Choosing Birth Control

How do you choose a birth control method?  Here is a link to help you understand the effectiveness, benefits and side effects of each method http://www.arhp.org/methodmatch/ . It will help you sort, filter and compare birth control options. It will also help choose a method that works with your unique sexual and reproductive health goals.

If you are seeking implant and/or IUD services we are here for you and will consult with you on those methods as well. If you are away at college or out of the area and need to find a Provider in your area… MyProvider is a free and mobile-friendly locator. This link will give you a searchable directory to make it easy for a woman to find a Provider –   http://larc.arhp.org/ .

As always, we are here to assist you. Please call our office to speak with a Triage nurse or to make an appointment with your Provider to further evaluate your medical needs.

I delivered my baby…. Now what?

A brief review for the first few weeks postpartum.

 

The first few weeks after the delivery of a baby is often a roller coaster ride; the physical changes that occur with a women’s body can be equally confusing. We wanted to discuss some of the physical changes occurring during the first few weeks postpartum and when to notify the office.

Breast changes:

Whether you choose to feed your baby breastmilk or formula you will have breast changes after delivery. Most often by the 3rd to 4th day after delivery a woman’s milk will “come in” and cause engorgement.  A woman may feel like her breasts have grown 3 sizes overnight, and she may notice a free flow of milk.  If you are breastmilk feeding (pumping or nursing) you will simply continue to feed your baby on demand (8 times in 24 hours on average).  If there are any hard areas of the breast, you can try using a warm washcloth, perform gentle massage, and continue to nurse the baby off both breasts starting with the more painful one – these steps can help to make you more comfortable and “work out” the hard area.  If you chose to formula feed, you should wear a tight-fitting bra throughout the day and night as much as possible.  You can apply ice to the breasts and use cold cabbages leaves (DO NOT USE IF YOU HAVE A SULFA ALLERGY) to help to “dry up” the milk as well.  Breast stimulation, touching or even with your breasts facing the shower head, should be avoided until you are no longer producing milk.  NSAIDS (Advil, Motrin, or ibuprofen) are helpful in keeping women comfortable whether breast or formula feeding.

If you develop fever, chills, flu-like symptoms, body aches, breast redness, or you notice a warm or hot area when you touch the breast, please call the office. You may need to be evaluated for Mastitis.

Bleeding/Discharge:

All women will have bleeding in the first few weeks after delivery. After a cesarean section, the lochia (bleeding after delivery) may be a lighter flow than women who have had a vaginal delivery.  Bleeding begins as a red color and after the first 5 to 7 days will become a lighter pink color.  Around 14 -21 days the bleeding will become a tan to white color.  Women may notice an increased amount of bleeding when they first begin to do more physical activity after delivery or have gushes when they are breastfeeding.  Some rest should improve this bleeding.

If the bleeding goes back to red after lightening and persists for more than 2 hours, or if you have a large amount of bleeding like a menstrual period or repetitive golf ball size or large clots you should call the office. Severe pelvic pain, foul discharge, and fever are not expected and if noted you should call the office and speak to a triage nurse.

Episiotomy / Tear / Hemorrhoid Care:

Some women do require an episiotomy, or naturally tear, during a vaginal delivery. The stiches which are used for the repair will dissolve on their own in the first 1-2 weeks after delivery, however this can take up to 6 weeks.  If the stitch remains after this time you can call the office for recommendations.  It is not uncommon to have some soreness of the perineum after delivery.  Applying witch hazel pads to the stiches, using a numbing spray, or using an ice pack may be helpful.  To make an ice pack, you can simply use a sandwich baggie of peas or carrots or get some inexpensive pads or baby diapers and fill them with water and freeze.  They work just as well as the hospital pads.  There are also recipes online – search “Padsickles”.

If you notice any severe perineal pain, foul discharge, or fever you should call the office and speak to a triage nurse.

Hemorrhoids are very common after pregnancy. You should consider taking a stool softener daily until you have returned to your normal bowel schedule.  Witch hazel pads, Preparation H and cushions can be helpful in keeping you more comfortable.

Weight and swelling:

Some women are lucky enough to leave the hospital in their pre-pregnancy clothing, however, this is UNUSUAL. Many women experience a great deal of swelling after giving birth, even once they are home.  Compression stockings, elevation, and hydration are helpful in eliminating the extra fluid collection women can get in their legs after delivery.

If you have calf pain, redness, trouble walking, or one leg is more swollen then the other, this is a reason to call in and speak to a triage nurse.

The baby weight may take some time to lose. Around 2 weeks you can begin to gradually resume your physical activity.  Any water activities should be avoided until 3 weeks after a vaginal delivery and 6 weeks after a cesarean section. Lifting your other children may be okay but you should have them climb up to you as much as possible in the first two weeks.  It is fine to take stairs immediately after delivery, but you should limit the times you take the stairs daily in the first two weeks and take them slowly.

Intimacy:

Intimacy commonly changes after delivery. It is normal for romantic relationships to be challenged; however, it is important for both partners to communicate openly about their needs and expectations.  Women who have had a vaginal delivery should wait until at least 6 weeks post-partum to become sexually active again.  Please remember that contraception (condoms) should be used, even while breastfeeding, if you choose to have intercourse before your postpartum appointment.

Emotional changes:

The emotional changes in a woman after delivery are known to many. It is very common for women to experience some sadness, anxiety, or depressed mood after delivery.  These feelings should improve as you adjust to life with your little one.  It is important to remember to take care of yourself and ask for help if you need it.  If a friend or family member wishes to visit, consider having them make a meal for you or take the dishes out of the dishwasher before they cuddle the baby.  Also try to nap when the baby is napping during the day.  If the emotional or mood changes continue beyond the 2nd week after delivery you may want to consider reaching out to the office for a meeting with one of the physicians.

However, if you ever have feelings of hurting yourself, someone else, or your child this could be a sign of something more.  Please know YOU ARE NOT ALONE.  Please contact 9-1-1, Crisis at UPMC-Pinnacle @ 717-232-7511, or Crisis at Geisinger Holy Spirit @ 717-763-2222.

Other adjustments:

Skin and hair changes are often seen in the first few months after delivery. Women may lose hair or having increased skin dryness.  This can all be normal as your hormones readjust.

Many women experience some urinary leakage after delivery. It may take the full 6 weeks after delivery for you to notice an improvement.  If you are still having urinary leakage at your postpartum appointment you should discuss this with your provider.

 

We hope that this information helps to make the postpartum transition less intimidating.

Menopause Minute

Menopause Minute

To some women, menopause can be a welcomed end to monthly hormone fluctuations and menstruation. Other women find menopause to be extremely emotional, since they may see it as an end of their child bearing years or that they are “aging” or “old”.

Though a natural phase of a women’s life, menopause can be a challenge to navigate. Perimenopause often begins in the mid-40s. This is a time when women can experience menstrual changes, causing cycles which are longer or shorter, and the flow to be heavier or lighter. This change in the menstrual cycle is due to irregularities in a women’s pattern of ovulation. As estrogen production continues to decrease, the menstrual cycle will eventually stop. This transition usually occurs by the mid-50s.The average age of menopause is 51.6 years. Women who have been without a period for 12 consecutive months are then considered post-menopausal.

** Women who are experiencing excessive menstruation (a flow lasting longer than 7 days or filling a pad every hour for 2 consecutive hours), blood clots, or vaginal bleeding that occurs separate from her “normal flow” can call in and discuss their symptoms further with the medical staff.

Hot flashes and/or night sweats can be another bothersome symptom caused by decreased or varying estrogen production. Some women experience these symptoms early in perimenopause, where other women hardly every experience them. Women can try light, “airy” clothing, ice packs, fans, and decreasing stress & caffeine.

**If the symptoms are bothersome, we recommend you schedule an appointment with your provider to discuss your particular case and options.

Another common symptom of menopause is vaginal dryness. This can be a challenging issue since it can affect both the menopausal women and her intimate partner. Women can try personal lubricants found in the feminine hygiene or family planning section of the drug store. Preferable options include water based lubricants (such as KY, Astroglide, Replens, or Luvena).

**If symptoms are unresolved by over the counter products or cause pain and/or bleeding, we do recommend an appointment.

We hope that this basic information about menopause can help to guide you and be a tool to use as you discuss any questions or concerns with you provider.

PARTNERS IN WOMEN’S HEALTHCARE EXPANDS PATIENT SERVICES

Screening Mammography Suite Grand Opening on May 24

Partners in Women’s Healthcare (PIWH) announces the opening of its new 3D screening mammography suite, located on the ground floor of their main location at One Lemoyne Square Plaza, Lemoyne.

Beginning Monday, May 22nd, PIWH mammography clients will be welcomed into a spa-like environment featuring a discrete, comfortable waiting area and warm plush robes. State-of-the-art Hologic 3D digital screening technology adds another level of comfort while at the same time producing high quality images. Having this service available on site and under one umbrella means that PIWH patients can now conveniently coordinate their routine exams with mammography screenings utilizing a single scheduling department.

A grand opening celebration will be held on Wednesday, May 24 from 10:00 AM – 2:00 PM. Current and prospective PIWH patients are encouraged to stop in during those hours to meet staff and enjoy some light refreshments. There will be representatives from the PA Breast Cancer Coalition joining in the grand opening functions. PIWH will also be selling t-shirts to support the PA Breast Cancer Coalition with their mission of education, advocacy and outreach. Be sure to look for their distinctive pink mini-van in the parking lot. Also The Perfect Match Boutique will be participating with representatives on hand to discuss post-breast surgery options available at their Camp Hill location.

Appointments are now being accepted. The experienced staff of PIWH’s Central Scheduling Department is available Monday through Friday, 8:00 AM – 4:00 PM, to answer questions and schedule appointments for the new facility as well as any of the practice’s four mid-state OB/GYN locations. They can be reached by calling 717-737-4511, option 2.

The 3D mammography (breast tomosynthesis) system utilized by PIWH is made by Hologic, the world leader in digital mammography. It offers exceptionally sharp breast images, an advanced ergonomic design providing more patient comfort, and the ground-breaking Hologic 3D Mammography platform designed to deliver superior screening and diagnostic performance for all breast types.

Partners in Women’s Healthcare is a leading provider of obstetrical and gynecological services in South Central Pennsylvania with locations in Lemoyne, Harrisburg, Carlisle, and Newport. The qualified and caring team of physicians, nurse midwives, nurse practitioners and staff strive to exceed the expectations of patients and their families. The new mammography suite is a continuation of the practice’s overall mission to provide excellence in healthcare by blending modern medicine with efficient use of technology in an environment that offers respect, empathy, and compassion.

For more information, visit the website at http://www.piwh.com or call 717-737-4511. They can also be found on Facebook and Twitter @ piwhobgyn.

Healthy Steps Diaper Bank

If you visited any of our offices in December, you may have noticed boxes for donations to the “Healthy Steps DIAPER BANK”. This organization partners with other area non-profit organizations to provide diapers, which are then distributed to families. Accepted diapers can be any brand, new bags / boxes, or opened packages that a child has outgrown.

Our physicians and staff were shocked to learn that, with the cost of diapers being approximately $80 a month, 1/3 of families struggle to buy diapers for their children. WIC and Food Stamps cannot be used to purchase diapers; therefore some families are faced with the decision of paying for diapers or going without other necessities of life. Still other families are forced to reuse diapers or keep a child in a used diaper all day long. Cloth diapers are often not an alternative, since most child care facilities will not accept children in cloth diapers. Additionally, cloth diapers cannot be cleaned in most laundromats.

Partners in Women’s Healthcare accepted donations this holiday season; however Healthy Steps DIAPER BANK is an organization with needs all year long. If you are blessed with extra diapers in any size, or if you are in need of clean diapers for your children, you can visit www.healthystepsdiaperbank.com for more information.

Planning To Take Baby Home

Planning for the delivery of your child, especially the first child, can be a very exciting time. It can also be very scary and stressful. We have compiled some tips to help parents get ready for their new baby.

1. Get an infant car seat and install it into your car by your third trimester. You will need a way to get your new baby home. Check with your local police department or fire department if you need assistance installing the car seat. Check out www.dmv.org/pa-pennsylvania/safety-laws.php for Pennsylvania car seat safety information.

2. Find a Pediatrician. Once delivered your baby will need their own doctor. You can take your child to a pediatrician or a family practice provider who cares for patients of all ages. A great place to start is to speak with friends or family members who have children and who have a positive strong opinion of their child’s pediatrician. You may also want to check with your insurance company to see who is participating with your plan.

3. Consider educating yourself on tips regarding breastfeeding your baby. There are several resources on breastfeeding through www.pawic.comwww.llli.org, as well as online support groups and resources.

4. Consider signing up for a birth preparation class. There are a variety of classes from Lamaze to ‘Preparing for your C/section’.

5. Include family members in classes if you wish. There are a few classes in the area which we can recommend. A schedule list can be provided at any of our offices.

6. Decide if you are going to take a CPR class.

7. Consider having your significant other, grandparents, or any other caregivers get a pertussis vaccine (Tdap). Family members can check with their primary doctor or pharmacy for availability of vaccines.

Consider these as some starting points or a brief primer that might stimulate further thoughts or ideas as you begin a spectacular journey!

Your First Gynecological Exam: When to Schedule Your First Gynecological Exam and What to Expect

Welcome to Partners in Women’s Healthcare. Many young women, and parents, wonder when they should begin to see a gynecologist, also referred to as a GYN. As a general rule, young women should see a gynecologist by the time they turn 21. However, many women decide to see a gynecologist earlier than that age, due to problems with their menstrual periods (irregularity, heavy bleeding, or cramping), vaginal infections, or because they are sexually active and need birth control.

The first appointment with a gynecologist can be scary and intimidating for many young ladies. The staff here at Partners in Women’s Healthcare does everything we can to provide you with a comfortable atmosphere and a friendly and educational experience. About two weeks before your first appointment you will receive a new patient packet in the mail. This paperwork can also be downloaded from our website. You should bring this completed paperwork, photo ID, insurance card, and any insurance copays with you at the time of your appointment. If you are under 18 years old, you will need to have a parent or guardian with you at the time of your appointment.

When you arrive at the office you can check in and then relax in our waiting rooms until your name is called. At that time, one of the medical assistants (MA) will take you to your room, after first stopping for a height and weight. The MA will often ask you for the first date of your most recent menstrual period. You will then go to a consultation room or office to meet with the physician, nurse practitioner, or nurse midwife. They will review your medical history, allergies, and current medications. They will also be able to discuss with you any issue, concerns, questions, or problems you are having. It is very common to be embarrassed or scared to discuss any subjects involving your body, the changes you may be experiencing, or any sexual activities. If you would like to discuss anything privately with the provider just let them know or feel free to say something to the MA. Any information you share with the provider will remain confidential, unless we are required to report something according to Pennsylvania laws. Our providers have extensive experience and will be happy to answer your questions in a professional and compassionate manor.

You will then move to an exam room where you will be asked to change. Once in the exam room you will receive a general physical exam. This includes things like listening to your heart, lungs or feeling your abdomen. Most patients will also receive a breast exam and an external genital exam to ensure things appear normal. If you are experiencing certain complaints or are sexually active you may also have an internal genital exam performed. This exam includes the use of a speculum to look at the vagina and cervix, as well as what’s called a bimanual exam where the provider will feel your uterus and ovaries with their hands.

During the exam the provider can teach you how to perform a breast self-exam, as well as discuss any recommendations, medication, or self-care behaviors.

Tests that may be collected at your appointment will be determined by what concerns or problems you have that day. The provider may collect a urine sample to test for things like a urinary tract infection or a sexually transmitted disease. You may also require a cervical or vaginal culture. This is done by placing a small Qtip like swab on the area and sending the sample to a lab. Blood work is not often required at your first appointment, but may be needed based on your complaints or concerns. PAP smears, a test to detect cervical cancer, and precancerous changes, begin at age 21 for all women.

We hope you find your first experience with Partners in Women’s Healthcare to be welcoming and educational.

American College of Obstetrics and Gynecology. (2015 March). Your First Gynecological Visit (Especially For Teens (FAQ 150 PDF). Retrieved from https://www.acog.org/-/media/For-Patients/faq150.pdf?dmc=1&ts=20160715T1427445635