Mesa Gynecologist

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.

Do I get an ultrasound in my third trimester? The function of ultrasound in late pregnancy.

December 13, 2011 by Dr. Tamar K. Gottfried Leave a Comment

For many expectant parents, the first comment after seeing their baby onscreen in a detailed ultrasound for the first time is, “when do I get to SEE my baby again?”. This is a natural question- after all, ultrasound is a wonderful way for parents and family to get to know and bond with a baby before the Birth day. However, ultrasound is a medical procedure and has limited use in the last few weeks of pregnancy.

Most women who have gotten prenatal care from an early stage of pregnancy get to see their babies at least once in the first trimester for a dating ultrasound and again for a genetic screening for down’s syndrome, if needed. In the second trimester of pregnancy, ultrasound is used to look at at the anatomy of the baby, make sure all the parts are there and functioning, and to look at the placenta, umbilical cord, and blood flow to the uterus. From a medical perspective, it is this ultrasound that really determines if the fetus is developing normally.

In the third trimester, ultrasound can be used to look at the health and functioning of the placenta and umbilical cord and to evaluate the baby’s growth. Unfortunately, the accuracy of ultrasound at predicting a baby’s weight diminishes later in the pregnancy so that an ultrasound can over or underestimate the weight by a pound. Late pregnancy ultrasound is essential for high risk pregnancies with conditions such as diabetes, high blood pressure, high or low amniotic fluid, and some twins. For most low risk pregnancies, ultrasound is mostly needed at the end if a baby is suspected of growing too much or not enough or if the baby isn’t moving as much as usual.

In conclusion, ultrasound is a vital and exciting tool during pregnancy. While it is most helpful at providing information about a fetus early in pregnancy, it can also be useful in selected pregnancies during the third trimester. Because there is no guarantee that ultrasound will be needed later in pregnancy, it is best to really enjoy and savor the second trimester ultrasound and to make sure and grab some good shots to start the baby album. We offer both early and late ultrasound in our Mesa ob gyn office.

When do I need to take my teenage daughter to see a gynecologist?

November 3, 2011 by Dr. Tamar K. Gottfried Leave a Comment

Many concerned parents have questions about if and when their adolescent daughters need to visit a gynecologist. While there is no official subspecialty in pediatric and adolescent gynecology, there are many Ob/gyns that have an interest in taking care of younger patients and their obstetric and gynecologic needs. That said, most teenage girls do not need to have a gyn visit once they begin developing and having periods. Gyn visits are reserved for those girls that are having problems with their periods, having undiagnosed abdominal pain, problems with discharge or itching, or need counselling for birth control or sexually transmitted disease prevention.

Perhaps the most important gyn issue for the teenage patient is vaccination for the Human Papilloma Virus (HPV). HPV is the virus that causes abnormal paps, genital warts and cervical cancer. There are 2 vaccines on the market available for women and girls ages 11- 26. In order to prevent abnormal paps caused by HPV, it is important to vaccinate women before they are exposed to the HPV virus through sexual contact. That is why the vaccine is given to teenagers. It involves 3 injections over 6 months and can be given in a pediatric or gynecology office. While teenagers do not have to have actual Pap smears until age 21, HPV prevention is an issue even in the teenage years.

Other reasons to see the gynecologist as a teen are menstrual problems such as late onset of periods, irregular bleeding or heavy, long or painful periods. A young woman doesn’t have to suffer and miss school and activities because of bad periods. There are treatments that can help lighten periods.

Of course, some teenagers are thinking about becoming sexually active or already are. For these young women, it is extremely important to visit a gynecologist to learn about protecting themselves from pregnancy and from sexually transmitted diseases. These are real risks, even for teenagers, and are preventable with proper education.

In conclusion, even though routine gyn exam or Pap smears are not needed for teenage girls, there are many others reasons for a teenager to visit a gynecologist. We are happy to see teenage girls in a comfortable and confidential manner for their ob/gyn needs at our Mesa office.