1. Do you do episiotomies routinely?
No, we only do them when it appears that the patient's skin is going to tear excessively at the moment of crowning. We especially avoid them when there appears to be a very small amount of tissue between the bottom of the vagina and the top of the rectum, or if the patient has previously suffered from a third or fourth degree tear. Sometimes episiotomies can help speed up delivery when the baby's heart rate is dangerously low.
2. How often do you do Cesarean sections?
We have a lower than average rate of Cesarean section as a rule. Of course, it depends on how many patients are choosing repeat Cesarean versus Vaginal Birth After Cesarean (VBAC). We discourage elective primary (first) C-sections without a sound medical reason to do so.
3. How do you feel about induction of labor?
We stress the importance of having a good medical reason to be performing an induction. The cervix should be favorable (ready), in particular for first babies. We usually do not schedule inductions before 39 weeks or for reasons of convenience alone.
4. How do you feel about natural labor?
Many patients come into labor with the idea that they do not want medicine for pain, Pitocin during labor, continuous fetal monitoring, frequent cervical examinations, and so on. We support a patients wishes to the extent that there is no danger to themselves or the baby. There are times, especially in a mother who has already had several children (and is therefore expected to have a shorter labor on average), when even an IV may not be necessary in labor. However, in many cases it is necessary to perform a variety of procedures in order to make sure that the mother and the baby proceed safely through the significant physiologic challenges of labor and delivery. No one can predict the course of any one individual labor, and we encourage everyone to keep an open mind and to have a relationship with us based in trust built over the course of the many months of your prenatal care. Ultimately we're all after the same end: Healthy Mother, Healthy Baby! We are happy to discuss your "wish list" in detail in our office. Paps are done annually until age 30 and we start screening for sexally transmitted diseases once a patient becomes sexually active.
5. Can I choose which doctor will deliver my baby?
In general, our deliveries, both spontaneous and scheduled, are performed by the doctor on call for the practice on that particular day. Occasionally we can arrange for a C-section to be performed on one doctor's day versus another's, but we are also considerably limited by what dates are available at The Birthing Inn on any particular date in question. We do not cross-cover with any other OB group. Your baby will only be delivered by one of the four of us.
6. Do you recommend circumcisions?
We neither recommend nor oppose circumcisions of male infants. We support the Academy of Pediatrics position that the procedure has some medical benefit, but is largely cosmetic/cultural in many countries, including our own. We use local anesthesia, Tylenol, and Sweet-Eze (sugar water) to ease the discomfort to the baby during the brief procedure. It is normally done the day after delivery for full-term healthy baby boys.
1. What about HPV testing?
Our borderline Pap smear results are normally automatically sent for testing for hi risk HPV to determine the next step in evaluation of the patient. In many cases, low risk patients over 30 will be offered screening for "high risk" HPV types to determine if their Paps can be done less frequently than annually. We highly recommend the Gardisil HPV vaccine for women and girls age 9--26, ideally before the first intercourse. Our office, your pediatrician or your family physician can provide the vaccine.
2. How do you treat menopausal symptoms?
Many women with mild--moderate symptoms of menopause can get by with over-the-counter remedies and behavioral modifications such as dressing in layers and avoiding certain triggers for hot flashes. Oftentimes, however, women with disabling symptoms will need prescription strength medications including various hormonal treatments (including "natural" formulations), as well as alternative treatments which include certain antidepressants, antihypertensives, sleep remedies, and vaginal estrogen preparations. We follow the maxim of "lowest effective dose for the shortest period of time" and tailor the treatment to each individual patient's needs.
3. How often do I need a mammogram?
We generally recommend mammograms every 1- 2 years starting at age 40 and yearly after 50. We haven't changed our recommendations despite the recent media attention to the subject. Some women with a family history of early onset breast cancer will be recommended to start screening earlier. Very high risk patients may be counseled regarding genetic testing and/or an increased level of surveillance. Unfortunately, there has not yet been developed a good alternative to mammography for breast cancer screening to date.
4. When should my daughter start seeing the gynecologist?
In general, Pap smears are recommended to be started by the age of 21 or within 3 years of first intercourse, whichever comes first. Many experts in adolescent GYN, however, advocate for a "sit-down" visit with a GYN between the ages of 15 and 16 in order to establish a doctor-patient relationship, talk over basic subjects such as period problems, contraception, safe sex and STDs, driving safety, substance abuse, and any other questions that are important to your adolescent.
5. What can I do about my poor sex drive?
This is a very complicated topic and often will require an appointment all it's own to be fully addressed. We will review a number of questions having to do with your physical, emotional, psychological, relational, and sexual history. While hormone levels can be drawn, they are of limited utility, and it's important to know there is rarely a quick and easy solution to the problem. That being said, most patients can be assisted in the achievement of an improved sexual relationship with some patience and persistence.
We encourage all our patients to either be vaccinated (less than or equal to 26 years old) and especially to have their daughters, nieces, and young friends undergo the series of 3 injections (on a 0, 2,and 6 months' schedule) to prevent contracting one of four HPV viruses. Two of the four are responsible for 90% of veneral wart, and the other two are responsible for 70% of all cervical cancer/precancer. It can be given as young as 9 or as old as 26, but works best when given before the first intercourse. It has not yet been determined if somewhere down the road a booster may possibly become necessary, but so far it's known to be effective long term. More vaccines which cover more viruses are in research, but the current vaccine is truly life-saving, not to mention a huge savings in anxiety by means of preventing the precancerous Pap changes as well. Paps are still recommended annually up to age 30 and every 1- 3 years thereafter, depending on the individual's history and viral status.