Mesa Gynecologist

COVID-19 Update

March 31, 2020 by Dr. Tamar K. Gottfried Leave a Comment

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

March 31, 2020 by Dr. Tamar K. Gottfried Leave a Comment

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.

My baby is almost due- do I need a birth plan?

September 10, 2012 by Dr. Tamar K. Gottfried Leave a Comment

Expectant mothers are bombarded with tasks to complete for the births of their babies- It can be a bit overwhelming. Is a birth plan a necessary part of the pre-baby preparation? Not necessarily.

A birth plan is a lists of likes and dislikes to help guide the medical staff in the labor and delivery department to meet the needs and expectations of a couple. There are many birth plan templates on line and in pregnancy advice books. However, for the majority of couples, the preferences expressed in these prefabricated birth plans do not apply to them. For example, many of the birth plans state that the couple wishes to avoid routine shaving, enemas, and episiotomies- most of which have not been standard practice since the 1970s. For a couple who do not have strong objections to hospital policies or who are not planning an unmedicated delivery, a birth plan may not be needed.

Birth plans are more important for couples whose wishes might deviate from standard labor and delivery practices. The couple who wants to avoid any intravenous fluids or fetal monitoring, who want certain music playing in the room, who do not want any pain medicine offered or even mentioned, or who want to deliver in an alternative position should write out their preferences ahead of time and discuss them with their OB well before they are in labor. That way, their doctor understands their vision of their labor, and can explain which desires are easy to fulfill, and which will be more difficult, or even unsafe and why.

The best birth plan is one that is put together during the last months of pregnancy and is brought to the obstetrician and labor and delivery units to be discussed before the craziness of labor begins. As an obstetrician, I am always happy to discuss birth plans with expectant parents at OB visits. Most importantly, the birth plan should also include some flexibility, since, however important a birth plan is, it is more important to have a safe labor and birth that ends with a healthy mother and child.

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 don’t want a pregnancy now, but maybe in the future. What are options in long term reversible contraception?

September 8, 2012 by Dr. Tamar K. Gottfried Leave a Comment

Although the birth control pill and sterilization are the most popular forms of contraception, these options are not for everyone. There is a large group of women that want to avoid pregnancy for several years, but want the option of a pregnancy in the future. For these women, who may worry about forgetting to take a daily pill, missing a doctor’s appointment or losing insurance coverage and not being able to pay for birth control pills or shots, long acting reversible contraception (LARC) methods are a safe and convenient option.

An increasingly popular example of a LARC is the Mirena Intrauterine Device (IUD). Mirena is a T- shaped device that is inserted in a woman’s uterus for up to 5 years. It slowly releases progesterone over that time period, making the uterus an unfriendly place for sperm, preventing pregnancy. A happy side effect of Mirena is that the hormones in it thins the uterine lining, lightening the monthly period to almost nothing. While there can be irregular bleeding at first, most women using Mirena have barely any bleeding each month. Fortunately, the dose of hormone in Mirena is quite low and mostly acts inside the uterus, so other side effects (weight gain, mood changes) are minimal.

Unfortunately, Mirena only comes in one size (designed for a uterus that has carried a pregnancy) and is not always a good option for the woman who has never been pregnant. Sometimes Mirena can be difficult to insert or can be pushed out by uterine cramps in these cases. Also, since Mirena goes into the uterus, it is not ideal for the woman who is not in a monogamous relationship and could be exposed to sexually transmitted diseases. These STDs, combined with an IUD can cause a more serious pelvic infection. For women who do not want these risks associated with an IUD, the Implanon device is a great alternative.

Implanon (soon to be called Nexplanon) is an small rod which is inserted into the inner arm in a painless office procedure, and slowly releases a form of progesterone over a 3 year period. Side effects are minimal, but include irregular bleeding, which lessens with time. This method is ideal for women who want long term birth control, without the risks of a uterine method. The rod is small, can’t be seen by others unless pointed out to them, and is easy to remove when the time comes.

The third LARC is for the woman who wants to avoid hormones altogether. The Paragard IUD has been around for decades and is a reliable long term method. It is a copper device that is inserted in the uterus and creates an anti- sperm effect on the uterus which prevents pregnancy. Major side effects include heavier and crampier periods, making it a better option for the woman who has light, reasonable periods to begin with.

In conclusion, there are multiple birth control options for the woman who wants a few years of protection. A gynecologist can help a woman decide which one is best for her individual situation.

I’m pregnant and stuff is leaking out of me- How do I know if my water’s broken?

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

One of the most vital pieces of information in pregnancy is whether or not an expectant mother’s membranes have ruptured. Once the water has broken, a fetus is no longer protected against infection. If this happens very early in a pregnancy, this can be devastating and endanger the health of mother and child. At term, ruptured membranes mean that it is time to deliver a baby- regardless of whether labor has started on its own. Sometimes the water breaks naturally during the course of labor. Other times, it breaks spontaneously and without warning. It can be a small trickle of fluid or a large gush- either way, it is important for the Mom to recognize what is going on and present to her maternity ward for evaluation.

There are other sources of “leakage” during pregnancy. It is extremely common for a pregnant mom to experience a white to clear, liquidy discharge during the 2nd and 3rd trimesters. This typically doesn’t have an odor or cause itching, but can be enough to require a change in panty liners several times a day. This is a harmless discharge of white blood cells and is normal. Another cause of leakage is urine. Pregnant bladders are often not as strong, and forces such as coughing, sneezing and laughing can cause urine to leak. Usually this fluid will have a typical odor and won’t continuously leak.

When a woman’s water breaks, the fluid is typically thin or watery, clear to yellow, sometimes green or blood tinged, and without odor. It will continue to leak, sometimes every time the woman moves or bears down. Sometimes it is difficult to distinguish from other sources of leakage. The important thing to know is that any suspicious of ruptured membranes in pregnancy has to be evaluated by a medical professional. This is not something that can wait until the next day or the next OB visit, it should be checked within a few hours.

At the hospital, the nurses or OBs can do a simple speculum exam and a lab test to determine if the water is broken. Sometimes an ultrasound is done to see if the amniotic fluid level is low. If the water is broken, it is time to have a baby, usually by induction of labor. If ruptured membranes are ruled out, a woman can go home to await her baby’s arrival with peace of mind.

Fetal movements during pregnancy: how do I know if my baby is normal?

January 23, 2012 by Dr. Tamar K. Gottfried Leave a Comment

Mesa Gynecologist Dr. Tamar Gottfried discusses one of the most memorable days of a pregnancy. This is the day that a mother first feels her baby move. Typically this occurs at about 21 weeks for a first time mom and as early as 15 weeks for an experienced mom. The fetus actually starts moving earlier than this, in the first trimester, but the early movements are so small and the uterine muscle so thick that these early movements are difficult to feel. The first fetal movments feel like intestinal gas bubbles or the fluttering of butterfly wings and are only felt by the mother-to-be. As the fetus grows larger and the uterine muscle thins out, both parents can start to feel the kicks, hits and somersaults of the developing baby. Early movements can be inconsistent and irregular, but, by the start of the third trimester at 28 weeks, regular daily movements should be noted.

As the third trimester progresses, mothers may notice that the fetus becomes less active. Sometimes they are simply noting the waking/sleeping cycles of the baby. Like babies once they are born, fetuses tend to be lulled to sleep by the movements of their mothers when they are active, and wake when their mothers are resting. An average fetus after 28 weeks should have at least 2 active periods a day- defined by 10 or more movements in an hour. Keeping track of these movements is called Kick Counting. We don’t expect to see this much movement every hour; just at least twice a day. While babies do move less dramatically (less turns and twists) as the end of pregnancy approaches, they should still have a good number of kicks, hits and taps.

What does it mean if a fetus is not moving at least 10 times in any hour? It may mean nothing or it may mean that the mother is dehydrated and needs to drink, or eat or that she is active and needs to rest and concentrate on counting fetal movements. However, if a mom has eaten or drank and relaxed and still can’t count 10 movements, it may mean that the placenta is no longer performing adequately. Decreased fetal movement can indicate a lack of fluid around the baby limiting movement or a placenta that isn’t working well enough to provide nutrition to the baby. For this reason, decreased fetal movement should prompt an immediate visit to the Ob office or to the maternity ward at the hospital for a nonstress test and ultrasound. Delay can have disastrous consequences. This is not something that can wait until the next morning to be evaluated.

In conclusion, fetal movement is a reassurance that a baby is doing well on the inside. A decrease in movement may indicate a problem and should be addressed right away. For more information regarding fetal kick counts or fetal movement charting, you can call our Mesa ob/gyn office.