Midwives: A Special Kind of Care

Midwives are best known for their care of women during pregnancy and childbirth, to make that journey as pure and natural as possible. Midwifery care is often described as having a “high touch, low tech” approach to medical care. Midwives are experts in supporting women in normal, healthy childbirth and focus heavily on building relationships with women and their families by listening and providing information, guidance, and counseling in a shared decision-making process.

Midwives are experts in pregnancy and health education, a combination that perfectly matches the needs of most women. They maintain and monitor the health of the woman and baby before, during and beyond pregnancy.

Words from patients can give a sense of perspective to those considering the services of a midwife:

• A midwife was with me for all of my pregnancies. I could call for literally anything and I was never afraid to ask questions, and I had plenty. It was the same feeling that you have with a good friend, where you’re always comfortable.
• My midwife was so knowledgeable and advocated for me in every way possible. She listened to every concern of mine, never interrupted, never took anything for granted.
• I talked to the midwife about my husband a lot, and she got to know him and made the same connection with him as she did me. That was amazing and awesome.

For many women, having the same care provider that they saw during their entire pregnancy with them throughout their labor and delivery is very comforting.

“One of the reasons I became a midwife was because I really enjoyed the relationships and bonds I was able to form with my patients,” said Kay Weina, Certified Nurse Midwife at Women’s Care of Wisconsin. “To care for them throughout their pregnancy, to be there for the delivery, and then to see them for years to come and grow with them, it’s really special.”

What many women do not know is that midwives specialize in the health needs of women throughout life. Midwives listen to your concerns about health and sexuality, perform pap tests and breast exams, provide birth control methods and family planning, as well as a host of other services.

"As midwives, we can essentially provide for women's health across their lifespans,” said Elise Gessler, Certified Nurse Midwife at Women’s Care of Wisconsin. “We don't just do labor and birth. We take care of teenagers with contraception, we do STI testing, we do wellness exams, and we treat menopause."

If you’re interested in seeing Kay (Neenah, Oshkosh) or Elise (Appleton), you can schedule your first appointment by calling or texting 920.729.7105. Learn more about them by clicking here.

The Path to Pregnancy is Not Always Easy

Dealing with fertility problems is hard. About one in six couples are troubled with fertility issues, and it affects both men and women equally.

Simply put, a lot goes into the conception process. There’s the egg, sperm, fallopian tubes, fertilization, the women’s embryo, hormones, and not to mention each of those pieces needing to be in a healthy state. All but one of those parts could function properly and infertility could still be the result. We at Women’s Care of Wisconsin are here for those times. We specialize in the diagnosis and treatment of infertility and will help you navigate this journey to make your dreams come true.

In having a conversation about fertility, here are some common questions regarding the process, treatments, and how we’re here to help.

How long do you wait before speaking with a doctor about possible fertility issues?

Fertility can happen at many points within a lifetime, and infertility issues differ at each of those points as well. A general rule of thumb is if you are over or under the age of 35. Couples under the age of 35 statistically have better chances of conceiving, yet should look into additional options after a year of actively trying (actively trying means you are having intercourse around ovulatory times month by month). Patients over the age of 35 should intervene just after six months.

Can you explain the difference between IUI and IFV?

The big technical difference is where the fertilization of the egg and sperm takes place. During IUI, the doctor inserts the sperm directly into the uterus to fertilize. With IVF, the egg and sperm are manually combined in a laboratory dish and then transferred to the uterus. We can facilitate any IUI treatments by providing medication, tracking cycles, and stimulating the ovulation cycle while collecting and processing the sperm to be placed in the uterus in our own office. If you were to choose the IVF route, we would be the helping hand in that process of referring our best local clinics in the area to take care of you, then assisting once you choose your preferred facility.

When would you recommend IVF to a patient?

We recommend each individual go through the initial testing and treatment options, then work in a conversation about additional options following those. Usually, we would like to start an IVF discussion with a patient after 3-4 rounds of insemination. However, time frames will be individualized to each couple depending on a multitude of personal factors.

So, no matter if you’re just starting to think of the conception process or you are months or years in, Women’s Care of Wisconsin is here to provide education, diagnosis, and treatments, and be with you every step of the way. It’s our goal to make your dreams of having a baby a reality.

To schedule your own personal consultation, call or text 920.729.7105 to set up an appointment with one of our three fertility specialists. Click on their names to learn more about each.

Dr. Allison Brubaker 

Dr. Amanda Reed 

Dr. Sara Swift

Therese Yarroch MD on Endometriosis

Are you doubling over in pain during your period? Do you have cramps you just can’t seem to shake throughout the month? For 1 in 10 women, these killer cramps are a symptom of endometriosis. Although endometriosis affects 190 million women worldwide, many go undiagnosed. Here’s what you need to know about this painful disease and how to find out if endometriosis could be affecting you.

What is Endometriosis?

"Endometrial cells are what make up the lining of the uterine cavity," Dr. Yarroch explains. "In women with endometriosis, these cells are found outside of the uterus where they cause inflammation."

Sometimes referred to as “endometrial implants,” they can be found on the ovaries, fallopian tubes, bladder, bowels and anywhere else in the pelvic region. This inflammation can result in pain and significant scarring to the surrounding tissue.

What Causes Endometriosis?

"We do have evidence that there is an increased risk of endometriosis in women with heavy menstrual bleeding and longer or more frequent menstrual cycles," Dr. Yarroch says.

Doctors also know that estrogen plays a role and women who have a close female relative with endometriosis are 5-7 times more likely to have it themselves.

Spotting the Symptoms

Although it’s a common misconception that endometriosis only occurs in women over the age of 20, the truth is that the disease can develop as soon as a girl gets her first period and can span the rest of a woman’s reproductive years.

"The most common symptom of endometriosis is pelvic pain," Dr. Yarroch says. “While this pain usually coincides with menstruation, some women can experience this symptom throughout their entire cycle.”

Other symptoms to look out for include:

• Pain during or after sex
• Severe cramps that do not go away with NSAIDs or that impede the activities of your everyday life
• A heavy menstrual flow
• Periods that last longer than 7 days
• Nausea or vomiting
• Urinary and bowel disorders
• Difficulty getting pregnant

Not every woman will experience all of these symptoms, but approximately 30%-40% of women who have endometriosis will experience issues with fertility.

Getting a Diagnosis

If you suspect that you may have endometriosis, we encourage you to speak with your doctor or make an appointment with one of the providers at Women’s Care. The only way to know for sure if you have endometriosis is through a surgical procedure called laparoscopy.

Treating the Symptoms

There are a wide range of treatment options for endometriosis and your doctor may suggest a few less invasive methods before ordering a biopsy. At Women’s Care, we work with you to choose a plan that fits your needs and your lifestyle. Some of the most common treatments include:

The use of NSAIDs, such as ibuprofen (advil, motrin) and naproxen sodium (aleve). NSAIDs can help relieve or lessen the pain caused by endometriosis by stopping the release of prostaglandins, one of the main chemicals responsible for painful periods. While NSAIDs can help manage the pain-related symptoms of endometriosis for some women, it’s not effective in every case.

Birth control methods such as the pill, the patch and the ring are often helpful to treat the pain associated with endometriosis because they reduce heavy bleeding. This method works best for women who only have severe pain during their period and not during the rest of their cycle.

Progestins are recommended for women who do not get pain relief from or who cannot take hormonal birth control that contains estrogen (such as smokers). This synthetic form of the natural hormone progesterone is available by prescription as a pill or an injection.

GnRH therapy uses medicines that work by causing temporary menopause. The treatment actually causes the ovaries to stop producing estrogen, which causes the endometriosis implants to shrink.

For some women, surgery may be the best treatment method. While there isn’t a cure for endometriosis yet, it is possible to remove some of the scar tissue and lesions with surgery.

If you have endometriosis, surgery could be an option if you:

• Have severe pain
• Have tried medications, but still have pain
• Have a growth or mass in the pelvic area that needs to be examined
• Are having trouble getting pregnant and endometriosis might be the cause

"It is important to note that there are other conditions that can cause many of the same symptoms as endometriosis," Dr. Yarroch explains. "An OB/GYN can help determine if endometriosis is the appropriate diagnosis."

So What Now?

"Endometriosis can have a significant impact on a woman's life. Fortunately, there are treatment options available to manage pain and minimize recurrence," Dr. Yarroch says.

If you have endometriosis or believe you could have endometriosis, we strongly encourage you to speak with your doctor or one of our highly trained providers. We want you to know that at Women’s Care, we’re devoted to you and your health. We’re here to meet both your physical and your emotional needs each step of the way, from diagnosis to treatment and recovery.

Dr. Therese Yarroch sees patients in Appleton and Shawano. To schedule an appointment with her, please call or text 920.729.7105. Learn more about Dr. Yarroch here.

Meet Effie Siomos MD, Women’s Care of WI

Effie Siomos is a strong advocate for women taking steps to care for themselves.

“We need to do nice things for ourselves once in a while,” Siomos said. “Make time to meet a friend for lunch. Take a walk, ride a bike, sign up for a mud run. See your doctor.”

Wait, what?

“I know people don’t think of going to the doctor as something nice you can do for yourself, but just do it,” said the OB/GYN from Women’s Care of Wisconsin. “It will make your day-to-day life better.”

With special interests that include pregnancy care, performing in-office procedures and minimally invasive surgeries, and consults with moms and daughters to manage heavy periods or discuss birth control, Siomos has seen—countless times—women who have been dealing with issues for three, five seven years until they finally come in to see her.

In one classic exchange, a patient said she had been dealing with a problem in silence ever since the birth of her baby. Siomos asked how old her baby was.

“He’s going into high school,” was the reply.

“It’s easier to take care of our kids or our parents than it is to take care of ourselves,” said Siomos. “Just because your friend doesn’t have the issue doesn’t mean this is your lot in life. There are so many options to get you back to where you should be.”

Siomos loves good conversations with patients and feels that by paying close attention, she can make sure people are getting what they need at her office.

“Whatever the issue, there are physical symptoms that come with it, but there’s an emotional component as well, and paying attention to that really helps guide the treatment for what the patient wants or needs and what solution is best for them,” Siomos said.

Though a Chicagoland native, Siomos has spent her entire career practicing in rural communities, first in Beaver Dam following her residency, and now in Berlin.

“It’s a nice way to practice medicine,” said Siomos. “It just feels a little more personal. People look after each other.”

Such a perspective, said Siomos, dovetails perfectly with the culture at Women’s Care of Wisconsin, the organization she joined in 2019.

“A lot of times when you go to a doctor's office you're not just getting the doctor. You're getting the person at the front desk, you're getting the person who takes your blood pressure and puts you in a room, you’re talking to the nurse if you're calling with a question afterwards. There are all these layers to what makes a great experience, and that’s where Women’s Care of Wisconsin really stands out,” said Siomos. “It’s our people.”

With a family background in healthcare, it wasn’t surprising to see Siomos follow the path, as she weighed a university job against a more hands on career in the field. The latter solidified itself upon her first delivery, an experience she described as different from anything else she had experienced in med school.

“It was an amazing chance to be part of someone’s life at such a moment,” Siomos said. “It’s also an extraordinary opportunity to make an impact in ways that might not be typical for healthcare.”

Many days find Siomos in her Berlin clinic, spending time with patients discussing their concerns and healthcare goals and learning what’s important to them, while other days she’s in surgery for planned procedures such as a hysterectomy or the removal of cysts.

It’s a job with plenty of variety, which Siomos embraces.

“It’s a great way to get to know people, when you can sit down and talk to them about what decisions would be best in their life,” she said. “I get to teach and present what treatments are available and provide my patients with a clear understanding of their options,” said Siomos.

Gone are the days, she said, of patting someone on the knee and sending them on their way, often with the cursory (and demeaning) advice to just tough it out.

“There are so many different ways women want to interact with their health care,” said Siomos. “And we have so many ways to help.”

Dr. Effie Siomos sees patients at Women's Care of Wisconsin in Berlin, located at 225 Memorial Drive, Suite 2030. To schedule an appointment with Dr. Siomos, please call or text 920.729.7105.

The Circle of Care: In Their Own Words

At Women's Care of Wisconsin, we empower women by involving them in all of their health care decisions. We strive to know our patients well, helping them achieve their personal goals and live their best lives. The doctors and midwives of Women's Care offer a well-rounded approach to OB/GYN care, one that meets both the physical and emotional needs of patients throughout every phase of life.

We call it our Circle of Care. It's not a slogan or catchphrase. For us, it's the foundation of the practice, delivering a premium experience that is completely built around you.

A good way to understand the significance of the Circle of Care and your part in it is to hear from the providers at Women's Care, in their own words.

David Austin Anderson MD, OB/GYN
“The Circle of Care is best represented by the ability to follow your patients through their journey and get to know them and their family. I love being a part of some of the greatest moments in my patients’ lives.”

Gretchen Augustine DO, OB/GYN
“The Circle of Care is our vision to take care of the whole patient on the whole journey, instead of just a piece of it.”

Allison Brubaker MD, OB/GYN
“The Circle of Care means developing a rapport with patients. They keep coming back to you—for their pregnancy, afterwards for postpartum, later on for their GYN care, you see them when they’re going through menopause, and then you start seeing their daughters and their granddaughters.”

Eric Eberts MD, OB/GYN
“I care about how the teamwork happens. We’re all partners here; we support one another. We have strengths, specialties, and the trust in each other to do the best for every patient that walks through our door, no matter the issue. Your patient, my patient. That’s completing the Circle.”

Valary Gass MD, OB/GYN
“I want my patients to feel that they were heard. There’s no one single fit for everyone, so I educate them on treatment options so they can choose what’s going to meet their goals and fit their lifestyles.”

Elise Gessler CNM
“I want to learn more about my patients and spend more time with them, and being a midwife I can really get to know them and care for them through all aspects of their life. To me, that represents what the Circle of Care is all about.”

Amanda Reed MD, OB/GYN
"At Women’s Care of Wisconsin, I have support all around me, and that also supports our patients, who are taken care of every step of the way. We really have it together here, and I hear that from patients all the time."

Adriana Schaufelberger MD, OB/GYN
“I love being there for the patient. I get to see them through their life span, so many important moments. It’s critical to have that connection.”

Marissa Schloesser MD, OB/GYN
"We’re following women through their life, through various journeys, from teenage years to reproductive years through menopause. There’s so much joy in each of those journeys, but the transitions can be difficult or stressful for patients, who look to us to help guide them through these challenging moments. We may not always have the answer for them, but we can always help them through it and help them get to a place that they need to be.”

Effie Siomos MD, OB/GYN
“Something that doesn’t get emphasized enough in health care is teamwork. All of us at Women’s Care understand the importance of each moment in the patient journey and use those as opportunities to elevate the experience.”

Sara Swift MD, OB/GYN
“It’s not just caring for women from their teenage years to their menopausal years, but it’s also caring for a woman as a whole, not just physically but mentally and emotionally as well.”

Maria Vandenberg MD, OB/GYN
“There is no greater privilege than standing next to a woman as she transitions to adulthood, becomes a mom, and lives a healthy life. Building life-long relationships with my patients is an important part of my practice. I strive to help women make health care decisions that are the best options for them."

Kay Weina CNM
“It's your body and it's your baby, and it's your choice. These decisions are up to you and I'm just there to help you figure that out and to answer the questions that you might have.”

Briana Williams DO, OB/GYN
“Developing relationships with patients and seeing them transition through multiple years of their life is the best part of my career.”

Therese Yarroch MD, OB/GYN
“We go through some critical times with our patients, and we are there to make a difference.”

When Should My Daughter Have Her First Gynecologist Visit?

For many young women, the thought of seeing a gynecologist for the first time can feel scary or even embarrassing, but this should be a time when your daughter feels comfortable and is able to ask questions about her developing body. We talked with Dr. Valary Gass of Women’s Care of Wisconsin to provide you with the information you need to help your daughter feel more positive and less stressed out about her first gynecologist visit.

What Age Should I Schedule My Daughter’s First Gynecologist Visit? “The American College of Obstetrics and Gynecology recommends that girls between the ages of 13-15 visit with a gynecologist,” Dr. Gass explains.
For many parents, a reasonable time to talk with your daughter about scheduling her first appointment is after her first menstrual period. The real purpose of this appointment is to establish a relationship between your daughter and her gynecologist so she can feel comfortable asking questions and learn about what changes she can expect as she develops.

Preparing For Your Daughter’s First Gynecologist Visit
The most important thing you can do to help ease your daughter’s nerves is talk to her. Explain to her why this visit is important and help her understand what she can expect. Having an open dialogue with your daughter will encourage her to ask questions and feel more comfortable about the experience.
It is also a good idea to have your daughter create a list of questions she may have for her gynecologist before the visit. Sometimes being nervous can cause us to be forgetful, so writing these questions down on a piece of paper will help her make sure she doesn’t leave anything out.
Common topics for questions include periods, hormones, birth control, sex, and sexually transmitted infections. These are all normal topics for your daughter to have questions about. Remind her that anything discussed with her gynecologist is protected by privacy laws, so she shouldn’t feel embarrassed about asking these questions.

What Your Daughter Can Expect During Her Visit “Most of the time, a girl’s first gynecologist appointment does not involve a pelvic exam,” Dr. Gass says, “but it should include taking a careful medical history, addressing any concerns like bad periods, and considering things like HPV vaccinations." During your daughter’s first gynecologist visit, she can expect to have a general physical exam where the nurse will record her height, weight, and blood pressure. Her gynecologist may then check for common health problems and talk with her about her medical history. While her gynecologist will probably not conduct a pelvic exam during her first visit, it is likely that your daughter will have an external genital exam. During the external genital exam, your daughter’s gynecologist will exam her vulva and may use a mirror to help her identify parts of her own body that she has yet to discover. The most important thing to keep in mind is that this visit is an opportunity for your daughter to speak openly with her gynecologist and ask questions.

When Is a Pelvic Exam Necessary? “The American College of Obstetrics and Gynecology suggests that most women begin regular Pap smear screening at age 21,” Dr. Gass says. At that point, women should continue regular screening every three years until age 30 when they can switch to having a Pap smear with HPV co-testing every five years. Your daughter most likely will not need a pelvic exam during her first gynecologist visit, unless she has expressed complaints of lumps, bumps, pelvic pain, or abnormal discharge. In these instances, her gynecologist may decide a pelvic exam is necessary.

When Should My Daughter Stop Seeing Her Pediatrician? Once your daughter is seeing a gynecologist regularly, you may wonder if she needs to continue seeing her pediatrician. This is largely up to you and depends on the specific needs your daughter has as well as her gynecologist’s preference for their practice. It is perfectly normal for your daughter to continue seeing her pediatrician well into college and it can be helpful if she has a complicated medical history. Just make sure your daughter continues her annual gynecologist visit as well.

Schedule An Appointment If you would like to schedule an appointment with one of our providers at Women’s Care of Wisconsin, please call or text us at 920.729.7105

Protecting Yourself from STIs

With the spread of STIs on the rise, we want to make sure every woman in our Circle of Care has the information she needs to live a safe and healthy life. That's why we're breaking down the most effective ways to prevent contracting an STI and what symptoms require a prompt visit to your OB/GYN.

What are STIs?
Sexually transmitted infections (STIs) are infections or viruses spread from person to person by intimate physical contact or through sexual intercourse. Common STIs include chlamydia, gonorrhea, HPV, genital herpes, and syphilis.

Aside from colds and the flu, STIs are the most common contagious (easily spread) infections in the United States. The American College of Obstetricians and Gynecologists reports that there are millions of new cases each year, so it's important to know the facts when it comes to protecting your body.

How Can I Protect Myself?
The good news is, that there are a lot of different ways you can protect yourself. You can reduce your risk of contracting an STI by:

• Limiting your number of sexual partners. 
• Using protection (such as condoms) every time you have vaginal, oral, or anal sex. 
• Making sure you are up to date on all of your immunizations. Vaccinations are available for hepatitis B as well as some forms of HPV.

 Regular screening is also key to catching an STI early if you do contract an infection.

 "It's recommended that sexually active women between the ages of 15 and 25 have at least annual gonorrhea and chlamydia screening," Dr. Gass says.

There are some STIs that can be cured, but early detection is important.

"Additional screening can be offered for HIV, syphilis, hepatitis C, and other STIs," Dr. Gass says.

What are the Most Common Symptoms of an STI?
Some of the most common STI symptoms to look out for include:

• A burning sensation when urinating
• Sores, bumps, rashes, or blisters in the genital or anal area
• Abnormal discharge 
• Redness or swelling in the genital area
• Pain in the pelvic or abdominal area
• Pain, soreness, irritation, or other discomforts during intercourse
• Bleeding after intercourse
• Recurring yeast infections 

 If you believe you are at risk for contracting an STI, it is very important to schedule an appointment with your healthcare provider.

    "Sexually transmitted infections can have an impact on future fertility," Dr. Gass says.

    During pregnancy, STI's can also cause harm to the fetus. If you are pregnant and you or your partner have had -- or may have -- an STI, be sure to inform your doctor so you can work out a treatment plan that will decrease the chances of your child getting the infection.

Schedule An Appointment

"If you have concerns about STIs or believe you could need screening, please talk to your healthcare provider," Dr. Gass says. 

At Women's Care, our providers are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information, and compassionate, caring staff.

To schedule an appointment with one of our providers to discuss STI screening or any other health related topic, please call us at 920-729-7105 or click here.