May’s blog was contributed by our CNM, Shelia Love.  Shelia’s focus in this blog is on Women’s Health Care.  One of our goals at The Midwife Group Women’s Health and Birth Center is to provide care to women throughout their lifetimes, and Shelia is one of our midwives helping us achieve that part of our mission.  

Gyn-Ecology

        Vaginal irritation, infections, discomfort, odor and leaking of urine are the most common reasons women seek out gynecological care. Thousands of dollars are spent annually on feminine hygiene products. Many of these items cause more harm than good. Most women self diagnose and treat for prolonged periods of time before contacting a health care provider.  

        Many of these disorders and discomforts are self-induced. Social media, magazines and television bombards us with products for various disorders or just to make us feel “fresh”. So we purchase and use these items, not knowing that they may actually cause more problems.

        So let’s sort out the facts. Nature has physiologically provided the vagina with a self-cleaning balanced environment. Vaginal discharge and personal odor are normal and fluctuate with hormonal changes, menstrual cycle, pregnancy, sexual activity, breastfeeding, menopause, diet and many types of medication. Odor should not be offensive or fishy. Normal discharge may change from a slippery egg white consistency to creamy or thick white. Normal vaginal balance supports lubrication, pleasurable sexual experience, urinary functions prevents infections, and assists in facilitating conception and birth.

        Vaginal balance is measured by the secretion’s pH. pH is the measurement of a solution’s acid or base status on a scale from 0-14. 0 being the most acid and 14 the most base. The vagina’s ph ranges from 3.5 to 6-7 associated with hormonal changes. This range can leave the vagina/genitals more susceptible to common infections.

        Common feminine products, laundry detergents, aggressive cleaning, or personal hygiene practices can interrupt this fluctuating environment. Your sexual partner’s cologne, lotions or soaps can also disrupt the vaginal eco system. Plant based oil lubricants (coconut, olive oil) are very popular, but are not compatible with safer sex barriers made from latex or polyisoprene.

        So here are the  do’s and don’ts of maintaining proper vaginal balance:

DO’S 

• Use mild soap for washing your body including anything that enters the vagina hands, objects, penis (i.e. plain bar Dove or Pure and Natural)
• Remove underwear as often as possible for better air flow
• If necessary, use lubricants compatible with vaginal pH (ex. Luvena)
• If you notice an odor, itch or discharge fill bath tub with 4-5 inches warm water add ½ cup table salt, sit in tub, depress vaginal opening and swish water in vagina for 2-3 minutes 3 times a week.
• If you are prone to vaginal infections consider daily probiotic specifically for vaginal and urinary health (ex. Fem Dophilus, RepHresh Pills)

DON’TS 

• Douche
• Routinely use panty liners
• Use feminine wipes
• Deodorant pads or tampons
• Bleach underwear (peroxide will remove stains especially blood)
• Use dryer sheets for underwear (air dry is ideal)
• Use antibacterial or perfume soaps, lotions or sprays (including sexual partner) on anything that enters the vagina
• Wash sex toys with antibacterial soap or alcohol (use warm soapy water with Dove or Pure and Natural, rinse and air dry)
• Share toys

REMEMBER – if you experience pain, fever or abdominal tenderness or signs and symptoms increase, contact your healthcare provider for evaluation.

        Protecting and maintaining vaginal health is a part of your long-term health and wellness. Like many health issues our choices may make the difference between wellness or disease and impact quality of life

       There are many over the counter homeopathic products that maintain vaginal health or treat imbalances or infections but only your health care provider can recommend the proper one for your specific situation.

        If you have concerns about any ongoing vaginal or urinary issues, contact me and together we can make a plan to improve your intimate feminine wellness and quality of life.

Shelia Love
Certified Nurse Midwife

Our blog today is written by one of our Certified Nurse Midwives, Stephanie Curtis, CNM, DNP  

“If I don’t know my options, I don’t have any.” – Diana Korte

Every woman deserves the right to choose where and how she will birth her children. She may wish to introduce her child to the world in the comfort of her own home. She may desire the benefits of epidural anesthesia. She may opt for a midwife or a physician as her prenatal care provider.

But at the end of the day, with the appropriate education, I believe every woman would choose the safest option for herself and her baby.

The safety concern usually has to do with her medical history and development of her pregnancy. There are important questions which should be asked at the onset and throughout prenatal care to help determine the best “where” and “how” for every woman. Most of us have heard the phrase “high-risk pregnancy” too often. While there are many mothers out there who have endured those difficult circumstances, there are at least twice as many whose experiences have been relatively uncomplicated. The University of California San Francisco (an internationally recognized leader in women’s health care) reports, “High-risk complications occur in only 6 percent to 8 percent of all pregnancies.”

That means, many women are good candidates for out-of-hospital birth. Here, at The Midwife Group and Birth Center, we complete an initial screening via phone to confirm this is the case. Our role in the health care system is to exclusively support physiologic birth. We recognize there are conditions which are more likely to cause the process of pregnancy to depart from its normal course. Let’s explore some of those pre-pregnancy factors further.

 One of the first questions we ask is about previous uterine surgeries, primarily, cesarean sections. When it comes to vaginal birth after cesarean (VBAC), uterine rupture is the complication which is most often mentioned. Research shows the absolute risk of uterine rupture to be less than 1% in both women who choose an elective repeat c-section and in those who choose a trial of labor after c-section (TOLAC). We are huge proponents of VBACs, but the state of Georgia’s regulations will not allow us to attend those deliveries at the birth center.

Next, we’ll ask about your health history. Chronic issues such as hypertension and diabetes often affect pregnancy and labor in such a way that a hospital birth is needed. If you are taking medications which are not recommended while pregnant, in many cases, we can help you find an appropriate alternative. We will use your height and pre-pregnancy weight to calculate a body-mass-index (BMI). If your BMI is 40 or above, an out-of-hospital birth could be potentially unsafe. You can calculate your BMI here https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. The great news about BMI is that it can change! If you are planning to become pregnant and hoping to be a birth center client, we would be happy to see you for an annual exam or preconception visit where we could help you identify goals and plan to optimize yours and your future newborn’s well-being.

Lastly, there are a few misconceptions about what makes someone “high-risk”. For example, having had first trimester pregnancy losses or being 35 years of age or older when you become pregnant DOES NOT make you a “high-risk” patient. The same goes for couples who have had assistance with conception via medications or procedures such as in vitro fertilization (IVF) or intrauterine insemination (IUI). We would much rather have a conversation with you about these subjects than to have you rule yourself out. Here are some examples of truly high-risk conditions: carrying twins, a baby who remains breech after unsuccessful attempts to turn, bleeding disorders, pre-eclampsia or high blood pressure in pregnancy, and having too much or too little amniotic fluid.

A birth center, while a wonderful option, is not the safest option for every woman. You may be unable to choose a birth center but may still be able to choose a midwife depending on where you live. Many hospitals and physician practices work closely with midwives who provide prenatal care and who attend births on your local facility’s labor and delivery floor. You can search for a midwife here http://www.midwife.org/find-a-midwife.