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Managing pain during labor

One of the most common concerns women have during their pregnancy is how to manage pain during labor and delivery.  Labor pain may be more or less intense than you expected, or may hurt in a different way. It is hard to predict how any labor will go or how anyone will respond to pain.

Labor pain is due to contractions of the muscles of the uterus and by pressure on the cervix. This can feel like strong cramping in the abdomen, groin, and back. Some women experience pain in their sides or thighs as well. Women can also feel pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina. Some find the hardest part is not the contraction itself, but the fact that the contractions keep coming.  

One of the best ways to alleviate fears for women is to learn about the available strategies for coping with pain. There are both medical and non-medical tools that may be a good match for you.

While you are deciding, think about what appeals to you most. Ask your health care provider these questions:

Information on emergency birth control

Oops, the condom fell off or broke. Oops, you went away for the weekend and your birth control pills stayed home. In the past, women ran the risk of an unintended pregnancy when birth control was not used or failed.
 
Emergency birth control has been available for many years, starting with medicine approaches that were not approved by the Food and Drug Administration. In 1999, Plan B, levonorgestrel pills taken by mouth, was approved for use by prescription and in 2006 was approved without prescription for women 18 years old and over. It was approved for those 17 and older in 2009 without prescription. In late February, 2014, FDA approved over the counter sales of generic emergency contraceptives without proof of age.
 
Another  ...

How to get the most out of your OB/GYN appointment

Unless you are having a baby, seeing an OB/GYN often makes women feel very nervous.  This can lead to forgetting questions, forgetting important information about your condition and leaving feeling dissatisfied.

In order to get the most out of your appointment here are some simple tips:

1. Come prepared!
  • Bring a list of your medications; this can help us be sure that anything we prescribe will be safe for you.  Your problem may also be related to your medication – for example, blood thinners can cause heavy periods.
  • Know your family history. Things that are important for OB/GYNs to know include family member with blood clots, recurrent (more than 3) miscarriages, family members with cancer of the breast, ovary, uterus or colon (bowel.)  It is also helpful to know the age they were diagnosed.
  • Bring a list of questions! The more you ask, the more you’ll know.  We want our patients to be well informed so that we can help you make the right treatment plan for you. Also, there may not be time to go over everything in one appointment so make sure you start with what is important to you.
2. Check your inhibitions at the door!
  • Trust me, we have seen and heard everything and there is very little than can shock us! It is important that you are open and honest so that we can make sure we understand exactly what is going on to come up with the right diagnosis. 
  • It is likely that ...

To Mammogram or Not to Mammogram? A note on recent studies

A Canadian medical research study has recently been published questioning the value of doing screening mammograms on women in their forties. The article has spurred controversy because the results contradict multiple other similar research studies which showed that women in that age group who get regular mammograms actually are spared death from breast cancer more often that women who are not invited to screening.

Some problems with the methods of Canadian study, published in the journal BMJ, were pointed out by a scientist at the University of Washington, Judith Malmgren, who has worked with Swedish Medical Center doctors to see how women in their forties have fared in our system. Click here to read Dr. Malmgren’s letter to the editor of BMJ.

There are two ironic features to the Canadian study. First, the authors say it is okay for women to not get screening starting in their forties “when adjuvant therapy for breast cancer is readily available.” This means that it is okay to diagnose breast cancer later because you can mop up bigger and more advanced cancers with treatment like chemotherapy, radiation and bigger surgery. But at Swedish, we do not think that many women prefer more severe therapy rather than earlier detection.

Secondly ...

4 alternatives to a hysterectomy

There are many reasons women need a hysterectomy.

Some of the most common are:

  • Heavy periods that are not controlled on hormones or an inability to take hormones to control the period.
  • Large fibroids that press on the bladder or the bowel, or are so large they can be felt on the abdomen.
  • Endometriosis (usually if this is requiring a hysterectomy it is due to both pain and bleeding).
There are several treatments to avoid hysterectomy:

  • Uterine artery embolization where microscopic plastic beads are inserted into the uterine arteries to block the majority of blood flow to the uterus.  This causes the uterus to slowly shrink in size.  The uterus may decrease to half of its normal size within 2-3 years.  Initially there is a lot of inflammation of the uterus as it loses its blood supply.  The pain associated with this will usually require ibuprofen and narcotics.  Most women stay in the hospital for overnight, and it is usually about 2 weeks before you are feeling well enough to resume normal activities.
  • Myomectomy, a surgical removal of the fibroids.  There are two ...

What you should know about ovarian cysts

Finding out there is a cyst on the ovary is often a concerning experience for a woman.  Women aren't sure what it means for them or what will need to be done.
 
A woman has two ovaries, which produce eggs, which allow a woman to get pregnant, and produce female hormones.  These hormones cause the lining of the uterus to grow, which then shed (as the period).  Ovaries are actively making hormones and ripening eggs from when the period first starts until when she goes through menopause.  As an egg is ripening in the ovary, several small cysts will form.  These grow to about 2.5 cm, or one inch, and then when the woman ovulates or releases the egg the cyst drains and is gone.  So when a woman has an ultrasound that shows a cyst less than 3 cm it is usually a "follicular" cyst - that is a cyst with a developing egg.  This type of cyst is completely normal and will come and go.
 
Cysts that are  ...

Why pregnant women should receive flu vaccine and pertussis booster

Why do we recommend that pregnant women receive both the flu vaccine and the pertussis booster during pregnancy? Here are a few reasons:
 
The influenza virus, better known as the flu, has been proven over and over to have the potential to cause serious disease in pregnancy.  That includes an increased risk that when pregnant women “catch” the flu, they may require admission to the intensive care unit, require a ventilator and, less commonly, even death.  It’s serious.   Babies of women who are infected with the flu during pregnancy are more likely to be born prematurely and are at increased risk for stillbirth.

We recommend the flu vaccine at any point in pregnancy and offer the single dose, preservative free vaccine in our office to all pregnant women (with the exception of those who have a medical reason not to get it.)  A common misconception is that the vaccine causes the flu - it does not.  Another misconception is that it is not safe for the developing baby to be exposed to the vaccine itself or the immune response it generates.  There is no evidence to support this fear in almost 50 years of administrating this vaccine and close follow up of those receiving it.

We recommend the flu shot, which is an inactivated virus. The Flumist is a live attenuated virus that is not recommended in pregnancy.

Your family members should also receive the vaccine as they can pass the flu on to a newborn who has not yet gotten the vaccine.  Babies can suffer severe complications if they are infected with the virus before they can receive the vaccine.
 
The other vaccine we recommend during pregnancy is the Tdap booster.  The benefit of the pertussis booster outweighs any perceived risk.  Pertussis, or the whooping cough, is at epidemic levels especially on the west coast including Washington State.  That may be  ...
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