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Why Preconception Health Matters

Preconception health is a woman's health before she becomes pregnant. It means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems, such as diabetes, also can affect pregnancy.

Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low-birth-weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.

The Five Most Important Things to Boost Your Preconception Health

Women and men should prepare for pregnancy before becoming sexually active — or at least 3 months before getting pregnant. Some actions, such as quitting smoking, reaching a healthy weight, or adjusting medicines you are using, should start even earlier. The five most important things you can do for preconception health are:

1. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) folic acid every day if you are planning or capable of pregnancy to lower your risk of some birth defects of the brain and spine, including spina bifida. All women need folic acid every day. Talk to your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.

2. Stop smoking and drinking alcohol.

3. If you have a medical condition, be sure it is under control. Some conditions that can affect pregnancy or be affected by it include asthma, diabetes, oral health, obesity, or epilepsy.

4. Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Be sure your vaccinations are up to date.

5. Avoid contact with toxic substances or materials that could cause infection at work and at home. Stay away from chemicals and cat or rodent feces.

Talk to Your Doctor Before You Become Pregnant

Preconception care can improve your chances of getting pregnant, having a healthy pregnancy, and having a healthy baby. If you are sexually active, talk to your doctor about your preconception health now. Preconception care should begin at least 3 months before you get pregnant. But some women need more time to get their bodies ready for pregnancy. Be sure to discuss your partner's health too. Ask your doctor about:

• Family planning and birth control.

• Taking folic acid.

• Vaccines and screenings you may need, such as a Pap test and screenings for sexually transmitted infections (STIs), including HIV.

• Managing health problems, such as diabetes, high blood pressure, thyroid disease, obesity, depression, eating disorders, and asthma. Find out how pregnancy may affect, or be affected by, health problems you have.

• Medicines you use, including over-the-counter, herbal, and prescription drugs and supplements.

• Ways to improve your overall health, such as reaching a healthy weight, making healthy food choices, being physically active, caring for your teeth and gums, reducing stress, quitting smoking, and avoiding alcohol.

• How to avoid illness.

• Hazards in your workplace or home that could harm you or your baby.

• Health problems that run in your or your partner's family.

• Problems you have had with prior pregnancies.

• Family concerns that could affect your health, such as domestic violence or lack of support.

Your Partner's Role in Preparing for Pregnancy

Your partner can do a lot to support and encourage you in every aspect of preparing for pregnancy. Here are some ways:

• Screening for and treating sexually transmitted infections (STDs) can help make sure infections are not passed to female partners.

• Male partners can improve their own reproductive health and overall health by limiting alcohol, quitting smoking or illegal drug use, making healthy food choices, and reducing stress. Studies show that men who drink a lot, smoke, or use drugs can have problems with their sperm. These might cause you to have problems getting pregnant. If your partner won't quit smoking, ask that he not smoke around you, to avoid harmful effects of secondhand smoke.

• Your partner should also talk to his doctor about his own health, his family health history, and any medicines he uses.

• People who work with chemicals or other toxins can be careful not to expose women to them. For example, people who work with fertilizers or pesticides should change out of dirty clothes before coming near women. They should handle and wash soiled clothes separately.

Genetic Counseling

The genes your baby is born with can affect your baby's health in these ways:

• Single gene disorders are caused by a problem in a single gene. Genes contain the information your body's cells need to function. Single gene disorders run in families. Examples of single gene disorders are cystic fibrosis and sickle cell anemia.

• Chromosome disorders occur when all or part of a chromosome is missing or extra, or if the structure of one or more chromosomes is not normal. Chromosomes are structures where genes are located. Most chromosome disorders that involve whole chromosomes do not run in families.

Talk to your doctor about your and your partner's family health histories before becoming pregnant. This information can help your doctor find out any genetic risks you might have.

Depending on your genetic risk factors, your doctor might suggest you meet with a genetic professional. Some reasons a person or couple might seek genetic counseling are:

• A family history of a genetic condition, birth defect, chromosomal disorder, or cancer

• Two or more pregnancy losses, a stillbirth, or a baby who died

• A child with a known inherited disorder, birth defect, or intellectual disability

• A woman who is pregnant or plans to be come pregnant at 35 years or older

• Test results that suggest a genetic condition is present

• Increased risk of getting or passing on a genetic disorder because of one's ethnic background

• People related by blood who want to have children together

During a consultation, the genetics professional meets with a person or couple to discuss genetic risks or to diagnose, confirm, or rule out a genetic condition. Sometimes, a couple chooses to have genetic testing. Some tests can help couples to know the chances that a person will get or pass on a genetic disorder. The genetics professional can help couples decide if genetic testing is the right choice for them.

How do you figure out when you're fertile and when you're not? Wondering if you or your partner is infertile? Read on to boost your chances of conception and get help for fertility problems.

Fertility Awareness, Menstruation and the Menstrual Cycle

The Menstrual Cycle

Being aware of your menstrual cycle and the changes in your body that happen during this time can help you know when you are most likely to get pregnant. See how the menstrual cycle works below.

Day 1 starts with the first day of your period. This occurs after hormone levels drop at the end of the previous cycle, signaling blood and tissues lining the uterus (womb) to break down and shed from the body. Bleeding lasts about 5 days.

Usually by Day 7, bleeding has stopped. Leading up to this time, hormones cause fluid-filled pockets called follicles to develop on the ovaries. Each follicle contains an egg.

Between Day 7 and 14, one follicle will continue to develop and reach maturity. The lining of the uterus starts to thicken, waiting for a fertilized egg to implant there. The lining is rich in blood and nutrients.

Around Day 14 (in a 28-day cycle), hormones cause the mature follicle to burst and release an egg from the ovary, a process called ovulation.

Over the next few days, the egg travels down the fallopian tube towards the uterus. If a sperm unites with the egg here, the fertilized egg will continue down the fallopian tube and attach to the lining of the uterus.

If the egg is not fertilized, hormone levels will drop around Day 25. This signals the next menstrual cycle to begin. The egg will break apart and be shed with the next period.

The average menstrual cycle lasts 28 days. But normal cycles can vary from 21 to 35 days. The amount of time before ovulation occurs is different in every woman, and even can be different from month-to-month in the same woman, varying from 13 to 20 days long. This is the most important part of the cycle to learn about, since this is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods) will have a period within 14 to 16 days.

Charting Your Fertility Pattern

Knowing when you're most fertile will help you plan pregnancy. There are three ways you can keep track of your fertile times. They are:

• Basal body temperature method – Basal body temperature is your temperature at rest as soon as you awake in the morning. A woman's basal body temperature rises slightly with ovulation. So by recording this temperature daily for several months, you'll be able to predict your most fertile days.

  Basal body temperature differs slightly from woman to woman. Anywhere from 96 to 98 degrees Fahrenheit orally is average before ovulation. After ovulation most women have an oral temperature between 97 and 99 degrees Fahrenheit. The rise in temperature can be a sudden jump or a gradual climb over a few days.

  Usually a woman's basal body temperature rises by only 0.4 to 0.8 degrees Fahrenheit. To detect this tiny change, women must use a basal body thermometer. These thermometers are very sensitive. Most pharmacies sell them for around $10. You can then record your temperature on our special Basal Body Temperature Chart (PDF file, 1.3 Mb).

  The rise in temperature doesn't show exactly when the egg is released. But almost all women have ovulated within three days after their temperatures spike. Body temperature stays at the higher level until your period starts.

  You are most fertile and most likely to get pregnant:

  • Two to three days before your temperature hits the highest point (ovulation),
           and

  • 12 to 24 hours after ovulation.

  A man's sperm can live for up to three days in a woman's vagina, uterus and fallopian tubes. The sperm can fertilize an egg at any point during that time. So if you have unprotected sex a few days before ovulation there is a chance of becoming pregnant.

  Many things can affect basal body temperature. For your chart to be useful, make sure to take your temperature every morning at about the same time. Things that can alter your temperature include:

  • drinking alcohol the night before

  • smoking cigarettes the night before

  • getting a poor night's sleep

  • having a fever

  • doing anything in the morning before you take your temperature — including going to the bathroom and talking on the phone
    

• Calendar method – This involves recording your menstrual cycle on a calendar for 8 to 12 months. The first day of your period is Day 1. Circle Day 1 on the calendar. The length of your cycle may vary from month to month. So write down the total number of days it lasts each time. Using this record, you can find the days you are most fertile in the months ahead:
  

  1. To find out the first day when you are most fertile, subtract 18 from the total number of days in your shortest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The X marks the first day you're likely to be fertile.

  2. To find out the last day when you are most fertile, subtract 11 from the total number of days in your longest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The time between the two Xs is your most fertile window.

  This method always should be used along with other fertility awareness methods, especially if your cycles are not always the same lengths.

• Cervical mucus method (also known as the ovulation method) – This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also change the kind and amount of mucus you have before and during ovulation. Right after your period, there are usually a few days when there is no mucus present or "dry days." As the egg starts to mature, mucus increases in the vagina, appears at the vaginal opening, and is white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation. During these "wet days" it becomes clear and slippery, like raw egg whites. Sometimes it can be stretched apart. This is when you are most fertile. About four days after the wet days begin the mucus changes again. There will be much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. Describe changes in your mucus on a calendar. Label the days, "Sticky," "Dry," or "Wet." You are most fertile at the first sign of wetness after your period or a day or two before wetness begins.
  

To most accurately track your fertility, use a combination of all three methods. This is called the symptothermal (SIMP-toe-thur-muhl) method. You can also purchase over-the-counter ovulation kits or fertility monitors to help find the best time to conceive. These kits work by detecting surges in a specific hormone called luteinizing hormone, which triggers ovulation.

Infertility

Some women want children but either cannot conceive or keep miscarrying. This is called infertility. Lots of couples have infertility problems. About a third of the time, it is a female problem. In another third of cases, it is the man with the fertility problem. The rest of the time, it is because both partners have fertility challenges or no cause is found.

Causes of Infertility

Some common reasons for infertility in women include:

• Age – Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35. As a woman ages, normal changes that occur in her ovaries and eggs make it harder to become pregnant. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality. Also, as a woman approaches menopause, her body does not respond as well to hormones that stimulate ovulation. In time, the ovaries may not release an egg each month. Also, as a woman and her eggs age, if she becomes pregnant, there is a greater chance of having genetic problems, such as having a baby with Down syndrome. Embryos formed from eggs in older women also are less likely to fully develop, a main reason for miscarriage.

• Health problems – Some women have diseases or conditions that affect their hormone levels, which can cause infertility.

  • Women with polycystic ovarian syndrome (PCOS) rarely or never ovulate. Failure to ovulate is the most common cause of infertility in women.

  • With primary ovarian insufficiency (POI), a woman's ovaries stop working normally before she is 40. It is not the same as early menopause. Some women with POI get a period now and then. But getting pregnant is hard for women with POI.

  • A condition called luteal phase defect (LPD) is a failure of the uterine lining to be fully prepared for pregnancy. This can keep a fertilized egg from implanting or result in miscarriage.

  Common problems with a woman's reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can't travel through the tubes into the uterus.

• Lifestyle factors – Certain lifestyle factors also can have a negative effect on a woman's fertility. Examples include smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder. Stress also can affect fertility.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm. They also have a slightly higher risk of sperm gene defects. Or they might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have health problems that affect their sexual and reproductive function. These can include sexually transmitted diseases (STDs), diabetes or surgery on the prostate gland.

When to See Your Doctor

You should talk to your doctor about your fertility if you:

• are under age 35 and have not been able to conceive after 1 year of frequent sex without birth control

• are age 35 or older and have not been able to conceive after 6 months of frequent sex without birth control

• believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant)

Happily, doctors are able to help many infertile couples go on to have babies.

Options for Infertile Couples

If you are having fertility issues, your doctor can refer you to a fertility specialist, a doctor who treats infertility. The doctor will need to test both you and your partner to find out what the problem is. Depending on the problem, your doctor might recommend treatment. About 90 percent of infertility cases are treated with drugs or surgery. Don't delay seeing your doctor as age also affects the success rates of these treatments. For some couples, adoption or foster care offers a way to share their love with a child and to build a family.

Infertility Treatment

Some treatments include:

• Drugs – Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur.

• Surgery – Surgery is done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

• Intrauterine (in-truh-YOOT-uh-ruhn) insemination (IUI), also called artificial insemination – Male sperm is injected into part of the woman's reproductive tract, such as into the uterus or fallopian tube. IUI often is used along with drugs that cause a woman to ovulate.

• Assisted reproductive technology (ART) – ART involves stimulating a woman's ovaries; removing eggs from her body; mixing them with sperm in the laboratory; and putting the embryos back into a woman's body. Success rates of ART vary and depend on many factors.

• Third party assistance – Options include donor eggs (eggs from another woman are used), donor sperm (sperm from another man are used), or surrogacy (when another woman carries a baby for you).

Finding the cause of infertility is often a long, complex, and emotional process. And treatment can be expensive. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Some states have laws for infertility insurance coverage. Some of these include Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia.

A missed period is often the first clue that a woman might be pregnant. Sometimes, a woman might suspect she is pregnant even sooner. Symptoms such as headache, fatigue, and breast tenderness, can occur even before a missed period. The wait to know can be emotional. These days, many women first use home pregnancy tests (HPT) to find out. Your doctor also can test you.

All pregnancy tests work by detecting a special hormone in the urine or blood that is only there when a woman is pregnant. It is called human chorionic gonadotropin (kohr-ee-ON-ihk goh-NAD-uh-TROH-puhn), or hCG. hCG is made when a fertilized egg implants in the uterus. hCG rapidly builds up in your body with each passing day you are pregnant. Read on to learn when and how to test for pregnancy.

Home Pregnancy Tests

HPTs are inexpensive, private, and easy to use. Most drugstores sell HPTs over the counter. The cost depends on the brand and how many tests come in the box. They work by detecting hCG in your urine. HPTs are highly accurate. But their accuracy depends on many things. These include:

• When you use them – The amount of hCG in your urine increases with time. So, the earlier after a missed period you take the test the harder it is to spot the hCG. Some HPTs claim that they can tell if you are pregnant one day after a missed period or even earlier. But a recent study shows that most HPTs don't give accurate results this early in pregnancy. Positive results are more likely to be true than negative results. Waiting one week after a missed period will usually give a more accurate result. You can take the test sooner. But just know that a lot of pregnant women will get negative test results during the first few days after the missed period. It's a good idea to repeat the test again after a week has passed. If you get two negative results but still think you're pregnant, call your doctor.

• How you use them – Be sure to check the expiration date and follow the directions. Many involve holding a test stick in the urine stream. For some, you collect urine in a cup and then dip the test stick into it. Then, depending on the brand, you will wait a few minutes to get the results. Research suggests waiting 10 minutes will give the most accurate result. Also, testing your urine first thing in the morning may boost the accuracy. You will be looking for a plus sign, a change in color, or a line. A change, whether bold or faint, means the result is positive. New digital tests show the words "pregnant" or "not pregnant". Most tests also have a "control indicator" in the results window. This line or symbol shows whether or not the test is working. If the control indicator does not appear, the test is not working properly. You should not rely on any results from a HPT that may be faulty.

• Who uses them – The amount of hCG in the urine is different for every pregnant woman. So, some women will have accurate results on the day of the missed period while others will need to wait longer. Also, some medicines affect HPTs. Discuss the medicines you use with your doctor before trying to become pregnant.

• The brand of test – Some HPT tests are better than others at spotting hCG early on.

The most important part of using any HPT is to follow the directions exactly as written. Most tests also have toll-free phone numbers to call in case of questions about use or results.

If a HPT says you are pregnant, you should call your doctor right away. Your doctor can use a more sensitive test along with a pelvic exam to tell for sure if you're pregnant. Seeing your doctor early on in your pregnancy can help you and your baby stay healthy.

Blood Tests

Blood tests are done in a doctor's office. They can pick up hCG earlier in a pregnancy than urine tests can. Blood tests can tell if you are pregnant about 6 to 8 days after you ovulate (release an egg from an ovary). Doctors use two types of blood tests to check for pregnancy:

• Quantitative blood test (or the beta hCG test) measures the exact amount of hCG in your blood. So it can find even tiny amounts of hCG. This makes it very accurate.

• Qualitative hCG blood tests just check to see if the pregnancy hormone is present or not. So it gives a yes or no answer. This blood test is about as accurate as a urine test.

Pregnancy lasts about 40 weeks, counting from the first day of your last normal period. The weeks are grouped into three trimesters (TREYE-mess-turs). Find out what's happening with you and your baby in these three stages.

First Trimester (Week 1-Week 12)

During the first trimester your body undergoes many changes. Hormonal changes affect almost every organ system in your body. These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant. Other changes may include:

• Extreme tiredness

• Tender, swollen breasts. Your nipples might also stick out.

• Upset stomach with or without throwing up (morning sickness)

• Cravings or distaste for certain foods

• Mood swings

• Constipation (trouble having bowel movements)

• Need to pass urine more often

• Headache

• Heartburn

• Weight gain or loss

As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals. Fortunately, most of these discomforts will go away as your pregnancy progresses. And some women might not feel any discomfort at all! If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.

Second Trimester (Week 13-Week 28)

Most women find the second trimester of pregnancy easier than the first. But it is just as important to stay informed about your pregnancy during these months.

You might notice that symptoms like nausea and fatigue are going away. But other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. And before this trimester is over, you will feel your baby beginning to move!

As your body changes to make room for your growing baby, you may have:

• Body aches, such as back, abdomen, groin, or thigh pain

• Stretch marks on your abdomen, breasts, thighs, or buttocks

• Darkening of the skin around your nipples

• A line on the skin running from belly button to pubic hairline

• Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. Patches often match on both sides of the face. This is sometimes called the mask of pregnancy.

• Numb or tingling hands, called carpal tunnel syndrome

• Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching. These can be signs of a serious liver problem.)

• Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

Third Trimester (Week 29-Week 40)

You're in the home stretch! Some of the same discomforts you had in your second trimester will continue. Plus, many women find breathing difficult and notice they have to go to the bathroom even more often. This is because the baby is getting bigger and it is putting more pressure on your organs. Don't worry, your baby is fine and these problems will lessen once you give birth.

Some new body changes you might notice in the third trimester include:

• Shortness of breath

• Heartburn

• Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of preeclampsia.)

• Hemorrhoids

• Tender breasts, which may leak a watery pre-milk called colostrum (kuh-LOSS-struhm)

• Your belly button may stick out

• Trouble sleeping

• The baby "dropping", or moving lower in your abdomen

• Contractions, which can be a sign of real or false labor

As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) to open during the birthing process. Your doctor will check your progress with a vaginal exam as you near your due date. Get excited — the final countdown has begun!

Your Developing Baby

First Trimester (Week 1-Week 12)

At 8 weeks: All major organs and external body structures have begun to form. Your baby's heart beats with a regular rhythm. The arms and legs grow longer, and fingers and toes have begun to form. The sex organs begin to form. The eyes have moved forward on the face and eyelids have formed. The umbilical cord is clearly visible. At the end of 8 weeks, your baby is a fetus and looks more like a human. Your baby is nearly 1 inch long and weighs less than 1/8 of an ounce.

At 12 weeks: The nerves and muscles begin to work together. Your baby can make a fist. The external sex organs show if your baby is a boy or girl. A woman who has an ultrasound in the second trimester or later might be able to find out the baby's sex. Eyelids close to protect the developing eyes. They will not open again until the 28th week. Head growth has slowed, and your baby is much longer. Now, at about 3 inches long, your baby weighs almost an ounce.

Second Trimester (Week 13-Week 28)

At 20 weeks: Your baby is more active. You might feel slight fluttering. Your baby is covered by fine, downy hair called lanugo (luh-NOO-goh) and a waxy coating called vernix. This protects the forming skin underneath. Eyebrows, eyelashes, fingernails, and toenails have formed. Your baby can even scratch itself. Your baby can hear and swallow. Now halfway through your pregnancy, your baby is about 6 inches long and weighs about 9 ounces.

At 24 weeks: Bone marrow begins to make blood cells. Taste buds form on your baby's tongue. Footprints and fingerprints have formed. Real hair begins to grow on your baby's head. The lungs are formed, but do not work. The hand and startle reflex develop. Your baby sleeps and wakes regularly. If your baby is a boy, his testicles begin to move from the abdomen into the scrotum. If your baby is a girl, her uterus and ovaries are in place, and a lifetime supply of eggs have formed in the ovaries. Your baby stores fat and has gained quite a bit of weight. Now at about 12 inches long, your baby weighs about 1½ pounds.

Third Trimester (Week 29-Week 40)

At 36 weeks: The protective waxy coating called vernix gets thicker. Body fat increases. Your baby is getting bigger and bigger and has less space to move around. Movements are less forceful, but you will feel stretches and wiggles. Your baby is about 16 to 19 inches long and weighs about 6 to 6½ pounds.

Weeks 37-40: By the end of 37 weeks, your baby is considered full term. Your baby's organs are ready to function on their own. As you near your due date, your baby may turn into a head-down position for birth. Most babies "present" head down. At birth, your baby may weigh somewhere between 6 pounds, 2 ounces and 9 pounds, 2 ounces and be 19 to 21 inches long. Most full-term babies fall within these ranges. But healthy babies come in many different sizes.

Medical checkups and screening tests help keep you and your baby healthy during pregnancy. This is called prenatal care. It also involves education and counseling about how to handle different aspects of your pregnancy. During your visits, your doctor may discuss many issues, such as healthy eating and physical activity, screening tests you might need, and what to expect during labor and delivery.

Choosing a Prenatal Care Provider

You will see your prenatal care provider many times before you have your baby. So you want to be sure that the person you choose has a good reputation, and listens to and respects you. You also will want to find out if the doctor or midwife can deliver your baby in the place you want to give birth, such as a specific hospital or birthing center.

Health care providers that care for women during pregnancy include:

• Obstetricians (OB) are medical doctors who specialize in the care of pregnant women and in delivering babies. OBs also have special training in surgery so they are also able to do a cesarean delivery. Women who have health problems or are at risk for pregnancy complications should see an obstetrician. Women with the highest risk pregnancies might need special care from a maternal-fetal medicine specialist.

• Family practice doctors are medical doctors who provide care for the whole family through all stages of life. This includes care during pregnancy and delivery, and following birth. Most family practice doctors cannot perform cesarean deliveries.

• A certified nurse-midwife (CNM) and certified professional midwife (CPM) are trained to provide pregnancy and postpartum care. Midwives can be a good option for healthy women at low risk for problems during pregnancy, labor, or delivery. A CNM is educated in both nursing and midwifery. Most CNMs practice in hospitals and birth centers. A CPM is required to have experience delivering babies in home settings because most CPMs practice in homes and birthing centers. All midwives should have a back-up plan with an obstetrician in case of a problem or emergency.

Ask your primary care doctor, friends, and family members for provider recommendations. When making your choice, think about:

• Reputation

• Personality and bedside manner

• The provider's gender and age

• Office location and hours

• Whether you always will be seen by the same provider during office checkups and delivery

• Who covers for the provider when she or he is not available

• Where you want to deliver

• How the provider handles phone consultations and after-hour calls.

Places to Deliver Your Baby

Many women have strong views about where and how they'd like to deliver their babies. In general, women can choose to deliver at a hospital, birth center, or at home. You will need to contact your health insurance provider to find out what options are available. Also, find out if the doctor or midwife you are considering can deliver your baby in the place you want to give birth.

• Hospitals are a good choice for women with health problems, pregnancy complications, or those who are at risk for problems during labor and delivery. Hospitals offer the most advanced medical equipment and highly trained doctors for pregnant women and their babies. In a hospital, doctors can do a cesarean delivery if you or your baby is in danger during labor. Women can get epidurals or many other pain relief options. Also, more and more hospitals now offer on-site birth centers, which aim to offer a style of care similar to standalone birth centers.

  Questions to ask when choosing a hospital:

  • Is it close to your home?

  • Is a doctor who can give pain relief, such as an epidural, at the hospital 24-hours a day?

  • Do you like the feel of the labor and delivery rooms?

  • Are private rooms available?

  • How many support people can you invite into the room with you?

  • Does it have a neonatal intensive care unit (NICU) in case of serious problems with the baby?

  • Can the baby stay in the room with you?

  • Does it have an on-site birth center?
    

• Birth or Birthing Centers give women a "homey" environment in which to labor and give birth. They try to make labor and delivery a natural and personal process by doing away with most high-tech equipment and routine procedures. So, you will not automatically be hooked up to an IV. Likewise, you won't have an electronic fetal monitor around your belly the whole time. Instead, the midwife or nurse will check in on your baby from time to time with a handheld machine. Once the baby is born, all exams and care will occur in your room. Usually certified nurse-midwives, not obstetricians, deliver babies at birth centers. Healthy women who are at low risk for problems during pregnancy, labor, and delivery may choose to deliver at a birth center.

  Women can not receive epidurals at a birth center, although some pain medicines may be available. If a cesarean delivery becomes necessary, women must be moved to a hospital for the procedure. After delivery, babies with problems can receive basic emergency care while being moved to a hospital.

  Many birthing centers have showers or tubs in their rooms for laboring women. They also tend to have comforts of home like large beds and rocking chairs. In general, birth centers allow more people in the delivery room than do hospitals.

  Birth centers can be inside of hospitals, a part of a hospital or completely separate facilities. If you want to deliver at a birth center, make sure it meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers. Accredited birth centers must have doctors who can work at a nearby hospital in case of problems with the mom or baby.

• Homebirth is an option for healthy pregnant women with no risk factors for complications during pregnancy, labor or delivery. It is also important women have a strong after-care support system at home. Some certified nurse midwives and doctors will deliver babies at home. Many health insurance companies do not cover the cost of care for homebirths. So check with your plan if you'd like to deliver at home.

  Homebirths are common in many countries in Europe. But in the United States, planned homebirths are not supported by the American College of Obstetricians and Gynecologists (ACOG). ACOG states that hospitals are the safest place to deliver a baby. In case of an emergency, says ACOG, a hospital's equipment and highly trained doctors can provide the best care for a woman and her baby.

  If you are thinking about a homebirth, you need to weigh the pros and cons. The main advantage is that you will be able to experience labor and delivery in the privacy and comfort of your own home. Since there will be no routine medical procedures, you will have control of your experience.

  The main disadvantage of a homebirth is that in case of a problem, you and the baby will not have immediate hospital/medical care. It will have to wait until you are transferred to the hospital. Plus, women who deliver at home have no options for pain relief.

  To ensure your safety and that of your baby, you must have a highly trained and experienced midwife along with a fail-safe back-up plan. You will need fast, reliable transportation to a hospital. If you live far away from a hospital, homebirth may not be the best choice. Your midwife must be experienced and have the necessary skills and supplies to start emergency care for you and your baby if need be. Your midwife should also have access to a doctor 24 hours a day.

Prenatal Checkups

During pregnancy, regular check-ups are very important. This consistent care can help keep you and your baby healthy, spot problems if they occur, and prevent problems during delivery. Typically, routine checkups occur:

• once each month for weeks 4 through 28

• twice a month for weeks 28 through 36

• weekly for weeks 36 to birth

Women with high-risk pregnancies need to see their doctors more often.

At your first visit your doctor will perform a full physical exam, take your blood for lab tests, and calculate your due date. Your doctor might also do a breast exam, a pelvic exam to check your uterus (womb), and a cervical exam, including a Pap test. During this first visit, your doctor will ask you lots of questions about your lifestyle, relationships, and health habits. It's important to be honest with your doctor.

After the first visit, most prenatal visits will include:

• checking your blood pressure and weight

• checking the baby's heart rate

• measuring your abdomen to check your baby's growth

You also will have some routine tests throughout your pregnancy, such as tests to look for anemia, tests to measure risk of gestational diabetes, and tests to look for harmful infections.

Become a partner with your doctor to manage your care. Keep all of your appointments — every one is important! Ask questions and read to educate yourself about this exciting time.

Monitor Your Baby's Activity

After 28 weeks, keep track of your baby's movement. This will help you to notice if your baby is moving less than normal, which could be a sign that your baby is in distress and needs a doctor's care. An easy way to do this is the Count-to-Ten approach. Count your baby's movements in the evening — the time of day when the fetus tends to be most active. Lie down if you have trouble feeling your baby move. Most women count 10 movements within about 20 minutes. Count your baby's movements every day so you know what is normal for you. Call your doctor if you count less than 10 movements within 2 hours.

Prenatal Tests

Tests are used during pregnancy to check your and your baby's health. At your fist prenatal visit, your doctor will use tests to check for a number of things, such as:

• Your blood type and Rh factor

• Anemia

• Infections, such as toxoplasmosis and sexually transmitted infections (STIs), including hepatitis B, syphilis, chlamydia, and HIV

• Signs that you are immune to rubella (German measles) and chicken pox

Throughout your pregnancy, your doctor or midwife may suggest a number of other tests, too. Some tests are suggested for all women, such as screenings for gestational diabetes, Down syndrome, and HIV. Other tests might be offered based on your:

• Age

• Personal or family health history

• Ethnic background

• Results of routine tests

Some tests are screening tests. They detect risks for or signs of possible health problems in you or your baby. Based on screening test results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or rule out health problems in you or your baby.

The following chart describes some of the most common prenatal tests:

Understanding Prenatal Tests and Test Results

If your doctor suggests certain prenatal tests, don't be afraid to ask lots of questions. Learning about the test, why your doctor is suggesting it for you, and what the test results could mean can help you cope with any worries or fears you might have. Keep in mind that screening tests do not diagnose problems. They evaluate risk. So if a screening test comes back abnormal, this doesn't mean there is a problem with your baby. More information is needed. Your doctor can explain what test results mean and possible next steps.

High-Risk Pregnancy

Pregnancies with a greater chance of complications are called "high-risk." But this doesn't mean there will be problems. The following factors may increase the risk of problems during pregnancy:

• Very young age or older than 35

• Overweight or underweight

• Problems in previous pregnancy

• Health conditions you have before you become pregnant, such as high blood pressure, diabetes, autoimmune disorders, cancer, and HIV

• Pregnancy with twins or other multiples

Health problems also may develop during a pregnancy that make it high-risk, such as gestational diabetes or preeclampsia. See Problems During Pregnancy.

Women with high-risk pregnancies need prenatal care more often and sometimes from a specially trained doctor. A maternal-fetal medicine specialist is a medical doctor that cares for high-risk pregnancies.

If your pregnancy is considered high risk, you might worry about your unborn baby's health and have trouble enjoying your pregnancy. Share your concerns with your doctor. Your doctor can explain your risks and the chances of a real problem. Also, be sure to follow your doctor's advice. For example, if your doctor tells you to take it easy, then ask your partner, family members, and friends to help you out in the months ahead. You will feel better knowing that you are doing all you can to care for your unborn baby.

Paying for Prenatal Care

Pregnancy can be stressful if you are worried about affording health care for you and your unborn baby. For many women, the extra expenses of prenatal care and preparing for the new baby are overwhelming. The good news is that women in every state can get help to pay for medical care during their pregnancies. Every state in the United States has a program to help. Programs give medical care, information, advice, and other services important for a healthy pregnancy.

Soon, you'll experience the amazing process of childbirth! Find out how to spot the signs of labor, and get the facts on pain management, cesarean delivery, and more.

Spotting the Signs of Labor

As you approach your due date, you will be looking for any little sign that labor is about to start. You might notice that your baby has "dropped" or moved lower into your pelvis. This is called "lightening." If you have a pelvic exam during your prenatal visit, your doctor might report changes in your cervix that you cannot feel, but that suggest your body is getting ready. For some women, a flurry of energy and the impulse to cook or clean, called "nesting," is a sign that labor is approaching.

Some signs suggest that labor will begin very soon. Call your doctor or midwife if you have any of the following signs of labor. Call you doctor even if it's weeks before your due date — you might be going into preterm labor. Your doctor or midwife can decide if it's time to go to the hospital or if you should be seen at the office first.

• You have contractions that become stronger at regular and increasingly shorter intervals.

• You have lower back pain and cramping that does not go away.

• Your water breaks (can be a large gush or a continuous trickle).

• You have a bloody (brownish or red-tinged) mucus discharge. This is probably the mucus plug that blocks the cervix. Losing your mucus plug usually means your cervix is dilating (opening up) and becoming thinner and softer (effacing). Labor could start right away or may still be days away.

False Labor

Many women, especially first-time mothers-to-be, think they are in labor when they're not. This is called false labor. "Practice" contractions called Braxton Hicks contractions are common in the last weeks of pregnancy or earlier. The tightening of your uterus might startle you. Some might even be painful or take your breath away. It's no wonder that many women mistaken Braxton Hicks contractions for the real thing. So don't feel embarrassed if you go to the hospital thinking you're in labor, only to be sent home.

So, how can you tell if your contractions are true labor?

Time them. Use a watch or clock to keep track of the time one contraction starts to the time the next contraction starts, as well as how long each contraction lasts. With true labor, contractions become regular, stronger, and more frequent. Braxton Hicks contractions are not in a regular pattern, and they taper off and go away. Some women find that a change in activity, such as walking or lying down, makes Braxton Hicks contractions go away. This won't happen with true labor. Even with these guidelines, it can be hard to tell if labor is real. If you ever are unsure if contractions are true labor, call your doctor.

Stages of Labor

Labor occurs in three stages. When regular contractions begin, the baby moves down into the pelvis as the cervix both effaces (thins) and dilates (opens). How labor progresses and how long it lasts are different for every woman. But each stage features some milestones that are true for every woman.

First Stage

The first stage begins with the onset of labor and ends when the cervix is fully opened. It is the longest stage of labor, usually lasting about 12 to 19 hours. Many women spend the early part of this first stage at home. You might want to rest, watch TV, hang out with family, or even go for a walk. Unless your doctor tells you otherwise, you can drink and eat during labor, which can provide you with needed energy later. While at home, time your contractions and keep your doctor up to date on your progress. Your doctor will tell you when to go to the hospital or birthing center.

At the hospital, your doctor will monitor the progress of your labor by periodically checking your cervix, as well as the baby's position and station (location in the birth canal). Most babies' heads enter the pelvis facing to one side, and then rotate to face down. Sometimes, a baby will be facing up, towards the mother's abdomen. Intense back labor often goes along with this position. Your doctor might try to rotate the baby, or the baby might turn on its own.

As you near the end of the first stage of labor, contractions become longer, stronger, and closer together. Many of the positioning and relaxation tips you learned in childbirth class can help now. Try to find the most comfortable position during contractions and to let your muscles go limp between contractions. Let your support person know how he or she can be helpful, such as by rubbing your lower back, giving you ice chips to suck, or putting a cold washcloth on your forehead.

Sometimes, medicines and other methods are used to help speed up labor that is progressing slowly. Many doctors will rupture the membranes. Although this practice is widely used, studies show that doing so during labor does not help shorten the length of labor.

Your doctor might want to use an electronic fetal monitor to see if blood supply to your baby is okay. For most women, this involves putting two straps around the mother's abdomen. One strap measures the strength and frequency of your contractions. The other strap records how the baby's heartbeat reacts to the contraction.

The most difficult phase of this first stage is the transition. Contractions are very powerful, with very little time to relax in between, as the cervix stretches the last, few centimeters. Many women feel shaky or nauseated. The cervix is fully dilated when it reaches 10 centimeters.

Second Stage

The second stage involves pushing and delivery of your baby. It usually lasts 20 minutes to two hours. You will push hard during contractions, and rest between contractions. Pushing is hard work, and a support person can really help keep you focused. A woman can give birth in many positions, such as lying on her back, squatting, or kneeling. You might find pushing to be easier or more comfortable one way. Some studies suggest that upright positions, such as squatting, may shorten this stage of labor and help keep the tissue near the birth canal intact.

When the top of your baby's head fully appears (crowning), your doctor will tell you when to push and deliver your baby. Your doctor may make a small cut, called an episiotomy (uh-peez-ee-OT-oh-mee), to enlarge the vaginal opening. Most women in childbirth do not need episiotomy. Sometimes, forceps (tool shaped like salad-tongs) or suction is used to help guide the baby through the birth canal. This is called assisted vaginal delivery. After your baby is born, the umbilical cord is cut. Make sure to tell your doctor if you or your partner would like to cut the umbilical cord.

Third Stage

The third stage involves delivery of the placenta (afterbirth). It is the shortest stage, lasting 5 to 30 minutes. Contractions will begin 5 to 30 minutes after birth, signaling that it's time to deliver the placenta. You might have chills or shakiness. Labor is over once the placenta is delivered. Your doctor will repair the episiotomy and any tears you might have. Now, you can rest and enjoy your newborn!

Managing Labor Pain

Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for everyone. So no one can predict how you will feel. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook.

Some women do fine with natural methods of pain relief alone. Many women blend natural methods with medications that relieve pain. Building a positive outlook on childbirth and managing fear may also help some women cope with the pain. It is important to realize that labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing your baby down and out of the birth canal. In other words, labor pain has a purpose.

Try the following to help you feel positive about childbirth:

• Take a childbirth class. Call the doctor, midwife, hospital, or birthing center for class information.

• Get information from your doctor or midwife. Write down your questions and talk about them at your regular visits.

• Share your fears and emotions with friends, family, and your partner.

Natural Methods of Pain Relief

Many natural methods help women to relax and make pain more manageable. Things women do to ease the pain include:

• Trying breathing and relaxation techniques

• Taking warm showers or baths

• Getting massages

• Using heat and cold, such as heat on lower back and cold washcloth on forehead

• Having the supportive care of a loved one, nurse, or doula

• Finding comfortable positions while in labor (stand, crouch, sit, walk, etc.)

• Using a labor ball

• Listening to music

Medical Methods of Pain Relief

While you're in labor, your doctor, midwife, or nurse should ask if you need pain relief. It is her job to help you decide what option is best for you. Nowadays women in labor have many pain relief options that work well and pose small risks when given by a trained and experienced doctor. Doctors also can use different methods for pain relief at different stages of labor. Still, not all options are available at every hospital and birthing center. Plus your health history, allergies, and any problems with your pregnancy will make some methods better than others.

Methods of relieving pain commonly used for labor are described in the chart below. Keep in mind that rare, but serious complications sometimes occur. Also, most medicines used to manage pain during labor pass freely into the placenta. Ask your doctor how pain relief methods might affect your baby or your ability to breastfeed after delivery.

Inducing Labor

Sometimes, a doctor or midwife might need to induce (bring about) labor. The decision to induce labor often is made when a woman is past her due date but labor has not yet begun or when there is concern about the baby or mother's health. Some specific reasons why labor might be induced include:

• A woman's water has broken (ruptured membranes), but labor has not begun on its own

• Infection inside the uterus

• Baby is growing too slowly

• Complications that arise when the mother's Rh factor is negative and her unborn baby's is positive

• Not enough amniotic fluid

• Complications, such as high blood pressure or preeclampsia

• Health problems in the mother, such as kidney disease or diabetes

The doctor or midwife can use medicines and other methods to open a pregnant woman's cervix, stimulate contractions, and prepare for vaginal birth. Inducing labor increases a woman's chance of cesarean delivery. So you will want to make sure with your doctor that the benefits of inducing labor outweigh the risks of continuing the pregnancy.

Cesarean Birth

Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in this country. The rate was 1 in 5 in 1995.

Public heath experts think that many c-sections are unnecessary. So it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

Reasons for C-sections

Your doctor might recommend a c-section if she thinks it is safer for you or your baby than vaginal birth. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:

• the mother is carrying more than one baby (twins, triplets, etc.)

• the mother has health problems including HIV infection, herpes infection, and heart disease

• the mother has dangerously high blood pressure

• the mother has problems with the shape of her pelvis

• there are problems with the placenta

• there are problems with the umbilical cord

• there are problems with the position of the baby, such as breech

• the baby shows signs of distress, such as a slowed heart rate

• the mother has had a previous c-section

Patient-requested C-section: Can a Woman Choose?

A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems.

But is it safe and ethical for doctors to allow women to choose c-section? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits.

Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger.

Supporters of elective c-sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery.

The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need.

The C-section Experience

Most c-sections are unplanned. So, learning about c-sections is important for all women who are pregnant. Whether a c-section is planned or comes up during labor, it can be a positive birth experience for many women. The overview that follows will help you to know what to expect during a nonemergency c-section and what questions to ask.

Before surgery

Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. See Medical Methods of Pain Relief for more information. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask:

• Can I have a support person with me during the operation?

• What are my options for blocking pain?

• Can I have music played during the surgery?

• Will I be able to watch the surgery if I want?

During surgery

The doctor will make 2 incisions. The first is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Next, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask:

• Can my partner cut the umbilical cord?

• What happens to my baby right after delivery?

• Can I hold and touch my baby during the surgery repair?

• When is it okay for me to try to breastfeed?

• When can my partner take pictures or video?

After surgery

You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually about 4 days, to rest and bond with your baby. C-section is major surgery, and recovery takes about 6 weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed. Questions to ask:

• Can my baby be brought to me in the recovery room?

• What are the best positions for me to breastfeed?

Vaginal Birth After Cesarean (VBAC)?

Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal birth after cesarean or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery. Of women who try VBAC, 60 percent to 80 percent are able to deliver vaginally.

But vaginal birth after cesarean isn't the right choice for everyone. Some women have health or pregnancy complications that make VBAC unsafe. For other women, the risks of c-section are more acceptable than the risks of vaginal birth after cesarean. Still, others don't live near a hospital where vaginal birth after cesarean is possible.

Your doctor can tell you if you are a good candidate for vaginal birth after cesarean. 

Vaginal birth after cesarean might be an option for you if:

• You had 1 previous planned c-section done with a low, horizontal incision ("bikini" incision).

• You have no other uterine scars (aside from the prior c-section) or problems.

• You have no known problems with your pelvis.

• A doctor will be present during all of labor and delivery and can perform an emergency c-section if needed.

• A surgical team is immediately available in case an emergency c-section is needed.

Your doctor can explain the risks of both repeat cesarean delivery and vaginal birth after cesarean. 

With vaginal birth after cesarean, the most serious danger is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. While very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. But doctors cannot predict if uterine rupture is likely to occur in a woman. This risk, albeit very small, is unacceptable to some women.

The percent of VBACs is dropping in the United States for many reasons. Some doctors, hospitals, and patients have concerns about the safety of vaginal birth after cesarean. Some hospitals and doctors are unwilling to do VBACs because of fear of lawsuits and insurance or staffing expenses. Many doctors, however, question if this trend is in the best interest of women's health.

Choosing to try a vaginal birth after cesarean is complex. If you are interested in vaginal birth after cesarean, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice.

After months of waiting, finally, your new baby has arrived! Mothers-to-be often spend so much time in anticipation of labor, they don't think about or even know what to expect during the first hours after delivery. Read on so you will be ready to bond with your new bundle of joy.

What Newborns Look Like

You might be surprised by how your newborn looks at birth. If you had a vaginal delivery, your baby entered this world through a narrow and boney passage. It's not uncommon for newborns to be born bluish, bruised, and with a misshapen head. An ear might be folded over. Your baby may have a complete head of hair or be bald. Your baby also will have a thick, pasty, whitish coating, which protected the skin in the womb. This will wash away during the first bathing.

Once your baby is placed into your arms, your gaze will go right to his or her eyes. Most newborns open their eyes soon after birth. Eyes will be brown or bluish-gray at first. Looking over your baby, you might notice that the face is a little puffy. You might notice small white bumps inside your baby's mouth or on his or her tongue. Your baby might be very wrinkly. Some babies, especially those born early, are covered in soft, fine hair, which will come off in a couple of weeks. Your baby's skin might have various colored marks, blotches, or rashes, and fingernails could be long. You might also notice that your baby's breasts and penis or vulva are a bit swollen.

How your baby looks will change from day to day, and many of the early marks of childbirth go away with time. If you have any concerns about something you see, talk to your doctor. After a few weeks, your newborn will look more and more like the baby you pictured in your dreams.

Bonding With Your Baby

Spending time with your baby in those first hours of life is very special. Although you might be tired, your newborn could be quite alert after birth. Cuddle your baby skin-to-skin. Let your baby get to know your voice and study your face. Your baby can see up to about 2 feet away. You might notice that your baby throws his or her arms out if someone turns on a light or makes a sudden noise. This is called the startle response. Babies also are born with grasp and sucking reflexes. Put your finger in your baby's palm and watch how she or he knows to squeeze it. Feed your baby when she or he shows signs of hunger. You can visit our section on breastfeeding for tips to make these first feedings go well.

Medical Care for Your Newborn

Right after birth babies need many important tests and procedures to ensure their health. Some of these are even required by law. But as long as the baby is healthy, everything but the Apgar test can wait for at least an hour. Delaying further medical care will preserve the precious first moments of life for you, your partner, and the baby. A baby who has not been poked and prodded may be more willing to nurse and cuddle. So before delivery, talk to your doctor or midwife about delaying shots, medicine, and tests.

The following tests and procedures are recommended or required in most hospitals in the United States:

Apgar Evaluation

The Apgar test is a quick way for doctors to figure out if the baby is healthy or needs extra medical care. Apgar tests are usually done twice: one minute after birth and again five minutes after birth. Doctors and nurses measure 5 signs of the baby's condition. These are:

• heart rate

• breathing

• activity and muscle tone

• reflexes

• skin color

Apgar scores range from 0 to 10. A baby who scores 7 or more is considered very healthy. But a lower score doesn't always mean there is something wrong. Perfectly healthy babies often have low Apgar scores in the first minute of life.

In more than 98 percent of cases, the Apgar score reaches 7 after 5 minutes of life. When it does not, the baby needs medical care and close monitoring.

Eye Care

Your baby may receive eye drops or ointment to prevent eye infections they can get during delivery. Sexually transmitted diseases (STDs) including gonorrhea and chlamydia are a main cause of newborn eye infections. These infections can cause blindness if not treated.

Medicines used can sting and/or blur the baby's vision. So you may want to postpone this treatment for a little while.

Some parents question whether this treatment is really necessary. Many women at low risk for STIs do not want their newborns to receive eye medicine. But there is no evidence to suggest that this medicine harms the baby.

It is important to note that even pregnant women who test negative for STIs may get an infection by the time of delivery. Plus, most women with gonorrhea and/or chlamydia don't know it because they have no symptoms.

Vitamin K Shot

The American Academy of Pediatrics recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K in their bodies. This vitamin is needed for the blood to clot. Low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns.

Newborns probably feel pain when the shot is given. But afterwards babies don't seem to have any discomfort. Since it may be uncomfortable for the baby, you may want to postpone this shot for a little while.

Newborn Metabolic Screening

Doctors or nurses prick your baby's heel to take a tiny sample of blood. They use this blood to test for many diseases. All babies should be tested because a few babies may look healthy but have a rare health problem. A blood test is the only way to find out about these problems. If found right away, serious problems like developmental disabilities, organ damage, blindness, and even death might be prevented.

All 50 states and U.S. territories screen newborns for phenylketonuria (fee-nuhl-kee-toh-NUR-ee-uh) (PKU), hypothyroidism, galactosemia (guh-LAK-tuh-SEE-mee-uh), and sickle cell disease. But many states routinely test for up to 30 different diseases. The March of Dimes recommends that all newborns be tested for at least 29 diseases.

You can find out what tests are offered in your state by contacting your state's health department or newborn screening program. Or, you can contact the National Newborn Screening and Genetics Resource Center.

Hearing Test

Most babies have a hearing screening soon after birth, usually before they leave the hospital. Tiny earphones or microphones are used to see how the baby reacts to sounds. All newborns need a hearing screening because hearing defects are not uncommon and hearing loss can be hard to detect in babies and young children. When problems are found early, children can get the services they need at an early age. This might prevent delays in speech, language, and thinking. Ask your hospital or your baby's doctor about newborn hearing screening.

Hepatitis B Vaccine

All newborns should get a vaccine to protect against the hepatitis B virus (HBV) before leaving the hospital. HBV can cause a lifelong infection, serious liver damage, and even death.

The hepatitis B vaccine (HepB) is a series of three different shots. The American Academy of Pediatrics and the Centers for Disease Control (CDC) recommend that all newborns get the first HepB shot before leaving the hospital. If the mother has HBV, her baby should also get a HBIG shot within 12 hours of birth. The second HepB shot should be given 1 to 2 months after birth. The third HepB shot should be given no earlier than 24 weeks of age, but before 18 months of age.

Complete Check-up

Soon after delivery most doctors or nurses also:

• Measure the newborn's weight, length, and head.

• Take the baby's temperature.

• Measure that baby's breathing and heart rate.

• Give the baby a bath and clean the umbilical cord stump.

Right now, you are focused on caring for your new baby. But new mothers must take special care of their bodies after giving birth and while breastfeeding, too. Doing so will help you to regain your energy and strength. When you take care of yourself, you are able to best care for and enjoy your baby.

Getting Rest

The first few days at home after having your baby are a time for rest and recovery — physically and emotionally. You need to focus your energy on yourself and on getting to know your new baby. Even though you may be very excited and have requests for lots of visits from family and friends, try to limit visitors and get as much rest as possible. Don't expect to keep your house perfect. You may find that all you can do is eat, sleep, and care for your baby. And that is perfectly okay. Learn to pace yourself from the first day that you arrive back home. Try to lie down or nap while the baby naps. Don't try to do too much around the house. Allow others to help you and don't be afraid to ask for help with cleaning, laundry, meals, or with caring for the baby.

Physical Changes

After the birth of your baby, your doctor will talk with you about things you will experience as your body starts to recover.

• You will have vaginal discharge called lochia (LOH-kee-uh). It is the tissue and blood that lined your uterus during pregnancy. It is heavy and bright red at first, becoming lighter in flow and color until it goes aware after a few weeks.

• You might also have swelling in your legs and feet. You can reduce swelling by keeping your feet elevated when possible.

• You might feel constipated. Try to drink plenty of water and eat fresh fruits and vegetables.

• Menstrual-like cramping is common, especially if you are breastfeeding. Your breast milk will come in within three to six days after your delivery. Even if you are not breastfeeding, you can have milk leaking from your nipples, and your breasts might feel full, tender, or uncomfortable.

• Follow your doctor's instructions on how much activity, like climbing stairs or walking, you can do for the next few weeks.

Your doctor will check your recovery at your postpartum visit, about 6 weeks after birth. Ask about resuming normal activities, as well as eating and fitness plans to help you return to a healthy weight. Also ask our doctor about having sex and birth control. Your period could return in 6 to 8 weeks, or sooner if you do not breastfeed. If you breastfeed, your period might not resume for many months. Still, using reliable birth control is the best way to prevent pregnancy until you want to have another baby.

Regaining a Healthy Weight and Shape

Both pregnancy and labor can affect a woman's body. After giving birth you will lose about 10 pounds right away and a little more as body fluid levels decrease. Don't expect or try to lose additional pregnancy weight right away. Gradual weight loss over several months is the safest way, especially if you are breastfeeding. A healthy eating plan along with regular physical fitness might be all you need to return to a healthy weight. But talk to your doctor before you start any type of diet or exercise plan.

If you want to diet and are breastfeeding, it is best to wait until your baby is at least two months old. During those first two months, your body needs to recover from childbirth and establish a good milk supply. Then when you start to lose weight, try not to lose too much too quickly. This can be harmful to the baby because environmental toxins that are stored in your body fat can be released into your breast milk. Losing about one pound per week (no more than four pounds per month) has been found to be a safe amount and will not affect your milk supply or the baby's growth.

You can safely lose weight by consuming at least 1800 calories per day with well-balanced, healthy food choices that include foods rich in calcium, zinc, magnesium, vitamin B₆, and folate. Eating less than 1500 calories per day is not recommended at any point during breastfeeding. This can put you at risk for a nutritional deficiency, lower your energy level, and lower your resistance to illness.

Feeling Blue

After childbirth you may feel sad, weepy, and overwhelmed for a few days. Many new mothers have the "baby blues" after giving birth. Changing hormones, anxiety about caring for the baby, and lack of sleep all affect your emotions.

Be patient with yourself. These feelings are normal and usually go away quickly. But if sadness lasts more than 2 weeks, go see your doctor. Don't wait until you postpartum visit to do so. You might have a serious but treatable condition called postpartum depression. Postpartum depression can happen any time within the first year after birth.

Signs of postpartum depression include:

• Feeling restless or irritable

• Feeling sad, depressed, or crying a lot

• Having no energy

• Having headaches, chest pains, heart palpitations (the heart being fast and feeling like it is skipping beats), numbness, or hyperventilation (fast and shallow breathing)

• Not being able to sleep, being very tired, or both

• Not being able to eat and weight loss

• Overeating and weight gain

• Trouble focusing, remembering, or making decisions

• Being overly worried about the baby

• Not having any interest in the baby

• Feeling worthless and guilty

• Having no interest or getting no pleasure from activities like sex and socializing

• Thoughts of harming your baby or yourself

Some women don't tell anyone about their symptoms because they feel embarrassed or guilty about having these feelings at a time when they think they should be happy. Don't let this happen to you! Postpartum depression can make it hard to take care of your baby. Infants with mothers with postpartum depression can have delays in learning how to talk. They can have problems with emotional bonding. Your doctor can help you feel better and get back to enjoying your new baby. Therapy and/or medicine can treat postpartum depression. Get more details on postpartum depression in our FAQ on Depression During and After Pregnancy.

Also see www.DepressionHelp.net

What is Gynecologic Urology?

Gynecologic Urology, also referred to as Uro-gynecology, is a subspecialty within the field of Obstetrics and Gynecology. Uro-gynecology's specialty is female pelvic disorders such as pelvic organ prolapse (bulges that extend from the uterus into the vagina or extend out of the vagina), urinary incontinence, fecal incontinence and constipation. 

Doctors that complete their residency in Obstetrics and Gynecology, then go onto complete fellowship training in Uro-gynecology, where they spend several years focusing only on Uro-gynecology and female pelvic disorders.


What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse or Pelvic Prolapse, is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapsee in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What is Pelvic Prolapse?

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse."  Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What are the symptoms that indicate a woman is suffering from  Pelvic Organ Prolapse?

• Loss of bladder control.

• Loss of bowel control.

• Increasing need and frequency to urinate - and then difficulty in completely emptying your bladder.

• The feelings that your of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something is "dropping."

• Recurrent bladder infections.

• Excessive vaginal discharge.

• Pain or lack of sensation during sex

But Pelvic Organ Prolapse is a real, common and treatable problem. Consider this:

About half of all women over age 50 suffer from some degree of Pelvic Organ Prolapse.

One in 10 women undergo surgery for Pelvic Organ Prolapse by age 80.

What is Pelvic Reconstruction?

Pelvic Reconstruction is a surgical procedure performed by gynecologists or uro-gynecologies to repair pelvic organ prolapse and vaginal vault prolapse, among types of prolapse, and to correct the problem(s) and relieve the symptoms. 

Typically, Pelvic Reconstruction is performed vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues. 

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is Colpopexy?

Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy 

What Is Sacral Colpopexy (Sacrocolpopexy)?

Sacral Colpopexy, also referred to as also referred to as also referred to as also referred to as Sacrocolpopexy, is the preferred surgical procedure for treating and correcting Vaginal Vault Prolapse with excellent results. Sacral Colpopexy (Sacrocolpopexy) has a very high rate of success  and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacrocolpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.

Why Is Sacrocolpopexy Performed? 

Sacrocolpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of the uterus.

A woman's vagina that has one or more of these vaginal protrusion(s) may experience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.  
• Difficulty with urination (e.g. unable to completely empty the bladder) 
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels) 
• Pain 
• Infection 
• Bleeding 

The objective of the Sacrocolpopexy operation is to relieve the woman's symptoms and to restore her vagina and her vaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacrocolpopexy surgery? 

Sacrocolpopexy surgery is a very common and relatively safe operation with excellent prognosis and outcomes.  However, like any surgical procedure, there are complications which may occur. Possible complications from Sacrocolpopexy surgery may include:

• Bleeding 
• Infection 
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines) 
• Formation of blood clot(s) in the legs or lungs 
• Recurrence of problem
• Slow return of bowel or bladder function 
• Erosion of synthetic material through vaginal mucosa 

What Happens Before Sacrocolpopexy Surgery? 

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for Sacrocolpopexy surgery. 

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing. 

3. You will be admitted to the hospital one day before Sacrocolpopexy surgery. 

4. You will be given preparations to clear your bowels.

5.  Your pubic hair surrounding your vulva will be shaved. 

6. You will not be allowed to eat or drink after midnight on the day before the surgery. 

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled. 

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at least one week before Sacrocolpopexy surgery. 

What happens during the Sacrocolpopexy surgery? 

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after the Sacrocolpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacrocolpopexy surgery? 

1. Immediately after the operation, you may experience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities. 

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort. 

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. You will need to wear a menstrual pad during the recovery period, but you will not be permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You will be encouraged to move around. Blood chemistries and normal follow-up visits will be performed. 

3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacrocolpopexy procedure. 

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor. 

• Using tampons, douching, sexual intercourse and driving for 4 weeks. 

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexy surgery.

6. You should (immediately) return to the hospital or notify your doctor if you notic any of the following:

• Heavy vaginal bleeding 
• Foul smelling vaginal discharge 
• Severe abdominal distension and / or pain not relieved by painkillers 
• High fever 
• Pain associated with passing urine 
• Difficulty in passing urine 
• Constipation 

Follow-up doctor visits after Sacrocolpopexy surgery 

You will be examined by your doctor (at your doctor's office) at approximately; 2 weeks, 4 weeks, six months and and one year after Sacrocolpopexy surgery. 

It is important to keep your follow-up appointments to ensure the best possible results.

What is "Colposuspension" surgery?

Age and vaginal childbirth takes it toll on women's pelvic organs.  

"Female Urinary Incontinence" is one of the problems most (over 50%) women who have delivered babies vaginally have to contend with.  Women with Female Urinary Incontinence "leak" urine when they strain,  cough, laugh or run. This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotional stress is causing her to "leak" urine.  

The problems associated with female urinary incontinence are corrected in the the "floor" of the woman's pelvis by several methods or types of surgeries - one of which is called Colposuspension. 

A woman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of the female pelvis. Women can feel it "tighten" when they try to hold back the flow of urine - or when they strain,  cough, laugh or run. The uterus and bladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through the pelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine is thereby weakened. 

Colposuspension surgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back up to their correct position within the woman's pelvis

Colposuspension comes from the Greek word for vagina - "colpos."

What is "Urethropexy"?

Urethropexy is a surgical procedure where the support of a woman's urethra is re-supported through sutures that surround the urethra's pelvic floor  and vaginal tissues to her pubic bone.

What is the Vaginal Vault and Where is the Vaginal Vault Located?

As previously stated, Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons. Vaginal Vault Suspension is the surgical procedure that corrects and repairs Vaginal Vault Prolapse.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). 

Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

Vaginal Vault Suspension is a surgical procedure that may be selected to correct/repair Vaginal Vault Prolapse.

What is Vaginal Vault Suspension?

Vaginal Vault Suspension is the surgical procedure that repairs Vaginal Vault Prolapse and also provides support for the apex or "vaginal vault" of the vagina to pelvic structures.

What is a Trachelectomy?

A trachelectomy, also referred to as a cervicectomy, is the surgical removal of the cervix. 

In this surgery, the uterus itself is saved or preserved, and therefore this type of surgery preserves a woman's chance of becoming pregnant and having children.  The trachelectomy surgical alternative - as opposed to the more radical hysterectomy which removes the uterus in addition to the cervix - is typically elected by younger women with early stage cervical cancer.

What Everyone Needs to Know About Reconstructive Pelvic Surgery.

Reconstructive pelvic surgery is an area of surgery dealing with a woman's pelvis, and includes gynecology and uro-gynecology.  Pelvic reconstructive surgery is many times very complex surgery that may require not just the removal of certain organs or tissues in a woman's pelvis, but may also include the resection of areas and putting her organs and tissues back together in a way that makes her more functional, with less/no pain and feels better. 

What is Pelvic Inflammatory Disease?

Pelvic inflammatory disease, or "PID" is an infection of a woman's pelvic organs which include the uterus, fallopian tubes, and ovaries. 

Bacteria causes pelvic inflammatory disease. Bacteria can move upward, from a woman's vagina or cervix - which is the opening to the uterus, or womb - into her fallopian tubes, ovaries and uterus, which then cause an infection. Many types of bacteria can cause pelvic inflammatory disease. But bacteria found in two common sexually transmitted diseases - chlamydia and gonorrhea - are the most frequent causes of pelvic inflammatory disease. 

After a woman becomes infected, it can take from a few days to a few months to develop pelvic inflammatory disease. 

The major symptoms of pelvic inflammatory disease are lower abdominal pain and abnormal vaginal discharge. 

Other symptoms of pelvic inflammatory disease may include one or more of the following; fever, pain in the right upper abdomen, pain during vaginal intercourse, and irregular menstrual bleeding.  

Pelvic inflammatory disease, particularly when caused by chlamydia, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs. 

Untreated, pelvic inflammatory disease causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic pain, and other serious problems. 

Pelvic inflammatory disease is more common and more aggressive in HIV+ women than in uninfected women. Pelvic inflammatory disease may become a chronic and relapsing condition as a woman's immune system deteriorates. 

Women can play an active role in protecting themselves from pelvic inflammatory disease disease by following these steps and precautions: 

*  Call your doctor if you have discharge with odor or bleeding between cycles. 

*  Use either male or female condoms during sex. 


What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction, which is also referred to as outlet obstruction or outlet delay, refers to a condition in which the pelvic floor muscles of a woman's lower pelvis - that surround the rectum, do not function normally. It is not known why these muscles fail to work properly in some women, but they can make the passage of stools difficult even when everything else seemingly is normal.

What Causes Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction find that muscle pain occurs when muscles are tense, strained, traumatized and/or otherwise inflamed. Their pelvic muscles are no exception. Causes of pelvic floor dysfunction can include:

*  Chronic faulty posture with weak core musculature 
*  Trauma (fall on tailbone, old tailbone fracture, auto accident)
*  Inflammation or infection
*  Pelvic organ disease (endometriosis, irritable bowel syndrome, interstitial cystitis) 
*  Repetitive motion injuries such as those from gymnastics, volleyball, soccer, ballet or ice
    skating
*  Abdominal muscle wall weakness or hernias 
*  Chronic constipation
*  Pregnancy or complicated vaginal delivery 
*  Abdominal or pelvic surgery such as a hysterectomy 

Do I have Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction often have changes in their spine and/or pelvis.  Symptoms or conditional might include; scoliosis, short leg, swayback or a "torsioned" sacrum. The most common symptoms of pelvic floor dysfunction include one or more of the following:

*  Vaginal pain 
*  Pain with urination 
*  Urinary urgency and frequency 
*  Rectal pain 
*  Pain during vaginal intercourse 
*  Pain with sitting, standing, walking 
*  Pain and/or difficulty getting up from a seated or lying down position
*  Hip pain often with loss of range of motion in hips 
*  Deep pain in lower back radiating to legs, thighs, groin, hips 
*  Abdominal and lower abdominal/intestinal pain
*  Pelvic pressure or a feeling like your vagina or uterus are "falling out."
*  Involuntary loss of urine or stool 

What are Pelvic Adhesions?

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

Examples of a pelvic inflammatory event include; fallopian tube infections that might occur from endometriosis, removal of an ovarian cyst, sexually transmitted diseases such as gonorrhea, post surgery infections, and even appendicitis and appendectomies.

As a woman's body's pelvic area recovers from an inflammation, trauma or surgery, it begins the healing process and starts to repair itself.  The woman's body and its' healing process may cause some tissues and structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal woman's healthy pelvis, this space is lined with a tissue called the peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In the pelvis of a non-injured/non-irritated woman, the peritoneum can be very "slippery" with the the organs and structures lying immediately next to each other that "slip" off each other and do not become bonded together. With a woman who has had a pelvic inflammation, trauma or injury, her body's healing process starts a sequence of events that may result in some of the pelvic tissues becoming "stuck" to or "adhering" to tissues or organs next to the inflamed, or injured tissue, and when this occurs, the outcome may be pelvic adhesions.

What is Menorrhagia?

Menorrhagia is the medical term for women (and young girls first starting their menstrual cycles) that excessive menstrual bleeding. Excessive menstrual bleeding is defined as having a period that lasts 7 or more days each menstrual cycle (period) or is so heavy that you saturate your menstrual pad and/or tampon and need to change your feminine hygiene product(s) every one to two hours.  It is very important to inform your doctor if you have excessive menstrual bleeding! 

Women that are suffering from Menorrhagia may experience; anemia, fatigue,  embarrassing menstrual accidents, and feel that you have to restrict your life and social activities to such an extent that you "miss out on life."  Many women prefer to stay close to home so as to avoid embarrassment due to their need to go to the restroom so often so that they can change their feminine hygiene products before they become too saturated and cause even more embarrassment.

How many women have Menorrhagia?

Approximately 1 in 5 women have Menorrhagia.

Are there any treatments or therapies for Menorrhagia?

Yes, there's hope and help for women with Menorrhagia!

Here are a few of the options and therapies you will want to discuss with your doctor.

Hormone therapy - also known as "both control pills," and/or other medications may be prescribed to treat hormone imbalance. Hormone therapy is effective about 50% of the time, and may be required for a long period of time. 

Uterine Balloon Therapy - Also known as Thermal Balloon Ablation) (see below for more information)

Dilation and curettage - also referred to as a "D & C" - is a surgical procedure whereby the doctor scrape the inside of the woman's uterus to remove the lining. For most women with Menorrhagia, a D&C is temporary and reduces excessive bleeding for only a few periods.

Endometrial Ablation is another possible therapy but only if you and your husband don't plan to have children in the future. Typical Endometrial Ablation removes the lining of the uterus with an electrosurgical tool or laser. Like any surgical procedure, there are risks, which include perforation of the uterus, bleeding, infection, or even heart failure due to fluids used to open up or distend the uterus.

Hysterectomy is the surgical removal of the uterus.  As a hysterectomy involves the removal of the woman's uterus, Menorrhagia will no longer be a problem. Hysterectomy is also a surgical procedure and also involves risks. The recovery period after hysterectomy is 3 to 6 weeks. 

Uterine Balloon Therapy 
www.UterineBalloonTherapy.com

What is Perineoplasty?

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation."  Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband/partner.

What is Colporrhaphy? 

Colporrhaphy is the surgical repair of the vaginal wall. This includes repairing many types of vaginal surgery, including the repairs of the vagina in a "Pelvic Organ Prolapse," "vaginal prolapse," "Vaginal Vault Prolapse," or the repair of a "cystocele" in the vaginal wall(s) or vaginal vault or a rectocele. A cystocele occurs when the bladder protrudes into the vagina, and a rectocele when the rectum protrudes into the vagina.

In the Colporrhaphy procudeure, a uro-gynecologist, or gynecological surgeon, places a vaginal speculum inside the vagina, which spreads/keeps the vagina open, for the doctor to inspect and repair the vagina. The vaginal wall is cut opened to reveal an opening in the supporting structures, or fascia and the defect is closed and then the vagina is repaired by suture and closed, and the speculum removed. 

Who performs the Colporrhaphy and where is it performed?

Colporrhaphy is usually performed in a nearby hospital operating room by a uro-gynecologist, urologist or gynecological surgeon.

Facts About Female Sexual Dysfunction

       *   43% of all women (and therefore, their husbands/partners as well) are
            suffering from various types of Female Sexual Dysfunction, also called
            "Female Sexual Problems."

       *   50% more women than men, are suffering from Erectile Dysfunction, which
            is referred to as "Female Erectile Dysfunction."

       *   Many people fail to recognize that unless a woman's clitoris is fully erect,
            that she is incapable of reaching an orgasm.

Vaginal Relaxation?

Ladies, is your loose vagina causing you embarrassment or have you lost the joy of intimacy?  

If one or more vaginal childbirths have caused your vagina to become loose, and "not tight", he has probably noticed as well. You can once again, have the "tight vagina" of your youth! 

What you, and he are experiencing, is something called "Vaginal Relaxation," the medical jargon for "loose vagina."

Vaginal Relaxation?

Did you know that over 35 million American women and their husbands are suffering loss of joy and intimacy due to "Vaginal Relaxation?" 

Have you or your husband noticed that the thrill of intimacy you and he used to enjoy has been diminished due to the loss of your vagina's tightness?

Stop the Suffering! 
Our Board Certified Physicians have 
Extensive Experience in Solving
Intimacy Problems Related to 
Vaginal Relaxation!

Our doctors can treat and cure your (or your wife's) 
"Vaginal Relaxation" Problems!

Did you know that about 35 million to 40 million American women – and their husbands and partners - are suffering from “Vaginal Relaxation.”?  

“Vaginal Relaxation” is often referred to as a “loose vagina” wherein the vagina is not as tight as it once was, whether due to vaginal childbirth, age, or other vaginal trauma. The vagina has become relaxed, or loose, and now it has become a problem for the woman, as well as her husband/partner.

Some women, as another symptom of Vaginal Relaxation, have problems controlling their urine in certain situations or notice changes in their bowel habits. These symptoms of Vaginal Relaxation are typically related to one or more problems that occur as a result of vaginal childbirth, other vaginal trauma, aging or a combination of the above.  

There is hope!  Women, and their husbands/partners, no longer need to suffer from Vaginal Relaxation.  More and more doctors are treating women and couples suffering from Vaginal Relaxation with treatments – sometimes including surgery – that will help them return to a life without the embarrassment, disappointments and heartache of the symptoms and discomforts associated with Vaginal Relaxation.

What is "Nerve Stimulation" and how does Nerve Stimulation help patients?

There are various types of nerve stimulation, each with its own protocols for treating various ailments and conditions.

One type of nerve stimulation is for treating people with moderate to severe depression.  Depression can be a very serious and life-threatening condition that may require life-long management and treatment.  Treating depression may sometimes have a lower than hoped for success rate and estimates indicate that more than half of all patients with depression have relapses. Anti-depressant drugs and medication may lessen symptoms but may not relieve all of the symptoms in some patients.

Seizures also do not always respond to treatment. Some patients have tried two or more medications and still have seizures, as well as side effects from the drugs, both of which affect their quality of life.

Vagus nerve stimulators are a small medial device that are implanted under the skin of the chest.  A very small wire runs to the patient's vagus nerve, which is then stimulated by the device, in the same manner a pacemaker works.  In general, patients with depression normally experience an improvement in alertness, energy. memory, their depression improves as a result. better mood. These quality-of-life benefits improve over time. 

Vagus nerve stimulators, in general, have proven to be a safe and effective way to control seizures and lessen the severity of depression.   Because Vagus nerve stimulators are used, drugs are usually not required, and there are no side effects that are associated with anti-depressant or seizure-control medications.

See:  www.DepressionHelp.net  for more information about depression.

What is Perineoplasty?

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation."  Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband/partner.

What is Vaginal Dryness?

Vaginal dryness is one of the most distressing, and painful problems a woman faces.  Vaginal dryness occurs when the natural vagina secretions decreases within the vagina. The amount of vaginal moisture varies throughout a woman's monthly menstrual cycle. Vaginal dryness is particularly problematical as a woman enters and becomes menopausal.

What is a "Vaginal Moisturizer"?

Vaginal moisturizers, provided by numerous companies, and a variety of brand names, are products designed to relieve the pain and discomfort of vaginal dryness. These products are applied or inserted, into the vagina, one or more times per day, depending on the amount of vaginal dryness she may be experiencing.

A vaginal moisturizer may or may not be a vaginal lubricant.  Vaginal lubricants are normally used as an aid for intercourse and used on a short-term basis to help a woman that is not able to produce enough vaginal moisture to permit her to comfortably (and painlessly) engage in intercourse.  

A menstruating woman's vaginal moisture changes from day to day, and varies depending upon her hormones that control the production of vaginal moisture.  A woman can experience vaginal dryness even during times of menstrual bleeding, especially when using tampons, as tampons can remove the natural moisture her vagina produces which can cause irritation and pain.

What is Female Sexual Arousal Disorder?

Female Sexual Arousal Disorder or simply "FSAD" occurs when a woman is unable to attain and maintain a full and complete erection of her clitoris along with sufficient vaginal lubrication during intercourse to be able to reach an orgasm.  

Female Sexual Arousal Disorder may also be diagnosed when the woman has no desire for sexual intercourse. 

Female Sexual Arousal Disorder affects up to 43 percent of all women, or an estimated 90 million women. Most women (more than 1/2) with FSAD are postmenopausal. Some women with Female Sexual Arousal Disorder describe the condition as being "unable to get turned on," or being continually disinterested in sex. Female Sexual Arousal Disorder has  also been called "frigidity." Other symptoms of Female Sexual Arousal Disorder may include dyspareunia and vaginismus, both of which involve pain during intercourse.

The woman and her husband/partner should both be seen as this is a "couple's problem" that is typically best resolved with both partners in treatment.  Their doctor will also insure that this  is not the result of another psychological disorder which could be a primary problem. 

If the husband/ partner of a patient with suspected Female Sexual Arousal Disorder feels that this is a problem within the relationship, that concern should be sufficient for the individual to seek psychological consultation.

What is Female Erectile Dysfunction?

Female Erectile Dysfunction occurs when a woman is unable to attain, and maintain a complete erection of her clitoris through orgasm.

If the husband/partner of a patient with suspected Female Erectile Dysfunction feels that this is a problem within the relationship, his concern should be sufficient for the individual the couple to seek medical and/or psychological consultation to determine the cause of her Female Erectile Dysfunction. 

What Are Female Sexual Problems?

Female Sexual Problems are also referred to as "Female Sexual Dysfunction."  A woman may have one or more Female Sexual Problems that we are just now learning that may be related to a number of factors.  

Typically, Female Sexual Problems are labeled generically as "Female Sexual Dysfunction" until such time as her doctor or therapist may be able to make a proper diagnosis.  

Female Sexual Problems may be a cause of significant distress to both her and her husband. 

If the husband/partner of a patient with suspected Female Sexual Problems feels that this is a problem within the relationship, his concern should be sufficient for the individual to seek psychological consultation. 

What is Female Orgasmic Disorder?

Female Orgasmic Disorder is defined as a sexual dysfunction that is characterized by a persistent or recurrent delay or absence of orgasm following the excitement phase of the female sexual response cycle, causing significant distress or interpersonal problems, and not being attributable to a drug or a general medical condition. 

Female Orgasmic Disorder is directly related with the woman's inability to attain and maintain a fully-erect clitoris.  

Without a full erection of the clitoris, a woman cannot reach an orgasm.

What is Hypoactive Sexual Desire Disorder?

Hypoactive Sexual Desire Disorder or "HSDD" has been defined as a deficiency or absence of sexual fantasies and desire for sexual activity. Hypoactive Sexual Desire Disorder is considered a disorder if it causes distress for the woman or husband.  The woman and her husband should both be seen as this is a "couple's problem" that is typically best resolved with both partners in treatment.  Their doctor will also insure that this  is not the result of another psychological disorder which could be a primary problem. 

If the husband/partner of a patient with suspected Hypoactive Sexual Desire Disorder feels that this is a problem within the relationship, his concern should be sufficient for the individual to seek psychological consultation.

What is menopause?

Menopause is a normal change in a woman's life when her period stops. That's why some people call menopause "the change of life" or "the change." During menopause a woman's body slowly produces less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row.

What is hormone therapy for menopause?

Hormone therapy for menopause has also been called hormone replacement therapy (HRT). Lower hormone levels in menopause may lead to hot flashes, vaginal dryness and thin bones. To help with these problems, women are often given estrogen or estrogen with progestin (another hormone). Like all medicines, hormone therapy has risks and benefits. Talk to your doctor, nurse, or pharmacist about hormones. If you decide to use hormones, use them at the lowest dose that helps. Also use them for the shortest time that you need them.

What are the symptoms of menopause?

Every woman's period will stop at menopause. Some women may not have any other symptoms at all. 

As women begin reaching the age of 40, their bodies are preparing for menopause, or the stopping of their monthly menstrual periods.  Menopause never happens all at once.  As young ladies approach their first period and monthly menstruation, her body's hormones are "transitioning" to producing hormones levels that will support monthly menstruation for about the the next 35 years. Similarly, as women reach their 40's, their bodies' hormone levels begin to change, and in preparation of menopause. 

Women will know they are approaching menopause, as they will notice the following symptoms:

• Changes in your period - time between periods or flow may be different.

• Hot flashes ("hot flushes") - getting warm in the face, neck and chest.

• Night sweats and sleeping problems that lead to feeling tired, stressed or tense.

• Vaginal changes - the vagina may become dry and thin, and sex may be painful.

• Thinning of your bones, which may lead to loss of height and bone breaks (osteoporosis).

Who needs treatment for symptoms of menopause?

• For some women, many of these changes will go away over time without treatment.

• Some women will choose treatment for their symptoms and to prevent bone loss. If you choose treatment, estrogen alone or estrogen with progestin (for a woman who still has her uterus or womb) can be used.

What are the benefits from using hormones for menopause?

Hormone therapy is the most effective FDA approved medicine for relief of hot flashes, night sweats or vaginal dryness.

Hormones may reduce your chances of getting thin, weak bones (osteoporosis) which break easily.

What are the risks of using hormones?

For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gall bladder disease. For a woman with a uterus, estrogen increases her chance of getting endometrial cancer (cancer of the uterine lining). Adding progestin lowers this risk.

Should I use estrogen just to prevent thin bones?

You can, but there are also other medicines and things you can do to help your bones.

Should I use hormone therapy to protect the heart or prevent strokes?

No, do not use hormone therapy to prevent heart attacks or strokes.

Should I use hormone therapy to prevent memory loss or Alzheimer's disease?

No, do not use hormone therapy to prevent memory loss or Alzheimer's disease.

Do hormones protect against aging and wrinkles or increase my sex drive?

Studies have not shown that hormone therapy prevents aging and wrinkles or increases sex drive.

How long should I use hormones for menopause?

You should talk to your doctor, nurse or pharmacist. Again, hormones should be used at the lowest dose that helps and for the shortest time. (For example, check if you still need them every 3-6 months.)

Does it make a difference what form of hormones I use for menopause?

The risks and benefits may be the same for all hormone products for menopause, such as pills, patches, vaginal creams, gels and rings.

Are herbs and other "natural" products useful in treating symptoms of menopause?

At this time, we do not know if herbs or other "natural" products are helpful or safe. Studies are being done to learn about the benefits and risks.

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Labia Reduction Surgery
www.LabiaReductionSurgery.com

What is Labia Reduction Surgery?

More and more women are seeking "female genital surgery" to correct problems relating to their vulvas whether they are unhappy with the looks of their vulva or if their elongated labia minora are causing them pain or embarrassment - female genital surgery can correct these problems.

Some of the more common reasons given by women to seek female genital surgery include;  

• labia minora (smaller lips of the vulva) are uneven, mis-shapen or elongated

• one of the labia minora lips is longer than the other

• labia minora feel "floppy"   

• no longer able to wear a bikini or favorite swimsuit because you are afraid that your labia minora may "fall out" of the bikini

• long labia minora cause pain during intercourse or when wearing tight jeans.

• clitoral hood has excess skin which is either unsightly or interferes with sexual pleasure

• too much skin surrounding your clitoris

• after childbirth, my vagina seems too loose, and intercourse doesn't feel the same

• your vagina feels like it is "gaping" open  

• intercourse is no longer pleasurable, for you - or for him and doesn't feel as good as it once did 

What you, and he, are experiencing, is something called "Vaginal Relaxation" the medical term for having a "loose vagina."

These are just some of the complaints we regularly hear from women who want to improve their vulva and how it looks (and feels) - and what we call "cosmetic gynecology." 

Cosmetic gynecology may be what you have been looking for!  Look great, feel great, we can help you have the labia minora, vagina or vulva you always dreamed of!

Vaginal Dryness
www.VaginalDryness.net

What is Vaginal Dryness?

Vaginal dryness is one of the most distressing, and painful problems a woman faces.  Vaginal dryness occurs when the natural vagina secretions decreases within the vagina. The amount of vaginal moisture varies throughout a woman's monthly menstrual cycle. Vaginal dryness is particularly problematical as a woman enters and becomes menopausal.

What is a "Vaginal Moisturizer"?

Vaginal moisturizers, provided by numerous companies, and a variety of brand names, are products designed to relieve the pain and discomfort of vaginal dryness. These products are applied or inserted, into the vagina, one or more times per day, depending on the amount of vaginal dryness she may be experiencing.

A vaginal moisturizer may or may not be a vaginal lubricant.  Vaginal lubricants are normally used as an aid for intercourse and used on a short-term basis to help a woman that is not able to produce enough vaginal moisture to permit her to comfortably (and painlessly) engage in intercourse.  

A menstruating woman's vaginal moisture changes from day to day, and varies depending upon her hormones that control the production of vaginal moisture.  A woman can experience vaginal dryness even during times of menstrual bleeding.

__________________________________________________________________________________

Vaginal Odor
www.VaginalOdor.net 

I have a Vaginal Odor ( VO) problem, what do I do? 

All menstruating women's vaginas go through monthly changes wherein their vagina's smell or scent changes from one day to the next, and throughout her monthly menstrual cycle. The amount of vaginal secretions, cervical mucous and vaginal moisture, changes from one day to the next, and throughout the monthly menstrual cycle.  This is due to the flow of hormones that produce these changes throughout her cycle and also the reason for her monthly menstruation, if she has not conceived. 

Vaginal odor problems can be related to many things related to her menstrual hygiene, vaginal hygiene, and/or feminine hygiene, but may also be an indication of a medical condition that may need immediate treatment.  

Here are some of the signs and symptoms related and possible causes of V.O. (vaginal odor):

Vaginal odor may be the result of an inflammation of her vagina.  The vaginal inflammation is often a result of infection in or around the vagina or vulva, called the vulvovaginal area. Sometimes this condition is referred to as vulvovaginitis.

Causes of Vaginal Odor

Bacterial Vaginosis 
Chlamydia  
Genital Herpes  
Gonorrhea 
Lymphogranuloma Venereum ("LGV") 
Pelvic Inflammatory Disease ("PID")
Sexually Transmitted Infection(s)
Syphilis 
Trichomonas
Vaginal Yeast Infection (candida)
Vulvovaginitis 


Bacterial Vaginosis leads to vaginal odor, what causes it?

Bacterial Vaginosis (BV) is a type of vulvovaginitis. Bacterial Vaginosis occurs due to an overgrowth of one or more organisms that are normally present in your/your wife's vagina. 

Many times, when a woman begins taking antibiotics, these antibiotics kill off the natural organisms in her vagina.  This may cause some organisms in her vagina to multiply, and these organisms produce chemicals that cause a fish-like odor characteristic of BV. Vaginal odor may be more acute, and stronger after sexual intercourse. 

Many times, while a woman may believe that vaginal douching prevents or helps prevent vaginal odor, especially after menstruation, douching actually disrupts the normal flora, or naturally occurring organisms that normally live in the vagina.  Vaginal douching, therefore,  may actually increase the risk of vaginal infection.

Signs and symptoms of Bacterial Vaginosis include(s): 

*  Grayish-white vaginal discharge
*  Vaginal itching or irritation
*  Vulva/labial redness, irritation, swelling and redness

Treating Bacterial Vaginosis is normally started after a visit to the ob-gyn who may  prescribe medication(s) - usually antibiotics.

Other causes of vaginal odor include the following:

Poor vaginal, menstrual or feminine hygiene methods.

Not changing tampons, or menstrual pads frequently enough.

"Losing" or forgetting a tampon in the vagina, which may lead to a vaginal infection. 

Rarely, an advanced tumor of the cervix or vagina will cause a vaginal odor problem.

Vaginal Hygiene is an area that focuses its studies, resources, and recommended products on proper Vaginal Hygiene, and overcoming Vaginal Hygiene problems. Whether you are concerned about menstruation, whether you should consider douching, vaginal odors, vaginal dryness, menstrual odors during menstruation, or general feminine hygiene information, this site is for you.

What is Gardnerella or Gardnerella Vaginalis?

Gardnerella or Gardnerella Vaginalis is an infection in the vagina caused by bacteria of the Gardnerella Vaginalis strain, often in combination with various anaerobic bacteria. This bacterial strain, "Gardnerella Vaginalis" is also the cause of "bacterial vaginosis" or "BV." 

A vaginal infection caused by Gardnerella often produces a gray or yellow discharge with a "fishy" vaginal odor that increases after washing the vulvovaginal area with alkaline soaps. 

Gardnerella Vaginalis is one of the most common causes of bacterial vaginitis - also called bacterial vaginosis, or "BV." 

Typically, the woman will see her family physician or gynecologist with complaints of a strong vaginal odor that is "fishy" smelling, along with a vaginal discharge which is gray to white in color.  The vaginal odor or fishy smell may be released on application of 10 percent potassium hydroxide to the vaginal secretion on a glass slide during a vaginal exam by the physician.

The normal vaginal pH is 3.7 - 4.5.  Women with Gardnerella typically have a vaginal pH above 4.5 

Gardnerella Vaginalis symptoms include:

• Vaginal Discharge that is white or gray in color. 

• Vaginal odor that smells like fish and is especially noticeable after sex.

• Vaginal pH above 4.5
  

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Gynecologic Urology
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