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

Injection:

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.

Sterilization:

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

Creating a Personalized Birth Plan for Your Delivery

A birth plan is a document that tells your healthcare provider and delivery team your wishes and preferences for your childbirth and early postpartum period.  The birth plan is not a legal contract but a written outline of your desires.  It serves as an opportunity for the expectant parents to consider and communicate their ideal birth experience.

Because childbirth doesn’t always go as planned, it is important to remain flexible and know that the plan may need to change for you and your baby’s health and safety.

There are many tools and sample birth plans available online and on our website to help you create your birth plan.

Some things you may wish to consider include:

Who will attend your delivery

Methods and medications preferred for induction or augmentation of labor

Methods, techniques and medications preferred for pain management

Fetal monitoring preferences

Eating and drinking during labor

IV access or saline lock

Position for delivery

Cutting the umbilical cord 

Cord blood banking

Any cultural or religious practices that you would like to incorporate

You may also like to consider care for yourself and baby after delivery.  Some considerations include:

Medications for baby after the birth

Bathing the baby

Rooming in

Exclusive breastfeeding

Pacifier use

Circumcision

It is a good idea to bring your birth plan to a prenatal visit during your third trimester to discuss your wishes with your doctor or midwife. And, if you have any questions, feel free to ask us at any of your prenatal visits!

-Kelly Hamade

OBGYN North and Natural Beginning Birth Statistics for 2013

In 2013 we saw 1500 births, of these only 13% were primary cesarean section.  Additionally we had an 82% VBAC success rate and 67% of patients planning birth without an epidural were successful.

4th Quarter Birth Statistics

October 68 deliveries 55 vaginal 13 c/s (7 repeats)

November 57 deliveries 46 vaginal 11 c/s (9 repeats)

December 66 deliveries 50 vaginal 16 c/s (6 repeats)

***Our December stats included 4 unsuccessful planned vaginal deliveries and 12 scheduled c-sections planned prior to labor for breech, placenta previa, repeat cesarean and other specific situations***

Prenatal Breastfeeding Workshop

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. 

Febrary 4,11,18,25

March 4,11,18,25

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. 

Febrary 9

March 2

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. 

February 9

March 2

May 4

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

The Importance of Folic Acid Before and During Pregnancy

Our bodies need folic acid all the time, but never more so than during the early weeks of pregnancy. Taking a daily prenatal vitamin with the recommended 400 micrograms (mcg) of folic acid before and during pregnancy can help prevent birth defects in your baby's brain and spinal cord. 

Folic acid, which is also called folate, is a B vitamin. Folic acid plays an important role in the production of red blood cells and helps your baby's neural tube develop into her brain and spinal cord.

Birth defects occur early in pregnancy, within the first 3-4 weeks, so it's important to have folic acid in your system during those early stages when your baby's brain and spinal cord are developing. The CDC recommends that you start taking folic acid every day for at least a month before you become pregnant, and every day while you are pregnant. However, the CDC also recommends that women of a childbearing age take folic acid every day, so you'd be fine to start taking it even earlier.

The recommended dose for all women of childbearing age is 400 mcg of folic acid each day. If you take a daily multivitamin, check to see if it has the recommended amount. While you're trying to conceive and throughout  pregnancy, women need 400 mcg of folic acid per day, It’s also recommended that breastfeeding women continue to take  folic acid.

Without enough folic acid in your body, your baby's neural tube may not close correctly and she could develop health problems called neural tube defects such as spina bifida . Getting enough folic acid may reduce your baby's risk of  neural tube defects by more than 50 percent. According to the CDC, if you've already had a baby with a neural tube defect, getting enough folic acid may reduce your risk of having another child with a neural tube defect by as much as 70 percent.

When taken before and during pregnancy, folic acid may also protect your baby against cleft lip and palate, premature birth, low birth weight, miscarriage and poor growth in the womb.

Folic acid has also been suggested to reduce your risk of pregnancy complications (one report found that women who took folic acid supplements during the second trimester had a reduced risk of preeclampsia), heart disease, stroke, some types of cancers and Alzheimer’s disease. 

Foods that can help you get more folic acid in your diet include fortified breakfast cereals, beef liver, lentils, spinach, egg noodles and great northern beans among many others. 

If you have questions about your prenatal vitamins or foods that contain folic acid, please don’t hesitate to ask us at your next appointment, we’d be happy to help ensure the best start for your baby!

November is National Prematurity Awareness Month

November is National Prematurity Awareness Month and we wanted to provide a little more information about premature birth, as well as offer support for women facing certain risk factors. A premature birth refers to a baby that is born at least three weeks before their due date. Important growth and development milestones occur throughout pregnancy, but even more so in the final months and weeks. Our hope is that through proper care and education, our patients can see their due dates and go home with healthy, full-term babies.

Although babies born very preterm are a small percentage of all births, these very preterm infants account for a large proportion of infant mortality rates. More infants die from preterm-related problems than from any other cause. Some premature babies require special care and spend weeks or months hospitalized in a neonatal intensive care unit (NICU). Those who survive are at risk of facing lifelong problems such as intellectual disabilities, cerebral palsy, breathing and respiratory problems, visual problems including retinopathy of prematurity, hearing loss, feeding and digestive problems. 

Even if a woman does everything "right" during pregnancy, she still at risk of having a premature baby. There are some known risk factors for premature birth. For example, one risk factor is having a previous preterm birth. Additionally, race can be a risk factor. Although most African American women give birth at term, on average, they are about 50% more likely to have a premature baby compared to Caucasian women. The reasons behind racial differences remain unknown and are an area of intense research at this time. Other known risk factors for premature birth include carrying more than one baby (twins, triplets, or more), problems with the uterus or cervix, chronic health problems such as high blood pressure, diabetes, and clotting disorders, certain infections during pregnancy, cigarette smoking, alcohol use, or illicit drug use during pregnancy.

On the other hand, sometimes doctors need to deliver a baby early because of concerns for the health of the mother or the baby. An early delivery should only be considered when there is a medical reason to do so. If a pregnant woman is healthy and the pregnancy is progressing well, it is best to let the baby come on his or her own time. Although most babies born just a few weeks early do well and have no health issues, some may have more health problems than full-term babies. For example, a baby born at 35 weeks is more likely to have jaundice, breathing problems and a longer hospital stay than a baby born at 37 weeks and beyond. 

It’s important, early on in your pregnancy to talk to us about ways to best control diseases such as high blood pressure and diabetes, how to pursue a healthy diet and which prenatal vitamins to include in your daily supplementation. It is also crucial to take 400 micrograms of folic acid daily before and during early pregnancy. Any concerns about pregnancy and any warning signs or symptoms of preterm labor will need medical attention and the care of a doctor or midwife. 

In most cases, preterm labor begins unexpectedly and with no known cause. It’s important to seek care if you think you might be having preterm labor, because we may be able to help you and your baby delay the onset of preterm labor.

Warning signs include contractions every 10 minutes or more frequently, change in vaginal discharge (leaking fluid or bleeding from the vagina), pelvic pressure (the feeling that the baby is pushing down), dull backache, cramps that feel like a menstrual period or abdominal cramps with or without diarrhea.

Birth is a complex and wonderful process. Fortunately, the outcome for most women is a full-term, healthy baby. More research still is needed to understand the risk factors for premature birth, such as how family history, genetics, infections, race and ethnicity, nutrition, and environment may work together to put some women at greater risk for a premature delivery.

If you have any specific questions about the occurrence of premature birth, feel free to give us a call. 

Additional Resources:

Preterm Birth—CDC's Division of Reproductive Health

Promotes optimal reproductive, maternal, and infant health. CDC scientists and their partners are collaborating with states, university researchers, and partners in health care to understand why preterm births occur, and what can done to prevent prematurity.

Preterm Labor and Birth

More information from the National Institute of Child Health and Human Development.

Premature Babies

The National Library of Medicine provides links to the latest news and research on preterm birth.

Premature Birth

Learn more information about the care of premature babies from the American Academy of Pediatrics.

Healthy Pregnancy

Learn how to be healthy (before, during, and after pregnancy) and give your baby a healthy start to life.

CDC's National Center on Birth Defects and Developmental Disabilities

Promotes the health of babies, children, and adults, and enhances the potential for full, productive living.