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We hope this is a helpful resource that answers questions you've always wanted the answers to!
Articles from Our Providers
Why Exercise?
Prevention or reduction of most pregnancy-related symptoms including back pain, ankle swelling, fatigue, varicose veins, constipation, and bloating.
Enhanced psychological well-being; more energy and improved mood.
Reduced cardiovascular stress on your body.
Reduced incidence of pre-eclampsia.
Prevention of excess weight gain.
Maintenance of fitness.
Improved sleep patterns.
Easier labor and delivery.
Faster recovery after delivery
What Exercises are Safe During Pregnancy?
Walking
Swimming
Riding a bicycle
If you were a runner prior to pregnancy, you most likely can continue running during your pregnancy, but may have to change the briskness of your routine as your pregnancy advances.
How Often Should You Exercise?
Unless advised by your medical provider, most women should exercise for 30 minutes most days of the week.
Types of Exercises to Avoid
Activities where there is a high risk of falling [gymnastics, skiing, horseback riding]
Contact sports [hockey, basketball, soccer]
Scuba diving
After 13 weeks of pregnancy [1st trimester] avoid any exercises on your back.
Exercise Safety
Before starting an exercise program, speak with your pregnancy care provider.
Monitor exercise intensity. Keep your heart rate less than 150 beats per minute.
Dress for the weather and stay cool while exercising.
Drink plenty of water! This will prevent you from overheating and dehydrating.
Have energy for exercising by eating a light, low-fat high protein snack at least one hour before exercising.
Warning Signs
If you experience any of the following symptoms, stop exercising immediately and consult your pregnancy care provider
Dizziness or fainting
Shortness of breath
Irregular or rapid heart beat
Chest pain
Difficulty walking or muscle weakness
Decreased fetal movement
Vaginal bleeding
Uterine contractions
Leaking of vaginal fluid
Calf pain or swelling
Headache
During pregnancy, a pregnant woman must be careful about anything she eats, drinks, smokes, inhales, and swallows. Please inform your medical provider of all medications [prescribed, over the counter, vitamins, & herbal supplements] that you are taking. Your provider will determine which are safe for you to take during pregnancy.
Avoid all tobacco, alcohol, marijuana, street drugs [example: cocaine, crack, heroin, LSD, meth], and unprescribed pain medications during pregnancy. All of these substances pass through the mother to the unborn baby and may cause harmful effects on the health of the pregnancy and for the health of the baby. Please be honest with your medical provider if you are having problems with substance use/abuse. Your prenatal provider will review the options that will help keep you and your baby safe.
Always inform any medical provider you see during pregnancy of your pregnancy. Some medications are not considered safe during pregnancy. Your provider will determine what is safe for you to take during pregnancy.
AVOID all medications that contain Ibuprofen [such as Aleve, Motrin, and Advil] and Aspirin unless your provider specifically recommends the medication. These medications may cause bleeding problems for mother and baby.
If you are taking prescription medications for health conditions such as high blood pressure, diabetes, thyroid disorders, or mental health conditions [depression, anxiety], you should immediately contact the medical provider prescribing these medications and inform them of your pregnancy. The medical provider will determine if these medications are safe during pregnancy. DO NOT STOP your medications until you talk with your provider.
Flu vaccine is highly recommended during pregnancy for the pregnant mother & her immediate family members. During pregnancy, the inactivated influenza is recommended for the mother. Talk with your provider about the most appropriate time to receive the vaccine.
Most common antibiotics may be prescribed in pregnancy for specific indications [example urinary tract infections, upper respiratory or sinus infections].
It is best to avoid ALL medications in the first trimester [1st 13 weeks of pregnancy], but it is safe to use the following medications at any time during the pregnancy if absolutely necessary, especially after 13 weeks of pregnancy.
For more information about medications in pregnancy, please reference www.mothertobaby.org.
Many couples wonder if sex is safe in pregnancy and if intercourse will harm the baby. In most pregnancies, sex is considered safe and healthy. However, you should avoid intercourse or any sexual activity that results in orgasm if you are experiencing:
Vaginal spotting or bleeding
Uterine contractions
Ruptured membranes
Placenta previa
Or if you have been advised by your doctor
Note: You may notice light vaginal bleeding after sexual intercourse. Please call you medical provider if bleeding continues for longer than 30 minutes.
The woman’s comfort should be the most important guide during sex. As pregnancy advances, you and your partner may wish to have sex in positions that do not put pressure on the growing abdomen, such as the mother on top or by lying side by side. If you have any questions about having sex during pregnancy, talk with your medical provider.
The changes of pregnancy can affect sexuality and levels of sexual desire for both the woman and her partner. It is normal for a woman’s sex drive to change with the stages of pregnancy as the body image changes and discomforts come and go. Sexual feelings may also change as the pregnancy progresses. Discussing your needs and emotions with your partner will help you enjoy a happy and satisfying sexual relationship during pregnancy.
A pregnant woman should be aware that sexually transmitted infections such as Herpes, Chlamydia, Gonorrhea, Hepatitis B, HPV, Syphilis, and HIV, can pass from a mother to her newborn. If you think you have been exposed to a sexually transmitted infection, please inform your medical provider. You can protect yourself and your baby from exposure to sexually transmitted infections by using condoms and limiting sexual partners.
In general, pregnancy is considered a state of health. These days, more mothers-to be are working right up until a few days, or even a few hours, before they go into labor. The fact that fewer than 40 percent of working women in the United States get paid pregnancy leave may have something to do with this trend. In fact, the U.S. is one of only a handful of developed countries that doesn’t guarantee paid pregnancy leave to working women. That’s the bad news. The good news is that most women, depending on a few key factors, can actually work through their pregnancies without jeopardizing their--or their baby’s – health.
Can I work while I'm pregnant?
Probably, but that depends on many factors you should discuss in detail with your physician and perhaps your employer. If you’re free from any medical conditions and experiencing a normal, low-risk pregnancy (and if your job isn’t hazardous, strenuous, or overly stressful), you can most likely continue to go to work through your pregnancy.
Is it okay to work right up until I go into labor?
If your pregnancy is going along smoothly and your job isn’t causing any problems for you or the baby, chances are you can work right up until your baby arrives if that’s what you want to do. Keep in mind, however, that you will likely experience more fatigue and back pain toward the end of your pregnancy, so try to go easy on yourself. If you can afford to take a little time off before your due date, you may just want to take advantage of what will be your last “alone time” for quite a while.
Are there any reasons why I might need to stop working or cut back on my hours?
If your job is hazardous, excessively strenuous, or potentially harmful to the fetus’s health, your physician may recommend that you limit your working hours, ask for a different assignment at work, or stop working altogether.
If you have a health problem such as diabetes, kidney disease, heart disease, or high blood pressure, or if you’ve had problems with past pregnancies, your physician may want to restrict what you do both on and off the job. Be sure to discuss all of your health issues with your physician and ask specifically how they may affect your ability to do your job during your pregnancy.
Similarly, if your developing baby has a condition that could be adversely affected by the strain or stress of working, your physician may recommend that you make changes. Women who are carrying twins or other multiples may also have to stop working earlier than planned.
What kinds of jobs might be considered unsafe for a pregnant woman?
Any job that exposes you to substances proven harmful to a fetus—including pesticides, some cleaning solvents, lead, and certain chemicals- can be extremely dangerous. Industries that are considered potentially risky for pregnant women including farming, health care, some factory work, dry cleaners, printing, some crafts businesses (such as painting and pottery glazing), highway or tollbooth jobs (where workers breathe in high levels of lead and carbon monoxide from car exhaust), and the electronics industry. Health-care workers may be exposed to other substances harmful to a developing baby, such as chemotherapy drugs, x-rays, organic mercury and other chemicals, as well as many viruses and bacteria.
Teachers and childcare providers who are constantly exposed to many viruses and bacteria should practice good hand hygiene. People in those professions can decrease their germ exposure through frequent hand washing.
Federal law requires your employer to inform you about any toxic agents you may be exposed to on the premises and to protect the health and safety or pregnant woman.
Should I continue working if my job is very physically demanding?
This is another issue you should discuss at length with your physician. While moderate exercise is good for you and your baby, too much hard work can definitely be harmful. If your job requires heavy lifting – generally defined as more than 20 pounds on a regular basis – climbing, or prolonged standing or walking, your physician may suggest that you work fewer hours or stop performing certain tasks. Remember that the extra weight and your growing belly can affect your balance and may cause falls. In the earlier stages of your pregnancy, nausea, and dizziness can also increase your chances of injury, especially if your job is very physical.
Be sure to ask your physician for advice. According to a report by the American Medical Association, “physical activities at work, such as prolonged standing, bending, or shift work, pose the greatest hazard when present in combination and in circumstances where women have limited opportunity for rest.”
How can I keep comfortable and safeguard my and my baby's health on the job?
Even if your job is easy and hazard-free, you’re still going to experience some discomfort and fatigue while working during your pregnancy. The American Medical Association recommends that employers accommodate a woman’s increased physical requirements during pregnancy by allowing her to take breaks every few hours.
There are also steps you can take to stay as comfortable as possible. For example to prevent back pain, the American College of Obstetricians and Gynecologists recommends that you wear low-heeled shoes with good support and make sure you have a chair with good back support. (You can also tuck small pillow behind your lower back.) Try wearing support stockings, which will prevent swelling in your legs and may decrease the odds of getting varicose veins.
If you have to sit for long periods of time, propping up your feet on a footrest – even a wastebasket or telephone book will help your circulation. You should try to avoid crossing your legs because it impedes circulation and may promise varicose veins. Also keep in mind that pregnant women are more susceptible to carpal tunnel syndrome, so if you use a keyboard a lot, adjust the height of your chair so that your forearms are level with the keyboard. And remember to give your hands and wrists a rest by talking regular breaks.
In addition, pregnant women should never skip meals and should drink plenty of water. Keep a full glass at your desk at all times to remind you to drink enough, and use bathroom breaks to take a short walk or do some stretches. (Varying your position is a great way to combat fatigue, too!)
If your job requires you to stand for long periods of time, try resting one foot on a stool or box. Sit down often on your breaks. If that’s not possible, or if your feet and legs swell anyway, support stockings will help.
By taking a few precautions and listening to your body, you can ensure a healthy and productive nine months on the job.
What if I want to stop working while I am pregnant? If you choose to stop working during your pregnancy, that is certainly your choice. Please understand that your physician cannot “take you out of work” unless there is a medical reason. Unless there is a medical diagnosis made that prohibits you from working, you will not be able to obtain disability benefits through your employer. Common discomforts of pregnancy are not generally considered medical indications to take a woman out of work. It is illegal for a physician to make a diagnosis simply at the woman’s request to be able to stop working.
How do I get my FMLA/Disability forms completed?
FMLA forms and Disability Forms are two different types of forms. FMLA (Family Medical Leave Act) is designed so that your employer will hold your job for you while you are out of work on approved medical leave. Disability will pay you a certain percentage of your normal income while you are out of work on medical leave.
Our office is now partnering with RecordQuest to process disability and FMLA forms. Please allow up to 10 business days for RecordQuest to complete the form process, so please ensure that you submit the required forms as soon as possible. Each form for a patient and/or spouse/partner will cost $25 paid directly to RecordQuest. Any modifications to a previously completed form is free. You can find information about RecordQuest and how to request form completion here: www.nashobgyn.com/disability-forms
Please be aware that any intermittent leave forms are completed only after it is authorized by our physician.
After delivery, our policy is to approve 6 weeks postpartum leave for a vaginal delivery and 8 weeks of postpartum leave for a C-section delivery, regardless of what your employer allows. If you elect to remain out of work longer than 6 weeks, then you will have to arrange the additional leave with your employer before you deliver. Any additional postpartum leave will only be approved by your physician if you are experiencing a complication that requires close monitoring.
For more information, visit PregnantAtWork.org.
Travel during a healthy, uncomplicated pregnancy has no harmful effects on your baby. Travel in properly pressurized aircraft offers no unusual risk and pregnant women can generally fly up to 34 weeks of the pregnancy.
It is recommended that pregnant women observe the same precautions for air travel as the general population, including periodic movement of the lower extremities, ambulation or walking hourly, and use of seatbelts while seated.
The seatbelt should be worn during the pregnancy. The leading cause of fetal death during automobile accidents is the death of the mother. The lap belt portion of the restraining belt should be placed under the growing abdomen and across the upper thighs. The belt should be snug as comfortably possible. Based on limited information, The American College of Obstetricians and Gynecologist concluded that is does not appear reasonable to recommend disabling airbags during pregnancy.
Learn More:
Zika Virus:
Be aware of urgent maternal warning signs and symptoms during pregnancy and in the year after delivery. Seek medical care immediately if you experience any signs or symptoms that are listed in the resource linked below. These symptoms can be a sign of a life-threatening condition.
Flu vaccine: As pregnant women can get very sick from the flu, it is advised to have a flu vaccine [Inactivated form] during pregnancy. Talk with your medical provider about the best time to receive flu vaccine in pregnancy. A pregnant woman should NEVER receive the live influenza vaccine. All household members should also receive the flu vaccine to decrease the risk of exposure for the pregnant woman. For more information, visit: www.acog.org/womens-health/faqs/the-flu-vaccine-and-pregnancy
Abrysvo (RSV) vaccine: Respiratory Syncytial Virus, or RSV, is a respiratory virus that spreads in the fall and winter and is very dangerous to babies and young children. You will be offered this vaccine during your pregnancy if appropriate. It is recommended that all pregnant women who are 32 to 36 weeks pregnant from September to January receive this vaccine. When a pregnant mom receives the vaccine, her body creates antibodies that pass to her baby before birth and during breastfeeding. This means that the baby will have some antibodies to protect them from RSV for the first 6 months after birth. If you do not receive the vaccine during pregnancy, there is the option for your baby to receive an antibody injection called Nirsevimab, after birth. For more information, visit: www.acog.org/womens-health/faqs/the-rsv-vaccine-and-pregnancy
Tdap vaccine [Tetanus, Diptheria, and Pertussis]: Pregnant women should get a dose of Tdap with each pregnancy to protect the newborn from Pertussis [whooping cough]. The ideal time to receive the vaccine is between 27 to 36 weeks of pregnancy. This vaccine will be discussed with you at your 26-28 week visit. If you do not have the vaccine during pregnancy, you will receive it after delivery while you are in the hospital. All other household members should also receive the Tdap prior to the baby’s arrival to decrease the risk of exposure for the newborn. For more information, visit: www.acog.org/womens-health/faqs/the-tdap-vaccine-and-pregnancy
COVID vaccine: COVID-19 vaccines are safe and effective and help to protect against serious illness. During pregnancy, you have a higher risk of severe illness from COVID-19 than people who aren’t pregnant. When you get vaccinated, the antibodies made by mom may be passed to her baby to help protect the baby after birth. We recommend the COVID vaccination for all patients, including those who want to be pregnant, are pregnant, and women who are currently breastfeeding. We do not offer the vaccine in our office, but we can provide with a statement of support if it is needed for your to receive the vaccine during your pregnancy at another location. For more information, visit: www.acog.org/womens-health/faqs/covid-19-vaccines-answers-from-ob-gyns
Other vaccines/immunizations: Before receiving any vaccinations or immunizations during your pregnancy, you should always consult with your Obstetrical provider as to the safety of the vaccine during pregnancy. Measles and chicken pox vaccinations should not be given during pregnancy.
Hot tubs and saunas: Pregnant women should avoid hot tubs, saunas, and very hot tub baths. The water temperature should be less than 102 degrees Fahrenheit. Limit your time to 10 minutes for tub baths. High temperatures can cause raise the mother’s blood pressure causing harm to the developing baby.
Dental care: It is safe and recommended for a pregnant woman to maintain good health during pregnancy. Our office can provide a dental care statement as guidance for your dentist in providing dental care during your pregnancy. When having dental x-rays, your abdomen should always be shielded.
Hair coloring and permanents: Hair treatments are acceptable during pregnancy, but they may not take as well as when non-pregnant. It is recommended that you wait until after the first 13 weeks of pregnancy before having hair treatments.
Exposures to infections: Pregnant women should avoid contact with cat litter or nesting material, urine, or droppings of rodents [household pests and pets such as hamsters and guinea pigs]. These animals can carry viruses in their urine and feces that can be very harmful to the developing baby.
Exposure to toxic substances: Toxic substances such as chemicals, cleaning solvents, lead, mercury, some insecticide, and paints [including paint fumes] can be harmful during pregnancy. A pregnant woman should avoid exposure to these substances. If you are concerned about exposure to substances in your workplace, contact your Safety Officer regarding the safety of these substances during pregnancy.
Exposure to x-rays & diagnostic tests: Always tell your medical provider that you are pregnant so that the appropriate safety precautions may be used. If you work in a field where you may be exposed to x-rays, please talk to your Employee Health or Safety Officer regarding specific precautions you should observe in your workplace. Unshielded x-ray exposure may affect your baby’s growth or cause birth defects.
Recommended Websites
The Internet offers unlimited access to worlds of information. However, information gathered through internet resources should be used with caution as not all information sites have accurate and/or reliable medical information. We encourage our patients to feel free to ask medical providers questions regarding their care. Reliable sources include:
marchofdimes.org [Spanish - nacersano.marchofdimes.org] - Health of moms and babies
Parenting: www.healthychildren.org
Sleep Safety for Infants: www.safesleepnc.org
According to the Center for Disease Control (CDC) there are about 20 million new cases of sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), in the United States every year. Getting tested for STIs is one of the most important things you can do to protect your health. Many STIs can have little to no symptoms which makes testing the only way to know for sure if you have an STI. If not treated, many STIs can cause severe health problems. Knowing your status is a critical step to stop the spread of STIs.
It’s especially important to get tested if:
you’re about to begin or are in a new sexual relationship
you and your partner are not using condoms, or are thinking about not using condoms
you are sexually active and have not been tested before
your partner has cheated on you or has multiple partners
you have more than one partner
you have current symptoms that suggest you might have an STI
If you and your partner are in a long-term relationship with each other, and only each other, and both of you were tested before entering the relationship, you may not need regular STI testing. But many people in long-term relationships weren’t tested before they got together. If that’s the case, it’s possible that one, or both, of you have been carrying an undiagnosed STI for years. The safest choice is to get tested.
During your doctor’s visit, make sure you have an open and honest conversation about your sexual history and STI testing with your doctor. Also, ask whether you should be tested for STIs. Don't assume that you're receiving STI testing every time you have a gynecologic exam or Pap test. If you think you need STI testing, request it. Talk to your doctor about your concerns and what tests you'd like or need. If you are not comfortable talking with your doctor about STIs, there are local clinics that provide confidential and free or low-cost testing.
Below is a brief overview of the CDC’s STD testing recommendations for women:
All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
All sexually active women younger than 25 years should be tested for gonorrhea and chlamydia every year. Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested for gonorrhea and chlamydia every year.
All pregnant women should be tested for syphilis, HIV, and hepatitis B starting early in pregnancy. At-risk pregnant women should also be tested for chlamydia and gonorrhea starting early in pregnancy. Testing should be repeated as needed to protect the health of mothers and their infants.
Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year.
Finally, there are additional tests for STIs that may not be necessary for all individuals. Be sure to have a discussion with your doctor about what STI tests are recommended for you.
For more information, take a look at the following websites:
Answer from KERRY C. BULLERDICK, MD (2020)
January is Cervical Health Awareness Month (as designated by the United States Congress, who knew!). The cervix is the lower portion of the uterus that opens into the vagina. I thought we might discuss cervical cancer screening. Generally, we think about the Pap test (Pap smear, or cervical cytology) first when we talk about cervical cancer screening.
What is the Pap test?A Pap test is a screening test (a test done to detect potential health disorders or diseases in people who do not have any symptoms of disease) that looks for precancerous changes (dysplasia) or cancerous changes in the cervical cells. The test was developed by Dr. George N. Papanicolaou in the 1920s and was widely introduced into medical practice in the 1940s after he published a paper describing the test. Before the Pap test was introduced, cervical cancer was the leading cause of cancer deaths in American women. Since the introduction of the Pap smear, death due to cervical cancer has dropped by more than 70 percent, and now ranks 13th in the U.S.. According to the American Cancer Society, over 13,000 new cases of invasive cervical cancer will be diagnosed this year, and about 4,250 women will die from cervical cancer. Cervical cancer occurs when the cells become abnormal, and grow over time without normal control over the cells. As the cancer develops, it can invade other surrounding organs, such as the vagina, the bladder, and the bowels. Early detection is important, and when detected early, the five-year survival rate approaches 92%. It usually takes cervical cells 3-7 years to change from high-grade (severe) dysplasia to cancer.
How is the Pap test performed? Cervical cells are obtained during a pelvic exam when a speculum is placed in the vagina so that the cervix can be clearly seen, and a sample is taken from the cervix with a brush or special device. The cells are examined under a microscope, sometimes with the use of a computer aiding in the examination, to look for abnormalities in the cells.
Who should get the test and how often should it be done?The recommendations have changed over the years, and now the new guidelines according to The American College of Obstetricians and Gynecologists are:
Women aged 21-29 years, should get a Pap test every 3 years.
Women aged 30-65 should have a Pap test and an HPV test (more on this later) every 5 years (“co-testing”), or a Pap test every 3 years.
Women over the age of 65 years should stop having Pap tests if they do not have a history of moderate or severe dysplasia, AND they have had either three Negative Pap test results in a row or two negative co-test results in row within the past 10 years, with the most recent test performed in the past 5 years.
Women with a history of a hysterectomy may still need Pap tests/screening, if the cervix was not removed with the hysterectomy (supracervical hysterectomy), or if they have a history of moderate or severe dysplasia, or cervical cancer.
These recommendations are for most women, but other medical history such as HIV infection, HPV infection, medical conditions causing weakened immune systems, DES (diethylstilbestrol) exposure before birth, cervical precancerous changes, or cervical cancer may need more frequent or longer screening.
You should avoid sexual activity, douching, or tampons for 24 hours before you have your Pap test.
What is HPV and how do you test for it?Human papillomavirus (HPV) is a common viral infection and it can be passed from person to person during sexual activity. HPV is the cause of most cervical cancers. The virus enters the cell’s DNA and can cause changes that can lead to cervical cancer. There are over 100 types of HPV, but there are some types associated with cancer of the cervix, vagina, vulva, anus, penis, mouth, and throat. These types are known as “high-risk types.” Most HPV infections will be cleared from the cells on their own. In some people, the infection does not clear over time. The HPV test looks for the DNA of the most common of the high-risk types. It is run from the sample taken from the cervix. HPV screening is not recommended for women ages 21-29 years old. A vaccine is available for prevention of certain types of HPV for ages 11-45 years old. Even if you have had an HPV vaccine, you should still have cervical cancer screening.
What happens if I have an abnormal Pap test or HPV test?Abnormal tests are common, due to the frequency of HPV infections. If you have an abnormal test, it does not mean that you have cervical cancer. Additional testing, such as repeating the Pap test, or colposcopy (a test that uses a microscope to look at the cervix for abnormal changes) with possible biopsy (a small sample of tissue is removed, and sent to the laboratory for examination) may be done. Your medical provider should discuss the results with you as well as the plan of care based on the findings.
Finally: It may be tempting to skip your routine GYN visits, but this can have significant consequences. If you have not had a cervical screening exam in the appropriate time frame, please call to schedule an appointment with your medical provider.
Answer from DENNIS J. VAN ZANT, MD (2020)
This is a more complex question than you might think. A routine breast self-exam was once recommended to be performed by all women every month. This was based on the idea that self-screening may help detect breast abnormalities sooner compared to only once a year screening with your doctor. However, recent data has suggested that routine breast self-exams may not help detect breast cancer or breast problems sooner and, surprisingly, may actually result in an increased risk of un-necessary medical and surgical procedures on women’s breasts.
As of 2019, breast self-exams are no longer recommended by several major societies, including the American Cancer Society and the United States Preventive Services Task Force. There are even recommendations by some societies that physicians no longer perform screening breast exams and instead rely only on mammograms when women are of age. This can all be confusing, both to you, and to physicians. What I tell my patients is that there are several different societies and research institutions interested in preventing breast cancer that use their own data, or their own interpretation of data, to come up with plans that maximize detection of breast cancer or breast problems while minimizing risks of unnecessary, invasive and/or costly procedures to patients. Thus, we do not have one recommendation, we have several, and not all of them agree on what is best for optimizing breast health.
The Centers for Disease Control and Prevention (CDC) has compiled the recommendations from some of the most prestigious organizations in the following linked document if you are interested. CLICK HERE to learn more. As more data becomes available in the future, recommendations will likely continue to change.
At this time, I think the decision to do a monthly breast self-exam should be a decision made between you and your doctor after reviewing your personal and family history and having a discussion about the benefits and risks of breast self-exams. If a decision to do a breast self-exam is made, your doctor will review how to perform one.
Please be aware that a breast self-exam is different than having a general idea of your breasts. It is always a good idea to know how your breasts look and feel as you would any other part of your body. If something looks or feels wrong, it may be, and you should always follow up with your doctor.
Answer from KERRY C. BULLERDICK, MD (2019)
Research gives new information that changes how we care for our patients. Much has been learned about cervical cancer, where it comes from, how to test for it, and ways to prevent the disease. We used to recommend getting Pap smears every year. But we now know that cervical cancer takes many years to develop, and is typically associated with Human Papilloma Virus, or HPV. Since more than 90% of cervical cancers come from HPV, a sexually transmitted disease, less frequent screenings can still identify the disease early. As a result, we no longer recommend annual Pap smears for most women.
Instead, the cervical screening is typically based on age:
Age 21 – 29: You should have your first Pap smear at age 21, and if it’s normal, have it repeated every 3 years. Because cervical cancer rarely, if ever, occurs in young women, we don’t recommend they have HPV testing.
Age 30 – 65: Women in this age group should have a Pap smear plus an HPV test every 5 years.
Age 65 and up: Women in this age group who have no history of abnormal cervical cells and no recent abnormal Pap smears can stop having cervical cancer screenings.
A conversation with your doctor is the best way to determine if you need more frequent screening. You should also talk with your doctor about the HPV vaccine, which can help prevent cervical, vaginal, and anal cancers and genital warts, and is now approved for women up to age 45.
We know this information is confusing, but Nash Ob/Gyn is committed to providing high quality care to our patients, through all stages of life. Your ‘annual’ exam is more than a pap smear and provides an opportunity to take charge of your health. Preventive health care includes the following:
Discussion of health topics relevant to your age and risk factors
Review and update your current medical problems and medications
Exams and screening tests
More specifically, we enjoy the opportunity to review birth control options, menstrual cycle regulation, management of menopausal symptoms, and bladder control. We may also discuss diet and exercise and review screening options for breast, colon and cervical cancers as well as testing for osteoporosis and sexually transmitted diseases.
While preventative visits such as the annual exam are usually covered by most insurances, it is important to realize that your insurance may not pay for you to have a pap smear test every year if you do not qualify based on the guidelines discussed here. You can request a pap smear be collected every year if you desire but if your insurance feels the pap smear is not medically necessary, you could receive a bill from the laboratory for that portion of your visit. We always recommend that you contact your insurance company directly if you have any questions about your benefits.
Please feel free at any time to contact our office if you would like to discuss this more with our staff or with your physician.
Answer from NANCY L. HANCOCK, MD, MPH (2019)
There are many women who would prefer just to skip “that time of the month.” Fortunately, for a majority of women, there are several options to either reduce and/or stop monthly menstrual periods some of which include pills. Your specific medical history as well as the current birth control pills you are taking should be reviewed by your doctor to see if this would be an option for you before making any changes to your current birth control pill regimen.
It is important to realize that while the goal may be to not have a period, many women may have irregular bleeding or spotting for the first few months while taking continuous pills. Furthermore, irregular bleeding and spotting can also return with prolonged use of continuous pills. For that reason, some women prefer taking extended-cycle pills that cause you to have a period every 3 months, meaning only 4 periods a year. We have found that this regimen reduces unscheduled and breakthrough bleeding compared to regimens where one never has a menstrual period.
While irregular bleeding on continuous or extended-cycle pills can often be due to the medications themselves, any irregular or unexpected vaginal bleeding should always be brought to your doctor’s attention as there can be other causes for your abnormal bleeding than just your birth control.
Finally, there are birth control formulations other than pills that can also decrease the frequency or stop periods as well. If not having a monthly period is something that interests you, be sure to talk with your doctor.
Answer from KERRY C. BULLERDICK, MD (2019)
Such a good question!
Like most things, it depends. A new patient visit for “just birth control” is so much more than just getting started on a medication. The visit should be seen as an opportunity to establish care with an OB/GYN who will review your personal medical history, review contraceptive options and provide education. For many new patients starting birth control a vaginal exam is not necessary. However, some women have questions or issues that may be best answered or evaluated by performing a pelvic exam. In these instances, we always perform an exam only with the permission of the patient.
If your daughter is sexually active, or planning to become active, we will discuss STD screening and prevention. If your daughter would like STD screening, a vaginal swab or urine specimen is required. While many young women feel comfortable self-collecting a vaginal swab or a urine sample, there are others who would prefer a physician obtain one for them.
Finally, if your daughter is 21 or over, a vaginal exam and pap smear as part of screening for cervical cancer is recommended. This is done as part of an annual exam, and we would recommend you or your daughter inform our office about her desire for an annual exam instead of a consult for birth control only, as these visits require extra time.
I hope this helps!
Answer from KERRY C. BULLERDICK, MD (2019)
Vaginal discharge can be normal, especially around the time of ovulation and during pregnancy. Diet, sexual activity, medication, and stress can also affect the volume and character of normal vaginal discharge.
Normal discharge may also be yellowish, slightly foul smelling and can be associated with mild irritation. Itching, pain, burning, redness, or lesions are not normal and need to be evaluated.
Abnormal vaginal discharge can be from sexually transmitted diseases, cervical precancer, yeast infections, retained tampons, or a variety of other causes.
Guessing at the problem by treating only the symptoms you describe often leads to the wrong diagnosis with the wrong treatment. The best approach is to see you in the office where we can ask questions about your symptoms, perform an exam and appropriate tests, and determine the exact cause of the symptoms so the correct treatment can be prescribed.
Answer from NANCY L. HANCOCK, MD, MPH (2019)
What you talk about with your doctor is private, and there are laws in North Carolina that help protect your privacy. We are not allowed to give information to anyone about pregnancy, birth control, sexual health including STD test results, substance abuse, or mental health under any circumstance without your written permission.
You can sign a release form that allows us to give your parents health information and tests results, but that decision is up to you. We will only give your health information to your parent or guardian if you have a life-threatening emergency, or your parent or guardian asks us about treatment or services being provided that are not related to those listed.
If there are any questions about what can and cannot be discussed, please let your doctor or other office staff member know. We are happy to talk with anyone at any time about privacy.
Answer from NANCY L. HANCOCK, MD, MPH (2019)
Mammograms are performed as a screening test to detect breast cancer. Screening tests are performed because the test can detect a disease earlier and that earlier detection leads to better treatment outcomes. When you start having mammograms and how frequently depends on whether you are having any breast complaints, your family history, and your own values regarding the potential benefits and potential harms from screening. Harms from mammogram include having stress and anxiety from abnormal results that are ultimately not cancer. You should talk with your doctor to determine when you should start having mammograms and how frequently.
Different national organizations have different recommendations about when to start having mammograms and how frequently they should be performed. According to the American Cancer Society, Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so. Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
However, the US Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in disease prevention and evidence-based medicine, has different recommendations. The USPSTF recommends a screening mammogram at age 50 and then every other year until age 75. The American College of Obstetricians and Gynecologists (ACOG) and the American College of Radiology recommend annual screening mammograms at age 40 until age 75.
The best test to detect breast cancer is yet to be discovered. Until then, your annual exam should include a conversation with your doctor to determine when and how frequently mammograms should be performed.
Answer from NANCY L. HANCOCK, MD, MPH (2018)
Most gynecologic ultrasounds are pelvic ultrasounds. The pelvic ultrasound allows visualization of the female pelvic organs including the uterus, cervix, fallopian tubes and ovaries. Pelvic ultrasound can provide information about the size, location, and structure of pelvic masses but cannot provide a definite diagnosis of a specific disease. The ultrasound will help your doctor determine if you pain is related to infection, growth, masses, cysts, or other types of tumors within the pelvis.
A pelvic ultrasound is performed by inserting a long, thin ultrasound probe covered with gel and a protective cover inside the vagina. There is no radiation used, but you may experience slight discomfort with the insertion of the transvaginal probe into the vagina. The transducer will be gently turned and angled to bring the areas for study into focus. You may feel mild pressure as the transducer is moved. Several pictures and measurements will be taken. After the ultrasound is performed by the ultrasonographer, you will see your doctor to discuss the results.
Answer from NANCY L. HANCOCK, MD, MPH (2018)
Vaginal bleeding after menopause isn't normal and should be evaluated.
The least likely but most concerning reason for bleeding after menopause is cancer of the uterus, which is why your gynecologist wants you to call if you have any vaginal bleeding. However, the more common reasons for bleeding include thinning of the tissues lining the uterus or vagina, some medications, uterine polyps, and bleeding from the urinary tract or rectum. The cause of your bleeding may be entirely harmless. However, postmenopausal bleeding could result from something serious, so it's important to see your doctor promptly.
If you have not had a period in over 1 year and have any vaginal bleeding, even if it’s just a few drops when you wipe after going to the bathroom, you should call the office to schedule an appointment.
Answer from NANCY L. HANCOCK, MD, MPH (2018)
Urinary tract infections, or UTIs, are the most common bacterial infections in women. Approximately 50% of women will experience at least one urinary tract infection in their lifetime. Typical urinary tract infection symptoms can consist of pain with urination, abnormal color or odor to urine, and abdominal pains. While other symptoms such as back pains and fevers can be seen with urinary tract infections, they are less common symptoms.
While many symptoms can seem like a urinary tract infection at first, there are several other conditions that can present with similar symptoms. Because of this, our office policy is that any patient complaining of urinary tract infection symptoms must have a scheduled appointment with a physician so that he/she can examine the patient and the patient can then have their urine evaluated by the lab to confirm that a urinary tract infection is present BEFORE prescribing antibiotics. This prevents you from taking medication that you may not need and ensures that you are being treated for the correct condition. Furthermore, in women with frequent urinary tract infections, there can be underlying issues with the urinary system or even bacteria that can be resistant to many common antibiotics. Because of this, your urine may be cultured, which is where we test to see which antibiotics the bacteria will respond to.
If you are diagnosed with a urinary tract infection it is important to complete all of the antibiotics you are prescribed to decrease the chances that the bacteria causing your urinary tract infection do not become resistant to that medication. This is true even if your symptoms resolve before completing your medication. If you are treated for a urinary tract infection and your symptoms do not improve, or start to worsen, it is important to call our office to let your doctor know this.
Answer from KERRY C. BULLERDICK, MD (2018)
The pap smear is a screening test for cancer of the cervix. The age to stop screening depends on how frequently you have been screened in the past and your specific medical situation.
In general, the American College of Obstetrics and Gynecology and the American Cancer Society agree that women over age 65 who have had regular screening in the previous 10 years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers (like CIN2 or CIN3) found in the last 20 years. Regular screening means at least 3 consecutive negative pap smears or 2 consecutive negative co-tests (pap smear and human papilloma virus, HPV, testing) within the last 10 years, with the most recent test performed within the past 5 years.
Women with a history of CIN2 or CIN3 should continue to have testing for at least 20 years after the abnormality was found. Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical pre-cancer (or cancer). Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the mentioned guidelines.
Regular visits with your gynecologist provide an opportunity to review your current health situation and may uncover problems related to your female health. Many women notice changes to their bladder habits or may experience pelvic organ prolapse as they age. Also, sexual discomfort may increase. We can help with these issues and provide so much more than just a pap smear!
Answer from NANCY L. HANCOCK, MD, MPH (2017)
Missing your period can be due to pregnancy, but there are other reasons why you might miss your cycle. In some cases, you skip cycles due to medical problems that affects her brain or reproductive system.
Absent or irregular periods can be caused by:
• Pregnancy
• PCOS (which stands for "polycystic ovary syndrome"). In women with this condition, the ovaries make too much male hormone. This can disrupt a woman's periods and cause excess facial hair, acne, and problems with weight. PCOS is the most common cause of absent or irregular periods.
• Being too thin or having too little body fat
• Exercising too much
• Too much prolactin – Prolactin is a hormone made in the "pituitary gland", which is a small organ at the base of the brain.
• Early menopause – Menopause is the time in a woman's life when she naturally stops having periods. Menopause usually occurs between the ages of 45 and 55. But in some women, menopause comes early – before the age of 40. Early menopause happens when the ovaries run out of eggs earlier than normal.
• Some medicines, including birth control pills
You should schedule an appointment if you used to get periods regularly, but you have not had a period for more than 3 months. You should also schedule an appointment if your periods consistently happen more than 45 days apart.
Answer from NANCY L. HANCOCK, MD, MPH (2017)
Congratulations! You have one of the most effective methods of birth control available. However, different IUDs can cause different changes to your bleeding pattern.
Bleeding is common after all IUD insertions. The Paragard, or Copper containing IUD, can make your menses heavier, longer, or more uncomfortable, especially in the first several cycles after insertion. There are 4 different progesterone containing IUDs: Liletta, Kyleena, Mirena, and Skyla. Changes to your bleeding pattern can happen with any of these IUDs. Prolonged bleeding and unscheduled bleeding are the most common changes. Amenorrhea, or no cyclic bleeding, and spotting can also happen. These changes are a side effect of the hormone on the uterine lining and are not dangerous. Most bleeding pattern changes typically improve within 6 months after insertion, and you can use ibuprofen or naproxen (nonsteroidal anti-inflammatory drugs, NSAIDS) to decrease the amount and duration of bleeding.
It's important to remember that all medications affect each individual differently. If you are concerned about how your IUD has changed your bleeding pattern, you should contact the office.
You can learn more about the available IUDs (Intrauterine Devices) at these sites:
- Mirena
- Kyleena
- Skyla
- Liletta
- Paragard
Answer from NANCY L. HANCOCK, MD, MPH (2017)
Herpes Simplex Virus (HSV) is a virus that causes both oral and genital herpes.
Oral herpes, such as cold sores or fever blisters on or around the mouth, is usually caused by HSV-1. Most people are infected with HSV-1 during childhood from non-sexual contact. For example, people can get infected from a kiss from a relative or friend with oral herpes. More than half of the population in the U.S. has HSV-1, even if they don’t show any signs or symptoms.
Genital Herpes can be caused by HSV-1 or HSV-2. HSV-1 can be spread from the mouth to the genitals through oral sex. As a result, HSV-1 is becoming a more common cause of genital herpes, especially in young women.
Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through skin and spread the infection.
Many people with HSV have no symptoms. Symptoms, when they do occur, can vary from person to person. After a person is first infected, HSV stays in the body but is not always active. You may not have an outbreak until something triggers it to become active again. This can occur years after the first exposure. In fact, some people never have sores at all.
To prevent STDs, use condoms consistently and correctly. Viruses like HSV, however, can be transmitted from infected areas that are not covered by condoms so condoms may not fully protect you from getting herpes. There are medications that you can take to help prevent transmission to a partner if you are known to carry HSV. Contact your doctor to discuss this more.
Answer from NANCY L. HANCOCK, MD, MPH (2016)
Dr. Google is not very smart. Google simply gives you an answer, based on the question you ask, but it doesn’t know what’s true and what’s not true. The first response to your search may not right. Or, you may also read one answer on one website, and then another website will say something completely different. It can be hard to know what’s most correct.
The good news is, there are reliable sources of information on the internet: you just have to know which ones consistently provide reliable information.
Overall health information: Medline Plus
MedlinePlus (medlineplus.gov) is operated by the National Institutes of Health’s U.S. National Library of Medicine. This website is a reliable source of scientifically-based, peer-reviewed health information. There are no advertisements because it is already paid for by tax dollars. All the information is written by healthcare professionals (MDs, PhDs, RNs, etc) and it is 100% available in Spanish. If you had one place to go for information, this should be it.
Information about Women’s Health
All of the Nash Ob/Gyn physicians are members of the American College Of Obstetrics and Gynecology, which is a national organization that provides information to providers and patients about best practices for Women’s Health. Their patient information website, www.acog.org/womens-health, can answer many questions you may have about different medical problems or treatment options.
Information about pregnancy
The Centers for Disease Control and Prevention (CDC) has information about many health topics. They have a dedicated website for pregnancy, www.cdc.gov/pregnancy/index.html, which has answers to questions about everything from how to get ready for pregnancy to what medicines are safe in pregnancy.
Information about sexual health
Intimacy is an important part of our lives. Sarleteen, www.scarleteen.com, is an inclusive, comprehensive, and supportive website about sexuality and relationships for teens and emerging adults. MiddleSexMD, middlesexmd.com, is a reliable, confidential women’s sexual health resource for information and products that can help you keep this part of your life vital and joyful for as long as you choose, for sex after 40, after 50, and beyond—sex after menopause.
Our website also has a lot of information, especially about pregnancy >
Knowledge is power. Take the time to learn about your medications and your diagnoses. But, do not attempt to diagnose or treat yourself based on any internet source. If you have any questions, don’t hesitate to contact us: we’re here to help!
Answer from NANCY L. HANCOCK, MD, MPH (2020)
A variety of genetic screening tests are available during pregnancy. Genetic screening tests offered by Nash Ob-Gyn include prenatal genetic screening for Down Syndrome, Trisomy 18, and Open Neural Tube defects and carrier screening for Cystic Fibrosis, Spinal Muscular Atrophy (SMA), and/or Fragile X Syndrome. These tests are available to all pregnant patients.
The genetic screening tests are optional: you choose if you would like to be tested. The decision to have testing is a personal decision and is to be decided by you.
It can be helpful to think about how you would use the results of prenatal screening tests in your pregnancy care. Remember that a positive screening test tells you only that you are at higher risk of having a baby with Down syndrome or another aneuploidy. A diagnostic test should be done if you want to know a more certain result. Some parents want to know beforehand that their baby will be born with a genetic disorder. This knowledge gives parents time to learn about the disorder and plan for the medical care that the child may need. Some parents may decide to end the pregnancy in certain situations.
Other parents do not want to know this information before the child is born. In this case, you may decide not to have follow-up diagnostic testing if a screening test result is positive. Or you may decide not to have any testing at all. There is no right or wrong answer.
Answer from NANCY L. HANCOCK, MD, MPH (2019)
A common question many women have in pregnancy is, “When is my baby due?” Knowing your baby’s due date is very important to know how far along your pregnancy has progressed.
With each pregnancy, your baby’s estimated due date will be calculated. Estimates are just that, and a due date does not mean that is definitively when it is expected that your baby will go into labor. In fact, some reports show that only around 5% of babies deliver on their estimated due date with most babies delivering between 3 weeks before the due date and up to 2 weeks after the due date.
Your estimated due date will be calculated based upon your last menstrual period and/or an ultrasound. Both of these methods can over or underestimate the due date of the pregnancy. For example, some women cannot remember their last period, do not have normal periods, or miss periods which can make it difficult to date the pregnancy. Similarly, with ultrasound, the further the pregnancy is along the more difficult it can be to accurately estimate the due date. In situations where the estimated due date by the last menstrual period and the estimated due date given by an ultrasound differ significantly, your due date may be changed to account for these things. Having your due date changed does not mean something is wrong, and is nothing to worry about. Your doctors are just trying to get the most accurate estimate for your baby’s due date.
Please note that the baby’s due date is not determined by the date of the conception, which is often unknown. If you have regular periods, conception usually occurs approximately 2 weeks after the first day of your last menstrual period but the exact date can vary which is why it is not used to calculate the estimated due date.
If you ever have any questions regarding your baby’s estimated due date please do not hesitate to ask your doctor and we will be happy to explain it to you.
You can also learn more about calculating due date by visiting the March of Dimes website.
Answer from KERRY C. BULLERDICK, MD (2017)
Water is an important nutritional need in pregnancy. Water helps maintain your normal bodily functions and helps eliminate waste materials. Your body is made up of about 70-80% water! During your pregnancy, the volume of the blood in your body will increase by 40-50% of its pre-pregnancy state. In order to get there you will need to drink more fluids. Water is the ideal fluid to meet that need. The National Academy of Medicine (formerly The Institute of Medicine) recommends that a pregnant patient should take in about 3 liters (a little over 100 ounces) a day, with 2.3 liters (about 80 ounces) coming from beverages, and the rest from fluids in your food. While other beverages such as milk, tea, juice, and coffee are also acceptable, they contain additional calories that can add to your weight gain. Your caffeine intake should be limited to about 200 mg per day based on recommendation from The American College of Obstetricians and Gynecologists. This is about two 8 ounce cups of regular coffee. Drinking more caffeinated beverages can actually cause you to urinate more than you take in. Your fluid intake should be taken in over the course of the day. I like to recommend that patients purchase a 2 liter soda, pour out the soda and fill up the bottle with water and drink from that over the course of the day ;).
Fluid intake in pregnancy helps prevent dehydration which can cause constipation, fatigue, headaches, hemorrhoids, nausea, and contractions. Drinking adequate water will help dilute the urine and help prevent bladder infections which are very common in pregnancy. If you do not take in enough fluids it can actually cause you to have fluid retention and swelling. During warmer weather or times of increased activity or sweating it is also important to take in more water to replace the fluids that you lose.
Adequate water in pregnancy can help prevent preterm contractions that can lead to preterm labor. It helps maintain adequate amniotic fluid around your baby and helps get needed nutrients to your baby. It can also keep your tissues well hydrated and improve your complexion.
As you can see, water is an important part of your daily routine to keep you and your baby healthy and happy.
Answer from DENNIS J. VAN ZANT, MD (2017)
All pregnant patients will have an “anatomy” ultrasound performed between 18-20 weeks of their pregnancy. This is a detailed ultrasound that looks at structures in the head, heart, spine, extremities and other organ systems. Whether it is a girl or a boy can usually be determined during this ultrasound as well. This ultrasound is usually not done before 18 weeks because not all body structures can be seen until that time.
Other ultrasounds may be performed during the pregnancy. An early ultrasound may be performed if there are certain medical problems affecting the mother or if there is uncertainty in how far along a pregnancy may be. Ultrasounds may be performed later in pregnancy if the pregnancy is considered to be high risk or if there is concern about the growth of the baby. Some of these high risk conditions include twin pregnancy, high blood pressure or diabetes.
For insurance purposes, there must be a medical reason for the ultrasound. Having an ultrasound just because you want to see your baby is not considered medically necessary and would not be covered by your insurance. Our office does offer an optional Keepsake Ultrasound between 28 and 32 weeks for that purpose but it is not covered by insurance. You can speak with our front office staff about scheduling this ultrasound.
So, to answer the questions specifically… You will get an ultrasound between approximately 18-20 weeks. Typically this is the only ultrasound you will have as long as you are considered low risk but there are numerous conditions affecting the mother or baby that may require earlier or later ultrasounds. I suspect your friend had something occurring in her pregnancy that made her doctors want to monitor her more closely with ultrasounds.
Answer from MATTHEW T. COLLINS, MD (2016)
This is a common question in pregnancy. However, it is one without an easy answer, as it will vary from person to person. Some women work up until labor occurs while other women may stop sooner. Every woman and every pregnancy is different.
If you work for a covered employer, some of your time off will be protected by the Family and Medical Leave Act (FMLA) which allows you to take up to 12 weeks off of your job without pay. If you stop working earlier before the baby comes that will mean you will have to go back sooner after the baby is delivered. It is a personal and individual choice but we encourage you to hold off as long as possible to maximize time with you and the baby after delivery.
Depending on your employer and insurance, many individuals are eligible for paid time off during part of this time through short term disability. For maternity leave, this is typically 6 weeks regardless of method of delivery. Any extensions of your maternity leave longer than 6 weeks must be considered medically necessary to be covered by your insurance. We recommend that you contact your insurance company to fully understand your benefits.
It is also a good idea to talk to your boss about your pregnancy and planned maternity leave. This allows you to both prepare for your absence from work, as well as see if any additional time off and/or benefits are available to you from your employer.
For more information, visit www.pregnantatwork.org and also visit the “Working During Pregnancy” page of our website.
Answer from KERRY C. BULLERDICK, MD (2016)
What is Preconception Health?
In North Carolina, 43.8% of all pregnancies are unintended and unexpected. With these surprise pregnancies the mother’s probably aren’t their healthiest, physically and mentally. That’s where preconception health comes in. Preconception health involves preparing both physically and mentally before conception occurs, ensuring the best possible start for the pregnancy and the well-being of the child.
Why Does Preconception Health Matter?
Preconception health sets the stage for a healthy pregnancy and a healthy baby. It focuses on the health of both partners before they conceive, addressing factors that could affect fertility, pregnancy outcomes, and the long-term health of the child. Preconception health care involves many things that each are very important for a healthy pregnancy:
Nutrition and Diet: Eating a balanced diet rich in vitamins, minerals, and nutrients is essential. Folic acid, for instance, helps prevent neural tube defects (like spina bifida) in babies. It's also crucial to limit intake of processed foods, sugars, unhealthy fats, and fast food.
Physical Activity: Pregnancy can be hard on the body, labor is also tough physically. Regular exercise not only helps maintain a healthy weight but also improves overall fitness which will prepare the body for the physical demands of pregnancy, labor and childbirth.
Managing Chronic Conditions: Conditions such as diabetes, hypertension, and obesity can affect becoming pregnant and pregnancy outcomes. Managing these conditions before conception can reduce risks to both mother and baby.
Avoiding Harmful Substances: Quitting smoking/ vaping, reducing alcohol consumption, and avoiding recreational drugs including marijuana are critical steps to protect the health of the developing fetus and increase the chances of a healthy pregnancy.
Screening for Infections: Certain infections, such as rubella and sexually transmitted infections (STIs), can pose risks during pregnancy. Screening and treating these infections beforehand can prevent complications.
Emotional and Mental Well-being: Pregnancy can be emotionally challenging, and addressing mental health concerns before conception is important. Stress management techniques and seeking support if needed can contribute to a healthier pregnancy.
Genetic Counseling: Discussing family medical history and considering genetic counseling if there is a family history of genetic disorders or concerns.
Family Planning: Effective family planning involves not only preventing unintended pregnancies but also preparing for planned ones. This includes understanding ovulation cycles, fertility windows, and making informed decisions about timing.
Whether you're considering starting a family soon or in the future, remember that preconception health is a journey worth embarking on. It’s about laying a strong foundation for new beginnings and ensuring the best possible start for your family's future. If this is something that you are interested in or curious about please don’t hesitate to reach out to us. At Nash OBGYN we would love to start your journey to parenthood with a preconception visit. If you are already an established patient and had no idea this type of visit even existed and feel like you could benefit, please make an appointment.
Answer from KAREN JOHNSON, CNM (2024)
It’s really more for you, the patient, than it is for us. We want you to feel comfortable with all the physicians in our practice so that no one is a stranger. When it is time for delivery, the physician on call will deliver your baby. This may not always be your primary doctor. We don’t want the first time you meet us to be in the hospital during your delivery. We want you to see a familiar face when you come to the Women’s Center. Labor and delivery is a joyous occasion, but it can also be very stressful. Having a physician you are familiar with deliver your baby can help lessen that stress.
Yes, you will have a primary physician who you will see the majority of the time during your pregnancy (from 12-20 weeks and then from 36 weeks until delivery) but we all work collectively as a group to provide the best possible care for our obstetric patients. During the middle of your pregnancy (from 20-36 weeks), you will be scheduled for appointments with each of our physicians in “rotation”. Each physician brings their own personal experiences and knowledge to the table in caring for you and we trust each other implicitly.
Working together as a group also allows us to provide our patients with continuous coverage 24 hours a day, 7 days a week. It is simply not possible for one physician to be available every second of every day.
After your pregnancy and delivery, you may return to the physician of your choice for your postpartum visit or for any problems that you may have. You can also change your primary physician at any time. We are a group practice whose primary goal is a safe and healthy pregnancy and delivery for all of our obstetric patients. We feel that we best meet that goal by working together as a group of physicians and not individually.
To learn more about all of our physicians visit our Physicians Page.
Answer from CHRISTINA R. PEYTON, MD (2016)
If you have other questions, please contact our office, your primary care doctor or your local health department.
1. Will the COVID vaccination affect my fertility?
Currently no evidence shows that any vaccines, including COVID-19 vaccines, cause fertility problems (problems trying to get pregnant) in women or men. After review of available data, the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, the Society of Maternal-Fetal Medicine and the CDC find no evidence that COVID-19 vaccination causes a loss of fertility. A recent study comparing women who had the vaccine with women who had COVID and women who aren’t vaccinated and did not have COVID showed no difference in their ability to become pregnant. There is currently no evidence that antibodies made following COVID-19 vaccination or that vaccine ingredients would cause any problems with becoming pregnant now or in the future.
2. I’ve been trying to get pregnant but my job is now mandating the vaccine. Should I get the vaccine?
Yes, COVID vaccination is recommended for women who are trying to get pregnant now or might become pregnant in the future, as well as their partners. The recommendation comes from reviews of available data in those who have been vaccinated by the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, the Society of Maternal-Fetal Medicine and the CDC. Additional information about the COVID vaccine for those who are trying for pregnancy is available here: www.cdc.gov/coronavirus/2019-ncov/vaccines/planning-for-pregnancy.html
3. What are the risks of getting COVID while pregnant?
Pregnant women are at increased risk of severe illness, including hospitalization, intensive care unit treatment, and need for special equipment to help them breath, like a ventilator. Pregnant women with COVID are also at increased risk for preterm birth.
4. I’m pregnant and just don’t know about being vaccinated. Any advice?
You can speak with any provider about your COVID vaccination questions and concerns. You can also contact MotherToBaby where experts are available to answer questions in English or Spanish by phone or chat. The free and confidential service is available Monday – Friday 8am–5pm. You can call 1-866-626-6847 or send a text to 855-999-8525 (standard messaging rates may apply).
5. Can I still breastfeed if I get the COVID vaccine?
Yes, you can still breastfeed after getting the COVID vaccine. You can still breastfeed if you get the COVID vaccination while pregnant, and you can still breastfeed if you choose to get the COVID vaccination after you have your baby. Recent studies show that none of the vaccine is present in breast milk. In fact, breastfeeding may pass some of your body’s immune response to your baby, which may help protect your baby from COVID infection.
6. Why are vaccinated people getting COVID?
No vaccine is 100% effective in preventing infection. A small percentage of people who are fully vaccinated will still get COVID-19 when exposed to the virus. These are called “vaccine breakthrough cases.” The risk of a breakthrough infection depends on your potential exposure to people with COVID. The more people around you that have COVID, the more you’re exposed. The more you’re exposed, the higher the chance your immune response will not be able to prevent infection. It’s also possible a person could be infected just before or just after vaccination and still get sick. It typically takes about 2 weeks for the body to build protection after vaccination, so a person could get sick if the vaccine has not had enough time to provide protection. Vaccinated or not, we should all continue to use the 3 W’s: wash your hands, wear a mask, and watch your distance.
7. How does getting vaccinated protect others?
Being vaccinated helps prevent you from becoming very sick, and also helps reduce your risk of transmission. So, if you are vaccinated, you are less likely to bring COVID home, which could infect any unvaccinated family member. One of the big benefits to being vaccinated is you reduce the risk of spreading to others. For example, in a recent study of those who received the Pfizer vaccine, fully or partially vaccinated study participants had 40 percent less detectable virus in their nose (i.e., a lower viral load), and the virus was detected for six fewer days (i.e., viral shedding) compared to those who were unvaccinated when infected.
8. Someone who is not vaccinated vs someone who is: what are the chances of one being in worse condition than the other?
You are much more likely to have a serious, life-threatening illness if you are infected and have NOT been vaccinated. Nearly all COVID related deaths now are in unvaccinated individuals. In a recent study, fully or partially vaccinated people who developed COVID-19 spent on average six fewer total days sick and two fewer days sick in bed. They also had about a 60 percent lower risk of developing symptoms, like fever or chills, compared to those who were unvaccinated.
9. I heard the COVID vaccine is causing heart inflammation in people under 30 years of age. What are the chances of this actually happening?
The risk of COVID is much greater than the risk of heart inflammation from the vaccine. Typically, heart inflammation itself doesn’t cause any problems, but can as time passes. The risk is greater in someone who develops high blood pressure, diabetes, is a smoker, or has other risks for heart problems. To date, per the CDC, more than 319 million doses of vaccine have been administered in the US, and there are about 1500 reported cases of heart inflammation. You have a higher risk of being hit by lightning than getting heart inflammation from a COVID vaccination.
10. Can I get an exemption from the vaccination?
There are very few medical reasons to not be vaccinated. The available COVID vaccines do not contain eggs, gelatin, latex, or preservatives. All COVID-19 vaccines are free from metals such as iron, nickel, cobalt, lithium, rare earth alloys or any manufactured products such as microelectronics, electrodes, carbon nanotubes, or nanowire semiconductors. If you have an allergy to a component of the COVID vaccine, or had a severe allergic reaction after a prior dose, you should not receive the vaccine. However, we do support your right to make your own decision and will be happy to discuss your specific questions, concerns, and circumstances at an appointment. If you have specific paperwork from your employer, please do bring the paperwork with you.
Answer from NANCY L. HANCOCK, MD, MPH (2021)
Our office is offering the flu vaccine to our obstetric and postpartum patients only at this time. You may also contact your PCP, local health department, or any local pharmacy and request a flu shot.
This year it is more important than ever to receive a flu shot, even if you do not typically get one. Both the influenza virus, which causes the flu, and the coronavirus, which is responsible for the current COVID-19 pandemic, are respiratory viruses. Both viruses have similar early symptoms and because of this Nash-OBGYN, and several other local health care facilities, are having to change the way we typically care for patients with flu symptoms. Effective immediately, patients with fever and/or respiratory symptoms will not be able to be seen in our office as we cannot determine if those symptoms are due to flu or coronavirus in the office.
We will be recommending any patient with either flu or coronavirus symptoms go to the Emergency Room or a drive through flu/coronavirus testing center (should one become available in the future) where safe evaluation of such patients can be performed.
By getting the flu shot now, you can protect yourself from influenza. This will decrease your risk of needless COVID-19 evaluation and testing as well as risks of developing symptoms that can be similar to COVID-19. Furthermore, while getting a flu shot will not prevent you from getting COVD-19 it might reduce your risk of getting a severe case of COVID-19. It is possible to get both flu and COVID-19 at the same time and if your body is already fighting one virus, having both at once might make it harder for your immune system to fight off the infections and put you at risk for severe complications.
For more information on the flu vaccine this year please see the following links below.
Answer from KERRY C. BULLERDICK, MD (2020)
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