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by Dr. Meghan A. Nichols, MD

family planning in a covid 19 worldYou had baby names to consider, crunched the numbers financially and were already decorating the nursery in your head. 2020 was going to be your year to begin trying to get pregnant. 

And then COVID-19 struck. 

Pondering the “best” time to get pregnant is a personal decision but as the global pandemic continues, couples are left wondering if this is really the safest time to get pregnant. Many have argued that a pandemic is no time to get pregnant. In fact, in May, a survey of 2000 women found that 34% wanted to delay pregnancy or have fewer children because of COVID-19. Others have argued that we will have a baby boom due to the pandemic and couples being stuck at home, potentially having more time and energy for intimacy.

While the decision to try to conceive may be more elusive due to COVID-19, this decision is absolutely personal, and there are no right or wrong answers. However, it is important to discuss your specific health history with your ob/gyn. Underlying health conditions, such as obesity, diabetes or heart disease, can increase your risk of pregnancy complications as well as the risk of poor outcomes with COVID-19. Fertility challenges also cannot be ignored and no one can guarantee that if you do choose to wait months, or years, for the pandemic to be over, that you will still be able to conceive. It is important to reflect on the urgency of your family planning. If you do decide that trying to conceive is the right choice for you - naturally or with fertility treatments - we have answered a few major pregnancy-related health questions to help guide your decision.

Would I Be High-Risk Because of My Pregnancy?

There is still a lot we don’t know about COVID-19 when it comes to pregnancy. As of now, there is no evidence that pregnant women are more likely to become seriously ill if they contract COVID-19. So far, COVID-19 infections don’t appear to cause congenital complications to the fetus. However, according to the Center for Disease Control and Prevention (CDC), pregnancy alone might increase your risk for severe illness.

by Dr. J. Anthony Heit, MD

is tubal ligation right for youTubal ligation (“tubes tied”) is a surgical procedure that many women elect to have done after they have decided they are done having children. It is categorized under permanent birth control, making the decision to have your tubes tied not a light or easy decision for many. 

In the procedure, your fallopian tubes are either cut, tied or blocked to prevent pregnancy. This process prevents an egg from traveling from the ovaries to the uterus, where it could potentially be fertilized by sperm. Tubal ligation can be done anytime, including after childbirth and in combination with other abdominal surgeries, such as C-section. Once it has been performed, reversal/reversibility is quite difficult and, at times, impossible, requiring major surgery.

The Pros and Cons of Tubal Ligation

Many of the pluses and minuses of this permanent birth control are the same. For example, if you are done having children the permanence is a huge benefit over other birth control methods. However, if you still want to expand your family, that tubal ligation is permanant removes it as a birth control option. Unlike many other forms of birth control, tubal ligation is non-hormonal and once you recover from the low-risk surgery, there are very few risks. Additionally, this procedure may also decrease your risk of developing ovarian cancer, particularly if your fallopian tubes are removed, making it an attractive option to women at higher risk. 

by Dr. Crystal M. Newby, MD

Could You Have Postpartum Depression?

Could You Have Postpartum Depression?From the anticipation during pregnancy to the joy when you first meet your precious new baby, new motherhood brings about so many emotions. There are high expectations from family and friends and society at large that the primary emotions should be ones of happiness, but it is not uncommon for women to experience a range of other emotions, including diagnosable depression.

More than 80 percent of all women experience some version of “the baby blues” after delivery. Thankfully for most, these feelings are short-lived and disappear on their own in a few weeks once hormones balance. However, for some new mothers, the symptoms of feeling down not only linger, but they also intensify.

by Dr. Meghan A. Nichols, MD

vbac how to predict your chance of successCesarean sections can be a life-saving procedure for mother, baby or both. However, there are many reasons why vaginal birth is preferable when possible. More and more women are able to successfully give birth naturally after a cesarean (VBAC), however, there are many factors that go into calculating the odds of success. 

Benefits and Risks of Vaginal Birth After Cesarean

C-sections account for almost a third of all first births in the United States. The success rate of VBACs is between 60 to 80 percent. VBAC often carries fewer risks than a repeat cesarean and offers a shorter recovery time and hospital stay, better bonding with your baby, and a higher chance of successful breastfeeding. If you plan on having more children, being able to have a successful VBAC will also decrease your risks of placental problems associated with multiple c-sections. 

However, a failed trial of labor that results in an emergency c-section is often riskier than a repeat planned c-section. Emergency c-sections carry a risk of uterine rupture, which can be life-threatening. The risk is low, occurring in about 1% of women attempting a vaginal birth after cesarean. 

Deciding if Vaginal Delivery Is Right For You

If you are interested in attempting a vaginal birth after cesarean, the conversation should begin with your ObGyn. Risks vary between individuals, so before making any decisions you should talk to your care provider to assess your specific risks to make an informed decision. Successfully having a VBAC depends heavily on the reason for your initial c-section. 

Your chance of successful VBAC improves significantly if you’ve had a least one vaginal birth before your cesarean, it’s been over 18 months since your c-section and if you have no obstetric problems such as placenta previa or fibroids that could make vaginal delivery risky. Your chance of VBAC success may be lower if you are over 34 years old, you are overweight, your baby is large, and if you go over 40 weeks. 

Preparing for a VBAC

There are several ways to increase your chances of successful VBAC. Generally, the healthier you are, the greater your odds of a vaginal delivery.

First, you need to be vigilant about weight management. Big babies tend to have long labors, increasing the risk of cesarean. Achieving a healthy weight gain and eating healthy can help you avoid gestational diabetes and keep your baby’s growth on track. When you are preparing for a VBAC, it is also important to have an accurate due date so that size predictions are reliable. An early ultrasound is the best way to determine an accurate date of conception and due date. 

It’s important to keep your blood pressure down. High blood pressure, or hypertension, can increase your chance of c-section. Keeping active and getting exercise each day can help keep blood pressure down. 

what is a menstrual cupTraditional feminine hygiene products like tampons and pads are still the most commonly used options amongst women during their menstrual cycle. However, there are alternatives, such as the menstrual cup, that has risen in popularity. 

What is a Menstrual Cup?

Menstrual cups are a feminine hygiene product intended for internal use, similar to a tampon, to collect menstrual fluid. Most commonly made of silicone or latex rubber, the cup is bell-shaped and some have a stem for easier insertion and removal. There are both reusable and disposable models on the market. Reusable cups can last several years with proper care. There are several brands, many available at major retailers, offering different sizes based on age and whether you have previously given birth. 

by Dr. Crystal M. Newby, MD

Winter Weather and Your PregnancyExpectant mothers often become very familiar with looking after their body throughout their pregnancy and preparing for childbirth. It’s common for all pregnant women to experience some discomfort and difficulties at points during their pregnancy but this can be aggravated in the erratic weather characteristic of the Kansas City winter. As well as staying warm, it’s also important to keep your body healthy and your mind happy during the cold winter months.

Here are six tips to prepare for the winter weather and your pregnancy.

1. Stay Safe On the Ground

The icy, snowy or wet ground poses a falling risk to pregnant women. Always stay alert when walking around, using steps and even getting in and out of the car. In extremely icy conditions, you might want to consider staying in, when possible, until the weather improves. You can best prepare for the hazardous, wintery conditions by investing in some high-quality winter boots with traction, and having deicing salt handy to use on your driveway, sidewalk and home entrance.

Sometimes falls can happen even when careful, so if you fall, don’t panic.  In most cases, it won't cause damage to you or your baby, but be sure to check with your doctor if you’re concerned.

Though it can be difficult to ask for help, don’t be afraid to ask for a hand where you need it!

7 Signs You Should Speak To Your OB About Infertility

Tired of Seeing Another Negative Pregnancy Test? 7 Signs You Should Speak To Your OB About InfertilityFertility difficulties are real and unfortunately affect many couples. Around 10% of women have trouble getting pregnant or carrying to term. It is normal for it to take some time to conceive, but if it’s been over a year (six months if you are over 35) or any of these seven signs apply to you, it’s time to speak with your obstetrician about infertility. Don’t just wait and hope it will happen next cycle. There are many ways to get help conceiving.

1. Are You Over 35?

When it comes to getting pregnant, age actually matters. If you are trying to get pregnant and are 35 or older, you should know that your odds of conceiving are reduced to 15-20% in a given month. As long as there are no other risk factors, many women successfully conceive and carry healthy babies to term. However, if you have been trying for more than 6 months, it’s time to speak with your OB about tracking your ovulation and potential fertility treatments available to you.

by Dr. Emily S. Minderman, MD

seven reasons to consider IUDWhen women in the US think about contraception, most only think of pills. However, worldwide, intrauterine devices are by far the most commonly used forms of reversible contraception, in stark contrast with the US where pills are still commonly used and intrauterine devices rarely are; in fact, estimates from the Guttmacher Institute indicate significantly more US women use pills and condoms than IUDs. Here we present seven reasons to consider an intrauterine device:

IUDs can prevent worry or surprises

The statistics from the US in regards to contraceptive choices are rather puzzling considering the many advantages of IUDs in comparison to pills and condoms. For starters, they are much more effective. The effectiveness of contraception is commonly expressed in terms of the failure rate, namely “if 100 couples used that method for a year while engaging in regular PIV sexual intercourse, how many would be expected to get pregnant?”

Usually two numbers are given, one with “perfect use” and one with “actual use out in the real world.” These two numbers reflect the difficulty couples have in precisely following contraception instructions – for example, “perfect use” of the pill is rather unrealistic, according to “SOURCE”

In the US, estimated failure rates for methods of contraception are:

  • No contraception: 85
  • IUD: 0.2
  • Birth control pill: 1 perfect use; 9 normal use
  • Condom: 2 perfect use; 15 normal use

Choosing a health plan can sometimes be the most confusing part of participating in your own medical care. This is true for everyone, but especially for teachers, who may have more limited options in our area. At Kansas City ObGyn, we understand that and we want to make your trip to the doctor as simple as possible. With open enrollment upon us, here are some more pointers to help you pick the right plan.

Teachers: Before You Choose BlueSelect, Consider This

open enrollment for teachersSince choosing the right health care for your specific needs can be complicated, we want to make sure that you are aware that Kansas City ObGyn is in-network if you choose BlueSelect and BlueSelect Plus plans. However, Overland Park Regional Hospital, where our team has privileges, would be out-of-network for these plans. 

For 2019, there are three BlueSelect Plus plans available: BlueSelect Plus PPO, BlueSelect Plus HDHP and BlueSelect Plus EPO, a new option. For all these plans, you will be left with the same issue: Kansas City ObGyn will be in-network but Overland Park Regional Hospital will be out-of-network. 

Teachers in Blue Valley, Shawnee Mission and Olathe have six health plans to choose from during open enrollment. Other options can allow you to choose the right health plan for you and still stay with your preferred provider at Kansas City ObGyn for your entire pregnancy and delivery at Overland Park Regional Hospital. 

by Dr. J. Anthony Heit, MD

What Is Pelvic Prolapse?

what you need to know about pelvic organic prolapseYour pelvic tissues and muscles cradle and support your pelvic organs. Pelvic organs consist of the uterus, bladder, rectum, cervix and vagina. When pelvic prolapse occurs, the muscles and tissues of the pelvic become weak or damaged and can no longer support the organs. As a result, one or more of the organs of the pelvis drop (prolapse). Prolapse of the pelvic organs can be extremely uncomfortable and requires medical diagnosis and treatment. Although rare, prolapse can occur after a hysterectomy procedure when any part of the vaginal wall may collapse and bulge into or beyond the vaginal opening.

Prolapse of the pelvic organ is just one type of pelvic floor disorder. The most common disorders are:

  • Urinary incontinence - the leaking of urine
  • Fecal incontinence - the leaking of stool
  • Pelvic organ prolapse - the loss of support of the organs in the pelvis

What are the Different Types of Pelvic Prolapse?

Anterior Vaginal Wall Prolapse (Cystocele or Urethrocele) is the most common type of pelvic prolapse and occurs at the top of the vagina when the bladder’s supportive tissue stretch or detach and the bladder falls into the vagina.  Posterior Wall Prolapse (Rectocele or Enterocele) occurs when the supportive tissues of the rectum stretch or detach from the pelvic bones and the rectum bulges into the vagina. Uterine prolapse occurs when the pelvic muscles and tissue weaken, allowing the uterus to drop into the vagina. Uterine prolapse can sometimes be associated with prolapse of the small bowel, called enterocele. When enterocele occurs, the small bowel or small intestine may bulge into the vagina.

Managing Your Painful Periods

Excessively painful periods with intense cramping is a condition called dysmenorrhea, which is one of four abnormal types of menstrual periods. Many women suffer from dysmenorrhea with every menstrual period and the pain can range from mild discomfort to disabling pain. Often women will find their pain to lessen after giving birth the first time but some women continue to experience significant pain even after having children.

Dysmenorrhea (AKA Painful Periods): Symptoms, Causes and Treatment

What Causes Menstrual Cramps?

Period cramps occur when the uterus contracts during your menstrual period. Your uterus is a muscle that may contract quite strongly during your period. If the uterine muscles contract too strongly due to an excess of prostaglandins, the muscles may cut off the supply of oxygen to that area, which in turn causes pain.