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.
I will be perfectly honest in saying NO, I don't find it creepy. I appreciate the diversity of having both genders in the work place. I understand why some women (or even most women) prefer seeing a female OBGYN. However, I think men are able to contribute medical expertise, professionalism, compassion and surgical skills, and I don't see why we shouldn't allow them to. Historically, more men than women have pursued a career in medicine, but today it is quite even. The number of men applying for residencies in OBGYN is dropping, however, and I, for one, will miss having male colleagues
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The HPV vaccine will protect you from the 4 most common strains of HPV, however there are over 100 different strains of HPV that we know of. Only some of these will cause genital warts. Others can cause precancerous or cancerous changes or the cervix or other organs. The Gardasil vaccine is thought to protect you from the strains that cause approximately 90% of genital warts and 70% of cervical cancers. Once a person has contracted HPV, he or she has the potential to always harbor the virus and have recurrences. Most people with healthy immune systems will clear the virus, however. If your husband has a strain that causes genital warts, he has the potential to have recurrences. If he does, any contact you have with him can cause the virus to spread. Although this is unlikely if he is healthy, you both should always be aware of any skin changes, and avoid contact if he has any evidence of genital warts.
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Part of my job includes discussing issues pertaining to sexuality. Patient's will often open up to me, and will trust me with intimate information that they might not even feel comfortable talking about with their partner, friend, family member or other health care providers. I value that trust and encourage patients to feel comfortable discussing any concerns they may have regarding sexuality.
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The Mirena IUD is a wonderful option for contraception in the appropriate patient. The benefits are the ease of use (not having to remember to take a pill each day), and the menstrual benefits (periods are scant to none). There are not many significant disadvantages. The insertion process can be briefly uncomfortable (but tolerable for most women). In the first 3-6 months after insertion, you may have irregular spotting that can be a nuisance, but will eventually resolve. There are no implications on future fertility- once the IUD is removed, it is safe to conceive within 2-3 months, and it will not have any effect on your ability to conceive. In someone who develops a sexually transmitted infection such as chlamydia or gonorrhea while the IUD is in place, the IUD needs to be removed and the patient needs to be treated with antibiotics. Untreated pelvic infections can lead to infertility due to scarring of the fallopian tubes. Therefore it is important for all women, whether they have an IUD or not, to protect themselves from sexually transmitted infections.
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The Hollywood version of labor is certainly over-dramatized. The profuse sweating, glass-shattering screams are actually not that common. In my practice, most patients choose to have epidurals during labor. With an epidural, the labor process is typically very calm. While it isn't necessarily painless, it is certainly a tolerable amount of discomfort. As a result, the mother can be coherent and mentally present for the delivery. For those women who choose to avoid any pain medications, I encourage them to take some sort of preparation classes so that they can practice breathing techniques and alternative methods of pain relief, as well as learn to focus and stay in control while under the stress of extreme pain.
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It is very common, so I'm afraid you'll just have to get over the embarrassment. Once you experience the delivery of a baby, you often lose a lot of the modesty you might have before you've experienced it.
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I do believe that postpartum depression is a condition for which one can receive short term disability, provided your physician has recommended that you not work based on your diagnosis. Of course, it is essential that one uses this time to get better- to take medications, seek counseling, and keep in close contact with one's physician. If one simply uses this as an excuse to stay home and remain isolated, it is unlikely that she will improve.
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As women age, risks of complications such as infertility, miscarriage, chromosomal abnormalities such as Down Syndrome, preterm labor, diabetes, hypertensive disorders and stillbirth increase. There is no black and white cutoff at which one reaches a "high risk" age. We choose the age of 35 as our designation of Advanced Maternal Age because this is the age at which we see a sharp rise in the risk of chromosomal abnormalities such as Down Syndrome, as well as an increase in the medical problems listed above. Although the risks are much higher at 35 than at 25, they are still relatively low. The risk of having a baby with Down Syndrome at age 35 is still <1%. But I don't think the risks are exaggerated- they are certainly real and should be taken seriously. If you have underlying medical problems such as obesity, hypertension, diabetes or pre-diabetes, then your risk of having a complication in pregnancy is much higher. However, if you are in good health and have the approval from your physician, then you are statistically likely go on to have a normal, healthy pregnancy.
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Yes. The active ingredient in marijuana, THC, crosses the placenta and enters the circulation of the baby. Use of marijuana in pregnancy can result in poor blood flow and growth of the baby. In addition, there have been studies that have shown cognitive delays, hyperactivity and behavioral disorders in babies born to mothers who abused marijuana.
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It is absolutely true that the risk of complications in pregnancy increase as maternal age increases. In particular, the risk of genetic disorders such as Down Syndrome, miscarriages, preterm labor, gestational diabetes, stillbirth and cesarean section rises with maternal age. However, if a patient is in good health and does not have a significant history of obstetric complications, then I support her in pursuing her pregnancy goals. As our society continues to delay childbearing to later ages, we see more and more patients beginning their families in their 40's. Advances in treatment of infertility have made it possible for these individuals to aggressively pursue childbearing. There certainly are examples of misuse of this technology- for example pregnancies that result in high order multiples, or pregnancies in patients with serious chronic medical problems. However, in general, this technology has allowed for countless women to conceive babies in the face of a heartbreaking struggle with infertility.
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The amazing thing about my job is that every day is a different challenge. I take care of women from their adolescent or teen years all the way through menopause and beyond. For most women, I am seeing them once a year for their annual exam, with an occasional visit in between for problem visits. Over the years, I get to know my patients, and really feel that I am a part of their lives. I see them through graduations, relationships, marriages, pregnancies, career changes,etc. When my patients get pregnant, I have the privilege of participating in perhaps the most memorable and emotional 9 months of their lives, culminating in the most life-changing experience possible when I am attending the delivery. Every day when I leave work, I can reassure myself that I have done my best to make the world a better place. While a career in OBGYN is immensely fulfilling, it obviously has its down sides as well. For one, the job requires taking call, which means that there are times when I have to be available at all hours of the night. I have had many 36+ hour stints during which I am constantly on the go. In addition, there is an immense amount of stress that comes with the knowledge that the actions I take can be life-or-death determining actions. I can't imagine doing anything else right now, but there are certainly moments after a long night of call when I wish I had considered a career in dermatology. But then I remind myself... rashes give me the willies!
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The practice of obstetrics is almost always a gratifying, life-affirming, joyous career. When things go badly, however, it can be devastating. Regardless of how meticulously and skillfully we perform deliveries, there will continue to be complications. Any time there is a complication, I feel the loss, grief and disappointment in a very personal way. I don't think "guilty" is the appropriate word- I always do my absolute best to "do no harm". But I think it is natural for any physician to replay any difficult delivery over and over again in his or her mind to see if there is anything that could have been done differently. While the answer is inevitably no, I hope that each challenging delivery can broaden the depth of my experience.
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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.
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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.
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After having one miscarriage, the risk of having subsequent miscarriage is only slightly higher (approximately 30% rather than 25%).
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While I am certainly not a therapist or psychiatrist, postpartum depression and other mood disorders are absolutely something I diagnose and treat on a daily basis. Although I don't know that we can prevent postpartum mood disorders, I certainly think we can prepare ourselves for and lessen the severity of postpartum mood disorders. Firstly, its important that you take care of your physical health- healthy diet, exercise and healthy sleep habits are the first line treatment for depression at any stage of life. Secondly, its important to utilize all of the social supports available- when a friend, neighbor or family member offers to help so that you can take a break from your newborn, then by all means, accept. Being cooped up with a fussy newborn while suffering from extreme sleep deprivation will lower anyone's threshold for a mood disorder. Lastly, but certainly not least, we need to be educated and informed on the signs and symptoms of postpartum mood disorders. Many times the earliest warning signs are attributed to "hormones" or "baby blues" when, in fact, they are a red flag for something much more serious. As an OBGYN, it is my job to educate my patients so that they can recognize the symptoms should they develop.
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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.
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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%.
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If a patient has evidence of an infection, I would certainly bring it up.
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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.
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Without becoming too political with this question, I'll simply say no. My responsibility to my patients is to provide them with counseling and the resources available to them when faced with a difficult decision about continuing or terminating a pregnancy. I always support my patients in their decisions. For every pregnant patient, I present the options for genetic screening available. Some people choose to be tested because they are looking for peace of mind, others choose to be tested because they would prefer to be prepared in the event that they are having a child with special needs. Others choose to be tested because they would terminate the pregnancy if there was an abnormality. All are valid options, and I want my patients to feel empowered to make their own decisions based on the education I provide and based on their own personal beliefs.
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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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Approximately half of c-sections are scheduled, mainly for indictions such as a previous cesarean section or breech presentation. The other half consist of unscheduled cesarean sections, for protracted labor, fetal intolerance to labor (fetal distress) or other unpredictable circumstances. So much about labor and delivery is unpredictable, and therefore the mode of delivery is often decided upon after a trial of labor that can last for minutes to hours to days. Because there is often an emergent nature to cesarean sections, I am very thankful for the advances in modern medicine that allow us to perform these lifesaving procedures immediately and safely.
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Of women who know they are pregnant, the miscarriage rate is approximately 20%. However, miscarriages can also occur so early that a woman might not even know she was pregnant. Thus, we believe that the overall miscarriage rate may actually be closer to 25-33%. Sadly, miscarriages are very common, but that certainly does not make it easier to come to terms with. I find the best way to approach this is by being direct and honest. I always try to be empathetic and express my sympathy for their loss. Many women have already emotionally and spiritually formed a relationship with the fetus they are carrying, and will experience grief and mourning with the loss of their potential child. Some women will even experience depression after their loss and may require counseling. Everyone responds differently to the news, but my job is to remain empathetic and available for questions and support.
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I believe the ratio is probably similar to the general population. Whether we consider them to be ethical, religious or personal beliefs, we all come into this profession with our own beliefs, and one's area of medical expertise doesn't tend to change those.
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Trained midwives are skilled clinicians who are fully capable of providing care throughout an uncomplicated pregnancy and delivery. I have worked with some outstanding midwives, and I do think they can offer a different approach to pregnancies for patients who desire a more non-interventional approach. When choosing a midwife, be sure that he or she is a Certified Nurse Midwife (in some cultures, the term 'midwife' is applied to a lay person who participates in deliveries but who may not have official training and certification). I would always be sure that your midwife has an affiliation with a physician who will provide emergency coverage in the event that things do not go as expected. For a healthy woman without any major complications during the pregnancy, labor and delivery, a midwife is absolutely capable of providing prenatal care, performing deliveries, and caring for you in your postpartum period. If there are concerns for preterm labor, gestational diabetes, hypertension, multiple gestation or other complicating factors, I would recommend consulting with, and perhaps transferring care to, a physician. Finally, I would always recommend delivering your baby in a hospital or birthing center affiliated with a hospital. I do not support the concept of home births with a midwife.
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During my training, I often worked for 48 hour shifts without sleep between, only to return 12 hours later for another shift. This was the traditional way of training residents. Nowadays, there a strict rules in place that limit the number of hours one can work at a time. In real practice however, we continue to work 24-36 hour shifts simply because we don't have the person-power to take shorter shifts. In addition, in our field, there is a need to keep continuity of care- we prefer to follow a patient in labor through delivery, and shorter shifts would mean more frequent turnovers in patient care. If I feel I am ever overtired or impaired, I would certainly call on my colleagues for help.
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The studies on alcohol consumption in pregnancy are unequivocal- drinking alcohol while pregnant can result in many complications ranging from birth defects to growth restriction, mental retardation and stillbirth. There is a clear dose response relationship between alcohol and poor outcomes, which means that as higher quantities of alcohol are consumed, the risk of complications is higher. However, because every individual metabolizes alcohol differently, there is no "safe" amount of alcohol that can be consumed in pregnancy. Bottom line, I recommend abstaining from all alcohol while pregnant. The critical developmental period for vital organs (such as the brain) occurs in the first trimester. Therefore, it makes sense that most of the birth defects are related to drinking in the early part of pregnancy. However, drinking later in pregnancy can result in cognitive and developmental delays. Of course, if there is a special occasion or celebration, I tell my patients it's acceptable to have a rare glass of wine. But my overwhelming opinion is that drinking in pregnancy should be avoided- why take the risk?
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If you are an avid runner, then I think it is safe to continue running during pregnancy, with modifications. First of all, you need to stay well hydrated whenever you are exercising and avoid overheating. Secondly, listen to your body; if it hurts or is uncomfortable, don't do it. Thirdly, you are not trying to condition or train, just maintain. So decrease the intensity and never push yourself to the point of chest pains, extreme fatigue or weakness, dizziness or severe shortness of breath. In general, I tell patients if you were previously pushing yourself to 100%, then dial it back to 50%. At some point in the pregnancy, it is likely that you will need to decrease your distance and/or pace. Again, listen to your body. I don't think that extreme long distances, such as marathons, are a wise choice during pregnancy. In general, you shouldn't be running as fast as you can or as far as you can, so I ask my patients to use common sense when deciding whether to continue running during pregnancy. Of course, if you develop contractions, pain, bleeding or other worrisome symptoms, you should immediately stop and contact your physician.
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Plenty of physicans realize mid-career that they have chosen the wrong profession. It is a challenging road to change course because by the time you've finished your training, you are well into adulthood. ObGyn training requires 4 years of college, 4 years of medical school and 4 years of residency. In order to retrain in a different field, you would need at least 3 additional years of residency (long hours, inflexible schedule). But I can't imagine what it would be like to practice OBGyn and be unhappy with my decision- the work hours, the call, and the stress would be pretty hard to tolerate if I didn't love what I do!
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I can't imagine how one could do a pap smear on oneself. That being said, I think it is difficult for all physicians to choose the provider for themselves and their family. But, doctors are patients too, and we look for exactly the same traits that everyone else does- intelligence, a good beside manner, and empathy.
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The joys of bringing new life into this world are countered by the devastation when a delivery does not go smoothly. Regardless of how advanced our fetal monitoring techniques are, we will never be able to prevent all bad outcomes such as stillbirth or birth injury. Not only is this responsibility emotionally strenuous, but there is also the stress that we could be sued over these bad outcomes that are typically not under our control. Unfortunately, we live in a litigious society, and most ObGyns will experience a lawsuit at some point in their career. This can be morally, emotionally, and financially devastating. The work hours of an ObGyn can be physically challenging, and takes away from family and home life. While I feel extremely fulfilled by my job, there are certainly times when I feel the emotional, physical and mental burnout from being an ObGyn.
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I have never had to break the news to someone that she is HIV positive. I have told someone that she has hepatitis C, which in many ways, is a very similar chronic disease. Fortunately, the treatments for HIV and hepatitis C have advanced to the point where people have the potential to live healthy, normal lives despite having the virus. I have taken care of patients with HIV and hepatitis C in pregnancy. If the viral loads are suppressed enough, and if they take their medications as instructed, these patients can go on to have healthy pregnancies without transmitting the infection to their babies.
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Yes. In very rare circumstances, a "perimortem" cesarean section can be performed. The decision to proceed with the surgery needs to be made immediately, before the loss of maternal blood flow has caused a lack of oxygen to the fetus. In skilled hands, a baby can be delivered by cesarean section within minutes, which may just allow at least one life to be saved.
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Most of the time, when a baby is coming out so rapidly that you don't have time to make it to the hospital (or are on an elevator), the delivery will happen on its own without any need for assistance. Maternal instinct takes over, and the mother will begin pushing when the right time comes. Once the head is crowning, just try to support the head and body as it delivers. Look around you for something relatively clean to dry off the baby and to keep the baby warm. Newborn babies are not able to maintain their body temperatures initially and can develop hypothermia very quickly. The best way to keep them warm is to put them directly skin-to-skin on the mother's chest and cover both up with something dry. If you have a shoelace, you could tie off the umbilical cord. Hopefully by then, help will have arrived!
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Hormonal contraceptives are not associated with long-term infertility. However, when you are ready, if you are the type of person who likes to plan ahead, you should probably plan to be off of your contraception for at least 3 months before you attempt to conceive. Sometimes it takes a few months for the body to resume natural cycles. With the shot (depo provera), it can take up to a year for the body to resume regular cycles.
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I'm not sure where you live, but I would start by talking to your infectious disease specialists for any good referrals. You should also check the website of any major local university hospital systems, as they may have gynecologists who specialize in patients with HIV. Another good source is the American College of OBGYN website physician finder: http://www.acog.org/About_ACOG/Find_an_Ob-Gyn
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A baby's gender cannot be identified by HCG and AFP results. The only tests that can identify a baby's gender at this time are ultrasound, amniocentesis, CVS, or a test for fetal free DNA. Unfortunately, I am not able to interpret a baby's gender based on the information you have given me.
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This is a difficult question to answer, because it depends on many variables. A high A1C may be indicative of either diabetes, or even a "pre-diabetes" state. If you are able to control this through diet or medications, your chance of successfully conceiving will be much higher. With a slightly high testosterone and A1C, it is likely that you have polycystic ovarian syndrome, which can put you at risk for many other medical problems such as diabetes and heart disease. It is important that you try to make lifestyle changes to improve your numbers- healthy diet, exercise and weight loss (if you are overweight) will be important. In the end, the biggest determining factor as to whether you will be able to conceive is whether or not you are ovulating. You can determine this by tracking your cycles carefully, paying attention to certain subtle signs, taking your basal body temperatures daily or by using an ovulation predictor kit. If you are ovulating regularly, then there is a good chance that you will be able to conceive without assistance. If you are not ovulating, then you will likely need assistance with either a medication that will induce ovulation (clomid), or a medication that will help control "pre-diabetes" (metformin).
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The cost of an IUD removal will vary between different offices, but costs approximately $200. It should only take a few minutes and is much less painful than an IUD insertion. Very rarely, the IUD strings are not visible, and the procedure may be more uncomfortable or invasive.
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I recommend you discuss any medication concerns with your physican.
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The only way to be certain would be to perform paternity testing after the baby is born.
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So, as I said, in order to graduate from medical school, you have to complete 4 years of college followed by 4 years of medical school. At that point, you choose your specialty. ObGYN happens to require 4 years of training. Once you have completed residency, if you wanted to change specialties, you would have to repeat a residency in whatever field you have chosen. General surgery requires 5 years, cardiology can require up to 6-7 years, neurosurgery 7 years, etc. It is generally an unattractive prospect to have to go back and retrain for anywhere from 3-7 years when you are already in your mid-30's, so most people aren't willing to do this. But, again, if you are unhappy with your job, you have to find the job that brings you fulfillment.
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The power of the human brain to sustain denial is incredible. I do believe it is possible, although it is very uncommon!
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An uncomplicated removal of an IUD is actually quite painless and fast, especially in comparison to insertion. Most patients are pleasantly surprised at how easy it is. Very infrequently, the IUD strings are not visible or the IUD is not in the proper position, which may make the removal more difficult and uncomfortable.
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Group B strep is a bacteria that is carried by 25% of healthy women. Women who carry Group B strep in the vagina can expose their babies to the bacteria during delivery, which can lead to infection in the baby. Therefore we test all pregnant women for Group B strep, and treat those that test positive with antibiotics while they are in labor. Group B strep is not a reason to induce labor. If your cervix remains unchanged for a significant period of time, pitocin is used to augment the labor process because your body will likely need the pitocin to generate the contractions it needs to allow the cervix to dilate. This is the same for women who do and do not carry Group B strep. In addition, if your water is broken, we want to limit the amount of time before delivery to minimize the risk of infection. Pitocin is a very safe and useful medication that we use to expedite delivery and to minimize the duration of ruptured membranes.
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Stress has never been scientifically linked to miscarriage. Unfortuantely, miscarriage is not preventable or predicatable.
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If you haven't already, you should talk to your gynecologist who placed the IUD. It is possible that he/she could trim the strings a bit to make it less 'pokey'. This is fairly common, but most of the time, a little trim will fix the problem.
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Unfortunately, I can't really answer this question without knowing more details about your history and menstrual cycles. I recommend you speak to your physician about whether or not this is an option for you.
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When a mother has an active herpes outbreak or symptoms suggestive of an upcoming outbreak, then cesarean section is the preferred method of delivery to avoid transmission to the baby. The baby can still be infected if he or she has contact with the active sores, however cesarean section will reduce the number of cases by about 6 fold. Herpes infections in newborns can be very serious and potentially life threatening, so a cesarean section is a very valuable treatment option to prevent passing the infection on to the baby.
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Typically, if a due date is changed, it is because an early ultrasound showed that the baby is not measuring the proper size for the original due date. The last menstrual period is usually the most accurate way to date a pregnancy unless you have irregular periods or bleeding after conception that may be mistaken for a period. In those situations, an early ultrasound may be a more accurate way to calculate the due date.
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I don't have enough information to answer your question. You may be interested in paternity testing, which you could discuss with your pediatrician.
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Unfortunately, symptoms of early pregnancy are often very similar to symptoms of PMS. The only way to differentiate is to be patient and wait for a missed period so that you can take a home pregnancy test. Typically, however, early pregnancy symptoms do not begin before the first missed period.
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Assuming the person has 28 day cycles with ovulation occurring on day 14, the estimated day of conception would be October 24.
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Absolutely, you should speak to your gynecologist about this. You have carried a very painful and traumatizing secret with you, and it clearly has had a deep effect on your sexual life. You need to find a good therapist who specializes in sexual disorders. I strongly encourage you to reach out for help. This can be a very challenging condition to treat, but with the right providers, you can really take big steps towards a recovery. You deserve the chance to heal, so please reach out for help from your gynecologist, internist, insurance provider or anyone you trust!
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When a new lump is detected, it is natural that everyone's greatest fear is cancer. Most of the time, routine testing can reassure us that the lump is benign. Rarely, testing comes back with a diagnosis of cancer. As an Ob/Gyn, the types of cancer I might diagnose would include uterine, cervical, ovarian, breast and thyroid. When breaking this type of news to a patient, it is, indeed, heartbreaking. However, I find that being direct and honest, as well as empathetic, is always the best policy. I try to have information available for referrals to specialists who will treat the disease, and I do my best to get the patient in as soon as possible to see the specialist. I encourage patients not to spend time on the computer reading both information and misinformation that is available online, but rather to wait until they are face to face with the specialist. I always try to find a way to have a positive outlook when they leave my office, and try to encourage them to do the same.
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Without knowing the details of your medical history and why you are taking the lo dose aspirin, I would encourage you to speak to your provider about this question.
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An ultrasound is never the confirmatory test for pregnancy. Reasons for a positive pregnancy test with a negative ultrasound can include a very early pregnancy that is too small to detect by ultrasound, an abnormally developing pregnancy (i.e. evolving miscarriage), an ectopic pregnancy (a pregnancy developing outside the uterus, which can be life threatening) or a rare antibody that causes false positive pregnancy tests. If your friend is unclear about what to do next, she should speak with her doctor immediately. She may need a blood test to confirm the pregnancy and may need to be followed closely by her doctors to rule out anything dangerous.
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400 mcg of folic acid is the recommended dosage in pregnancy unless you have other underlying medical issues such as twins, use of certain anti-seizure medications or history of a baby with a neural tube defect.
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I find this is true of most professions- when you meet a lawyer or an electrician or a physical therapist, people liine up with questions. It's pretty common and not a big deal at all. Actually, most people have their own ObGyn already, and find the topic too personal to discuss in a social situation.
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It is unlikely that your partner would be able to tell if you have had intercourse before. There are subtle signs, but they are subtle. If you have specific questions, I would ask your provider to examine you.
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I would strongly advise you to have a provider remove the IUD. There can be complications related to the procedure. Only someone trained in IUD insertion and removal, as well as someone who can manage any possible complications, should perform this procedure.
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Yes, not only is it safe, but it is advisable and recommended to receive a flu shot while pregnant.
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Typically, when a clinic is closing, the physicians will make arrangements to transfer their patients to another local clinic. Be sure to ask your clinic if they have made these arrangements, and where you should be scheduling your future appointments. If not, then you should be sure to make an appointment with your current clinic for the last possible date they are open. It may be difficult to find a clinic that will accept you as a new patient this late in the pregnancy. Be sure to request a copy of your entire medical chart from your current clinic, and keep a copy of that in your purse. Call your hospital labor and delivery department and ask to speak to the charge nurse. Ask if there is a doctor available for patients who do not have an assigned clinic to take care of them. Typically, all hospitals have a call system in which physicians will take on the care of patients who present to the hopsital but do not have their own physicians. The hospital cannot turn you away if you are in labor or have a pregnancy-related issue. They will find an appropriate physican to take care of you and your baby. Of course, all of this will be made easier if you have a copy of your medical records. If you have had complications in the pregnancy or have medical problems, you should work hard to call around and find another physician in your area who would be willing to accept you as a new patient.
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If the Mirena IUD is placed properly, it should not shift positions with intercourse. No method of contraception is 100% effective, but the Mirena is reported to be >99% effective. If you do conceive with the Mirena in place, it could be harmful to the pregnancy. You should immediately consult with your doctor in that unlikely situation.
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You will need to discuss this with your physician. This forum is intended to answer questions about the profession of OBGYN, not to answer specific medical questions.
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In our practice, as in most practices, patients may choose who they see throughout their pregnancy for outpatient care. However, when they are in the hospital for delivery, we have one doctor assigned to take call. The reality of this profession is that in order to maintain a healthy personal life, we simply can't be available 24/7. Instead, we've opted to maintain a call schedule in which one physician is available for deliveries and emergencies at all times. Without such a system, it would be impossible for Ob/Gyns to maintain any sort of healthy lifestyle. The consequence of this is that patients don't get to choose who will deliver their baby. Almost all patients are understanding of this and are willing to get to know all of the physicians throughout their pregnancy so they are not meeting us for the first time on the big day.
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I actually don't agree. Sperm preservation may become more common, as it is a non-invasive simple process. However egg retrieval is more complicated. The donating patient would have to start fertility medications to stimulate production of eggs (normally women only produce one egg per cycle, but with a retrieval, they want to stimulate production of multiple eggs). In addition, the retrieval of eggs is invasive, uncomfortable, and requires anesthesia. Most women would not want to undergo this procedure without a medical necessity. In addition, eggs are less tolerant of the freezing process than sperm, and do not the survive the process as easily. However we are fortunate to have this technology at our disposal for the times when it is truly indicated, and hopefully these procedures will become less cost-prohibitive over time.
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This is a very important question, not lame at all. I would start by asking friends and family who may live in your area. Post a question on your Facebook wall or ask your coworkers. Personal experiences with people you know are probably the best way to choose your provider. I don't put much trust in the online sites that allow patients to rate their doctors anonymously. I find that mostly people with negative experiences tend to post reviews, which makes the ratings really skewed. If you have a family practice doctor or internist, you could ask him or her for recommendations. Finally, you could use your insurance provider website for suggestions.
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Due dates are established based on last menstrual period, if known accurately and periods are regular, or based on the earliest ultrasound performed. If your due date is pushed back a month, it does not mean your pregnancy will be prolonged. It means that your original dating was incorrect. Most likely your ultrasound showed that the fetus measured a month smaller than anticipated, thus you likely conceived a month later than you had originally thought. The growth of a fetus in early pregnancy is a very accurate way of dating a pregnancy.
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This forum is designed to ask questions about the experience of being a practicing obgyn. If you have personal medical concerns, you should contact your physician.
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Yes, this was traditional practice to stimulate a cry in the newborn so that the baby could clear his or her lungs of amniotic fluid. More recently, we have realized that drying the baby off with a warm blanket and placing the baby skin-to-skin on the mother's chest is a better method to stimulate the baby.
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It is nearly impossible for you to have conceived in that manner.
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Without health insurance, the cost of prenatal care is approximately $2000. The cost of a vaginal delivery may be around $10,000, while the cost of a cesarean section is around $15,000. Of course, there are many variables that can change these numbers, and you should speak to your provider and hospital to get more accurate estimates.
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It sounds like you need to talk to your own physician about this, and perhaps discuss paternity testing. I don't have enough information to give you an accurate answer, and this is not a forum for medical advice.
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In obstetrics, gestational age is traditionally calculated from the time of last menstrual period rather than date of conception. Because ovulation typically occurs on day 14, gestational age will always be 2 weeks ahead of conceptional age.
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This forum is not intended to exchange medical advice. Your daughter should discuss your concerns with her physician.
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I'm not able to answer this question because it varies so much by geography, where the procedure is performed (hospital vs outpatient setting), timing in pregnancy when it is performed. Roughly speaking however, one would make approximately the same amount as when performing a D&C for a miscarriage.
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No, pelvic exams are not associated with miscarriage or preterm labor.
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This forum is designed to ask questions about the experience of being a practicing obgyn. If you have personal medical concerns, you should contact your physician.
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Airplane travel is safe during pregnancy and is not associated with miscarriage.
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Yes, this would certainly be considered a high risk pregnancy. As maternal age increases, the risk of complications exponentially rises. I would be very concerned for conditions such as gestational diabetes, hypertension and pre-eclampsia, abruption, placental insufficiency, intrauterine growth restriction. She would require very close surveillance throughout the pregnancy, particularly in the third trimester.
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You need to make an appointment with your physician.
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The doctor can give you an estimated date of conception, but it will depend on how regular her cycles are, and when she ovulated.
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Menstrual periods can be irregular and can still be normal. Sometimes irregular cycles are a sign that you are not ovulating, so you should discuss this with your physician.
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The answer all depends on how far along you were. Very early miscarriages would result in passage of pregnancy tissue, but not necessarily fetal tissue.
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I do recommend waiting a cycle after an IUD is removed before trying to conceive so that the endometrium has time to normalize and recover from the presence of the IUD. Please contact your provider if you have additional concerns.
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This is probably completely normal. You may have a separation in your abdominal muscles called diastase recti, which happens as your abdomen grows and the muscles are stretched. This would result in discomfort when you are straining your abdominal muscles, such as when you are sitting up from reclining. It will improve drastically, if not resolve, after the baby is delivered. For now, you just need to move slowly and take your time when you are sitting up. You should discuss this with your physician as well.
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You should discuss this with your physician.
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This forum is designed to ask questions about the experience of being a practicing obgyn. If you have personal medical concerns, you should contact your physician.
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While hot tubs are not advised during pregnancy, radiant heat from the sun is not likely to be damaging to the fetus.
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As long as she is hydrating well and is conditioned to work out at this intensity, exercise should not interfere with a healthy pregnancy.
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If you are concerned about pregnancy, then you should take a pregnancy test. Ovulation cramps can be normal and are not specific to pregnancy or conception.
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Thank you for the compliment! I'm glad you find the Q&A educational. The art of bedside manner is difficult to teach. All medical schools have some form of humanities, but compassion is something that comes naturally. Just as I try not to judge my patients based on first impressions- anyone can have a bad day or have stressors in their life that I don't know about- I would ask that you at least give your physician a second chance. With the way medical practices run these days, we are over scheduled, burdened by the electronic medical records and hospital charting, and never have as much time as we would like to have with out patients. If you still do not care for her style, then by all means, you should find a different physician. The birth of a child is one of the most important moments in your lives, and you should have a physician that you trust and also feel connected with.
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I can only infer that he actually meant to say "parous" rather than multipara. There is no reliable visible external cue to determine whether a woman has had more than one baby, although there may be subjective signs that a woman has delivered at least one baby vaginally.
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I would recommend you wait a few days and then repeat a pregnancy test or call your physician and request a blood test for pregnancy. Ultrasound is not the first-line method to diagnose a pregnancy because you may not see the pregnancy until you are at least 6 weeks along.
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An echogenic intracardiac focus does slightly increase the risk of a Down Syndrome baby. You should discuss this further with your physician. There are genetic tests that are available to you want more information.
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There is no exact cutoff for progesterone in pregnancy, but in general, I look for a number >15. We do sometimes treat patients with a history of recurrent miscarriages or infertility with progesterone if their levels are below this level.
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This site is not intended for medical advice. You should contact your physician for recommendations.
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You should speak to your physician about this. Sex can trigger mild cramps, but if they are severe or persisting, then you should discuss this with your doctor.
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The answer depends on how your due date was calculated. If it was based on an early ultrasound, then the dating is accurate up to +/- 5 days. With irregular periods and PCOS, timing of ovulation can be erratic, but will typically still fall within the 5 day window of ultrasound dating.
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These results depend on what type of symptoms you are having. If you are having hot flashes, night sweats and vaginal dryness, it could mean that you are menopausal and your ovaries are no longer functioning at the level they were when you were premenopausal. If you are not having those symptoms, it could mean that you were near your ovulation time when the bloodwork was drawn. It is difficult to interpret the results without a clinical history. You should discuss it further with your physician.
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Soy products, when taken in moderation, are safe in pregnancy. Theoretically, however, soy products can have hormonal-like effects and have the potential to cause harmful effects to the fetus if taken in very high quantities. The difficulty with assessing vitamins and supplements is that the actual amounts of each substance is hard to interpret, and are often not regulated by the FDA. There is no recommendation to take soy supplements in pregnancy.
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Only time will tell. It is difficult to be patient at a time like this, but there is no way to know what the ultrasound will show in a week.
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The due date is calculated 40 weeks after your last menstrual period, so the time of conception is approximately 14 days after that date, depending on your cycles.
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The days of the solo practitioner OB who takes call every night are pretty much non-existent these days. Most OBGYN practices have adopted a group call system or a night float system. With the group call system, you are only on call once every 4-7 nights, depending on how many physicians are in your group. This allows for a very reasonable lifestyle. I am able to attend my kids' concerts and recitals, spend most weekends with my family, and in general feel like I have control over my schedule. It does require that you take your share of the holidays, so I am typically on call over one of the major holidays (Thanksgiving, Christmas, and New Years) and one minor holiday (Memorial Day, July 4, Labor Day) per year, but that is a sacrifice that you really become accustomed to over time. Sure, your non-physician friends and family may be whooping it up while you've been up all night at the hospital, but you learn to feel good about the ways you've made the world a better place. As I drive to the hospital on a holiday morning, I think how lucky I am to have a job that feels important and is gratifying. I think how many people are working at Starbucks, gas stations and movie theaters on holidays, and how that must feel unnecessary.
Many large groups have adopted a night float system in which one physician is responsible for night call for an entire week, but will have the days off to sleep and recover. With this system, you might only take a few weeks in a year.
In the end, being an OBGYN is a great career choice because you truly make a difference in people's lives every day. While there is personal sacrifice, the rewards certainly make up for any time lost from your personal life. You learn to function on less sleep- I typically have a full day of office on a post-call day and then go home to make dinner for the family, help with homework and get ready for bedtime. I wouldn't have it any other way!
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Talk to your doctor on Monday.
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It is not healthy to smoke marijuana in pregnancy.
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This is not a forum for medical advice. Please consult a medical provider.
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This is not a forum for medical advice. Please contact your physician if you have concerns.
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This site is not for medical advice. You should contact your physician for recommendations.
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You should speak to your health care provider about this.
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This site is not for medical advice. You should contact your physician for recommendations.
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Pregnancies are dated from the first day of your last menstrual period. If you have regular 28 day cycles, then you would have ovulated approximately 14 days after your period began, which is approximately when you would have conceived.
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This is not a forum for medical advice. You should speak to your provider.
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It is normal to bleed with initiation of intercourse. I can't really comment on why you are not having a period now, so you should speak to a medical provider if you have concerns.
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You should discuss this with your provider.
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This site is not for medical advice You should contact your physician for recommendations.
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