OB-GYN NORTH is the practice of

Christina Sebestyen, MD, FACOG, Tesa Miller, MD, FACOG, April Schiemenz, MD,
Siobhan Kubesh, CNM, Lisa Carlile, CNM, Kathy Harrison-Short, CNM and Katherine Davidson , FPNP

Monday, December 8, 2014

Getting to Know Siobhan Kubesh, CNM

What is your favorite way to exercise or where do you spend time outdoors in Austin?
I love walking my neighborhood with my girlfriends and spending time boating on Lake Austin and Lake Travis with my family.

How would your encourage women or what would you say to the about the process of pregnancy and delivery?
Surrender and trust. Years ago I was attending a birth with a midwife whom I greatly admire. The mother was laboring so peacefully and I whispered to my peer, “This is so beautiful! She is in complete control.” My wise friend said, “Siobhan, it is the opposite. She is not in control, she is completely surrendered.”  Educate yourself about options for birth, surround yourself with people who believe in you, create your plan, then emotionally surrender once labor starts. 

What was one of your favorite moments in a birth?
There was a beautiful birth recently at our birth center (and this mother knows how much I admire her!) As a first time mother she was on her hands and knees in the tub, gently blowing little puffs of air through her contractions. With no change in expression, she quietly said to me, “I think something is coming out.”  Since she was not visibly pushing, I reached under the water, expecting to feel the tip of the baby’s head. The entire head had gently emerged as this mother so peacefully welcomed her baby! As the baby arrived, the mother rotated so she could sit back in the tub, with just the baby’s head above the warm bath water. The baby let out two strong cries, cleared her lungs, then spent the next few minutes pink and healthy as can be, blinking up at her parents. It was truly one of the most peaceful births I have ever witnessed. 

How long have you been in practice?
I have been working with mothers and babies for 21 years, first as a registered nurse, and have been a nurse-midwife for 15 years.

What is the most interesting thing you have learned lately?
That crocodiles have a “v” shaped mouth, are brown and their dominant teeth protrude from the bottom jaw. Alligators on the other hand, have a “u” shaped mouth, are green and their dominant teeth protrude from the top jaw.  This I learned from my six year old nephew in the car drive to school.  It may not be accurate information, but it is tucked away in my brain, and now in yours. Someday it may be useful. 

How is your view on birth different now that you have experienced it so may times?
There are a million right ways to birth. I am reminded of that all of the time. Each woman has her own journey and each birth unfolds differently. 

What are some of the ways you strive for optimal health.I am a huge advocate for healthy eating and living life in moderation. Nurturing our emotional health is just as important as physical wellbeing. I try to create time to relax with friends and family and spend time outdoors. I am not always successful in creating this balance, but I try!

Wednesday, December 3, 2014

Getting to Know Dr. Piparia

When did you know you wanted to be a physician?
I knew I wanted to be a physician in my 7th grade biology class. I remember learning that there were 206 major bones in the human body and I remember thinking I wanted to know each and every one of them and how they all worked together. Little did I know that there was much more to human anatomy...when I found out, it made my desire to learn even stronger 

What is your favorite part of your job?
My favorite part of the job is knowing that I can motive women to push their bodies to show them what they were made to do, and to show them how amazingly we were created. 

What are your favorite resources for women in Austin?
I’m still a bit new to the city and I don't know Austin as well as I’d like to, but I love what the Milk Bank is able to do for our community of new Moms and their babies. 

What is your favorite way to exercise?
My favorite way to exercise is to dance! Bollywood style!  

What would you say to women about the process of pregnancy and delivery? 
Believe in your self. Your body got you to where you are in this moment, and you'll be amazed at what more it can do. Just stay positive and give your body a chance! 

How many babies have you delivered? 
More than you would expect. Even though I am young, I worked in one of the busiest centers in downtown Chicago and gained a lot of experience in a short amount of time! 

How is your view on birth different now that you’ve experienced it so many times? 
Although it seems like we only look at things though medical eyes, I really see birth as an experience that our bodies were created to perform. It is more natural than we realize regardless of what you are getting to help contractions along or what you might need for discomfort. I view birth as a celebration of a moment in someones life, rather than a medical event that is clouded by IV poles, hospital beds and monitors. 

What is something that surprises you about deliveries? I still get excited every time I see a new parents’ reaction to their newborn. The moment their baby is delivered surprises me every time, each individual reaction is so different. 

Monday, November 24, 2014

Getting to Know Lisa Carlile, CNM

When did you know you wanted to be a midwife? 
During my 3rd pregnancy I was cared for by CNMs in the Air Force and got to work with some in the hospital where I worked.  I was already considering further education, but I began to discuss it with a CNM I enjoyed working with and she encouraged me to become a midwife. I also thought about becoming a nurse  anesthetist, but I felt like I would miss interaction with people and I knew I would very much miss birth.

What is your favorite part of your job?
I really enjoy seeing women year after year and getting to know them. And, I enjoy helping women work through problems. The relationships are what I love the most about my job.

How do you see the birth community changing in the years to come?
I hope to see the c-section rate drop and for women to gain more acceptance of alternative birth locations.

What is your favorite way to exercise or where do you spend time outdoors in Austin?
I work outside in my yard most weekends and mornings.  Digging up rocks and building gardens is one of my favorite things to do outside.

How many babies have you delivered? More than I can remember!

How long have you been in practice? I graduated midwifery school in 1997 and practiced for about 5 years before taking a job with a hospital. That was where I met Margaret Thompson, MD in 2001 (who previously owned this practice). In 2002 she hired me to work in her office but not to deliver babies.  When Christina Sebestyen, MD bought the practice in 2008 I began delivering babies again.

Thursday, November 20, 2014

Getting to Know Dr. Sebestyen

When did you know you wanted to become a physician?
I thought I might want to be a physician in high school, so I got a job as a receptionist in a pediatric office to investigate the possibility. I ultimately decided with certainty in my senior year of college after completing my bachelors thesis on the manifestation of aggression in feral ponies. I loved the research but felt as though I was not helping the world with my gifts and that I would better serve others through medicine. 

What is your favorite part of your job?
I love the relationships I am able to develop with women over the course many years. Watching families grow and change offers a special window into their world which is precious. 

How do you see the birth community changing in the years to come?
I am hopeful that evidence-based medicine will prevail causing induction and c-section rates to decline. This will require a change in the financing of birth (which unfortunately is not apt to change soon). 

What are your favorite resources for women in Austin?
Special Addition 
Stroller Strides
Central Texas Doula Association
Hand to Hold
Planned Parenthood

What is your favorite way to exercise or where do you spend time outdoors in Austin?
I love to walk on Lady Bird Lake with my older son. 

What are some of the ways you strive for optimal health?
I wear a Fitbit which guilts me into walking more!

How would you encourage women or what would you say to them about the process of pregnancy and delivery?
Believe in yourself and your convictions. Surround yourself with people who share those beliefs and will hold you up throughout the process. 

How many babies have you delivered?
Lots :)

What was one of your favorite moments in a birth?
There is a couple who I have had the honor to assist twice in labor who have an uncanny rhythm with each other. It is their birth and I am just a helping hand. I hope for that type of relationship for all couples. 

How long have you been in practice?
Since 1999. 

What is the most interesting thing youve learned lately?
We choose our own path and need to embrace it or change the path. 

How is your view on birth different now that youve experienced it so many times?We shape our own birth experience through our preparation and attitude, and need to embrace that rather than blaming others or the world around us. 

Tuesday, November 11, 2014

2015 Childbirth Classes at OBGYN North

Prepared Childbirth (4 Classes)

January 5, 12, 19, 26

January 13, 20, 27 & February 3

February 2, 9, 16, 23

February 17, 24 and March 3, 10

March 2, 9, 16, 23

March 24, 31 & April 7, 14

April 6, 13, 20, 27

April 28 & May 5, 12, 19

May 4, 11, 18 (no class 5/25) & June 1

June 2, 9, 16, 23

June 8, 15, 22, 29

Labor Skills (1 Class)
Sunday, January 4
Sunday, February 1
Sunday, March 1
Sunday, March 29
Sunday, May 3
Sunday, June 7

VBAC Preparation (1 Class)
Sunday, January 4
Sunday, March 1
Sunday, May 3

Monday, September 15, 2014

What is a Cesarean Section?

(Tips to Avoid) Cesarean Delivery 

According to legend, Julius Caesar was born surgically, thus lending his name to the well-known practice of Cesarean section or C-section for short. In this past, this was done for a truly life saving purpose for the mom or baby. Fortunately, today's modern C-section techniques are safer, but when do you really need one? At OBGYN North, our midwives and physicians strive to avoid c-sections unless medically necessary. We invite all mothers to be proactive throughout pregnancy by maintenance of a healthy weight, healthy diet, exercise, and childbirth preparation.

The national C-section rate is nearly 1 in 3 births.  At OBGYN North, we think this is too high of a number.  Our practice average is about 1 in 5, including planned repeat C-sections. For a first time c-section our rate is 1 in 7. Additionally, we are excited to support women with vaginal birth after C-section, known as VBAC with one or two prior cesarean deliveries. After obtaining the documentation of your previous cesarean scar(s), we provide consultation with our physicians to help you determine if this is a good option for you. (This is not common at many other practices). Our VBAC success rate is over 80%!

How is this possible? At OBGYN North, we will do our best to help you avoid a C-section. This blog post will focus on how we as a team (midwives, doctors, mothers-to-be, and their support team) help avoid this surgery.  

A common reason for a C-section is dysfunctional labor or failure to progress. One of the common reasons for a failure to progress is the result of induction of labor when the body is not ready. For this reason, we induce only for medical indications (fetal or maternal health risks). It is best to allow moms to labor without intervention when none is needed. To avoid a medical induction of labor we may suggest herbals, ambulation, nipple stimulation, and encouraging doula support of your labor. Should induction be medically necessary, we will walk you through the process and proceed slowly as the body intended helping you get into labor.

Labor preparation is also very important. We offer many options for preparation classes so that you will find one that fits your personality and philosophy of labor best. Our physicians and midwives want to help support your birth plan; therefore, we recommend discussing all your pain management options with your providers.  Epidurals are safe, but sometimes they slow the normal labor process. We have other options available.

Our next most common reason for a C-section is a breech delivery (baby's head not turned down). Our strategy to avoid this outcome is to identify the position of the baby early. Your assistance is important here: such as identifying where the baby is kicking and discussing any concerns to your providers during your visits. A quick ultrasound late in the third trimester can be very helpful as well.  Regular exercise, acupuncture, and the Webster technique (chiropractors typically perform this) are helpful to turn the baby's head down. Spinningbabies.com is great resource for mothers with breech babies and other less optimal positions for labor. Finally, at 37 weeks, about 5% of babies are still breech. At this point, our physicians will offer to turn the baby head down.

The majority of pregnancies are healthy and normal, and do not need intervention.  Our mission is to support our moms through a safe pregnancy and delivery. Sometimes in labor, contractions lead to baby heart rate changes. This is probably the result of cord compression or a problem with the placenta. To help avoid placental problems, we recommend a healthy diet and regular exercise throughout pregnancy.   If it is an issue of cord compression, then we may ask you to change positions as you labor to help your baby maintain heart rate and get enough oxygen.  Some other methods to improve the baby's situation include oxygenation, hydration, and an amnioinfusion (replace fluid around the baby). 

Unfortunately, there are times when C-sections are necessary for you and your baby.  If we can't resolve one of the above issues like persistent breech positioning or if your baby still doesn't tolerate labor, we may need to do a C-section. One other reason for a C-section may on occasion be a placenta previa (placenta over the cervix).  A suspected "large" baby is rarely an indication for a cesarean delivery in a low risk mother. If we are recommending a cesarean section, then we will counsel and involve you in the decision making process. If you are having a scheduled C-section, we can offer a family-centered (otheriwse known as a gentle C-section). See this link for more information.  

If we recommend a C-section, please know it is after we have exhausted all our other options.  Our physician midwife team will work together to help your birth experience to be a joyous occasion. At OBGYN North from the time of your pre-conception visit throughout your pregnancy, we strive to offer the highest quality pre-natal care. By doing so, we can reduce your risk of C-section and avoid unnecessary labor interventions. We want to encourage moms'-to-be and their family's participation throughout the process, leading to a healthy and happy outcome for you, your baby, and your whole family.

Best wishes for a happy and healthy labor! 
April Schiemenz, MD

Wednesday, August 27, 2014

Get to Know Dr. Maansi Piparia

Hi there everyone! I'm Dr. Maansi Piparia, and even though I have been here at the practice for a year now, I am still the newest doctor of the group!

I am sure some of you have met me already but just to give you a little background, I was born in Canton, Ohio but was mostly raised in Tulsa, Oklahoma. Growing up in Tulsa was great but Texas always seemed a little more appealing so I made it my goal to move here someday. I finished high school and was accepted to a six year combined BA/MD program in Kansas City, Missouri. The program is an accelerated path for young adults who a sure they want to become a physician, and I knew at a pretty early age! Although I didn't have a normal college experience, it was six years of bonding with friends who were also going to school all year-round with intensity and stress! After medical school, I journeyed up to Chicago where I completed my residency in Obstetrics and Gynecology. I found a love for teaching and laparoscopy and found my husband while we were early in training! 

After residency, my husband and I moved to Austin. We were starting fresh, as we didn't know anyone here, and just hopeful it would be a good experience. We have been extremely thrilled with our choice! Since we have been here we have had a great time in the city, experiencing the music, the culture and the amazing Mexican food!  We recently bought a house in Round Rock and we are hoping to start a family very soon!

If we ever get off topic in a clinic visit there's a good chance I might be talking about how much I love the OU Sooners (of course better than the Longhorns, haha) or about my big fat Indian wedding that I had almost 1 year ago!

I will never forget a quote that was presented to me in my early years, "Choose a job you love and you will never work a day in your life." Of course we all know that Obstetrics is hard work for all of us, the patient and physician, partners and families all included, but this quote is true. Essentially, if you are doing something you truly love in life, then even if it takes sleepless nights and stress, its still enjoyable and worth every second. That is in a nutshell why I am here and why I am doing what I do! I hope that I get to meet all of you sometime and thanks for reading a little about me!

Tuesday, August 19, 2014

Lessons for a Labor Coach (reposted from the Sacramento Bee)

The article below, by Adrian Kulp, was originally written for TheBump.com and was posted today on the Sacramento Bee. The article quotes our very own, Dr. Sebestyen, in an informative article for expecting Dads!

Lessons for a Labor Coach

When it was my turn to coach my wife through the birth of our first, I wish I'd been better prepared. Case in point: As I rode the hospital elevator with another expectant dad, he asked me if I knew about "the bathing suit thing." What!? (More on that below.) Since I've been down that road three times now, allow me to share my experiences with you, along with some advice from the experts.


And I'm not talking about an escape plan! (It's too late for that.) Before labor, sit down with your partner to map out how you want delivery day to go. To get started, research different hospitals, consult a doula or take a childbirth class together. Discuss what will make her feel positive and negative during a vulnerable time, says Latham Thomas, a doula and founder of MamaGlow.com. She recommends positive affirmations and guided imagery to help calm mom in the delivery room.


She's giving you a child, the least you could do is give her a couple of lollipops, right!? You'll win major points if you show up with some unexpected extras to comfort her, like her favorite music, some bottled water, mints or hard candies to alleviate dry mouth, and some lip balm. You have no idea how dry her lips and mouth can get during labor, Thomas says. Plus, the more prepared you are, the more relaxed everyone will be.


Huh? As I mentioned, this one caught me off guard. Why? Am I headed to the hot tub with the nurses clocking out from the day shift? Nope, sorry. Even if you're not planning on a water birth, there may actually be a time during the rigors if early labor when water therapy could be used to alleviate some of the pain and stress on mom. Many hospitals have a tub or whirlpool available in the maternity ward (the shower can be used too), and it's not uncommon for a coach to jump in (no cannonballs, please!) and offer some physical and emotional support.


Wait, isn't that what got us into this mess to begin with? But seriously, delivery isn't just exhausting for her; coaching can be labor-intensive for you too. As a coach, it's important to help the process progress as much as possible, says Christina Sebestyen, MD, a physician and owner of OBGYN North in Austin, Texas. Part of that includes suggesting that your partner switch positions when she seems to be "hitting a wall." Changing positions can bring some relief and rejuvenate her mental state, Sebestyen says. So prepare to bend or squat behind her or even squeeze into the bed with her - whatever you need to do to help support and comfort her while she's experiencing pain.


I'm not going to lie, seeing your partner in pain can be tough to take, and it'll be even tougher to leave her side. But as much as you need to focus on her, you also need to take care of yourself. An exhausted, nauseated or panicked coach won't do mom any good. A lot goes on during labor, and you could be in it for the long haul. To start, bring a few changes of comfortable clothes and your toiletry kit (or in my case, a gallon-size zip-top bag with my toothbrush and random bathroom gear). If you need to step away for a break - whether it's to grab coffee or to collect yourself if you get queasy - don't feel bad. Just have a pinch hitter on standby, like her mom or sister, to relieve you for a bit.


"Please, please, no eating in the labor or delivery room," is a common refrain dads hear. This one drives doctors crazy - you can't imagine what people do. In fact, Sebestyen once found some family members sitting around eating take-out while the mom-to-be was mid-contraction. General Tso's chicken with a side of grunting and screaming? Not a good idea. Instead, you want to help create a serene environment throughout the entire process. You never know when a certain smell, sound or action could upset your partner. Translation: Go eat in the lounge!


Unless you want to get slapped across the face with a bag full of IV fluid, try to keep your complaining in check. Avoid any negative triggers, warns Linda Perry, a home birth midwife, who has been working with families for 23 years at Complete Woman Midwifery. I'm fairly certain these triggers could be physical actions - for instance, breathing through my mouth or cleaning my teeth with my tongue - but verbal too. Inappropriate banter includes: "Hon, how long do you think we'll be here?" and "This stupid hospital guest chair is uncomfortable; it's kind of digging into my back a little." Seriously? Nothing you're going through is anywhere near as bad as her situation, so suck it up and repeat after me: "This day is all about her!"


No matter how much you've planned in advance, you never know what might happen next in this whole crazy process. Regardless of whether or not labor and delivery takes two hours or turns into a 48-hour marathon, or if this is your first child or even your fifth, you'll want to be prepared for the unexpected. The birth plan you come up with beforehand may all work out, but there's a chance it will fall by the wayside, and if so, you'll need to go with the flow. Get a good night's rest during the weeks leading up to the due date, so you can be as present as possible for whatever may get thrown your way. Your job is to help maintain some semblance of peace and calm during the height of the storm, Thomas says.


There may be times throughout labor when mom won't be in the best frame of mind to ask for what she wants or needs. Instead of constantly repeating questions like "How are you doing?" try taking a more proactive approach. Go down the hall and get her a cup of ice chips, find a pillow or a sock full of tennis balls that she might want to put behind her back, or call a nurse to come adjust the pain medication if she's using it. Oh, and don't be afraid to speak up if the doctors and staff aren't following the plan you and your wife discussed. There may be a good reason why they're veering from the original instructions, but you won't know unless you remind them of what you want.

Wednesday, July 23, 2014

Upcoming Childbirth Classes and Natural Beginning Birth Center Orientation

Shelley Scotka, ICCE, ICD is a certified Childbirth Educator and Birth Doula and has been helping families prepare for birth since 1998. She has training in ICEA, Lamaze, Hypnobirthing, Bradley, and Birthing From Within, and her classes reflect a mixture of the various styles. As a doula, she has supported hundreds of women through labor. Her classes teach real life, hands-on skills which will help women and their partners have a positive and empowering birth experience.

Classes are for both mom and her support person. Dress comfortably in clothing they can move around in (no short skirts), bring water and/or snacks, a yoga mat or blanket and 2 pillows for relaxation/practice sessions. Plan to arrive 5-10 minutes early, so you have a few minutes to get settled. 

Childbirth Class Sessions (classes are 6:30-9p.m.)
August 4, 11, 18, 25
September 8, 15, 22, 29
October 6, 13, 20, 27
November 3, 10, 17, 24

VBAC Skills Sessions (one-day course, 12:30-3:00p.m.)
Sept 7 VBAC

Labor Skills Sessions (one-day course,3:30-6:00p.m.)
August 14
September 18
October 16
November 20
December 18

Natural Beginning Birth Center Orientations
August 19, September 23, October 28

To register for your birth classes, please call our office at 512-425-3825.

Wednesday, June 4, 2014

First Quarter Birth Stats for 2014

56 deliveries 
45 vaginal, 11 cesarean sections (5 primary, 6 repeat)

57 deliveries
45 vaginal, 12 cesarean sections (7 primary, 5 repeat)

58 deliveries 
45 vaginal, 13 cesarean sections

48 deliveries

37 vaginal, 11 cesarean sections

Thursday, May 29, 2014

Breast Cancer Awareness and Prevention

Breast cancer is the most common cancer in females in the United States and the second most common cause of cancer death in women. Approximately one-half of newly diagnosed breast cancers can be explained by known risk factors, such as age at menarche, first live birth, menopause, and proliferative breast disease. An additional 10% are associated with a positive family history. Risk factors for breast cancer may be modified by demographic, lifestyle, and environmental factors. 

So, what increases our risk? What can we change? What do have no control over? 

Age:  the risk of breast cancer increases with older age.  In recent surveillance risk stratifies as such: Birth to age 39 - 1 in 203 women;  Age 40 to 59 - 1 in 27 women;  Age 60 to 69 - 1 in 28 women; Age 70 and older - 1 in 15 women;  Birth to death - 1 in 8 women.

Female gender:  Breast cancer occurs 100 times more frequently in women than in men.  In the United States, over 200,000 women are diagnosed with invasive breast cancer each year, compared with approximately 2000 cases that occur annually in men. 

Caucasian race:  the highest rate of breast cancer occurs among white women, although breast cancer remains the most common cancer among women of every major ethnic group.  

Weight:  Obesity (defined body mass index ≥30 kg/m2) is associated with an overall increase in morbidity and mortality.  However, the risk of breast cancer associated with BMI appears to depend on the menopausal status of women. 

Postmenopausal women:  A higher body mass index (BMI) and/or perimenopausal weight gain have been consistently associated with a higher risk of breast cancer among postmenopausal women.  The association for risk can be explained by higher estrogen levels resulting from the adipose tissue to estrogen.  

Premenopausal women:  Unlike postmenopausal women, an increased BMI is associated with a lower risk of breast cancer in premenopausal women.  The explanation of this finding remains unclear.

Tall stature:  Increased height is associated with a higher risk of breast cancer in both premenopausal and postmenopausal women.  The mechanism underlying this association is unknown, but may reflect the influence of nutritional exposures during childhood and puberty. 

Estrogen levels:  High endogenous estrogen levels increase the risk of breast cancer (particularly hormone receptor-positive breast cancer) in both postmenopausal and premenopausal women. For postmenopausal women, the correlation between an increased risk for breast cancer and increasing hormone levels (eg, estradiol, estrone) has been consistent.  

Benign breast disease:  A wide spectrum of pathologic entities is included in the category of benign breast disease. Among these, proliferative lesions (especially those with histologic atypia) are associated with an increased risk of breast cancer. 

Dense breast tissue:  The density of breast tissue reflects the relative amount of glandular and connective tissue (parenchyma) to adipose tissue. Breast density is a measure of the extent of radiodense fibroglandular tissue. Women with mammographically dense breast tissue, generally defined as dense tissue comprising ≥75 percent of the breast, have a 4 to 5 times risk of breast cancer compared with women of similar age with less or no dense tissue.  It is unclear whether screening recommendations should differ for women with dense breasts in the absence of other risk factors. 

Bone mineral density:  Because bone contains estrogen receptors and is highly sensitive to circulating estrogen levels, bone mineral density (BMD) is considered a surrogate marker for long-term exposure to endogenous and exogenous estrogen. In multiple studies, women with higher bone density have a higher breast cancer risk.

Androgens:  Elevated androgen (ie, testosterone) levels have been associated with an increased risk of postmenopausal and premenopausal breast cancer. 

Insulin pathway and related hormones:  Although diabetes is not considered a breast cancer risk factor, a large pooled analysis drawing from 17 prospective studies suggested that insulin growth factor-1 was associated with breast cancer risk in both premenopausal and postmenopausal women.

In utero exposure to diethylstilbestrol:  Before 1971, several million women were exposed in utero to diethylstilbestrol (DES) that was given to their mothers to prevent pregnancy complications. Whether these women are also at an increased risk for breast cancer is unclear.  

Exogenous hormones:  Much of the available evidence supports a causal relationship between menopausal hormone replacement therapy and breast cancer. The duration of use and type of hormone formulation seem to be important factors in the risk for breast cancer.  While long-term use has been associated with the highest risk, short-term use of combined estrogen-progestin therapy (<3 administration="" an="" appear="" as="" associated="" breast="" cancer.="" clearly="" contraceptives="" does="" estrogen="" exogenous="" for="" hormones="" however="" in="" increase="" increased="" induction="" is="" nbsp="" not="" of="" or="" oral="" ovulation="" premenopausal="" previous="" purpose="" risk="" significantly="" span="" the="" to="" users="" with="" years="">

Earlier menarche or later menopause:  Early age at menarche is associated with a higher risk of breast cancer.  Women with menarche at or after age 15 years of age were less likely to develop estrogen receptor/progesterone receptor positive breast cancer compared with women who experienced menarche before the age of 13 years.  Women with menarche at or after age 15 years also had a 16 percent decreased risk of estrogen receptor/progesterone receptor negative breast cancer.

Nulliparity:  Nulliparous women are at increased risk for breast cancer compared with parous women, however, the protective effect of pregnancy is not seen until after 10 years following delivery.  

Increasing age at first pregnancy:  Women who become pregnant later in life have an increased risk of breast cancer.  One study showed when compared with nulliparous women at or near menopause, the cumulative incidence of breast cancer (up to age 70) was 20 percent lower, 10 percent lower, and 5 percent higher among women who delivered their first child at age 20, 25, or 35 years, respectively.  A later age at first birth may confer a greater risk than nulliparity because of the additional proliferative stimulation placed on breast cells that are more likely to be fully developed and perhaps more prone to cell damage.

Personal history of breast cancer:  A personal history of ductal carcinoma in situ (DCIS) or invasive breast cancer increases the risk of developing an invasive breast cancer in the contralateral breast. A 2010 study using Surveillance, Epidemiology, and End-Results (SEER) data that included almost 340,000 women with a primary breast cancer found the incidence of invasive contralateral breast cancer was 4% during an average follow-up of 7.5 years.

Family history of breast cancer:  The risk associated with a positive family history of breast cancer is strongly affected by the number of female first-degree relatives with and without cancer. In addition to a family history of breast cancer, the age at diagnosis of the affected first-degree relative also influences the risk for breast cancer.  Women have a threefold higher risk if the first-degree relative was diagnosed before age 30, but only 1.5-fold increased if the affected relative was diagnosed after age 60. 

Inherited genetic mutations:  Specific genetic mutations that predispose to breast cancer are rare; only 5 to 6 % of all breast cancers are directly attributable to inheritance of a breast cancer susceptibility gene such as BRCA1, BRCA2, p53, ATM, and PTEN. 

Alcohol:  Alcohol consumption in early life as well as later adult life is associated with an increased risk of breast cancer development. There appears to be a significant dose-response relationship between alcohol consumption (eg, beer, wine, liquor) and an increased risk of breast cancer, which begins with alcohol intake as low as three drinks per week compared with abstainers. The risk appears to increase with greater alcohol consumption and additive with the use of menopausal hormone therapy. There does not appear to be a difference by type of alcohol (wine versus beer versus liquor). 

Smoking:  The relationship between cigarette smoking and breast cancer is complicated by the interaction of smoking with alcohol and endogenous hormonal influences.  Although results have varied widely, multiple studies suggest there is a modestly increased risk of breast cancer in smokers. 

Night shift work:  Night shift work is recognized by International Agency for Research on Cancer and the World Health Organization (IARC/WHO) as a probable carcinogen.  This association may be related to nocturnal light exposure, which results in the suppression of nocturnal melatonin production by the pineal gland. Evidence to support this comes from the finding that low levels of 6-sulfatoxymelatonin (the major melatonin metabolite) are associated with an increased risk of breast cancer.

Exposure to therapeutic ionizing radiation:  Exposure to ionizing radiation of the chest at a young age, as occurs with treatment of Hodgkin lymphoma or in survivors of atomic bomb or nuclear plant accidents, is associated with an increased risk of breast cancer. The most vulnerable ages appear to be between 10 to 14 years (prepuberty), although excess risk is seen in women exposed as late as 45 years of age. After age 45, there does not appear to be any increased risk. 

So what can we do to help ourselves?
In addition to modifying some of the risk factors above and spreading awareness, some protective factors that may also reduce breast cancer risk are breastfeeding, soy/phytoestrogens (such as soybeans, legumes and lignans) and increased physical activity. 

Let us be your resource for concerns or questions about your breast health--that is what we are here for! 

Here are some other reliable resources too:
National Cancer Institute (www.nci.nih.gov)
People Living With Cancer: The official patient information website of the American Society of Clinical Oncology (www.cancer.net/portal/site/patient)
National Comprehensive Cancer Network (www.nccn.com)
American Cancer Society (www.cancer.org)
National Library of Medicine (www.nlm.nih.gov/medlineplus/healthtopics.html)

Susan G. Komen Breast Cancer Foundation (www.komen.org)

-Maansi Piparia, MD

Tuesday, May 13, 2014

It's National Women's Health Week!

National Women’s Health Week kicked off on Mother’s Day and yesterday was National Women’s Checkup Day. These nationwide awareness campaigns happen every year in the month of May to encourage women to schedule their annual well-women visits. 

The U.S. Department of Health and Human Services suggests women set aside time to discuss their health habits, family history and goals for optimal health at their annual well-women visit. During these visits, women receive preventative care and necessary screenings for blood pressure, cholesterol, cervical cancer and many other conditions. 

People often confuse the well-woman exam as just a pap smear—but it is truly our opportunity as women to assess our whole health status. Well-women visits help identify diseases such as cervical precancers early, when they are easier to treat. They allow providers to teach preventative strategies that empower women to reduce their risk for illness. And now, under the Affordable Care Act, most health plans allow women to receive these services without cost.

The goal of National Women’s Health Week is to encourage women, in their busyness, to find time to schedule screenings for potentially life threatening, but mostly preventable diseases. 

To participate in National Women’s Health Week, women are asked to make a well-women appointment with their provider, learn which screenings they need during each phase of life, urge others to participate and share information on women’s health through social media. 

Proper Technique and the Importance of Breast Self Exam

Breast self exam has long been included with the standard instructions during the annual well woman exam. However, there are very few randomized trials examining the effectiveness of this routine.  One large study in China compared breast self exam (BSE) to a control group who did not do them. The BSE group was instructed in proper technique and received a review of those instructions at one and 5 years. They also had supervised exams every 6 months for 5 years.  The women were followed for 10 years and they found no difference between the two groups in breast cancer deaths but more benign breast lesions were diagnosed in the self-examination group.  Other studies also failed to find a benefit of regular BSE in the rate of breast cancer diagnosis, death, or tumor size. These studies also found an increased rate of biopsy for benign breast disease in the BSE groups. The findings of two other case controlled studies suggest that proper BSE technique is important. Despite these studies and the findings that BSE might not change diagnosis we still recommend that women get to know their breasts so they will recognize any changes. This new approach is breast awareness...being comfortable and knowledgeable about your own body.  

Breast awareness and self-exam

At the wellness exam, all women should be told about the benefits and limitations of breast self-exam (BSE). Starting in their 20's, women should become comfortable with how their breasts normally look and feel.  They should report any breast changes to their provider as soon as they are found. Not all changes indicate cancer. Most changes are benign but should be evaluated and documented. 

A woman can choose to be aware of how her breasts normally look and feel and feeling her breasts for changes (breast awareness), or to use a systematic scheduled approach to examine her breasts with monthly breast self exam. 

If BSE is the chosen method, a step by step approach is important to follow. The best time for a woman to examine her breasts is when they are not tender or swollen, usually after their menstrual cycle.  Women can choose not to do BSE or to do BSE occasionally. Women who are pregnant or breastfeeding, or who have implants can also choose to examine their breasts regularly. There is some thought that the implants push out the breast tissue and may make it easier to examine. 

How to examine your breasts (taken from cancer.org)

Lie down on your back and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.

Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.

Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you're not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).

There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast without missing any breast tissue.

Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)

Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

This procedure for doing breast self-exam is different from previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman's ability to find abnormal areas.

uptodate.com. Screening for breast cancer: Evidence for effectiveness

cancer.org. Breast awareness and self exam

Saturday, April 26, 2014

Upcoming Childbirth Classes and Natural Beginning Birth Center Orientation

Shelley Scotka, ICCE, ICD is a certified Childbirth Educator and Birth Doula and has been helping families prepare for birth since 1998. She has training in ICEA, Lamaze, Hypnobirthing, Bradley, and Birthing From Within, and her classes reflect a mixture of the various styles. As a doula, she has supported hundreds of women through labor. Her classes teach real life, hands-on skills which will help women and their partners have a positive and empowering birth experience.

Classes are for both mom and her support person. Dress comfortably in clothing they can move around in (no short skirts), bring water and/or snacks, a yoga mat or blanket and 2 pillows for relaxation/practice sessions. Plan to arrive 5-10 minutes early, so you have a few minutes to get settled. 

Childbirth Class Sessions (classes are 6:30-9p.m.)
-May 6, 13, 20, 27
-June 10, 17, 24 and July 1
-July 22, 29, Aug 5 and 12
-August 26, September 2, 9, 16
-September 30, October 7, 14, 21

VBAC Skills Sessions (one-day course, 12:30-3:00p.m.)
May 4 VBAC 
July 6 VBAC
Sept 7 VBAC

Labor Skills Sessions (one-day course,3:30-6:00p.m.)
May 4 
June 1 
July 6 
August 3
September 7
October 5

Natural Beginning Birth Center Orientations
June 3, July 8, July 15, August 19, September 23, October 28

To register for your birth classes, please call our office at 512-425-3825.

Tuesday, April 8, 2014

Prenatal Vitamins: What You Should Know

The best way to meet your nutritional needs is through a healthy, balanced diet.  However, you may still be missing some key nutrients.  Prenatal vitamins help to ensure pregnant women get the extra vitamins and minerals needed for the development of a healthy baby.  They also help to meet your nutritional needs when trying to conceive and while breastfeeding.

Prenatal vitamins provide the same nutrients as standard multivitamins with extra folic acid and iron.  Folic acid is a B vitamin that helps to prevent neural tube defects – abnormalities of the brain and spinal cord. There is also evidence that supplemental folic acid during pregnancy may also lower the risk of other abnormalities like cleft lip and palate and heart defects. Taking folic acid may also decrease risk factors for preeclampsia. Iron is a mineral and is often deficient in the diet.  Supplemental iron aids in the production of hemoglobin, prevents anemia and decreases the risk of low birth weight babies and premature delivery.

Taking a prenatal vitamin is especially important for women with special diets and food intolerances and for women with health concerns.  Women who have had gastric bypass surgery may have trouble absorbing nutrients or meeting their nutritional needs through diet alone and will require supplementation.  Prenatal vitamins are also especially important for women pregnant with two or more babies or at increased risk for complications during pregnancy.

When considering which prenatal vitamin to take, look for a vitamin that contains 400-800mg of folic acid, 250mg of calcium, 30mg of Iron, 50mg of Vitamin C, 15mg of Zinc, 2mg of Copper, 2mg of Vitamin B6 and 400 IU of Vitamin D.

Keep in mind that prenatal vitamins do not replace a healthy diet.  In addition to your daily prenatal vitamin, you may also consider adding a supplement of Omega-3 fatty acids DHA and EPA, which are important for brain, nerve and eye development.

Talk with your provider at your next office visit about your specific needs and concerns to determine the right supplements for you.

Wednesday, April 2, 2014

Technology in OB/GYN

At OB GYN North and Natural Beginning Birth Center, we see the value of the latest medical technology in improving your health and ensuring you have the safest and least invasive obstetric and gynecological care.  Therefore, we continue to invest our time and resources in having access to some of the most recent improvements in technology like 3D ultrasounds, laparoscopic and robotic surgery, and wireless electronic fetal monitoring.

What is ultrasound?
Ultrasound is a technique to make images of the baby in the uterus (womb) by using sound waves (far beyond the range of human hearing). The ultrasound begins by placing gel over your abdomen to help the ultrasonographer get a picture of the baby. Then a transducer (scanning device) is moved lightly over your abdomen making sound waves that pass through the abdomen and uterus. These sound waves bounce off the developing baby and are sent back to the transducer. The information that comes back to the transducer generates pictures of the baby, the uterus and other nearby structures. These pictures can then be seen on a monitor. Gynecological ultrasound uses a special transducer that is inserted into the vagina. This is similar to having a pelvic examination and some mild discomfort may be experienced. 

Why is ultrasound used?
An ultrasound is not a treatment for any condition, but is performed only for diagnostic purposes. Ultrasounds are considered part of routine maternal-fetal care. The benefits of having a diagnostic ultrasound in pregnancy  are numerous. It can confirm the presence of a fetal heart beat, detect  the presence of multiple babies, monitor  the baby’s growth, detect  some, but not all, birth defects, establish  an accurate due date, evaluate placental function and position, evaluate amniotic fluid volume, and fetal presentation. Gynecological ultrasound provides the provider with information about the shape and contents of the pelvic structures including the uterus and ovaries. This is helpful for the evaluation of gynecological conditions such as abnormal uterine bleeding, pelvic masses, and infertility. New advances in ultrasound include the capability to create images that show the three dimensional view of the baby. We can also visualize the uterus in three dimensions, which helps aid the detection of fibroids (smooth muscle overgrowths), polyps, and uterine anomalies.

Are there any risks to ultrasound use?
Currently there are no known risks to the patient or baby during an ultrasound examination when ordinary power and frequency is used. No adverse fetal effects of diagnostic obstetric ultrasound have been demonstrated in humans after decades of clinical use. In our facility, we use the lowest power level that can reasonably achieve a meaningful image and for as brief of a duration as possible. We also use this important tool only for diagnostic purposes when deemed medically necessary.

Minimally invasive surgery
Women with gynecologic conditions such as fibroid tumors, endometriosis, heavy menstrual bleeding, cancer, and pelvic prolapse often undergo surgery as a last resort for treatment. The most common minimally invasive surgery is laparoscopy. Instead of a large open incision, surgery is done through a few small incisions using a tiny camera and long, thin surgical instruments. The camera takes images inside your body and those images are sent to a video monitor in the operating room, which guides surgeons as they operate.

What is robotic surgery?
Robotic surgery is another minimally invasive option for women facing gynecologic surgery. Similar to traditional laparoscopy, a few incision are made on the abdomen. The robotic device, known as the da Vinci, features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision, dexterity and control.  State-of-the-art da Vinci uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body.

What are the risks and benefits of minimally invasive surgery?
The benefits of minimally invasive surgery include: less operative bleeding, less hospitalization stay, less pain, and an overall greater patient satisfaction when compared to traditional techniques.  Procedures can be longer and can accrue higher costs when compared to traditional surgery. The usual operative risks are still present with any type of procedure performed. There is a small risk of conversion to traditional open technique (larger incision).  All our gynecologists at OB GYN North are skilled surgeons in minimally invasive surgery. We perform minimally invasive procedures at North Austin Surgical Center and St David's North Austin Medical Center.

Electronic Fetal Heart Monitoring 
During late pregnancy and labor, we may recommend monitoring the fetal heart rate and other functions. The average fetal heart rate is between 110 and 160 beats per minute, and can vary five to 25 beats per minute. The fetal heart rate may change as the fetus responds to conditions in the uterus. An abnormal fetal heart rate or pattern may indicate that the fetus is not getting enough oxygen or that there are other problems.

What are the types of fetal monitoring?
  • Doppler: This is a handheld ultrasound device that transmits the sounds of the baby's heart rate either through a speaker. This can generally pick up heart tones after 12 weeks gestation.  This is generally performed at every obstetrical visit to document the presence of a fetal heartbeat.
  • External Electronic Fetal Monitoring: This is a device used during labor and birth, or during certain testing (non-stress test, contraction stress test, etc.) to record the baby's heart rate, and sometimes mother's contractions. It can be used intermittently or continuously.
  • Internal Fetal Monitoring:  This is an internal monitoring with an electrode attached to the baby's head to record heart tones, and a pressure catheter to record contractions. This is also used during labor and birth; however, it is not used intermittently.
  • Telemetry Monitoring: It is a lot like the regular Electronic Fetal Monitoring; however, one can maintain mobility.
What are the benefits and risks?
  • Doppler: This method is also used intermittently, requires little training to use, has a live person on the other end, and allows mother to maintain her mobility. It may also be easier to use during a contraction. This device does not provide the continuous monitoring needed for high-risk labors.
  • External Electronic Fetal Monitoring: This method provides beat-to-beat view of the baby's heart tones, in relationship to mother's contractions. This may be used either continuously or intermittently. This is of benefit for the high-risk mother, but of questionable benefit to the low risk mother. This method does leave room for interpretive error, which may lead to alterations in your birth plan. . There is the potential for loss of maternal mobility, which may slow labor.
  • Internal Fetal Monitoring: This is more accurate than the external electronic monitoring, does not use ultrasound, and can provide continuous monitoring for the high-risk mother. This method requires that your water be broken and is almost exclusively used in high-risk situations. This type of monitoring also has been associated with fetal injury (from the electrode) and infection for mother or baby.
  • Telemetry Monitoring: This is the "newest" type of monitoring available. It uses radio waves, connected to a transmitter, to transmit the baby's heart tones to the nurses' station. You can maintain your mobility. We offer this for all our high and low risk deliveries.

Which is right for me?

Depending on your birth wishes, your monitoring will be tailored to your situation. If you are high-risk, are induced with medications, or choose epidural anesthesia, you will have continuous monitoring. Low risk mothers may choose intermittent monitoring in labor. In most low risk pregnancies, routine continuous fetal monitoring does not improve fetal or maternal outcomes. In some situations, it may become medically necessary for you to have continuous monitoring; we are able to allow ambulation at North Austin Medical Center Women's Center. At Natural Beginning Birth Center, we offer intermittent Doppler. Please discuss with our providers at your visits which monitoring is safest for you and your baby.

Monday, March 24, 2014

Summer Breastfeeding Classes with Kelly Hamade

Empower yourself with the basics to get you and your baby off to the best start! Join us for a prenatal breastfeeding workshop (a one night session) on establishing milk supply, positioning and latching, pumps and equipment, common challenges and local resources. 

Class size is limited and the course is $40/couple for a 2.5 hour session.  

Classes will be offered:

May 21
June 18
July 30
August 27

Monday, March 17, 2014

In-House Childbirth Classes Exclusively for OBGYN North Patients

Get Ready for Birth! 

In-House Childbirth Classes exclusively for OBGYN North Patients 

Classes facilitated by Shelley Scotka, certified Childbirth Educator and Birth Doula

Prepared Childbirth    $200 for a four week series Tuesday evenings, 6:30-9:00pm
This class is perfect for first time parents who need a comprehensive preparation for childbirth. We'll cover the physiology of labor and delivery, recognizing signs of labor, when to call your care provider, and the normal stages of labor. We'll learn and practice with your support person a variety of methods to cope with labor pain including breathing, relaxation, visualizations/meditation, touch and massage, positioning, and water therapy. We'll discuss what happens at the birth both in a hospital and birth center setting. What if medical interventions become necessary? We'll look at the possible interventions that are common, and cover the risks and benefits of each, including cesarean birth. We'll also review the recovery and postpartum periods, and what to expect for both you and your baby during that time. It's recommended you begin the series by 32 weeks. 

April 1,15, 22, 29 (no class 4/8)
May 6, 13, 20, 27

Labor Skills   $50 for a one time 2.5 hour workshop Sundays 3:30-6:00pm
This workshop is designed for those who want to focus exclusively on natural ways to cope with labor pain, ideal for those who have birthed before and need a "refresher" or for those who just want to work on their labor skills with their partner. We'll discuss and practice relaxation, breathing, using visualizations/meditation, touch and massage, positioning and water therapy. We'll discuss the importance of the birth environment and creating an "oxytocin friendly" space for your labor. We'll give your support person plenty of ideas, tools and suggestions to help you get through labor, and review typical "challenging" scenarios during birth and how to get through them. Ideal anytime during the last trimester. 

April 6
May 4

Planning your VBAC   $50 for a one time 2.5 hour workshop Sundays 12:30-3:00pm
This class is designed for those planning a Vaginal Birth After Cesarean. We'll discuss the most up to date research on VBAC and review the benefits and risks. We'll look at ways to prepare for a successful VBAC both physically and emotionally, and offer you and your support person an opportunity to explore the emotions surrounding your previous birth experience. We'll talk about hospital protocols and learn what to expect during a VBAC labor. What if another cesarean becomes necessary? We look at the reasons why a repeat cesarean may become a necessity and ways to make that birth family centered. Ideal during the second trimester. 

May 4

To register, (512) 425-3825 or email: jcousins@obgynnorth.com

Tuesday, March 11, 2014

The History of Modern Obstetrics and Gynecology


Gynecology as a branch of medicine dates back to Greco-Roman civilization, if not earlier. In the early and mid-19th century, physicians became able to successfully perform a limited variety of surgical operations on the ovaries and uterus. The American surgeon James Marion Sims and other pioneers of operative gynecology also had to combat the violent prejudice of the public against any exposure or examination of the female sexual organs. The two great advances that finally overcame such opposition and made gynecologic surgery generally available were the use of anesthesia and antiseptic methods. The separate specialty of gynecology had become fairly well established by 1880; its union with the specialty of obstetrics, arising from an overlap of natural concerns, began late in the century and has continued to the present day.

Gynecologists make routine examinations of cervical and vaginal secretions to detect cancer of the uterus and cervix. They perform two main types of surgical operations: repairing any significant injuries caused to the vagina, uterus, and bladder in the course of childbirth; and removing cysts and benign or malignant tumors from the uterus, cervix, and ovaries. The first ovarian cystectomy was performed in 1809 in Kentucky and the first recorded vaginal hysterectomy, performed accidentally and unplanned was in 1812! Later, in 1853, the first successful abdominal hysterectomy was performed. The modern practice of gynecology requires skill in pelvic surgery; a knowledge of female urologic conditions, because the symptoms of diseases of the urinary tract and the genital tract are often similar; and skill in dealing with the minor psychiatric problems that often arise among gynecologic patients. Screening has also become a large part of gynecological practice, with the first screening test for cervical cancer developed in 1941 by George Nicolas Papanicolau: the pap smear! Most recently, laparoscopic and robotic procedures have infiltrated the world of gynecologic surgery which allows for surgeons and patients to have a minimally invasive major procedure with quick recovery time and less risk of infection. 


Obstetrics had for a long time been the responsibility of female midwives, in fact, Obstetrix was the Latin word for midwife and it is thought to derive from obstare, to “stand before”, because the attendant stood in front of the woman to receive the baby. In the 17th century, European physicians began to attend on normal deliveries of royal and aristocratic families; from this beginning, the practice grew and spread to the middle classes. Interestingly, in 1668 it was a physician who pioneered primary suturing of the perineum after delivery, “cleansing .. with red wine then applying three or four stitches.” Then in the 20th century, medical schools changed the practice from midwifery to obstetrics.

The name “caesarean” is likely derived from the Latin word caedere, to cut. The Roman law Lex Caesare stated that a woman who died in late pregnancy should be delivered soon after her death, and if the baby died they should be buried separately. The first cesarean section of modern times (with survival of both mother and child) is attributed to a Swiss sow gilder, Jacob Nufer, who in 1500 gained permission from the authorities to operate on his wife after she had been in labor for several days. Nufer's wife subsequently had five successful vaginal deliveries. During this age, cesarean sections were performed without anesthesia. In the mid-19th century death rates remained high and cesarean section was often combined with hysterectomy. In the 1880s, with the introduction of asepsis, a conservative operation was developed and the “classical” operation—a vertical incision in the upper part of the uterus—became more frequently used. This incision did not heal well, however, and in 1906 the modern “lower segment” operation was introduced, which carried less risk of subsequent uterine rupture.

In 1827, fetal heart tones were auscultated for the first time. The invention of the forceps used in delivery, the introduction of anesthesia, and the discovery of the cause of puerperal (“childbed”) fever in 1847 with the introduction of antiseptic methods in the delivery room were all major advances in obstetrical practice. By the early 19th century, obstetrics had become established as a recognized medical discipline in Europe and the United States. Prenatal care and instruction of pregnant mothers to reduce birth defects and problem deliveries was introduced about 1900 and was thereafter rapidly adopted throughout the world. The first epidural for labor anesthesia was given in 1901 and oxytocin was first synthesized for labor augmentation in 1953. Beginning with the development of hormonal contraceptive pills in the 1950s, obstetrician-gynecologists have also become increasingly responsible for regulating women’s fertility and fecundity. With the development of amniocentesis, ultrasound, and other methods for the prenatal diagnosis of birth defects, obstetrician-gynecologists were been able to abort non-viable fetuses and unwanted pregnancies. At the same time, new methods for artificially implanting fertilized embryos within the uterus have enabled obstetrician-gynecologists to help previously infertile couples to have children. The first successful in vitro fertilization was performed in 1978.

With the new age of safe childbirth, the main focus for maternity care is now the quality of the birth experience for the woman and her partner. Services are encouraged to provide choice, including home or hospital delivery, epidurals, or water births.

If you have any more questions, feel free to ask us! We'd be happy to share as much information as we can with you. 

Tuesday, February 11, 2014

Contraception and Family Planning Options

Choosing a contraceptive option is not an easy task. Before choosing the method right for you, you must consider several things including: method of delivery and your comfort level with that method, benefits, risks, side effects, and efficacy. Always consult your healthcare provider if you have any underlying medical conditions to see which methods are safe for you. This is meant as a brief overview. Each method could be discussed for pages upon pages, so always discuss the option that sounds the most suitable for your life with your provider prior to initiation.

Natural Family Planning:

Natural Family Planning is when you do not have sex or use a barrier method on the days you are most fertile. A woman choosing this method needs to keep record of her cycles, cervical mucous and basal body temperature. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. To record your basal body temperature, you need to chart your temperature daily first thing in the morning. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. Pregnancy rate: 25/100. Side effects/Risks: None

Barrier Methods:

The sponge is a soft, disk-shaped device with a loop for taking it out. It is made out of polyurethane foam and contains the spermicide nonoxynol-9. Pregnancy rate: 16-32/100. Side effects/Risks: Irritation, Allergic reactions, Hard time taking it out, Toxic shock if left in too long

The diaphragm is a shallow latex cup. The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap. For both, you must be "fitted" for the method. Both must be left in place for 6 to 8 hours after having sex to prevent pregnancy. Pregnancy rate: 15/100. Side effects/Risks: Irritation, Allergic reactions, Urinary tract infection, Toxic shock if left in too long

A female condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant and can be inserted up to 8 hours before sex.Pregnancy rate: 20/100. Side effects/Risks: Irritation or Allergic reactions

Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Pregnancy rate: 11-16/100. Side effects/Risks: Allergic reaction

Oral Contraceptives:

Combined oral contraceptive pills contain the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg. Pregnancy rate: 5/100. Side effects/Risks: Dizziness, Upset stomach, Changes in your period, Changes in mood, Weight gain, High blood pressure, Blood clots, Heart attack, Stroke, New vision problems

Progestin only pills are also available to patients unable to take estrogen due to an underlying medical condition or breastfeeding. Pregnancy rate: 5/100. Side effects/Risks: Spotting or bleeding between periods, Weight gain, Sore breasts

The Patch:

The patch, Ortho Evra, is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period. Pregnancy rate: 5/100. Side effects/Risks: Similar to side effects for the combination pill but a greater exposure to estrogen


Depo-Provera is an injection of the hormone progestin in the buttocks or arm every 3 months. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg. Pregnancy rate: less than 1 per 100. Side effects/Risks: Bleeding between periods, Weight gain, Sore breasts, Headaches, Bone loss with long-term use (more than 2 years)

Vaginal Ring:

NuvaRing is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.
Pregnancy rate: 5/100. Side effects/Risks: Similar to side effects for the combination pill, Swelling of the vagina, Irritation, Vaginal discharge

Implantable Rod:

Nexplanon is a matchstick-size, flexible rod that is put under the skin of the upper arm by your healthcare provider. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years. Pregnancy Rate: Less than 1/100 Side effects/Risks: Acne, Weight gain, Ovarian cysts, Mood changes, Depression, Hair loss, Headache, Upset stomach, Dizziness, Sore breasts, Changes in period, Lower interest in sex

Intrauterine Device:

An intrauterine device (IUD) is a small device shaped like a "T" that goes in your uterus. IUDs are placed by your healthcare provider. Pregnancy rate: Less than 1/100. Side effects/Risks: Cramps, Bleeding between periods, Pelvic inflammatory disease, Tear or hole in the uterus, Expulsion

Paragard is a copper IUD. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. It can stay in your uterus for up to 10 years.

Mirena releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. It can stay in your uterus for up to 5 years.


Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining. It can take about 3 months for the scar tissue to grow, so it's important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes. Pregnancy rate: Less than 1/100. Side effects/Risks: Pain, Ectopic (tubal) pregnancy

For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This stops the eggs from going down to the uterus where they can be fertilized. Pregnancy rate: Less than 1/100. Side effects/Risks: Pain, Bleeding, Complications from surgery, Ectopic (tubal) pregnancy

For men, having a vasectomy keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a semen analysis. Pregnancy rate: Less than 1/100. Side effects: Pain, Bleeding, Complications from surgery