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

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.