OBGYN | Gynecologist | Chicago | OB GYN Blog

An increasing number of patients are now forgoing hospital visits and opting for in-office surgical procedures in private practices, reducing stress and saving time and money during a recession. Medical technology and anesthesia have advanced so that physicians in private practices can now perform procedures that once required a hospital, outpatient surgical setting - procedures established by the industry as safe, yet have the advantage of retaining a patient’s privacy and allowing them to be in more nurturing, less clinical environments. This trend has drastically increased in recent years, with USA Today reporting in January that visits to free-standing surgical centers have tripled to 15 million surgeries and procedures from 1996 to 2006.

At the Northwestern Specialists for Women, we are doing more and more in-office procedures that used to be performed only in hospitals. We offer a full range of surgical services that allow us to administer the same anesthesia for comprehensive procedures that a woman would typically receive in the hospital. Some of the more common in-office procedures performed at NSW include dilation and curettage, diagnostic hysteroscopy, hysteroscopy with polyp removal, endometrial ablation for abnormal menstrual bleeding, simple perineorrhaphy and more.

Patients recovering in our office receive much more personalized care, report quicker recoveries and also save money. Many patients are also comforted knowing that their spouse, significant other or simply a friend can be with them during their recover time.

More patient benefits from the growing demand for in-office procedures include:
• Comfort – As opposed to lengthy hospital stays, patients recover more comfortably which in turn typically reduces the recovery time.
• Convenient Scheduling – A hospital visit can take several days, whereas an in-office or outpatient procedure can be completed in one day.
• Lower Cost – Medical bills are greatly lessened without a lengthy hospital visit. Patients also don’t need to sacrifice work time or paid time off, which is particularly critical with the current economy.
• Decreased Stress – Patients don’t have to worry about being away from home and their family.
• Pleasant Environment – As opposed to the often sterile hospital environment, more progressive facilities such as NSW provide a calm and soothing environment and relaxing décor to set patients at ease.

At NSW, were are a progressive full service obstetrics and gynecology practice providing superior medical services and cutting-edge procedures for women of all ages. For more information on the array of in-office surgical procedures we offer, feel free to stop in to take a look at our facilities and speak with any of our staff members, or simply call 312.775.1100 for more information.

By Denise Mann
WebMD Feature
Reviewed by Louise Chang, MD

women’s minds, especially when they are dealing with nausea, vomiting, and overwhelming fatigue. Other women, however, may crave sex in pregnancy. And men, too, are split into different camps regarding sex during pregnancy. Some men may find nothing sexier than a pregnant woman, but other men may be too afraid of hurting the baby or their pregnant partner to enjoy sex.
But desire aside, is sex during pregnancy even safe?

The good news — or bad news, depending on how you look at it — is that “sex during pregnancy is extremely safe for most women with uncomplicated, low-risk pregnancies,” says Dayna Salasche, MD, an associate professor of obstetrics/gynecology at Northwestern University Feinberg School of Medicine and an obstetrician at Northwestern Specialists for Women, both in Chicago. “Some people feel like they enjoy sex during pregnancy more and others enjoy it less,” she tells WebMD.
Trimester by Trimester Guide to Sex During Pregnancy

During the first trimester, many women report no great desire for sex because they feel tired and nauseous, but during the second trimester, “they are feeling better, there is more lubrication, and they have engorgement in the genital area,” says Monica Foreman, MD, an obstetrician at Montefiore Medical Center in the Bronx, N.Y. This makes sex more appealing and potentially more satisfying. What‟s more, most women are still fairly comfortable during second trimester because their stomach is not overly rounded yet. This is not quite true during third trimester. As the stomach grows and fatigue returns with a vengeance, sex may seem less attractive — not to mention physically difficult during the final weeks of pregnancy.

If the dad-to-be is nervous about having sex with his increasingly pregnant partner, “we tell them that their baby is well protected. It is an egg surrounded by a pillow and another pillow and that there is no way they will hurt the baby, and that usually makes them feel much better,” Salasche says.
Whether or not having sex close to your due date during third trimester can bring on labor is an old wives‟ tale, but having an orgasm causes the release of prostaglandins, which can theoretically cause contractions.
“At 40 weeks, this can‟t hurt,” Foreman says.
Sexual Positions During Pregnancy
“As she grows, the traditional man-on-top position is more uncomfortable for pregnant women,” Foreman says. Other, more comfortable sexual positions during pregnancy may include intercourse from behind or side-to-side (spooning).
And “at some point, a pregnant woman should not be flat on her back because the growing uterus can compress major blood vessels,” Salasche says. This can cause pelvic pressure and pain. This phenomenon typically occurs during the third trimester. Lying flat on her back can also cause “supine
hypotensive syndrome,” which results in a change in heart rate and blood pressure that can lead to dizziness and other symptoms or signs.

One sexual act to avoid during pregnancy is blowing during oral sex, Foreman adds. “If oral sex is performed on the pregnant woman while blowing air into the vagina, the woman can develop an air embolus, which can travel to the lung and have potentially fatal consequences.”
Reasons to Avoid Sex in Pregnancy Sex during pregnancy may not be safe for women with a history of repeated miscarriages, preterm labor, bleeding, or an incompetent cervix (a condition in which the cervix effaces and dilates without contractions in the second or early third trimester, when the baby‟s weight puts increasing pressure on it), she says.

That’s not all. Women with placenta previa (a condition where the placenta is covering the cervix) are at risk of hemorrhaging if they have sex during pregnancy. Women with premature rupture of membranes (PROM), which occurs when the sac containing the developing baby and the amniotic fluid bursts or develops a hole before labor, should also avoid sex during pregnancy, Salasche says.
“If there are not any contraindications, a woman can have intercourse throughout her whole pregnancy,” Foreman says.

Other red flags that sex during pregnancy may not be wise may occur after intercourse. “If you have bleeding or foul-smelling discharge after sex during pregnancy, tell your doctor right away,” she says. Discharge may be a sign of an infection that can travel upward to the uterus, and bleeding may be a sign of a problem in general.

Pregnant women should also be aware that if their partner has an STD, they still need to use a barrier method of contraception, such as a condom, to protect themselves.
“Most people think, „I am pregnant, I don‟t need contraception,„ but you still need a barrier method for protection against STDs,” says Manju Monga, MD, the Berel Held Professor and the division director of maternal-fetal medicine at the University of Texas Health Sciences Center in Houston.
Let’s Talk About Sex During Pregnancy

“We discuss intercourse in the general prenatal discussion because a lot of women feel uncomfortable bringing into up,” Foreman says. “We tell them what is and isn‟t OK.”
“I do bring up sex during pregnancy when it is contraindicated,” says Monga, who sees mainly high-risk patients. “Physicians who see low-risk pregnant patients on a day-to-day basis discuss sex at the first prenatal visit, but I tend to see women later in their pregnancy, when they develop complications.”
The bottom line when it comes to sex during pregnancy is “to have fun, listen to your body, and be open with your partner,” Salache says.

ABC Online
Healthy Tips for Women
Tues, January 13, 2009 | 12:10 PM

While hopes for successful New Year’s resolutions always run high, it is unlikely that you’ll lose pounds in 2 months, quit smoking, give up sweets forever, get to the gym 7 days a week, and never drink a glass of wine again. Unrealistic resolutions are commonplace, with statistics showing that 90% of Americans make annual resolutions and 30% are broken within one month.

To combat stress and have better women’s health in a shaky economic environment and take steps towards being healthy and happy in 2009, gynecologist Dr. Seema Venkatachalam of Northwestern Specialists for Women offers 10 realistic and everyday resolutions for women to consider for better women’s health in Chicago.

1. Build Strong Bones
Osteoporosis is a health threat for 44 million Americans, but with vitamins and diet you can build strong healthy bones, increase calcium in your diet with three servings of dairy a day, such as skim milk, low-fat cheeses and yogurt. Nondairy options include canned salmon with bones, dark green vegetables, dried beans and calcium-fortified juices and cereals for better women’s health in Chicago.

Recommended Calcium Amounts:

From age 11 to 24, between 1,200 and 1,500 milligrams daily
From age 25 to 50, 1,000 milligrams daily
For postmenopausal women 1500 milligrams daily, 1200 mg if on menopausal hormone therapy
For pregnant and breastfeeding women, 1,200-1,500 milligrams daily

2. Dose Up on D
Without the proper amount of Vitamin D. calcium absorption is reduced. Vitamin D is found in fatty fish, fish liver oil and dairy products fortified with vitamin D. The recommended amount for adults is 200-600 international units a day. Vitamin D is also great for combating symptoms of winter depression during the long and dreary Chicago winters.
3. Get Checked Out

Take a trip to the doctor and do the recommended tests to solidify a clean bill of health.

Osteoporosis – screenings recommended for women 65+
Annual Mammograms – should being at 40
Annual Pap Smears – should begin at 21
Colorectal Cancer – start screening at 50
Skin Cancer – screenings should begin at 50
Blood and cholesterol tests – should be taken every 5 years, starting at 20

*begin testing earlier if you are predisposed or have a family history with a health risk and visit a gynecologist or ob gyn on a regular basis.

4. Get Active & Make Fitness Fun

For better women’s health in Chicago get your body moving and your heart rate up for at least 30 minutes a day. 3-5 times per week. Not only does regular exercise reduce stress, your energy and metabolism levels will increase. So, take the stairs and explore different sports to see what you enjoy most. If fitness isn’t your favorite activity, consider something different like belly dancing classes, yoga, pilates, pole dancing, aerobics, self defense and more. A tip for the early birds: working out in the morning is best because it keeps your metabolism high all day!

5. Drop Sizes Safely

Weight loss goals are safest for the body when achieved slowly over time. Losing 1-2 lbs. per week is a healthy, realistic goal. Of course, you may lose weight and stay the same on the scale – keep in mind that muscle weighs three times as much as fat!

6. Portion Control

Denying yourself every food you crave will simply make you desire more. Instead, allow yourself to eat meals and snacks in moderation and appropriate size portions while avoiding seconds. For example, one serving of meat (3 oz.) should be about the size of a deck of cards, while one serving of pasta (1/2 cup) is the size of a tennis ball.

7. Make Sense of Nutrition

It is hard to change your body without understanding what you should be putting in it. Start reading the labels of your products and research the recommended amounts of each food group. Over time, things will start to make sense. For those looking to learn quickly, consult a nutritionist or research online.

8. Curb Caffeine and Hydrate

Over 50% of Americans above the age of 18 drink 3.1 cups of coffee per day, while soda consumption is now reported to be growing even more rapidly. Not only do these beverages add chemicals to the body, they also dehydrate.  Cut down on caffeine and increase your water consumption. Easy tip: before every cup of coffee or soda, drink a glass of water first.

9. Cut Back on Alcohol and Cigarettes

Quitting smoking isn’t easy, but if you adopt a healthier lifestyle you will find your cravings will lessen. With strength and will power, they can go away for good. All changes are gradual, so if you slowly decrease your intake of both, you will find that you don’t need them like you thought you did. To achieve optimal health or if you are trying to conceive, you should not smoke at all and limit alcohol intake to the equivalent of one unit per day.

10. Guard Against Stress

With family, the house, friends and an economy in chaos, it is easy for the stress-o-meter to hit the red zone. It is imperative to take steps to de-stress; without doing so your job, relationship, happiness and overall health will suffer. Pamper yourself with a massage, warm bath or a quiet night in at least once a month, if not more.

For more information: visit these websites:
http://www.e-importz.com/Support/specialty_coffee.htm
http://www.cancer.org/docroot/PED/content/PED_3_2x_Portion_Control.asp
http://www.associatedcontent.com/article/166413/weight_loss_tips_for_real_people.html?page=3&cat=5
http://www.women.webmd.com/features/health-resolutions-for-women?page=3
http://www.webmd.com/menopause/guide/health-checklist-for-women-over-40
About Dr. Seema Venkatachalam, Physician with Northwestern Specialists for Women

www.nswobgyn.com
Dr. Venkatachalam graduated from the University of Pennsylvania with a BA in Biology and French Literature. She received her Masters in Public Health from the George Washington University in Washington D.C., specializing in Epidemiology and Biostatistics. After earning her MD from the University of Tennessee, Memphis, she completed her residency in obstetrics and gynecology at New York University.

Dr. Venkatachalam is a Junior Fellow of the American College of Obstetrics and Gynecology and a member of the Association of Professors of Obstetrics and Gynecology. She has spent time abroad providing prenatal care in developing countries. She is fluent in Spanish and proficient in French.

Prior to joining Obstetric and Gynecologic Specialists of Northwestern in 2007, she served on faculty at Emory University, acting as a residency coordinator in addition to providing outstanding patient care. She is currently a Clinical Instructor of Obstetrics and Gynecology at Northwestern University’s affiliate medical school, The Feinberg School of Medicine.
While interested in all aspects of general obstetrics and gynecology, Dr. Venkatachalam’s particular obstetrical interest is in high risk pregnancies, particularly those complicated by diabetes, hypertensive, cardiac, and hematological disorders, and has presented research at the regional and national levels. She is also adept at minimally invasive surgery, particularly in new modalities to treat abnormal uterine bleeding, fibroids, and providing permanent sterilization.

Articles Brought to you by NSWObgyn Doctors include:

Dr Bonnie Wise
Dr Kimberly (or Kim) McMahon
Dr Dayna Salasche
Dr Seema Venkatachalam
Dr Melissa Dugan

the fertility advocate
It’s January 5th…How Are Those New Year’s Resolutions Going?

So, it’s the beginning of the New Year and I am wandering around my kitchen thinking about what I am going to do for breakfast. I want toast – but the New Years Resolution that I made was all about the continuation of my Atkins Program. I have other things on my list too – keeping my closet in an orderly manner – buying less – and keeping up on my exercise program. I often find making New Year’s Resolutions boring. It often feels like the same things over and over again. On Facebook – someone started a thread where she asked for people to come up with one word to describe their New Year’s Resolutions. I liked that a lot. I was able to come up with a list of words that described how I want to FEEL or BE in the New Year. Here is my list:
1. Happy
2. Compassionate
3. Courageous
4. Inspired
5. Forgiving
6. Laughter
7. Fit
8. Trouble Maker
9. Friend
10. Change Maker

Take a stab at it. I think it is a great exercise! I also heard from Dr. Bonnie Wise, an Obstetrician and Gynecologist in Chicago or OB/GYN with Northwestern Specialists for Women who shared her ideas for 10 Realistic Resolutions for optimal health is 2009. Dr. Wise talked about health resolutions that all women can achieve and the importance of staying healthy in a recession.

According to Dr. Wise – it is unlikely that you’ll lose 30 lbs in 2 months, quit smoking, give up sweets forever, get to the gym 7 days a week, and never drink a glass of wine again. Unrealistic resolutions are commonplace, with statistics showing that 90% of Americans make annual resolutions and 30% are broken within one month. Well, I didn’t eat toast this morning!!
So here are Dr. Bonnie Wise’s Top Ten Realistic and Everyday health resolutions for women to consider…

1. Get Active & Make Fitness Fun
Get your body moving and your heart rate up for at least 30 minutes a day. 3-5 times per week. Not only does regular exercise reduce stress, your energy and metabolism levels will increase. So, take the stairs and explore different sports to see what you enjoy most. If fitness isn’t your favorite activity, consider something different like belly dancing classes, yoga, pilates, pole dancing, aerobics, self defense and more. A tip for the early birds: working out in the morning is best because it keeps your metabolism high all day which is great for women’s health in Chicago!

2. Drop Sizes Safely
Weight loss goals are safest for the body when achieved slowly over time. Losing 1-2 lbs per week is a healthy, realistic goal. Of course, you may lose weight and stay the same on the scale – keep in mind that muscle weighs three times as much as fat!

3. Portion Control
Denying yourself every food you crave will simply make you desire more. Instead, allow yourself to eat meals and snacks in moderation and appropriate size portions while avoiding seconds. For example, one serving of meat (3 oz.) should be about the size of a deck of cards, while one serving of pasta (1/2 cup) is the size of a tennis ball.

4. Make Sense of Nutrition
It is hard to change your body without understanding what you should be putting in it. Start reading the labels of your products and research the recommended amounts of each food group. Over time, things will start to make sense. For those looking to learn quickly, consult a nutritionist or research online.

5. Curb Caffeine and Hydrate
Over 50% of Americans above the age of 18 drink 3.1 cups of coffee per day, while soda consumption is now reported to be growing even more rapidly. Not only do these beverages add chemicals to the body, they also dehydrate.  Cut down on caffeine and increase your water consumption. Easy tip: before every cup of coffee or soda, drink a glass of water first.

6. Build Strong Bones
Osteoporosis is a health threat for 44 million Americans, but with vitamins and diet you can build strong healthy bones, increase calcium in your diet with three servings of dairy a day, such as skim milk, low-fat cheeses and yogurt. Nondairy options include canned salmon with bones, dark green vegetables, dried beans and calcium-fortified juices and cereals for women’s health in Chicago.

Recommended Calcium Amounts:
From age 11 to 24, between 1,200 and 1,500 milligrams daily
From age 25 to 50, 1,000 milligrams daily
For postmenopausal women 1500 milligrams daily, 1200 mg if on menopausal hormone therapy
For pregnant and breastfeeding women, 1,200-1,500 milligrams daily

7. Dose Up on D
Without the proper amount of Vitamin D. calcium absorption is reduced. Vitamin D is found in fatty fish, fish liver oil and dairy products fortified with vitamin D. The recommended amount for adults is 200-600 international units a day. Vitamin D is also great for combating symptoms of winter depression during the long and dreary Chicago winters.

8. Get Checked Out
Take a trip to the doctor and do the recommended tests to solidify a clean bill of health.

Osteoporosis – screenings recommended for women 65+
Annual Mammograms – should being at 40
Annual Pap Smears – should begin at 21
Colorectal Cancer – start screening at 50
Skin Cancer – screenings should begin at 50
Blood and cholesterol tests – should be taken every 5 years, starting at 20
*begin testing earlier if you are predisposed or have a family history with a health risk.

9. Guard Against Stress
With family, the house, friends and an economy in chaos, it is easy for the stress-o-meter to hit the red zone. It is imperative to take steps to de-stress; without doing so your job, relationship, happiness and overall health will suffer. Pamper yourself with a massage, warm bath or a quiet night in at least once a month, if not more.

10. Cut Back on Alcohol and Cigarettes
Quitting smoking isn’t easy, but if you adopt a healthier lifestyle you will find your cravings will lessen. With strength and will power, they can go away for good. All changes are gradual, so if you slowly decrease your intake of both, you will find that you don’t need them like you thought you did. To achieve optimal health or if you are trying to conceive, you should not smoke at all and limit alcohol intake to the equivalent of one unit per day.

So are we ready for 2009? It is the beginning of the first full week!!! Rev your engines! Take it on – deep deep breath– have fun – and let’s make it happen!!!!

Articles Brought to you by NSWObgyn Doctors include:

Dr Bonnie Wise
Dr Kimberly (or Kim) McMahon
Dr Dayna Salasche
Dr Seema Venkatachalam
Dr Melissa Dugan

In response to the American Health Association’s February Heart Health Month, the Northwestern Specialists for Women based in Chicago are offering 8 everyday tips to improve heart health and fight America’s number 1 health threat – heart disease.

1. Keep Cholesterol in Check:

There is such a thing as good and bad cholesterol. Good cholesterol - in the form of HDL - helps promote new cells, produce important hormones and insulate nerves. In women however, low levels of HDL are a strong predictor of cardiovascular disease, even more so than having high levels of the bad cholesterol LDL. Every woman over 20 should have fasting cholesterol levels checked every 5 years and carefully monitor intake of high-cholesterol foods such as whole milk, eggs, and red meat. Exercise also helps raise the levels of HDL.

2. Monitor Blood Pressure:

High blood pressure - or hypertension - is another high risk for heart disease. Levels of 120/80 are ideal; anything above puts a woman at higher risk. You can monitor blood pressure by getting tested by a medical professional at least once a year. If levels are high, diet and weight loss are two key factors in reducing blood pressure.

3. Feed Your Heart:

A diet rich in fish, vegetables, fruits, whole grains and legumes is recommended. Control fat intake and limit saturated fats and trans fats found in butter, fried foods, snack foods and desserts. Focus on eating healthy protein-rich foods low in cholesterol, and complex carbohydrates such as whole grain pasta and breads. Also - remember to stay away from salt!

4. Get your BMI in check:

Instead of concentrating on weight - which can be discouraging for many women - it’s more important to focus on BMI, body mass index. BMI indicates how a person’s weight relates to their height and is a much better predictor of cardiovascular risk, particularly in women. A normal BMI should range between 20 and 25; over 30 is considered obese. A woman can successfully lower her BMI by losing one pound a week, through exercise, cutting calories and portion control.

5. Get Active:

Exercise not only aids in weight loss, it keeps the body and heart healthy and strong. Regular, moderate cardiovascular exercise such as walking, jogging, swimming or biking can greatly reduce your risk of developing heart disease - while also increasing your physical strength and overall health. It is ideal to work out for 30-40 minutes three to five times per week. Also, taking a multi-vitamin actually makes the body more efficient during exercise, helping to promote weight loss as well.

6. Quit Smoking:

Cigarettes account for 440,000 deaths per year. Health risks posed by smoking include immense - increased blood pressure, increased tendency for blood clots, lowered ability to engage in physical activity and increased risk of recurrent coronary heart disease after bypass surgery. Add years to your life and save money by simply saying no!

7. Alcohol in Moderation:

Studies have shown that one drink per day for women or lighter persons and no more than two drinks for men may actually help your heart rather than hurt it if combined with a proper diet. Be sure to stick within the guidelines of one serving: 12 ounces of beer/wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

8. De-Stress:

Stress can also contribute to your overall heart health, so it is important to manage stress levels. Be sure to get 7-8 hours of sleep at night, take time for yourself and follow all of the tips above. A positive mental attitude and healthy body are crucial to fighting heart disease!

Follow these simple, everyday health tips and you’ll be well on your way to attaining perfect heart health and helping fight America’s biggest health threat. If you have any major heart concerns, or simply want to follow up with more questions, feel free to call us on 312.775.1100 and schedule an appointment with one of our physicians. We look forward to helping you take that first step in achieving optimal heart health!

Articles Brought to you by NSWObgyn Doctors include:

Dr Bonnie Wise
Dr Kimberly (or Kim) McMahon
Dr Dayna Salasche
Dr Seema Venkatachalam
Dr Melissa Dugan

We’ll Tell You Later - Waiting Until Later in the Pregnancy to Share the News
By Kim Seidel

Dr. Dayna Salasche waited until after her first trimester to share news of her pregnancy. It’s a practice that’s becoming more common with couples.

“My husband and I felt that this was a private time for us to enjoy the pregnancy,” says Dr. Dayna Salasche, an OB/GYN or Obstetrician and Gynecologist at Northwestern Specialists for Women in Chicago. “I also had some early complications and didn’t want everyone to be asking me about the pregnancy if there had been an unfavorable outcome.”

Dr. Salasche reaped the rewards of her decision. “My husband and I are very close to being with, but this really took that relationship to a different level – we became even closer, “ she says. “I also felt much ‘safer’ telling my friends and family once we did share our news.”

Along with the benefits, she encountered the downsides too. “I wasn’t feeling very well and it was hard to keep that from those around me.” Dr. Salasche says. “I am very close with my family, friends and the people I work with. So it was also difficult to keep such an important life event a secret from them. I wanted to tell them because I knew how happy they were going to be.”

Despite any downsides, many couples may wait to reveal the pregnancy because, in fact, after the first trimester, the chance for having a miscarriage drops significantly. “Similar to my situation, some couples have had a complicated beginning to their pregnancy and want to wait to tell until they feel it’s safe, just in case they have a bad outcome,” Dr. Dayna Salasche says, “Couples who have had an unfortunate experience with other pregnancies tend to keep their news private longer.”

Reasons to Wait

Marie Davidson, a clinical psychologist with Fertility Centers of Illinois in Chicago, Ill., echoes Dr. Salasche’s thoughts on the advantage of postponing pregnancy news. “As excited and optimistic as anyone is when they get that positive test, early pregnancy is not a sure thing,” Davidson says. “So waiting a while, or being very selective about whom you tell, makes sense.”

Newly pregnant couples may have an order in which they want to tell others – such as parents and siblings, good friends and then the world, Davidson says. She adds that most women will delay telling their boss and co-workers to avoid possible issues at work.

The major advantage to waiting is that the couple maintains control of the information, until they feel the pregnancy is well established. Then, they can decide who should know and in what order, Davidson says.

The pregnancy seems to go by faster if you don’t announce it to others until the second trimester, Dr. Salasche, who is a Gynecologist in Chicago, says. It’s a huge benefit for women to not have to explain to people why they don’t look pregnant if the baby was lost in the first trimester.

Disadvantages of Waiting

“Sometimes, feelings get hurt when a major secret like a pregnancy is kept for three months”, Dr. Salasche says.

Angie Sparks of Thousand Oaks, Calif., says her sister-in-law waited until her second trimester to share all three of her pregnancies with family members. Although she gave reasons, the situation caused upset emotions. “Her decision to wait was not easy for the family – or for me, especially as we had been good friends for many, many years,” she says. “It felt as though we were left out of some loop that my brother – and maybe even her side of the family – was in on. It seemed as though we were the last ones to know and the last ones able to celebrate.”

Spark’s sister-in-law postponed it because she is a neonatal intensive care nurse, and knows firsthand the fragility of pregnancy. “She didn’t want there to be unmet expectations – to make it harder on her or family – if she were to miscarry,” Sparks says. “While I understand her perspective, we were all still hurt.”

Sparks compares that experience with her sister’s pregnancy. “She called me on her cell phone from the doctor’s office to announce the news. “Sparks says. “I can see that I missed out on all of those feelings of excitement and wonder and joy for my sister-in-law.”

Now, Sparks herself found out she was pregnant with her first child early this year, and she and her husband notified family immediately. “We called all the parents and all the siblings, conferencing them in and sharing the news that way, “she says. “We didn’t’ want to wait around trying to figure out the ‘best’ or ‘most creative’ way to tell them.

They contacted their mother’s first. They also made sure to explain to their family that it was an early pregnancy, confirmed only with a home pregnancy test at that point. “As for friends and co-workers, we’re taking it a little more carefully,” she says. “Since my pregnancy will definitely affect the small business I work for, I have to be more strategic about sharing the news.”

If a woman decides to keep her pregnancy to herself, she won’t have the support needed in the event of a miscarriage or other pregnancy challenges, says Rebecca Macdonald, a mom from Aurora, Colo. She didn’t have a miscarriage, but experienced infertility treatments for several years before having her two boys. “I was open and honest with almost everyone about what was happening to me,” Macdonald says. “When I was given the diagnosis that I could not have children on my own, it was so important that my friends and family were there to support me.”

A co-worker of Macdonald’s kept her pregnancy a secret. “When she had a miscarriage, no one could understand why she was sobbing silently in her cubical, “Macdonald says. “She eventually shared the news of her miscarriage, but I think it was harder on her.”

Fun Ways to Share the News

While there may be no perfect time to announce a pregnancy, many couples decide to wait until the first trimester is over, or until the woman begins to show. Davidson says. “It is really important to talk this over with your spouse and reach an agreement,” she says.

Dr. Dayna Salasche, an OB/GYN, encourages her patients to be excited and to share their news. But, in the first trimester, they may want to limit it to the people they would tell and need for support if something bad were to happen.

Holidays and birthdays are especially wonderful times to announce pregnancy. It’s fun to reveal exciting news in person when everyone is already in a celebratory mood, Dr. Salasche says.

“A great moment to share your pregnancy news is going around the table at Thanksgiving dinner, taking turns saying why you are grateful,” Davidson says. “Just try to go last because your news will be hard to follow.”

Christmas, of course, and any other big holiday, is a neat time to give a pregnancy message. “However, your news could get lost in the shuffle of festivities, so consider how to keep it special and not have to compete with the holiday itself,” Davidson says.

Father’s and Mother’s Day are good times to celebrate special announcements as well. “I know one woman who waited a short while to tell her husband, so she could make it a Father’s Day surprise,” Davidson says. “It’s also the ideal birthday gift for a grandparent-to-be.”

Articles Brought to you by NSWObgyn Doctors include:

Dr Bonnie Wise
Dr Kimberly (or Kim) McMahon
Dr Dayna Salasche
Dr Seema Venkatachalam
Dr Melissa Dugan

Not According to (Birth) Plan
When Your Birth Plan Goes Astray
By Teri Brown

Women love the birth plan concept – it gives us the illusion that we, not our bodies, are in control. But it’s hard to be prepared for everything. Just ask Sarah Skofield, mother of three from Bowdoinham, Maine. She was having a planned C-section and thought she knew how everything was going to play out.

“It was a complete shock when the anesthesiologist couldn’t get a spinal and told me he needed to use general anesthesia,” says Skofield. “I consented and wasn’t aware of the birth of my son until I woke up an hour later. My husband had been waiting for me to wake up and he made sure the first thing I saw was our baby. I cried, but not happy tears. I was so confused and in pain. I felt cheated. Things definitely did not go the way I thought they would. It never occurred to me that I might need general anesthesia. I think if I had thought of that possibility, I would have been more prepared and it would have been a little easier.”

Elizabeth Thelen, mother of two from Rochester, N.Y., also made plans that didn’t turn out exactly the way she wanted them to. “We got the nursery set up, painted and got it all accessorized,” says Thelen. “I remember going to the doctor, a Gynecologist/Obstetrician in Chicago on a Tuesday, and my son was breech. I could feel his head in the middle of my chest. Well, later that week, he turned and broke my water. He was born five weeks early.”

The Benefits of a Birth Plan

Dr. Shelley S. Binkley, a board-certified OB/GYN with 16 years experience delivering babies and caring for pregnant women in Glenwood Springs, Colo., says that creating a birth plan can be very empowering. “If you’re going to develop a birth plan discuss it with your Obstetrician provider in the last month of pregnancy, before you actually arrive in labor,” Dr. Binkley says. “If you address it ahead of time questions can be answered and you’re more likely to make your provider aware of your wishes and align her behavior with your goals.”

If you want special music, bring it. Lighting can be adjusted by you or the labor staff. Remember that a birth plan is a wish list, the things you hope will happen, but don’t get too attached to it.

“There are some things to be aware of regarding birth plans,” Dr. Binkley says. “You, the labor nurses and the Obstetrician provider are, to a large extent, at the mercy of your labor. There are some things you and they can affect, and others that are completely out of their and your hands.”

Keep Expectations in Check

Often times, high expectations cause high frustration. If things don’t go as planned, the disappointment can be devastating. “It seems to me, after years of delivering babies, people with detailed prescriptions about how things will go often have more difficult labors and are more likely to wind up with a Cesarean section or difficult birth than families who approach labor with a relaxed but positive attitude and are willing to make adjustments in their expectations,” Dr. Binkley says.

It’s difficult to be prepared for everything that can happen during birth as there are a thousand variables. Most people want a minimal intervention as possible. They want their baby on the tummy, they want Daddy to cut the cord they want to be able to breastfeed right away. But what they want isn’t always what happens.

Dr. Kimberly McMahon, an Obstetrician and Gynecologist at the Northwestern Specialists for Women in Chicago, says it’s good to be prepared no matter what the plan is. “Nothing can really prepare a woman for her first labor, and no one can predict how long or how painful it might be,” Dr. McMahon says. “The best approach is for patients to keep their options open. If she needs pain medication, then she should be given the various options.”

Even second births can be unpredictable. A woman may have a perfect labor that follows the birth plan to the letter and still have a second birth that is completely different. By keeping your plan flexible, you are no only protecting yourself from disappointment, but you are giving your care providers the freedom to help no matter what the circumstances.

“Every woman would like to know when it will happen, how long it will take and whether or not she really will need pain medicine,” Dr. Binkley says. “Here are the definitive answers to these questions: It won’t happen soon enough or it will happen before you’re ready. It will take way too long or will be much faster than you thought; and it will hurt less or more than you expect. Some labors will be quick and uneventful while others may take days and require medical intervention to accomplish the deed.”

So having a birth plan is a good thing – being flexible about your plan is an even better thing.

Birth Plan Do’s and Don’ts

· Do write down your ideal labor experience.

· Don’t be bound by that ideal.

· Do discuss the plan with your doctor ahead of time.

· Don’t be close-minded about your doctor’s thoughts and ideas.

· Do as much as you can to follow the birth plan while in labor.

· Don’t be rigid about possible changes.

Articles Brought to you by NSWObgyn Doctors include:

Dr Bonnie Wise
Dr Kimberly (or Kim) McMahon
Dr Dayna Salasche
Dr Seema Venkatachalam
Dr Melissa Dugan

It’s that time of year again ladies! While hopes for successful New Year’s resolutions often run high, it is usually unlikely that you’ll stick to (and sometimes even take steps towards) those insurmountable goals - lose 30 lbs in 2 months, quit smoking, give up sweets forever, get to the gym 7 days a week, and never drink a glass of wine again! Unrealistic resolutions are commonplace, with statistics showing that 90% of Americans make annual New Year resolutions and 30% are broken within one month.

Given the current economic climate and a higher level of stress for many, there has never been a more important time to focus on overall wellbeing and taking steps towards being healthy and happy in 2009. If you want to get the New Year off to a great start, why not consider some of the following everyday health resolutions:

1. Get Active & Make Fitness Fun

Get your body moving and heart rate up for at least 30 minutes a day, 3-5 times per week. Not only does regular exercise reduce stress, your energy and metabolism levels will increase. So, take the stairs at work and explore different activities to see what you most enjoy. If you struggle with motivation, consider something a little different and fun, like belly dancing, yoga, pilates, even pole dancing or self defense classes. A tip for the early birds: working out in the morning is best because it keeps your metabolism high all day!

2. Drop Sizes Safely

Weight loss goals are safest for the body when achieved slowly over time. Losing 1-2 lbs. per week is a healthy, realistic goal. Keep in mind that you may lose weight and remain the same on the scale – remember that muscle weights three times as much as fat!

3. Portion Control

Denying yourself every food you crave will simply make you desire more. Instead, allow yourself to eat meals and snacks in moderation and appropriate size portions, while avoiding seconds. For example, one serving of meat (3 oz.) should be about the size of a deck of cards, while one serving of pasta (1/2 cup) is the size of a tennis ball.

4. Make Sense of Nutrition

It is hard to change your body without understanding what you should be putting in it. Start reading the labels of your products and research the recommended amounts of each food group. Over time, things will start to make sense. For those looking to learn quickly, consult a nutritionist or research online.

5. Curb Caffeine and Hydrate

Over 50% of Americans above the age of 18 drink 3.1 cups of coffee per day, while soda consumption is reported to be growing even more rapidly. Not only do these beverages add chemicals to the body, they also dehydrate. Cut down on caffeine and increase your water consumption.

Easy tip: before every cup of coffee or soda, drink a glass of water first.

6. Build Strong Bones

Osteoporosis is a health threat for 44 million Americans, but with vitamins and diet you can build strong, healthy bones. Increase calcium in your diet with three servings of dairy a day, such as skim milk, low-fat cheeses, and yogurt. Non-dairy options include canned salmon with bones, dark green vegetables, dried beans and calcium-fortified juices and cereals.

Recommended Calcium Amounts:

· From age 11 to 24, between 1,200 and 1,500 milligrams daily

· From age 25 to 50, 1,000 milligrams daily

· For postmenopausal women 1500 milligrams daily, 1200 mg if on menopausal hormone therapy

· For pregnant and breastfeeding women, 1,200-1,500 milligrams daily

7. Dose Up on D

Without the proper amount of Vitamin D, calcium absorption is reduced. Vitamin D is found in fatty fish, fish liver oil and dairy products fortified with vitamin D. The recommended amount for adults is 200-600 international units a day. Vitamin D is also great for combating symptoms of winter depression during the long and dreary Chicago winters.

8. Get Checked Out

Come and see us, or take a trip to your family doctor and get the recommended tests to solidify a clean bill of health. You will be grateful you did!

· Osteoporosis - screenings recommended for women 65+

· Annual Mammograms - should begin at 40

· Annual Pap Smears - should begin at 21

· Colorectal Cancer - start screening at 50

· Skin cancer - screenings should begin at 50

· Blood and cholesterol tests - should be taken every 5 years, starting at 20

*begin testing earlier if you are predisposed or have a family history with a health risk

9. Guard Against Stress

With work, family, the house, friends and an economy in chaos, it is easy for the stress-o-meter to hit the red zone. It is imperative to take steps to de-stress; without doing so your job, relationships, happiness and overall health will suffer. Pamper yourself with a massage, warm bath, or a quiet night in at least once a month, if not more.

10. Cut Back on Alcohol and Cigarettes

Quitting smoking isn’t easy, but if you adopt a healthier lifestyle you will find your cravings will lessen. With strength and will power, they can go away for good. All changes are gradual, so if you slowly decrease your intake of both, you’ll find that you don’t need them like you thought you did. To achieve optimal health or if trying to conceive, you should not smoke at all and limit alcohol intake to the equivalent of one unit per day.

If you would like more information on these tips or a head start on your health checks for ‘09, feel free to call our office on 312.775.1100 to make an appointment with any of our physicians. Have a happy New Year ladies!

Articles Brought to you by NSWObgyn Doctors include:

Dr Bonnie Wise
Dr Kimberly (or Kim) McMahon
Dr Dayna Salasche
Dr Seema Venkatachalam
Dr Melissa Dugan

pregnancy, bed rest may be prescribed for many reasons, including preeclampsia, cervical shortening/weakness, premature rupture of membranes, placenta previa and, most commonly, preterm labor. However, the definition of “bed rest” isn’t always clear.

“There are different degrees of bed rest,” says Shari Criso, certified nurse midwife and owner of The Birth Boutique in New Jersey (www.birthboutique.com). “It is important for a woman to get clarification and fully understand why she is being prescribed bed rest, what are the specific limitations and what are the risks to her and her baby if she is noncompliant.”

General Questions

Dr. Seema Venkatachalam, OB/GYN at Northwestern Specialists for Women in Chicago, provides a list of basic questions every woman should ask when told to go on bed rest:
 Why am I being put on bed rest?
 How long do you think this will be necessary?
 Why do we think this will help me?
 Can I be on bed rest at home versus at the hospital?
 Does it matter whether my baby is head down versus breech? “In many cases, if the head is down, a little more leeway is given in terms of activity if the membranes are ruptured since there is less likelihood of cord prolapse,” says Dr. Venkatachalam.
 Finally, perhaps the most important question: What does bed rest mean?
“This may have different answers depending not only on the reason it’s being prescribed, but even what the provider’s interpretation of bed rest is,” says Dr. Venkatachalam.
Mobility Questions Bed rest doesn’t necessarily mean resting in bed 24/7. “For the most literal definition [of bed rest], it can mean no more than one to two hours out of bed, allowing a woman only to shower and go to the bathroom,” says Dr. Venkatachalam. “This usually is only prescribed if a woman requires hospitalization. In most cases, if a woman is put on ‘bed rest’ at home, it means ‘modified bed rest.’ It means that a woman should no longer go to work, can move around the home a bit and do no more than light work at home. Most of the time, she should either be resting in bed or on the sofa.”

But even the specifics of modified bed rest must be clarified. Can you go up and down stairs? If so, how often? Are you allowed to sit up in a chair or work at a desk, or must you lie down? Does lying down mean flat on your back, on either side, or on a specific side? (Lying on your left side, for instance, eases pressure on the vena cava, which may be important.)

If light housework is allowed, what constitutes “light?” “Light household chores might be OK, but if the tasks involve heavy lifting of laundry or multiple trips up and down stairs, it’s probably not a good idea,” says Dr. Benito Alvarez, OB/GYN at Women’s Health Institute, Cleveland Clinic. Clarify exactly what is allowed with your doctor.
While on hospital bed rest, Kelly Damron of Phoenix, Ariz., asked if she could exercise. This is important, as women on bed rest are prone to blood clots, muscle wasting and deconditioning. “It took a few days, but I received permission to exercise in bed,” she says. “The exercises were simple, but it was helpful to keep my body moving even though I was bedridden.”

“A woman should ask if she is allowed to at least walk and, if so, how much, to try to maintain some cardiovascular conditioning,” says Dr. Venkatachalam.
Getting Specific There are so many things moms might not think of when it comes to specifics about bed rest. Can you drive, or do you need someone to drive you? “Ask if you can sit up or have to lie down in the back seat while driving to your doctor’s appointments,” says Natalie Caine, a mom from Los Angeles, Calif. “I had to lie down. I also had to lie down if I was going to attend a birthing class.”

Ask about resources available for help. You may find your insurance covers a home health nurse if you are on strict bed rest. It may also cover renting a hospital bed to make bed rest more comfortable.
Diet may be modified also to prevent constipation, heartburn or other issues related to decreased activity. Ask your doctor what might be helpful.

Making Sure It’s Clear

When discussing bed rest with your doctor, it’s very important to be specific about what is expected of you. In this case, what your doctor doesn’t know about your lifestyle can hurt you – or, more important, your baby.
When Maureen Doolan Boyle was pregnant with triplets, her doctor told her she needed to take it easy and not do as much as she normally did in her everyday life. “So I did,” says Boyle. “I ran only 3 miles a day instead of 5.”
When, at her next visit, she mentioned this to her doctor, he “freaked.” “He thought that I was home eating bon-bons,” says Boyle. “I am an exceptionally active person who had a 2-year-old. Bon-bons were not a part of my life.” When he confirmed that he really meant bed rest, Boyle complied.

Now, as the executive director of MOST (Mothers of Supertwins), Inc. (www.mostonline.org), Boyle regularly works with mothers with high-risk pregnancies, who are expecting triplets or more. “Doctors and patients need to somehow get on the same page and understand that ‘taking it easy’ and ‘bed rest’ might mean totally different things to different people,” Boyle says.

Dr. Alvarez has seen this in his practice. “If a woman has a specific activity she is unsure about, she should ask,” he says. “When I place a patient on bed rest, I usually inquire about their extracurricular activities. Some have told me skydiving, bowling, etc. On occasion, patients have seemed surprised when I restrict these because it hadn’t crossed their minds.”

MOST provides their families with a list of questions to help their doctors become familiar with their lifestyle. “If you live in a four-story walkup, your doctor needs to know that,” says Boyle. “If you have a long commute to work (with walking involved) and your doctor has you on partial bed rest allowing you to still work – he needs to know that, too.”
Boyle also reminds moms that what is fine to do one week, at your next visit may no longer be permissible. “You need to bring your checklist with you and review it every week with your doctor,” says Boyle.

One topic women may be uncomfortable talking about with their doctor is sex. “I have spoken with expectant moms who have said that they are on bed rest and only get up to go to the bathroom, shower once or twice a week and possibly one meal a day, but they are having sex three or more times a week,” says Boyle. “When your doctor puts you on bed rest does this mean no more sex? What specifically are you not allowed to do? A patient (and her partner) needs to have a frank discussion with their doctors about this.” Whatever your physician’s definition of bed rest, it’s in your best interest to comply. “Some of the risks if a woman chooses not to comply with bed rest include preterm delivery, seizures and even maternal or fetal death in extreme cases,” says Criso.

In the end, those few months of inconvenience can help you give your child a better chance at a healthy life.

Articles Brought to you by NSWObgyn Doctors include:

Dr Bonnie Wise
Dr Kimberly (or Kim) McMahon
Dr Dayna Salasche
Dr Seema Venkatachalam
Dr Melissa Dugan

Dr Seema Venkatachalam discusses improving your life on ABC News