Friday, November 2, 2012

Back in the Sack…Dyspar-whatia?

Dyspareunia, or painful intercourse, can be a medical condition – and women can do something about it...


By Michelle Landsverk, PT, DPT
Physical Therapist at PT Center for Women
View Michelle's Video Here


Have you ever gone to your doctor with an embarrassing problem? Like, one that you might not tell your mother about? But one that you might tell your girlfriends about? Like a problem that you think NOBODY else would have? Like a problem like painful sex?

As women, a lot of us have experienced it, but we tend not to talk about it. Many women who experience painful sex have thoughts like, This is SUPPOSED to feel good; what is the problem? Did I do something wrong? Is my partner too big? Is my uterus tipped? Is it our position during sex? Are my hormone levels the problem? Worse yet, they may ask the question, Is it my fault? because somehow they were made to feel that way by their partner or caregiver, or society at large.

The situation of pain with intercourse that many women harbor is called dyspareunia, which is the clinical term for experiencing pain with attempted vaginal penetration. For some women, that means that they cannot use a tampon, and for others, they have pain that either limits vaginal intercourse, or prevents it entirely.

In fact, pain with sexual intercourse is so common that:
• 40-50% of women in the United States have experienced dyspareunia for a period of time shortly after pregnancy
• Another third or so of women have experienced pain with attempted vaginal penetration not related to pregnancy
• And 5-10% of women have experienced dyspareunia ever since their first try at vaginal intercourse.

So now that we are finally talking, what are we going to do about it? And what does Physical Therapy have to do with dyspareunia? …Well… Lots!

First and foremost, you need to tell your doctor about it, in order to make sure that no disease process or hormone issue is the problem. Your doctor will perform a few tests in order to make sure that you don’t need medical treatment. And when your health checks out, your doctor will probably refer you to physical therapy, but if they don’t, it doesn’t hurt to inquire about it.

The reason is rather simple: our pelvic floor has muscles in it, just like any other region in our body. If you don’t have something that can be treated medically, then chances are, the problem lies within the pelvic floor musculature. The medical professional best equipped to help you rehabilitate an injured or dysfunctional muscle is a physical therapist.

There are plenty of women out there who experience pain with vaginal penetration, and they think if they just relax it’ll go away…only to feel extreme disappointment when sex hurts, again and again. And there is a vicious circle accompanying the problem, whereby the muscles of the pelvic floor tense up simply by ANTICIPATING the pain. This very real mind and body connection will lead to pain every time one tries to stretch an already tight muscle. The pelvic floor is meant to stretch, and when you think about it, you realize the functions of the pelvic floor muscles include allowing for intercourse and childbirth without catastrophic consequences, for example.

We do, in fact, have conscious control over most of the muscles in our body (except for muscles in the organs, like the heart muscle for example). But it’s easier said than done. One potential reason is that the muscle is in a state of chronic spasm, meaning, it’s not going to relax simply because you want it to. The cycle of spasm needs to be broken. And this is definitely possible.

So what are you going to do about all this? How are you going to climb this mountain to reach the summit of fulfilling, intimate vaginal sex?

Well, once you have been cleared of any medically treated problem, the next step is to become aware of your body, specifically the pelvic floor muscles. Through awareness exercises and muscle re-education, you will be able to sense when your muscles are in a relaxed state versus a tense state. You will learn how to relax a tense muscle, and even how to gently stretch a tense muscle. Your physical therapist can help you with this process.

The next step is to realize that first you will tolerate penetrative intercourse BEFORE it is actually a pleasurable experience. Meaning, you might achieve vaginal intercourse before it actually feels good. That is not to say that it should hurt, because it shouldn’t. And if it does hurt, then you are not quite ready to be back in the sack, so to speak.

Finally, realize that there is a solution. You don’t need to live with this. And fixing the problem can dramatically improve the quality of your sex life, and thereby the most important of your relationships.

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W. Prospect Avenue, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for WomenAt PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com.

Monday, September 24, 2012

Endometrial Ablation: an Option for Irregular Menstrual Flow

Learn more about treatment options for abnormal uterine bleeding...

By Marley Kercher, MD
Obstetrician/Gynecologist
View Dr. Kercher's Video


Abnormal uterine bleeding, in the form of heavy menstrual flow or irregular cycles, is one of the most common complaints that bring women in to see a gynecologist.

How to Treat Abnormal Uterine Bleeding
Option 1: Medication
Sometimes medications, usually in the form of birth control pills or other hormonal remedies, are prescribed to treat abnormal uterine bleeding. However, there are many women who either are unable to take these medications because of other underlying medical conditions, or who do not wish to be on long-term hormonal therapy.

Option 2: Surgery
For women who suffer from abnormal uterine bleeding and who are done with child bearing, surgical options are the next step. Traditionally, the only option for these women is a hysterectomy, which, although a reasonable choice for many, is a more radical step than some women wish to take, and it requires more recovery time than is sometimes feasible.

Option 3: Endometrial Ablation
There are now newer, less invasive options for the treatment of problematic uterine bleeding that can be performed right in your doctor’s office without the use of general anesthesia and with minimal down time.

Endometrial ablation in general refers to any procedure that destroys (i.e., ablates) the endometrium (uterine lining). When this technique was initially introduced, laser was used as the energy source. This limited the performance of endometrial ablation to operating rooms that were equipped with expensive and oftentimes cumbersome laser equipment.

More recently, newer ways of achieving quick, effective destruction of the uterine lining using other energy sources, such as heated fluid and radiofrequency electricity, have allowed physicians to offer endometrial ablation safely in an office setting.

There are various types of endometrial ablation. The most commonly performed is called a Novasure® procedure. This involves inserting a mesh electrode into the uterus through which radiofrequency energy (heat) is applied, thus cauterizing the uterine lining. This is typically achieved in about 90 seconds.

Success rates with Novasure® have been very favorable:
• approximately 90% of women report overall satisfaction; and
• about 30% report a complete cessation of menstrual flow 12 months after the procedure.

Endometrial ablation is not appropriate for every woman suffering from abnormal uterine bleeding. Premenopausal patients with a normal uterus, without evidence of cancer or pre-cancer and who have completed childbearing, are considered candidates for this procedure. Your physician will run tests, such as a pelvic ultrasound and a biopsy of the lining of the uterus, to determine the advisibility of ablation in your particular case.

Endometrial Ablation and Birth Control
Endometrial ablation itself does not provide effective contraception and any pregnancy that occurs after a woman has had an ablation is extremely dangerous. Therefore, your doctor will often recommend permanent sterilization as well if you have not already undergone tubal ligation, or your partner has not had vasectomy.

Permanent birth control can be accomplished in the office at a separate visit with something called the Essure® procedure. This involves inserting tiny coils into the fallopian tubes, which induces scarring in the tubes causing obstruction. If done in tandem with ablation, this portion is typically done first, and then followed by the ablation 3 months later after complete tubal blockage has been proven with a simple x-ray study.

Dr. Marley Kercher is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Kercher at 920-729-7105 or meet her here.

About Women’s Care of WisconsinThe physicians at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause management and more at www.womenscareofwi.com.

Thursday, August 23, 2012

Reasons for Irregular Menstrual Cycles

Symptoms to recognize and when to see a physician to help ease your pain...

By Beth Helgerson, MD
Obstetrician/Gynecologist
View Beth's Video


Many women experience menstrual cycles that may not be “regular.” There are some reasons that can be pinpointed as to why this may occur.

What happens during the menstrual cycle?
Normal menstrual rhythm and cycling involves complex interactions between areas of the brain, the ovaries, and the uterus.

Regions of the brain stimulate the ovary to function. The ovary produces the hormone estrogen, which signals growth and thickening of the endometrium (the lining of the uterus). An egg is released from the ovary and moves into one of the fallopian tubes. The ovary also produces the hormone progesterone, which stops the growth of the endometrium. If the egg is not fertilized, the hormone levels decrease, resulting in the shedding of the uterine lining – which is the menstrual flow.

Many factors can interfere with the menstrual process, causing it to be “irregular:”
- The age of a woman can influence how the brain stimulates the ovary, and whether or not the ovary can respond.
- The ovary may not cycle properly. It is ovulation (which is the production of an egg) that results in the proper rhythm of production and secretion of these hormones.
- The uterus itself may have muscle growths, or changes in the glandular lining, which can alter regularity.
- Also, issues such as infection, pregnancy, blood clotting/bleeding abnormalities, and other illnesses can also interfere with menstrual rhythm.

Is it normal to have pain during menstruation?
Mild cramping in the lower abdomen or pain in the lower back is normal. Usually, exercising or placing a heating pad or hot water bottle on your stomach helps with mild cramping.

What is Dysmenorrhea?
If you suffer from severe cramps, nausea, or pain so intense that it keeps you from your usual daily activities, you may suffer from dysmenorrhea. Dysmenorrhea is defined as menstrual periods that are accompanied by severe pain in the lower abdomen or pelvis region that is either extremely sharp or dull, aching pain. This is not uncommon: painful menstruation affects approximately 50% of menstruating women, and 10% are incapacitated for up to 3 days. Menstrual cramps can dramatically improve with physical therapy.

What is Amenorrhea?
Amenorrhea is when a period never starts or a menstrual cycle stops completely. You should see your doctor if you have not started having periods by age 15 years or if you have not had a period for 3 months.

What can cause a missed period?
The most common reason is pregnancy. Other reasons you might miss your period include the following:
• Sudden change in weight
• Illness
• Stress
• Extreme exercise
• Hormone problems
• Taking certain medications

In summary, regular and predictable menstrual rhythm is a complicated process involving several factors. Problems in a number of possible areas that involve the reproductive system can all result in menstrual irregularities. Diagnosis can, at times, be complicated.

Your doctor may choose to use ultrasound evaluation, laboratory evaluation, and history with physical exam to fully evaluate your unique symptoms.

Dr. Beth Helgerson is an Obstetrician/Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Helgerson at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The physicians at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause management and more at www.womenscareofwi.com.
 

Thursday, August 2, 2012

Feeling Blue After Giving Birth?

The symptoms and differences between the “baby blues,” postpartum depression and postpartum psychosis...


By Amber Post, MD
Obstetrician/Gynecologist
View Dr. Post's Video



Many women who have recently given birth experience feelings of sadness, irritability, and anxiety. There are three conditions postpartum women should be aware of, with different levels of severity.

The “Baby Blues”
The “baby blues” is a mild form of depression that occurs in 40% or more of new moms. The symptoms usually include rapid mood swings, irritability, anxiety, tearfulness, difficulty concentrating, and insomnia. Typically the symptoms start within 2 or 3 days of delivery and peak at 5 days.

We don’t know why these feelings happen, but perhaps hormonal changes or sleep deprivation play a role. Women are at a higher risk of developing baby blues if they have a history of depression or tend to have strong mood changes around the time of their period. Support, reassurance and rest are very helpful and typically women will notice an improvement within 2 weeks.

Postpartum Depression
Women with stronger symptoms that are not improving might be suffering from a more severe form of postpartum depression. Nearly 10% of women will experience postpartum depression. Symptoms include changes in sleep, energy level, appetite or weight, and sex drive. Other feelings can include anxiety, anger, guilt, being overwhelmed, feeling like a failure as a mother, or not bonding to the baby.

Symptoms usually start within the first month after giving birth but can be delayed. Risk factors for postpartum depression include previous depression, strained relationships with spouse or family, living without a partner, and unplanned pregnancy.

Postpartum Psychosis
The most severe form of postpartum depression is postpartum psychosis. These women have psychotic symptoms such as delusions or hallucination that usually start within a few weeks of delivery. This condition is considered an emergency because of the high risk of suicide or injury to the baby.

Women’s Care of Wisconsin has screening tools that can help distinguish whether these feelings are an appropriate response to the fatigue of child care and sleep deprivation, or if they are a more serious condition.

Increasing sleep and finding support and stress relief from family and friends will often help to improve the symptoms of baby blues. Do not try to do it all! Take special care of yourself; shower and dress each day and get out of the house. If your symptoms are worsening or persistent, talk to us about treatment options for postpartum depression. Counseling or medications may help to get you feeling like your normal self again. The most important thing to do is to seek help immediately if you have thoughts of harming yourself or your baby. The support you need is available and we are here to help you begin on the amazing journey of motherhood.

Dr. Amber Post is an Obstetrician/Gynecologist at the Neenah and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Post at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com.

Tuesday, July 3, 2012

Got Milk?

Women's Care now offers Certified Lactation Counselors to its patients.

Women’s Care of Wisconsin is proud to announce a new service we can offer to the Fox Valley – lactation and breastfeeding counseling!  There are three clinical employees who have completed an intense, up-to-date, research-based training course to become Certified Lactation Counselors.  These ladies, Brooke, Kristy and Heather, completed this course in May and are excited to be able to start putting all the knowledge they have learned into helping moms-to-be and current mothers with any breastfeeding topic. 

We often hear about how helpful the nurses and lactation consultants are while you’re still in the hospital after delivering your baby…but then after you go home, who do you call if you have questions or concerns?  Well, we would love to help!  If you have questions about how milk is produced, correct latch, feeding cues, positioning, milk supply, sore nipples, engorgement, pumping, returning to work…please call us.  Breastfeeding is the best choice for both you and your baby, and we would like to help make it a rewarding and successful experience for you. 

Although breastfeeding is a natural act, not all parts of it come easily to every mom.  Studies have shown that with good support systems, mothers are more likely to breastfeed their babies longer.  Maybe you haven’t had your first baby yet but would just like to ask some questions about what to expect.  Maybe this is your third child, and even though the first two breastfed without any problems, this new baby isn’t latching correctly.  Whatever the topic, our Certified Lactation Counselors can help you with issues over the phone or in person in the office.  Even if all you need is a little reassurance that you’re already doing everything correctly, we can provide that too!

Brooke, Kristy and Heather chose to take this course because helping moms be successful with breastfeeding is something they are all very interested in. Please don’t hesitate to call our office at 920-729-7105 if you have any questions or concerns.

About Brooke
Brooke is a Registered Nurse at Women's Care who graduated from UW-Oshkosh with a Bachelor's Degree in Nursing. She's always loved any nursing care that has to do with pregnancy, labor and babies. Brooke has two daughters, Allicyn and Whytni, who she nursed for a year each.  After having nursed her girls, she feels like she learned a lot “the hard way” and would love to pass on her knowledge so that no one else has to learn that way. She's very excited for this new opportunity of being a Certified Lactation Counselor and can’t wait to help!

About Kristy
Kristy is a Registered Nurse who has worked for Women's Care for over three years. She has over six years experience in labor and delivery. Kristy has three children who she breastfeed and enjoys helping and educating others on the benefits for mom and baby. She looks forward to working with patients so they can have a good breastfeeding experience as well.

About Heather
Heather is a Registered Medical Assistant who graduated from FVTC in 2006 and has been with WCOW for almost 6 years. She is so excited to be able to help other new moms with breastfeeding as she will be learning right along with them, experiencing hands on herself... Heather is currently six months pregnant with her first child! She's learned and gained so much knowledge of breastfeeding through her training to become a Certified Lactation Counselor and looks forward to her new teachings and experiences with our patients.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com.

Monday, June 25, 2012

Preventive Care

Helping patients make informed decisions regarding their preventive benefits...


By Jenny Hoier, CPC
Patient Advocate at Women's Care of Wisconsin


Healthcare reform was introduced over a year ago and we are still experiencing confusion on coverage for medical services, specifically preventive care. With the increase in coverage premiums, patient out-of-pocket expenses, and coverage limitations, patients and providers need to work together to maximize care, improve outcome, and contain costs to create a positive “healthcare experience.”

Preventive care is synonymous with routine, annual, check up, and yearly exam, to name a few. The definition of preventive care is “absence of a chief complaint.” The purpose of preventive care is to perform age appropriate risk assessment, update complete medical history, and provide counseling and recommendations based on risk and age.

Examples of preventive services would be the comprehensive exam from head-to-toe, where the provider is assessing numerous body systems. A flu shot and other vaccinations can be considered preventive. A pap smear is a preventive service. Mammograms, colonoscopies, osteoporosis screens can all be considered routine and preventive screenings when used to establish healthy baselines. The US Task Force publishes a list of covered preventive services. Additional questions regarding tests not listed should be directed to your insurance company.

Services that are not considered preventive would then be classified as diagnostic and include ultrasounds, biopsies, or any service that is being driven as a work up due to a patient’s symptom. The provider is performing these tests based on a condition that was brought forward to rule out underlying disease process and pathology. If the results return abnormal, future tests cannot be considered screenings as a diagnosis has been made. For example, a patient has a cholesterol screen, the results return high, and the patient then has to begin medication. Future cholesterol tests would then be diagnostic and not preventive/screening.

The point to remember is that preventive tests must be performed under the umbrella of appropriate age, frequency, and lack of symptoms. A common misconception that occurs is when a patient schedules their annual appointment and mentions a symptom they’re experiencing during that appointment. The provider orders additional testing to rule out disease. These tests are no longer considered screening despite occurring simultaneously with a preventive appointment. The symptom has now established medical necessity for the test to occur, or a “reason to perform.”

On the flip side, each insurance company is allowed to write their own benefit plan, so essentially, no two plans are the same. It is impossible for providers to be aware of every policy and the services covered and not covered.

At Women's Care, we strongly recommend a patient call their insurance company prior to receiving services to verify their individual benefit plan. Patients need to know frequency (once every 365 days or one visit per calendar year), preventive services covered (do they pay for TSH, lipid, and diabetes testing) and benefit maximum (payer allows only $300 per visit per year and the patient pays the difference).

We hope you find this helpful in explaining the guidelines we have to follow and the options patients have in making informed decisions regarding their preventive benefits. These recommendations apply to commercial insurance companies; Medicare has a unique set of coverage guidelines.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com.

Friday, June 15, 2012

The Facts About Essure®: Permanent Birth Control

Is your family complete? Are you done having children? If so, you may want to consider Essure…


By Michelle Koellermeier, MD
Obstetrician/Gynecologist


Permanent birth control, also known as sterilization, refers to a number of medical techniques that intentionally leave a woman unable to reproduce. Sterilization options include both office-based procedures (in-office) and hospital-based procedures. Knowing the pros and cons of each option will help better inform your decision when the time is right.

Office-Based Permanent Birth ControlOffice-based sterilization options are performed within the comfort of a Women’s Care of Wisconsin clinic; not in a hospital. These in-office procedures offered through Women’s Care were designed with busy women like you in mind—women who don’t have a lot of extra time in their busy schedules to recover.

The benefits to having procedures performed within a Women’s Care clinic include:
-         no additional hospital fees
-         no incisions
-         no general anesthesia
-         no hormones
-         and best of all, virtually no recovery!

Many of our gynecologic procedures, not just permanent birth control, can be performed in the comfort of our office and are complete within minutes.

One Office-Based Sterilization Option: Essure
Essure is a permanent birth control procedure that works with your body to create a natural barrier to prevent pregnancy. Because there is no general anesthesia required, the Essure procedure can be performed comfortably and quickly (it usually takes about 10 minutes) in a Women’s Care clinic with no incisions and no hospital stay. Also, the Essure procedure is covered by most insurance providers. If the procedure is performed in our clinic, your payment may be as low as a simple co-pay, depending on your insurance plan.

During the procedure, your Women’s Care provider slides the small, soft inserts through the natural pathways of your vagina and cervix into your fallopian tubes. Over the next three months, your body works with the Essure inserts to form a natural barrier within each of your fallopian tubes. These barriers prevent sperm from reaching the eggs so that pregnancy cannot occur.

After three months, you will schedule an Essure Confirmation Test to verify you are protected. During this simple test, a special dye is introduced into your uterus and viewed on an x-ray, so your provider can confirm that your fallopian tubes are completely blocked and the inserts are in place.

Essure is proven to be the most effective permanent birth control available and more than half a million women have chosen Essure as their permanent birth control since 2002.

All permanent birth control procedures, including Essure, are associated with certain considerations. Some things to be aware of when considering the Essure procedure:

·        no form of birth control should be considered 100 percent effective
·        the Essure procedure does not protect against sexually transmitted diseases
·        not all women will achieve successful placement of both inserts
·        side effects during or immediately following the procedure may include mild-to-moderate cramping, nausea/vomiting, dizziness/light-headedness, bleeding and/or spotting
Hospital-Based Permanent Birth Control
Hospital-based sterilization options are performed either as an in-patient or out-patient procedure in a hospital. Hospital-based procedures will incur additional hospital fees. These methods include, but are not limited to:

- a tubal ligation, known popularly as "having one's tubes tied"
- a hysterectomy, in which the uterus is surgically removed, permanently preventing pregnancy
Women’s Care of Wisconsin is the number one provider for OB/GYN services at Theda Clark Medical Center and Appleton Medical Center, performing 55% of all out-patient procedures.
Learn MoreFor more information about Essure or any other in-office procedures offered by Women’s Care, please visit our website at www.womenscareofwi.com or check out www.essure.com. Women’s Care has the options you need to make healthy choices for your life!

Michelle Koellermeier is an Obstetrician and Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of WisconsinThe providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com.

Thursday, May 3, 2012

Does Having a Baby Cause Back Pain?

Examining some of the causes of back pain after delivery for new mothers...

By Michelle Landsverk, DPT
PT Center for Women
View Michelle's Video


It seems like it’s a weekly occurrence in my practice to field this question: My back has been hurting ever since I had my baby. Did my delivery have something to do with it? Is it the way I hold my baby?

There is a little bit of a trick to answering this question: women want to know if any one of a number of variables surrounding the delivery has influenced how their back feels at this present moment. Problem is, variables happen every day, and so it is really hard to pinpoint any one of them and to say, “That’s it! That’s the root cause of the pain!”

Even so, women will ask me about a wide variety of potential factors that may or may not contribute to their back pain: epidurals, duration or intensity of pushing, C-sections, posture, rapid labors, perineal tears, and weight gain. They also ask me about the way in which they are breast or bottlefeeding their babies, how they hold and carry them, and sleep postures after baby arrives. Let’s take a look at several of these factors in order to either confirm or deny their impact on the health of our back.

Epidurals: Women will often come into the clinic and tell me that they had an epidural, and sometimes one of these questions will follow:
“I had an epidural when I delivered my baby three months ago. Could that be contributing to my back pain?” The short answer: Potentially, yes.
Or a woman might say: “I had an epidural when I delivered my baby 2 years ago. Could that be contributing to my back pain?” The short answer: not likely.

Let’s look at this on a large scale for just a moment. If epidurals used for pain relief during labor did in fact cause back pain, then thousands of new moms in the Fox Valley alone would be complaining of chronic backache every year. That simply doesn’t happen. Now, if we were to survey new moms who had an epidural (or even not) within twelve weeks of their delivery and ask if they had a backache, a significant percentage of them would say, “yes.”

So, it could just be the actual delivering of a baby that does it, and/or it could be the short-term effects from having an epidural placed that does it. Who is to say? And to complicate matters, there are a whole host of daily activities related to caring for an infant that could cause or aggravate a backache.

Rapid Labor or Back Labor: The amount of time spent pushing is more directly related to pelvic floor trauma than it is to back pain. Interestingly enough though, a strong and healthy pelvic floor is important in order to have a strong and healthy back.

There is a bit of physics in the explanation of this phenomenon, so I will give you the short version. There is a closed pressure system involving our diaphragm, abdominal musculature, intervertebral discs, and pelvic floor. If any one of those areas is compromised, then the other areas are stressed. If the stress is great enough, then signs and symptoms will follow. So, as far as the pelvic floor is concerned, if it is “bottoming out,” so to speak, then the other areas will have to work harder, and you may develop symptoms over time. Concerning the back, the symptom would be pain.

C-section: Having a C-section is definitely a potential risk factor for developing lower back pain, particularly in the short term. The surgery itself involves making an incision through the lower abdominal wall, thereby cutting the lower abdominal musculature. Now, if we take a step backward a moment, we may recall the saying, “strong abdominal muscles lead to a healthy back.” As we stated previously with the pelvic floor, the abdominal muscles are a part of a closed pressure system, thereby making the converse also true: weak abdominals can contribute to low back injury and pain.

There are solid reasons why your physician gives you lifting restrictions after you’ve undergone c-section, and one of those reasons is potential back injury. Your body needs that full six-week recovery in order for the abdominal muscles to heal enough to start working properly again.

Feeding: Whether you’re breastfeeding or bottle feeding, the way in which you are feeding your baby can most definitely contribute to both lower and upper back pain. The lower back pain component is related to sitting posture while you feed your baby. If your baby is like most babies, he or she tends to eat when you would rather be sleeping. And since you’d rather be sleeping, I am fairly certain that correct posture is not the thing that you are thinking about during a 3am feeding. Slouching into that glider rocker is more like it. Rounding out the lower back into the shape of a “C”—Yes! That is how the middle of the night feedings go. Usually to be followed by a, “Wow, it hurt to get out of that chair!” response.

A very similar circumstance precedes upper back and neck strain followings feedings. Typically, it’s due to the fact that we are looking down at our baby while he nurses. It’s natural, after all, to watch our baby eat; it’s part of the bonding process. Problem is, we end up with a terrible neck, shoulder, and upper back ache out of the deal. Bonded baby equals kinked neck. Ouch!

Holding Baby: If you are an experienced mom, did you hold your baby consistently on one side? And if you were good and switched back and forth between sides, are you constantly resting the baby on one hip? If you were standing in one place for prolonged periods of time, hip and lower back strain can occur. Likewise, if you were holding your baby when sitting, were you allowing your arms to rest on armrests of the chair, or a “Boppy” pillow, or were you making your shoulder and upper back muscles do all the work?

Weight Gain: Weight gain is another factor that can affect our spine health after baby arrives. It is totally normal to gain weight while you are pregnant. It most cases, it is preferred! The only exception to that rule is the case where a woman started out too heavy. So, the important thing to keep in mind is that making good food choices and maintaining an active lifestyle will help you lose that baby weight in a safe manner. It may not happen overnight, but certainly the weight will come off.

Sometimes finding the cause of your back ache is very clear, and sometimes it is not. If you can figure out some daily activity that causes your pain, try changing it and see what happens. If however you cannot figure it out, or self-modification doesn’t seem to be helping you, then you may need to be evaluated by your physician.

Michelle Landsverk is a Physical Therapist at PT Center for Women, 3913 W. Prospect Ave., Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for WomenAt PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at http://www.ptcenterforwomen.com/.

Friday, March 30, 2012

What is a Midwife & Why Would You Choose One to Help You with Pregnancy & Delivery?

Women’s Care of Wisconsin now offers midwifery services in the Fox Valley...


By Becky Kahler-Thyssen, MSN, CNM, APNP
Nurse Midwife and Nurse Practitioner

View Becky's Video Here

I am very excited to be working with the team at Women’s Care of Wisconsin to now offer hospital-based midwifery services to the women of the Fox Cities community. I will help women through their pregnancies and births with midwifery care, and will be delivering babies at Appleton Medical Center.

What is a nurse midwife?
There is some confusion regarding the term "midwife" since there are differences in education and experience among those who practice midwifery. There are lay midwives, direct-entry midwives, licensed midwives, certified midwives and nurse midwives, and likely other terms that I might be unaware of.

A nurse midwife, like myself, has a Master's Degree, usually in nursing, and is board certified to practice as a nurse midwife by the American Midwifery Certification Board. I have a Master’s of Science Degree in Nursing with a specialty in Midwifery from the Frontier School of Midwifery and Family Nursing in Hyden, KY. My clinical preparation was at Gunderson Lutheran Medical Clinic in Lacrosse, WI, where I was certified by the American College of Nurse Midwives. I also have a Bachelor of Science in Nursing from Bellin College of Nursing in Green Bay.

Midwives are also primary care providers who specialize in the health needs of women throughout life. We listen to your concerns about your health and sexuality and can perform Pap tests and breast exams; provide birth control methods and family planning; HIV screenings and mammography referrals; and diagnose and treat vaginal and sexually transmitted infections. Midwives manage urinary tract infections, incontinence and many other gynecologic conditions.

Midwives offer:
• Cancer Screening and Mammography Referrals
• Childbirth Education & Preparation
• Comprehensive Gynecologic Care
• Family Planning and Contraception
• Infertility Counseling
• Osteoporosis Risk, Treatment and Reduction
• Sexual Health Management
• Menopause Management

What does a midwife do, and why should I chose a nurse midwife?
Midwife means "with woman." We approach women’s health with personalized care to empower women and their families.

A nurse midwife may do many different things. Besides the exceptional prenatal care a nurse midwife can offer, during labor a midwife (someone you personally know and trust) is present at your bedside nurturing, encouraging, and guiding you, all the way to when we deliver the baby into your arms. This can be very comforting and soothing for a woman and her family. Studies show that this can often shorten labor and decrease risk of cesarean birth and other interventions.

We are also there for you after delivery to help guide you on the best choices for your baby’s health, listening and helping you with your questions and concerns.

What if something goes wrong?
Electing to use a nurse midwife is appropriate for low risk pregnancies, which make up 60 to 80% of all pregnancies. Although we approach pregnancy and birth as a natural and normal process, we are always watchful for signs that may suggest otherwise. Women's Care of Wisconsin has a cohesive and supportive team of providers that are always available for consult, collaboration, and referral if the need arises. In these special cases, a woman may get the care of two professionals instead of one.

Why did I become a midwife?
When I was going to nursing school I loved learning about pregnancy, labor and birth. I was fascinated with a woman's ability to produce such a miracle! I cried like a baby when I watched my first birth. It was a very moving experience for me. I then started working on the labor and delivery floor and I absolutely loved it!

During this time, I had 3 beautiful children. With the experience of my own pregnancies and births, I realized I was really missing out on so much. I wanted to be with women and their families from the very beginning of their pregnancy as well as during the labor and birth. So I went back to school and graduated from Frontier Nursing University with my Master's Degree in Nursing and became board certified as a nurse midwife in 2003.

Learn moreFor more information on midwives, please go to myMidwife.org. This is a wonderful website that offers women and their families information regarding midwifery services.

Becky Kahler-Thyssen is a Midwife and Nurse Practitioner at the Neenah and Appleton locations of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com.

Friday, March 2, 2012

Caffeine: The 5th Food Group for College Students – But at What Cost?

The importance of healthy sleep patterns to combat fatigue...

By Tracy Fritz, MS, RN, FNP-BC, APNP
Nurse Practitioner
View Tracy's Video Bio!


It’s 11pm on a Sunday. You are driving back to school after visiting your friends at a neighboring college. You’ve been up all day contemplating when to start writing that 6-page editorial for English but then remembered that you also have a quiz for another class bright and early at your 8am Monday class. How in the world are you going to get it all done? You could zip over to the 24-hour library at the school but, man; you are so tired you can barely keep your eyes open. You know! You’ll pick up some coffee or an energy drink and that will at least help you get through the first couple of hours. But when you can’t get to sleep and your heart is racing from all the caffeine…

Then what do you do?  You need to SLEEP!

Does this sound familiar?

I don’t miss the endless hours of sleep lost over big exams and major papers, then trying to pull working a job on top of it. As a nurse, I have experienced not only the fun and stress of college but also I was a night-shift worker for 8 years. Three of those years, I was doing both! How can a person survive? I can’t lie; I resorted to drinking as much caffeine as was humanly possible to drink. But at what cost to my health?

The use of supplements, whether that is in the form of caffeine in energy drinks, soda or coffee, or in the use of oral stimulants normally used for ADHD, is becoming a growing trend for college students. However, students don’t realize the health risks associated with overuse of caffeine.

Consuming a lot of caffeine not only leads to poor sleep habits and increases your risk for hypertension and heart arrhythmias, but it can lead to addiction. Using a roommate or friend’s oral stimulant is not only dangerous but VERY illegal, and if caught can hurt your chances of obtaining a job after college.

Lack of regular restful sleep can also cause major health concerns. Insufficient sleep is associated with a number of chronic diseases and conditions, such as:
• Diabetes
• Cardiovascular diseases
• Obesity
• Depression
It can also cause daytime sleepiness, sluggishness, and difficulty concentrating or making decisions. Teens and young adults who do not get enough sleep are at risk for additional problems, such as automobile crashes, poor grades and school performance, depressed moods, and problems with friends, fellow students, and adult relationships.

Quick Tips:
• Avoid stimulants like caffeine and nicotine. The stimulating effects of caffeine in coffee, colas, teas, and chocolate can take as long as 8 hours to wear off fully.
• Avoid pulling an all-nighter to study.
• Create a good sleeping environment. Make sure your bedroom is quiet, dark, relaxing, and not too hot or cold. Get rid of anything that might distract you from sleep, such as noises or bright lights.
• Make sure your bed is comfortable and use it only for sleeping – not for other activities such as reading, watching TV, listening to music or working on your computer.
• Stick to a sleep schedule. Go to bed and wake up at the same time each day, even on the weekends.
• Avoid large meals before bedtime.
• Be active for at least 2 ½ hours every week. Regular physical activity helps improve your ability to sleep and your overall health. However, do not exercise within a few hours of bedtime.
• Eat a balanced diet. Regular healthy meals help you maintain your energy level without the necessity to add caffeine into the mix.
• Get routine health check-ups, which will help you stay healthy and help identify and correct any health concerns early.
• See your health provider at Women’s Care of Wisconsin if you have trouble sleeping or need additional advice on how to avoid caffeine and maintain regular sleeping patterns.

Tracy Fritz is a Nurse Practitioner at the Oshkosh location of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.