Gilbert Obgyn

Can I find a doula- friendly obstetrician?

May 2, 2013 by Dr. Tamar K. Gottfried Leave a Comment

Historically, the birth of a baby has been a family event. Throughout much of human history, a woman has given birth surrounded not only by her birth attendant, but by female family and friends who bring their combined experiences to help make her labor and delivery as easy as possible. Nowadays, this is no longer a given. Many women live far from family members or find that their close friends and family may not have any prior birth experience to share with them. This lack of support and knowledge can often complicate the birth experience, especially for a woman who is planning an unmedicated labor and delivery.

In the modern, mobile society, many couples need an extra person to help them navigate the birth process, someone to replace the knowledgeable family members of the past. This is where a doula comes in. A doula is an experienced birth attendant that can be hired by a couple to help them during labor and delivery and even after the baby comes home. Sounds like a great idea- why wouldn’t most obstetricians be thrilled to have a doula in the labor and delivery room? Unfortunately, many OBs have a misconception of the role of the doula or have had an isolated bad experience and feel that their role in the process will be threatened if a couple has a doula there.

Ideally, a doula is an asset to both the laboring woman and to the medical staff. She can help a woman find different ways to transcend the pain of labor, she can help translate medical terminology and what is going on, she can support a couple in the decisions they make during the birth process. A doula, an expectant couple and their medical team all have the same goals- a healthy mom and baby, achieved by as natural a process as can safely happen.

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

I feel a vaginal bulge- Are my insides falling out?

July 27, 2012 by Dr. Tamar K. Gottfried Leave a Comment

Pelvic prolapse is a common complaint in women, especially those who have ever been pregnant. Sometimes, it is something noted by a gynecologist on a yearly exam. Other times, women notice a bulging while in the shower or wiping. Although many women are initially alarmed by this, pelvic prolapse comes in varying degrees and often has little to no impact on a woman’s daily life.

Prolapse is when there is a decrease in strength or a tear in the supportive tissue of the vagina, allowing the nearby organs to bulge into the vagina, especially during bearing down (exercise, coughing, straining for a bowel movement). A bulge in the vagina can be the rectum (rectocele), the bladder (cystocele), the intestines (enterocele), or the uterus. If a woman has had a hysterectomy, the vagina itself can prolapse, bulging into itself. The organs don’t actually come into the vagina, they just push onto the vaginal wall, creating a bulge or ball.

In severe cases, prolapse can cause an uncomfortable pressure sensation, can irritate the vaginal tissues, and can cause bladder or bowel dysfunction. A woman with symptomatic prolapse can try physical therapy or can use a device called a pessary to relieve her symptoms. Pessaries are made of rubber or silicone and come in different sizes and shapes. They are worn in the vagina to hold things in place. Some women use these only during waking hours- others wear them all the time and, if they are not capable of taking them in and out, see a gynecologist for regular removal and cleaning every few months. When conservative measures fail, there are a number of surgeries that can be done for prolapse. However, it is important to refrain from repetitive coughing or heavy lifting after prolapse surgery to minimize the chance of recurrence.

Fortunately, many cases of pelvic prolapse are mild. For these women, who have mild prolapse and minimal to no symptoms, there is no treatment necessary. This is a condition that can be monitored yearly at the Annual Gyn Exam and may never impact a woman’s life.

What is it like to have robotic assisted gynecologic surgery- a physician’s perspective

July 26, 2012 by Dr. Tamar K. Gottfried Leave a Comment

As an ob/gyn physician, the last thing I wanted to do was have gynecologic surgery on myself. Much to my dismay, I discovered that my uterus was hosting several large fibroid tumors. Since I didn’t have any of the typical symptoms of heavy or painful periods, my first instinct was to ignore them. However, given that my uterus was the size of a 4-5 month pregnancy, it became apparent that the fibroids were going to have to be removed before they got larger or grew enough tumor friends that a minimally invasive surgery was not an option.

Although many women in their 40s would jump at the opportunity to have a hysterectomy and be done with periods forever, I was relatively fond of my uterus. It had carried three lovely kids, and I was hoping to go through life with as many of my parts intact as possible. For this reason, and the distant dream of having a little girl to add to my brood of boys, I chose to have a myomectomy, a surgery to remove just the fibroids and preserve my uterus. Additionally, because I am self employed and do not like to spend more than a few days away from my patients, I chose to have the surgery done laparoscopically. My surgeon would use the da Vinci robot to remove my fibroids through 4 tiny incisions and I would return to work in a week.

There is a joke among medical personnel that our medical issues always turn out to be more complicated than anticipated and I was no exception. My surgery- supposedly to remove 5 fibroids in 4 hours- turned out to be a 6 hour procedure to remove 14 tumors. Even so, my gifted surgeon did this through the promised 4 tiny incisions and I was walking unassisted to the restroom within a few hours postop. I was off the IV, drinking fluids and on just a few pain pills that first night and home the next day. My second day home, I went for a 25 minute walk outside and was taking over the counter Advil for pain.

In earlier times, a surgery like the one I had would have meant 6 weeks out of commission and a difficult recovery. I am fortunate that the latest technology has allowed me to return to activity within days. At this rate, I plan to be running and lifting weights by next week. This may not be a “typical” recovery, but it is possible. In conclusion, minimally invasive surgery, like the one I had, is possible and available to appropriate candidates. Although I am not currently performing the robotic procedures, my office partner, Dr. Lori Carrillo and my own surgeon, infertility specialist, Dr. Millie Behera, are available for consulation.

My uterus has been invaded by fibroid tumors! What am I to do?

January 22, 2012 by Dr. Tamar K. Gottfried Leave a Comment

Uterine fibroid tumors are a very common finding on pelvic ultrasound or pelvic exam and tend to cause women to worry unnecessarily. As many as one in 5 women have fibroids, and most will never cause any disruption in a woman’s health. Most commonly, a woman will have an annual exam and an ultrasound will be ordered because her uterus is felt to be enlarged or for another reason such as abnormal bleeding or pelvic pain, and fibroids will be one of the findings on the ultrasound. Fibroids can range in size from very small (grape sized) to very large (grapefruit sized) and can be solitary or numerous. Whether or not something needs to be done about them depends on factors such as size, number, location and symptoms.

What are the symptoms of fibroids? They can vary immensely. Most women with small or few fibroids may have no symptoms at all. These fibroids can be monitored periodically with ultrasound to check for growth. Fibroids that are asymptomatic and not growing rapidly can be left alone because they will shrink after menopause. Other fibroids can cause symptoms such as heavy bleeding, pain, pressure on the bladder or rectum, increased abdominal size, and difficulty becoming pregnant or carrying a pregnancy.

Treatments for fibroids vary based on symptoms. Some menstrual bleeding abnormalities can be managed with medications, even when fibroids are involved. There are nonsurgical solutions for fibroids such as uterine artery embolization or MRI guided ultrasound treatment- these procedures block the blood supply to the uterus or fibroids and shrink the tumors. They should not be used if future childbearing is desired.

Fibroids in the uterine lining can be removed with outpatient hysteroscopic surgery or can be treated during a uterine ablation procedure. Larger fibroids in the muscle of the uterus can be removed with a surgery called a myomectomy, if a woman desires future childbearing. Alternatively, a hysterectomy can be done if a woman is done having children. Either of these surgeries can be done open or laparoscopically. While there is no medicine available that can eliminate fibroids, a drug called Lupron is often used prior to fibroid surgeries to shrink the tumors.

In conclusion, a diagnosis of fibroid tumors usually does not mean disruption to a woman’s life or health. Many fibroids live quietly in the uterus and never cause symptoms. Luckily, if and when fibroids become symptomatic, there are a number of nonsurgical and surgical treatments to treat them. Further information about fibroid tumors can be found at my Mesa Ob/gyn office.

My doctor just told me I have HPV! I have been monogamous for years- What do I do with my husband?

December 14, 2011 by Dr. Tamar K. Gottfried Leave a Comment

This statement above is not an unusual one when a woman is diagnosed with a Human Papilloma Virus (HPV) infection for the first time. The easy answer to the question is to relax and stop considering harm to a spouse: HPV does not mean that a partner has been unfaithful. It can live in a person harmlessly for years, even decades in some cases.

HPV is a virus that is responsible for abnormal paps and precancers of the cervix, as well as cervical, vaginal, vulvar, and even anal cancers. There are many forms of HPV- low risk strains may cause warts, but don’t cause the more dangerous lesions. High risk strains can cause precancerous cells to develop and grow, but can also live silently in a person for years. In past years, HPV was only found when someone had an abnormal Pap smear. Recently, due to advances in the technology used to detect HPV, high risk HPV screening is done at the time of Pap smear in most women over 30 years of age. Because of this, and to the surprise of many women, asymptomatic infections are found at the time of routine annual exams.

HPV infection is very common in both men and women- perhaps one out of every four women has been infected with a high risk HPV strain. This is why there is such a push to vaccinate teenagers before the onset of sexual activity. While teenagers and women in their 20s are more likely to come into contact with HPV, become infected, and then clear the virus through the work of their immune systems, older women are less likely to clear the virus. For this reason, it can live in someone, but go to hibernation, only to emerge at a later time. While women may not be able to permanently get rid of HPV (there is no treatment for the HPV itself, only its effects when they occur), HPV can go silent again once it has emerged. Most people do not stay HPV+ for extended periods of time.

So what does being positive for high risk HPV mean? It means that a woman has come into contact with HPV through sexual activity at some point in her life, perhaps years prior, and is now showing up on a Pap. Having HPV does not equal having cancer or even precancer, it just means that a woman needs to be monitored more closely by her gynecologist until the HPV clears. Any woman who has more questions about HPV should contact our Mesa Ob Gyn office.

Do I really need to have a menstrual period? Info on the art of menstrual manipulation.

November 14, 2011 by Dr. Tamar K. Gottfried Leave a Comment

Gilbert Obgyn Tamar Gottfried discusses menstrual manipulation;

Although the monthly menstrual period is essential to the reproductive process, it can easily become a burden for women not interested in becoming pregnant. Many women ages 12-55 experience problems with their periods ranging from too far apart to too often to too heavy to too long. This raises a common question: If I’m not trying to become pregnant or if I’m done having babies, do I really need to have a period?

From puberty to menopause, the monthly period bleed is a means to shed the lining of uterus that builds up each month and, in the absence of a pregnancy, is not needed. While an average cycle is every 4 weeks, the range can be from every 3 weeks to every 8. Some women have very infrequent periods and wonder if this is healthy. In women that are not on some kind of hormonal manipulation (the pill, the shot, the IUD), it is important to bleed at least every 3 months. Without some kind of shedding of the uterine lining, the lining can build up and cause pre-cancerous changes. Some women don’t have periods because they are very skinny or are athletes with low body fat percentages. They are at risk from having low estrogen levels and can develop problems such as weak bones. Therefore, in women who are naturally not having regular periods (especially those with polycystic ovaries or are over or underweight), it is best to start some kind of hormonal medication to bring on a regular or more frequent period.

For women who have medical problems associated with their periods (menstrual migraines, irritable bowel syndrome, anemia, horrible cramps, etc) or for women that would prefer not to menstruate, there are ways to safely minimize or skip the period. The birth control pill was originally designed with a placebo or sugar-pill week so that women on the pill would have a monthly bleed and know that they weren’t pregnant. However, there is no medical need for this monthly bleed on the pill or on other methods of hormonal therapy. Therefore, women who want to skip a period can skip the sugar pills in their pill pack each month. Alternatively, they can use a medication like Depo Provera or the Mirena IUD to minimize monthly bleeding.

Women who have seen or heard ads in the media for “stop the flow” often inquire about surgical means for avoiding periods. While a hysterectomy will definitely stop bleeding, it is not necessary for most women. Endometrial ablation, such as the Thermachoice procedure, is an in-office surgical procedure that can minimize and sometimes eliminate monthly bleeding. However, it is designed to lighten bleeding and cramps for women with extremely heavy and/or painful periods, not to eliminate them for women with normal flow. Complete absence of periods after this procedure can never be promised. It is a wonderful, minimally invasive option for improving periods in women who suffer with their cycles each month.

In conclusion, periods are a necessary event for women not on medication, but can definitely be controlled or eliminated temporarily by medical or surgical means. To further discuss menstrual control or the in office Thermachoice procedure, contact my Mesa Ob Gyn office for a consult.