy transition and women aren’t considered to be in menopause until they have had 12 consecutive months without a period. It’s important to note that pregnancy is still possible during perimenopause; the potential for pregnancy only goes away after a woman has gone through menopause.

At what age does perimenopause start and how long does it typically last?

Women enter perimenopause at different ages. Typically, women will begin to notice symptoms in their 40s, but some may experience them sooner, some as early as their 30s. Perimenopause can last as short as two years or as long as 10 years.

What are the symptoms of perimenopause?

  • Irregular menstrual cycles – they may become longer, shorter, heavier or lighter and sometimes more or less frequent
  • Hot flashes or night sweats
  • Sleep problems
  • Vaginal dryness, which can cause pain during intercourse
  • Moodiness
  • An increasing number of headaches or migraines
  • Weight gain
  • Heart palpitations

 

What is not normal during perimenopause?

  • Menstrual bleeding that is extremely heavy (changing tampons or pads every hour)
  • Menstrual bleeding with clots
  • Menstrual bleeding lasting longer than eight days
  • Bleeding between periods or after sexual intercourse
  • Periods often occurring less than 21 days apart
  • Depression
  • Incontinence

 

What are some treatment options that can help with the symptoms of perimenopause?

  • Diet: Avoid caffeine, alcohol and spicy foods. A diet rich in fruits, vegetables, beans, soy, flaxseed and fish oils can help keep symptoms at bay.
  • Exercise: There are many benefits to a regular exercise routine. Exercising during perimenopause and menopause can help decrease hot flashes, prevent weight gain and help with depression and sleep problems.
  • Oral contraceptives: Low-dose pills can help regulate periods and reduce hot flashes and vaginal dryness.
  • Progestin therapy: This therapy can be accomplished through medications or some intrauterine devices (IUDs). Progestin therapy can help with heavy bleeding during perimenopause.
  • Herbal products: There are many different herbal products available, but little data to support their effectiveness. Some women have found relief from menopausal symptoms by using the following herbal products: black cohosh, soy supplements, St. John’s wort and ginseng. It is important to try these under the direction of a physician as they can interact with other medications.
  • NovaSure® Endometrial ablation: This short procedure, which can be done in the office at Virginia Women’s Center, can help reduce or stop menstrual bleeding by permanently removing the endometrium, or the lining of the uterus. To learn more, visit our Web site.

 

As you enter perimenopause and menopause, the need for an annual visit to your OB-GYN is still an important aspect of your health regimen. Regular visits will help you stay up-to-date on age-appropriate screenings as well as evaluate different therapy options if you find menopausal symptoms to be disruptive to your life. Just as the symptoms and length of perimenopause vary from woman to woman, the treatment options also differ. It’s important to discuss different treatment options with your health care provider so that together you can create an individualized plan based on your health and medical history.

Your First Visit to an Ob/Gyn, Part One

This post is the first of two to help prepare young women for their first visit to the gynecologist. It might help to read them in order; the second post can be found here.

You might know that Ob/Gyns are the doctors that deliver babies. While that’s true, pregnancy care and deliveries are only two parts of their jobs. Obstetrician gynecologists (Ob/Gyns) are physicians who specialize in health care for women throughout all stages of their lives, starting in their teen years.

At Virginia Women’s Center, in addition to nearly thirty Ob/Gyns, we have several women’s health nurse practitioners. Our nurse practitioners have advanced degrees and are trained in obstetrics and gynecology. They collaborate with our physicians to provide care for any typical health need.

As you grow and develop into your teen years, some questions might arise that would be better answered by a women’s health care provider as opposed to your pediatrician. The American College of Obstetricians and Gynecologists (ACOG) recommends that young women have their first gynecologic exam between the ages of 13 and 15 or when they become sexually active, whichever comes first. We recommend that you talk to your parent or guardian so that together you can decide the appropriate timing for this appointment. However, ultimately, the decision of when to have your first gynecologic exam depends on you. For example, if you are having problems with your menstrual cycle or are interested in learning more about birth control, you should make an appointment with an Ob/Gyn or nurse practitioner.

When you’re thinking of scheduling your first gynecologic visit, it is important that you pick a physician or nurse practitioner with whom you feel comfortable. A good place to start is our Web site where we have biographies of all our health care providers.

No matter the age at which you first go to the gynecologist, the first visit is an important time to establish a relationship with your physician or nurse practitioner. Your first visit might just be for counseling or, depending on the reason for your visit, your health care provider might perform certain examinations. During your visit, you will be asked questions about your menstrual cycle and your sexual health. Even though these questions can be uncomfortable, it is important that you are open and honest with your health care provider so that he or she can provide the best care for you.

Just like nutrition, exercise and getting enough sleep are important components of a healthy lifestyle, your sexual health is one more thing to consider and monitor as your grow up. In our next post, we’ll go into further detail about the kinds of examinations you can expect during an annual exam as well as your rights as a patient.