Category: Blog

It is becoming more common for mothers who are nearing the end of pregnancy to request an induction of labor early, but waiting until natural labor occurs is good for both the mother and the baby in a healthy, uncomplicated pregnancy. A pregnancy is considered full term between weeks 37-40. Even though 37 weeks is the earliest point of a pregnancy being considered full-term, there is still so much growth and development that is happening in the last couple weeks of pregnancy.

It is hard to believe that there would be any benefit to the mother to stay pregnant any longer than she would absolutely have to, but there are several reasons to not induce labor unnecessarily (elective induction). Here are a few benefits for the mother:

• Increased likelihood that you will go into labor on your own when your body is ready, which can improve your labor experience
• Fewer medical interventions to start or continue the labor process
• Increased success with breastfeeding since the baby is more interested in eating
• Decreased chance of having a cesarean section

The baby seems to get the most benefit of not electively inducing labor. Here are some things mothers can focus on in the last weeks of pregnancy so they know they are doing the most for their baby:

• Important organs, especially the brain, have time to fully develop
• Less likely to have breathing, hearing or vision concerns immediately after birth and long-term
• Increased interest in eating and a better latch during breastfeeding
• Better at maintaining their body temperature and blood sugar levels following birth
• Able to transition to the outside world easier
• Less likely the baby will be separated from the mother for testing thus decreasing the initial mother-baby bonding

There are many favorable reasons to not pursue an elective induction that both the mother and the baby can benefit from. Ask your provider about helpful techniques that can mentally and physically help you with the last few weeks of pregnancy. Certified nurse-midwives are knowledgeable about ways that can help pregnant women get the most out of their pregnancies even in the last couple of weeks. In addition to caring for pregnant women, certified nurse-midwives also provide routine gynecological care to women of all ages. This includes pre-conceptual care, family planning, annual exams, contraceptive counseling and menopausal care.

Adolescence, simply defined, is the state or process of growing up… sounds easy enough. One’s body knows what to do: eat, sleep, drink and one day, as if by magic, it wakes up and is different. But, what about those other changes, the ones we’re not so eager to discuss; changes in mood, acne, menstruation. Is this normal? Though the simple answer in most cases is yes, there are many topics and questions a healthcare provider familiar with adolescent women’s health can help to address.

While there is no set age or reason to begin routine care with a women’s health professional, the American Congress of Obstetricians and Gynecologists recommends adolescents establish care between the ages of 12 and 15. By initiating this relationship early in one’s reproductive life, patients and physicians are more easily able to bridge communication barriers, particularly regarding the sensitive issues which arise in the course of care for adolescent women.

Unfortunately, the fear of one’s first gynecologic visit deters many young women from going to the doctor. A visit to a gynecologist does not necessarily mean a pelvic exam will be performed. In fact, a first visit is sometimes just a good chance to talk about health, healthy behaviors and answer questions a young woman may not feel comfortable asking anyone else. Initial visits can include a pelvic exam in certain situations. This may involve an external exam only or a gentle internal exam depending on a patient’s health history or concern.

In addition, there are many situations in which an adolescent woman may seek care for a specific problem or need. Common reasons to consult with your women’s health professional are: concerns regarding the menstrual cycle, pain in the pelvic region, overall sexual health, or questions about normal growth & development.

In recent years recommendations have changed for immunizations and routine health screening in the adolescent population. It is recommended that all young women be administered a HPV vaccine series. HPV (human papiloma virus) is the main cause of abnormal pap smears. The HPV vaccine is recommended between ages 11-12, though can be given up to age 26. Though the vaccine will not protect against all forms of HPV, it does offer protection against the two most common forms of high-risk HPV which cause cervical cancer.

In the case of heavy or irregular menstruation, there exists a broad spectrum of normal for young women. This is especially true of the first one to two years following menarche (a woman’s first period.) In the adolescent patient, the interval between periods may fall outside of the typically accepted normal range due to ongoing development of hormone producing centers in the brain.

Frequently missed school or participation in sports due to heavy menstrual bleeding or pelvic pain should be discussed with a physician. Any woman experiencing bleeding so heavy as to prompt evaluation in an Urgent Care facility or Emergency department, should be followed up by a thorough evaluation in her doctor’s office.

A major health concern for women after menopause is the risk of heart attack and stroke. Throughout the last decade, Hormone Replacement Therapy (HRT) has been used to treat menopausal symptoms and help prevent cardiovascular disease. Now, there is a large body of evidence that has shown that women who take HRT are also at a lower risk of heart disease.

In the first 5-10 years after menopause, estrogen is actually effective in preventing cardiovascular disease. It is in this group that HRT can make a difference. This concept was discovered in the first and only prospective, double blinded, placebo controlled study of HRT in older women, called the Women’s Health Initiative Study (WHI). This was a controlled study designed to test the hypothesis that HRT is beneficial in preventing heart disease in women. Primarily studied were older women, well past menopause.

Because this was such a large study, the data was analyzed by looking at many aspects of women’s health. The issue of breast cancer is paramount in women’s concerns for their immediate and long-term health. Recently, the data from the WHI showed that there was less breast cancer in the group of women who only took estrogen and not both hormones (estrogen and progesterone). However, this is not necessarily the answer. Many observational studies suggest that there is an increased risk of breast cancer when estrogen is used over a long period of time. This risk is reduced after about five years of discontinuing use. The risk of breast cancer is higher in those women who use both estrogen and progesterone daily.

The key is to speak with your health care provider in order to individualize HRT to the individual situation:

• If a woman has symptoms that are affecting the quality of her daily life at work and/or at home, there are many options for her to manage her symptoms. Some of these include better handling of stress, and avoiding hot drinks, coffee, alcohol, spicy foods and carbohydrates.
• For women who need hormone replacement and who still have their uterus, a patient specific combination of estrogen and progesterone should be considered.
• Women who do not have a uterus should not take progesterone because of the increased risk for breast cancer with daily use.

Advantages of HRT

Lower risk of cardiovascular disease (when started around the time of menopause), improvement in bone strength, symptom improvement, lower risk of colon cancer, and improved bladder and vaginal health.

Disadvantages of HRT

Increased risk of cardiovascular disease (if started well after menopause), and increased risk of breast cancer if used for an extended period of time.

Recommendation

With the help of your health care provider, use the lowest amount of estrogen and progesterone as needed to control symptoms of menopause, and stop its use when symptoms abate. Exercise, breast monitoring, and controlling alcohol intake will lower the risk of breast cancer. A healthy diet, exercise, monitoring cholesterol and not smoking will lower the risk of cardiovascular disease.

October is Breast Cancer Awareness Month, and an opportunity for us to consider ways in which women can empower themselves when facing the possibility of this disease. A woman can make lifestyle decisions for prevention, choose to access early detection methods for diagnosis, and understand her options if diagnosed with breast cancer.

With respect to prevention, it can be as basic as diet and exercise choices. We know that diets focused on richly colored vegetables and fruits, low in saturated fats, and limited to one alcoholic drink per day can lower risk of developing breast cancer. Maintaining an ideal body weight and exercising just 30 minutes five days per week is also beneficial. If you are unsure about the use of hormone replacement therapy, meet with your primary care physician or gynecologist to discuss the pros and cons in your particular situation. For those women with a strong family history of breast cancer, ask your primary care physician about the need to see a breast surgeon or genetics counselor about more aggressive ways to manage potential higher risks.

There has been some debate in the press recently regarding the usefulness of mammograms. It is important for women to know that the American Cancer Society, American Society of Breast Surgeons, and the American College of Radiology continue to recommend that women of average risk begin screening mammography at age 40. This recommendation is based on many studies that have shown screening mammography improves survival from breast cancer, and that newer digital mammography is more effective in younger women with dense breasts than the older film mammograms, leading to earlier detection. Patients diagnosed at an earlier stage are less likely to require mastectomies and chemotherapy, and have improved survival rates. You may be advised to start screening at an earlier age if you have other risk factors, including a strong family history. In some patients, there may be additional tests available to help with early detection. If you feel a mass, you should seek an evaluation with your primary care provider regardless of your age. While there is still debate about recommending self-breast exams, I continue to advocate them for women who feel comfortable performing them. Many women in my practice found their own breast cancer with a thorough self- breast exam.

If you are facing a diagnosis of breast cancer, here are some things to remember:

1. Most women have early stage disease, which is often curable.
2. There are effective treatment options available for all stages of breast cancer. Discuss options for seeking care with your health care provider.
3. Each woman’s treatment plan needs to be planned carefully and individualized. When looking for a surgeon, inquire if they focus their practice on treating patients with breast disease. Most surgeons who focus on the most up-to-date treatment of breast cancer also partner with medical oncologists, radiation oncologists, pathologists, radiologists, nurses, reconstructive surgeons, social workers, and research coordinators in a team approach to offer cohesive, compassionate and exemplary care to each and every patient.

In the end, you should feel that your team of physicians and other care providers partner with you and your loved ones to obtain the best outcomes possible.