“I just don’t want a C-section, Doc.” – The Fear of the Caesarean section

I hear it often in my clinic with the women who are gearing up to have a baby. They just don’t want to have a c-section.

For some women, it is a feeling that they have failed to have a natural childbirth. For others it is the distrust of modern physicians, and the feelings that doctors perform unnecessary procedures because they are easier. And for some, it is genuinely just the fear of having surgery.

I can absolutely relate to all of these concerns. It’s an extremely overwhelming thing, the preparation to have a child. Most of us cope with the fear of the unknown by controlling as many elements as we can, and as any of you mothers out there can attest to, childbirth, and child rearing in fact, rarely goes as planned.

As a physician, we rely on two faculties to make clinical decisions: our training and knowledge, and then our instinct. Labor and delivery is one of the few arenas of the hospital where these two aspects are tied so closely together. We have to make difficult calls about both a mother and baby’s health within minutes. Even now after practicing for 9 years, there are moments where I second guess my decision, and regardless of the colleague I speak to, I am told time and time again, “You have to trust your gut.”

joshua-k-jackson-261210Labor Pain Control Options

I always like to discuss pain control options with expectant mothers. Labor is hard. It’s long and taxing on a woman, both physically and mentally. I always say, it’s important to enjoy the experience, and if you are dropping the F bomb, or yelling at the nurses, or kicking the doctor (It has happened. Luckily they missed, but it was close), you will not be enjoying the experience.

Furthermore, a lot of women have natural tearing during childbirth. To repair this, the doctor has to piece together a swollen puzzle. It is already not fun for the new mother to be laying there when everyone else is hovered around this cute new person while she is unable to take her legs out of the stirrups. It is immensely worse when your pain is out of control, if the local anesthetic is not cutting it.

Sidebar: the vagina is an extremely forgiving area and you will look beautiful again, just don’t use a hand mirror for 6-8 weeks.

An epidural can make the put-back-together process way easier for the patient AND the doctor. Here’s my disclaimer on epidurals: They are a process. The patient has to be admitted, in some cases have baseline labs drawn and resulted, get a bolus of fluids through their IV, and then they have to be assessed by the anesthesiologist to make sure they can sit still long enough to have the epidural placed. I have had patients who walk into labor and delivery in pain, who expect to have the thing in their back within 5 minutes of getting there. This is a medical procedure too. It takes some time and there are steps preceding it.

So what happens if you don’t get an epidural?

Some women don’t want one or, in some cases can’t have an epidural. As a physician caring for ladies without an epidural, I do realize that it is your choice and just want you to be aware of the pros and cons, so you can make an informed decision about pain control. You should know that if an emergency occurs during your labor that results in the need to quickly deliver your baby, without an epidural, this delivery would have to happen under general anesthesia which is much riskier. To be fair, epidurals themselves have risks too and most women do not need emergent deliveries who are epidural-free. It is a risk that should be understood, however, before the first contraction hits. Also keep in mind that NO epidural does not automatically mean you will have a vaginal delivery, nor does an epidural equal a c-section.

Roughly one third of all deliveries are via c-section. Epidurals placed in active labor do not increase a woman’s chance of having a c-section, according to multiple studies. Again, everything has risks.

Chance of Mom or Baby Being Harmed During Childbirth

Something that is always devastating to discuss is maternal and neonatal morbidity- meaning the chance of mother or baby being harmed during childbirth. My patient matt-palmer-171734.jpgpopulation tends to be very healthy and low-risk. Having a baby is a joyful occasion, and because of this, we tend to overlook the tremendous risk and danger that can come from having a child. As I continue to practice, my reverence to pregnancy and my realization as to just what a miracle it is that any of us made it out of the womb alive, with all our faculties, limbs and organs working, continues to grow.

In developing countries, it is a given that children die during and after childbirth, just as it is a given that mothers often do as well. In the United States, though, bad outcomes are unacceptable. Despite this incredible focus on creating good outcomes, maternal morbidity has continued to rise in this country for a variety of reasons. I always stress to any woman who is contemplating childbirth to stop smoking, start exercising, lose weight if they need to, and get a general check-up to ensure there are no underlying issues that can worsen during pregnancy.

When people say to me, “I just really don’t want a cesarean section”, I tell them all the same thing:

The only way to avoid a c-section is to not get pregnant.

Childbirth is a wonderful and beautiful miracle. It is also not something anyone should take for granted. Ask your doctor questions, research the things they are telling you (not on Google chat groups), make sure you are keeping an open dialogue with them during your nearly 10 months of prenatal care so that you trust their judgment and their gut instinct during the unpredictable but amazing labor and delivery process.

If something doesn’t seem right, speak up. If your baby isn’t moving enough to satisfy your kick counts in the third trimester, call the doctor that day. If your doctor says you need surgery to prevent irreparable damage to you or your unborn child, please trust them. You may fear having a c-section, but walking away with a healthy mother and baby is 100% of the time a win for me as an obstetrician.  

And my final thought… get an epidural 😉

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Speculum Sizes: “One Size Does Not Fit All,” Says Your Friendly Neighborhood Gynecologist

I feel like Clarke Kent in this opening pic. On our Facebook page I recently shared a post about what percentage of women do not see their gynecologist every year. The startling number out of 1000 women was over 300. For some, the reason is misinformation about how often one should go to the gynecologist. Annual check ups are still recommended, even if the Pap test is not required. Also an annual Pap test is still covered by most insurance plans, so if you are someone who wants a yearly pap despite present guidelines, that is acceptable.

I am guessing that more than confusion about frequency of exams, more women don’t see their Lady Doctor regularly because the exams are uncomfortable, even often painful. Discomfort I expect. Pain, I don’t.

I have been told countless times over the years that my Pap tests don’t hurt. Women often marvel at how much better tolerated my exams are than with previous doctors. I don’t know why that is. I have never compared my technique to other physicians. I do want to use this moment, however, to highlight a difference in speculum sizes and types used.

At my practice, we are fortunate to have speculums from all around the world. Just kidding. We actually have multiple types of speculums for different types of women. I believe this plays a role in the tolerability of a Pap or other speculum exam.

What is a Speculum?

Let’s back up for a moment to answer, “what is a speculum?”. The speculum is a metal or plastic device that is used to open the vagina enough to see inside. A physician can evaluate the walls of the vagina, the cervix, perform STD testing, examine discharge quality and quantity, and even perform procedures and surgeries with the aid of visualization provided by the speculum. The are very helpful in the field of gynecology as a whole. What they are not is one-size-fits all.

Enter Bubba Gump:

You have your metal speculum, your plastic speculum, your pediatric speculum, your Graves speculum, your Pederson speculum, your disposable speculum, your reusable speculum, your bivalve speculum, your weighted speculum, your… okay enough.
Here are is a picture that highlights the differences:

Multiple speculums on table including pediatric, large and small Pederson, large and small Graves, and the extra-large Pederson.
Pictured here are pediatric, large and small Pederson, large and small Graves, and the extra-large Pederson. What can I say? Women come in all shapes and sizes
 Dr. Wendy’s book is available! Check out the sidebar for more about It Smells Just Like Popcorn!

cactus plants on table of doctor's office
Don’t Laugh. I included this pic because you may need a quick pic to pan to if anyone walks behind your phone or computer. How do you explain looking at an assortment of speculums? These Succulents I purchased as a set on Amazon, though.

The Pederson speculums are designed for women with more narrow vaginas. I prefer these for my ladies who have never had children before.

The Graves are particularly useful in women who have delivered babies vaginally. The curvature allows for better visualization of the cervix.

The pediatric speculum is excellent for my patients who have not been sexually active. The population, however, that gets the most benefit from pediatric speculums is ironically the elderly and postmenopausal women.

I could get into more speculum history, but you’re not interested in those details. Much more fun are my many Gyne’s Angels pics taken in the office last week:

Thanks Arshi for capturing the essence of the pediatric, small Pederson, and extra-large Pederson specs in perfect light! It’s not just awesome recipes and food photography with you! Check out Arshi’s Instagram page for more.

If you don’t like visiting your gynecologist because of the sheer weirdness of the whole experience, I can accept that sentiment. Make an appointment anyway. If you avoid this vital screening primarily because of pain, you may need a more customized evaluation. Just a thought. Oh, and one final public service announcement for complete clarification:

Every speculum exam is NOT a Pap smear.

An exam with the formerly (until now) dreaded speculum can be performed to visualize the cervix, do STD testing, check for abnormal bleeding etc. The Pap smear is specifically screening for cervical cancer.

Visit my YouTube channel for more of these shenanigans….

Click here for more about Dr. Wendy, aka, Dr. Every Woman and click here for more information and FUN from The Gyneco-(b)Logic.

Can’t leave my girl Shelly out of this one:

Dr. Shelly holding Small Speculum
Good morning Charlie… with a vagina

What Did This Doc Do To Her FEET?

We haven’t featured a Logic-al Choice product in a while. It’s not for lack of retail-love, but more so because I wanted to present something more interesting and fun than the latest lipstick or handbag. How about the latest favorite in foot beauty pedicure products?

Intrigued?

Summer is coming and those toes will soon be in the open. Don’t think that that peep-toe shoe is hiding anything. We can still see if your feet are under performing.

I have been criticized in the past for not keeping my feet well maintained in the winter. I keep the nails clipped for shoe comfort only. Cuticles, nails, or extra pedile skin (I just made up the term pedile, but I like it) are not my priority when it’s cold outside.

Enter spring-winter mix for us in Chicago- sounds like CaramelCrisp CheeseCorn Chicago Mix at Garrett’s. One day it may be 40 degrees, then the next day 75 degrees . Any given day may be a potential open toe day. One has to be ready. A single spring end-hibernation pedicure is not going to completely buff away months of heel skin collection. I don’t even want that pedicurist scrubbing hard enough to buff me down. These pit bulls are sensitive.

So what’s my solution?

It was a late night at Prentice Women’s Hospital when one of the nurses began talking about this new foot exfoliation product that she had tried. She was marveling that she initially thought it didn’t do anything. Less than a week after trying this stuff, she began to slough like a snake.

Intrigued? Check this out. These pics are my own feet during Patchology PoshPeel Pedicure.

Patchology PoshPeel Pedi Cure peeling

Patchology PoshPeel Pedi Cure close up of peeling skin
Up close and personal!

Patchology PoshPeel Pedi Cure Review: I have now used this stuff twice because of how much I love it. I used it once last fall, and again a couple of weeks ago. Completely painless and thorough. The only downside is that I need to wear socks the whole time that the slough is in progress because the dead skin volume is abundant. Is it just me? Possibly.

To use it, you pour this clear solution into the foot bags and put your feet in them for about an hour. The bags have stickers to wrap around your ankles so that  they don’t move and you can walk around.

After my most recent treatment, I went to get a pedicure for nail beautification and general relaxation. The pedicurist didn’t have to buff my feet AT ALL. They were already smooth as baby feet. If I ever become a professional singer, I can call myself Wendy “Babyfeet” McDonald. Maybe not the brand I was shooting for, but it’s catchy!

Check this stuff out if you won’t be grossed out by your own painless shedding. I loved it and will be doing it again in a few months.

Scrub blue nail color
I call this nail color Scrub Blue. I also like Mammogram Mauve and Speculum Silver (smh)