Vaginal bleeding: For the first three days after delivery, you may experience a bloody discharge of leftover blood, mucus and tissue from your uterus. This discharge, called lochia, is generally as heavy or heavier than a menstrual period and may contain several clots. The discharge will turn pink, then brown and finally a yellowish-white as it decreases in quantity. The bright red flow may resume when you are breastfeeding or during periods of increased activity. Normally, this will stop completely within four to six weeks.

Things to help: Sanitary pads

What to watch for: Saturating more than one pad an hour for more than a few hours or discharge that has a bad odor

Abdominal cramps (afterbirth pains): Abdominal cramps, or “afterbirth pains,” are caused by contractions of the uterus as it returns to normal. They may be more obvious while you are nursing and will gradually subside within a week.

Things to help: Change positions, empty your bladder, take Tylenol® or Motrin® (Ibuprofen)

What to watch for: Severe abdominal pain, nausea/vomiting

Perineal discomfort: The stretching and bruising of the perineum during delivery can cause discomfort, pain and numbness. If your perineum was torn or if you had an episiotomy, you will have stitches. In most cases, this area will be very tender and sore for three to four days following delivery. Your stitches will dissolve in about 15 days, but tenderness may last several weeks.

Things to help: Warm sitz baths, witch hazel soaked in gauze pads or Tucks®, local anesthetic spray, Tylenol®

What to watch for: Increasing pain, swelling or discharge

Cesarean incisional pain: If you delivered by cesarean birth, your wound will be painful and you may experience numbness or a tingling sensation when the anesthesia wears off. Medication to relieve your pain will generally be ordered by your physician. Avoid lifting anything other than your baby, and try to keep stair climbing to a minimum.

What to watch for: Fever, increasing pain or drainage from your incision site

Constipation: Your first bowel movement after childbirth may be difficult.

Things to help: Fiber (whole grains, fresh and dried fruit), drinking water, Colace®, Milk of Magnesia® or Dulcolax® tablets

Hemorrhoids: If you have hemorrhoids, they can become swollen and painful and protrude after delivery.

Things to help: Laxatives, Anusol® or Preparation H®

Infant feeding: If you are bottle-feeding, remember to wear a well-fitting bra and avoid breast stimulation. Breast engorgement will generally improve two to four days following delivery.

If you are breastfeeding, you may not produce milk for three to four days after delivery. When your baby nurses, he or she will receive a clear liquid, called colostrum. This fluid contains important antibodies. When your milk finally begins to come in, your breasts may become enlarged, tender or unusually firm.

Things to help: Nurse your baby more frequently, apply warm compresses to your breasts or take a warm shower.

What to watch for: Body aches, chills and a fever of 101⁰ or 102⁰ as these can be signs of a breast infection called mastitis. With mastitis, one breast may become extremely firm, red hot and tender.

As always, you are welcome to call our office at 804.288.4084 with any questions or concerns you may have. If you experience any of the following symptoms, please call us immediately.

• Elevated fever over 100.4
• Nausea and vomiting
• Painful urination, burning and urgency
• Heavy vaginal bleeding
• Pain, swelling and tenderness in the legs
• Chest pain or cough
• Hot, tender breasts
• Persistent pain in the perineum with increasing tenderness
• Vaginal discharge with a bad odor
• Feelings of hopelessness that last more than 10 days after the delivery

Additional Resources:

• Postpartum mental health
• Safe medications while breastfeeding
• Returning to normal activities

About Virginia Women’s Center
Our care team – comprised of OB-GYNs, high-risk pregnancy specialists, nurse practitioners, ultrasound technologists, psychologists and a genetic counselor – are experienced in all aspects of pregnancy and welcome the opportunity to provide care that revolves around you. We have added all of these services and specialists to our practice not only for your convenience, but also because we believe that you will benefit from a coordinated and comprehensive approach to your pregnancy care. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

The pelvic floor is a set of muscles, ligaments and connective tissue in the lowest part of the pelvis that supports a woman’s internal organs, including the bowel, bladder, uterus, vagina and rectum. Weakened pelvic muscles or tears in the connective tissue can occur when excessive strain is put on the pelvis through childbirth, repeated strenuous activity or pelvic surgery. Other factors that can increase the risk of pelvic floor disorders include repetitive heavy lifting, menopause, chronic disease, tobacco use and family history.

What conditions can a urogynecologist treat?

• Pelvic organ prolapse: One or more of the organs in the pelvis drops down causing a sense of pressure or a bulge in the vagina. It may also cause urinary incontinence, pain or constipation.
• Stress urinary incontinence: Leakage of urine with coughing, sneezing, laughing or any other activity that increases the pressure on the bladder and/or the supporting tissue.
• Overactive bladder syndrome: Frequency, urgency (a sudden and strong desire to urinate that is bothersome) and nocturia (waking up more than once at night to void) with or without urge incontinence (accidental urine loss associated with a sudden and strong desire to urinate).
• Anal and fecal incontinence: Involuntary leakage of gas and/or stool.
• Fistulas: An abnormal connection between two organs (i.e. bladder and vagina or vagina and rectum)
• Complications from third and fourth degree tears following vaginal childbirth

What treatment options are available?

There are a variety of non-surgical approaches as well as surgical options that can help relieve the symptoms associated with pelvic floor disorders. After consultation, you and your physician will work together to find the solution that works best for you, your lifestyle and your overall health.

Why should I see a urogynecologist?

While many of the symptoms and conditions listed above are very common, it is important to know that these are not a normal part of aging or something that women need to put up with. Consulting with a urogynecologist will provide you with specialized expertise to help determine the best way to relieve your symptoms and restore your quality of life.

At Virginia Women’s Center, we are excited to welcome our first urogynecologist, Dr. Tovia Smith. Dr. Smith will work with female urologist Dr. Lonny Green and gynecologists Dr. Elizabeth Roberts and Dr. Louis Thompson to care for women whose qualities of life are being affected by bladder and pelvic health issues.

About Virginia Women’s Center
Since 2006, Virginia Women’s Center has been dedicated to helping women with urinary incontinence and other bladder problems find solutions to restore their quality of life. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

How do you know if you need to take vitamins? And, if you do, which one(s) should you choose?

A good place to start is to take a look at your eating habits. It’s important to remember that vitamins cannot replace balanced meals and healthy snacks. If you eat a well-balanced diet, you may not need a multivitamin.

Are you hoping to take vitamins to prevent a chronic disease? If so, eating a nutritious diet, exercising regularly, quitting smoking and getting recommended health screenings are likely better solutions.

Prenatal Vitamins

There are certain times where vitamins are essential. If you are planning pregnancy, currently pregnant or breastfeeding, prenatal vitamins are recommended. An adequate intake of folic acid has been shown to prevent birth defects. Prenatal vitamins are essentials for moms-to-be and their babies because they provide folic acid, iron and calcium. They can help fill in any gaps in vitamins and minerals, but they are not meant to substitute the need to eat a healthy diet. Learn more about prenatal vitamins here.

Calcium and Vitamin D for Bone Health

If you are perimenopausal or postmenopausal, you may need to increase your intake of Calcium and Vitamin D. Calcium and Vitamin D work hand-in-hand to slow the rate of bone loss and prevent Osteoporosis.  Vitamin D is necessary to ensure that Calcium is adequately absorbed and incorporated into your bones. Without Vitamin D, Calcium would be sent out of the body as waste.

Ideally, you should obtain Calcium by eating foods that are rich in Calcium. Some good sources include low-fat dairy products, dark green vegetables and fish.  If necessary, you may also need to take a Calcium supplement.

You can increase the amount of Vitamin D you get by choosing milks, yogurts, cheeses and cereals that are fortified with Vitamin D. In addition, tuna and salmon are good sources. Spend time outside each day as exposure to sunlight converts a chemical in the skin to Vitamin D. Vitamin D supplements and/or therapy might be recommended for individuals who are not getting an adequate amount.

Talking with your Health Care Provider

There are other situations where vitamins might be recommended. For example, if you are vegan or vegetarian, you may need to supplement your diet in order to maintain a balanced supply of nutrients. Similarly, vitamins might be recommended if you have certain medical conditions or allergies that affect how your body absorbs or uses nutrients.

It is always important to talk with your health care provider to weigh the potential benefits and risks of any vitamin/supplement before starting. Vitamins can be beneficial to some individuals, but they are not right for all people. There are side effects, medications and health conditions that need to be considered.

About Virginia Women’s Center

Virginia Women’s Center is a full-service women’s health care provider specializing in obstetrics, gynecology, urology, high-risk obstetrics, obstetrical genetic counseling, ultrasound, in-office procedures, mammography, bone health, psychology, nutrition and clinical research. The practice sees patients in four locations in the Richmond area and has additional offices in Kilmarnock and Tappahannock. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

Here are our six tips for a healthy 2014:

1.       Eat nutritiously

Sure it’s easier said than done, but start with small changes you can make that will help you develop nutritious habits. What you eat—and drink—and what you don’t eat and drink can definitely make a difference to your health. Eating five or more servings of fruits and vegetables a day and less saturated fat can help improve your health and may reduce the risk of cancer and other chronic diseases. Eat a balanced diet and watch your portion sizes.

Depending on your personality, you may wish to master one tip before moving to the next or you may prefer to do an “all or nothing” approach. Check out our healthy eating tips here.

 2.       Get moving

Keep in mind that any activity that gets your body moving and heart pumping is exercise. Cleaning your house, parking your car farther away and walking to your destination as well as taking the stairs instead of the elevator all add up.

The Centers for Disease Control and Prevention (CDC) recommend 150 minutes of moderate-intensity aerobic exercise every week. If you haven’t been getting regular exercise, you should work up to these recommendations.

Here are some suggestions to help you prioritize exercise:

• Find a partner (a human or a dog) to help keep you motivated and accountable.
• Make it a family affair; suggest a nightly walk before curling up on the couch.
• Try something new. Mix up your exercise routine to prevent boredom and work different muscle groups.
• Don’t forget strength training. The CDC recommends you perform muscle-strengthening activities two or more days a week in addition to aerobic exercise. As we age, strength training plays an important role in preventing Osteoporosis.
• Remember that exercise is important throughout every stage of life – even during pregnancy. Check out this post for tips on exercising when you are pregnant.

3.       Practice prevention

Prevention is an integral part of good care at every stage of life. Routine doctors’ appointments can help detect signs of illness when they are most treatable.

Learn what health screenings you should have through each age and stage of your life.

4.       Invest in your mental health

Remember that your mental health is as important as your physical health. Take steps to manage stress, know the signs and symptoms of postpartum disorders, practice deep breathing, mindfulness and self-compassion.

Know when it is time to consult a professional and learn more about psychological counseling at Virginia Women’s Center.

5.       If you smoke – QUIT

Check out these tips and consult with your health care provider about effective ways to quit smoking. Help lines, counseling, medications and other forms of support are available to help you quit. Health concerns associated with smoking include cancer, lung disease, early menopause, infertility and pregnancy complications. Smoking triples the risk of dying from heart disease among those who are middle-aged.

6.       Make room for sleep

As a society, we are quick to “burn the candle on both ends” and give up sleep in order to complete our to-do lists. This strategy will come at a cost if we routinely deprive ourselves of sleep, as it plays a very important role in maintaining healthy, productive and safe lives.

Learn tips for practicing good sleep hygiene and for getting more sleep when you are pregnant.

We wish you a year of health and joy!

While the signs and symptoms of PCOS can vary greatly from one woman to another, they can include:

• Irregular menstrual periods. Periods are considered irregular if:
  • Cycles are longer than 35 days,
  • Less than eight cycles in one year,
  • No menstruation for four months or longer, or
  • Periods that are prolonged and may be light or heavy
• Difficulty becoming pregnant or infertility
• Weight gain, trouble losing weight or obesity
• Excess hair growth on face, chest, abdomen and/or upper thighs
• Hair loss
• Oily skin and acne
• Patches of thickened, velvety, darkened skin
• Multiple small cysts on the ovaries
• Depression
• Elevated insulin levels and insulin resistance
• High cholesterol
• Elevated blood pressure

The first step in treating PCOS is to make healthy lifestyle decisions. Exercising regularly, eating a nutritious diet, losing weight and quitting smoking can help reduce the symptoms of PCOS. It is important to eat a diet rich in vegetables, fruits, nuts, beans and whole grains. Try to limit foods that are high in saturated fats and carbohydrates. Some women with PCOS find that even losing 10 pounds can help regulate their menstrual cycles.

In addition to these lifestyle changes, there are several different medications that can help manage the symptoms of PCOS. Birth control pills can be used to regulate menstrual cycles for women who are not trying to become pregnant. There are also medications that can be used to reduce excessive hair growth if over-the-counter solutions are not sufficient. A diabetes medication, called metformin, can help restore regular cycles and fertility. For women who are having difficulty getting pregnant, fertility medications can help with ovulation. With treatment, women with PCOS are usually able to get pregnant. However, they will have an increased risk of high blood pressure and gestational diabetes during pregnancy.

If you are experiencing some of the symptoms of PCOS, speak to your health care provider. Early diagnosis and treatment of PCOS can help reduce the risk of long-term complications, which include: type 2 diabetes, high blood pressure, heart disease and endometrial cancer.

About Virginia Women’s Center
Throughout each phase of your beautiful life, we’re here to provide care that revolves around you. In addition to gynecologic care, we offer urology, in-office procedures, mammography, bone health and psychology services in the comfort and convenience of our offices. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

In order to maximize the likelihood of getting a good night’s sleep, it is important to establish good sleep hygiene. Here are some tips:

1. Have a set time when you go to bed and a set time when you wake up (yes, even on weekends and holidays!).
2. Establish a “winding down” period in the evening about an hour before bedtime. Try soaking in a hot bath, listening to soothing music or meditating.
3. Create a sleep-conducive environment. Sleep on a comfortable mattress and pillow. Keep the room dark, quiet and cool. Get rid of or hide electronic lights from cell phones, computers, TVs and clocks. Keep your pets out of your bed.
4. Use your bedroom for sleep and intimacy only. Watch TV, read or work in other rooms of the house.
5. Avoid eating heavy meals within two hours of going to bed. Limit caffeine and alcohol close to bedtime and stop smoking. Nicotine is a stimulant and can impede sleep.
6. Exercise daily (30-60 minutes), but not too close to bedtime. Regular exercise in the late afternoon has been shown to deepen sleep.
7. Try not to nap, but if you must, keep naps short (20 minutes or less) and not too close to bedtime.
8. Manage your stress. Before bed, write down your list of worries and set them aside for tomorrow.
9. Make sure that you never spend more than 15 minutes tossing and turning. If you do, get up and go through your night time routine again. When your eyes get heavy, go back to bed and try to fall asleep. If you are still having trouble after 15 minutes, get up and do you routine again. Do not do an activity that will activate your brain. For example, avoid turning on the computer/TV or cleaning your house.
10. Limit your use of sleeping pills. Some sleep medicines can be habit forming and may have side effects. Sleeping pills should only be used as a very short-term solution while other lifestyle and behavior changes are put into place.
11. Know when to contact your doctor. Most people experience an occasional sleepless night, but if you often have trouble sleeping, contact your doctor as there could be an underlying cause. For the times when practicing good sleep hygiene isn’t enough, check out this article on overcoming insomnia.

Remember: sleep is not an expendable part of our lives that we can cut out in order to accomplish more tasks or have more fun. Similar to regular exercise and good nutrition, qualitative sleep is an important component of good stress management and is an essential component in our lives. By establishing good sleep hygiene and incorporating these tips, you can maximize your ability to live well and get the most out of each day.

About Virginia Women’s Center

At Virginia Women’s Center, we value the complete health of women. As researchers continue to identify the significant relationship between physical and mental health, Virginia Women’s Center has emerged as a leader in innovative health care for women by providing psychological counseling services to our patients since 2005. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

While it’s not as dreaded as the birds and the bees talk, talking to daughters about periods is not usually high on the list of parenting milestones that moms look forward to. Take a deep breath and read through these tips to help prepare you for this exciting time in your daughter’s development. 

While the exact timing depends on your child and your family culture, it’s important that you start talking about puberty and menstruation before your daughter begins her period. You’re likely to see other signs of puberty – developing breasts, pubic hair and/or vaginal discharge – appear before her period. When you start noticing these changes, it is time for you to bring up the subject if you haven’t already.

On the other hand, many girls begin asking questions at a fairly young age. If your daughter asks questions, be open, honest and age-appropriate.  Start fairly generic and add more details as she gets older. Try having many smaller conversations instead one tell-all session. If your daughter is resistant, don’t force the subject that day, but don’t give up! Having honest and encouraging conversations with your daughter can help pave the way for open communication down the road.

On average, girls will start their menstrual cycles between the ages of 11 and 13. However, some can start as early as eight or as late as 16. While it is important to provide accurate biological information about what happens in her body (diagrams are helpful!), your daughter will likely be more interested in the practical side.

Many girls are anxious or frightened about their periods. Some may come with several questions, but others may be afraid to ask them. Ask what your daughter has heard and correct any misinformation. Assure her, empower her and provide practical tips so she knows what to expect. Some common concerns are:

• What if I get my period when I’m at school? Be proactive. Suggest she carry supplies with her in her purse or backpack or keep them in her school locker.
• How do I use a pad/tampon? Explain how to use and the difference between pads, tampons and panty liners. Provide several options so she can choose what she is most comfortable using. Empowering her to make her own decision, rather than trying to impose your own bias, helps her feel like the woman she is. No matter her choice, stress the importance of changing pads and tampons every three to four hours.
• Am I normal? Assure her that there is no normal and what she is experiencing may be different from her best friend. There is a wide range of ages when girls can start their periods and not all periods are the same. It may take several months for her cycles to become regular.
• Will it hurt? Assure her that it will not hurt, but that some women do experience symptoms like cramps. Most of the symptoms can be eased with over-the-counter medicines or heating pads. Learn more about menstrual cramps and other PMS symptoms.
• Will I gush blood? Most girls will only have light spotting for their first periods.
• Will everyone know I’m on my period? Make sure she knows that pads and tampons are not visible through clothes. She will be the only one who knows that she’s on her period.

Most of all be positive, open and encouraging. Let your daughter know that being a female is a blessing, not a curse, and that this is an exciting milestone and not a reason to feel ashamed or upset. Enjoy the time you can spend together and encourage her to come to you with any questions. Let her know that you are here for her, no matter what. How you embrace and lead her through this transition will lay the groundwork for how she feels about her body, health and femininity.

Additional Resources:

• Your first visit to the OB-GYN

Be sure and visit Richmondmom.com each week to see our Weekly Health Tips from Virginia Women’s Center too!

About Virginia Women’s Center
Virginia Women’s Center is a full-service women’s health care provider specializing in obstetrics, gynecology, urology, high-risk obstetrics, obstetrical genetic counseling, ultrasound, in-office procedures, mammography, bone health, psychology, nutrition and clinical research. The practice sees patients in four locations in the Richmond area and has additional offices in Kilmarnock and Tappahannock. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

There are many reasons why some individuals choose to delay or avoid having a mammogram. Check out the infographic below to learn why some of the myths you may hear are simply not true!

In an earlier blog post, I reported that I was fortunate to be able to attend the American Urological Association annual meeting in early May. Attendees traveled to San Diego from around the globe to learn about the latest scientific breakthroughs for various urologic conditions. It was a stimulating conference with many new findings and reports. In this part two, I will present information on Botox for overactive bladder and the safety of slings done for stress urinary incontinence.

Botox is the most exciting new treatment for overactive bladder in years and data on its effectiveness was presented at the meeting by Dr. Victor Nitti. Patients who were part of an initial study on Botox could then enroll in an extension study. During this extension study, patients could receive repeat Botox injections over the course of a number of years, if needed. Analysis of large numbers of patients showed very positive results. Not only was Botox extremely effective in decreasing urgency, frequency and leakage, it also remained effective for a long time. Further, when repeat injections were done, the results were just as good and just as long lasting as when they were done for the very first time.

Botox injections can be performed right in our office in a few minutes. Numbing medicine is put into the bladder and there is very little discomfort. While the effects of Botox wear off over time, many patients see dramatic improvement for six to 18 months before noting a decline. At that time, the procedure may be repeated. Read patient testimonials from our own VWC patients who have had Botox for overactive bladder.

Another update from the AUA looked at the safety of slings done for stress incontinence. Stress incontinence is leakage related to exertion, such as a cough, sneeze or exercise. Dr. Anne Suskind and other investigators reviewed 6,698 mesh sling procedures done between 2006 and 2008, as well as 445 non-mesh procedures. They found that complications were extremely uncommon. Many other studies have confirmed the long-term safety and effectiveness of slings for treating urinary incontinence. This is in line with our experience here at Virginia Women’s Continence Center. The sling procedure – done as an outpatient – is minimally invasive. Patients are up and about and driving the very next day. The improvement in quality of live can be enormous – read what some of our own patients are saying.

There are many TV advertisements warning against the danger of vaginal mesh. It is important to understand that the sling procedure, done strictly for urinary incontinence, is not the same as the surgeries that were done with large pieces of mesh for “bladder tacking” or fixing pelvic prolapse. In fact, the sling does not sit under the bladder at all – it is completely under the urethra. In 2011, the FDA declared that manufacturers of the larger mesh kits had to do new studies and get new approval before being allowed to proceed. At the same time, the FDA said that companies did not have to do new studies on slings, with the exception of ongoing studies of the newest design modification of one of the slings. Further information on this can be found here.

These are just some of the new developments in the ongoing diagnosis and treatment of bladder problems. No matter the type of bladder problem you are experiencing, we are ready and willing to find a solution that will restore your quality of life. Make an appointment with Virginia Women’s Continence Center by calling 804.288.4084 and find out for yourself.

Vaccines for the seasonal influenza virus are often also available at primary-care physician offices, through your job, local pharmacies and some grocery stores.  In line with recommendations from the Centers for Disease Control, our practice suggests the following:

If you will be attempting pregnancy, are currently pregnant (in any trimester) or breastfeeding during flu season (October through March), the seasonal flu shot is recommended. The vaccine poses no danger to the baby, and you cannot get the seasonal flu from the seasonal flu shot. Pregnant women should not have the “live” or activated seasonal influenza vaccine which comes in nasal spray form.

It is especially important that our pregnant patients receive the flu vaccine. In addition to protecting the mother, the vaccine will also protect her unborn baby during pregnancy and after birth. Because of the changes that occur during pregnancy, the flu is more likely to cause severe illness in pregnant women and pregnant women who have the flu have a greater chance of having serious problems with their unborn babies, including miscarriage or preterm birth. Even if you received the flu vaccine last year, it is important to have annual vaccination as the virus can change from year to year and the vaccine becomes less effective over time.

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