Atlanta Women’s Specialists offers a unique class for expectant fathers. If you are expecting a baby (and are one of our patients), please encourage your baby’s dad to join us for this event.

The Fathers’ Only class is designed for you to learn from other dads who understand and have been in your shoes recently. Ask questions and learn the need-to-know basics before your baby arrives and enjoy pizza at the same time.

This class is expecially helpful for first-time dads. Even if you have been down this road before, we encourage you to join us.

Where: Meridian Mark Office
5445 Meridian Mark Rd
Ste 350
Atlanta, Georgia 30342

When: 4/27/2010

Time: 6:00pm until 7:00pm
Cost: FREE!

A Sign up sheet is on the table in the main waiting room at each office. You can also register (and get additional information about the class) by sending an email to Mary Alice Hedden, mhedden@awsphysicians.com.

We hope you’ll join us.

Atlanta Women’s Specialists has adopted the new guidelines for cervical cancer screening established by the American College of Obstetricians and Gynecologists (ACOG). These guidelines were released and published in the December 2009 issue of Obstetrics & Gynecology.

According to the new guidelines, women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended.  Most women younger than 30 should undergo cervical screening once every two years instead of annually, and those age 30 and older can be rescreened once every three years. We’ve posted more detailed information on these new guidelines here.

Annual Visits and Pap Smears

Many women equate the annual “well woman” visit with getting a PAP smear.  These new guidelines do not change the recommendation for an annual visit.  A breast and pelvic exam should be obtained annually, but the laboratory test for cervical cancer screening (the PAP) does not need to be obtained annually in most cases.  In addition, the Centers for Disease Control (CDC) recommends yearly screening of all sexually active women 25 and under for Gonorrhea and Chlamydia.

Cervical cancer rates have fallen by more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. The American Cancer Society estimates that there will be 11,270 new cases of cervical cancer and 4,070 deaths from it in the US in 2009. The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all. Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men. HPV also causes genital and anal warts, as well as oral and anal cancer.

As the media blitz continues regarding the H1N1 influenza virus, otherwise known as the swine flu, I continue to receive questions from patients  anxious to take the appropriate steps to prevent or treat  the flu.  We at Atlanta Women’s Specialists understand these fears, and have taken steps to help give you the most up to date information possible and to aid you in disease treatment and prevention.  Please browse through the information that is listed under our  Health Topics  section regarding the H1N1 Flu.  The Centers for Disease Control (CDC) also has continually evolving information that is listed on their website at www.cdc.gov or you can check at www.flu.gov.  The information is extremely helpful and answers most questions that  my patients have been asking.  If you have further questions, or would prefer to talk about this in more detail, feel free to inquire through our office or discuss with your physician at your next appointment.

As a large number of our patients are pregnant, and therefore have been classified as a “high risk population” by the Centers for Disease Control, I would like to give some answers to the most commonly asked questions that I receive.  Again, I believe that you will find these answers supported by the information provided by the CDC.

What should I do to prevent the flu?  Pregnant women are considered a high risk population.  Secondary to some of the underlying physical changes that happen with pregnancy, pregnant women have been shown to have a more difficult time in handling the flu.  For that reason, it becomes of ultimate importance to try and prevent infection with either of the seasonal flu or the H1N1 Flu.  To that end, practicing the appropriate techniques of hand washing, hand sanitizer, coughing into your sleeve and avoidance of others suspected of being ill is our first line of defense.  

Should I be vaccinated against the flu?   Vaccinations for both the seasonal flu and the H1N1 flu are extremely important.  The seasonal flu vaccine has been considered crucial for pregnant women for many years.  Now, the recommendation naturally extends out to the H1N1 flu.  Although this is a “new” vaccine, it is constructed along the same lines that the seasonal flu has been previously.  They have just included the new H1N1 virus strain into the same type of transport media as the seasonal flu.  My patients have been extremely concerned regarding its safety with pregnancy.  However, it is considered more dangerous to actually contract the flu while pregnant, than the theoretical risk of the vaccine.  Also, this vaccine, like the seasonal flu vaccine, is a killed virus and therefore there is not a risk of “catching the flu” from the vaccine itself.  As for the timing of the vaccine,  it will be possible to get both vaccines on the same day.  However, we do recommend that you get the flu vaccine as soon as possible, and then get the H1N1 vaccine once it is available (currently scheduled for release in mid October).

What do I  do if I am  exposed to someone who is diagnosed with the flu?   The current recommendations are to start antiviral medications as soon as you are informed of the exposure and take a once-daily dose for 10 days to help prevent developement of the flu.  We would ask, as the CDC recommends, that you call the office for a prescription.  We will then forward this to your pharmacy without requiring a visit in the office.  Again, the antiviral medications are a category C medication which means that there are no human studies that have been done on pregnant women.  However, as stated previously, the limited information on animal studies that have been done, show no effects to offspring.  Although this information is limited, the risk of the disease is still considered much more significant than any risk from the medication.

What happens if I develop signs or symptoms of the flu?   Again, as per the CDC, please notify our office with these symptoms so that we may direct the next appropriate steps.  It is recommended that we NOT have patients come into the office for confirmation of infection, but rather start a twice daily medication regimen for 5 days.  As this infection has been shown to spread easily, the authorities have recommended that we keep people out of the physicians offices to try and prevent further transmission.  However, if anyone develops symptoms of  significant shortness of breath or signs of respiratory compromise, they will be directed to the hospital for further evaluation so that they can be treated most effectively and quickly. 

What should I do if I become ill  and am breastfeeding?  The current recommendations are to continue breast feeding, but try to avoid coughing or breathing directly on the baby.  If you become too sick to nurse yourself, it is recommended to continue with pumping and then have the breast milk fed by bottle by another family member.

These are just a few of the questions that I have received recently.  This is by no means an exhaustive list.  I am sure that there are more questions that will arise.  Please feel free to contact us for more information.   We will continue to follow the ever-evolving information, and will attempt to forward this to you as we receive it.

Take care, and remember….wash your hands!!!

Michael A. Dawson, MD

“Breeching Out”

It was a longstanding tradition in my family that upon every birthday, each child would have to sit down with our mother and relive the torment that she had gone through to give us life.  As the years passed, I can remember that the story became a little more “embellished”, shall we say, and much more memorable.  ( I come from a long line of southern story tellers who always put  the truth in there somewhere, but usually utilize it more as a basic frame work from which to build a true masterpiece…. sorry, I digress).   So… On the tenth day of April every year, my mother would start her tale of how her labor had begun with me, her third (and FINAL) child.  It started off with her typical contractions, and then went down hill from there.  As luck would have it, her obstetrician was on vacation (which I am SURE that he deserved), and he was being covered by another physician about whom she had only heard “horror stories”.  This was problem number one.   Upon his examination of my mother, he concluded that she was indeed in labor and moving quickly.  He then went on to tell her that “”this young one was coming bottom first”.  Yes, that was problem number two.  As if the story wasn’t bad enough, he shared with my parents that he was afraid that I might be “not so small” (enter problem number three).  To hear my mother tell it, the Doctor then “doped” her up so that she couldn’t remember anything and then told my Dad to go find a quiet room and “pray hard” because there was the potential that he might lose one, or both of us.  Now at this point in the story, I usually rolled my eyes and gave her the usual “hmmph” of disbelief.  We were all relieved when she finally got to the healthy delivery of a 9 lb 15 ounce bouncing baby boy who, of course, became the center of her whole existence (okay, on that part, I might be exaggerating a little… eye rolls are allowed).

Now since the first time I have heard that story, I have been through quite a few years of medical education, and have learned a great deal more about breech deliveries.  It is funny, that the more that I learn about breech deliveries, the more I understand how very lucky both my mother and I were.   Although breech deliveries complicate only about 3-4% of term pregnancies, they can definitely be associated with some problems not usually attributed to vaginal deliveries. 

The tricky part is that with babies, the largest part is generally the head.  When the head is the first part to deliver, it usually follows that the remainder of the baby should follow without much problem.   However, if the presenting part is the buttocks or the feet, there is not the same certainty that the head would be able to fit through unobstructed.  This type of head entrapment can cause severe problems with deliveries, and can lead to poor outcomes for the babies.  For this reason, we as a practice have chosen not to attempt vaginal breech deliveries. 

Therefore, when a patient has a breech presentation discovered before the time of labor there are generally 2 options that are available.  The first option is to proceed with a planned cesarean delivery scheduled during the 39^th week of pregnancy.  The risks associated with cesarean delivery include pain, bleeding, infection, injury to the bowel and bladder, and wound breakdown.   Although these are risks, we do believe that the risks to the baby from a vaginal breech delivery are higher. 

The second option involves an attempt to turn the baby by pushing externally on the mother’s abdomen.  This is called an external cephalic version.  When successful, these can decrease the incidence of cesarean and its risks significantly.  However, external cephalic version does have some risks of its own.  In addition to being an uncomfortable procedure for mothers, external versions have been associated with causing labor, rupturing membranes, separation of the placenta from the uterus (uterine abruption), and fetal distress.  Because of these risks, the procedure is performed inside the Labor and Delivery unit where monitoring of the baby and emergency cesarean can be performed as needed.  The success rate from this procedure is generally in the range of 60% or so, but is dependent upon the size of the baby, amount of amniotic fluid and the starting position of the baby.

Luckily, this information will not be useful to the majority of our patients, but for the 3-4% that may have breech babies, know that there are options available.  We will be more than happy to discuss these choices in more detail.

Michael A. Dawson, MD

I’m a reader and am always looking for another good book. The Pause, by Lonnie Barbach has long been a favorite of mine. She does a great job of discussing menopause, possible symptoms and body changes. She not only talks about what might happen but why. And because of her extensive background in sexuality, she talks about sex. What I really love about her book is her balanced view. There isn’t going to be one right answer for every woman and Lonnie Barbach does a wonderful job of presenting the options. She talks about diet, exercise, herbs, hormones, accupuncture and much more.

So does anyone else have a great book they want to share? What are its strengths? Why do you recommend it?

Yvette Smith, MD