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Category: Obstetrics

Understanding Ovulation

Ovulation is a key part of the menstrual cycle and is the process that brings eggs from the ovaries into the uterus so they may be fertilized.

If you are trying to conceive or are using natural family planning and fertility awareness methods such as the rhythm method for birth control, it is important that you understand the process of ovulation. 

The American Pregnancy Association is a great source for learning more in-depth about the process of ovulation and how you can track it, but here some basic things to help you gain a better overall understanding of ovulation.

Ovulation and the Menstrual Cycle

Ovulation is the part of the menstrual cycle in which a mature egg is released from an ovary and travels through one of the fallopian tubes and towards the uterus where it may be fertilized by sperm.

During the menstrual cycle, an egg will mature in an ovary. When it is mature, it will be released from its follicle and the ovary itself to make the journey towards the uterus and the possibility of fertilization.

While the egg has been maturing, the uterine lining has also been thickening in anticipation of a fertilized egg implanting in the uterine wall. A menstrual period occurs when there is no fertilization or implantation and the uterus sheds the lining and the egg with it.

Without ovulation, natural conception cannot be achieved. To successfully conceive there are several processes that depend on each other. Ovulation is one of those key processes that enable procreation.

Tracking Ovulation

Perhaps the easiest and most accurate way to find out if you’re ovulating is by using a testing kit. These over-the-counter kits test your urine for increases in certain hormones to determine the likelihood of ovulation. 

You can also keep track of when you might be ovulating by tracking your menstrual cycle. In a typical 28-day menstrual cycle, ovulation occurs about 14 days before the next menstrual period starts. But in practice, the menstrual cycle is not always 28 days precisely. In most women, ovulation happens in the four days before or after the midpoint of the cycle. So, you can calculate ovulation by keeping a menstruation calendar, finding the midpoint, and then identifying days you are most likely to be ovulating.

There are also a few physical signs you might notice that can indicate you are ovulating. These include changes in basal body temperature and vaginal secretion. 

Your basal body temperature is the temperature of your body when it is at rest. During ovulation, basal body temperature will increase. You can monitor this by using a thermometer specifically made for taking basal temperature to record your temperature at the same time each morning before you get out of bed. You can use this recorded data to see patterns in temperature each month. You are most fertile the two to three days before your temperature rises.

Vaginal secretion changes during ovulation and becomes clearer, stretchy, wet, and less viscous. This is due to an increase in the cervical mucus needed for ovulation. Many women will notice this difference because when they are not ovulating, secretions are less noticeable and may be cloudy and thick. 

Ovulation Facts and Stats 

Here are some facts and statistics to keep in mind as you begin to track your cycle in preparation for conception or for fertility-awareness-based birth control:

  • Stress or illness can affect ovulation and alter the menstrual cycle.
  • Spotting (light bleeding) sometimes occurs during ovulation for certain women.
  • Some women experience pain or aching near the ovaries during ovulation. This is referred to by the German term “mittelschmerz,” which translates to “middle pain.”
  • You can have a menstrual period even if you have not ovulated.
  • You can ovulate without having a menstrual period.
  • An egg lives between 12 and 24 hours after leaving the ovary. If it is not fertilized during that time period it will disintegrate and be absorbed by the uterine lining.
  • Implantation of a fertilized egg generally occurs 6-12 days after ovulation.
  • Women are born with all the eggs they will ever have. The ovaries start out with millions of immature eggs.
  • Typically, only one egg is released during natural ovulation. This number may increase when using fertility treatments. Ovarian stimulation is often achieved with hormones and other medications so that multiple eggs will be released and can, in turn, be harvested for IVF or cryopreservation.

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 GreenValley OB/GYN was founded over 70 years ago and has been committed to providing the highest quality to the women of the Triad ever since. Our certified OB/GYN physicians and our fantastic staff are dedicated to working with patients to achieve health goals and maintain

9 Questions to Ask at Your First Prenatal Appointment

Congratulations, you’re pregnant! You are probably feeling a lot of different things right now– excitement, nervousness, uncertainty, joy, disbelief and just about every other emotion under the sun. When you go to your first appointment (usually at 8 to 10 weeks) you can calm a few of those emotions by having a plan and a list of questions to ask your doctor. You may have your own questions ready, but also consider these nine questions to ask at your first prenatal appointment:

1. What lifestyle changes do I need to make immediately?

Once you learn you are pregnant, you’ll need to change some things about your lifestyle right away. Depending on your habits pre-pregnancy, these changes may seem drastic or they might not be super noticeable. Either way, you will not have a problem making these changes for the good of your child (and your own health while carrying the child, which is top priority).

Here are some things to discuss at the beginning of the pregnancy to avoid possible negative effects:

  • Diet: Obviously, alcohol should be cut out immediately. Caffeine should be limited and some other foods should be eliminated (usually deli meat, unpasteurized cheese, certain fish). Your doctor will give you a written list of what to avoid and explain why you should do so. They can also give guidance on what kind of foods and drinks to add or increase in your diet.
  • Medication: This is so important because many medications are not safe for use during pregnancy. Both over the counter medications and prescriptions should be looked at as soon as you know you’re pregnant. Working with your doctor, you can decide what is safe to keep taking and at what dosages. And if you need to come off of a certain important medication, they can help you come up with a plan to discontinue use as some are dangerous to discontinue cold turkey. When possible, they may be able to prescribe an alternative.
  • Sleep habits: If you aren’t getting the recommended amount of sleep each night, consider changing your sleep habits. Your body will be going through a lot of changes in the coming months, so adequate rest is important. You’ll also want to be well rested before those sleepless newborn nights start.
  • Work environment: Ask if your occupation or work environment might pose any risks. Make sure you aren’t exposed to chemicals or toxins that could be harmful. Work with your care team as well as a safety manager at your job.
  • Beauty products: If you’re worried about certain beauty products being safe for your baby during pregnancy, check with your doctor. A lot of women are concerned about hair dye, nail polish or treatments (especially chemicals present in some nail salons), sunless tanning lotions, retinols, serums, and essential oils. Your doctor can help steer you in the right direction for making safe choices where these products are concerned. You can also ask about massages or other spa treatments.

2. What things am I at risk for given my personal history?

This is a very important question to ask from the very beginning of your pregnancy. Pregnancy is not an illness by any means, and the human body is built for it. However, pregnancy can still put a lot of stress on your body, especially if you already have a condition that can be worsened.

Chances are if you continue care with your regular OB/GYN your doctor will know most of your medical history. But if you’re using a new doctor due to your pregnancy or for any other reason, you need to be sure they know everything. And it never hurts for a current doctor to go back over and re-check history.

If you have specific concerns your doctor does not address, be sure to speak up. Some common conditions that are important to note include, but aren’t limited to: depression, seizures, high blood pressure, diabetes, and thyroid issues. Any problems with anesthesia, antibiotics, medication, or surgeries should also be brought to your doctor’s attention.

3. What will the frequency of my appointment be?

In order to have an idea of the big picture of your pregnancy care, talk to your doctor about the base number of prenatal appointments you can expect. They’ll want to schedule the appointments regularly and the frequency will increase the further along you get in your pregnancy. The actual number will depend on your individual needs but in general you can expect to see the doctor more near the due date.

4. What vitamins do I need to take?

If you were actively trying to conceive, then you might have been taking a prenatal vitamin before you got pregnant. But if you got pregnant unexpectedly, or weren’t on a prenatal vitamin, your doctor will recommend you start taking one.  He or she will give you guidance on what to look for in a vitamin if they do not prescribe one or recommend a specific brand.

5. What exercise can/should I be doing?

Staying active during pregnancy is important. If you are fit while you’re pregnant, recovery could be easier depending on how labor goes. Exercise and general fitness can also help you feel better both mentally and physically throughout the pregnancy. Many exercise regimens, excluding extreme examples, are safe as long as you feel physically comfortable. However, you should follow your doctor’s instructions on what kind of exercise is appropriate.

6. How much weight should I gain?

The amount of weight you should gain will depend on how much you weighed before you were pregnant. Your doctor can give you a more precise number or range but generally, women with healthy pre-pregnancy weights should gain 25-30 pounds. Women who are underweight should gain about 40 pounds and overweight women should gain 11 to 20 pounds. These weights can change based on your unique circumstances.

7. What about prenatal testing?

During your pregnancy, certain prenatal screenings are required whereas others may be optional. You can expect to have blood work done in the first and second trimester. You can also expect a test to determine whether or not you have gestational diabetes. Genetic testing is also available. What kind of genetic testing you get or if you decide to get it, is a personal decision and you should talk to your doctor about the risks and what certain results might mean, including false positives.

8. What is normal and what should I call you about? And when should I call 911 or go directly to the hospital?

Speak with your doctor about what is normal or common or when you need to call about problems. Make sure you’re clear on what is “normal” for your stage of pregnancy as you go along. But always err on the side of caution. Also ask the best way to contact your doctor with ask questions (email, phone, online patient portal) and who you should call in certain situations.

You should also know who to call in case of a medical emergency and where you should go. This might change based on how far along in your pregnancy you are.

9. What should I start considering to prepare my birth plan?

It might seem premature to start thinking about your delivery since you’re just at the beginning of your pregnancy, but in reality, the sooner you start talking with your doctor about your options and preferences, the more comfortable you’ll feel when the day gets closer. Some things to discuss with your doctor regarding a birth plan include:

  • Birth location: You probably already know which hospital your OB/GYN is affiliated with, but this is still a topic worth discussing. Some people prefer to deliver at birthing centers or at home. If you want to go this route, the sooner your doctor knows, the better so everyone is on the same page.
  • Care philosophy: It’s important to know your provider’s views on vaginal labor, C-sections, induced labor, epidurals, delivering without pain medication, etc.
  • Who will actually deliver the baby? Will it be the doctor you see for your regular appointments or someone else? As mentioned above, if you’re planning on delivery outside of a hospital, your doctor might not be the one delivering the baby, so midwives or doulas may need to be part of the discussion.

At Green Valley OB/GYN we have extensive experience in managing both high-risk and low-risk pregnancies. And when you’re at the beginning of your pregnancy we know you will have a lot of questions and concerns. Call (336) 378-1110 to make an appointment at our Greensboro office. The office is open Monday through Friday from 8 a.m. to 5 p.m. and we have an on-call physician available 24/7 in case of emergencies.

Gestational Diabetes: 8 Facts You Need to Know

If you are trying to get pregnant or are currently in the early stages of pregnancy, you probably have concerns about certain pregnancy-related health issues and risks. One condition that many mothers have heard of and are concerned about is gestational diabetes.

According to the CDC, gestational diabetes is a type of diabetes seen in a pregnant woman who did not have diabetes prior to pregnancy. Gestational diabetes is a condition that occurs when the body does not produce enough insulin to process sugar and convert it into energy. This leads to high glucose levels in the blood (hyperglycemia). 

If you have concerns about gestational diabetes, it is best to consult your doctor. But there are some important things you should know about it in the meantime. 

1. Gestational Diabetes Occurs During the Middle of Pregnancy

Doctors usually begin testing for gestational diabetes between 24 and 28 weeks. However, if you are overweight, older than 35, or have a family history of diabetes, you may be tested earlier and more frequently.

2. If You Have Symptoms, See Your Doctor ASAP

If you think you have gestational diabetes, do not wait until the standard 24 to 28 weeks to get tested. See your doctor or healthcare provider right away so you can take steps to treat the condition if you do in fact have it. Symptoms include:

  • Unusual thirst
  • Blurred vision
  • Frequent urination
  • Frequent vaginal, bladder and skin infections
  • Fatigue
  • Nausea

3. It Might Develop Due to Pregnancy Hormones

According to the American Diabetes Association, there is no universally proven and agreed-upon cause for gestational diabetes. However, there are certain things that point to why a woman without diabetes develops diabetes while pregnant. 

During pregnancy, the placenta produces hormones needed for the baby to develop properly, which is a good thing for the baby. But these hormones can cause insulin resistance in the mother. This makes it difficult for the body to use its insulin.

4. More than One Test May Be Needed for Diagnosis

There are a couple of tests used to determine whether a woman has gestational diabetes. The first is called a Glucose Challenge Test. Depending on the results of this first test, a second test called a Glucose Tolerance Test may be necessary.

For the glucose challenge test, you do not need to fast before the appointment. There are two steps for this test:

  • At the beginning of the appointment, you’ll be given about five ounces of a glucose solution to drink. The solution is syrupy and some women may find they do not like the taste.
  • You stay in the office or lab setting for an hour (bring something quiet to do to pass the time) to wait to have your blood tested. After the hour is up, blood is drawn from a vein in your arm. The blood will then be tested to see your blood sugar level.

If your blood sugar is too high (above 140 mg/dL), you might have gestational diabetes. To confirm the diagnosis, you will need to have a different test done. 

The second test will be a glucose tolerance test. This test differs from the glucose challenge test in several ways even if the general idea is the same. For example, the glucose tolerance test takes three hours instead of just one and you must fast before the appointment. Then the process is as follows:

  • A blood sample is taken at the beginning to determine fasting blood sugar.
  • You will drink about eight ounces of the glucose solution.
  • Your blood glucose level will be tested again one, two and three hours after you drink the solution. 

The results of that test will be analyzed. If the glucose level in one of the four samples (fasting, one hour, two hours, three hours) is too high, your doctor will probably have you schedule another test for four weeks later. If the glucose levels are too high in two or more of the samples, then you will be diagnosed with gestational diabetes.

5. Gestational Diabetes is Often Controlled Through Diet and Exercise

The goal of treating gestational diabetes is to get blood glucose close to those of women without gestational diabetes. First, your doctor will help you with a specific meal plan. You will also need to schedule regular physical activity. Sometimes this is enough to lower blood glucose and manage gestational diabetes. Other times, gestational diabetes needs to be treated with insulin. You may also need to do daily blood glucose testing.

You may be able to decrease your chances of developing gestational diabetes by making the same basic lifestyle changes before you get pregnant. Losing weight can lower the risk for type two diabetes in people who are not pregnant, and one of the risk factors for gestational diabetes is being overweight. Eliminating that risk factor before it can become a problem might be helpful.

6. Gestational Diabetes Can Make Babies Large

If your diabetes is not effectively controlled, the high blood sugar will “overfeed” the baby. This causes the baby to become extra-large, a condition called macrosomia. An extra-large baby can complicate delivery, harming both mother and baby. C-sections are more common with large babies.

Macrosomia can cause issues for the baby after birth as well. They are at high risk for childhood obesity and type 2 diabetes as an adult.

7. Gestational Diabetes Increases the Chance of Needing a C-Section

Whether it is because of the baby being large or other complications, patients with gestational diabetes are more likely to require a C-section than those without the condition. C-sections require a longer recovery time than vaginal birth in most cases.

8. You Should be Tested for Diabetes after Pregnancy

After you deliver the baby, you still need to monitor your blood sugar. You should be tested for diabetes six to twelve weeks after the baby is born. After that, you should get tested every one to three years. Half of all women who had gestational diabetes later develop type 2 diabetes. Continuing to eat well and exercise can reduce your risk.

At Green Valley OB/GYN, we want to make sure you and your future baby get the best care possible to promote good health for you both. If you have concerns about pregnancy, whether it be gestational diabetes or something else, call us at (336) 378-1110 to schedule an appointment. 

Is VBAC Right for You?

If you’ve had a baby via C-section and are looking at your options for your next delivery, you may have considered vaginal birth after Cesarean (VBAC). This option is attractive to many mothers who want to avoid another abdominal surgery. Only a qualified OB/GYN can determine if this option is right for you. Read on to learn more about this type of delivery and to find out if you might be a candidate for it.

What is VBAC?

If you’ve had a baby with a Cesarean section, you have two options for how you can deliver your next baby. You can choose to schedule another C-section or you can attempt to have the baby vaginally. This is known as vaginal birth after cesarean, which is more commonly referred to as VBAC. The attempt to have a VBAC is called a trial of labor after cesarean delivery (TOLAC). If a TOLAC is successful, it results in a vaginal birth. If it is not successful, a C-section is necessary.

Benefits

Many women want a TOLAC or vaginal birth after cesarean because there are several benefits when compared to another C-section.

  • No abdominal surgery: A cesarean section is a major abdominal surgery that takes about 6 weeks of recovery. While C-sections are generally very safe, any surgery carries risks of potential complications.
  • You can use a birth plan: If you have a vaginal birth rather than a C-section you can have more control over your labor and delivery experience.
  • Lower risk of infection: Your risk of developing an infection after vaginal birth is lower than your risk after a C-section.
  • Less blood loss: Surgeries like C-sections generally have a higher risk of blood loss than vaginal birth.
  • Shorter recovery period: The recovery time after vaginal birth is generally shorter and requires less bed rest than the recovery period following abdominal surgery.
  • Less chance of future C-Sections: If you have multiple C-sections, your chances of needing a scheduled cesarean for a future pregnancy increase. 

Risks

While there are many benefits to vaginal birth after cesarean, there are some risks as well. You need to talk to your doctor about what type of birth is best for you based on your history and other factors. In rare cases, there is a risk that the cesarean scar on the uterus may rupture. This is very rare but can be very serious and puts the mother and the baby in danger.

Am I a Candidate for VBAC?

Only you and your doctor can determine whether or not you are a good candidate for TOLAC based on your current health and your health history. However, you can get an idea of whether or not you might be able to attempt VBAC by taking a look at the general guidelines below.

You might be a good candidate for VBAC if you meet the following criteria:

  • You are pregnant with only one baby
  • You have had a vaginal birth before
  • You’ve had 1 or 2 previous C-sections with low transverse incisions
  • Your prior C-section was done with a low transverse incision and not a low vertical incision or a high vertical incision.
  • You have never had a uterine rupture and are not at risk of having one
  • Any past surgeries involving the uterus (such as procedures to remove fibroids) were not extensive or invasive
  • Your doctor determines you do not have any problems that would prevent or complicate a vaginal birth after cesarean
  • You have access to a doctor on-site who can monitor your labor and perform an emergency C-section if necessary
    • Other doctors, medical personnel, and equipment necessary for an emergency C-section must be available

If you are a candidate for TOLAC, you have a high chance of having a successful vaginal delivery. According to the March of Dimes, more than 70% of women who try a VBAC are successful in having their babies vaginally.

Your chances of having a successful VBAC decrease if one or more of the following are true:

  • You are pregnant with more than one baby
  • You have gone beyond 40 weeks of gestation
  • You require labor induction
  • Your labor has stalled
  • Your baby has a high estimated birth weight
    • Generally over 8.8 lbs or 4 kg
  • You are overweight or obese
  • There were fewer than 19 months between your last pregnancy and your current pregnancy
  • You have a high vertical uterine incision
  • You’ve had a prior uterine rupture
  • You are 35 or older

Consult an OB/GYN

Green Valley OB/GYN has been providing the highest quality of obstetric and gynecological care for over 70 years. We offer a comprehensive list of services, including vaginal birth after cesarean. To set up an appointment to talk to a doctor about whether you are a good candidate for VBAC, call us at (336) 378-1110 to schedule an appointment.

Gestational diabetes and risk factors


Dr. Michelle Horvath discusses gestational diabetes, a form of type 2 diabetes that is only present during pregnancy on WGHP television in High Point, NC.

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This is a very well-run office. I never wait long, the staff is super friendly and my physician is wonderful, very professional, and personable!

Ines

I haven’t met a provider that I didn’t absolutely love! During my last pregnancy, I transferred from another OBGYN that I did not care for at all. I couldn’t have picked a better place to put my trust in!

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I travel 2800 miles for my visit with Dr. Wein! He is the most thorough, kind, and knowledgeable doctor EVER! No matter your age, you will be in the best hands.

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Dr. Callahan and her team are absolutely amazing. I have been her patient for over nine years and drive over an hour to see her because I know I am receiving the very best care. From the time you check-in at Green Valley, to the conversation with the nurses , to your exam, and aftercare — you feel known and valued. I truly cannot say enough about how amazing everyone is. Dr. Callahan has my very highest regard and praise (as do Vlora, Stacy, and Cathy!) They are wonderful. Look no further!

Schaeffer

I love seeing Dr. Kendra Ross. She is so friendly and personable yet professional all at the same time. She listens to me and makes sure she’s addressing any concerns or questions I may have. She explains things and has an amazing sense of humor and she always makes me laugh.

Sharon

After having one GYN provider for so long in NY, Dr.Hovath definitely has made my transition a great one without even knowing. She has made me feel super comfortable and is greatly appreciated. I never cared for female GYN from past bad experiences but I have now found one that as long as she’s is practicing I will be a patient. Too bad no more babies for me! Awesome M.D.

Nikkia

Dr. Clark is an outstanding provider. I have recommended several other ladies to see her. She is always so kind and very personable. Her bedside manner is very professional and caring. She takes her time and seems to really care about your concerns. She also delivered my 2-year-old daughter and was awesome in the delivery room. I highly recommend her.

Nicole

This place is AMAZING. I cannot stress enough how much I love Green Valley OBGYN. Everyone is so friendly and caring. There’s almost no wait time. I’ve recommended this place to friends and family.

Ivana