Friday, May 3, 2013

Pelvic Organ Prolapse


Hi Ladies, this is a guest article from a writer at They help with awareness for drugs and products that can have harmful effects when used incorrectly or which have been found later to have been found to have harmful effects. One of these is the product mesh that has been used for pelvic prolapse surgery. This article is well written and discusses alternative options to surgery and little bit about prolapse in general. Hope you all enjoy:)  Christy

Strengthening the Pelvic Floor
Though many women are not aware of their pelvic floor, it performs many functions. The pelvic floor primarily supports the pelvic organs—like the uterus, bladder and rectum—but also provides support for the baby during pregnancy, plays a role during childbirth and contributes to sexual function and orgasm, balance and continence.

The pelvic floor HYPERLINK ""can be HYPERLINK "" weakened as a result of obesity, pregnancy, depleted estrogen levels during menopause, straining during childbirth, high-impact activities or chronic cough. When it loses its ability to function properly, pelvic floor disorders like stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can result.

Pelvic Floor Disorders
SUI refers to the accidental release of urine during everyday activities like laughing, coughing or sneezing, or anything that places pressure on the bladder.

Prolapse occurs when pelvic organs droop into the vagina. It can have varying levels of severity. Some women never experience symptoms, and it is not a condition that necessarily progresses. However, women who experience symptoms describe the pain and pressure of pelvic organs shifting out of position, moving lower and resting against the vaginal wall.

In severe cases of these conditions, surgery to repair the pelvic floor can bring relief. However, surgeries that use HYPERLINK ""transvaginal HYPERLINK "" mesh have higher rates HYPERLINK "" of complications like debilitating pain, organ perforation, sexual dysfunction and the need for revision surgeries. Procedures that do not can be equally effective.

Surgery should be considered only after natural treatments have proven unsuccessful. Nonsurgical treatments—ranging from physical therapy to the use of a vaginal pessary—can be effective in reducing symptoms.

How to Strengthen the Pelvic Floor
As with all things, eating well and exercising can do wonders for pelvic floor maintenance. Exercises like Pilates and yoga are known for encouraging core strength, pelvic floor engagement and good posture.

Physical therapy gives women individualized pelvic health care. Physical therapists may use electrical stimulation, similar to chiropractic, to exercise pelvic floor muscles. In a similar way, therapists may use biofeedback therapy to help locate and isolate the pelvic floor muscles.

After using biofeedback to make sure the correct muscles are being used, physical therapists will recommend that women perform Kegel exercises every day. These subtle contractions can be performed while lying down or sitting, but therapists recommend completing them standing and during other activities to really build strength.

Kegel exercises have been known to restore continence, ease labor, prevent prolapse or reverse mild symptoms, and improve the sex lives of many women. These exercises are particularly important after childbirth, which is known to weaken the pelvic floor.

Physical therapists may also include massage therapy to reduce inflammation, increase blood flow and help realign displaced tissues and organs. Therapists can also create custom exercise plans and provide instruction on techniques that women and/or their partners can use at home.

Linda Grayling is a writer for She enjoys keeping up with the latest news in the medical field.

Monday, March 25, 2013

Postpartum Depression

Depression is a problem that can occur at any time in a person's life. However, women are more prone to it than men, particulary after childbirth. I'd like to first say, that if you have depression or have had depression in the past, you are not alone! This is a topic that many women don't talk about or neglect to tell their phyician or midwife about it out of fear or belief there is nothing they can do about it. Women build up excitement and anticipation for the birth of the their baby for nine months, sometimes to feel let down and depressed after the experience when they wish they felt joy and elation.
   During pregnancy, female hormones estrogen and progesterone are high. They help maintain the pregnancy and prepare the body for childbirth. After delivery, there is a rapid decline in hormones to allow the body to produce prolactin for breast feeding and to go back to "normal." Unfortunately, the mixture of drop in hormones, plus lack of sleep from a newborn, frustrations with a fussy baby or breast feeding difficulties, and pain from delivery can all attribute to depressed mother. It is important to note that these feelings are valid and not abnormal. Newborns are time consuming and difficult no matter how much you love them and how great of a mother you are.
  Recovering from depression may take time and some different approaches. I like to tell my patients first off to take care of themselves! You cannot take care of someone else unless your own needs are met. Take time each day to shower, get dressed, do your hair or make up if desired. I also recommend light exercise or more moderate to intense exercise if you are past 6 weeks and your doctor has cleared you to do so. Exercise releases endorphins that make you feel good naturally. It also helps with post partum weight loss that boosts most womens' mood. Communication with your partner, friends, and family is also beneficial. They often do not understand if you don't tell them that you need help. Most would be happy to watch the baby for an hour or so so you can take time for you! Let people help you! Let your partner know how you feel and what he or she can do to alleviate your stress or anxiety.
  Lastly, there are medications to take to help the depression if you are still not feeling any better. Most medications are safe to take with breast feeding and may help you feel more rational, less anxious, and better rested. There are medications such as Prozac, Zoloft,  Celexa, and Wellbutrin that have been around a long time and are well studied and tolerated and can provide some much needed relief for some people.
  There are also counselors who are available to talk with you and help you work through your own individual situation, as everyone has different stressors and problems that may worsen their depression.
  It is important to remember that a depressed mother may have difficulty bonding with her newborn. It is so important in the beginning for mom and baby to have a special bond, and for the baby to feel love and trust from his or her mother. These beginning relationships are the foundation for your baby's life long relationships with people and the outside world. Make them worthwhile and meaningful for both of you!!
  So don't be ashamed if you are depressed. Feel free to call and speak with your provider and get help. Good Luck!!

Thursday, January 17, 2013

The Different types of Midwives

So I often get asked about the different types of midwives. Sometimes, I get strange looks when I tell people I'm a midwife. Unfortunately, in this day and age people still think that midwives are all the same. That we all deliver babies at home or that we have worse outcomes than medical doctors when the opposite is actually true. There are different types of midwives however. Just like there are different specialities of doctors. Before I start, I would like to say that midwife means "with woman." I believe all of us midwives have the best interest of the woman and her baby at heart although our levels of education and types of practice may differ. First off, there are Certified Nurse Midwives, which is what I am. We are midwives with a Master's degree in nursing and emphasis in midwifery. We have been registered nurses most of us with experience in the hospital setting in labor and delivery prior to going to a nurse midwife program. We first have to have a Bachelor's degree in nursing followed by acceptance to a Master's or doctorate program in midwifery. We are trained in natural childbirth as well as medical intervention childbirth when necessary with care being taken to fully understand women's individual needs and birth preferences. We also provide some primary care and gynecologic care as well such as pap tests, birth control and care of menstrual problems, etc. The majority of us deliver babies primarily in the hospital setting at 96%. We have arrangements with an obstetrician for emergencies and are under the same credenitaling and review process for hospital privleges as physicians are. We also carry malpractice insurance that typically only covers us for delivering babies in a hospital setting. Some CNM's also deliver in birth centers and at home.

The next type of midwife is a Direct Entry Midwife. These midwives primarily deliver babies at home or in birth centers. Many do have arrangments for OB back up if needed, but the majority do not have malpractice insurance and they will have you sign consents prior to your care having you acknowledge this. They do not have hospital privileges. Most of them have had some experience in assisting other midwives prior to going to training in midwifery. They do not have to be nurses prior to being midwives. They usually go through a midwifery training program that lasts about a year. They are licensed with the state and are accountable for their statistics in delivery, etc. The majority do a great job and have great outcomes. They are very suitable for low risk and completely natural delivery. They do not however have licensure to prescribe if emergency drugs or pain relief medications are desired. They are allowed to administer oxytocin and oxygen in emergencies and they must transfer their patients to the hospital if an emergency arises.

There are also lay midwives who get their training more apprenticeship like. Their experience and time of training may vary. They are much like Direct entry midwives in giving oxytocin and oxygen as needed and that they usually deliver at home or in a birth center, sometimes with a group of other similar midwives. Many have great outcomes as well as less intervention in many circumstances leads to better outcomes in low risk women.

On a side note, I'd like to say that 90% of home birth in low risk women go just fine with no complications. Statistically, midwives have lower incidence of cesarean section (because we don't stick with Friedman's curve for labor progress) and less interventions that could cause an emergency. We also rarely use vacuum extraction which increases risk of brain injury or shoulder dystocia. We rarely cut epiosotmies which decreases risk for third and fourth degree lacerations. Also, statistically midwives have bigger babies perhaps because of the stress on proper nutrition and weight gain that is within normal ranges for different size women. Overall, midwives have great outcomes and very personalized intuitive care:)