Your urinary tract is made up of your kidneys, bladder, ureters (tubes that connect your kidney to your bladder) and your urethra. The primary function of your urinary tract is to flush waste, including bacteria, out of your body through your urine. Sometimes things can go wrong and potentially harmful bacteria will begin to reproduce in your urinary tract and cause infections. 

Most infections are commonly found in the lower urinary tract in the bladder and urethra. If left untreated, it can spread to your upper urinary tract (i.e. bladder and kidneys) and can lead to serious health problems that can be potentially life-threatening. Unfortunately, if you’re a woman, your chances of developing a urinary tract infection are far greater because of your anatomy. 

The most common UTIs in women affect the bladder (cystitis) and urethra (urethritis) and 90% of the time they are caused by the gastrointestinal bacteria, E. coli. Since a woman’s urethra has a shorter distance to the bladder and is in closer proximity to the rectum, the chances of transmitting bacteria from the GI tract increases. 

However, people of any age or sex can develop a urinary tract infection, but women are at a higher risk. About 40 to 60% of women will experience a urinary tract infection in their lifetime. Certain medical conditions and lifestyle factors can increase your chances of developing a UTI if you:

• Are sexually active
• Are post-menopausal
• Are pregnant.
• Use diaphragms or spermicide
• Have a spinal cord injury or nerve damage around the urinary tract
• Have urinary tract blockage, such as kidney stones
• Have diabetes or immune deficiencies 
• Recently used a urinary catheter
• Experienced a UTI in the past

How do you know you have it?

Symptoms common to any type of urinary tract infection include: 

• Strong, frequent urge to urinate
• Painful, burning sensation while urinating
• Bad-smelling urine
• Cloudy urine or urine with blood in it
• Passing small amounts of urine, frequently
• Abdominal discomfort

Other Types of Infections

UTIs can be confused with symptoms caused by other types of infections. Sexually transmitted infections (STIs) such as herpes, gonorrhea, chlamydia, and mycoplasma can also cause urethritis. Yeast infections are a fungus that causes a thick, white vaginal discharge that doesn’t have an odor but shares some symptoms with UTI including burning sensations while urinating. 

Life-threatening Complications

If your UTI is left untreated, it can spread from your bladder into your kidneys. Kidney infections can be serious and lead to a potentially life-threatening condition called sepsis. In addition to UTI symptoms, kidney infections can include fever, chills, pain in your lower back or side and nausea or vomiting. 

Although most kidney infections are from a UTI they can happen following kidney surgery or from an infection that spreads from another part of your body. With March being National Kidney Month, now is a good time to learn how you can improve your kidney functions with a few simple lifestyle steps. 

You can lower your risk of developing a urinary tract infection by:

• Drinking plenty of water to dilute your urine and flush out bacteria. 
• Drink cranberry juice.
• Wipe from front to back.
• Empty your bladder after intercourse.
• Avoid irritating products like douches and powders.
• Change your birth control method. Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth. 

Treatment

UTIs, including kidney infections, can be treated with a course of antibiotics. You may begin to feel better after a few days on your antibiotics, however, you should continue taking the medication as prescribed. If you don’t take it as prescribed, stronger bacteria may not be killed causing another flare-up. People with severe kidney infections may need to be hospitalized. While being treated:

• Drink plenty of fluids.
• Take over-the-counter pain medication.
• Use a heating pad to ease the pain.
• Avoid coffee and alcohol, which can make you feel like you need to urinate more often. 

If you are concerned by the symptoms you are experiencing, call our Raleigh OB/GYN Center at (919) 876-8225 to schedule an appointment. Our team of healthcare providers has provided personalized and comprehensive care for women in all stages of life for more than 40 years. 

Most women are familiar with the pain and cramping associated with menstrual periods. However, the severity of period pain can vary greatly on an individual basis. Some women experience mild discomfort that is easily managed, while others have pain severe enough to interfere with everyday activities during the menstrual cycle each month. Painful periods may be caused by several factors. Depending on how bad the symptoms are and what is causing them, your gynecologist can help you manage the pain.

Causes of Painful Periods

Period pain, medically referred to as dysmenorrhea, is separated into two categories: primary and secondary.

Primary Dysmenorrhea 

Primary dysmenorrhea is pain that is caused exclusively by the menstrual period. Dysmenorrhea is described as throbbing or cramping pain in the lower abdomen or pelvic area. Cramps are caused by the uterus contracting to help expel its lining, which is the purpose of menstruation. These contractions are triggered by prostaglandins, a hormone-like substance. Higher levels of prostaglandins are linked to inflammation and more severe dysmenorrhea.

Secondary Dysmenorrhea

Secondary dysmenorrhea is caused by another condition in the reproductive system. Some conditions that cause secondary period pain include:

• Endometriosis: Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of the uterus. It is a common health issue, and according to the US Office on Women’s Health, endometriosis may affect more than 11% of American women between the ages of 15 and 44. The primary symptom of endometriosis is pain, including severe menstrual cramps that may worsen as the disease progresses. Endometriosis also causes pain in the lower back, pelvis, and intestines. It is also one of the most common causes of infertility in women of reproductive age in the US.

• Adenomyosis: Although it is much rarer than endometriosis, adenomyosis is also a disorder involving the uterine lining. In adenomyosis, the uterine lining grows into the muscle of the uterine wall. Symptoms of the condition include prolonged periods with heavy bleeding and pain.

• Polycystic Ovary Syndrome (PCOS): Polycystic ovary syndrome is a hormonal disorder found in many women of reproductive age. According to the CDC, PCOS affects between 6% and 12% of US women of reproductive age.  Some women with PCOS have irregular periods, which may be infrequent and/or prolonged. When women with PCOS have a menstrual period, they often experience heavy bleeding, clots, and severe period pain. As with endometriosis, as PCOS progresses, symptoms like period pain will get worse as well. Other symptoms of PCOS include weight gain, fatigue, painful intercourse, excess facial and body hair growth, acne, male-pattern baldness, ovarian cysts, and infertility.

• Uterine Fibroids: Fibroids are noncancerous growths in the uterus. Often, uterine fibroids don’t cause noticeable symptoms. However, the size, location, and the number of fibroids may cause symptoms like heavy, painful periods that last more than a week. Other symptoms include pelvic pressure or pain, frequent urination, backaches, and leg pain.

• Pelvic Inflammatory Disease (PID): Pelvic inflammatory disease is an infection in the uterus, fallopian tubes, or ovaries. PID is usually caused by sexually transmitted bacteria that travel from the vagina into other parts of the reproductive system. The infection causes inflammation. If the infection is present during the menstrual period, cramping and discomfort may be more severe than normal.

• Cervical Stenosis: Cervical stenosis is a rare condition in which the cervix is much smaller or narrower than usual. It can cause menstrual flow to slow, resulting in increased pressure and pain in the uterus.

How Your Gynecologist Can Help

If you are experiencing period pain that interferes with your daily life every month, then you should talk to your gynecologist. They can determine whether your period pain is primary or secondary dysmenorrhea. From there, the gynecologist can prescribe treatment that will help you manage your symptoms.

If your pain is caused by primary dysmenorrhea, or menstrual cramps on their own, the doctor may prescribe medication to relieve pain. Period pain can also be managed with hormonal birth control, which prevents ovulation and reduces the severity of cramps. Birth control can be given orally, by injection, through an implant in the arm, vaginal ring, dermal patches, or intrauterine device (IUD).

If period pain is caused by an underlying condition, your doctor can recommend treatment options based on the specific condition. Conditions like endometriosis and PCOS are also treated with hormonal birth control and pain relievers but further treatment such as other medications or surgery.

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Raleigh OB/GYN Centre provides state-of-the-art care for gynecologic conditions, including painful periods, endometriosis, bleeding problems, and pelvic pain. If you have concerns about severe period pain or another condition, call (919) 876-8225 to schedule an appointment at one of our convenient locations.

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

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

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

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

Pros of the Menstrual Cup

• Eco and Budget-Friendly: Switching to the cup will reduce the amount of garbage you produce during your menstrual period because you will not be throwing out pads and tampons. Reducing landfill waste is definitely good for the planet, making the menstrual cup an eco-friendly choice. Also, because you do not need to replace the menstrual cup each month, it is cost-effective as well. If you take care of them properly, some cups can be used for years. A menstrual cup may be a slightly larger investment at first, especially higher quality versions. However, any extra expense is more than made up for after a few cycles. There are also less expensive reusable menstrual cups available that are comparable in price to a box of tampons.

• Less Shopping for Menstrual Products: If you’re using disposable menstrual products like tampons or pads, you have to keep buying them for each period. Not only is this more expensive than using a menstrual cup, but multiple trips to the drug store can also be an inconvenience. As long as you maintain your menstrual cup properly, you will always have it on hand without needing to go to the store for supplies. Just keep track of when your period is due and have it ready to go before that date to be prepared. If you are concerned about starting your period when you’re away from home, a case can be used to keep it in a purse or book bag around the time you expect it to start.

• Helps with Maintaining Healthy Vaginal pH: Tampons are used to absorb blood, but they also absorb any other vaginal fluid present. This may lead to a disturbance in your vaginal pH or the healthy bacteria that should be there. The menstrual cup does not absorb anything, so this problem is avoided.

• Less Odor: If you’ve used tampons or pads before, you may have noticed they can develop an odor as they absorb more blood. The odor becomes more noticeable when it is exposed to air, which is especially a problem with menstrual pads. With the cup, the blood is contained by a non-porous barrier, so it is not exposed to air. Therefore, odor is less common when using a menstrual cup.

• Longer Wearability: In addition to the general longevity of a menstrual cup, you can also usually go longer between trips to the bathroom to deal with your period. The menstrual cup is often able to hold more blood than a pad or tampon can absorb, which means it needs to be emptied less often than other products need to be changed.

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

Cons of the Menstrual Cup

• Learning to Properly Insert It Takes Practice: The most common complaint about the menstrual cup is that it is difficult to insert at first. Because there is a learning curve, some women get frustrated and give up after several attempts. This is especially true for young women who have just started their menstrual cycles and women who have not had intercourse. However, with practice, most women can get the hang of proper insertion. It should be noted that individuals with IUDs may want to consult their doctor about using the menstrual cup because it may pull on the IUD’s strings and dislodge it.

• Fit Issues: The menstrual cup comes in a variety of sizes, with guidelines and recommendations for what size may be appropriate for certain women. However, if you have a condition like a dropped uterus or severe fibroids, fit may be an issue.

• More Mess: A couple of menstrual cup pros and cons are related to the way it collects blood rather than absorbing it. This is a pro for reusability and length of time between changes. However, for some women, dealing with the menstrual blood is a turn-off. If you’re used to simply throwing away menstrual pads and tampons, it may take some getting used to the menstrual cup. With practice, many women will master removal with minimal mess.

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

• Issues with Cup Removal: Removing the menstrual cup can have as much of a learning curve as inserting. And removing it improperly can cause a lot more mess than inserting it incorrectly. While each cup as a “stem” at the bottom, it is not the best idea to use it on its own for removal. The cup should be squeezed just above the stem and pulled out.

• Proper Maintenance: Because the menstrual cup is reusable, it must be taken care of properly. If you neglect proper maintenance of your cup, it can introduce bacteria or other germs into the vagina the next time you use it. Or if it is not taken care of properly, it will not last as long as it should. After each cycle, you should sanitize it by using boiling water or a cleanser made for the material, like solutions used for baby bottle nipples.

Have More Questions?

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

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

What Does Breech Mean?

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

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

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

Risks Related to Breech Presentation

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

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

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

What Can Cause Breech Presentation?

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

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

What Are the Options if My Baby is Breech?

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

1. External Cephalic Version is Attempted

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

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

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

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

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

2. Cesarean Delivery is Planned

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

For More Information

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

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

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

1. Vaccinations 

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

2. Family Planning and Birth Control Counseling

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

3. Bone and Joint Health

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

4. Weight Monitoring and Management 

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

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

5. Skin Issues 

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

6. Thyroid Problems

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

7. Depression, Anxiety, and Mood Issues

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

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

8. Educating Children on Reproduction and Sexual Health 

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

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

9. Transitioning Through Life Stages

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

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

May is National Mental Health Month, so we thought it would be fitting to shed some light on postpartum depression (PPD)–a mood disorder an estimated 1 in 9 women experience after childbirth. In some areas of the country, the estimate may be as high as 20% of new moms.

In recent years, discussions and research about postpartum depression have helped to reduce the stigma surrounding it. However, there is still far more that needs to be done in terms of awareness and education. From signs and symptoms to risk factors and how to seek help, here is what you need to know about postpartum depression.

What is Postpartum Depression?

Often initially mistaken as the “baby blues,” postpartum depression is a medical condition that involves lasting feelings of extreme sadness, anxiety and exhaustion following childbirth.

In the days following childbirth, a normal amount of worry, overwhelm and fatigue is to be expected considering the hormone fluctuations that occur during pregnancy and after delivery. However, when these feelings don’t subside within a week or two and worsen to the extent that they interfere with day-to-day life, postpartum depression may be the culprit.

Postpartum depression may develop at the time of birth or in the days that follow, but it most commonly starts between a week and a month following delivery. Symptoms may occur up to one year postpartum.

Though postpartum depression is often used interchangeably or as an umbrella term, there are several other postpartum disorders that women may experience including postpartum anxiety, post-traumatic stress, panic disorder, obsessive-compulsive disorder and postpartum psychosis.

What Causes Postpartum Depression?

According to the National Institute of Mental Health, postpartum depression cannot be attributed to a single cause. Instead, it is likely caused by a combination of physical and emotional factors.

Physical factors include the rapid decline of hormones (estrogen and progesterone) that occurs after a woman gives birth which causes chemical changes in the brain that may trigger mood swings.

These factors are often exacerbated by a mother’s inability to get the adequate rest need to recover from childbirth. Continued sleep deprivation can contribute to the symptoms of PPD, particularly feelings of physical pain, discomfort and exhaustion.

One thing that is for certain is that PPD is not caused by something that a mother does or does not do.

What are the Symptoms?

Postpartum depression shares many of the same symptoms as clinical depression, as well as some that are unique to women following childbirth. Some of the common symptoms may include:

• Feeling sad, hopeless, empty or overwhelmed
• Feeling shame, guilt or like a failure
• Feeling panicked or scared a lot of the time
• Feeling worried or overly anxious
• Feeling restless, moody or irritable
• Feelings of anger or rage
• Crying more often than usual or for no apparent reason
• Oversleeping
• Inability to sleep even when the baby is asleep
• Difficulty concentrating, remembering details or making decisions
• Loss of interest in activities once previously enjoyed
• Physical symptoms such as aches, pains, frequent headaches, or stomach problems
• Changes in appetite; Eating too much or too little
• Withdrawal from family and friends
• Difficulting bonding or forming an emotional attachment with the baby
• Doubting one’s ability to care for the baby
• Thoughts of harming oneself or the baby

Women may experience one or many of the symptoms above which can range from mild to severe. Untreated, PPD may last for months or longer.

When to Seek Help

If you or someone you love recently had a baby and is experiencing any of the above symptoms of postpartum depression, contact your healthcare provider right away to evaluate your treatment options. If you are worried about harming yourself or your baby, please call 911.

Because the symptoms of postpartum depression are broad, may vary among women, and often overlap with symptoms of other conditions, it is important to seek help from a licensed healthcare professional who is experienced in the diagnosis of perinatal mood and anxiety disorders such as your OB/GYN.

The board-certified physicians at Raleigh OB/GYN can help determine if the symptoms you are feeling are due to postpartum depression or something else. And if needed, recommended a mental health professional in your area as part of your treatment. To schedule an appointment, call (919) 876-8225.

An estimated 70-80% of pregnant women experience some type of morning sickness during their pregnancy, however, around 2% will experience severe morning sickness–a condition called hyperemesis gravidarum. The tricky thing is that what is considered “normal” morning sickness can be difficult to discern, particularly if it is your first pregnancy. Here are some indicators that can help you decide what’s normal and what’s not:

Morning Sickness vs. Hyperemesis Gravidarum (HG)

Source: American Pregnancy Association

What is hyperemesis gravidarum?

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids.

Unlike morning sickness, HG usually extends beyond the first trimester. It may resolve by 21 weeks, but for some women, it may last for the duration of the pregnancy.

The cause of hyperemesis gravidarum is currently unknown but most theories indicate that it may be hormone-related. It is more common in multiple pregnancies (twins or more) and in women with migraines. Women with a family history of hyperemesis gravidarum or who had the condition in a previous pregnancy are much more likely to have it with future pregnancies.

Diagnosis and Treatment

There is no test to diagnose hyperemesis gravidarum. A diagnosis is usually made by measuring weight loss, conducting a urinalysis to check for ketones, and assessing the overall condition of the mother, including whether she is having difficulty performing her normal, daily activities.

Fortunately, there are medications and other treatment options available with the goal of reducing nausea and vomiting, replacing fluids and electrolytes, and improving nutrition and weight gain. In some cases, hospitalization for treatment may be necessary.

In severe cases or left untreated, HG is commonly associated with:

• Loss of greater than 5% of pre-pregnancy body weight (usually over 10%)
• Dehydration and production of ketones
• Nutritional deficiencies
• Metabolic imbalances
• Difficulty with daily activities

Other concerns include liver damage, jaundice, thiamine deficiency, preterm delivery, low birth weight, and the effects of excessive maternal weight loss and poor nutrition on fetal growth.

When to Seek Help

With no identifiable cause, researchers believe that although the condition is considered rare, hyperemesis gravidarum is likely underreported and undiagnosed. If you are unsure whether your symptoms of morning sickness are considered normal or severe, talk to your physician as soon as possible. Early intervention can help prevent the condition from becoming more severe.

The team of board-certified physicians at Raleigh OB/GYN have been caring for expectant mothers for more than four decades and are experienced in treating a variety of pregnancy-related conditions. To schedule an appointment, call (919) 876-8225.

Pregnancy can bring on a wide range of symptoms from cravings and “the glow” to morning sickness and of course, weight gain. While most are merely uncomfortable, others may indicate a potential complication. It’s important to be aware of what pregnancy symptoms you should call your doctor about right away:

1.  Extreme fatigue or dizziness

While is natural to feel a little more tired than normal during pregnancy, extreme fatigue and dizziness may be a sign of anemia. Anemia is the result of a low count of red blood cells, meaning that not enough oxygen is being transported throughout the body.

In addition to extreme fatigue and shortness of breath, shortness of breath and breathing complications can be seen. This is another indication that oxygen transport is inefficient. Normally, this can be treated conservatively by consuming more iron-rich foods or iron supplements.

2. Severe nausea

Nausea and vomiting are common symptoms, especially in the early stages of pregnancy (thanks, hormones). Commonly referred to as morning sickness, these symptoms can actually strike at any time of day. However, there is a fine line between normal and extreme. If vomiting becomes constant, it may be a sign that you have hyperemesis gravidarum–a condition that has the potential to cause severe dehydration if left untreated. If you are unable to keep fluids down for more than 8 hours, you should call your doctor.

3. Vaginal spotting/bleeding

Research shows that an estimated 20-30% of women experience some degree of bleeding in early pregnancy. In some cases, particularly within the first two weeks following conception, this may be implantation bleeding which occurs as the fertilized egg implants itself in the lining of the uterus. Other potential causes in early pregnancy could be an infection, such as UTI, or irritation caused by intercourse.

However, vaginal bleeding may also be a sign of a more pregnancy complication. If you are bleeding, the American Pregnancy Association recommends wearing a pad or panty liner so that you can monitor how much you are bleeding and what type of bleeding you are experiencing. If you experience heavy, bright red vaginal bleeding or passing clots, you should call your doctor.

4. Severe cramping

While pain with kicking is normal, especially in the later stages of pregnancy, severe cramping or stomach pain should be noted. If the cramping does not subside, this may indicate a potential problem with the placenta or a disruption in the natural progression of the pregnancy, including but not limited to miscarriage.

5. A spike in the mother’s blood pressure

A slight increase in blood pressure during pregnancy can be normal due to the extra stress on the body. However, if blood pressure starts to spike, in association with other symptoms such as swelling and blurred vision, a condition known as preeclampsia may be present.

If this does occur, early delivery may be necessary and the baby may need additional time under medical supervision to continue natural development before being released.

6. Decreased fetal movement

Sometime between 13 and 25 weeks, you will feel your baby begin to move. In many cases, first-time moms may not feel these movements as early as women who have been pregnant before, but it’s important to remember that each woman and each pregnancy is different. If you are more than 20 weeks pregnant and have not felt movement, talk to your doctor.

Once you feel your baby move, you should contact your doctor if you notice a decrease in fetal movement (less than 10 movements in a one hour period).

7. Fever over 101°F

You may think a mild fever is no big deal, but if you are pregnant and have a fever over 101°F that does not respond to Tylenol it’s important that you don’t ignore it.

8. Urinary burning, frequency or pain

Burning or pain when urinating, or changes in the frequency of urination, may be a sign of a urinary tract infection. Around 5% of women can expect to develop at least one UTI during pregnancy and of those, 1 in 3 are likely to experience a recurrence. Generally, UTIs are treated with an antibiotic, but in cases where infection has reached the kidneys, IV antibiotics may be recommended.

Left untreated, UTIs can lead to kidney infection, as well as an increased risk of fetal growth restriction, preeclampsia and preterm birth.

9. Vaginal fluid with color or odor

Discharge is not uncommon during pregnancy, however, it should be clear or white with no smell.

10. Labor Symptoms

If you experience labor symptoms, you should call your doctor immediately. These include five contractions in 1 hour, if less than 36 weeks; contractions every five minutes or less for 1 hour; and/or rupture of membranes, commonly known as your “water breaking.”

Contact Raleigh OB/GYN

While no one ever wants to incur a complication during pregnancy, preparing for the “what-ifs” and knowing what to look out for is the best way to prevent harm to the baby or the mother. Careful observation and open communication with your physician is necessary in order to promote the best interests for both throughout the duration of a pregnancy.

If you experience any of the above symptoms, call Raleigh OB/GYN at (919) 876-8225. One of our physicians is on call 24 hours a day to handle emergencies and deliveries.

One of the common misconceptions about labor and delivery involves the various pain relief options that are available. In particular, many first-time moms might assume that the options include epidural or no epidural. But, there are various other medication and non-medication forms for pain management.

Each woman has a different threshold for pain and reacts to pain medications differently. In many cases, you won’t know what kind of pain relief you want until you’re in labor. But, in order to make an educated decision, it’s important to understand the pros and cons of each. Here are six options to relieve labor pain that you may consider:

1. Epidural Anesthesia

As an expectant mother, you have more than likely heard of epidural anesthesia. One of the most common medical pain relief options available, an epidural is a regional anesthesia that blocks pain in a particular part of the body, a pain management option chosen by more than 50% of women giving birth at hospitals.

Before epidural anesthesia is administered, the pregnant patient is given intravenous (IV) fluids. While sitting up and leaning forward to arch your back, an anesthesiologist will apply an antiseptic solution then inject a local anesthetic to numb the area.

A needle is then inserted into the spinal cord in the lower back followed by a catheter which is threaded through the needle into the epidural space. Once the needle is removed, the catheter remains in place and allows the medication to be injected either periodically or continuously. Pain relief typically occurs in around 20 minutes.

While an epidural does not slow dilation, it may slow your ability to push effectively. As with any medication, epidurals do have potential side effects such as nausea, itching, shivering, drop in blood pressure or severe headache.

If you have had spine surgery, are allergic to anesthetic or have blood-clotting problems, you may not be able to get an epidural and will need to consider other options to relieve labor pain.

2. IV Analgesics

For women who choose not to get an epidural, or are early in labor and would like to wait to get an epidural, pain medication through an IV is an option. This type of medication relieves pain without the loss of feeling or muscle movement that occurs with an epidural. While IV analgesics can help to dull the pain, they typically do not take the pain away like an epidural may. They are commonly administered with a single shot or intravenously (IV). It’s important to know that analgesics are another term for opioids. They have the potential to make your baby drowsy, so may not be an option if you are within an hour of delivery.

3. Nitrous Oxide

Rex Hospital also now offers nitrous oxide, which is an inhaled gas, to help with labor pain. According to the Journal of Midwifery & Women’s Health, “Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of endogenous oxytocin, and has no adverse effects on the normal physiology and progress of labor.”

Those who choose to use nitrous oxide during labor may still have an awareness of labor pain, but many women find it helps them relax and decreases their perception of labor pain.

4. Heat or Cold Therapy

Your body temperature may change drastically throughout the labor and delivery process. A hot or cold pack can help relieve the pain and discomforts that arise with contractions.

Cold therapy can useful for reducing swelling and inflammation. Similarly, heat therapy may help relieve severe pain and tension in your muscles. By relieving major muscle tension and loosening your body, you may be better able to rest between your contractions making for a more enjoyable labor and delivery.  

5. Rhythmic Breathing

Another common non-medical labor pain relief tactic is to ‘just breathe’. Breathing along with your contractions can significantly help you control your ‘labor waves’ and offer relief. During your pregnancy, consider taking a Lamaze class or learn guided meditation techniques.

Depending on what feels most natural for you, you will want to either take deep inhales that expand your diaphragm or short patterned breaths that keep you focused more on your breaths than on the pain.

Not only does rhythmic breathing help pregnant women feel more relaxed and in control during labor but increased oxygen also helps the individual in pain feel stronger and have more energy during the pregnancy and labor.

Additionally, patterned rhythmic breathing can quickly become an automatic response to pain which can help mothers even after their pregnancy to manage stress in their everyday lives.

6. Averting Focus: Music, Imagery, Conversation

Similar to breathing exercises and rhythmic breathing, you can use music, imagery, and conversation to avert your focus and still feel in control during labor.

According to the College of Nursing and Health Sciences, music therapy is one of the most powerful non-medical treatments for labor pain because music targets the parts of the brain that also respond to pain and replaces them with feelings of happiness and calm.

Similarly, by choosing imagery such as your phone, your significant other’s face, or an object in the room, you can focus your attention on something other than the pain which can help you cope.

Lastly, just like medical professionals recommend talking to people who have experienced a trauma such as a car accident, having a conversation as you labor can help shift your focus away from the pain.

Which Option is Best?

When it comes to options to relieve labor pain, there is no one size fits all solution. What works for you or what you feel most comfortable with may be different than another expectant mother.

Of course, any woman can choose not to have any medications for pain control in labor, and if this is your desire, it may be helpful to take a childbirth class with this focus or to work with a labor support person, like a doula.

Your doctor can help answer any questions and address any concerns you have about the various options and offer suggestions about what may be best for you.

At Raleigh OB/GYN, our goal is to help expectant parents have a positive labor and delivery experience. For more information or to request an appointment, call (919) 876-8225.