It has been raining babies these past few weeks, keeping Dr. James and I very busy! As I reflect back on the different birth experiences, what jumps out at me is 2 dramatically different birth stories. In one birth story, I was with a woman who seemed to effortlessly labor with and birth her beautiful baby girl in a hands and knees position. The lights were dim, relaxing spa music created a soothing environment, and dad helped to catch the baby girl just as we had planned. The other was a woman who underwent an induction of labor, and despite her total commitment to unmedicated birth and the incredible strength and dedication she brought to the table, she got the absolute opposite experience she had desired. We had a healthy mom and healthy baby at the end, but it required 36 hours of labor, multiple epidurals, and a cesarean delivery under general anesthesia to achieve it. Almost nothing on her birth plan unfolded the way she planned. I spent a lot of time with each mama in the days following the birth, admiring the new babies, debriefing the birth experiences, and offering support and advice for the postpartum period. What strikes me as amazing is how equally empowered these two women felt in the days following their births.
How is that possible? One thread of commonality is that both had a strong relationship with a trusted provider. What I love about midwifery is that at its core it’s about a relationship and sense of trust between a woman and her midwife. My objective is to develop a sense of rapport with a woman and her family through the journey of pregnancy, and then at the time of birth be a calming presence and offer guidance when obstacles arise. I aim to hold the space for the woman and her family to explore options, ask questions, review alternatives, and have time to process as we move through the birthing experience. The reality is that I (and all midwives and OBGYNs) have no idea how the birth will go, or how the baby will ultimately deliver. Sometimes babies dictate a different course of action than what a woman wants, and we need to be flexible. Having a trusted provider at your side, someone that you know is supportive of you and your desires, can make all the difference and make for an empowering experience regardless of the outcome. In thinking about my mama who ended up with a cesarean birth, she and her partner shared in the decision-making. They chose the epidural, they chose to proceed with surgery for delivery. They have total confidence that we exhausted all options. While safety of mom and baby is our absolute top priority, the journey is important too.
Dr. James and I work in a truly collaborative practice, where women have access to both a midwife and a doctor on a personal level throughout their pregnancy. Our goal is to build a relationship with you and enable your birthing experience to be one of the best experiences of your life. Regardless of whether you want an elective cesarean or an unmedicated birth using Hypnobabies and essential oils, having a supportive team by your side is critical to having a safe and empowering pregnancy and birth experience. Dr. James and I would love to be your team!
The cervix is just one small organ on a woman’s body. It is the passage way for childbirth. Keeping your cervix healthy can prevent many long-term problems and help keep you out of the doctor’s office.
Back in the early 1900’s, Dr. Papanicolaou changed women’s health care indefinitely. He instituted a screening test to help lower the incidence of cervical cancer worldwide: The Pap Smear. Cervical cancer affects over 12 thousand women worldwide annually and causes over 4 thousand deaths. This screening test immediately became an integral part of our annual well women’s visit. The question that has arisen over the last 20-30 years is not the validity of the test but the necessary frequency of the test.
Since this discovery women have been making a conscious effort to visit the OBGYN for ‘their annual pap’. Prior they may have seen the OB for pregnancy, irregular bleeding, contraceptive counseling, abdominal pain, abnormal discharge or menopausal symptoms. If none of these issues were concerning then a visit to the GYN was nonexistent. The pap made the annual visit necessary, fashionable and more importantly made women aware of all the other issues in women’s health. We as OBGYN’s have the opportunity to encourage mammograms, colonoscopies, bone health, exercise, nutrition, family planning, contraceptive options, STD prevention, emotional support and therapy and referrals to other health care specialists who can help improve women’s health and quality of life.
In 2003, our awareness of the relationship between HPV (Human Papilloma Virus) and pap smear abnormalities became more evident and we now incorporate HPV screening with the pap smear for a more comprehensive understanding of cervical cancer risk factors. In 2008 the Nobel prize in Physiology or Medicine was given to Harald zur Hausen for his discovery of “human papilloma viruses causing cervical cancer”
We know that most of cervical cancer is caused by high-risk types of HPV. We now do co-testing which includes a pap smear with HPV screening routinely for all women over 30 years old.
Now to review the screening plan:
- Begin screening for all women at age 21, not before.
- Between the ages of 21-30 we perform a pap every 3 year.
- Ages 30-65: Pap every 3 years or co-testing every 5 years. (Pap with HPV)
- If age 65 or you had a hysterectomy removing the cervix you can stop testing.
- If you are HPV positive then repeat your pap in 1 year.
- If your pap is abnormal then you need further testing: a colposcopy.
Beware: Shorter testing intervals may lead to the detection of many more clinically insignificant transient HPV infections, which results in many more colposcopies and potential procedures, with negligible additional reduction in cancer risk.
In 2006, the Food and Drug Administration approved a vaccine against the human papilloma virus. The vaccine prevents most cervical cancers and genital warts. It is a simple 3 shot series you can get with any health care provider especially your child’s pediatrician or your OBGYN (a pelvic exam is not required). It is recommended to children ages 9-26, preferably prior to sexual activity. It is very safe, very effective and can PREVENT CANCER!
You can find information on the web about pap smears, cervical cancer and prevention. Please do your research and take advice from your physicians or health care provider. My last bit of advice for prevention of cervical issues is “don’t trust anyone, use a condom and please stop smoking”, these 2 are the leading causes of getting and worsening cervical cancer and simple things to do to prevent cancer.
The overwhelming euphoria of delivering a baby is one of life’s greatest pleasures. Not only are you bringing a child into the world that is made in your image but you get to physically, emotionally, and intellectually experience an unbelievable life altering chain of events. From the decision to prevent pregnancy to the ‘golden hour’ your life is ever changed.
The experience of childbirth may be a singular event or a repeated cycle but is limited in number. Why not make each experience the best it can be? We plan vacations, parties, weddings and Bar Mitzvah’s to help ensure we get the experience we want why should childbirth be any different. With the right set of friends your party will be a raging success, same goes with your health care providers. I see many patients in consultation who are unhappy with their present choice in Obstetrician because they are either ‘too busy to listen’ or snicker when they discuss their ‘birth preferences’.
Obstetrics in Latin means ‘to stand by.’ Over the past 30 or more years’ physicians have changed that definition to actively manipulate labor to help ‘ensure a fast, safe and pain free experience’ where emergency care is readily available and cesarean sections are an alternative not a last resort. We have seen the cesarean section rate reach an all-time high of over 33% of births. If this was acceptable then there would not be a national push to lower the cesarean section rate with an aim of under 15%. The best way to change this culture is to readdress guidelines and reintroduce midwifery care into modern day practice.
Since I moved to Laguna Beach in 2007 I have had the privileged to consult and supervise several Certified Nurse Midwives. Not only have they impressed me with their skills, compassion and attentiveness to pregnant women but they have helped recreate my views, attitude, and even my skills in the field of obstetrics. I have gained a greater appreciation of the natural progress of labor, the different techniques of coping with natural labor and the patients to wait ‘just a bit longer’ for progress. With this new attitude, my cesarean section rate has cut in half, my patient satisfaction scores have doubled and I feel prouder to be an Obstetrician.
Not only has my attitude towards childbirth changed but so has our nation. New recommendations and guidelines have been published by the American College of Obstetrics and Gynecology in 2017. They have recently expanded their opinion on labor management as well as views on midwifery care. Recently I expanded my practice to include a Certified Nurse Midwife, Allison Molinski. We established the first true Physician/Midwife collaborative practice in Orange County. Patients see both of us during their pregnancy and then get both of us for delivery. It is unique in the sense that you will not find such a comprehensive and collaborative practice anywhere in Orange County not to mention there are very few in the United States. Midwives are low risk obstetric speicalists and physicians are high risk specialists. Together we offer excellent care, an amazing experience with wonderful outcomes, all this to ensure happy new parents.
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