Kendra’s Story

“I really felt in my spirit after having such a good midwife experience with my first child, which was a difficult pregnancy, that I wanted that same experience with my second pregnancy.”

Here’s how Kendra found Jenny Taubel. And as they say, the rest is history:

I originally started with a midwife at Women's Care who is no longer there. And then I started with another who changed roles and was no longer delivering babies. Because of recommendations I had from friends, I actually scheduled an appointment with an OB, but I really felt in my spirit after having such a good midwife experience with my first child—which was a difficult pregnancy—that I wanted that same experience with my second pregnancy.

There were two choices for midwives, and simply put I went with the one that was closer to me. That was Jenny, and I cannot explain how grateful I am to her.

I have a really cool story that speaks to Jenny’s care. I had a very difficult pregnancy. I had to go to the ER seven times in two weeks. Oh, my God, it was awful. Every time it was late in the night or early in the morning, so my husband would stay home with our four-year-old. I’d drag myself out of bed and call a friend, and be crying the whole way there. If you want to share this next part, I don’t mind: I had urinary retention. I had to have a catheter bag, and then the catheter got infected, so I had to get it taken out.

This was on a Friday, and I know Jenny doesn’t work on Fridays. She sent me a message that said, “I’m thinking about you, and I want to tell you how brave you are.” Sending this little note to me, just when I needed it, solidified my choice even though my pregnancy could be considered high risk.

Jenny went above and beyond in other ways, too. She’s very hands-on, and as soon as we talked about urinary retention, she was helping me find solutions. Wrote me a referral right away for physical therapy. Got me set up with the urology group, and even called there to see if I could get in sooner.

I just feel Jenny went the extra mile that perhaps not every provider would. I can’t say enough about her. She supports you, she loves and encourages you, she builds you up. She’s your biggest champion. When I was going through a dark season in my pregnancy and was very sick, every week Jenny continued to encourage me. “I'm proud of you,” she’d say each time. I felt so cared for.

I was induced when I was three weeks early (preeclampsia), so Jenny wasn’t able to deliver the baby. My baby went straight into the NICU, which was hard. Jenny came to visit me in the hospital, and she sat and talked to me about all my concerns, how I was doing, the NICU experience. And then she said to me, “Make sure when you come see me that you bring your baby. I can’t wait to meet her.”

That was really precious to me. When I went for my six-week appointment, I brought Mira, and it really felt like it came full circle.

Amanda’s Story

“This is baby’s life, my family’s life. This is our future.”

Amanda’s story is unique, of course. It’s also universal, this story of a mother who needed answers and endeavored to find them.

And her message to every expectant mom, simple yet profound, should be emblazoned on t-shirts, billboards, mountaintops.

In her own words, this is Amanda’s journey:

I have a history of two normal labors and deliveries, but not the best experience afterwards. Both times I had retained placenta (when the placenta is not expelled from the uterus following delivery, which leaves the mother susceptible to infection and extreme blood loss). For my third pregnancy, at twenty weeks, I went to my provider and, following a scan, they told me I had placenta previa, a condition where the placenta attaches low in the uterus and partially or completely covers the cervix, potentially causing severe bleeding in the mother before, during or after delivery and leads to a c-section. The provider just said it was common and normally resolves by delivery. We were just grateful everything was fine with the baby at the time and didn’t fully process the ‘placenta previa.’

Of course, at home I looked up placenta previa. I found there were different types of placenta previa— marginal (partially covering the cervix) or complete (fully covering the cervix)—and that distinction mattered. Marginal placenta previa resolved itself in about 90% of the cases, but with complete previa, there was more risk of significant premature bleeding and a necessary c-section. In my research, it seemed other providers gave patients measurements of how much it was covering the cervix and restrictions to try and prevent maternal bleeding.

I called my provider back.

“We’re not sure, but we’ll have you back in the third trimester and check it again. Really not a concern.”

This is where I had a gut feeling to get a second opinion.

Back in 2021, I had a miscarriage, and my previous OB provider had retired. Dr. Swift, although 45 minutes from where I lived, was the only OB I found willing to fit me into her schedule and helped me through that difficult time. So that was my connection to her, and while I hadn’t seen her since (I wanted a provider closer to home), I scheduled an appointment with her at 24 weeks for a second opinion. I was really just wanting ‘piece of mind’ to see if the placenta had started to move and there was less chance of bleeding, but she came in after the ultrasound with more than I wanted or expected to hear. 

Along with stating the placenta previa was definitely ‘complete,’ she said it looked ‘spicy and membrany’ and alerted me to the possibility I might develop a rare condition called ‘vasa previa.’ This means the baby’s (fetal) vessels go over the cervix and can lead to severe fetal blood loss and she told me I might end up losing my uterus because of what she termed a “sticky placenta.” 

Swift said be ready for a 36-week baby and potentially the loss of my uterus.

Okay, let’s just say I was kind of upset and shocked with the news. I was just expecting confirmation of the placenta previa and had hoped it had already started moving. I had never heard of ‘vasa previa’ before and I didn’t know that my placenta sticking to the uterus was even a possibility. 

As it would turn out, unfortunately, Dr. Swift was correct. I actually had a bi-lobed placenta, meaning I had two placentas, the main posterior one (and the only one identified on the 20-week ultrasound) and a secondary anterior accessory lobe. Between those two placentas there’s a membrane of baby’s blood vessels over the cervix that wasn’t protected by placenta—Type 2 vasa previa.

What that means is if you go into labor (cervix dilating, water breaks, contractions) or strain too much, the vessels rupture and hemorrhage and the baby can bleed out in less than 10 minutes, causing death or brain damage.

I was in denial, upset and frustrated that the other doctor hadn’t told me that. I was overwhelmed and anxious and had no idea what questions to ask at the time. 

I didn’t think I wanted to see Dr. Swift anymore. I was hopeful she was mistaken, the original provider correct. 

So, I went back to my original provider and after a couple more scans, they confirmed what Swift had said. I mean, they confirmed it technically, but as far as I’m concerned Swift gets credit for the diagnosis. Without her intervention, no one would have known about it yet. That’s the scary thing: my provider originally said they weren’t going to recheck the placenta until 32 weeks and in my research, many times the exposed vessel isn’t seen that late in the pregnancy as the baby's head is in the way. If this diagnosis was missed, it could have been devastating to baby.

As much as I didn’t want to believe Dr. Swift, she ended up saving our baby.

My original provider referred me to the maternal fetal medicine (MFM) specialists. They re-confirmed and said I’d be hospitalized between 28-32 weeks, with a goal of a c-section at 34 weeks (the reason for inpatient hospitalization is in case of premature rupture of the membranes and fetal vessels, the only chance of baby survival is to be close to an operating room).

I was still processing: How do I go from originally just placenta previa and a 90% chance of any issues resolving themselves to a worst-case scenario of being hospitalized and having a c-section after four weeks of being inpatient? I was still in denial and had two other kids at home to take care of.

I got the feeling from my providers that this was rare and scary, even for them. My anxiety intensified after seeing this MFM knowing I’d have a NICU baby at 34 weeks. I was grateful baby was healthy but felt so bad baby would be forced out so early and wanted to see if there were other options.

This is baby’s life, my family’s life. This is our future. If I start bleeding or go into premature labor, will baby die? That would be devastating, and on my conscience—forever. If baby is born so early and survives, will baby have health issues or learning disabilities? 

I really needed a provider that was confident and that I could trust. So, I thought I’d take steps to make that so. I’m very much an advocate for myself and just wanted to make sure that I was seeing the right doctor and that this rare complication was being treated properly. After the diagnosis was confirmed, I was up late every night for weeks doing my own research. 

And here’s what I found: older research confirmed that the 28-32 inpatient and 34-week delivery was indeed the recommended timeline. But I looked at every scientific article I could find and discovered that newer research suggested a different timeline was plausible, one that got you to 36 weeks or more.

Finding those studies was one thing, interpreting them another. 

I decided to reach out to the authors of these scholarly papers I had researched to understand my situation better. What’s the worst thing that can happen? They don’t respond?

Guess what? I talked with a maternal fetal medicine doctor from one of the Harvard hospitals in Boston, a leader in the field. He called me on a Sunday evening and we talked for an hour and a half and went over all his research and advice. Another expert was from Houston; he got in touch with me late at night after he was done seeing patients. Yet another MFM from Chicago called me on a Saturday afternoon!

The expert doctors doing the research for this are so passionate, and so generous, and it made such a difference in my anxiety to be informed.

I had a gut feeling about this, and followed it through. I guess this is one of the main messages I want people to take from my story: when you have that gut feeling, listen to your instincts, always listen to your intuition, because it will serve you well. If I would have ignored it, our outcome would have been very different.

The expert from Boston actually came out of retirement to research vasa previa more, because many babies are being born too prematurely unnecessarily since so many providers are scared of this condition. If vasa previa goes undiagnosed, that’s the worst-case scenario. I learned that a high percentage of situations where you go into labor at home or your water breaks will result in the death of baby. If it’s diagnosed, there’s a very high chance that baby will be fine. He wanted to spread the research that patients can make it further and can get to 36 or 37 weeks safely in uncomplicated cases.

He gave me comfort, telling me now that I had been diagnosed (thank you Dr. Swift), the hard part was done. I just needed to find the right provider.

Long story short, I went back to the original provider and maternal fetal medicine specialists, and they were going off the older data of early hospitalization and delivery at 34 weeks. They weren’t receptive to the new data and said we should just get baby out and let NICU take over. There’s a big difference in a baby born at 34 weeks needing NICU vs 36 weeks (if I could make it that far). I felt like a number, being treated from a page in a textbook from twenty years ago. I was nervous to go “inpatient’ under this provider because I knew I wouldn’t be in control and didn’t trust them to deliver baby even earlier. I’m sure they had the best intentions at heart. Maybe it was just me, being a difficult patient. I didn't want to make anybody uncomfortable. I just wanted to find a provider that was more confident and that I could trust to be in control of mine and baby’s lives.

At 28 weeks, I had a bleeding episode after going for a walk and playing with my toddler. On the way to the hospital I was so scared that they’d deliver baby unnecessarily or keep me there until delivery that I had my husband pull over at a gas station to use the bathroom and the bleeding had stopped and baby was kicking (the bleeding was from the placental and not fetal vessels). I do not recommend this—in hindsight this was very risky and I was lucky. This made me realize the reality and danger of the situation. My anxiety about bleeding and losing the baby after this episode was pretty bad. I was grateful for the distraction of work and my other kids and thankful for the help of grandparents!

My gut, once again, was telling me something, namely that I shouldn’t be going back to my original providers. 

The next day I scheduled appointments with MFM doctors in Madison and Milwaukee to see if they were up to date on the latest research. I figured a month away from home being inpatient was a short amount of time in the grand scheme of things to travel further if it meant a healthy baby.

As part of my research, I joined an international Facebook group on vasa previa and asked a question: ‘Anyone in Wisconsin have this, and where did you go?’ And there was somebody who delivered at Women’s Care at 37 weeks, and she happened to have Dr. Reed. 37 weeks!!

I called Women’s Care to make an appointment with Dr. Swift again, but because of needing to get in asap and her being booked, I got to see Dr. Reed. 

I actually didn’t tell Dr. Reed anything about my research. She came in prepared with all of my previous history and was up to date on all the latest research for vasa without me even saying anything. She thought we could aim for 36/37 week delivery and 34/35 week inpatient as long as there were no complications. I asked her all the questions I had after doing my research and all of her answers followed the most recent data. She said we didn’t even need to see MFM. I was impressed! 

Finally! I felt instant relief. I knew Women’s Care and ThedaCare-Neenah was where baby and I needed to be. 

I switched to Dr. Swift since she had made the original diagnosis. She agreed with Dr. Reed that I could go to 36-37 weeks and was also up to date on the latest research. She treated me like a person and looked at my clinical situation and not just a textbook. At one of my appointments while I was hooked up to the contraction and fetal monitor, she came in and spent her entire lunch with me, and I know she’s a busy lady. The first thing Dr. Swift asked me was about my mental state.

‘How are you feeling?’ she asked.

No one had ever asked me that before. 

She was very informative and treated me like a friend. She cared about making the best possible decisions together for my situation. I knew I could trust her and that she had mine and baby’s best interest in mind and I could just sense her confidence when she told me not to worry, that it would be okay (I know that’s not always true but still comforting).

I also saw Dr. Vandenberg a few times during my hospital stay as well as other providers and I can tell you without hesitation: Women’s Care doctors are in a different league. Their compassion. Their confidence. Their knowledge. Their bedside manner. I wish all patients could experience this level of care.

I went inpatient at ThedaCare-Neenah at 33 weeks and 4 days, a little earlier just because I was anxious with previous providers wanting to admit earlier and I'd have a hard time forgiving myself if something happened at home. I was monitored three times a day with NST testing (fetal and contraction monitors). Baby gave us a few heart rate scares and had contractions daily, but the doctors always remained calm and encouraging.

I forgot to mention I’m a big wimp with blood draws and IVs, so I was terrified of being cut open for a c- section. Again, Dr. Swift and the nurses were amazing and encouraging that everything would be okay and always went above and beyond to explain things and ease my mind. Dr. Swift stopped in daily to check on me and chat. Not only did I appreciate her as a well-educated doctor, but also as an incredible person being a friend to me in the hospital.

I was at the hospital for 3 weeks. Living on the Labor and Delivery floor I got to witness, firsthand, top notch doctors and nurses that truly care. Our precious little vasa previa survivor, Thomas James, was delivered June 12, 36 weeks plus one day. Dr. Swift and I picked this goal date and we made it!

Seven pounds, 14 ounces. A month early and no NICU time. Relief, grateful, exhausted—so many emotions. All the research and anxiety was worth it.

After months of worry I felt oddly as calm as possible for the surgery. I was able to put all my faith in Dr. Swift and knew that I had chosen the best provider for us. The delivery had its moments. After I got the spinal, my blood pressure went down and that affected baby, but Dr. Swift was very quick at getting him out. My placenta was indeed sticking to the uterus (something termed accreta). She warned me ahead of time she may need to take my uterus and do a hysterectomy to prevent major hemorrhaging, but she was able to get it out at the last second and save my uterus and a blood transfusion. Dr. Swift communicated exactly what she was doing and she and her team kept me calm and informed the entire time.

I did ask doctor to take photos of my placenta and after seeing the multiple large exposed fetal vessels was humbled by how lucky we were and that Dr. Swift caught this problem. Dr. Swift is an amazingly talented surgeon. I was always confident she had everything under control. And she was fast!

I feel like she saved my baby, saved my fertility, saved us NICU time, and helped get me through a long hospital stay. Without her diagnosis and care, my sweet little baby boy, Thomas, may not be here today. 

She saved us both.

Photography by Erika Krause

 

 

Achieving Your Ideal Birth: One Mother's Story

Following the birth of her daughter Emory and her son Everett, both delivered by an OB/GYN she called phenomenal, Natalie Demler was greeted with the news that her longtime provider was leaving the area.

She found out three weeks before her due date.

"I'd been with him since I turned 21," Natalie said. "We had a really close bond; he was with us during our miscarriage. I was pretty devastated that he was leaving and worried about how things were going to go. That's when I found Kay."

In her search for a new provider, Natalie contacted Women's Care of Wisconsin, and the receptionist felt that midwife Kay Weina would be a great fit for her. Natalie asked around and heard nothing but good things ("Kay's amazing!" "You'll love her!").

At 35 weeks, Natalie met Weina for the first time and transferred her care to the midwife.

"She hugged me, and immediately asked if I wanted a tour around the facility and to look at the room," Natalie said. "She was so personable and right away I had a feeling that everything was going to be fine, that she was going to take good care of me and the baby."

Weina made clear that whatever vision Natalie had for the birth was the way they were going to make it happen.

"Birth is sacred and spiritual for every woman, and it's every woman's own unique experience to bring a child in the world," Natalie said. "My husband and I prayed every day that we'd find the perfect provider, one who believes in you and helps you through intense moments. 

I knew Kay was going to be there for me. She made me feel safe."

*    *    *

Kay delivered Elsie Rae on July 13, 2023

"Kay was phenomenal during labor, cheering me on. Jake was encouraging me the whole time. I focused in on what I needed to do. With Kay and Jake's support, Elsie was born into a room full of love and joy." 

Midwives: Care Throughout the Lifespan

When thinking of a midwife, the first thought of many is the extraordinary care they provide to mother and child before, during and after delivery. But let us not forget the expert and compassionate care they provide to gynecologic patients as well. Today, we share Diana’s story:

“I was a nurse for 40 years and worked with Jenny Taubel when she was just getting started. In working with her, it was so easy to see the rapport that she had with her patients. It just so happened at that time I didn’t have an OB/GYN, and one day I just asked her if she’d be my provider. ‘Of course!’ she said, and that’s kind of how we started. She’s such a sweet person, so easy to get along with and easy to talk to. She listens to your story, listens to the problem, and then she gives you the options. And she takes her time with you and forms a bond. Having been through some tough times herself, she has such empathy. I drive from Fond du Lac to see her and I’d drive a lot further if I had to. I just love her to death.”

Note: Diana has been retired for three years now. With grandkids involved in sports and in the arts, she keeps busy indeed. She and her husband love to ride their motorcycle. They have been involved with a group that rides for St. Jude’s Children’s Hospital, 232 bikes strong and growing. This year riders raised $1,300,000 for St. Jude.

Tayler’s Story: A First-Time Mom Calls the Midwife

For National Midwifery Week (October 6-12, 2024), we reached out to patients and asked them if they would share their midwife experience. Tayler responded just as we had hoped (“I’d absolutely love to!”) and generously spoke about how she found her provider, Elise Gessler.

Note: Elise has stopped her OB practice and is working in the role of a nurse practitioner at our Appleton clinic. She can still see pregnant patients for occasional visits but is no longer available as a delivering provider. Elise still provides care for women throughout the lifespan.

How did you arrive at using the services of a midwife for your pregnancy?

I started with a lot of information on the internet because, honestly, I didn't really know anyone that had used a midwife before. But I had heard a lot of good things about them, like how they are an extra layer of support during the birthing process. And being a first-time mom, I was like, oh, I need all the support I can get! I just hopped on Google and was looking at different midwives, and I kept seeing Women's Care Wisconsin. Fantastic reviews online. So I was like, okay, let's give it a try here. I requested Elise Gessler after seeing her on the website and looking at the reviews of people that had seen her.

And how did it work out for you?

It was such a good experience with Elise, because she was so involved. An important thing about a midwife that I learned through my research was that no matter what time of day or night you're giving birth, they're going to be there. I wanted that consistent person that was going to be with me, for my appointments, through all the struggles and whatnot, and to deliver my baby. Elise was that consistent person, that extra layer of support that I wanted.

What else can you share about your experience?

So I made my appointment, and then I saw Elise for the first time, and she kind of just explained to me what her role was in the birthing process, how I would be seeing her for all of my appointments, what to expect. Anything that I should need while I was pregnant, I could reach out to her. She was very available, which I really loved as a first-time mom when everything seems really scary. You're just not sure what warrants concern and what is completely normal. And so I liked that she was always available for anything, for questions, concerns, whatever. Yeah, at that first appointment I was like, this is fantastic! Exactly what I want. And then throughout my pregnancy I had some complications. She was always very supportive and always let me know my options. And it was always up to me how I wanted to proceed. But I really leaned into her expertise and fully trusted her opinion.

What was the delivery experience like?

At delivery I was induced, and then I actually ended up being in active labor for four hours, which is like the max amount of time they allow you to push before they have to intervene. That's a really long time to push, by the way. And I will never forget what Elise said: “We have 10 minutes to get this baby out or we need to call the doctor.” If you've never met Elise before, she's a very soft-spoken person. Delivery Elise is different. She was the intense cheerleader. “You got this Tayler, you can do this! Just think about her coming out and getting to hold that little girl that you've been waiting for for the last nine months!” Honestly, her words are what did it for me. I pushed as hard as I possibly could, and it happened. I truly believe the pep talk that she gave me right towards the end was what pushed me across the finish line.

Bet you can’t summarize things in a single sentence, can you?

Now I have this perfect girl, my baby Shay, and this perfect boy, my stepson, so I feel very content.

5 Myths About Midwives

Even though midwifery has evolved alongside today’s modern health care system, many myths surrounding this profession are based in common misunderstandings that are centuries old. At Women’s Care of Wisconsin, we believe education is a powerful tool, so we’ve teamed up with our three certified nurse midwives to set the record straight! 

Jenny Taubel, Kay Weina and Elise Gessler have more than 50 years of combined experience as certified nurse midwives and are passionate about the work they do.

Myth #1: Midwives are just untrained labor coaches.

Despite this myth’s popularity, certified nurse midwives often start out as labor and delivery nurses. While labor and delivery nurses are required to hold a bachelor’s in Nursing, certified nurse midwives go back to school to get their Master of Science degree in Nursing (MSN). They are also required to pass a national certification exam and maintain that certification by meeting continuing education requirements.  Combined with their training and medical expertise, this qualifies them to deliver babies.

“I think a lot of nurse midwives were labor and delivery nurses to begin with, like us,” said Kay, who was a labor and delivery nurse for 10 years before going back to school. “When you’re a labor and delivery nurse, you get that patient to delivery, and when you get to that point, the doctor comes in to catch the baby. I always thought -- well gosh! -- that’s the best part! I could do that!”

“I like to think of our role as an OB-GYN Nurse Practitioner, with the added special perk of delivering babies,” said Jenny.

Myth #2: Midwives can only deliver babies at home.

“We do not deliver at home, but we can refer you to some of the licensed professional midwives in the area that would provide you with that type of care,” Jenny said.

According to the American Midwifery Certification Board, 94.1% of CNM-attended births occurred in hospitals in 2017. That same year, 3.2% occurred in freestanding birth centers and just 2.6% occurred in homes.

At Women’s Care of Wisconsin, our certified nurse midwives’ practice is strictly hospital births only, with Kay primarily delivering at the ThedaCare Regional Medical Center-Neenah and Jenny going back and forth between ThedaCare Regional Medical Center-Appleton and ThedaCare Regional Medical Center-Neenah. Elise has stopped her OB practice and is working in the role of a nurse practitioner. She can still see pregnant patients for occasional visits but is no longer available as a delivering provider. Elise works out of Women’s Care of Wisconsin’s Appleton clinic and still provides care for women throughout the lifespan.  

Myth #3: If I choose to have a midwife, my birth has to be all natural.

“I think a lot of people wonder, if you choose a midwife, do you have to have a natural birth? And I think a lot of women probably seek out midwifery because they’re looking for a non-medicated or low-intervention birth, but we certainly can provide medications,” Kay said.

While you can choose to have a natural birth with your midwife, certified nurse midwives are licensed, independent health care providers who can prescribe medications in all 50 states. This includes IV medications and epidurals, which can be an option during labor even for women who originally wanted a natural birth but change their mind during the delivery.

“I think the biggest thing about midwifery care is that we want to listen to the women, we want to give them options, and we want your birth experience to be the most positive one because you’re telling your birth stories forever!” said Kay.

“I like to think of myself as a ‘travel guide’ through a woman’s pregnancy, labor, and delivery journey,” said Jenny. “I’m here to offer comfort, support, encouragement, education, and help in making decisions when needed.”

Myth #4: If I choose to have a midwife, I am putting my baby at risk if something goes wrong.

If you’re considering working with a midwife, but worried about what would happen to your baby if something goes wrong, you can relax! Our certified nurse midwives partner with Women’s Care of Wisconsin OB-GYN physicians through collaboration and referral to provide the best possible care.

“We have a great group of very supportive physicians that are on call and available to us around the clock, so if you develop a concern, such as high blood pressure, preterm labor, or a problem during labor, we have those physicians to consult with,” Jenny said.

While this doesn’t necessarily mean your certified nurse midwife will transfer care, it could mean you will have a team of people working with you to ensure you have a healthy pregnancy rather than working with just one healthcare provider.

“There are some situations where a pregnancy starts off as low risk, but a new problem causes it to become high risk, and then we transfer care to the physicians,” said Jenny.

Certified nurse midwives are also available to assist physicians in the event of a c-section.

“If patients have had a previous cesarean delivery, and would like to schedule a repeat C-section, I can still see them for prenatal care and be there to assist in the surgery with the MD, which is really nice,” said Jenny.

Myth #5: Midwives only work with women who are pregnant.

“We see patients from adolescence all the way up to menopause,” said Elise.

While many people think of midwifery as a practice solely focused on pregnancy and childbirth, nurse midwifery actually encompasses a full range of gynecological health care services.

“We offer contraceptive counseling for all methods and procedures to insert or remove IUDs and Nexplanon, screen for and treat STIs or vaginal infections, do preventative wellness exams, and treat menopausal issues,” Elise said.

The services midwives offer also include primary care, gynecologic and family planning services, preconception care and postpartum care.

If you’re interested in seeing one of our certified nurse midwives, you can schedule your first appointment by calling or texting 920.729.7105 or request an appointment online by visiting our website.