We’ve come a long way, baby

National Midwifery Week (Sept. 30–Oct. 6) highlights the evolution and modern importance of a time-honored vocation

National Midwifery Week highlights the role of the modern midwife

Anne Vaillant, CNM

In recent decades, expectant moms across the nation have been making a slow but steady return to their historical roots in terms of pregnancy care and childbirth. An increasing number are choosing a delivery experience that was the norm in early America and, in many parts of the world, still is today. These women are embracing the traditional—yet evolving—practice of midwifery.

Sept. 30–Oct. 6 marks National Midwifery Week, when Women’s Health Associates joins the medical community and family-centered organizations everywhere in highlighting the work of America’s certified nurse-midwives (CNMs) and certified midwives (CMs). With passion and dedication, we collectively deliver more than 300,000 babies in the U.S. every year and provide primary gynecological care throughout countless women’s lives.

Midwifery: A Natural History

In times past, the primary attending caregiver during labor and delivery typically was a “lay” woman, informally trained to support the mother and provide initial care for the newborn. While these functions remain at the core of modern midwifery practice, today’s midwives are specially trained, licensed and certified, most in nursing as well. Certified nurse-midwives address women’s health needs from adolescence through menopause and beyond, in addition to our essential role as care provider during pregnancy, labor and childbirth.

With the establishment of obstetrics as an important medical field in the early 1900s, the vocation of midwifery faded from common practice for several decades. Its gradual resurgence came in the 1960s and 1970s, as a handful of hospitals began offering formal training programs.

According to a report from the American College of Nurse-Midwives (ACNM), the proportion of CNM/CM-attended births has risen nearly every year for at least the last 20 years.

Advantages of Midwife-Led Care

Women often choose midwifery care for its holistic, woman-centered approach, which actually may lead to better outcomes and lower health-care costs. Research shows that women receiving care from CMNs experience lower rates of cesarean births and labor induction, lower use of regional anesthesia and higher rates of breastfeeding than women strictly under physicians’ care.

While these facts speak volumes, it’s important to note that collaboration is critical in today’s Ob/Gyn practice. As CNMs, we work very closely with our physicians, ensuring that every woman has access to the best medical intervention if concerns should arise.

If you’re seeking a personalized, optimal care experience during pregnancy and childbirth, or at any stage of life, our CNMs are ready to partner with you. Contact us for an appointment today.

Learn the subtle signs of a dangerously silent disease

Teal signifies support for those affected by ovarian cancer. During National Ovarian Cancer Awareness Month, join us in promoting awareness of this potentially devastating disease.
Teal signifies support for those affected by ovarian cancer. During National Ovarian Cancer Awareness Month, join us in promoting awareness of this potentially devastating disease.

Dr. Robert Wool

September is National Ovarian Cancer Awareness Month

Though considered rare among all cancers, ovarian cancer is the deadliest of gynecological malignancies—due, in large part, to its notorious silence. During the month of September, we join the National Ovarian Cancer Coalition and others nationwide in promoting awareness around this potentially devastating disease.

Because early signs of ovarian cancer, if present at all, often go unnoticed or are attributed to less serious conditions, diagnosis typically occurs at advanced, less treatable stages. For this reason, staying attuned to your body and recognizing when something isn’t right is the key to earlier diagnosis and, ultimately, effective treatment.

Most cases of ovarian cancer are seen in women over age 55, but it can develop at any age. It sometimes presents with common gastrointestinal issues, such as indigestion, bloating, pain, bowel changes or feeling full quickly. Other possible symptoms include urinary urgency (feeling of having to go) or frequency, back pain, pain during sex, period changes and extreme fatigue. Although ovarian cancer is an unlikely cause, never dismiss these problems, especially if they are new or unusual for you, get worse or don’t go away. Make an appointment with your ob/gyn as soon as possible.

Just as important as paying attention to your body’s signals is having regular gynecological exams, or “well woman” checkups. These allow your provider to get an overall picture of your health, including new concerns or recent changes. Unlike some other abdominal or pelvic cancers, ovarian masses themselves are difficult or impossible to feel on regular examination until they are quite large. This makes good communication critical for determining whether certain tests, such as transvaginal ultrasound, may be warranted.

If you’re due for a regular checkup or have any concerns about your gynecological health, call us for an appointment today. You know your body best. Be sure to listen to it closely—this month and always.

Vaccines during pregnancy: what expectant moms need to know

Some vaccines can be an important part of protecting the health of both mom and baby.
Some vaccines can be an important part of protecting the health of both mom and baby.

Dr. Jacqueline Kates

August is National Immunization Awareness Month

When it comes to health and wellness in pregnancy, any choice an expectant mom makes is for two (or more!)—including whether to receive vaccines. During National Immunization Awareness Month, we’re taking the opportunity to educate our patients and all pregnant women on this critical area of their care.

As with any medical treatment, recommendations around vaccinations center on risk vs. benefit. In general, a vaccine that contains inactive viruses is safe in pregnancy, and its protective benefits almost always outweigh its risk.

The flu shot and the Tdap vaccine—which prevents against tetanus, diphtheria and pertussis (whooping cough)—are primary examples of vaccines that contain no live viruses.  Not only do these vaccines protect both mother and fetus from potentially serious infections, but the baby will then retain some of that immunity after birth. For these reasons, we routinely recommend that women receive the flu shot and the Tdap vaccine during pregnancy.

That having been said, it’s important to note that only the flu shot—not the nasal mist—is recommended in pregnancy, as the nasal mist is made from a live virus. Other common vaccines that contain live viruses include the chickenpox (varicella), measles-mumps-rubella (MMR) and shingles (varicella zoster) vaccines. Since it’s possible a live virus vaccine, while generally safe for children and infants, could pose a risk to the baby, pregnant women should avoid these vaccines.

Health care providers may recommend other vaccines during pregnancy in certain cases, such as upcoming travel outside of the U.S. If a mom is at higher risk for infection due to certain health factors, we may determine that hepatitis A and hepatitis B vaccines would be beneficial.

It’s the job of your obstetric provider to explain the risks and benefits of receiving any vaccine, and to make recommendations based on your particular situation. Call us with any questions or to make an appointment. We can help you make the best choices for your baby’s health and yours.

A hot topic: menopause myths busted

The hype surrounding menopause often makes the anticipation worse than the actual experience
The hype surrounding menopause often makes the anticipation worse than the actual experience

Dr. Robert Wool

Women often look forward to menopause with a mix of anticipation and dread. On the one hand, not having their period anymore may be a welcome relief. However, the thought of hot flashes and other symptoms and changes that accompany this phase of life can seem daunting.

With many of our patients, we’ve found the hype surrounding menopause often makes the anticipation worse than the actual experience.

Menopause Takes Time

Many of the changes women experience as they enter menopause are gradual. You are clinically in menopause once you have not had a period for 12 months. But it’s not like flipping a switch; it can take anywhere from several years to a decade for that to occur. During that period, which we call perimenopause, your body is experiencing gradual changes.

For example, it’s important to know that missing a period or two does not mean you are in menopause. Even if your periods become irregular or if you don’t have one for a few months, you may still be fertile and able to conceive until you are truly in menopause.

Hot Flashes

People also have misperceptions about hot flashes, perhaps one of the most talked about symptoms of perimenopause. But not all women experience hot flashes as they enter menopause and those who do don’t all have the same experience. Hot flashes can range from mild to moderate or severe. Some women have a few episodes and others have them more frequently. Others may experience them only at night.

Hot flashes are not the only symptom of menopause. There is a wide range of changes and symptoms women may experience, including sleep disruption, irritability, mood swings, changes to skin and hair, weight gain, vaginal dryness and incontinence.

Easing the Transition

The majority of related symptoms are the result of decreased estrogen production during the perimenopausal and menopausal years. The good news is there are ways we can correct or minimize the severity of many of these symptoms.

Treatment options vary based on specific symptoms. Hormone replacement therapy may help alleviate several symptoms, but many women are reluctant to take them.

There are certainly women for whom hormone replacement is not recommended due to other health issues, such as high cholesterol or blood pressure, obesity, breast cancer and other conditions. For generally healthy women, however, hormone replacement can help ease the transition to menopause.

Talk to your healthcare provider about your specific symptoms. It’s often helpful to jot down notes about what you are experiencing, from trouble sleeping too hot flashes and other symptoms, to track frequency and severity. This can help us come up with strategies that will work best for your individual situation.

 If you are beginning to experience signs of menopause, or are struggling with some of the changes, schedule an appointment and we’ll work with you to address any concerns.

Practicing safe sex important for both lesbians and heterosexual women

2 woman hugging
It’s important for your health care providers to have a complete picture of your health and lifestyle.

June is Lesbian, Gay, Bisexual and Transgender Pride Month

Debra Ames, CNM

While all women face certain health risks just by being women, those who have same-sex partners may mistakenly believe they are at less risk than heterosexual women. In honor of June as Lesbian, Gay, Bisexual and Transgender Pride Month, we discuss these conditions and how you can reduce your risks.

Understanding your personal health risks is important. For example, depression is more prevalent in women than men, but women who are lesbians or bisexuals can be at a higher risk of depression and anxiety. That’s why it’s important for your health care providers to have a complete picture of your health and lifestyle.

Women who have sex with women are less likely to get vaginitis but are still at risk for certain sexually transmitted infections (STIs) such as human papillomavirus (HPV), herpes, HIV, bacterial vaginosis and trichomoniasis (a parasite infection).

Just like with heterosexual sex, if you are a woman who has sex with other women, you should practice safe sex and have regular checkups and screenings to reduce your risks, especially if you are not in a monogamous relationship in which both partners have been tested for STIs.

Some infections may not have symptoms, but can still be passed along, which underscores the need for regular testing. Having the appropriate vaccinations is also important, such as those for HPV, hepatitis A and hepatitis B.

It can be a challenge for lesbian and bi-sexual women to find a provider with whom they feel comfortable. But it’s key to find a provider with whom you can be honest about your health concerns so you can make routine health care a priority. Annual checkups paired with the appropriate testing, as well as seeking care at the onset of concerns or symptoms, will go a long way in terms of reducing your health risks.

If you are looking for a women’s health provider who takes the time to get to know patients and enjoys providing a personal level of care, call us for an appointment today.