ACOG President's Blog

James Breeden

James T. Breeden, MD

(May 2012–May 2013)

Dr. Breeden is president of the Carson Medical Group, a 26-physician multi-specialty group in Carson City, NV, where he has practiced ob-gyn for 35 years and for the past eight years has specialized in women’s office care and gynecologic surgery.

Time Flies When You're Having Fun
Posted on May 2, 2013

What a ride this past year has been! As I wind down my time as ACOG president, I’m proud of our accomplishments—we remained a strong and vocal supporter of women’s reproductive rights, made strides in standardization of care and patient safety, and moved forward in communication and technology, including the introduction of the new ACOG app for ob-gyns.

Two main themes during my presidential year have been the essentialness of contraceptive access for all women and the importance of having women in leadership roles. For the “grand finale” of my presidency—the President’s Program on May 6 at ACOG’s Annual Clinical Meeting (ACM) in New Orleans—I’ve assembled a roster of phenomenal speakers that will offer their unique spin on these topics.

I’m happy to welcome Malcolm Potts, MD, chair of population and family planning at the University of California Berkeley’s School of Public Health. Dr. Potts has studied extensively the positive societal changes that come when women can make their own reproductive health choices. In a recent speech, Dr. Potts said “If you’re working in cancer or orthopedics or pediatrics, you make people healthier by trying to relieve pain and suffering. What we’ve done in gynecology is change civilization.” His lecture “Sex, Ideology, and Religion: How Family Planning Frees Women and Changes the World” is one not to be missed.

Next, I’ve invited two exceptional leaders, colleagues, and ACOG vice presidents, Sandra A. Carson, MD, and Barbara S. Levy, MD, to present “Your Personal Path to Leadership: The Road Less Traveled.” They’ll discuss their own not-so-traditional journeys to becoming leaders in our field and the need for diversity in leadership.

Rounding out the program, Gary Chapman, PhD, author of The Five Love Languages, will present his speech “The Five Languages of Apology.” His insightful presentation will discuss the importance of apology in developing, maintaining, and repairing relationships.

Though my year as ACOG president is coming to a close, my involvement will continue. I’m looking forward to supporting our new president, Jeanne A. Conry, MD, PhD, in her endeavors and continuing to be an outspoken advocate for women. I’m also looking forward to more time for family and mountain biking in Nevada! Many thanks to ACOG Fellows and staff for your support and friendship throughout this amazing year.

Guest Blog: How ACOG Sections Can Increase Member Advocacy
Posted on April 25, 2013

As women’s health continues to come under attack at the federal and state level the importance of advocacy cannot be overstated. We need educated voices to weigh in on key issues. It is only through continued advocacy that we can protect our patients’ access to care and preserve the sanctity of the physician-patient relationship.

Ob-gyns are getting the message: More than 330 ob-gyns attended ACOG’s annual Congressional Leadership Conference (CLC) in March—our highest attendance yet. During the CLC, we have the opportunity to meet with congressional leaders to call attention to key ob-gyn issues. We also learn about the importance of women’s health advocacy on the state level, where many laws that affect how we care for our patients are passed. Often, our expert testimony can be very meaningful when bills are still in committee.

In Virginia, we were struggling to find a way to have physicians available for these committee sessions, but we believe we’ve found a good solution. Each year, the Virginia Section sponsors approximately six members to attend the CLC. This year, to encourage state advocacy, we adopted a “pay it forward” approach to this sponsorship. We now expect our sponsored members to spend one full day during the legislative session in Richmond, ready to speak to lawmakers.

The Virginia General Assembly meets every year from January to March. The key committees meet on Tuesdays and Thursdays, and bills often come up without warning. Our lobbyist can testify on our behalf, but the message is always better received when delivered by a physician. In 2013, we aimed to have at least one ACOG Fellow or Junior Fellow attend each Tuesday and Thursday of the legislative session.

By implementing this new system, as bills came up, there was always someone who could testify. Our lobbyist knew she would have coverage, and we knew our voices would be heard. On days when testimony was not needed, the ob-gyn would accompany our lobbyist on “rounds” of key legislators to discuss women’s health issues from our perspective.

Our CLC group wasn’t large enough to cover every Tuesday and Thursday during the session, so we also asked other ob-gyns to volunteer, offering to reimburse them for mileage and lunch. Our ob-gyn representatives enjoyed their one-on-one experience and are looking to build on the relationships they formed in the off-season so that we can continue to be strong advocates for women’s health.

We found this new process to be a very effective way to encourage state advocacy, and we hope to expand participation in 2014 by increasing volunteer outreach at our annual section meeting. I invite other ACOG sections to give this formula a try. More voices in more states speaking up for women is a goal that we should all strive to achieve.

Holly S. Puritz, MD is chair of ACOG’s Virginia Section.

Then Comes the Baby Carriage... Or Maybe Not
Posted on April 18, 2013

Infertility—the inability to conceive after six months to a year of unprotected sex—is a common problem in the US. More than 7 million people struggle to have a baby, often facing frustration and confusion along the way. Fortunately, many people who are treated for fertility problems are able to conceive after therapy.

Infertility affects men and women nearly equally. About one-third of cases can be attributed to the male partner, one-third are related to the female partner, and the remainder are caused by a combination of problems with both partners or by unknown factors.

In women, increasing age, irregular ovulation (release of eggs from the ovaries), abnormal anatomy, or scarring or blockages in the fallopian tubes are the main causes of infertility. Gynecologic conditions, such as polycystic ovary syndrome, endometriosis, and fibroids, can also make it difficult for a woman to conceive. Lifestyle factors, such as smoking, eating a poor diet, or being underweight, overweight, or obese, may also make it harder to get pregnant.

Male fertility also declines with age, but at a slower rate. Infertility in men usually involves problems with the sperm. Sexually transmitted diseases (STDs) or an injury to the testicles, such as overheating (from spending too much time in a hot tub, for example) or a reaction to medication, can lead to short-term fertility issues.

If you are having trouble getting pregnant, see your ob-gyn. Your doctor may order tests to understand what is causing the problem. You may also be referred to a doctor who specializes in infertility (reproductive endocrinologist) or to other counselors and specialists.

Standard fertility testing for women includes a physical exam and a health history survey that focuses on menstrual function and a woman’s history of pregnancy, STDs, and birth control use. Blood and urine samples may be analyzed to confirm that normal ovulation is taking place. X-rays or ultrasounds may be used to view and inspect the reproductive organs for any abnormalities. To test for male fertility, a semen sample will be checked for the number, shape, and movement of the sperm and for signs of infection.

Infertility can be treated in a variety of ways depending on the cause. If you are overweight or obese, losing weight may improve your chances of getting pregnant. Medications that stimulate the ovaries or regulate blood insulin levels (which can interfere with ovulation) may be prescribed. Your doctor can also help you decide if surgery or assisted reproductive therapies, such as in vitro fertilization, are right for you.

National Infertility Awareness Week is April 21–27, 2013. Learn more.

Chlamydia and Gonorrhea Screening a Must for Women 25 and Younger
Posted on April 11, 2013

Each year, approximately 19 million Americans contract a sexually transmitted disease (STD). STDs are infections spread from one person to another during sexual activity. Chlamydia and gonorrhea are the most commonly reported STDs.

There are an estimated 2.8 million new cases of chlamydia and 700,000 cases of gonorrhea in the US each year. Both infections are most common in young women and both pose a serious risk to women’s reproductive health. If left untreated, gonorrhea and chlamydia can cause pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, and other parts of the pelvis. PID may cause chills, fever, pelvic pain, infertility, and ectopic pregnancy.

Many women may never know they have an STD—the symptoms can be vague. Within two days to three weeks of infection, women may experience a yellow vaginal discharge; painful or frequent urination; vaginal burning or itching; redness, swelling, or soreness on the outside of the vagina (vulva); pain in the pelvis or abdomen during sex; abnormal vaginal bleeding; and rectal bleeding, discharge, or pain. Many women and men will experience no symptoms at all.

ACOG and the US Centers for Disease Control and Prevention (CDC) recommend that all sexually active women age 25 and younger be regularly screened for chlamydia and gonorrhea. Women over 26 should be screened for chlamydia and gonorrhea annually if they have multiple sexual partners or if their partner has multiple sexual contacts. Despite these recommendations, the CDC recently reported that only 38% of young sexually active women are screened for chlamydia and that more than 20% who test positive become reinfected within six months.

ACOG urges ob-gyns to talk to their patients about STDs and screen those at high risk of infection. Chlamydia and gonorrhea can be treated with antibiotics. To lower the risk of reinfection, ACOG suggests that ob-gyns write a prescription both for their patient and her sexual partner, who may be unlikely or unable to get treatment on his or her own. It is important that both partners are treated and take all of their medicine before resuming sexual activity.

Using a male or female condom correctly every time you have sex can also help reduce transmission of STDs. Practice abstinence or monogamy, or limit your number of sexual partners. And be up front: it’s better to have a frank conversation with your partner about your sexual histories beforehand than to be unpleasantly surprised down the road.

April is STD Awareness Month. For more information, check out the CDC’s STD Awareness Month page.

Gynecologic Oncologist = Women's Cancer Specialist
Posted on April 4, 2013

For many women, ob-gyns are their primary health care provider. It’s not uncommon for women to see their ob-gyn at least annually, and for good reason. Ob-gyns receive a comprehensive education in caring for women from adolescence through childbearing and into menopause. Our training includes care of both pregnant and non-pregnant women, surgery, pharmacology, and more.

Because we see our patients regularly, especially during their reproductive years, ob-gyns have the opportunity to build and maintain a strong patient-doctor relationship. We can observe patients when they’re healthy, establish a baseline of what’s normal, and potentially spot suspicious changes or health problems when they are most treatable.

When a patient reports out-of-the-ordinary changes and symptoms, an ob-gyn can perform diagnostic exams and tests to confirm the problem. He or she can treat changes that may lead to cancer and prevent cancer from ever developing. When invasive cancers of the female reproductive organs—cervix, ovary, uterus, vagina, or vulva—are diagnosed, ob-gyns will often consult with other ob-gyns with advanced training and experience, such as gynecologic oncologists. This can be especially helpful for cases that are thought to be more advanced.

Gynecologic oncologists are ob-gyns who have completed several additional years of training in surgery, treatment, and research on women’s cancers and received board certification in gynecologic oncology. They see patients with these cancers every day. Following diagnosis, gynecologic oncologists can perform the sometimes complicated surgical procedures (staging) necessary to improve a woman’s chances of controlling and beating cancer. They are experts in the timing and order of treatment and can also serve as the “traffic controllers” overseeing the coordination of nurses, primary care physicians, radiologists, and other health care professionals who will be involved in all aspects of the patient’s care.

Today, there are more than 1,000 board-certified gynecologic oncologists in the US. To learn more about these cancer specialists, visit the Society for Gynecologic Oncology website.

To Supplement or Not to Supplement
Posted on March 28, 2013

Do you take calcium and vitamin D supplements? If you’re a woman over 60, chances are you do. More than half of women in this age range take these dietary supplements, and for good reason. Fully 80% of the 10 million people in the US with osteoporosis—a debilitating disease marked by porous, fragile bones—are women. Another 37%–50% of women over 50 have osteopenia (low bone mass). Both conditions put sufferers at risk for bone fractures, which can take longer to heal as you age and can cause major mobility problems, and sometimes death.

So when the US Preventive Services Task Force (USPSTF) recently recommended that postmenopausal women should stop taking calcium and vitamin D supplements, it caused some confusion. The USPSTF concluded that the small risk of kidney stones associated with taking calcium and vitamin D outweighs the protection against bone fractures that most postmenopausal women receive from the supplements.

ACOG and the Institute of Medicine recommend that women over 50 get 1200 mg/day of calcium and 600 IU/day of vitamin D (800 IU/day in women 71 and older). The National Osteoporosis Foundation has similar recommendations.

While the debate continues, there are a few facts we can all agree on:

  • Calcium is a nutrient that’s vital to bone health and vitamin D helps the body to use it efficiently
  • It’s important that women get enough of these bone-protecting nutrients
  • Supplements can help you reach optimal levels, but they don’t replace the need for eating a variety of foods with calcium and vitamin D

The average American only gets 500 to 750 mgs of calcium each day, far short of the recommended daily intake. You can increase your daily levels by eating calcium-rich foods such as lowfat dairy (yogurt, cheese, milk), dark leafy greens (kale, collards, spinach), and canned fish with soft bones (salmon and sardines). You can get more vitamin D by eating fortified foods such as milk or cereal, or aiming for 15 minutes of sun exposure on your hands and face or arms a few days each week. Weight-bearing exercise, such as walking, tennis, dancing, yoga, or tai chi, can help strengthen bones, too.

For some women, certain types of hormone therapy and other medications containing bisphosphonates, estrogen, and calcitonin can also help prevent fractures. Talk to your doctor. He or she can determine whether you’re getting enough calcium and vitamin D, suggest a supplement to make up for what you’re missing in diet alone, or help choose a medication that may work for you.

With Delivery Times, Defer to Mother Nature
Posted on March 22, 2013

“Let nature take its course.” Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born. The start of natural labor is the main sign, but we’re not always patient enough to wait for it.

Today, one in three babies in the US are born by cesarean—the delivery of a baby through an incision in the mother’s abdomen and uterus. The rate of labor induction is also at an all-time high. Unfortunately, many of these births occur before the pregnancy is considered “term” at 39 weeks. These upward trends have long been a source of concern in the medical community, especially considering the increased risks to a baby who may not be fully developed at delivery.

Among cesarean deliveries, an estimated 2.5% (more than 100,000 births each year) are scheduled on a designated date by the mother and her doctor. Some women cite reasons such as a lower risk of future incontinence, better sexual functioning after childbirth, and fear of pain as motivations to schedule cesareans. Inevitably, some cesareans (and labor inductions, too) are scheduled before a pregnancy is full term, increasing the risk of negative outcomes for the newborn, including respiratory problems and time spent in the neonatal intensive care unit. The fact remains that due dates are estimates, and you can never be sure that the infant will have reached optimal maturity at the time of a scheduled delivery.

Women should keep in mind that cesarean delivery is no walk in the park. While it’s a safe option, cesarean delivery is a major surgery and comes with a number of risks, such as placental complications in future pregnancies, problems with anesthesia, infection, and longer recovery times.

Certain urgent situations—such as preeclampsia, eclampsia, multiple fetuses, fetal growth restriction, and poorly controlled diabetes—may make it necessary to deliver the baby before the onset of natural labor. However, newly issued guidelines from ACOG remind women and ob-gyns that in uncomplicated pregnancies, a vaginal birth that occurs after the natural onset of labor is ideal. Additional new ACOG guidelines reaffirm that cesareans and labor inductions should only be performed when medically-necessary.

Delaying delivery until labor starts naturally may not make ob-gyns too popular with a patient who’s uncomfortable and near the end of her pregnancy, but it’s a decision that will pay dividends by giving the baby the extra time it needs to face the world.

Guest Blog: Every Reproductive-Age Woman At Risk, Every Time
Posted on March 14, 2013

Frances Casey, MDFull implementation of the Affordable Care Act (ACA) will remove many of the financial barriers women face to obtain effective methods of contraception. While making contraception affordable for every woman is a good first step toward improved prevention of unintended pregnancies, it remains the responsibility of health care providers to counsel women about all methods of contraception and help them find the one that may be the most effective.

The CHOICE project demonstrated that removing financial barriers related to the most effective methods of contraception decreases rates of unintended pregnancy and abortion. But the CHOICE project also did something many of us ob-gyns do not. Every reproductive-age woman eligible for the study was read a script about the effectiveness of long-acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and hormonal implants.Instead of discussing LARC with their patients, many providers continue recommending less effective contraceptive methods based on misconceptions that adolescents, women who have never been pregnant, or women they estimate are at high risk for sexually transmitted infections (STIs) are not good candidates for LARCs. However, according to ACOG, LARC is the most effective form of contraception available and safe for use in all of these groups.

Because LARCs don’t require ongoing effort by the user, continuation and correct usage rates are higher. This could significantly reduce unintended pregnancy among teens and women if widely adopted. Additionally, women at high risk of both STIs and unintended pregnancy can be screened, obtain a LARC method the same day, and receive treatment without removing the device. Women with medical conditions and physical and mental disabilities can also benefit from both the pregnancy prevention and the non-contraceptive benefits of LARC.

Other women may also benefit from a longer-acting option. Without strict breastfeeding, postpartum moms are at risk for ovulation and repeat pregnancies even earlier than six weeks after delivery. LARC methods can be inserted immediately following delivery or at four weeks postpartum. Despite slightly higher expulsion rates, the benefits of immediate postpartum insertion of LARC methods may outweigh risks for women who are unlikely to receive postpartum care.

Minimizing financial barriers will make contraceptive methods more accessible for women at risk of unintended pregnancies, but it is up to us, as their partners in prevention, to counsel them on the most effective methods, including LARCs, at every opportunity.

Frances Casey, MD, is a Family Planning Fellow at Washington Hospital Center in DC.

Big HIV News and An Important Reminder
Posted on March 7, 2013

Earlier this week it was reported that a Mississippi toddler born with human immunodeficiency virus (HIV) apparently cleared her HIV infection and is now disease-free. The story of her innovative medical treatment and remarkable results is truly exciting. However, as an ob-gyn, I can’t help but think that this entire situation could have been avoided.

Today in the US, mother-to-child transmission of HIV is a rare occurrence. HIV-positive women have roughly a 2% chance of passing along the virus to their babies. This is due in large part to increased HIV screening among pregnant women. Those who test positive for HIV during pregnancy can begin treatment with antiretroviral medications before they give birth. These medications significantly reduce the risk that a child will be born with HIV. The earlier the medication is given during pregnancy, the better, but it can still have a positive effect when administered just 24–48 hours before delivery and/or to the newborn within the first two days of life.

ACOG recommends that all pregnant women be screened for HIV as a part of routine prenatal care. Repeat third-trimester testing is also recommended for pregnant women in areas with high HIV prevalence. Not all women receive prenatal care, and it’s not uncommon for ob-gyns to see women for the first time when they come to the hospital to deliver. In this case, rapid HIV testing can confirm a woman’s HIV status. If she tests positive, she may still be able to receive medication in time to protect her baby from infection.

I cannot stress enough the importance of knowing your HIV status. Screening is the best method we have to both head off HIV transmission to infants and stop the spread of the disease to people of all ages. In addition to the screening recommendations for pregnant women, ACOG also recommends that all women ages 19–64 be routinely screened for HIV, regardless of individual risk factors.

Guest Blog: Fighting Violence Against Women Together
Posted on March 4, 2013

Susan M. Lemagie, MD, is an ob-gyn in Alaska and a member of ACOG’s Executive Board.Every day news from around the world highlights acts of egregious violence against women: the rape and murder of a female medical student in India, acid throwing and subsequent suicides of women in Central Asia, and the Taliban bullet to the brain of a 15-year-old girl in Pakistan who was targeted for promoting education for girls and women. While the scale here at home may be different, women in the US are not immune to violence.

Today, 1 in 4 women in the US has been physically or sexually assaulted by a current or former partner. Homicide is a leading cause of pregnancy-associated mortality in the US, with the majority being committed by an intimate partner. And as demonstrated in the last election, there are still many people who attempt to dictate a woman’s relationship with her doctor and her ability to make her own reproductive health choices. These efforts teeter on the edge of reproductive and social coercion.

In defense of women, ACOG has issued several recent documents—including committee opinions on reproductive and sexual coercion, sexual assault, intimate partner violence, and human trafficking—to raise awareness of the abusive treatment that some women in the US regularly face. ACOG has also developed patient outreach materials that provide information and resources to women in need.

ACOG has partnered with Futures without Violence on a guide titled Addressing Intimate Partner Violence, Sexual and Reproductive Coercion, which encourages ob-gyns to screen patients for domestic violence and recognize the signs of abuse. It also provides tools for health care providers to help women build healthy relationships and be safe in their own homes. Many thanks to ACOG’s Committee on Health Care for Underserved Women and the ACOG National staff for their ongoing efforts to advocate for women.

Now it is our turn as ob-gyns to speak up for our patients and their families. At this year’s Congressional Leadership Conference, March 3–5, 2013, more than 300 ob-gyns will lobby Congress to support ACOG’s Women’s Health Resolution. The resolution lists 14 non-negotiable rights that every woman in the US should be allowed, including the right to be free from gender-based violence. We will also convey to our legislators that our highest professionalism emerges when we base our care on the best scientific evidence, without legislative interference in our role as women’s health care physicians.

As we prepare for our lobby day, I’m filled with both a sense of duty and of pride. We can once again stand up as supporters of our patients and champions of women. It’s what we signed up for as ob-gyns, and it’s the right thing to do.

Susan M. Lemagie, MD, is an ob-gyn in Alaska and a member of ACOG’s Executive Board.

Guest Blog: Cultural Sensitivity Is a Must in Patient Communication
Posted on February 28, 2013

Sarah Ward Prager, MDHave you ever gone to the doctor and felt like he or she just wasn’t understanding you? You’re not alone. Many women have their own beliefs about health, medicines, and other treatments. Sometimes those beliefs don’t match up with what doctors recommend, even though the doctor’s suggestions are based on research proving they work. When patients bring their own cultural beliefs, sensitivities, or fears about health and health care to their appointment, they may need more explanation than just the evidence.

In some cases, doctors just need to listen better and avoid making assumptions about patients. For example, ob-gyns may believe all young women are at risk for an unintended pregnancy, but that’s not the case for women in committed same-sex relationships. Other times, doctors may need to be more clear in explaining the reasons for certain tests or medications, using words and examples that fit into the patient’s own cultural framework.

ACOG understands that approaching patient encounters with cultural awareness and sensitivity creates a more satisfying and caring relationship. To help ob-gyns become more aware of health-care related issues and beliefs in different cultures, ACOG has developed resources that address the traditions and cultural norms common among women of certain backgrounds. ACOG’s cultural sensitivity committee opinion offers typical doctor’s office scenarios with examples of sensitive vs. non-sensitive approaches to a patient’s culture and background. Additionally, ACOG will soon release a video training series that includes clinical vignettes demonstrating a wrong way and a right way to communicate with a patient, taking her heritage and beliefs into account.

Your ob-gyn wants to understand you and communicate with you effectively, and using these ACOG’s cultural sensitivity resources can help make that happen. Also, remember to tell your doctor about the cultural beliefs that are important to you. In the end, sharing what you value is one of the most helpful tools for facilitating better two-way communication.

Sarah Ward Prager, MD, is an ob-gyn at the University of Washington and is a member of ACOG’s Committee on Health Care for Underserved Women.

With Routine Medical Tests and Procedures, Choose Wisely
Posted on February 21, 2013Hal C. Lawrence, III, MD, ACOG Executive Vice President, speaking during the press briefing.

Open lines of communication are the basis of successful doctor-patient interactions. However, when it comes to medical tests and procedures, doctors and patients alike can easily slide into cruise control without taking the time to discuss what’s truly needed, appropriate, supported by evidence-based research, and in the best interest of the patient’s care.

With this in mind, ACOG has teamed up with the Choosing Wisely campaign—an initiative that aims to spark a conversation about commonly performed tests and exams in different areas of medicine. By taking a critical eye to routine health care practices, we can make better decisions on how to provide thorough and comprehensive care while avoiding unnecessary, redundant, or even risk-increasing procedures.

Today, at a joint press conference with 16 other partnering organizations, ACOG made the following recommendations:

  1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
    Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.
  2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
    Ideally, labor should start on its own initiative whenever possible. Higher cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.
  3. Don’t perform routine annual cervical cytology screening (Pap tests) in women 30–65 years of age.
    In average–risk women, annual cervical cytology screening has been shown to offer no advantage over screening performed at 3-year intervals. However, a well-woman visit should occur annually for patients with their health care practitioner to discuss concerns and problems and to have appropriate screening with consideration of a pelvic examination.
  4. Don’t treat patients who have mild dysplasia of less than two years in duration.
    Mild dysplasia (Cervical Intraepithelial Neoplasia [CIN 1]) is associated with the presence of the human papillomavirus (HPV), which does not require treatment in average–risk women. Most women with CIN 1 on biopsy have a transient HPV infection that will usually clear in less than 12 months and, therefore, does not require treatment. 
  5. Don’t screen for ovarian cancer in asymptomatic women at average risk.
    In population studies, there is only fair evidence that screening of asymptomatic women with serum CA-125 level and/or transvaginal ultrasound can detect ovarian cancer at an earlier stage than can be detected in the absence of screening. Because of the low prevalence of ovarian cancer and the invasive nature of the interventions required after a positive screening test, the potential harms of screening outweigh the potential benefits.

Learn more.

Guest Blog: With the ACA, Many Ounces of Prevention
Posted on February 14, 2013

Have you ever heard the phrase “an ounce of prevention = a pound of cure”? It’s an often-used mantra in the medical community and a message we continuously repeat to our patients. That’s because intervention through prevention makes good sense. In many cases, catastrophic illness can be avoided by nipping small problems in the bud or diagnosing and treating disease early. In addition to living a healthy lifestyle, regularly visiting your doctor for routine screenings and counseling is paramount to achieving this goal.

As women, we are often the primary (or sole) caregiver for our families—not to mention the cook, head nurse, and chief financial officer among many other roles. Without a second thought, we may put the needs of others before our own. This is especially true if money is tight and it’s a decision between getting an annual well-woman exam, paying $50 for a birth control prescription, or meeting the needs of a child, spouse, parent, or friend. But this philosophy doesn’t serve women well—if you’re sick, who will look after the people you care about?

The Affordable Care Act (ACA)—the new US law that expands health care coverage by making health care more affordable and accessible—focuses on expanded access to preventive services. Making preventive services available for little or no out-of-pocket cost makes it easier for women to do the right thing for their health and put themselves first. As I discussed in my last post, a growing number of women are now eligible to receive contraception and other preventive health services without a co-pay. 

Preventive services that are now covered include:

  • Annual well-woman visit
  • Human papillomavirus (HPV) testing
  • Preventive vaccinations including HPV, flu, hepatitis A & B, shingles, and chicken pox
  • Sexually transmitted disease prevention counseling
  • Obesity screening and counseling
  • Smoking cessation
  • Depression screening

The ACA chips away at many of the barriers to access and care that women have faced for years. Here at ACOG, we’re closely monitoring the implementation of the law and will continue to advocate for comprehensive care for the women we serve. I believe this legislation is a major step in the right direction to improving women’s health and improving health outcomes for all Americans.

Check out these links to learn more about ACA and how it will affect you: 

Prevention, Wellness, and Comparing Providers ( 

Benefits for Women and Children of New Affordable Care Act Rules on Expanding Prevention Coverage ( 

Effective Date: Women’s Preventive Health Coverage Requirements (ACOG)

Barbara S. Levy, MD, is vice president of health policy at ACOG.

Guest Blog: The Co-Pay Question—Contraceptive Access Under the ACA
Posted on February 7, 2013

If you’ve been to the pharmacy or doctor’s office lately, there’s a good chance that you noticed something different about your bill—there may not have been one. Depending on what type of insurance you have, you may now be eligible to receive all FDA-approved contraception and other preventive health services without a co-pay. This is due to the Affordable Care Act (ACA), a law with a lofty goal: overhauling our current health care system to provide the majority of Americans with affordable access to health care. While the intricacies of the ACA—and health insurance policies—are complex, it’s important for women to understand these most recent changes because they so specifically apply to us.

Whether or not you still have a co-pay for contraceptives depends on where you get your health insurance. More than half of people in the US get their insurance either through their job or by purchasing an individual insurance plan. Currently, the contraceptive coverage provision applies to most of these private plans. Insurance companies that adopted ACA policy changes early on may have already updated their plans to offer free contraception beginning in August 2012. As time passes, more plans will comply. However, there are some exceptions—some plans have grandfathered status that gives them more time to meet the terms of the new requirements, and some religiously affiliated organizations are currently exempt from providing this coverage.

State Medicaid programs already provide no-cost contraception to enrollees. The ACA expands Medicaid’s reach, potentially decreasing the number of uninsured women ages 19–64 from 20% to 8%. Many states are still hammering out exactly how Medicaid provisions will be implemented. ACOG is following this issue closely and supports the adoption of the ACA’s Medicaid expansion in all states.

So how can you find out whether your plan has changed and what new services are covered? You’ll need to ask a few questions and then update your records to be sure your health care team (you, your insurer, pharmacy, and your doctor) is on the same page:

  • Ask your employer or your health insurer whether the ACA has caused any significant changes to your plan. If so, what are they, and specifically, is contraception now covered without a co-pay?
  • If there are updates to your plan, be sure to notify your pharmacy and your doctor’s office and report any problems to your plan administrator or insurance company. It’s up to you to be sure you’re being charged correctly based on what your policy covers.

As an ob-gyn, I am thrilled by the increased availability of no-cost contraception that the ACA provides. Contraception is a basic health necessity for women. More access puts women in the driver’s seat, helping us avoid unintended pregnancy and take control of our reproductive health.

Learn more about contraceptive coverage and the ACA.

Barbara S. Levy, MD, is vice president of health policy at ACOG.

Guest Blog: 40 Years After Roe v. Wade—Politics or Patients, Who Is Winning?
Posted on January 24, 2013

This week marks the 40th anniversary of the Roe v. Wade decision—the US Supreme Court ruling that protects a woman’s right to have an abortion. In the years since, state legislatures have been primarily responsible for the laws that have at times validated and secured this right, and at other times severely limited it. However, in recent years, there has been a troubling trend. We have seen an unprecedented number of legislative attempts by politicians and government officials to interfere with women’s reproductive rights and with medical practice.

According to the Guttmacher Institute, 17 states now mandate that women undergoing abortion be given factually inaccurate information such as links between abortion and breast cancer and abortion and mental health. Eleven states have seen bills that attempt to limit medication-induced abortion, including some that specify the dose and route of such services. These laws completely disregard the meticulous and thorough process of scientific investigation that has been the cornerstone of medical advancement.

At least two states have proposed or enacted legislation that allows physicians to withhold information from a woman about her pregnancy if they feel the information would result in her choosing to terminate, essentially permitting reproductive coercion by the physician, which I believe is a universally deplorable form of violence against women. At least 18 states have introduced some version of legislation that not only requires an ultrasound for women seeking abortion but often dictates who can perform it, how and when it is performed, and what the provider must say to the woman undergoing it.

No matter where you stand on the abortion debate, this invasion of politics into medical practice should concern you. This scripting of patient-doctor interaction is unacceptable. The commitment we made when choosing to become women’s health care physicians was to promote the health of women through the execution of the best science. Our education and training tell us that these laws have not been created in the spirit of promoting the health of our patients.

As we reflect on this anniversary, consider the burden these laws pose for the girls, women, and families we care for. I hope that the 41st anniversary will be marked with something to celebrate: widespread comprehensive sexual education, improved access to the most effective contraceptive methods, and, ultimately, a reduction in unplanned pregnancies.

Colleen McNicholas, DO, is a Family Planning Fellow at Washington University in St. Louis.

Guest Blog: A Changing Tide—Have New Pap Test Recommendations Taken Hold?
Posted on January 17, 2013

If you’ve been following women’s health news, you know that a lot’s changed recently with Pap screening. Over the last decade, health organizations including ACOG, the American Cancer Society (ACS), and the US Preventive Services Task Force (USPSTF), have been reviewing research to determine how we can best prevent cervical cancer without excessive testing and unnecessary medical intervention.

The latest round of recommendations issued by each of these groups in 2012, building on guidance from ACOG in 2009, is generally consistent. All three organizations agree that for most women, cervical cancer screening should:

  • begin at age 21
  • stop after age 65 or following a hysterectomy in which the cervix has been removed
  • be performed every three years (Pap test only) OR every five years in women over 30 who’ve received negative results on a simultaneous Pap and human papillomavirus (HPV) test

The Centers for Disease Control and Prevention (CDC) recently published two studies looking at the use of Pap testing from 2000 to 2010. Much of what they found was good news and strongly suggests that doctors and patients are increasingly following the new recommendations. Fewer women younger than 21 were tested, and there was less Pap screening of women who had hysterectomy.

Unfortunately, there was also disappointing news. Many women continued to receive unnecessary Pap tests, including more than half of women younger than 21. Given the frequency of HPV infection in this age group, these young women are at significant risk for harms of testing without any expected benefit of cancer prevention. A much better strategy for prevention in this age group is HPV vaccination, but data from other sources suggest only a small portion of eligible women are receiving the full three-shot course of the vaccine. Additionally, 60% of women age 30 and older who had a hysterectomy continued to get Pap testing over this timeframe, according to CDC. Only a few of these women will need continued testing.

The studies also found that women age 22 to 30 who have never been screened increased from 6% to 9%—disturbing data considering most cervical cancer occurs in women who have never been screened or have not been screened in more than five years. Women age 30 to 64 who did not have health insurance were also less likely to be up to date with Pap screening in 2010 than in 2000.

For women to get the best protection against cervical cancer, they should get the HPV vaccine and be screened using the Pap and HPV tests according to ACOG recommendations. Let’s hope that the 2010—2020 summary finds that more women are getting screened according to the recommendations.

David Chelmow, MD, is professor and chair of the department of obstetrics and gynecology at Virginia Commonwealth University Medical Center in Richmond. Dr. Chelmow is a member of The American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology.

A Healthy Weight for Pregnancy
Posted on January 10, 2013

It’s no secret that the US has a weight problem. Roughly two-thirds of us could stand to lose a few (or more) pounds. Today, more than half of all pregnant women in the US are overweight or obese. Maintaining a healthy weight is always important to overall health, but it becomes an even more important vital sign when a woman is pregnant or planning a pregnancy.

Carrying too much weight can throw a wrench in a woman’s reproductive works. Not only can it interfere with getting pregnant, but it can also make pregnancy more difficult once achieved. Overweight and obese women are at increased risk of a number of complications during and after pregnancy, such as high blood pressure, preeclampsia, gestational diabetes, and cesarean delivery. They are at a higher risk of problems related to cesarean delivery—including complications with anesthesia, excessive blood loss, blood clots, and infection. Overweight and obese women also have increased odds of miscarriage, stillbirth, premature birth, or having a baby with a birth defect.

So what’s a woman struggling with weight to do if she wants to achieve the best pregnancy outcome? Losing weight before becoming pregnant is ideal, but that doesn’t always happen. According to new ACOG recommendations on weight gain and obesity during pregnancy, some overweight and obese women may be cleared to gain less weight than typically recommended to reduce risk factors. Gaining less weight during pregnancy may also help with losing extra pounds post-delivery.

If you’re considering getting pregnant in 2013 and are currently outside of a healthy BMI range, it’s not too late to make a New Year’s resolution to lose weight. There are many resources and articles focused on eating right and getting fit at this time of year, so investigate and develop your plan of attack. If you’re already pregnant, be sure to ask your doctor about a healthy amount of weight gain and an exercise plan to help you stay active.

Reach Your Fitness Goals With Health Apps
Posted on January 3, 2013

Nearly half of people in the US make a New Year’s resolution each year. We often vow to lose weight and be more healthy—both noble and important aims to strive for. But if you’ve ever made a resolution, you probably won’t be surprised to find that by the end of January, many people have abandoned their newly set goals.

If you think that expensive trainers or diet plans are the only thing that will help you stick to your resolution, you may want to explore your smartphone first. There are apps aimed at keeping you honest and focused—or at least get you moving in the right direction. Many fitness apps are available to help you track your calories, log daily activity levels, and tailor your routine to get results.

Food tracking apps allow you to keep a detailed log of what you’re eating, often helping you spot patterns in your eating that are sabotaging weight loss (eg, that daily mid-morning doughnut or the twice-weekly buffalo wings at happy hour that regularly push you over your recommended calorie goals). Calorie trackers give you a recommendation for the number of daily calories you need in order to reach your weight goals alongside the actual number of calories you take in on a given day. Some food tracker apps have extensive databases of foods, which make logging calories easier and faster than ever.

To help you maintain your exercise goals, give fitness trackers a try. With these apps, you can log your routes, pace, miles, and different types of workouts. Many allow you to share your activities and progress on social media sites such as Facebook and Twitter, allowing you to engage your support network (friends and family) for encouragement and accountability.

Not sure which app to try? Check out the Huffington Post’s list of the best fitness apps. You can also see what ACOG Fellows have recommended on our Facebook page. Or if you have a food or fitness tracking app that you love, please share it with us in the comments section. We’d love to hear what you’re using and what’s working for you.

Here’s to a healthy and active 2013!

The Battle of the Bloat
Posted on December 27, 2012

For many people, rich and decadent foods are a hallmark of holiday celebrations—and while we all know that egg nog and cookies are not health food, a holiday treat here and there is not the end of the world. But eating too much heavy fare can wreak havoc on the digestive system, especially in women.

Digestive problems such as constipation, diarrhea, heartburn, and gas occur more frequently in women than in men and may be made worse by changes in hormone levels caused by menstruation and pregnancy. Women are also more likely to develop irritable bowel syndrome (IBS), a common digestive disorder marked by persistent abdominal pain and bowel changes. IBS sufferers may have a strong digestive reaction to stress, large meals, caffeine, dairy products, and large amounts of alcohol—typical staples of the holiday season.

Look out for these common problems:

Too many large meals and not enough fiber can lead to constipation. Symptoms may include having fewer than three bowel movements a week, firm or hard-to-pass stools, abdominal swelling or bloating, straining during bowel movements, and a full feeling after a bowel movement. The Fix: Eat at least 25 grams of fiber each day, drink plenty of fluids, exercise, and use the bathroom when you have the urge. Your doctor may also prescribe laxatives or other therapies.

A case of diarrhea—defined as having three or more loose bowel movements in a day—may develop after eating or drinking foods that contain harmful viruses or bacteria. Dairy products, caffeine, artificial sweeteners, certain additives, or medications such as antibiotics can also be a cause. The Fix: Eat hot foods hot and cold foods cold. Skip foods that have been sitting out too long. Drink fluids to keep hydrated, and if diarrhea lasts more than a few hours, drink liquids that contain salt, such as sports drinks or broth. Avoid drinks that include dairy products, caffeine, or sugar, which can make diarrhea worse.

Heartburn—a burning feeling in your chest and throat—can be caused by rich, fatty, or acidic foods; chocolate; coffee; alcohol; mints; and big meals. The Fix: Avoid overeating. Instead of lying down after a meal, try taking a walk.

Gas and bloating can be triggered by hard-to-digest foods, such as beans, broccoli, cabbage, and dairy products (for lactose-intolerant people). The Fix: Pay attention to which foods give you gas and avoid them. An over-the-counter treatment may also help.

It’s OK to enjoy your favorite holiday treats in moderation, just remember to eat a healthy, fiber-rich diet at non-party times. However, if you’ve experienced digestive discomfort or symptoms for at least 12 weeks out of the last 12 months, talk to your doctor. It may be a sign of IBS or a more serious condition, such as colon cancer.

Over the River and Through the Woods = A Good Winter Workout
Posted on December 20, 2012

It’s the time of year when schedules are full of holiday parties and meals, and opportunities for food-and-alcohol-centered merriment abound. It’s also the time when the average adult packs on a sneaky, often unnoticed, pound or two that has a high chance of lingering on your waistline long after the calendar changes over. This is one of the many reasons why it’s so important to make time for fitness.

You may already know the benefits of regular physical activity such as a reduced risk of heart disease, stroke, some cancers, type II diabetes, osteoporosis, high blood pressure, and high cholesterol. It can also improve your ability to perform daily tasks, keep you mentally sharp, and help you avoid injuries. Winter fitness is especially beneficial because it helps with health concerns specific to cold weather:

It boosts immunity. During cold and flu season, exercise can help you dodge the seasonal sniffles. Regular activity appears to boost the immune system, making it easier for your body to handle wintertime germs. Flu vaccination and frequent hand-washing also help keep you healthy.

It staves off holiday spread. Weight gain during the holidays can contribute to the 20–30 pounds that most Americans gain during adulthood. Exercise can help you balance the number of calories that you eat with the number of calories you burn, so you can enjoy some treats without the negative consequences.

It improves your mood. The shorter days of fall and winter cause some women to experience seasonal affective disorder, a condition marked by symptoms such as tiredness, irritability, cravings for complex carbohydrates (such as bread and pasta), and depression. For others, a hard day at work or holiday visits with family and friends can be very stressful. Exercise is one of the best natural antidepressants around and can help relieve stress and anxiety, improve your mood, lower levels of stress hormones, and boost levels of feel-good hormones.

ACOG recommends at least 30 minutes of moderate-intensity exercise (eg, brisk walking or bicycling) on most days of the week to lower your risk of chronic disease, 60 minutes on most days of the week to maintain weight, and at least 60 to 90 minutes a day to lose weight. If you can’t get a full workout in every day, try going for a walk after meals, raking leaves, vacuuming, or taking the stairs. Or winterize your workout with cold weather activities such as ice skating, snow shoveling, or skiing. Any physical activity helps, so fight your inner couch potato this winter and get moving.

Don't Invite Stress Home for the Holidays
Posted on December 13, 2012

The holidays are upon us. Are you joyous and bright? Or would “a heaping pile of stress” be a more accurate description? If you answered the latter, you’re not alone. The frenzy of the holiday season can amplify the everyday stressors we face, such as work, traffic, family obligations, being a caregiver, and the economy.

Stress is your body’s natural response to demand or pressure. While periodic stress is normal and can be good for you—helping you to act quickly, overcome challenges, and boost your immunity—ongoing stress can lead to a number of health problems.

Stress-related spikes in blood pressure may be damaging to blood vessels if they occur too often and can lead to long-term high blood pressure, heart attack, and stroke. Ongoing stress has also been linked to lowered immunity and physical, mental, or emotional symptoms such as headaches, fatigue, insomnia, stomach problems, anxiety, depression, irritability, crying spells, forgetfulness, poor concentration, and low productivity.

The way you handle the inevitable holiday and everyday stressors can make all the difference in your overall health. These helpful tips from National Foundation for Cancer Research may be a good place to start:

  • Plan ahead. Stress can build up if you procrastinate your “To Do List.” Try to accomplish small tasks each day leading up to the holiday. Buying gifts, decorating, and cooking can be much more stressful if done last-minute.
  • Know your limits. Being overwhelmed with events during the holiday season can impede your daily responsibilities. Be sure to practice saying “no” and avoid overcommitting. Don't be afraid to ask for help, and be sure to get a healthy amount of rest.
  • Try to eat nutritious foods and limit sweets during the holiday season. As tempting as it may be, consuming large amounts of unhealthy foods can contribute to decreased energy levels, not to mention feelings of guilt. Try to choose alternative options like whole grains, fruits and vegetables filled with cancer-fighting antioxidants, and lean meats. Still enjoy desserts (it is the holidays, after all), but keep it in moderation.
  • Let things go. Nothing’s going to be perfect. Relax and enjoy time with family, even if a pie burns or someone is disappointed with his (or her) gift. Reconcile the situation, move on, and embrace the holiday cheer!
  • Exercise. Exercise is not only a great way to stay fit and reduce your risk of getting cancer, but it increases your endorphin levels and helps keep you stress-free.

Best wishes for a healthy, happy, and easy holiday season!

A Turn of the Stomach
Posted on December 6, 2012

We heard exciting news out of the UK this week: Prince William and his wife Kate Middleton are expecting their first child. But the excitement was tempered with concern when reports of Middleton’s pregnancy-related hospitalization surfaced. She’s reportedly suffering from hyperemesis gravidarum, a severe form of morning sickness that affects up to 2% of pregnant women.

“Morning sickness” refers to the nausea and vomiting of pregnancy. The phrase is misleading because it’s not confined to the morning—as many pregnant women can attest—but the condition is common in early pregnancy, affecting roughly 70%–85% of pregnant women. Symptoms usually strike without warning and can range from mild, occasional nausea, to severe, continuous nausea with bouts of vomiting. Some women may become nauseated by the smell of certain foods or get sick after eating.

Morning sickness typically begins within the first nine weeks of pregnancy, with symptoms often improving by week 14. What causes morning sickness is unknown, but the surge of pregnancy hormones is a likely factor. Though morning sickness can weaken a pregnant woman’s quality of life, most mild to moderate cases will not harm you or your baby’s health.

More serious problems can arise in women who can’t keep any food or liquids down and begin to lose weight, as is the case with hyperemesis gravidarum. Women who cannot tolerate liquids without vomiting and show signs of dehydration may need to be given intravenous fluids and nutrients in the hospital. The risk of developing hyperemesis gravidarum may be higher if you are carrying multiple fetuses, have a mother or sister who had the condition, are carrying a female fetus, have a history of hyperemesis gravidarum in a previous pregnancy, or have a history of motion sickness or migraines.

Many women assume that morning sickness is a pregnancy rite of passage and avoid telling their doctor about their symptoms or downplay how bad they feel. This is not the time to grin and bear it. Symptoms can get worse over time and it’s often harder to treat morning sickness once it becomes severe. If you can’t keep any food or fluid down for more than a day or are becoming dehydrated, contact your ob-gyn right away.

If you have mild morning sickness, these tips may help:

  • Try vitamin B6 supplements
  • Eat crackers before getting out of bed
  • Drink beverages made from real ginger such as tea or ginger ale
  • Consume smaller nutritious, high-protein meals and snacks throughout the day
  • Get enough rest
  • Avoid foods and smells that make you feel sick.

For more severe cases, anti-nausea medications or a short hospital stay may be necessary.

Learn more.

When Periods Are Heavy and Painful
Posted on November 29, 2012

Five to 15% of girls and women with heavy periods may have von Willenbrand disease (VWD), though most people have never heard of the disorder. 

VWD is an inherited bleeding disorder in which the person doesn’t have enough von Willebrand factor, a protein necessary for blood to clot properly. Both men and women can have VWD, but women often first experience problems when they get their first period.

VWD is not the only cause of heavy periods, so it’s important for your ob-gyn to rule out other potential causes, such as endometriosisuterine fibroids or polyps, or a malfunctioning thyroid.

Women with VWD can have heavy, painful periods that last more than seven days. This is not normal, but women may not realize this because they don’t have anyone to compare it to or because their sisters and mother may also have had heavy periods. It’s important to know that VWD runs in families and often goes undiagnosed.

The disorder may also cause nosebleeds, easy bruising, bleeding after tooth extraction, bleeding from minor cuts, and bleeding gums. Women experiencing such symptoms should talk with their doctor.

A proper VWD diagnosis can help prevent unexpected and serious complications such as postpartum hemorrhage or bleeding after surgery. If a woman is diagnosed with VWD, her ob-gyn should work with a hematologist—a physician who specializes in blood disorders—to coordinate her care.

VWD can be treated, often with hormonal contraception that can make periods shorter and lighter. Other medications to control bleeding are also available. Heavy, painful, and long periods are not normal. Talk with your ob-gyn so you can find some relief.


Strive for a Healthy Body—and Mind—this Thanksgiving
Posted on November 21, 2012

Are you already salivating over the turkey and stuffing? Or maybe you’re a sweet potato casserole person? Or perhaps you’re looking beyond dinner to those pumpkin and pecan pies? Whatever your taste buds crave on Thanksgiving, it’s easy to consume 2,000–4,000 or more calories during our annual feast.

As you gather with family this year, consider ways you can be thankful, healthy, and stress-free during this special time of year. ACOG gathered these six articles to help you aim for a healthier holiday season:

  1. 7 Thanksgiving Diet Disasters to Avoid
  2. 10 Tips for a Thinner Thanksgiving
  3. Simple Food Substitutions to Help Decrease Calories and Fat
  4. Top 5 Ways to Exercise during Thanksgiving
  5. How to Inject More Thanksgiving Gratitude into Our Daily Lives
  6. 6 Breathing Exercises When You Need to De-Stress

Guest Blog: Pregnant Women—Avoid the Flu, Get Vaccinated
Posted November 16, 2012

Preventing flu when you’re pregnant is an essential element of prenatal care, and the best way to do that is to get your annual flu shot. Seasonal influenza is a virus that spreads easily and is most common in the US between October and May, often peaking in February.

It is especially important for pregnant women to be vaccinated because they can become sick enough from the flu that it can lead to severe lung infections requiring hospitalization and preterm delivery. I offer flu shots to all my pregnant patients and those who are considering becoming pregnant. In fact, ACOG and the Centers for Disease Control and Prevention recommend that everyone older than six months of age receive the flu vaccine every year.

It’s important that pregnant women get the flu shot, not the nose spray version of the vaccine, which contains a live attenuated virus. The flu shot is safe for pregnant women and their unborn child during any trimester; it is also safe after delivery and for breastfeeding women. Flu vaccination will not only protect new mothers but can provide protection to their babies in the first six months of their life. Family members, caregivers, and others who will be around the baby should also be vaccinated.

Ob-gyns should offer the flu shot to all their pregnant patients. During pregnancy, the flu shot is the best protection there is against serious illness from seasonal influenza.

The flu vaccine is now widely available at doctors’ offices, clinics, pharmacies, and health departments. To find a vaccination location near you, see this HealthMap Vaccine Finder.

For more information about the flu vaccine, other vaccine-preventable diseases, and the immunization needs of special populations, visit ACOG’s Immunization for Women website.

Laura E. Riley, MD, is chair of The American College of Obstetricians and Gynecologists’ Immunization Expert Work Group. Dr. Riley is director of Labor and Delivery at Massachusetts General Hospital in Boston.

Guest Blog: Urgent News! Tips to Keep Your Bladder Healthy
Posted November 8, 2012

Most of us don’t spend much time thinking about the bladder. Normally working to store urine until the socially appropriate time to eliminate it, the bladder largely goes ignored until things go awry, whether it’s accidental leakage, a strong urge to go that interrupts our sleep and daily activities, or pain and infections.

Enter National Healthy Bladder Week (NHBW) November 12–16. As an ob-gyn who specializes in correcting problems such as urine leakage, I don’t think one week is enough time to devote to this extremely important organ, but it’s a start. During NHBW, my goal is to raise awareness of common bladder problems and educate women on ways to maximize their bladder health.

Here are two questions I get a lot from my patients:

What is urinary incontinence and how is it treated?

An estimated 13 million Americans—mostly women—suffer from urinary incontinence, aka–urine leakage. Making the correct diagnosis is the first step in treating this condition. The three main types of bladder control issues are:

  • stress incontinence (leakage associated with laughing, coughing, and sneezing)
  • urge incontinence or overactive bladder (leakage associated with the urge to urinate and not making it to the bathroom in time) and
  • mixed incontinence, which encompasses aspects of both types.

For stress incontinence here are three things beyond Kegels (pelvic-floor strengthening exercises) that I suggest:

  • Lose weight—Studies have found that for each five points of increase in body mass index (BMI), the risk of urinary incontinence increases 20% to 70%. A 10% decrease in BMI has been shown to reduce the incidence of incontinence by greater than 50%.
  • Try a pessary—When placed in the vagina, these diaphragm-type devices press against the urethra and block urinary leaks.
  • Sling surgery—This outpatient procedure can cure stress leakage by up to 86%, and there is excellent long-term data on safety and effectiveness. An experienced surgeon should perform this operation.

For urge incontinence, start with behavioral modifications like limiting your liquid intake and just drinking to thirst (preferably caffeine-free beverages). A recent clinical trial found that Botox® injections in the bladder were very effective for overactive bladder. Women in the Botox® group were twice as likely as those taking daily medication (27% vs. 13%) to report complete resolution or cure of their incontinence problem. These findings are promising, especially for women who might better tolerate or prefer one bladder injection per year than one pill a day.

How do I prevent bladder infections?

Most of us will suffer at least one urinary tract infection (UTI) during our lifetime. Help prevent UTIs by:

  • drinking enough fluid so that your urine is a light yellow/lemonade color
  • urinating before and after sexual intercourse and
  • for menopausal women with vaginal dryness, talking to your doctor about low-dose vaginal estrogen to restore vaginal pH and prevent bacterial overgrowth that can lead to UTIs

Cheers to you and your healthy bladder!

For more information:

Visit the American Urogynecologic Society’s consumer website to learn about incontinence and other pelvic floor disorders.

The National Association for Continence offers an Absorbent Product resource guide comparing products for light bladder leakage.

Cheryl B. Iglesia, MD, is an associate professor in the departments of ob-gyn and urology at MedStar Washington Hospital Center and Georgetown University School of Medicine in Washington, DC. Dr. Iglesia is also a member of ACOG’s Patient Education Editorial Board.

Guest Blog: Why Expanding Medicaid Matters for Women
Published October 31, 2012

Gerald F. Joseph, MDMany women in the United States do not have health insurance. As a result, they don’t get the health care they need and their health suffers. Compared to women with health insurance, uninsured women are: 

  • * Less likely to receive preventive care or treatment for disease.
  • * More likely to be diagnosed with cervical and other cancers at a late stage and die from the disease or its complications due to a delay in diagnosis.
  • * Less likely to get prenatal care during pregnancy. The babies of uninsured women are also more likely to be born with a low birthweight and die within the first year of life.
  • * Less likely to use a prescription contraceptive, which can lead to unintended pregnancy.

The Affordable Care Act (ACA) can help. It expands Medicaid—the state-federal health insurance program for low-income individuals—which is one of the health care reform provisions that ACOG supports. The percentage of uninsured women ages 19–64 could decrease from 20% to 8%, but this will happen only if all 50 state governors decide to expand their Medicaid programs. ACOG encourages all states to accept this expansion offer, under which the federal government will pay all the costs until 2016. After that, the federal contribution gradually drops, but only to 90% in 2020 and beyond.

The ACA also makes it easier for states to provide Medicaid birth control coverage to low-income women by eliminating bureaucratic red tape.

With Election Day approaching rapidly, I encourage you to find out what the candidates in your state support. Use your vote to make it clear to your state lawmakers that expansion of Medicaid is good for women’s health.

For more information:

Gerald F. Joseph Jr, MD, is ACOG vice president for practice activities.

Guest Blog: The Recipe for Preventing Unintended Pregnancy
Posted October 25, 2012

Ob-gyns are on the front lines of the effort to decrease the rate of unintended pregnancy, which accounts for half of all pregnancies in the US. Now, we have more information about how we can best accomplish this goal. 

Recent findings from the Contraceptive CHOICE Project made news headlines, and for good reason. The project—which included more than 9,000 contraception-seeking adolescents and women in the St. Louis region who were at risk for unintended pregnancy—found that the rate of unintended pregnancy dropped with just two simple interventions. Women were given:

  1. A short contraceptive counseling session that covered all methods of reversible contraception and emphasized the superior effectiveness of long-acting reversible contraception (LARC) methods: intrauterine devices (IUDs) and hormonal implants.

  2. The contraceptive method of their choice for free.

Seventy-five percent of the women selected a LARC method. Among all the women, there were lower rates of abortion, including repeat abortion, and lower rates of teen births. These findings support ACOG’s recommendations on the use of LARC methods as first-line contraceptive options to reduce unintended pregnancy and highlight the benefits of providing women with no-cost access to contraception.

ACOG advises ob-gyns to:

  • Provide counseling on all contraceptive options, including implants and IUDs, even if the patient initially states a preference for a specific contraceptive method
  • Encourage implants and IUDs for all appropriate women, including those who’ve never given birth
    Adopt same-day insertion protocols. Screening for STIs may also occur on the day of insertion, if indicated
  • Avoid unnecessary delays to LARC initiation, such as waiting for a follow-up visit after an abortion or miscarriage or waiting to time insertion with the menstrual cycle
  • Advocate for coverage of all contraceptive methods by all insurance plans
  • Support local, state, federal, and private programs that provide contraception, including IUDs and implants

The problem of unintended pregnancy in the US is not going away. As ob-gyns, we are uniquely positioned to help women avoid unintended pregnancies. Let’s work with our patients and help them make the best choices for their reproductive health.

Erika E. Levi, MD, MPH, is a Family Planning Fellow at the University of North Carolina at Chapel Hill.

Placenta Problems during Pregnancy
Posted October 18, 2012

How much do you know about the placenta? If you’re like most people, probably not much. But for the millions of women in the US who become pregnant each year, the placenta becomes a very interesting organ.

The placenta forms during pregnancy and serves as the life support system for a growing baby. It supplies the baby with oxygen, nutrients, and hormones, removes waste products through the umbilical cord, and is vital for a healthy pregnancy and delivery. In some pregnancies, problems with the placenta occur that can endanger mother and baby.

You may have recently heard about placenta previa, a condition that threatened actress Tori Spelling’s fourth pregnancy. Roughly 1 in 200 pregnant women will experience this potentially serious complication. Blood vessels attach the placenta to the uterus. In women with placenta previa, the placenta lies low in the uterus and may partially or completely cover the cervix, blocking the baby’s exit from the uterus. Placenta previa can also cause excessive bleeding in the mother when the cervix begins to thin and open in preparation for delivery. The risk of developing placenta previa is higher in women who’ve had more than one child, a cesarean delivery, surgery on the uterus, or who are carrying twins or triplets.

Roughly 1% of women will experience placental abruption—the detachment of the placenta from the uterus before or during birth. Placental abruption deprives the baby of oxygen and can cause the mother to lose large amounts of blood. Symptoms may include vaginal bleeding and severe abdominal or back pain. Placental abruption usually occurs in the last 12 weeks of pregnancy and is more common among women who have high blood pressure, smoke, or use cocaine or amphetamines during pregnancy. Women who’ve had a previous placental abruption, have had children, are older than 35, or have sickle cell disease are at higher risk.

Placenta accreta occurs when the blood vessels that attach the placenta grow too far into the uterine wall. The condition can cause bleeding during the third trimester of pregnancy and severe, life-threatening blood loss during delivery. Previous cesarean delivery is the main risk factor for placenta accreta, and the risk increases with each cesarean a woman has had.

If you experience bleeding during pregnancy, talk to your doctor right away. It may be related to a placental problem that requires prompt treatment. Learn more about placenta problems during pregnancy.

Guest Blog: Taking on the Obesity Epidemic
Posted on October 11, 2012

20121011BlogMost women in the US struggle and are frustrated with weight control. Obesity rates are at an all-time high not just for adults, but now also for children. The clear nationwide progression in weight gain despite accompanying growth in the weight-loss industry underscores the need for physicians to get more actively involved. It is absolutely vital that we equip ourselves with the tools and knowledge to effectively reach patients who are overweight or obese.
A body mass index (BMI) of 25 to 29.9 is considered overweight, while a BMI of 30 or higher is considered obese. The health hazards of high BMI are well known and include diabetes, heart disease, high blood pressure, and stroke. Less known is the fact that obese women are also at a far greater risk for numerous types of cancer, including esophageal, pancreatic, colorectal, postmenopausal breast, endometrial, ovarian, and renal.
It is estimated that more than 60% of adults are now overweight and obese. Unfortunately, there are indications the situation could get even worse. A new report from the Robert Wood Johnson Foundation and Trust for America’s Health reveals that based on current trends, most Americans could be obese within the next two decades.
The cost to society in dollars must also be considered. The Centers for Disease Control and Prevention reports that in 2008 alone, medical costs associated with obesity were estimated at $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight. All of this is sobering news—but news that must be considered as we work together to help our obese patients find success through a healthier lifestyle.
Women rely on us for guidance, and ob-gyns are in an ideal position to help educate and direct women toward a healthier lifestyle. I am happy to be working with ACOG colleagues from across the country on a soon-to-be-launched initiative addressing women and obesity. Our goal is to provide ACOG members with educational and clinical information on the impact of obesity in our field, along with useful tools to share with patients so we can address this national epidemic.
Eva Chalas, MD, FACOG, FACS, is chair of ACOG District II (New York). She is director of clinical cancer services, vice-chair, Department of Obstetrics and Gynecology and chief in the Division of Gynecologic Oncology at Winthrop-University Hospital. Additionally, Dr. Chalas serves as a professor at Stony Brook University School of Medicine.

The Truth about Breast Cancer
Posted October 4, 2012

During National Breast Cancer Awareness Month (NBCAM) in October, health organizations, advocacy groups, and women and men across the country shine a spotlight on the second leading cancer killer of women. Raising the visibility of breast cancer and how to both prevent and detect it has helped fuel a steady decrease in death rates since the 1990s. More women are getting mammograms—one of the best weapons for detecting breast cancer—and earlier treatment. But despite increased attention, fears and misconceptions about the disease remain

A recent Health magazine study of women and ACOG Fellows shows that women are receiving mixed messages about how to best reduce their chances of developing breast cancer. For example, 63% of women think family history is the biggest breast cancer risk factor. In actuality, most people with breast cancer do not have a family history of the disease, but do have the two biggest risk-increasing factors: being female and getting older.

With so much misinformation, it’s important to continue educating women about prevention and detection strategies that work. ACOG recommends that women begin annual mammography screening at age 40. Lifestyle changes such as achieving and maintaining a healthy body weight, avoiding alcohol, and exercising have also been shown to reduce risk.

The truth is, you can wage your own war against breast cancer during NBCAM and throughout the year. Learn more about lowering your risk here.


Guest Blog: Prevent Teen Pregnancy on a LARC
Posted September 27, 2012

PhotoIn my Chicago clinic I see a lot of adolescents, and by extension, I prescribe a lot of contraception. Although, by “prescribe contraception” I actually mean “place IUDs and implants,” which, until recently, had been considered a fairly edgy clinical practice in some circles. Imagine my excitement, then, over ACOG’s latest recommendations from the Committee on Adolescent Health Care and the Long-Acting Contraception Work Group that encourage us to offer these two contraceptive methods as first-line options for sexually active teens.

Family planning specialists have long known that long-acting reversible contraception (LARC) devices are safe for adolescents and are significantly more effective at preventing pregnancy when compared with other forms of short-acting contraception, such as pills, patches, or vaginal rings. In fact, a recent study found that women using a LARC device were 20 times less likely to experience an unplanned pregnancy than women using short-acting methods. This is hugely important considering that:

- 82% of adolescent pregnancies are unplanned
- 20% of adolescent mothers will experience a second pregnancy within two years of their first pregnancy
- Condoms are the most common method of contraception used by adolescents. While still important for preventing sexually transmitted infections (STIs), they are the least effective contraceptive method for preventing pregnancy.

LARC methods work better than short-acting ones because there’s no user error. As I tell my patients, a pack of pills only works if you’re actually taking them. Also, the continuation rates are better—in that same study, 86% of adolescents using a LARC device were still using it a year later, compared with 55% of those using a shorter-acting method.

And LARC methods are very safe for adolescents:

- IUD expulsion is uncommon in adolescents
- There is no increased risk of infertility for IUD users
- Any increased risk of pelvic inflammatory diseases (PID) is limited to the first 20 days after insertion of an IUD and is related to infection at the time of insertion rather than the IUD itself. This is another important reason ob-gyns should screen all their patients under 25 for chlamydia and gonorrhea annually.
- IUDs and implants can be placed immediately post-delivery or post-abortion
- IUDs and implants can decrease menstrual blood loss and decrease anemia, a plus for many teens

So make sure LARC methods are at the top of your list when you’re counseling adolescent patients. For many teens, LARC devices—combined with condoms for STI prevention—are the best way to ensure they get on the right reproductive track early.

Elisabeth J. Woodhams, MD, is a Family Planning Fellow at the University of Chicago in Illinois.

Keeping It Sexy during Menopause
Posted on September 20, 2012

While hot flashes typically top a woman’s list of menopausal concerns, they are not the only disruptive symptom of menopause. For some women, menopause also brings unpleasant and unexpected sexual changes—such as a decreased sex drive or pain during sex.

It is not uncommon for women to occasionally encounter problems with sex throughout their lifetime. Studies suggest that 35%–45% of women believe they have sexual problems that make sex difficult. While sexual function can be affected by many things, hormone fluctuations are often the culprit. During menopause, loss of estrogen leads to increased vaginal dryness, thinning of vaginal tissue, decreased interest in sex, and more difficulty reaching orgasm. These complications can make sex painful or cause women to avoid intimacy. But here’s the good news: menopause is no sentence for a sexless life.

If you are experiencing sexual troubles, talk to your doctor. He or she can assess what may be causing the problem and suggest changes for you and your partner, such as trying a water-soluble lubricant to combat vaginal dryness. Hormone therapy may also be a good solution for some women.

A healthy sex life can have a positive impact on a woman’s quality of life. Don’t ignore problems in the bedroom. Speak up and get your groove back.

How We Can Help Prevent Suicide
Posted on September 13, 2012

Nearly 40,000 Americans—one person every 15 minutes—committed suicide in 2009. This is the highest rate recorded in 15 years and one that continues to increase. And contrary to popular belief, teens aren’t the only age group at risk. The highest rate of suicide among women occurs between the ages of 25 and 64. Although more men commit suicide each year, women are three times more likely to attempt suicide than men.

This week, the US surgeon general announced a new plan to battle suicides nationwide, with the goal of saving 20,000 lives over the next five years. The plan includes $55 million in grants for state and community prevention programs. Individuals can also play a big part in reducing suicide. Friends, family, and coworkers may have an opportunity to spot a problem, provide support, and get their loved one the help they need.

Would you recognize the warning signs that someone may be contemplating suicide? They may include:

  • Talking about killing or harming themselves
  • Trying to access guns, pills, or other items to inflict self-harm
  • Expressing hopelessness or feeling that they have nothing to live for
  • Sleeping too much or too little
  • Drastically changing some behaviors
  • Increasing drug or alcohol use
  • Showing rage or talking about revenge

Suicide is a tragedy that affects women of all races and ages, their friends, families, and communities. If you or someone you know is experiencing emotional distress, don’t brush it off. Tune in, take it seriously, and seek help as soon as possible.

To find suicide support and resources, visit the National Suicide Prevention Help Line website or call 800-273-TALK (8255).

Guest Blog: Women and Alcohol–Think Before You Drink
Posted on September 6, 2012

David J. Garry, DO

As an ob-gyn taking care of women every day, it’s not uncommon for one of my patients to tell me, “I just have some shots and beers on the weekend—what’s the harm in that? All my friends do it.” However, what a patient may consider “normal” drinking could put her health at great risk now and in the future.

Women who drink too much often end up losing out. Judgment becomes clouded. They may have accidents and car crashes. If the drinking continues, they may lose their job, their friends, their family, and other things they hold dear. Women who drink and have sex without using birth control are at risk for becoming pregnant and having an alcohol-exposed infant. Sunday, September 9, is International Fetal Alcohol Spectrum Disorders (FASDs) Awareness Day. Alcohol use during pregnancy is the greatest preventable cause of mental retardation in children. Children exposed to alcohol during pregnancy may also have problems with coordination, controlling emotions, socialization, decision-making, understanding consequences of their actions, and more.

The amount of alcohol in a drink can vary widely. A 12-ounce can of beer, 5-ounce glass of wine and 1 ½-ounces of hard liquor (rum, tequila, vodka, etc.) all contain the same amount of alcohol. But, just one martini or margarita could actually have three servings of alcohol in it. Risky drinking for women is defined as more than three drinks per occasion or more than seven drinks a week.

If it takes a woman more than two drinks in one hour to feel tipsy, she may be developing a tolerance to alcohol, a strong sign of problem drinking. Other signs include:

  • Friends and family telling her that she drinks too much
  • Her own personal feelings that she needs to cut down on drinking
  • Her needing or wanting a drink the morning after a night out to relieve a hangover

Do not drink any alcohol if you are pregnant, trying to become pregnant, taking medications that warn of alcohol use on the label, or have medical conditions in which alcohol use can cause further harm. If you drink, use birth control exactly as prescribed, and if you miss a pill, use condoms until your next period. Be smart and learn your safe limits.

David J. Garry, DO, is co-director of obstetrics and maternal-fetal medicine and associate professor of clinical ob-gyn, Montefiore Medical Center/Einstein College of Medicine, Bronx, NY.

It’s a Family Affair
Posted on August 30, 2012

This week, the American Academy of Pediatrics (AAP) released an updated statement on male circumcision. ACOG endorsed the new guidance, which found that the health benefits—such as a lower risk of contracting HIV and other sexually transmitted diseases, penile cancer, cervical cancer in sexual partners, and urinary tract infections in the first year—outweigh the risks of the procedure.

For many families, circumcision carries both religious and cultural significance. While routine circumcision is not recommended for all newborn boys, AAP reiterates—and ACOG agrees—that the final decision lies with the parents. No matter what you decide, it’s important to discuss your family’s wishes before the baby is born and convey them to your doctor.

Workout to Prepare for Baby
Posted on August 23, 2012

Pregnant or planning a pregnancy? If so, how have you worked exercise into your prenatal care? During pregnancy, exercise can reduce backaches, constipation, bloating, and swelling; boost mood and energy; promote muscle tone, strength, and endurance; and improve sleep quality. It can reduce the risk of gestational diabetes, too. Pregnant women who exercise may also have an easier time with labor and delivery and weight loss after childbirth.

Most pregnant women should aim for 30 minutes of moderate-intensity exercise on most, if not all, days of the week. Contrary to what you may have heard, there’s no magical heart rate or beats per minute threshold for pregnant women during exercise. Just keep in mind that if you can’t talk at normal levels at all times, you may be working too hard and need to reduce your intensity. Talk to your doctor before beginning or continuing an exercise program to be sure you don’t have any health problems that would limit your activity.

A few tips to remember:

  • Gentle exercise such as walking, swimming, cycling, or low-impact or water aerobics is suitable for exercisers of all levels.
  • Avoid contact sports and activities that could injure your abdomen such as soccer.
  • Skip activities that come with a high risk of falling, such as downhill skiing, horseback riding, or vigorous racquet sports.
  • Stop exercising and call your doctor if you experience dizziness or feel faint, increased shortness of breath, uneven or rapid heartbeat, chest pain, trouble walking, vaginal bleeding, calf pain or swelling, headache, uterine contractions that continue after you rest, fluid leaking or gushing from your vagina, or decreased fetal movement.
  • Be sure to wear comfortable clothes and a supportive bra and shoes.
  • Drink plenty of water to avoid dehydration and overheating.

Getting moving is the most important part, so pick an activity you enjoy and have fun! Read more about exercise during pregnancy in ACOG’s Patient FAQ.

Guest Blog: A Global Focus on Maternal Mortality: Saving Mothers, Giving Life
Posted on August 16, 2012

Blog PhotoFor most families, the arrival of a new child is a joyous and celebrated occasion. However, in many countries in the developing world, having a baby can be a dangerous undertaking: Approximately 800 women die during childbirth each day; 99% of all maternal deaths occur in the developing world. The loss of a mother is a tragedy for her family and her community.
Imagine you are a physician in rural Uganda: You know there is a high-risk patient who lives in a village several hours away from your regional hospital. She has no transportation, no running water, no electricity, and no cell phone access. Despite the fact that you have the skills to assist in a safe delivery, the barriers to access will likely prevent this woman from coming to the hospital, greatly increasing the chance she will die in childbirth.
Complications that cause most maternal deaths in the developing world are severe bleeding, high blood pressure, obstructed labor, and infections. Our challenge and our hope is this: We have proven life-saving interventions routinely used in the US and other industrialized nations to prevent these deaths. And while they have the potential to dramatically improve maternal outcomes, it has been very difficult to implement these interventions in low-resource settings.
We now have a wonderful window of opportunity with a groundswell of support to develop initiatives to improve maternal and infant health. The American College of Obstetricians and Gynecologists (The College) is playing an integral role in Saving Mothers, Giving Life (SMGL), an innovative public-private partnership that aims to reduce maternal mortality in the developing world. As a founding member of SMGL, The College has joined with the governments of US and Norway, Merck for Mothers, and Every Mother Counts to dramatically accelerate progress in preventing maternal death. Work has already begun in Uganda and Zambia with a goal to reduce the number of maternal deaths by up to 50% in a year, and plans are under way to expand our reach into other developing nations disproportionately affected by maternal mortality.
I’m both honored and excited to represent The College and be a part of SMGL. This coalition has a unique opportunity to make a difference. I firmly believe we can and we will. Watch for updates and opportunities on The College website to get involved in these important initiatives.

“I Don’t Get It”—How Not to Miss the Point at Your Next Doctor Visit
Posted on August 9, 2012

“You know what I mean?” It’s a common phrase that many of us use every day. We check in to confirm that our listener gets our point. Understanding and being understood are integral to daily communications with others. Yet, in the doctor’s office, misunderstandings are not uncommon, and can result in life or death situations.

Nearly half of all Americans, including highly educated people, have a hard time understanding health information. Patients who don’t fully understand their health condition, treatment options, or the importance of taking medication as directed may be in for trouble. They are at increased risk for hospitalization, encounter more barriers to getting necessary health care services, and are less likely to understand their doctor’s medical advice, which can lead to poor outcomes, including death. Better comprehension of health-related information and services—or health literacy—can lead to better health decision-making and overall well-being.

Getting physicians to speak in plain English is one part of the equation. To that end, ACOG and the American Medical Association have developed guidance for health professionals to help them better communicate with their patients.

Patients can also do their part to improve their understanding. Try the following tips at your next doctor’s visit:

  • Ask your doctor to speak in simple and plain language
  • Consider bringing a friend or relative with you who can help you interpret and remember what your doctor said
  • Take careful notes throughout your visit and read them back to your doctor to make sure you fully understand what’s been said and what you’re supposed to do after the visit
  • If you’re confused by something, don’t be afraid to ask your doctor to repeat the information

For more tips, check out ACOG’s Patient Fact Sheet “Making the Most of Your Health Care Visit”.

Prenatal Screenings: Spot Health Risks Before Birth
Posted on August 2, 2012

During pregnancy, ob-gyns use routine lab and diagnostic tests to help monitor the health of women and their babies, identify problems, and develop treatment plans. Most women will receive these common screenings as part of their prenatal care:

  • Blood glucose tests screen for the amount of sugar (glucose) in the bloodstream. High levels can signal diabetes. Unchecked diabetes can lead to liver damage, birth defects, stillbirth, and other complications for mother and baby.
  • Blood type and antibody testing determines a woman’s blood group (A, B, AB, or O) and Rh type (positive or negative). Fetal problems may occur when an Rh negative woman carries a fetus that is Rh positive.
  • Screening for birth defects (such as Down Syndrome) may be performed in the first and/or second trimester.
  • Late in pregnancy, women are tested for group B streptococcus (GBS) bacteria, which can cause infections of the blood, lungs, brain, or spinal cord in infants. GBS can be transmitted from an infected mother to the baby during delivery.
  • Hemacrit and hemoglobin tests check the blood for low iron levels (anemia).
  • HBV testing screens for Hepatitis B, a virus that affects the liver and can cause severe complications in newborns if passed from mother to baby.
  • All pregnant women should be screened for HIV infection—a disease that attacks the body’s immune system. Treatment of HIV-positive mothers during pregnancy can drastically reduce the risk that the infants will become infected and help improve the mother’s health.
  • A blood test is used to check for signs of past rubella (German measles) infection. Pregnant women who have not had or not been vaccinated against rubella should avoid any infected individuals and be vaccinated after delivery.
  • Screening for sexually transmitted diseases, such as chlamydia, gonorrhea, and syphilis, may be recommended. They can cause preterm birth, miscarriage, eye infections, birth defects, or other problems.
  • At each prenatal visit, urine analysis checks for elevated blood sugar and protein levels and signs of bladder and kidney infections.

Depending on a woman’s age, health history, or ethnic background, additional screenings may be offered for genetic disorders and birth defects, such as cystic fibrosis or spina bifida. Learn more about prenatal screenings on ACOG’s website.

HIV/AIDS: Looking Back to Move Forward
Posted on July 26, 2012

For the first time in more than two decades, HIV/AIDS researchers and activists are convening in the US for this week’s International AIDS Conference. American attitudes toward HIV/AIDS have changed significantly since this conference was last held on our soil. Fortunately, education and awareness efforts have helped tame fear and misconceptions about the disease. However, the growing number of people with HIV/AIDS who go on to live long and healthy lives has given way to complacency as many people start to assume the worst is over.
Make no mistake, HIV/AIDS still takes a great toll on Americans. More than 1.2 million people in the US are living with HIV, with approximately 50,000 new HIV infections occurring each year. Women account for more than 25% of new infections, mostly as a result of heterosexual contact. Women of color are particularly hard hit.
Screening is key to prevent the spread of HIV. ACOG recommends that all women age 19–64 be regularly screened for HIV. HIV screening is especially important for pregnant women and those planning pregnancy. Increased prenatal testing, treatment of HIV+ pregnant women and their newborns with antiretroviral medications, and avoidance of breastfeeding have helped drastically reduce transmission of the virus to newborns to less than 1%. Additionally, researchers continue to make advances with medical therapies to suppress and prevent HIV.
Though the pandemic continues, the feeling in the lead-up to the International AIDS Conference is one of hope that a cure is within reach. I share the optimism and hope that the conference will remind Americans that prevention, screening, and early treatment are vital to beating HIV/AIDS and that, most importantly, the battle is not yet won.

Understanding PCOS
Posted on July 19, 2012

Approximately 4% to 6% of women in the US have polycystic ovary syndrome (PCOS), a serious disorder that can make it hard to become pregnant and can lead to other severe health problems. The causes of PCOS are unknown, and many women may not recognize the seemingly unrelated symptoms—irregular periods, being overweight, and having extra facial hair—as signs of a serious health problem.

So what happens in women with PCOS? Unlike normally functioning ovaries which release a single mature egg every month, polycystic ovaries have many eggs that do not get released. This leads to a hormonal imbalance that can cause irregular menstruation and infertility. Women with PCOS also have higher than normal levels of male hormones (androgens). Excess androgens can disrupt ovulation and cause acne and hair growth on the face, the lower part of the abdomen, between the breasts, and on the inner thighs. Women with severe PCOS may experience balding and develop bigger muscles and a deeper voice.

Up to 80% of PCOS sufferers are obese, and they often have difficulty regulating blood sugar and insulin, the hormone that lowers blood sugar. These problems may lead to an increased risk of diabetes, high blood pressure, and heart disease.

Though PCOS cannot be cured, it can be treated, and its symptoms can be relieved. Overweight women benefit from exercising for at least 30 minutes a day and losing weight. Dropping even 10–15 pounds may improve symptoms such as menstrual irregularity, high levels of insulin and cholesterol, acne, and excess hair growth. Less insulin can stimulate ovulation and slow undesired hair growth. Birth control pills to regulate your menstrual cycle or medication to control insulin may also be prescribed. For those who want to become pregnant, medications can be used to induce ovulation.

For more information about PCOS, check out ACOG’s Patient FAQ.

Plan for the Unexpected
Posted on July 12, 2012

You may have heard the statistic that roughly half of all US pregnancies are unplanned. As ob-gyns, we worry about this number because many women discover that they are pregnant before they’ve had a chance to make lifestyle changes from which they and their developing fetuses can benefit. The days that immediately follow conception are some of the most important in the development of a child, so it’s never too early to prepare for a healthy pregnancy, birth, and baby.

ACOG encourages all reproductive-aged women to talk to their doctors about preconception care whether actively trying to have a baby or not. You can discuss your desire for children, the optimal time to have them, the amount of space you’d like between pregnancies, and your current birth control needs. Your doctor can also review personal health information that could affect a future pregnancy, such as family medical history, environmental and work-related exposure to harmful substances, the risk of sexually transmitted infections, and substance abuse.

If you are considering having children, your doctor may suggest some changes before you conceive:

  • Enrich Your Diet. Folic acid and other vitamins and minerals are vital for healthy fetal development, but most women do not receive enough of these nutrients in their diets. It’s a good idea to begin taking a prenatal vitamin before pregnancy.
  • Get Enough Exercise. If you do not currently get at least 30 minutes of exercise on most days, your doctor may recommend that you increase activity now for a more active and comfortable pregnancy later.
  • Achieve a Healthy Weight. Being overweight can cause high blood pressure and diabetes, put extra stress on your heart, and increase the chance of having a very large baby. Underweight women may find it difficult to conceive and are at risk of delivering low-birth-weight babies. Aim to fall into the normal BMI range for your height.
  • Control Preexisting Medical Conditions. Women with medical conditions such as diabetes, high blood pressure, seizures, heart disease, or obesity may need special care during pregnancy or may be using medications that are harmful to fetuses. Try to get your condition under control and discuss the safety of all current medications with your doctor.
  • Confront Substance Abuse. Smoking, drinking, and using illegal drugs have been proven to cause birth defects in newborns. Women contemplating pregnancy should not use these substances.

A Guide to Midlife Health
Posted on July 5, 2012

“Keeping women healthy for a lifetime.” This may sound like a marketing tagline for ob-gyns, but it’s really more like a job description. It’s what we try to do in our practices day in and day out. We see our patients through transitions big and small—among these, adolescence, pregnancy, and menopause.

The changes that occur during the time surrounding menopause rival those experienced during puberty. Raging hormones, physical changes, bone concerns, and a menstrual cycle that is more like a rollercoaster in some cases, can seemingly turn the world upside down. It’s enough to throw a normally pulled together and in-control woman into a tailspin.

As a doctor, I try to provide my patients with helpful resources that they can use to educate themselves and complement the conversations we have during our routine health visits. One fantastic resource is pause magazine. The publication, along with its website——is dedicated to maintaining and improving health leading up to, during, and following menopause.

The newly released spring/summer issue covers a range of health concerns most important to women in midlife, from advice on dealing with hot flashes, maintaining bone health, and keeping the brain sharp to tips on losing weight, saving money on health care, finding the right bra, and keeping the love alive in your marriage.

If you’re approaching menopause or know someone who is, this is a resource too valuable to miss. I invite you to take a look.

Health Care Hope for Millions after Supreme Court Ruling
Posted on June 28, 2012

The lead up to the US Supreme Court's decision on the Affordable Care Act (ACA) has been a bumpy road at best. But beneath all the rhetoric and partisanship surrounding the ACA lies a solemn and unfortunate truth: Too many Americans are uninsured, and lives are being lost because of it. An estimated 18,000 Americans between the ages of 25 and 64 die prematurely each year because they lack health insurance. The uninsured receive less preventive care, disease diagnoses at more advanced stages, and fewer medical interventions post-diagnoses than people with insurance.
The ACA is important and necessary legislation. It helps ensure insurance reforms that guarantee availability and renewability, prohibit preexisting condition exclusions, and prohibit gender rating—insurance reforms that will work best under an individual mandate. Beginning in 2014, the ACA prohibits new insurance plans from denying women coverage on the basis of pregnancy, previous cesarean delivery, history of domestic violence, or other preexisting medical conditions. These protections are landmark improvements in women's health. The ACA also guarantees women direct access to obstetric and gynecologic care. My own state of Nevada and 42 other states already allow direct access—now, with this new national ob-gyn direct-access standard, all women in every state will no longer face costly and burdensome delays and denials.
Today's Supreme Court ruling affirming the constitutionality of the ACA is a victory for women indeed. It gives the US Congress the opportunity to act now to improve the legislation to ensure that America's practicing physicians are able to provide quality health care for all. ACOG supports the many elements of the ACA that have enormous potential to improve women's health, and we urge all states to act swiftly to implement these important access and coverage guarantees.

Guest Blogger: Owen C. Montgomery, MD, ACOG Fellow-at-Large
Posted on June 26, 2012

I'm Dr. Owen Montgomery, a practicing ob-gyn in Philadelphia, and I was recently elected Fellow-at-Large to ACOG's Executive Board. This is a new position, and I'm extremely lucky and excited to be involved in molding how the Fellow-at-Large can have an impact on members and women alike.
The Fellow-at-Large is intended to fill a void. While most Fellows are represented by district (regional) and section (statewide) ACOG leadership who can voice their concerns to the Executive Board, some Fellows do not have representation. This includes ob-gyns outside of our established districts and sections and international ob-gyns from certain regions. In addition, there are ACOG members who are not Fellows, but educational affiliates or associate members who are our collaborative partners in women's health. I will be an ear attuned to the needs of these Fellows, helping them to become more engaged in ACOG and bringing the needs of their patients to light.
Being a liaison for our international colleagues dovetails with my deep personal interest in global women's health. One of ACOG's missions is to provide support to colleagues who care for women around the world. As part of this effort, ACOG recently attended the “Bilateral Collaboration to Improve Women's and Infants' Health” forum with our colleagues in Russia.
Just like us, these physicians are passionate about doing the best for their patients. They have made tremendous strides in advancing the quality of ob-gyn care available to Russian women over the last 10 years and building stronger doctor-patient relationships. ACOG has signed an agreement that will allow for collaboration with our Russian counterparts—granting them access to ACOG documents, helping to expand their knowledge, introducing them to new and cutting-edge techniques, and building on what we've learned at ACOG to address the problems that women encounter in their corner of the world.
As I continue as Fellow-at-Large, I'd like to hear from ACOG Fellows out in the field, about your patients and the challenges you face. Email me at, and let's explore the ways that ACOG can help. Let's work together to find solutions for our patients and practices.

Dr. Montgomery is chair of the department of obstetrics and gynecology at Drexel University College of Medicine in Philadelphia. A specialist in female pelvic reconstructive surgery, Dr. Montgomery has explored a range of concerns throughout his career, including gender education; the provision of care to underserved women, both nationally and internationally; electronic medical records; and the prevention of sexual assault.

What You Need to Know about Fibroids
Posted on June 21, 2012

Have you ever heard of fibroids? If you’re a woman, especially in your 30s or 40s, it’s important that you know what they are. An estimated 70–80% of women in the US have these non-cancerous growths that form in, on, or around the uterus. They may vary in shape, location, and size—some fibroids are roughly the size of a pea while others can grow large enough to fill a woman’s pelvis or abdomen.

Fibroids do not always cause symptoms, so many women may never know they’re there. If symptoms do occur, they may include menstrual changes such as heavier, longer, or more frequent periods; vaginal bleeding at times other than during menstruation; pain during menstruation or sex; lower abdominal or pelvic pain or abdominal cramps; difficult or frequent urination; constipation, rectal pain, or difficult bowel movements; an enlarged uterus and abdomen; or miscarriages or infertility.

Today, there are more options than ever available to treat fibroids. If symptoms are mild, medication, such as birth control pills to control heavy bleeding and painful periods, may help. Older women may decide to forgo treatment because fibroids generally shrink after menopause. Some women, regardless of age, decide to skip treatment altogether.

Surgery or other non-surgical procedures to remove fibroids may be necessary when fibroids cause severe discomfort, excessive bleeding, fibroid-related infertility, or when it is unclear whether the growth is a fibroid or another type of tumor (such as ovarian cancer). More information about treatment options is available on the ACOG website.

Women who experience symptoms should report them to their doctor. If fibroids are to blame, an appropriate treatment plan can be developed. When considering treatment possibilities, it’s important to weigh the severity of the symptoms, plans for having children in the future, age, and whether a surgical or non-surgical approach is preferred.

A Vitamin for Healthy Moms and Babies
Posted on June 14, 2012

Pop Quiz: What vitamin is associated with a 50–70% reduction in birth defects? Answer: Folic Acid

recently wrote about the importance of eating your vitamins through food, but getting enough folic acid from natural sources can be tough. Folic acid is an essential B vitamin necessary for proper cell growth. It's vital to the development of a baby's brain, spinal cord, and central nervous system and integral in preventing birth defects such as spina bifida, anencephaly, and cleft lip and palate. Here's the catch: In order for folic acid to provide the best protection against birth defects, levels of the vitamin need to be high in a woman's body before she becomes pregnant and through the first three months of pregnancy.
Because nearly half of the pregnancies in the US are unintended, it's important that reproductive-age women build up their folic acid stores, whether planning a pregnancy or not. ACOG recommends that all childbearing-age women take 400 micrograms of folic acid each day. Women who have had a child with a neural tube defect or certain other birth defects, are pregnant with twins, have particular medical conditions (such as sickle cell disease), or take some forms of medication (such as antiseizure medication) may need more.
Our bodies can't process folate—the naturally occurring form of folic acid found in leafy green vegetables, citrus fruits, and beans—as easily as the man-made form. Folic acid-enriched breakfast cereals, breads, flours, pastas, rice, and other grains can help, but even women who eat diets high in these sources may not get enough. To make sure you get the recommended amount, take a daily supplement or multivitamin containing 0.4 milligrams or 400 micrograms of folic acid.

Summertime and the Eatin' Is Easy
Posted on June 7, 2012

Do you struggle to eat right? Do you count the piece of lettuce and slice of tomato on your burger as two servings of vegetables? Does your usual fish serving come in a deep-fried square slathered in tartar sauce? If you answered "yes" to any of these questions, you may have considered taking a multivitamin to fill in the gaps of a less-than-perfect menu, and you have a lot of company. An estimated 110 million Americans buy vitamin supplements each year.
For those of you hoping for a salad bar in pill form, I've got bad news: A growing body of research says that vitamin and nutritional supplements leave a lot to be desired. While these supplements can be helpful in staving off common deficiencies, such as low iron in premenopausal women or inadequate calcium in postmenopausal women, often touted claims of cancer prevention, heart protection, and overall improved health have not been proven.
If you have a health problem related to a deficiency, it's best to consult with your doctor on the best way to right what's wrong. But for many women, a colorful and varied diet containing an abundance of whole foods, such as fruits, vegetables, healthy fats, and whole grains, still trumps anything you can buy in a bottle. Whole foods contain not just one or a few isolated vitamins and nutrients, but a number of components—think fiber, minerals, antioxidants, water content, etc—that work together to make the whole greater than the sum of its parts.
This summer, I challenge you to think about your food choices more holistically. Look for natural sources for the nutrients you need. Aim to get your calcium from low-fat dairy and leafy greens, and your fish oils from actual (not fried) fish. For those of you in climates where gardens will soon overflow with fresh produce, work in more servings of what's in season near you. No matter where you are, shoot for 7–9 servings of fruits and vegetables each day (it IS possible), make at least half of your grain servings of the whole grain variety, and get plenty of protein from low-fat sources like beans, nuts, and lean meats. By the end of the season, you may find that getting your vitamins the way nature intended isn't as hard as you thought.

Choosing a Hospital or Home Birth
Posted on May 31, 2012

Home or hospital? The question of where to give birth is a topic of ongoing discussion among expectant moms, doctors, midwives, and home birth advocates. As the number of women who give birth at home increases, the sometimes heated debate about which is safer for women, babies, and families will surely continue. The author of a recent New York Times Magazine article wrote “It is unfortunate that the choices and the rhetoric around birth—like many of the choices and rhetoric around motherhood in general—are so polarized.” It’s a big decision.

A woman’s health and risk factors should be central considerations in deciding on a birth venue. Although studies have shown that absolute risks of planned home birth are low, home births don’t always go as planned. Planned home birth is associated with increased risk of neonatal death when compared with planned hospital birth. Risks also increase in women with certain medical conditions such as hypertension, breech presentation, or prior cesarean deliveries, or in births where there are inadequately trained attendants. It is important for any woman choosing home birth to have a certified nurse-midwife, certified midwife, or physician practicing within an integrated and regulated health system with ready access to consultation and a plan for safe and quick transportation to a hospital in case of an emergency.

While ACOG believes that hospitals and birthing centers are the safest place for labor and delivery, we respect a woman’s right to make a medically informed decision about her birth experience. ACOG also continues to support collaborative practices between physicians and certified nurse-midwives/certified midwives to further improve outcomes for pregnant women and their babies.

Ultimately, women have a choice in where to give birth. As ob-gyns, it’s our job to educate our patients on the risks and benefits of hospital vs. home delivery and help them make the best decision for themselves and their families.

Safe Travels during Pregnancy
Posted on May 24, 2012

For millions of Americans, Memorial Day means the start of the summer travel season. If you’re pregnant, here are a few tips for a safe trip:

*The middle of your pregnancy—weeks 14 through 28—is the best time to travel, but many women can travel safely until a few weeks before their due date. Talk to your doctor before traveling late in pregnancy.

*Air travel is almost always safe up to 36 weeks of gestation for women with low-risk pregnancies. Try to sit near the front of the plane, where the ride is smoother, and choose an aisle seat for easier access to the restrooms. On long flights, get up and walk around every hour or so to reduce the risk of leg swelling and blood clots.

*If you’re planning a road trip, try to spend no more than five or six hours driving each day, and take regular breaks so you can get out and stretch your legs. Keep airbags turned on and sit at least 10 inches back from the dashboard, if possible.

Use a lap/shoulder belt every time you get into a car. Wear the lap belt low on the hip bones, not across your belly. The shoulder belt should be worn across the center of the chest between your breasts (never under your arm), and the belt should be tightened to a snug fit.

*When traveling by bus or train, be sure to hold on to railings and seat backs when moving through small aisles and in bathrooms, and use caution when entering and exiting.

*Taking a cruise? Ask your doctor about safe medicines for calming seasickness. Make sure there is a staff doctor or nurse on board and that the ship will dock in areas with modern medical facilities.

*Before planning a trip abroad, check with your doctor to ensure that your destination is safe for pregnant women. Allow enough time to get any vaccinations you might need. Also, keep a copy of your medical records on hand.

*Drink extra fluids and eat regularly to maintain your energy. It’s a good idea to bring your own juice or water (avoid carbonated drinks, especially before flying) and healthy, high-fiber snacks. Wear comfortable shoes, support hose, and a few layers of light clothing.

*Finally, remember the reason you’re going away in the first place: rest and relaxation! Get plenty of sleep and don’t overdo it.

Enjoy your trip!

A Victory for Healthy Moms
Posted on May 17, 2012

According to a recent New York Times article, maternal deaths have plunged from more than half a million per year in the 1990s to roughly 287,000 in 2010. A report released by the United Nations attributes the decline to better access to and use of contraceptives and of antiretroviral therapies among mothers with AIDS, and more births being attended by doctors, nurses, and medically trained midwives. Though this number is still far too high, the drop in maternal mortality is dramatic and serves as a powerful reminder that we’re heading in the right direction.

Contraceptive access is essential for all women because, according to the World Health Organization, if the 215 million women desiring contraception could get it, each year unintended pregnancies would drop by 71% and maternal deaths would decrease by 67%. In a world of limited resources and 7+ billion people, helping women control their fertility is the right thing to do. By providing women with options that help them make better reproductive choices and protect their health, and by making childbirth safer, women, families, and their communities become stronger and more empowered. The decline is confirmation that inroads can be made and that small changes can make a huge difference.

Maternal mortality remains a major threat to women of all backgrounds. ACOG continues to explore methods of lowering maternal deaths at home and abroad. In the meantime, this good news puts wind in the sails of physicians, women’s health advocates, and communities who tackle this problem from the front lines. And during National Women’s Health Week, it’s an especially fitting time to celebrate.

Healthy Women = Healthy Families
Posted on May 10, 2012

A personal note from ACOG President James T. Breeden, MD: This week, I became the 63rd president of ACOG. I am looking forward to the year ahead and to the opportunity, through this blog, to address key health issues for women and the ob-gyn specialty.
In the week leading up to Mother’s Day, many people (myself included) are busy buying flowers, gifts, cards, and candy for the special women in our lives. During this time, I also like to remind my patients that the best gift they can give to their families and friends is a healthy self.
“Take care of yourself first” may be advice that you’ve heard before, but it bears repeating. So often, women juggle schedules, home life, and work for everyone in their household. In the midst of keeping others on track, their own needs get sidelined. The family calendar may include soccer games, birthday parties, business dinners, and school projects, but what about a spa treatment, time for regular exercise, and a yearly well-woman doctor’s visit?
Mother’s Day kicks off National Women’s Health Week. This year’s theme, “It’s Your Time,” encourages women to take time every day to do something healthy. Try incorporating good habits, such as being more active each day, making smarter food choices, getting a full night’s sleep, or finding a new way to keep stress under control. If you haven’t had your annual exam, now’s a good time to schedule your appointment.
Starting now and throughout the entire year, remember to make self-health a top priority.

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