Obstetrical Services

Annual Examinations

A well-woman exam, also called an annual exam, is a visit 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 will take your vitals, height, and weight. We will then give you a regular physical exam and as 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 perform pelvic and breast exams. The pelvic exam is very important to every woman’s health and consists of a check of your reproductive organs, including your vulva, vagina, cervix, and uterus. Your physician will check for ovarian cysts, sexually transmitted infections, or certain cancers, usually by taking a pap smear. A pap test consists of gathering cells from your cervix with an extended swab. Pap smears are typically recommended every three to five years. These procedures are very quick, typically painless, and vital to your health.

A breast exam is very important 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 such as lumps, pain, or changes in size that may be of concern. These could include changes found during a breast self-exam. You should report any changes that you notice to your doctor or healthcare provider.

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

Birth Control Options

We offer all types of birth control including:

• Oral Contraceptives

  • One of the most popular forms of birth control, oral contraceptives are most commonly called “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 may reduce heavy periods and can offer some protection against some health conditions, such as PMS, endometriosis, polycystic ovary syndrome, and cancer from endometrial hyperplasia.

• Implant (Nexplanon)

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

• IUD

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

• Sterilization

  • For women who are sure they are done having children, sterilization is a permanent birth control option. Options for sterilization include tubal ligation, hysterectomy, and in some cases, minilaparotomy (removal of a section of the fallopian tubes on each side. 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 women, but it can take up to a year to get pregnant after removal.

• Patch (Ortho Evra)

  • The patch is an adhesive square worn on the body, which releases hormones similar to the pill that prevents 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. The ring releases estrogen and progestin to prevent pregnancy.

• Barrier Methods 

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

Breast Cancer Screening

A breast exam is very important 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 to undergo a mammogram. The frequency of a mammogram will depend on your risk factors. A woman should begin with yearly mammograms at age 40, or sooner if your family has a history of breast cancer.

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

Colposcopy, Cryotherapy & LEEP

Colposcopy is done when results of a cervical cancer screen show abnormal changes in the cells of the cervix. Colposcopy 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 if a woman is over 35 and 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 tests and urine tests to check hormone levels

• Pap smear to check the health of the cervix

• Urine test to evaluate LH surges

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

• An endometrial biopsy, in which the physician removes a piece of tissue in the uterine lining. Examining this tissue will tell 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.

• Laparoscopy, in which the physician checks for scar tissue or endometriosis in the woman’s fallopian tubes or ovaries. The woman usually has to undergo general anesthesia for this procedure.

• Hysterosalpingogram, in which 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 typically aren’t needed to diagnose menopause because women tend to experience irregular periods and hot flashes as her hormone levels fluctuate. Under certain circumstances, your doctor may recommend blood tests to check your level of:

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

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

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and 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), which has been shown to help reduce hot flashes.

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

• Medications to prevent or treat osteoporosis.

Premarital Examinations

A premarital exam is a basic gynecological exam where you establish a relationship with your doctor before you begin having sex. The exam 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’ve had unprotected sex, have a new partner (or more than one partner), or for any reason are worried you have been exposed to an STI, talk to your healthcare provider tests for this common STIs: 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 of this, or other types of STIs.

Surgeries

• Minimally Invasive Hysterectomies

  • Also known as laparoscopic hysterectomy, the physician will use specialized tools which are inserted through fingernail-size incisions in the abdomen. This approach may result in a much faster recovery and typically 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, and it allows for the 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 called a laparoscope to increase visibility. The surgeon will remove the lesions or cysts through excising, or destroys 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, this is highly accurate in diagnosing abnormalities of the endometrial cavity and the endocervical canal.

• In-office Endometrial Ablation

  • This is a procedure where a doctor uses a thin tube with a tiny camera 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 and tissues supporting the urethra, bladder, uterus, or rectum are damaged. There are different types of surgery for treatment:

• Injections

  • Synthetic materials are injected into the tissue around the urethra to provide support and to 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. It may take two to three or more injections to get the desired result. The injections may improve symptoms but usually, do not result in a complete cure of incontinence.

• Urethral Sling

  • There are two types of urethral slings:

    • Midurethral sling—The mid-urethral sling is the most common type of surgery used to correct SUI. The sling is a narrow strap made of synthetic mesh that is 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 at achieving pregnancy after one year, we ask that both partners undergo a comprehensive physical and medical assessment. Women and Men are each responsible for 50% of all infertility cases. We test the male through a semen sample. For females, tests are more comprehensive and can include exams 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 care you receive throughout your pregnancy. You can start getting 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 future baby’s development and do routine testing to help find and present possible problems.

Ultrasound and 3D Ultrasound

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

Vaginal Delivery

Labor itself is divided into three phases – early labor, active labor, and transitional labor. All women who deliver vaginally will experience all three phases of labor, though you may not notice the first phase at all. 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)

One-third of babies in the United States are born via C-section. Your baby may need to be delivered by cesarean section for certain medical conditions, 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

Vaginal Birth After C-Section, VBAC, 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, become 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, and when you’re pregnant with twins (or more), those worries can multiply. For today’s parents of multiples, it is easier than ever. Chance are excellent that you’ll have a healthy pregnancy, an uncomplicated delivery, and two (or more) healthy babies.

Postpartum Depression