Category Archives: Blog

if that is part of your ideal birth plan.

PCOS: What You Need to Know

Women of all ages can experience a number of gynecological and hormonal issues. Luckily, OB/GYNs and other medical professionals can successfully treat and manage them. One condition that affects a number of women is polycystic ovarian syndrome, which is often referred to by the initials PCOS.

What is PCOS?

Polycystic ovarian syndrome, or PCOS, is a hormonal condition that affects females. It is the most common cause of infertility in women. The cause is unknown but it is thought to be related to environmental factors as well as genetic influences. Though “polycystic” implies that multiple cysts are involved, not all women have cysts on the ovaries. As the PCOS Awareness Association explains, three main hormones come into play in polycystic ovarian syndrome:

  1. Androgens: Though androgens are considered male hormones, all females make them as well. In PCOS, the levels of androgens are often elevated, leading to symptoms like acne, hair growth, and irregular periods.
  2. Insulin: This hormone helps regulate blood sugar and helps the body turn it into energy. Women with polycystic ovarian syndrome sometimes become insulin resistant, so the body produces more. High levels of insulin lead to high levels of androgens.
  3. Progesterone: This female sex hormone helps regulate the menstrual cycle and ovulation. People with PCOS have low levels of progesterone, which makes periods irregular.

Signs and Symptoms of Polycystic Ovarian Syndrome

Sometimes people experience the symptoms of PCOS soon after puberty, but some women will not see symptoms until early adulthood. The symptoms can be attributed to other conditions, so sometimes it takes a while for polycystic ovarian syndrome to be diagnosed. Common symptoms include:

  • Irregular or missed periods: ovulation is often interrupted so menstruation does not occur regularly.
  • Infertility: PCOS is one of the most commonly diagnosed causes of infertility. Not all women will have fertility issues. Some can conceive naturally and some can conceive with fertility treatments.
  • Weight gain: Difficulty losing and managing weight is common, as is obesity.
  • Unwanted hair growth on body/hirsutism: Excess hair growth on the face, back, chest, arms
  • Thinning hair on head: While unwanted hair appears on the body, hair on the head may fall out and thin, which can increase in middle age.
  • Mood changes: There is an increased likelihood of mood swings and/or developing anxiety and depression.
  • Fatigue: Feelings of tiredness and low energy may be related to sleep disturbances.
  • Sleep disturbance: People may experience insomnia or sleep disorders such as sleep apnea.
  • Skin changes: Hormonal changes can cause skin changes such as acne, skin tags, or hyperpigmentation.
  • Pelvic pain: Pelvic pain during periods is a common symptom, as is heavy bleeding. Pelvic pain may be present when not bleeding as well.
  • Headaches: Disturbances in hormonal balance can cause frequent headaches.

Diagnosis and Treatment of PCOS

If you have symptoms, there is not a specific test to diagnose polycystic ovarian syndrome. The doctor will ask you questions about your symptoms and perform a physical exam with a family history. Other tests may be ordered to rule out other conditions. These tests might include ultrasounds to evaluate the ovaries and look for cysts. Blood tests to check sugar and hormone levels are also used.

If you are diagnosed with PCOS, you may or may not be referred to an endocrinologist that can work with your regular doctor for treatment. An endocrinologist is a doctor that specializes in hormonal issues. There are several treatment options that can help manage symptoms and promote regular ovulation, but the condition cannot be cured.

Medications used to treat polycystic ovarian syndrome include:

  • Hormonal birth control: Birth control with both progestin and estrogen can help with regulating menstruation, reduce excess hair growth, and reduce acne. It can be taken orally or via a patch or vaginal ring.
  • Spironolactone: Treats acne by blocking androgen’s effect on the skin. Should not be used if you are pregnant or planning to become pregnant because it has been linked to birth defects.
  • Clomiphene: Anti-estrogen medication used to help stimulate ovulation and help with fertility.
  • Metformin: Originally used to treat type 2 diabetes, this medication can help control insulin levels. It is often given in conjunction with clomiphene and can help with weight loss.
  • Letrozole: A breast cancer treatment that can stimulate the ovaries for ovulation.
  • Progestin therapy: Can help regulate the menstrual cycle and guard against endometrial cancer.
  • Gonadotropins: Hormonal injections that stimulate ovulation.

You can also make lifestyle changes to improve and manage symptoms. The changes seem simple but can make a real impact. Eat a healthy diet low in simple carbohydrates to control insulin levels and get regular exercise. Both of these can also help you manage your weight, which can make a big difference in symptoms. Maintaining a healthy weight can help keep insulin lower as well as androgens. This might restore regular ovulation.

Make an Appointment

The team of physicians, nurses, and medical staff at Raleigh OB/GYN Centre have been providing the women of the Raleigh area with personalized and comprehensive care for 45 years. From the first well-woman appointment to menopause management and every stage in between, our team will be there. If you have concerns about any obstetric or gynecological issues, including PCOS, call us at (919) 876-8225 to make an appointment. You can also request an appointment online

Young woman hand holding menstrual cup. Selective focus and shallow DOF; blog: menstrual cup pros and cons

The Menstrual Cup: Pros and Cons

There are many menstrual products on the market for people to choose from when dealing with their periods. One product that has been around for quite some time but has become more popular in recent years is the menstrual cup.

The menstrual cup is a device that is inserted into the vagina to collect blood and prevent it from leaking out during a menstrual period. When the cup is full, it can be removed and emptied into a toilet before being cleansed and reinserted. 

Menstrual cups are usually made out of silicone, with some being made of rubber. People with latex allergies should choose silicone versions.

When deciding whether or not this product is right for you, take a look at this list of menstrual cup pros and cons.

Pros of the Menstrual Cup

  • Eco and Budget-Friendly: Switching to the cup will reduce the amount of garbage you produce during your menstrual period because you will not be throwing out pads and tampons. Reducing landfill waste is definitely good for the planet, making the menstrual cup an eco-friendly choice. Also, because you do not need to replace the menstrual cup each month, it is cost-effective as well. If you take care of them properly, some cups can be used for years. A menstrual cup may be a slightly larger investment at first, especially higher quality versions. However, any extra expense is more than made up for after a few cycles. There are also less expensive reusable menstrual cups available that are comparable in price to a box of tampons.
  • Less Shopping for Menstrual Products: If you’re using disposable menstrual products like tampons or pads, you have to keep buying them for each period. Not only is this more expensive than using a menstrual cup, but multiple trips to the drug store can also be an inconvenience. As long as you maintain your menstrual cup properly, you will always have it on hand without needing to go to the store for supplies. Just keep track of when your period is due and have it ready to go before that date to be prepared. If you are concerned about starting your period when you’re away from home, a case can be used to keep it in a purse or book bag around the time you expect it to start.
  • Helps with Maintaining Healthy Vaginal pH: Tampons are used to absorb blood, but they also absorb any other vaginal fluid present. This may lead to a disturbance in your vaginal pH or the healthy bacteria that should be there. The menstrual cup does not absorb anything, so this problem is avoided.
  • Less Odor: If you’ve used tampons or pads before, you may have noticed they can develop an odor as they absorb more blood. The odor becomes more noticeable when it is exposed to air, which is especially a problem with menstrual pads. With the cup, the blood is contained by a non-porous barrier, so it is not exposed to air. Therefore, odor is less common when using a menstrual cup.
  • Longer Wearability: In addition to the general longevity of a menstrual cup, you can also usually go longer between trips to the bathroom to deal with your period. The menstrual cup is often able to hold more blood than a pad or tampon can absorb, which means it needs to be emptied less often than other products need to be changed.

Also, menstrual cups are made of body-safe materials that do not contain the chemicals some single-use products do. The risk of a rare condition known as toxic shock syndrome (TSS) that is associated with tampon usage is eliminated when using a menstrual cup.

Cons of the Menstrual Cup

  • Learning to Properly Insert It Takes Practice: The most common complaint about the menstrual cup is that it is difficult to insert at first. Because there is a learning curve, some women get frustrated and give up after several attempts. This is especially true for young women who have just started their menstrual cycles and women who have not had intercourse. However, with practice, most women can get the hang of proper insertion. It should be noted that individuals with IUDs may want to consult their doctor about using the menstrual cup because it may pull on the IUD’s strings and dislodge it.
  • Fit Issues: The menstrual cup comes in a variety of sizes, with guidelines and recommendations for what size may be appropriate for certain women. However, if you have a condition like a dropped uterus or severe fibroids, fit may be an issue.
  • More Mess: A couple of menstrual cup pros and cons are related to the way it collects blood rather than absorbing it. This is a pro for reusability and length of time between changes. However, for some women, dealing with the menstrual blood is a turn-off. If you’re used to simply throwing away menstrual pads and tampons, it may take some getting used to the menstrual cup. With practice, many women will master removal with minimal mess.

Another con related to mess is the need to rinse or clean the cup before reinsertion. Some feel uncomfortable doing this in the sink, especially in public restrooms. To deal with this, some women carry a small squirt or spray bottle of water while using the cup, or bring wipes.

  • Issues with Cup Removal: Removing the menstrual cup can have as much of a learning curve as inserting. And removing it improperly can cause a lot more mess than inserting it incorrectly. While each cup as a “stem” at the bottom, it is not the best idea to use it on its own for removal. The cup should be squeezed just above the stem and pulled out.
  • Proper Maintenance: Because the menstrual cup is reusable, it must be taken care of properly. If you neglect proper maintenance of your cup, it can introduce bacteria or other germs into the vagina the next time you use it. Or if it is not taken care of properly, it will not last as long as it should. After each cycle, you should sanitize it by using boiling water or a cleanser made for the material, like solutions used for baby bottle nipples.

Have More Questions?

Raleigh OB/GYN Centre has been caring for women in all stages of life for over 40 years. From the first gynecological exam through managing menopause, our expert physicians will be there. To speak to one of our doctors about any gynecological issue, including the best options for menstrual products, you can call us at 919-876-8225. You can also request an appointment online.

Woman holding an ultrasound scan of her unborn baby; blog: what happens if my baby is breech

What Happens if My Baby is Breech?

As a woman approaches her due date, there are many concerns she may have about giving birth and safely delivering a healthy baby. If you are in your third trimester and getting close to full term, then you might be aware of the possibility of breech presentation. This condition affects a relatively small percentage of pregnant women, but that knowledge may not be enough to stop you from wondering: what happens if my baby is breech?

What Does Breech Mean?

When answering the question “what happens if my baby is breech?” the first thing that needs to be done is to find out what breech means in terms of the fetal position. As the American College of Obstetrics and Gynecology (ACOG) explains, breech presentation is when the baby is not head-down during birth. Instead of being in a position for the head to come through the birth canal first, a baby in breech presentation is positioned so that his or her feet, bottom, or both would come out first.

There are a few types of breech presentations that differ due to the exact position the baby is in and where his or her head is.

  • Frank breech: The baby’s bottom is down and the legs are pointing up and near the head. This is the most common type of breech presentation.
  • Footling breech: The baby is head up and has one or both of his or her legs hanging down.
  • Transverse breech: The baby is lying horizontally in the uterus.
  • Complete breech: The head is up, the bottom is down, and the legs are crossed.
  • Oblique breech: The baby’s head is down but is pointed towards one of the mother’s hips

Risks Related to Breech Presentation

There are several risks associated with breech presentation in both vaginal and cesarean births.  

Risks during vaginal delivery include cord prolapse, which happens when the umbilical cord is squeezed as the baby moves down the birth canal. The squeezing of the cord slows down the supply of oxygen and blood to the baby. Another complication associated with vaginal delivery of a baby with a breech presentation is that the baby may not move as easily through the birth canal, which can require the use of forceps or other tools.

Cesarean deliveries have risks as well, mostly related to it being a surgery that requires sedation or anesthesia. You can read more about this in our previous blog what to expect when you have a C-section.

What Can Cause Breech Presentation?

Breech presentation occurs in about 3 to 4% of full-term pregnancies. Some women are more likely to have a fetus in breech position. The following factors can contribute to an increased risk of breech presentation:

  • Too much amniotic fluid
  • Not enough amniotic fluid
  • Two or more fetuses in the uterus
  • Mother has been pregnant before
  • Pregnancy is less than 37 weeks along
  • Presence of uterine abnormalities such as fibroids
  • The placenta is covering either a part of or all of the of the uterine opening (placenta previa)

What Are the Options if My Baby is Breech?

There are several ways to approach labor and delivery with breech presentation. The two most common are: 

1. External Cephalic Version is Attempted

External cephalic version (ECV) is an attempt to turn the baby so that he or she is head down. Women who desire a vaginal birth often have ECV in attempt to stick to their birth plan. ECV is suggested for a fetus with breech presentation in pregnancies greater than 36 weeks.

Over half of ECV attempts are successful in getting the baby in a head-down position. But some babies may move back into breech presentation after this treatment is performed. Another attempt may be made, but it gets more difficult to perform ECV as the birth date approaches because there is less room for the baby to move.

ECV is performed by a healthcare professional who will use their hands to apply firm pressure to the abdomen so the baby will roll into a head-down position. More than one healthcare professional may be needed to help turn the baby and sometimes ultrasound guidance is used to determine the positioning.

Before ECV is attempted, the baby’s heart rate will be checked with fetal monitoring and it will be checked again after the attempt. In case a problem arises with the heart rate, a C-section may need to happen quickly. For this reason, ECV is often done in or near a delivery room.

Sometimes external cephalic version is not suggested. If there is more than one baby (twins or more), the placenta is not in the right place or has come away from the wall of the uterus, or if there are other concerns about the baby’s health, then ECV is not an option.

2. Cesarean Delivery is Planned

Another course of action used if a baby is breech is a planned cesarean delivery. There are times when a planned vaginal birth with a baby in a breech position is safe, but often a C-section is chosen due to the lower incidence of complications.

For More Information

At Raleigh OB/GYN Centre, we know that you will have concerns about your pregnancy, including what happens if your baby is breech. We have been dedicated to providing quality obstetric care to the women of the Raleigh area since 1974 and will be there with you every step of the way from preconception to delivery. If you want to speak to one of our doctors about any obstetric or gynecological concern, then you can call us at 919-876-8225. You can also request an appointment online.

Hygiene feminine pads, tampon menstruation in the beautician; blog: feminine hygiene products

Feminine Hygiene Products: What You Need to Know

Feminine hygiene product options have grown over the years. Many women remember when disposable pads and tampons were the only options. Some may remember further back when there was no such thing as an applicator on a tampon and pads didn’t have adhesive. But things change.

Whether you are reevaluating your hygiene needs or are helping a young person who is just entering her reproductive years decide which product is right for them, you might want to brush up on what is available. The Center for Young Women’s Health aims to educate young women on issues affecting them, including menstrual hygiene but can be a useful resource if you’re curious about the ins and outs of the variety of feminine hygiene products available today. 

Menstrual Pads 

Menstrual pads are placed in the underwear to catch and absorb blood once it leaves the vagina. Most pads do this with an adhesive that sticks to the underwear but can be peeled off easily for disposal. Menstrual pads are available in a wide range of sizes and lengths to accommodate different levels of menstrual flow and women of varying sizes. They can be very thin and referred to as a “panty liner” or thicker and more absorbent (sometimes called a “maxi pad”). Young girls just starting their menstrual cycles may feel more comfortable with an external menstrual pad rather than an internal product like a tampon.

Traditional menstrual pads that you buy in drug and grocery stores are disposable and must be thrown away after use. This means they create a significant amount of waste, which makes them unpopular among some eco and/or health-conscious women. Additionally, we’re learning that the cotton and rayon used in most menstrual pads are bleached and may contain unknown chemicals. 

If you prefer external absorption over an internal product, there are options that are friendlier to your body and the environment. Natural, organic, and unbleached cotton pads have become more widely available in recent years.

Another option is a reusable cotton pad that is used the same way as a regular pad but is washed and dried after each use to be reused later. The reusable pad usually has a liner to absorb the menstrual blood and a holder to attach it to underwear. The liner is washed by hand or in the machine so it can be used over and over. These pads also come in different sizes and absorbencies and are available with organic cotton. You can find options for reusable cotton pads online.


One of the most common and popular types of feminine hygiene products is the tampon. This internal hygiene product is inserted into the vagina to absorb menstrual blood. Some women prefer tampons to pads because the blood is absorbed internally, making less of a mess if changed with the right frequency. Many women also feel more comfortable exercising, playing sports, and swimming with an internal product like a tampon. Tampons are widely available in stores and some public bathrooms have dispensers that sell them, though this practice is declining.

Tampons are usually made of cotton, rayon, or a combination. They can come with applicators to help with insertion or without an applicator which requires insertion using the fingers. Applicators can be made of plastic, cardboard, or other plant-based material. 

Tampons come in different sizes, or absorbencies, to accommodate different levels of menstrual flow. Like menstrual pads, tampons are disposable and should not be flushed down the toilet, especially in septic systems. Because they are single-use and disposable, they are not considered eco-friendly.

There has been some concern, especially in recent years, expressed about chemicals present in tampons and their possible effects. Because the tampon is inserted into the vagina, concerns about exposure to unknown chemicals are even greater than with menstrual pads. Due to these increased concerns, there are many organic and unbleached tampons on the market. You can find natural and organic brands at larger supermarket chains, drug stores, natural food stores, and online. Some companies offer recurring subscription services so you can have the products sent to you each month so you won’t be caught without supplies when your period comes.

It’s also important to note that there is an extremely small risk of a condition called toxic shock syndrome (TSS) when using tampons, but it is minimal.

Menstrual Cups

Menstrual cups are a form of internal period products that are used in place of tampons. Rather than absorb blood like a tampon, a menstrual cup collects and contains menstrual blood to prevent it from exiting the vagina. To dispose of the blood, the user pulls on a tab to remove the cup and pour out the blood, usually into a toilet. A menstrual cup is usually made of medical-grade silicone or rubber safe for inserting into the vagina. The flexible material makes it possible for the cup to be folded and inserted. 

Most menstrual cups are reusable, meaning users can cleanse them between uses and keep them for many menstrual cycles before replacement is necessary. If you take proper care and cleanse them properly, they can last for years. This makes them an eco-friendly option for those looking for an alternative to tampons. Also, they are not linked to toxic shock syndrome (TSS) in the same way tampons are. 

There can be a learning curve when switching from disposable feminine hygiene products to the menstrual cup, but many women swear by them and say it is worth figuring out. The cups come in different sizes based on flow and whether you’ve given birth vaginally. Popular brands include the DivaCup, Moon Cup, and many others.

Period Panties

A new alternative to disposable feminine hygiene products is the period panty. These specially made underwear are designed to absorb menstrual blood without the aid of a disposable cotton pad. The crotch of the panties is reinforced with four layers of material, which will absorb light or medium flows. 

Some women prefer to wear these in conjunction with a tampon rather than regular underwear with a safety panty liner and some women feel comfortable only wearing the underwear. The fabric is designed to be leak-proof, odor resistant, non-staining, and completely washable. 

One drawback to period panties is that they are costly, with the higher-rated brands being about $30 per pair. However, there are often deals or coupons you can use and because they are completely washable and reusable, they will eliminate waste and replace the disposable pads that you are currently buying. 

Thinx is the brand most commonly associated with period panties as they popularized the product, but versions from other companies like Knix are also available.

About Raleigh OB/GYN

At Raleigh OB/GYN, we are happy to answer any questions you might have about your menstrual cycle, including which feminine hygiene products might be best and safest for you. We can be reached at 919-876-8225 or you can request an appointment online.

Portrait of young female patient seated on clinic chair wearing hospital gown; blog: health screenings for women

Health Screenings Every Woman Should Get

Throughout a woman’s life, there are many health concerns she should keep in mind. Often, these concerns change with age. One of the best practices in maintaining good health is getting recommended screenings to detect any illness early so it can be treated more easily. American Congress of Obstetricians and Gynecologists has a guide to well-woman care based on age. We will look at an overview of some of the important screenings every woman should get throughout her life when she should get them, and how often. And because September is Sexual Health Awareness Month, we will end by touching on some of the screenings you should get to improve and maintain sexual health.


Women should get their cholesterol tested regularly starting at age 20 if they are at increased risk of heart disease due to family history or other illnesses that might be linked to heart disease or high cholesterol. Because it varies on individual health, your doctor can talk to you about how often you should be tested.

Blood Pressure

Your blood pressure is probably taken at the beginning of most doctor’s appointments. But if not, it should be tested regularly. If you have normal blood pressure lower than 120/80, then you can get tested every 2 years. If you have blood pressure between 120/80 and 139/89, then a test once a year is necessary. If your blood pressure is any higher than that, you should discuss a treatment plan with your doctor. 

Breast Cancer

Doctors recommend women of all ages to do monthly self-exams to detect any lumps or changes in breast tissue. Beginning at age 40, the American College of Obstetrics and Gynecology recommends annual mammograms.

Cervical Cancer

If you have a cervix (for various reasons not all women do), you should get regular screenings for cervical cancer. Pap smears, or Pap tests, are performed by collecting cells from the cervix with a swab and then screening them for abnormalities. HPV tests can also be a part of a cervical cancer screening, as HPV is a leading cause of cervical cancer.

 Many gynecologists include a Pap smear in an annual well-woman exam, but not all of them do. So, if it’s not part of your annual checkup, how often should you get tested?

  • Women 21 and over should get a Pap test at least every 3 years.
  • Women 30 – 64 can get an HPV test and a Pap smear together every 5 years.
  • Women 65 and older should talk to their doctor about when and if you need to get a Pap test.

Colorectal Cancer

From ages 50-75, a woman should get screened for colorectal cancer once every 5-10 years. This range changes if you are at greater risk for colorectal cancer due to family history, a hereditary condition, inflammatory bowel disease, or if polyps have been found in prior screenings. Then the frequency could be every 1-5 years.

There are several types of colorectal screenings, and your doctor will discuss with you the best option for you. These screening methods can include:

  • Colonoscopy
  • CT colonography
  • Flexible sigmoidoscopy
  • Barium enemas
  • Stool tests


Type 2 diabetes affects almost 10% of the U.S. population, with even more Americans considered prediabetic. How often and when you should get tested for diabetes varies on your overall health, family history, and whether you have other conditions that are linked to the disease. 

It is recommended for most people to get tested for diabetes once every 3 years after age 45. If you have high blood pressure, especially if you take hypertension medication, you should get screened for diabetes earlier and more often than people without hypertension. Other factors that may cause your doctor to recommend more frequent screenings include family history, personal history of gestational diabetes, and obesity.

Sexually Transmitted Infections

Depending on the kind of sex education you had and how well you’ve educated yourself outside of school, you may or may not know the risks of common sexually transmitted infections (STIs). Even if you are generally knowledgeable, then you might not know when or how often to get tested for STIs. The CDC has excellent information on many sexually transmitted diseases, including the symptoms, risks, and guidelines for testing and treatment.

If you are sexually active, it is important to know the symptoms of STIs and when you should get tested, even if you use protection. STIs can not only affect your sexual health but other body systems. Left untreated they can be serious. However, with appropriate screening, many STIs are treatable if not curable. To get details on each STI, click the link at the beginning of the screening recommendations.

  • HPV (Human Papillomavirus): For most women who are not immunocompromised, HIV positive, or have a history of cervical cancer, screenings for HPV are based on age.
    • Age 21-29: Pap test with cytology (looking at cells under a microscope) screening every three years. No separate HPV testing is done.
    • Age 30 – 65: Pap test with cytology and an HPV test should be given together every five years.
    • Age 65+: Recommendations vary based on previous results
  • HSV (Herpes Simplex Virus): If you are sexually active, you should be tested for HSV if you are exhibiting symptoms or are concerned you may have been exposed to HSV by a sexual partner. If you think you or your partner may have herpes and are pregnant, talk to your doctor about testing and ways to prevent passing it on to your baby.
  • Chlamydia: If you are sexually active and under 25, you should get tested for Chlamydia every year. Continue or resume yearly testing if you are over 25 and have new or multiple partners or a partner that has been diagnosed with an STI. Pregnant women should also get tested.
  • HIV (Human Immunodeficiency Virus): Every woman should be tested for HIV at least once if they’ve been sexually active. The CDC recommends that all pregnant women be tested for HIV. Talk to your doctor about your sexual activity to determine if you are at higher risk and need to be tested more frequently.
  • Gonorrhea: If you are sexually active, an honest conversation with your doctor can determine whether and when you should be tested for gonorrhea. If you have new or multiple sex partners or a partner who has an STI, get tested once a year. Testing is also recommended for pregnant women.
  • Syphilis: You should get tested for syphilis if you are sexually active and have had a partner who has tested positive for the infection. Pregnant women should also get tested at least once to avoid passing the infection to the baby.
  • Trichomoniasis: Testing for this common STI should be done if you are sexually active, at increased risk, or are experiencing symptoms.

 At Raleigh OB/GYN, we are committed to providing care for all stages of a woman’s life. This includes making sure she gets the necessary screenings to monitor her health and prevent illnesses. If you have questions about what kind of screenings you should get and when, contact us at 919-876-8225 or request an appointment online

C section Cesarean operation heal after mother holding baby postpartum recovery; Blog: What to Expect if You Have a C-Section

What to Expect if You Have a C-Section

Whether you are currently pregnant or planning on getting pregnant, you have probably thought about birthing plans and the different ways babies can be delivered.  

While vaginal birth is generally the recommended option in uncomplicated pregnancies, some women may require a C-section due to complications either during pregnancy or while in labor.

It is important to talk to your OB/GYN and other members of your care team to decide on the best plan to keep you and your baby safe and healthy. But it is good to have some information going into those conversations. With any pregnancy, it’s always a possibility, so it’s important to know what to expect if you have a C-section: 

What is a C-Section? 

A cesarean section, or C-section, is the surgical delivery of a baby through incisions made in the mother’s abdomen and uterus. This is done as an alternative to vaginal delivery. A C-section may be necessary for the safety of the mother and/or baby when a vaginal delivery poses some danger.

A C-section is abdominal surgery, so before the procedure, you will be prepped for the operation. You will be given an IV to administer fluids and medications, which can include anesthesia medication or medication to prevent infection. Your abdomen will be washed and other sanitary measures will be taken. You will also be given a catheter to keep the bladder empty during surgery, which decreases the risk of injury to the organ during the procedure.

A C-section requires anesthesia and you may be given general anesthesia, a spinal block, or an epidural block. General anesthesia will put you to sleep, so you will not be awake during the procedure. The other two methods numb the lower half of the body and you will be conscious during the procedure.

 There are multiple layers that your surgeon must go through before reaching the baby. These include incisions in your abdominal wall and then in the wall of the uterus. These incisions can either be transverse (horizontal) or vertical. The doctor and surgical team will deliver the baby through the incisions, the umbilical cord will be cut, followed by the removal of the placenta. The uterine incision will be closed with special stitches that will dissolve into your body as it heals. The abdominal incision will be closed using staples or stitches.

When is a C-Section Necessary

There are certain conditions and situations that make a C-section a safer option than vaginal delivery. The C-section may be planned due to pre-existing conditions or issues that develop during pregnancy. It may also be deemed necessary if complications arise once labor for a planned vaginal delivery has begun.

A C-section may be necessary for one or more of the following reasons:

  • Breech presentation
  • A very large baby
  • Pregnancy with multiples (twins, triplets, etc.) which has an increased risk of premature labor, poor positioning, or other issues
  • Maternal medical conditions like hypertension or diabetes
  • Maternal infections such as HIV or herpes
  • Failure of labor to progress (the cervix may not open enough for the baby to move into the vagina)
  • Concern for the baby due to abnormalities detected in fetal monitoring or umbilical cord compression
  • Concern for the mother such as hemorrhaging or placenta
  • Uterine rupture
  • Placental abruption, which is the placenta peeling away from the uterine wall

If you have had a C-section with a previous pregnancy you are more likely to require the procedure for additional births. However, it is possible to have a vaginal birth after cesarean delivery (VBAC) in some cases. Talk to your doctor about the risks to see if you are a candidate for VBAC.

What are the Risks and Complications Associated with a C-Section?

While a C-section does carry increased risks, most complications are usually easily treated. Some of the risks are specific to cesarean delivery, but many are the same as the risks of other surgeries that require anesthesia. The most common risks include:

  • Blood loss
  • Blood clots in legs, lungs, or pelvic organs
  • Adverse reaction to anesthesia or other medications
  • Injury to the bowel or bladder
  • Infection

What is Recovery from a C-Section Like?

As with other surgeries, recovery from a C-section can vary from woman to woman. Unless you were given general anesthesia, you will be able to see your baby immediately. After delivery, the baby is often placed on the mother’s chest. You should also be able to breastfeed right away. 

Typically, the hospital stay after a C-section is two to four days long. While you are in the hospital recovering, your incision will be checked regularly. Your blood pressure, pulse, and breathing will also be monitored following the surgery. You will need to stay in bed for a while after the procedure, but as soon as the anesthesia has worn off you will be encouraged to start taking short walks. The first few times you leave the bed you should have assistance from a nurse or another adult.

The most common issue women experience during recovery from a C-section is pain or soreness at the incision site. Your doctor can prescribe pain medication to ease the pain after the anesthesia wears off after surgery. Other symptoms you may experience during the recovery period include: 

  • Bleeding or discharge for 4 – 6 weeks
  • Cramping, especially if you’re breastfeeding
  • Bleeding with clots and cramps

Before you are discharged from the hospital, you will be instructed on how to care for the incision to prevent infection or trauma. You will also be given instructions on limiting your activity and other ways to take care of yourself when you return home.

If you develop a fever or if the pain or symptoms above worsen, contact your OB/GYN immediately as these can be signs of infection. 

Whether you and your doctor have decided on a scheduled C-section or you require one to safely deliver the baby after the onset of labor, Raleigh OB/GYN will be there for you every step of the way. We strive to create a supportive and nurturing environment no matter the birthing situation. Our doctors, nurses, and staff are all committed to providing the highest standard of care to you and your baby at every stage. To make an appointment, call 919-876-8225 or request one online.

Doctor or psychiatrist consulting and diagnostic examining stressful woman patient on obstetric - gynecological female illness, or mental health in medical clinic or hospital healthcare service center; Blog: Things You Didn’t Know Your OB/GYN Could Help You With

9 Things You Didn’t Know Your OB/GYN Could Help You With

If you’ve ever been pregnant or had a routine annual well-woman exam, you are probably familiar with many of the services an OB/GYN can provide. Things that immediately spring to mind include pregnancy care and all that can be involved in annual or other routine exams (Pap smears, pelvic exams, breast exams, etc.). However, these are not the only things your OB/GYN can help you with. After all, an OB/GYN is a fully-trained medical doctor with a large knowledge base.

Naturally, OB/GYNs are associated with reproductive health, but they are also committed to helping you achieve optimal overall wellness. Many obstetrician-gynecologists also offer an array of well-woman care in addition to the typical reproductive care you are familiar with. Let’s look at nine things you might not have known your OB/GYN can help you with.

1. Vaccinations 

Many doctors will tell you that providing immunizations is one of the most basic forms of healthcare they can provide. Your OB/GYN can assist you in keeping up to date with your vaccinations. This is especially true for women that use an OB/GYN as their primary health care provider. If your gynecologist is indeed your primary source for health care, then you both should discuss other routine procedures like colonoscopies or other screenings that are necessary throughout a woman’s life.

2. Family Planning and Birth Control Counseling

Your doctor can counsel you on the best birth control methods for you depending on when you want to have kids, if at all, and how many you want to have. While a primary care or clinic physician can certainly talk to you about birth control and give you a prescription, your OB/GYN may have more information for you based on your individual circumstances and knowledge of your reproductive health and history. This is especially true if you are considering long-term or even permanent birth control. 

3. Bone and Joint Health

Many women may think joint and bone health should only be a concern during menopause, but this is not true. The average woman begins to lose minerals in her bones starting at around 35. That’s well before the average age of women experiencing the onset of menopause. So, it’s important to be proactive and talk about prevention with your doctor before it becomes a problem.

4. Weight Monitoring and Management 

Ideally, you should make an appointment with your gynecologist at least once a year. Because of this frequency, your chart will have a comprehensive record of your weight history. Using this information, you and your doctor can discuss concerns about your weight and healthy ways to manage it. Whether your goal is to get to a healthy weight for overall wellness reasons or to be in a healthy weight range for pregnancy, your OB/GYN is a great resource. 

As a part of monitoring and helping you manage your weight, he or she can check and test for diabetes, which is often linked to being overweight or obese.

5. Skin Issues 

Skin issues can sometimes be indicators of conditions that affect reproductive hormones. The most common example of this is the onset of acne during puberty. But your OB/GYN can also be helpful with skin issues that are not linked to hormonal issues. If you see a new mole or growth during a routine self-examination, you can ask your OB/GYN to take a look. They can then refer you to a dermatologist if necessary.

6. Thyroid Problems

Thyroid problems affect one in eight women at some point in their lives. As previously mentioned, this can be linked to weight management problems because unusual weight gain and loss are symptoms of thyroid disorders. Your OB/GYN can evaluate for these types of conditions.

7. Depression, Anxiety, and Mood Issues

If you are having issues with your mood or suffering from depression or anxiety, talking to your OB/GYN can a good first step. Many women find that they are more comfortable with talking to their OB/GYN about mood-related concerns than their primary care doctor.

Whether your mental health is being affected by a condition that can alter your hormones (like pregnancy or menopause) or another reason, they can help you. If it is not something they can handle by themselves, then they often have good relationships with counselors or other mental health specialists that they can refer you to. 

8. Educating Children on Reproduction and Sexual Health 

If you have a daughter that is either asking questions and/or approaching puberty, you may be uncomfortable about discussing the mechanics of reproduction or the changes her body will go through during puberty. Your OB/GYN is a great resource and ally to have on your side for this. Have a conversation with your doctor to see what they recommend before having “the talk.”

Your doctor can help you by providing you with suggestions that can make an awkward conversation a bit smoother. Because of their extensive medical experience, they may be able to guide you with the right words to use as well as highlighting which topics to make sure you discuss. Having the medical and technical knowledge to back up a potentially emotional topic and provide reassurance and clarity to a young woman facing big changes.

9. Transitioning Through Life Stages

While treating you for the physical changes you go through during your life, your OB/GYN can help you cope with these sometimes difficult transitions emotionally. They can provide you with strategies to keep your sanity through the transition from puberty all the way through menopause and after. Your doctor is also a great resource when you’re looking for recommendations for other professionals, like other specialists or counselors.

At Raleigh OB/GYN we are committed to providing our patients with state-of-the-art care throughout all stages of a woman’s life. Whether you are pregnant, going through menopause, or at any point in between, our team of physicians, nurses and medical staff will create a supportive environment to address any medical concerns. Call 919.876.8225 or request an appointment online.

July is Cord Blood Awareness Month. Cord blood is used in the treatment of nearly 80 diseases today. Learn more about cord blood banking.

What is Cord Blood Banking?

Cord blood banking involves the preservation of a baby’s cord blood–the blood that remains inside the umbilical cord and placenta after birth. Usually, the umbilical cord and placenta are discarded with the blood still inside. But cord blood banking is a way to keep and store this valuable resource.

Why Should I Preserve and Store My Baby’s Cord Blood?

Cord blood is medically valuable because it contains hematopoietic stem cells. This type of stem cell can be used to treat certain diseases. Hematopoietic stem cells are different than most cells because while most cells can only make copies of themselves, these stem cells can mature into different types of blood cells. 

This type of stem cell is also present in blood and bone marrow. The stem cells in cord blood will match more people than those from bone marrow and stem cells from cord blood are less likely to be rejected by the transplant recipient. It is also easier to collect cord blood than bone marrow.

Hematopoietic stem cells can effectively treat more than 70 types of diseases. These diseases include genetic disorders, neurologic disorders, and immune system diseases. There are also some forms of cancer that have successfully been treated with hematopoietic stem cells, including lymphoma and leukemia.

Stem cells collected from cord blood are used to treat diseases via two different types of transplants: 

  • Autologous transplants are transplants in which the cord blood collected after birth is used by that same child. This is an uncommon transplant type due to the fact that it cannot treat the kind of diseases cord blood is often used for. This is due to the fact the stem cells have the same genetic makeup of the child.
  • Allogenic transplants are transplants in which donated tissues, organs, or cells (in this case, the stem cells in cord blood) come from another person. Sometimes the cells are donated by a family member and sometimes they come from a stranger from a blood bank.

The American College of Obstetricians and Gynecologists can provide you with more detailed information on what makes cord blood valuable and how it is used on this fact sheet.

How is the Cord Blood Collected?

Cord blood collection poses no risk to the baby or mother. It happens after the umbilical cord has been cut so it is safe and pain-free for all involved.

There are two methods used to collect cord blood.

  • In the syringe method, blood is drawn from the cord using a syringe, similar to a regular blood draw. The collection should take place shortly after the umbilical cord is cut.
  • Using the bag method, the umbilical cord is elevated and the cord blood is drained into a bag.

Bags and syringes are pre-labeled with an ID number to link it to your baby. No matter which method is used, the cord blood collection should take place within the first 15 minutes after birth. The lab needs to process the cord blood within 48 hours of collection.

What Happens to Cord Blood after Collection?

Once cord blood is collected it must be processed. During processing, the cord blood screened and typed. Both the cord blood and the mother’s blood are tested for blood or immune system disorders, genetic disorders and infections before the cord blood is banked. 

The blood is then sent to the blood bank where it is “typed” (tested to see which blood type it is). When it is stored, it is entered into a computerized tracking system. That way it can be found and retrieved quickly when it is needed.

Choosing a Cord Blood Bank

When choosing a cord there are several things to consider. You want to choose a reliable and accredited blood bank equipped to store the cord blood properly. 

First, you need to decide the type of bank to use. The type of bank you use will depend on if you are donating the cord blood or keeping it yourself. There are two types of cord blood banks

  • Public cord banks store cord blood for allogeneic transplants. There is no charge to store cord blood at public banks because you are donating the blood for someone else to use. Sometimes public banks offer something called “directed donation.” In a directed donation you donate the blood to be used for a family member that may benefit from stem cell treatment. Not all public banks offer this and often private blood banks are used for this purpose.
  • Private banks store blood that will be used in autologous transplants or for a directed donation to a family member. Private banks charge fees to collect, preserve, and store the cord blood. Sometimes exceptions are made for directed donations, but not always.

Whichever type of blood bank you decide on, make sure you choose an American Association of Blood Banks (AABB) accredited blood bank.

Is Cord Blood Banking Expensive?

If you are using a private bank, cord blood banking does require an investment for the initial fee to have the blood collected, preserved, and initially stored. There is also the ongoing expense of storing the blood in the facility. 

The cost of private cord blood banking varies depending on the bank you choose. Often the initial fee is between $900 and $2,100 depending on how long the initial storage period is. Many private cord blood banks offer pre-paid and discount plans to help make cord blood banking more accessible for families that are interested. After the initial fee, annual storage fees are often around $100.

At Raleigh OB/GYN we can provide you with education and support throughout your pregnancy. And if there is something more specialized you are interested in, like cord blood banking, we can help direct you to the best resources. We partner with Carolinas Cord Blood Bank (CCBB) which is part of the Duke University School of Medicine and one of the largest public cord blood banks in the world. 

To talk to someone on our team about pregnancy or gynecological care, request an appointment online or by calling (919) 876-8225.

Teen suffering belly pms symptoms

5 Tips to Help Ease PMS Symptoms

We’ve all heard the stereotypes about premenstrual syndrome (PMS) that make it seem like women who suffer from it are just irrational and unpredictably moody. But PMS can be more than pesky mood swings that are inconvenient to the person dealing with PMS and those around them. Severe PMS can be a condition that disrupts daily life for several days every month.

What is PMS?

As the name suggests, premenstrual syndrome is a condition that affects women before their menstrual period. According to the Office on Women’s Health, the symptoms can occur up to two weeks before the start of menstruation. 

While there no one definitive cause of PMS, according to the Mayo Clinic, it is thought to be related to cyclical hormone changes, fluctuation in chemicals in the brain, and perhaps even undiagnosed depression. However, it is impossible to positively diagnose with a lab test or physical examination.

Symptoms of PMS

The most common symptoms can be emotional or related to behavior. These symptoms include depressed mood, mood swings, irritability, anger, crying spells, change in libido, and insomnia.

Physical symptoms of PMS can include abdominal bloating, breast tenderness, weight gain, fatigue, headache, joint or muscle pain, digestive issues, and acne flare-ups.

How to Ease PMS Symptoms

In some cases, PMS can be managed with lifestyle changes. In other cases, consultation with women’s health care professional is necessary. Severe PMS may be a sign of premenstrual dysphoric disorder (PMDD), which is a more serious condition.

If you are suffering from the symptoms of PMS and they are becoming difficult to manage on your own with lifestyle changes or over the counter medication such as ibuprofen or acetaminophen to ease discomfort, you should talk to your doctor to get a definitive diagnosis and professional treatment. 

For many women, here are some other tips that may help ease PMS symptoms:


1. Exercise 

Exercise is something that can help with a multitude of health issues. Along with diet, exercise will help keep your body in top working condition. It is one of the most basic steps you can take to improve your overall health. 

Exercise helps with the depressed mood and fatigue associated with PMS. It is recommended that you get at least 30 minutes of exercise most days of the week. Aerobic exercises like swimming, biking, and walking briskly are good options


2. Change in Diet

Like exercise, changing dietary habits is one of the most frequently recommended things to improve your health and wellness. To ease PMS symptoms, take the following steps to manage your diet:

  • Avoid caffeine and alcohol
  • Limit salt to help with bloating
  • Eat frequent smaller meals rather than a few big meals
  • Look for foods high in calcium (a supplement may also help)
  • Avoid processed simple carbohydrates and eat complex carbs instead. Complex carbohydrates include fruits, vegetables, and whole grains

If you need more help with your diet, you can consult with your OB/GYN for suggestions or seek counseling from a qualified nutritionist or dietician.


3. Stress Reduction

Stress can make almost any health issue worse, and PMS is no exception. To combat stress you can try:

  • Getting adequate sleep
  • Yoga
  • Massage
  • Deep breathing exercises
  • Progressive muscle relaxation


4. Medication

If lifestyle changes do not help enough, your doctor may prescribe medication or suggest over the counter meds.

  • Antidepressants are often prescribed to help with PMS and PMDD mood symptoms. The types of antidepressant used in the treatment of these conditions are selective serotonin reuptake inhibitors (SSRIs). Your doctor may prescribe one of these types of antidepressant such as Prozac, Sarafem, Zoloft, Paxil, Pexeva and their generic versions.
  • Hormonal birth control may be prescribed to treat PMS symptoms. Hormonal birth control stops ovulation, which can make your menstrual cycle more regular and decrease the intensity of symptoms. There are also hormonal birth control options available that prevent you from having a period. For these reasons, hormonal birth control is also prescribed for women who experience heavy and painful periods.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most common over the counter pain relievers. They can be helpful in treating cramps and breast tenderness. You are probably familiar with many of these drugs, which include ibuprofen (Advil and Motrin IB) or naproxen sodium (Aleve).
  • Diuretics can help reduce water retention and ease bloating when exercise and limiting your salt intake are not effective enough. Known as “water pills,” diuretics like Spironolactone push excess fluid through the kidneys. Although versions may be available over-the-counter, diuretics should never be taken without first consulting a licensed healthcare provider.


5. Alternative Remedies

While these treatments are not regulated by the FDA, and are not scientifically proven, many women report they have benefitted from alternative medicine. Anecdotal evidence is not a viable replacement for professional medical advice. Examples of alternative remedies that may help are:

  • Vitamin supplements
  • Herbal supplements
  • Acupuncture

The main thing to remember with vitamin and herbal supplements is that they are not regulated by the FDA, so there is a small chance you won’t be getting exactly what is on the label. You should always speak to your provider before trying products, even those marketed as “safe” and/or “natural.”

If you make positive lifestyle changes for a while and do not experience enough of an improvement in your symptoms, it might be time to consult a professional. At Raleigh OB/GYN we offer comprehensive gynecological care and can help with issues related to your menstrual cycle, including PMS. To make an appointment, call 919-876-8225 or request one online.

VBAC; Emergency In the Hospital: Woman Giving Birth, Husband Holds Her Hand in Support, Obstetricians Assisting. Modern Delivery Ward with Professional Midwives.

Am I a Good Candidate for a VBAC?

Many women in the US have given birth via Cesarean, or C-section. There are many reasons that this may be necessary or planned for, but there are some preconceived notions about C-sections that may not be true. One of those notions is that once you’ve had a C-section, all of your subsequent deliveries must be via C-section as well. This is not necessarily true. Given the circumstances of your previous Cesarean, you may be a candidate for VBAC.

What is VBAC?

VBAC stands for vaginal birth after Cesarean. This type of delivery is pretty much what the name says: it is vaginal childbirth in a woman who has had a previous Cesarean. If you’ve given birth by Cesarean before, you will probably have a choice of how to give birth again: a scheduled C-section or a VBAC. The latter may not be an option for you depending on the circumstances of your previous Cesarean, but there’s a good chance that it is. Below are some things to know about VBAC when speaking to your doctor about the plan for your next delivery.

What are the Benefits of VBAC?

There are many reasons women are interested in Vaginal Birth after Cesarean. One is that a lot of women desire the experience of vaginal birth. Also, if the woman is planning on giving birth to more children in the future, VBAC can help them reduce the risk of complications from multiple C-sections.

A big reason VBAC is attractive to a lot of women is that it does not require abdominal surgery. Recovery after childbirth is different for every woman no matter how she delivers, but major surgery can make it a little more difficult.

Cesarean is often necessary for the safety of the mother and child, but if it’s an option, some women might choose vaginal birth so they do not have to cope with the longer recovery period of a major surgery while taking care of a new baby.

Also, because there is no surgery required, the risk of infection and blood loss are lower in a VBAC.

What are the Risks of VBAC?

Of course, along with benefits, VBAC has risks. You and your doctor should pay special attention and go over your medical history, especially involving pregnancy and birth when considering VBAC over a repeat Cesarean. But before you have that conversation with your physician, there are a few risks you might want to know about.

The American Pregnancy Association says the biggest risk for women who have had a previous C-section is that of uterine rupture during vaginal birth. Or rather, rupture of the Cesarean scar on the uterus. This risk is fairly low statistically, as stated below, but if you have had a previous uterine rupture or have a condition that makes you vulnerable to uterine rupture, Vaginal Birth after Cesarean should not be attempted.

Other risks include infection, blood loss, and other complications related to vaginal childbirth.

What are the Statistics on VBAC?

Most studies show results of about 60-80% of women who have previously undergone Cesarean birth can successfully give birth vaginally.  As stated above, the biggest risk is generally uterine rupture, and in the past, the American College of Obstetricians and Gynecologists (ACOG) reported that in women with previous C-sections with low transverse incisions (instead of high vertical, or classical, incisions), the chance of uterine rupture during vaginal delivery was about 1 in 500.

What Makes Someone a Good Candidate for VBAC?

There are a number of criteria that should be met for someone to be a good candidate for Vaginal Birth after Cesarean. In recent years, these criteria have become a bit less restrictive as more has been learned about the risks and benefits of VBAC. And in accordance with the statistics above, many women will fit into these criteria. These include:

  • Your prior Cesarean was performed using a low-transverse incision rather than a high
  • You’ve never had a uterine rupture.
  • Past uterine surgeries haven’t been extensive, such as a myomectomy to remove fibroids.
  • Having access to a doctor on-site who can monitor labor and perform an emergency Cesarean if needed.
  • In addition to the doctor who can do the C-section, other doctors and personnel such as an anesthesiologist as well as equipment are available to you and your baby.

What Factors Might Make a VBAC Less Likely?

There are other factors that make it less likely for a woman to be considered a candidate for VBAC. These factors may create conditions that could pose a threat to the health of the mother or the child. These risk factors include:

  • Being overweight
  • Going beyond 40 weeks of gestation
  • Requiring labor induction
  • Being an older mother
  • Having a short period between pregnancies, usually 18 months or less
  • Having a baby with a high estimated birth weight. This is usually over 8.8 pounds or 4 kg

Schedule an Appointment

Of course, you and your doctor are the only ones who can determine if you can safely deliver vaginally after having a previous cesarean. The board-certified physicians at Raleigh OB/GYN can work with you figure out what your birth plan might look like. If you want to talk more about Vaginal Birth After Cesarean and whether or not it might be possible for you, schedule an appointment by calling (919) 876-8225