Preparing for pregnancy: 5 health and family considerations

Preparation can help set the stage for a healthy pregnancy and delivery.

Dr. Jacqueline S. Kates

Thinking about having a baby? A little preparation goes a long way in setting the stage for a healthy pregnancy. Before you start trying to conceive, it’s a good idea to talk to your women’s health provider about your health and risk factors.

Consider these five key health questions:

  1. Are you in good general health? Levels of fitness, nutrition and stress can affect fertility and a healthy pregnancy. It’s worth taking time to address these issues in advance, making lifestyle changes such as exercising, following a healthy diet rich in folic acid and other important nutrients, and catching up on missed immunizations.
  2. Do you have any pre-existing conditions that may lead to a complicated pregnancy? Conditions like asthma, depression/anxiety, diabetes, high blood pressure and others can affect pregnancy. This doesn’t mean you shouldn’t get pregnant, but we can help you have a plan in place before conception for how best to manage these conditions during pregnancy.
  3. What unhealthy habits need to be kicked? Smoking and tobacco use, alcohol consumption and drug use should be stopped before trying to get pregnant. In addition to affecting the fertility of both men and women, these things have a serious impact on a developing pregnancy. It may be challenging to quit once you’re pregnant, so it’s best to do it in advance. Talk to us for support and strategies.
  4. What prescription and over-the-counter medications, vitamins, and herbal supplements are you taking? Again, some medications can affect fertility, so we may need to make changes before you start trying to conceive. Also, some medications and supplements can be harmful during pregnancy, so we’ll work with you to either wean you off medications or transition you to something else.
  5. Are there any red flags in your family medical history? Certain genetic conditions run in families. We can test for some conditions in advance so you’ll know your risk level before getting pregnant, or develop a plan for testing during pregnancy.

In addition to health issues, consider big picture questions as well. Babies are amazing, and they can also be all-consuming, especially in the early years. Ask yourself the hard questions. Are you ready to make lifestyle changes necessary to be a parent? Are you financially able to care for a child? Do you have the support you need from a partner or others? What impact do you expect a child to have on your home life, career and family?

When you are ready to start trying to conceive, call us for an appointment. We’ll work with you to a personalized care plan.

Knock Out PMS: Help is available for symptoms ranging from mild to intense

We can help you develop a plan to knock out your PMS symptoms
We can help you develop a plan to knock out your PMS symptoms

Amy L. Metzger, CNM

Premenstrual syndrome, more commonly called PMS, is common fodder for jokes, but for many women, it’s no laughing matter. It’s hard to pin down exactly how many women are affected, but it’s likely that 75 to 90 percent of women experience PMS in some form during their lifetimes, and symptoms range from mild to intense.

While the exact cause of PMS is unknown, it seems to be the result of cyclical hormonal changes and chemical changes in the brain. There is also no test to diagnose PMS––instead, women are often tested to rule out other causes, like pregnancy, endometriosis or cancer, when symptoms arise.

While we don’t really know what causes PMS, and why some women experience it and some don’t, it is a true medical condition. Unfortunately, many women are made to feel like they are being dramatic about how bad they feel. Everyone is different, and each person’s experience can change over time. The good news is there are things we can do to lessen its impact.

PMS Symptoms

PMS typically occurs just past mid-cycle, between ovulation and the onset of menstruation, and can last from a couple days to a week or more.

Symptoms of PMS are many and include emotional and behavioral problems such as tension, anxiety, mood swings and depression, appetite changes and cravings, insomnia and trouble concentrating.

Physical symptoms can include muscle and joint pain and cramping, breast tenderness, fluid retention and bloating, fatigue, headaches, acne, constipation, diarrhea and more. Most women with PMS experience several symptoms each month.

We ask women to keep a journal of their symptoms for a few months. When we see a pattern to the symptoms, and rule out other causes, PMS is the most likely diagnosis. For women with extreme symptoms, especially the emotional and behavioral ones, the diagnosis may be premenstrual dysphoric disorder (PMDD).

Lifestyle Improvements

We can also use the journal to help pinpoint triggers. For example, if you get headaches a few days before your period, we may recommend cutting back on caffeine the week before your period to see if that helps.

Lifestyle changes you can make that may relieve or at least lessen your PMS symptoms, include:

  • Eating smaller, more frequent meals and limiting salt intake
  • Regular exercise, like walking for 30 minutes a day
  • Getting enough sleep
  • Yoga and massage
  • Limiting caffeine and alcohol
  • Not smoking
  • Eating a healthy diet that’s rich in calcium

You may need to experiment to find out what works best for you. If your symptoms are severe enough to impact your daily life––you regularly miss school, work or other activities–– and nothing you’ve tried is working, it’s time to talk your women’s health provider.

Medical Treatment for PMS

Medical treatment varies based on each woman’s symptoms and their severity:

  • Antidepressants can help women with mood symptoms. Some can be taken daily, and others only in the two weeks prior to each period
  • Nonsteroidal anti-inflammatory (NSAIDS), such as ibuprofen or naproxen, can help relieve muscle, joint and breast pain
  • Diuretics can help with swelling and bloating
  • Hormonal contraceptives, like the pill, can relieve or lessen a range of symptoms

If you have symptoms that disrupt your life every month before your period, come and see us. We’ll work with you to develop a plan to treat your specific symptoms so you can have as little disruption to your life as possible.

Worried about what’s normal “down there?”

Women are inundated with ideas about what they should look and feel like in their nether regions. We can help you separate fact from hype.

Ignore marketing and celebrity hype about products and treatments
Debra (Burt) Ames, CNM

Like an ear, a nose or a myriad other body parts, women’s genitalia comes in a variety of shapes and sizes. Unfortunately, due to the proliferation of marketing, celebrity endorsements and societal pressures, it’s become another area of the body for women to feel insecure about.

Like a fingerprint, every woman’s genitalia––including the pubis, labia, clitoris, vulva and vagina––are all different. But more than ever, women are subjected to a wide variety of ideas about what “perfect” looks like, when there’s no such thing. Even many textbooks portray the female genitalia as pink and smooth, with no hair and thin, trim labia; this doesn’t reflect reality.

The result is an increase in the use of unnecessary vaginal products––including douches and cleansers––and unnecessary cosmetic services, like waxing and even surgery. In fact, a recent report by the American Society of Plastic Surgeons showed that labiaplasty (a procedure in which the labia minor is trimmed to tuck up into the labia majora) increased 39 percent from 2015 to 2016.

Here are a few key things to remember:

Size doesn’t matter. There is no standard size and shape of a woman’s external genitalia. Some women have longer or thicker labia, and others are smaller or thinner. Texture can vary tremendously from relatively smooth to very wrinkled or bumpy, with lots of folds. Some women have a more prominent clitoris, and others are more hidden. It’s all fine.

Hair is normal. Currently, our culture seems to encourage women to remove all or most of their pubic hair. It’s fine if that’s what you prefer, but there is no medical reason to do so. Actually, in addition to the time, effort and discomfort involved, hair removal increases the risk of problems like irritation and infection from things like ingrown hairs for nicks from a razor.

Color may vary. The color of genitalia can range from pink to red, brown, or even purplish. Just like skin tone, the color of women’s genitalia varies. It can also change over the course of your lifetime, such as after childbirth.

Vaginas are self-cleaning. There is no need for you to wash the inside of your vagina, or to douche it, steam it, moisturize it or any of many other things we’re currently seeing promoted in the media.

All you really need to do is regularly wash your external genitalia with water, or if preferred, with a very mild soap, and forget the rest. Cleansers can strip the vagina of its healthy flora and increase your risk of yeast and other infections. Fragrances (including scented tampons) can also cause irritation and upset the vagina’s natural pH balance.

The amount of normal vaginal discharge varies from woman to woman, and changes at different points in a woman’s cycle. This is how the vagina cleans itself. The smell and consistency of the discharge will also change throughout your cycle.

When to see a women’s health provider

If you are considering using a new product or treatment for your vaginal area, talk to your women’s health provider first. Tell us your concerns. We will work with you to come up with a solution that won’t do more harm than good.

You should also see your provider if you experience:

  • Pain or discomfort during or after sex or other activities. There are some anatomical issues or conditions that can be corrected if they cause a problem.
  • New lumps or growths. It’s normal to get the occasional pimple or even a bug bite, but if you find a lump or growth, get it checked.
  • Whitish patches or a rash that’s not due to hair removal.
  • Intense itching, burning, or bleeding of the skin.
  • A discharge that is lumpy, gray, yellow or green.
  • Spotting between periods.

There are lots of products and trends out on the market that promise to rejuvenate or enhance women’s genital areas, preying on, or even creating, insecurity and unnecessary worries. However, it’s an area of the body that’s pretty low-maintenance: a daily, gentle, external cleansing with water and regular annual- or semi-annual exams by a women’s health care provider to catch potential problems early.

There is nothing you can ask us that you should be embarrassed about. We pride ourselves on our ability to get to know our patients and address their concerns without judgement so you can feel comfortable talking about anything. A big part of what we do in many cases is to set your mind at ease.

Have questions or concerns? Schedule an appointment online or call us: 413-562-8016 for our Westfield office or 413-736-9978 for our Springfield office.

Choosing the birth control method that’s right for you

Anne Vaillant, CNM, says there are a number of factors to consider when choosing a birth control method.
Anne Vaillant, CNM, says there are a number of factors to consider when choosing a birth control method.

Factors to consider when weighing your options

Anne Vaillant, CNM

A generation ago, birth control options were pretty limited: condoms, the pill, and the rhythm method (abstaining from sex when you are at your most fertile). Today, there are a wide variety of options, but it’s important to find the one that will work the best for you and your lifestyle.

Consider This

Effectiveness: When estimating the effectiveness of the various forms of birth control, it’s important to remember that they are calculated assuming you are using the method as instructed. For the pill, this means you must take it every day at about the same time to maximize its effectiveness. Start skipping days or taking it erratically, and its effectiveness decreases. Other options require diligence once a week or once a month. Some require regular trips to your health care provider. This requires a level of commitment.

On the other hand, options like a condom allow you to only think about birth control when you really need it—right before sex—but because condoms can tear or come off, you may be sacrificing effectiveness for convenience.

Price: Depending on your insurance, some birth control options are more affordable than others. Many options require prescriptions, while some are available over-the-counter.

Convenience: Some methods of birth control, like implants, are effective for up to three years, and even longer with IUDs. Once you have them, you don’t have think about birth control for significant periods of time. However, if you aren’t interested in a long-term option, you may be more willing to put up with the inconvenience of, for example, getting the shot every three months.

“Ick” Factor: Some women are more squeamish than others. If you will feel uncomfortable inserting something far up in your vagina, options like the ring may not be for you. Also, some require the addition of a spermicide before insertion, which some women find messy.

Allergies/Sensitivities: If you have any allergies or sensitivities, it’s important to know what each birth control option contains. Latex allergies may rule out some of the most common type of condoms (they are available in latex-free varieties). Some women have reactions to spermicide; others find the patch gives them a rash. If you are prone to urinary tract infections, the diaphragm may increase your risk for more.

Side Effects: Many forms of birth control (such as the pill, patch and ring) contain hormones—typically estrogen and progestin—that can result in a range of side effects, including some that are short-term and some that aren’t. Some women tolerate progesterone better than estrogen, so an option like the injection, which contains progestin only, may be a better choice.

Side effects aren’t all bad; certain forms of birth control, like the pill, can reduce the frequency, heaviness and cramps of your period.

At A Glance

The chart below provides a brief synopsis of the most common types of birth control, comparing them based on the factors described above.

Method Effectiveness Frequency Prescription Do-It-Yourself Estrogen
IUD/Hormonal 99%+ 5-7 years Yes No Yes
Implant 99%+ Every 3 years Yes No No
Vasectomy 99%+ Once/ permanent Surgery No No
IUD/Copper 99% 10-12 years Yes No No
Shot 94-98% Quarterly Yes No No
Pill 92-99% Daily Yes Yes Yes
Patch 92% Weekly Yes Yes Yes
Ring 92% Monthly Yes Yes Yes
Diaphragm (w/spermicide) 88% Every time you have sex (within 6 hours) Yes Yes No
Male Condom 82% Every time you have sex No Yes No
Cervical Cap (w/spermicide) 80% Every time you have sex (within 48 hours) Yes Yes No
Female Condom 79% Every time you have sex No Yes No
Sponge (w/spermicide) 76-88% Every time you have sex (within 24 hours) No Yes No
Rhythm Method (or withdrawal) 76-78% Every time you have sex No Yes No


Talk to Your Healthcare Provider

Your OB/GYN or certified nurse-midwife can help you choose the birth control method that’s right for you. Let them know what factors are most important to you, and be honest about any concerns you have.

For example, let your provider know if you want long-term or short-term—or even permanent—protection against pregnancy, as some options are easier to reverse than others. If you also want protection from STDs, condoms are the only option that offers this, but they can be used in conjunction with other birth control options to boost their effectiveness for pregnancy prevention.

Often, short-term side effects resolve in a few months, but if you are experiencing side effects that you find intolerable or concerning, talk to your health care provider about what you are experiencing and discuss other options.

If you need guidance about birth control, schedule an appointment online or call us: 413-562-8016 for our Westfield office or 413-736-9978 for our Springfield office. We’ll be happy to talk with you about your options and find birth control method that’s best for you.

Period Pain

Don’t assume that nothing can be done
Amy L. Metzger, CNM

Amy L. Metzger, CNM, says help is available for painful periods.
Amy L. Metzger, CNM, says help is available for painful periods.

Most women get a monthly period, but for some, it is a monthly ordeal.

Many of our patients report painful periods. This comes as no surprise; the American College of Obstetricians and Gynecologists (ACOG) says dysmenorrhea (the clinical name for intense menstrual cramps) is the most commonly reported menstrual disorder, with more than half of menstruating women reporting having some pain for one to two days each month.


Dysmenorrhea encompasses more than just painful abdominal cramps. You may also experience:

  • Changes in your bowel movements ranging from constipation to diarrhea
  • Nausea, or even vomiting
  • Pain in your lower back, or radiating down your legs

Try this at home

There are steps you can take to relieve or at least lessen your symptoms. You may need to experiment to find out what works best for you.

  • Over-the-counter pain relievers that reduce inflammation, such as ibuprofen, may help. Take with food to prevent stomach irritation. Start taking the pain reliever as soon as you think your period is about to start.
  • Apply heat to the area that hurts. A hot water bottle or heating pad usually brings some relief.
  • Exercise can help to limit cramps if you do it regularly.
  • Other lifestyle changes may also help. Be sure to get enough sleep and stay well-hydrated. Try reducing your consumption of caffeine and alcohol. If you smoke, quit.
  • Some women find relief in holistic treatments, including acupuncture, massage or herbal supplements. Talk to your provider before starting any supplements to reduce the risk of harmful interactions or side effects.

 When to seek help

If your symptoms are severe enough to impact your daily life – you regularly miss school, work or other activities – we can help.

We will talk with you about your medical history, symptoms and menstrual cycle. We will also do a pelvic exam and possibly an ultrasound to rule out any conditions that may be causing the problem, such as endometriosis or fibroids.

Once we’ve ruled out other conditions, we can work with you to develop a plan to reduce your symptoms. This may include some of the self-care options described above, or prescription medication. A variety of birth control methods can be used to treat dysmenorrhea, including the pill, the patch, the vaginal ring and intrauterine devices (IUDs). We can help you choose the option that works best for you and your lifestyle.

If you suffer from painful periods, schedule an appointment online or call us: 413-562-8016 for our Westfield office or 413-736-9978 for our Springfield office.