OBGYNDoc
Minneapolis, MN
Female, 36
I am a practicing Obstetrician and Gynecologist, providing care for women in all stages of life. Approximately half of my practice consists of pregnancy-related care, including routine prenatal care, high risk obstetrics, and delivering babies at all hours of the day. The other half consists of gynecologic care, which ranges from routine annual check-ups to contraception and menopause. I perform many surgeries, including laparoscopies and hysterectomies.
We screen all newly pregnant patients for HIV, and early detection is the key to a healthy pregnancy. If an HIV infected mother has a very low viral load, then she has a very good chance of delivering an HIV uninfected baby. Recent studies show that the risk of transmission is <2% if the mother is appropriately treated. The medical advances in treating HIV in pregnancy have made incredible progress such that HIV infected women have an excellent chance of having a healthy baby.
In my practice, we do not perform water births. For one, when a patient is in a tub full of water, it is extremely difficult to intervene should an unforeseen emergency arise. I have seen enough difficult and harrowing deliveries to know that I always need to be prepared for an emergency- vacuum and forceps deliveries, as well as maneuvers for shoulder dystocia (when the baby's shoulders get stuck under the mother's pubic bone and won't deliver) can be life-saving, and the decision to use these maneuvers is made in a split-second. Every minute of delay could result in permanent injury to the baby. Secondly, as a provider, it is also important that I protect myself from exposure to any bodily fluids. When a patient is delivering in a tub, I think it is nearly impossible to avoid direct contact with the water, which is contaminated with the patient's bodily fluids. We all should practice with universal precautions- protect ourselves from direct contact with blood, amniotic fluid, etc, regardless of who the patient is and what diseases they have been tested for. I don't have a problem with laboring in a tub, however. As long as the baby can be monitored safely and appropriately, and as long as the baby's heart rate is appropriate, then I think a tub labor can be a nice alternative for someone who is hoping to avoid an epidural or IV pain medications.
Most couples do relax a bit with their second and subsequent pregnancies because most of the anxiety is related to the fear of the unknown. Just having had the experience of knowing what a labor room looks like, what it feels like to have an IV, what to expect when it is time to push, and how to cope with the sleepless nights of caring for a newborn can alleviate the stress that a first-time parent experiences.
If a patient has evidence of an infection, I would certainly bring it up.
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What do you think is the most corrupt industry, city, and State in the country?Personal Stylist & Life Coach
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What made you go the entrepreneur route after college instead of a typical job?The majority of miscarriages occur in the first trimester. By the time you reach 12 weeks, if a normal heartbeat is detected, the risk of miscarriage is only 3%.
When it comes to circumcision, I can only present the facts, and then the parents have to make their informed decision. The benefits of circumcision include decreased transmission of STDs such as HIV and HPV, and therefore decreased penile cancer; there are also decreased rates of urinary tract infections. However, the American Academy of Pediatrics states that there is no medical indication for circumcision. There are many reasons people choose to have their child circumcised- religious, cultural, and social. It is now standard to use local anesthesia during the procedure, but of course, there will be discomfort associated with the procedure.
The cesarean section rate is at an all time high right now, and while cesarean section is usually a very safe surgery, there are risks to performing any major surgery. Having a vaginal birth after cesarean section (VBAC) is one way to reduce the cesarean section rate. Benefits to having a VBAC include less bleeding, a shorter and less painful recovery, and lower overall cost. However VBACs also come with significant risk. The uterine scar, through which the baby was delivered at the time of cesarean section, may be weak, and may not tolerate the stress of repetitive uterine contractions. If this is the case, the scar could open up, or rupture. Although rare, uterine rupture can potentially result in hemorrhage, loss of blood flow to the fetus, and ultimately fetal and/or maternal death. When we discuss the possibility of VBAC, we want to make sure that the patient is a good candidate for a successful VBAC- we aren't willing to take this risk unless there is a high likelihood of success. Therefore, patients who had their cesarean sections performed for poor labor progression or because the size of her pelvis was too small for the baby to pass through may not be ideal candidates. If you are considering VBAC, you need to have a discussion with your physician to see if you are a good candidate. If you decide to attempt VBAC, you will be monitored very closely during your labor, and if anything out of the norm occurs, your doctor will likely recommend a cesarean section. It's very important that you understand that at any time during the labor, if there are worrisome signs for uterine rupture or the baby not tolerating contractions, you will likely undergo a cesarean section.
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