Obstetrical Services

Annual Examinations

A well-woman exam, also called an annual exam, is a visit with your caregiver once a year. This exam helps you to learn more about your body and what steps you need to take to become healthier.

We take your vitals, height, and weight. We will then give you a routine physical exam and ask for updates on your current life and work situation, family health history, and basic questions about your diet and health status.

If you are over 21, and in some cases, under 21, we will also give pelvic and breast exams. The pelvic exam is very important for women’s health and consists of checking your reproductive organs. This includes your vulva, vagina, cervix, and uterus. Your physician will also check for ovarian cysts, sexually transmitted infections, or certain cancers by taking a pap smear. A pap test gathers cells from your cervix with an extended swab and are typically recommended every three to five years. These procedures are very quick, typically painless, and vital for your health.

A breast exam is crucial to detect breast cancer as early as possible. In addition to your annual breast exam, we encourage you to give yourself a monthly breast exam. Being familiar with how your breasts look and feel can help you notice symptoms like lumps, pain, or abnormal changes in size. You should report any changes to your doctor or healthcare provider.

We also offer vaccines, including Gardasil. This is a vaccine for HPV, a virus that is known to cause certain cervical and uterine cancers.

Birth Control Options

We offer several types of birth control including:

• Oral Contraceptives

  • One of the most popular forms of birth control, oral contraceptives are most commonly known as “the pill.” Oral contraceptives come in an estrogen/progestin combo pill or a progestin-only form. You must take the pill at the same time every day for maximum effectiveness. It can reduce heavy periods and offer some protection against certain health conditions, such as PMS, endometriosis, polycystic ovary syndrome, and cancer from endometrial hyperplasia.

• Implant (Nexplanon)

  • A small plastic rod is inserted into your upper arm and releases a hormone called etonogestrel. The implant prevents pregnancy for three years. They have the advantage of being low-maintenance and fairly long term. Implants are considered safe for use when breastfeeding and for women who cannot use estrogen.

• IUD

  • IUDs are small, flexible devices inserted into the uterus to prevent pregnancy. They have the advantage of being long-term, low-maintenance forms of birth control that are as effective as sterilization—with the added benefit of reversibility. Fertility usually returns quickly after removing an IUD.  Women who choose an IUD also have the option between a hormonal or non-hormonal IUD. Hormonal IUDs (Mirena and Skyla) emit small amounts of progesterone into the uterus to prevent pregnancy. Depending on the brand, they are effective for three to five years. Non-hormonal IUDs emit trace amounts of copper to prevent pregnancy. They are effective for up to 10 years.

• Sterilization

  • For women who know they are done having children, sterilization is a permanent birth control option. Options include tubal ligation, hysterectomy, and in some cases, minilaparotomy (removal of a section of the fallopian tube on each side and done one to two days after a woman gives birth).

  • For men who wish to undergo sterilization, we ask that you visit with your urology physician.

• Depo-Provera Shot

  • Depo-Provera is a progastrin shot you receive from your OB/GYN every 12 weeks. This low-maintenance shot can offer fewer cramps and lighter periods for some, but can take up to a year to get pregnant after removal.

• Patch (Ortho Evra)

  • The patch is an adhesive square worn on the body and releases hormones similar to the pill to prevent pregnancy. You must change the patch weekly.

• Vaginal Ring (Nuva Ring)

  • The vaginal ring is a flexible, small ring that you insert into the vagina every three weeks. It releases estrogen and progestin to prevent pregnancy.

• Barrier Methods

  • There are various barrier methods including condoms, diaphragms, and spermicide.

Breast Cancer Screening

A breast exam is needed to detect breast cancer as early as possible. In addition to your annual breast exam, we encourage you to give yourself a monthly breast exam. Here is more information on how to give yourself a breast exam. Discuss with your physician how often you should undergo a mammogram because the frequency will depend on your risk factors. A woman should begin with yearly mammograms at age 40-45, or sooner if your family has a history of breast cancer.

Being familiar with how your breasts look and feel can help you notice lumps, pain, or changes in size that may be of concern. These changes are often found during a breast self-exam. You should report any changes that you notice to your doctor or healthcare provider.

Colposcopy, Cryotherapy & LEEP

A Colposcopy is done when results of a cervical cancer screen show abnormal changes in the cells of the cervix. It is a way of looking at the cervix through a special magnifying device called a colposcope. This exam allows your physician to find problems that cannot be seen by the eye alone.

Once the cells are identified, your physician may use an instrument to freeze and essentially kill the abnormal cells. This is called cryotherapy.

Or, your physician may elect to use a procedure called LEEP (Loop Electrosurgical Excision Procedure). A small electrical wire loop is used to remove abnormal cells from your cervix. LEEP surgery may be performed after abnormal cells are found during a Pap test, colposcopy, or biopsy.

Infertility Testing & Treatment

If a woman is under 35 and has not conceived after 12 months of contraceptive-free intercourse, or a woman over 35 has not conceived after six months of contraceptive-free sexual intercourse, she may be considered infertile.

Normally, a complete medical history and physical exam are the first steps in diagnosing a fertility problem. After that, some of the diagnostic tests may include:

• Blood and urine tests are used to check hormone levels

• A Pap smear to check the health of the cervix

• A urine test to evaluate LH surges

• Basal body temperature test—checks whether the woman’s ovaries are releasing eggs.

• An endometrial biopsy. The physician removes a piece of tissue in the uterine lining. Examining this tissue tells the physician whether eggs have been released and whether the corpus luteum is producing enough progesterone.

• An ultrasound to look for fibroids and cyst in the uterus and ovaries.

• A post-coital test, in which the physician takes a sample of mucus from the woman’s vagina. She must have the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell the doctor if the man’s sperm can survive in the woman’s cervical mucus.

• A laparoscopy involves the physician checking for scar tissue or endometriosis in the fallopian tubes or ovaries. The woman usually has to undergo general anesthesia for this procedure.

• A hysterosalpingogram is when the cervix is clamped and a needle filled with dye is injected into the woman’s uterus. An x-ray is taken to determine whether the dye passes through the open ends of the fallopian tubes. This procedure is performed at Logan Regional Hospital.

Menopause Management

Tests aren’t typically needed to diagnose menopause because women tend to experience irregular periods and hot flashes as hormone levels fluctuate. Under certain circumstances, your doctor may recommend a blood test to check your levels of:

• Follicle-stimulating hormone (FSH) and estrogen (estradiol). Your FSH levels increase and estradiol levels decrease as menopause occurs.

• Thyroid-stimulating hormone (TSH). An underactive thyroid (hypothyroidism) can cause symptoms similar to those of menopause.

Menopause does not require medical treatment. Instead, care focuses on relieving symptoms and preventing or managing chronic conditions that may occur with aging. Talk with your physician about which treatments are right for you. Treatments may include:

• Hormone therapy

• Vaginal estrogen

• Low-dose antidepressants

• Gabapentin (Neurontin, Gralise, others) has been shown to help reduce hot flashes.

• Clonidine (Catapres, Kapvay, others) can provide some relief from hot flashes

• Medications to prevent or treat osteoporosis.

Premarital Examinations

A premarital exam, or basic gynecological exam, helps you establish a relationship with your doctor before you begin having sex. It usually includes a discussion of birth control options, what to do if you get a UTI, and what to expect on your wedding night.

STI Testing

If you have had unprotected sex, have a new partner (or more than one partner), or worried for any reason that you may have been exposed to an STI, talk to your healthcare provider. Common STIs we test for include: chlamydia, gonorrhea, HIV, herpes, HPV, syphilis, and trichomoniasis. You and your healthcare provider work together to determine if you need to be tested for all of these, some, or other types of STIs.

Surgeries

• Minimally Invasive Hysterectomies

  • Also known as a laparoscopic hysterectomy, the physician uses specialized tools that are inserted through fingernail-size incisions in the abdomen. This approach can result in a much faster recovery with less pain than a traditional hysterectomy.

• Laparoscopic Treatment of Endometriosis and Ovarian Cysts

  • Laparoscopy is the most common type of surgery for both the diagnosis and treatment of endometriosis. It allows observation of the reproductive organs without the need to create a large abdominal incision. During the procedure, the surgeon makes a small incision in the abdomen to insert the surgical instruments and a small camera (laparoscope) to increase visibility. Your surgeon will remove the lesions or cysts or destroy them with intense heat and cauterization.

• In-office Hysteroscopy

  • This procedure allows the physician to visualize the uterine cavity for diagnostic purposes. As a minimally invasive procedure, it is highly accurate for diagnosing abnormalities in the endometrial cavity and the endocervical canal.

• In-office Endometrial Ablation

  • A thin tube with a tiny camera is used to look inside the uterus. There are no incisions. The physician then uses another device to burn the lining of the endometriosis.

• Bladder Repair & Incontinence procedures

  • Sometimes a woman’s muscles or tissues that support the urethra, bladder, uterus, or rectum are damaged. There are a few different types of surgery for treatment:

    • Injections

      • Synthetic materials are injected into the tissue around the urethra to provide support and tighten the opening of the bladder neck. The procedure usually is performed in your health care professional’s office with local anesthesia. A lighted scope is inserted into the urethra and the material is injected through a thin needle. The procedure takes less than 20 minutes and may take two or three injections to get the desired result. The injections may improve symptoms but do not usually result in a complete cure of incontinence.

    • Urethral Sling — There are two types

    • Midurethral sling—The mid-urethral sling is the most common type of surgery used to correct SUI. It is a narrow strap made of synthetic mesh and placed under the urethra. It acts as a hammock to lift or support the urethra and the neck of the bladder.

    • Traditional sling—In this type of surgery, the sling is a strip of your tissue taken from the lower abdomen or thigh. The ends of the sling are stitched in place through an incision in the abdomen.

    • Colposuspension

      • In colposuspension, the part of the urethra nearest to the bladder is restored to its normal position.

Fertility Testing

When a couple has been unsuccessful in achieving pregnancy after one year, we ask that both partners undergo a comprehensive physical and medical assessment. Both men and women are each responsible for 50% of all infertility cases. We test the male through a semen sample. For females, exams are more comprehensive and can include tests for:

• • A hormone imbalance

  • A tumor or cyst

  • Eating disorders

  • Alcohol or drug use

  • Thyroid gland problems

  • Excess weight

  • Stress

  • Intense exercise

  • Brief menstrual cycles

  • Pelvic inflammatory disease

  • Polyps in the uterus

  • Endometriosis or fibroids

  • Scar tissue or adhesions

  • Chronic medical illness

  • A previous ectopic (tubal) pregnancy

  • A birth defect

  • DES syndrome (the medication DEC, given to women to prevent miscarriage or premature birth can result in fertility problems for their children.)

  • Abnormal cervical mucus

Pregnancy Testing

We offer free (urine) pregnancy testing at our clinic. If you suspect you are pregnant, please come into our office and speak with our receptionist.

Prenatal Care

Prenatal care is the important care you receive throughout your pregnancy. You can start with prenatal care as soon as you know you are pregnant. Your physician, nurse, or midwife can help you stay healthy during your pregnancy by monitoring your baby’s development. Routine testing also helps find and prevent possible problems.

Ultrasound and 3D Ultrasound

An obstetric ultrasound uses sound waves to produce pictures of a baby (embryo or fetus), as well as the mother’s uterus and ovaries. It does not use ionizing radiation, has no known harmful effects, and is the preferred method for monitoring pregnant women and their unborn babies. A 3D ultrasound works the same as a traditional ultrasound, but the image projected includes 3D details.

Vaginal Delivery

Labor is divided into three phases—early labor, active labor, and transitional labor. All women who deliver vaginally will experience all three phases of labor. When your cervix reaches the 10cm mark, you are fully dilated and can begin pushing your baby the rest of the way through the birth canal.

Cesarean Delivery (C-Section)

1/3 of babies in the United States are born via C-section. Certain medical conditions may cause a need for a cesarean section, such as:

• Heart disease

• High blood pressure

• Diabetes

• Kidney disease

• Any disease that makes vaginal delivery dangerously stressful to your body.

• Infections such as HIV or active genital herpes

• Your baby’s health

• A large baby

• Your weight

• Your age

• Breech position

• Multiples

• Placental problems

VBAC Delivery

A VBAC, or Vaginal Birth After C-Section, is encouraged for a subsequent baby for women who’ve had a prior C-section. Elective repeat C-sections are slightly riskier than successful VBACs because moms are at greater risk of infection, blood loss, and organ injury. Talk with your physician about your success rate of a VBAC.

Multiple babies

There’s never been a safer time to conceive, carry, and give birth to multiples. Every pregnancy has its share of discomforts and worries. So when you’re pregnant with twins (or more), those worries can multiply. Chance are excellent that you’ll have a healthy pregnancy, an uncomplicated delivery, and two (or more) healthy babies.

Postpartum Depression