OBGYN Mesa

Dr. Tamar K. Gottfried, MD.

Arizona Pregnancy

Are birth control pills dangerous?

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That is a common question these days as the risk of blood clots with the J and J vaccine is being compared to the risk of clots with certain birth control methods.

All combination contraceptives ( a combination of estrogen and progesterone, with estrogen being the more risky for clots ) have a small risk of blood clots. These aren’t the clots you see during your period, but the ones that form and block blood flow in important blood vessels- deep vein thromboses in legs (DVT), clots in lungs that can be fatal (pulmonary emboli or PE) or blockages in the vessels of the head and neck , which lead to strokes.

Anyone on the pill, patch or ring needs to understand that these clots are a rare, but dangerous complication of estrogen ( also occur during pregnancy and in women using estrogen replacement therapy for menopausal symptoms) and to know the warning signs. If you are on these medications and have a hot, swollen, tender leg without a recent injury- you need to seek medical care immediately to rule out a clot, because a clot in the leg can travel to the lungs or other organs and cause major issues.

That said, these methods of birth control are still very safe for most people and pregnancy carries a higher risk of clot than these medications. For women wanting to avoid these risks, or women with certain medical issues that make them more prone to blood clots, there are a number of progesterone only methods of preventing pregnancy- progesterone only pills, IUDs, implants and more.

Related Article

Birth Control Methods and the Risk of Blood Clots

COVID-19 Update

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As we all change our habits to slow the spread of the Covid-19 virus, we are exploring new, safer options to take care of our ob/gyn patients. Current recommendations are to avoid any routine office visit that can wait a month without harm. We have not yet been cancelling existing appointments, but that may be required at some point. In an effort to be available for our patients, we will now offer some Telehealth visit options.

We can currently use Facetime, Facebook messaging and will be adding an app called doxy.me to use as well. We will need your email to invite you to the visit.

For our pregnant patients: If you are low risk and feeling well and prefer not to come in for routine visits that don’t need bloodwork or ultrasound, please ask to reschedule to a Telehealth visit. We will ask you to get a home blood pressure cuff / a thermometer/ and a scale at your pharmacy and take your blood pressure, weight and temperature prior to the visit. We will email you a link and a time to log in for the visit like a regular appointment. You will have a 10-15 minute with Dr. Gottfried or Terri. For patients who need monitoring once or twice a week or have other issues needing in person evaluation,  we will see you in the office like usual. 

For our non- pregnant patients, if you would like to use Telehealth for a counselling or results visit, please schedule a time by calling in , texting , or using zocdoc. We will schedule a visit for you and this will be billed to your insurance using the Telehealth codes. 

For all patients who need to come in to the office for a visit, we are doing our best to protect you and to protect our staff . If you have a fever, cough, or are otherwise feeling ill, please call us first to receive specific instructions. For all patients, please come to the visit by yourself if possible to have as few people in the office at a time as possible. Please leave children at home as they may be carriers of the virus without symptoms. If you are coming in for an ob ultrasound, you can have one other person accompany you. We can include other family members in the ultrasound visit via your phone and a conferencing app.

For all of us, please observe social distancing- only leave your house when you have to. Walks outside are okay if away from other people who don’t live in your household. Store visits and food pick ups should only be made by one , low risk member of your household. If everyone goes out to the store or restaurant, it defeats the purpose of social distancing. 
Please do what you can to keep you and your family healthy. We are here for you to help you through this difficult time. Please call if we can help in any way.

How to address feminine health questions during the Covid-19 pandemic

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As we are trying to limit patient traffic through our office during this difficult time, I am thrilled to announce new telemedicine options for ob and gynecology consults. 

What is telemedicine?  Telemedicine means that you can have confidential access to YOUR doctor or nurse practitioner from the comfort and safety of your home. A lot of what we do in medicine is listening and talking and counselling and coming up with a diagnosis and treatment plan, and that can be done just as easily in a remote setting. We can even look at incisions or bumps or rashes in this format since it is private and secure

How does telemedicine work? First, we schedule an appointment time for your visit and update your insurance information and any demographic information that may have changed since your last visit here.  Then, one of the medical assistants Eli or Pattie will call you to update your medical information, and finally, at the time of your visit (it can be a a few minutes delayed since we are still seeing urgent and pregnant patients in the office and are still delivering babies ) you will get an email with the link to your visit. Click on the link and Terri or Dr. Gottfried will be there to speak with you. 

What kinds of visits can be done with telemedicine? Any visit that doesn’t require immediate physical exam, ultrasound or lab test can start this way. Birth control consults, birth control pill refill visits, Abnormal bleeding, rash or new skin lesion checks, wound checks, questions about pregnancy symptoms or problems, menopausal symptoms, even consults for our new Viveve procedure, which treats bladder leakage (which can be very helpful if you are coughing or sneezing a lot or exercising more at home). Also, this kind of visit is ideal for consults about lab results or ultrasound or biopsy results. 

What are the costs of telemedicine visits? If you are pregnant, these visits are part of the ob package. For gyn visits, these are billed to your insurance just like an office visit, but using different codes Even AHCCCS and Medicare are encouraging patients and doctors to do visits using this technology. 

In summary, we are here for you both in person and remotely.  While we are asking routine visits to wait until the recommendation for staying at home has been lifted, we are available for pregnancy and gynecology problem visits and your other female health needs. We still are offering in house ultrasound and laboratory services for your convenience . Please call with any questions or book online through the website. 

So I’m pregnant and eating for two- Can I eat as much as I want now?

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The old adage that pregnancy is a time of “eating for two” has been around for some time. Yes, the pregnant mom IS eating for two, but one of them is very small. For most of us, eating whatever and as much as we want IS a fantasy. Unfortunately, during pregnancy, it is no more of a reality than at any other time.

Diet during pregnancy is important to the health and growth of the growing fetus, but the amount of weight gain required varies according to a mother’s pre-pregnancy weight.  While an underweight woman needs to gain over 35 lbs to grow a healthy baby, an overweight lady can gain as little as 10-15 lbs to do the same. Not gaining enough weight in pregnancy cause cause issues with inadequate fetal growth, while excessive weight gain can lead to gestational diabetes, large babies, cesarean delivery and difficulty with weight loss after delivery.

It is perfectly normal to maintain weight, or even lose weight in the first trimester due to decreased appetite, nausea, or even vomiting, which is common in early pregnancy. Some women even gain weight in the early months of pregnancy because they find that eating throughout the day can reduce nausea. In contrast, by the third trimester, an average weight woman should be gaining about a pound a week.

How does a pregnant woman gain a healthy amount of weight during pregnancy? For the underweight to normal weight mom, it may mean eating 6 small meals throughout the day, snacking healthily on smoothies and trail mix and peanut butter sandwiches or granola. For the woman at risk for an excessive weight gain, it may mean drinking only calorie free beverages ( no sugary soda, juice or vitamin waters) and low or nonfat milk ( a couple glasses a day max).  It also means making sure that there is protein at each meal (even breakfast) and weighing and measuring foods to keep a food diary. Some women gain too much even though they are eating the right kinds of foods, because they are eating too much of them.

For women of all sizes who are experiencing an uncomplicated pregnancy, exercise is an important component of every day. Simply moving enough to get the heart rate up at least 30 minutes a day helps promote healthy fetal growth and development. No one is required to become a distance runner during pregnancy, but continuing previous exercise routines or developing new low impact habits is ideal.  For more personalized advice about weight gain and exercise during pregnancy, contact your obstetrician.

Tamar Gottfried is a Board Certified Obstetrician/ gynecologist  practicing  general Ob/gyn in Mesa Arizona and affiliated with Banner Desert and Banner Gateway Medical Centers. She can be contacted at 480-545-0059. This is a general interest article only and is not intended to be medical advice. See a medical professional before making medical decisions

If a pregnancy is full term at 37 weeks, why can’t I be induced?

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Although pregnancies are considered to be full term after 37 weeks,  there are advantages to waiting until 39 weeks to deliver. Pregnancies are dated from the mom’s last menstrual period, not from the date of conception. Full term pregnancy is a range rather than a date, with 37-41 weeks considered to be full term.

There has been a lot of press lately about the ideal time to electively deliver a baby. Recent recommendations from the March of Dimes and the American College of Obstetrics and Gynecology take into account the fact that babies are healthier if they are born after 39 weeks. Babies born from 35-38 weeks, considered near- term, have more problems with feeding, maintaining their temperature and other factors than babies born after 39 weeks. They are also more likely to spend time in the Neonatal Intensive Care Unit and not go home from the hospital with their mothers.

Banner Health Care, based in Arizona and including Banner Desert Medical Center in Mesa Arizona, has been leading the way in the movement to only electively deliver babies after 39 weeks. This new policy only applies to elective (non medical) deliveries- not to medically indicated ones. For example, if a mother has high blood pressure, or if the fluid around the baby is low, or if her water breaks and her labor needs to be induced or if she’s in labor, she will be delivered even if she is not 39 weeks along. On the other hand, if a mom is planning a repeat cesarean delivery, or wants to deliver on a specific day, or is simply tired of being pregnant, that will have to wait until she is 39 weeks. This policy ensures that that babies are born at the safest time for them and their mothers.

Tamar Gottfried is a Board Certified Obstetrician/ gynecologist  practicing  general Ob/gyn in Mesa Arizona and affiliated with Banner Desert and Banner Gateway Medical Centers. She can be contacted at 480-545-0059 . This is a general interest article only and is not intended to be medical advice. See a medical professional before making medical decisions