Frequently Asked Questions

Welcome to our practice. Our practice consists of seven Obstetrician / Gynecologists, one Nurse Practitioner, and seven Certified Nurse-Midwives. All obstetric patients have the option of physician or midwifery care throughout pregnancy and birth. Gynecologic patients also may choose to see either an M.D. or C.N.M. for their visits. Click here for a list of the names and all the resumes of our professional staff.

A Certified Nurse Midwife (C.N.M.) is a registered nurse with advanced training in women’s reproductive health. Midwives specialize in providing personalized care during pregnancy, labor, birth, and postpartum. Midwives also provide routine gynecologic care to non-pregnant women including birth control counseling, health education, and pap smears.

C.N.M.s are committed to ongoing patient and family education regarding pregnancy, nutrition, exercise, childbirth preparation, breast feeding, and parenting. Prenatal care includes routine prenatal visits, education, and emotional support. During labor, the C.N.M. stays with the woman and her support person(s) to provide individualized labor support, reassurance, and to continually evaluate the well being of the mother and baby. The C.N.M. encourages natural methods of labor and pain management, but is happy to provide or even suggest medication (including epidurals) for pain relief if needed.

Certified midwives perform vaginal births and repair episiotomies if needed. In the event complications arise or a cesarean section is indicated, the physician is consulted and the midwife remains with the woman to provide support. Midwives do not perform cesarean sections.

After delivery, midwives stay with the family to encourage bonding, assist with breast feeding, and to share the celebration of life.

Our physicians are obstetrician-gynecologists who have completed four years of specialty training after medical school concentrating on conditions of childbearing and the female reproductive organs. In addition to caring for pregnant woman, an ob-gyn is a gynecologic surgeon trained to perform pelvic surgery such as hysterectomy and laparoscopy. All operative procedures requiring anesthesia are performed at South Shore Hospital.

In our offices, the physicians offer a full range of gynecologic services including routine exams, routine and high risk prenatal care, infertility evaluation, and menopause management. In the office the physicians perform minor procedure such as colposcopy for evaluation of abnormal pap smears and endometrial biopsy for the evaluation of abnormal bleeding. In addition, we also offer office hysteroscopy and tubal ligation with Essure.

The physicians and midwives at South Shore Women’s Health enjoy working together as a team to provide the best possible care for our patients. Each patient in our practice chooses to see either the midwives or the physicians as her primary providers, but our practitioners frequently assist each other as needed in the birthing unit, post partum floor, and the office. As a group we value health, prevention, and knowledge of health care choices.

It is our privilege to be your partner in health care.

The Center for Disease Control (CDC) has extensive information on this topic and we suggest you visit that site for more details but here are the basics.

Gardasil is the first vaccine developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV). It protects against four HPV types which are responsible for 70% of cervical cancers and 90% of genital warts.

The vaccine is very effective for certain population groups.

Here is what the CDC has to say about the efficacy of the vaccine:

Studies have found the vaccine to be almost 100% effective in preventing diseases caused by the four HPV types covered by the vaccine— including precancers of the cervix, vulva and vagina, and genital warts. The vaccine has mainly been studied in young women who had not been exposed to any of the four HPV types in the vaccine.1

The vaccine is most effective in girls/women who have not yet acquired any of those four HPV types. It is less effective to females who have been exposed to one or more of the HPV types. This vaccine does not treat existing HPV infections, genital warts, precancers or cancers.

More from the CDC about who should receive the vaccine:

The HPV vaccine is recommended for 11-12 year-old girls, and can be given to girls as young as 9. The vaccine is also recommended for 13-26 year-old girls/women who have not yet received or completed the vaccine series.2

There was some controversy about vaccinating young girls to prevent something that will only become an issue when they become sexually active. The problem, of course, is that the vaccine is not effective once a girl or woman has acquired one of the HPV types. Therefore, the vaccine must be administered years before it is needed.

In June 2006, the Advisory Committee on Immunization Practices (ACIP) voted to recommend the first vaccine developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV). The vaccine, Gardasil®, protects against four HPV types, which together cause 70% of cervical cancers and 90% of genital warts.

The HPV vaccine is recommended for 11-12 year-old girls, and can be given to girls as young as 9. The vaccine is also recommended for 13-26 year-old girls/women who have not yet received or completed the vaccine series.

These recommendations have been proposed by the ACIP— a national group of experts that advises the Centers for Disease Control and Prevention (CDC) on vaccine issues. These recommendations are now being considered by CDC.

1,2: http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm

The average age of menopause is 52, but there is considerable personal variation (and there is no test to predict when menopause will occur). Menopause means that the period totally stops. Prior to menopause is the perimenopause, which is a time of several years during which the periods become erratic and the woman may experience menopause symptoms such as insomnia and hot flashes. Usually these symptoms worsen as the periods wind down, and then last for several years after the periods cease. But again, there is considerable personal variation. There are women who without warning suddenly stop menstruating, never get a hot flash, and they're done!

The big question - hormone replacement, should I or shouldn’t I?

There are pros and cons of hormone replacement therapy. Simply stated, the major advantages are:

1. HRT relieves menopausal symptoms (hot flashes, insomnia).
2. HRT helps prevent osteoporosis and may prevent colorectal cancer.

On the other side of the coin, the major disadvantages are:

1. HRT increases your chance of breast cancer and heart attack.
2. HRT causes vaginal bleeding, often like a period, even after menopause.
3. HRT increases your chances of phlebitis (blood clots in the legs).

So, what is the right choice? Because we are all different, there is not one right answer. The most important question is - how do you feel at menopause time? Are you debilitated by hot flashes, do you have difficulty sleeping, or other menopausal symptoms? You have to feel healthy, and you have to be able to function well on a day to day basis. The other question to ask yourself is how do you view menopause? Is it a natural passage or is it an uncomfortable state requiring treatment? In other words, are you comfortable with the idea of taking hormones?

There are many different hormone regimes, including “natural” hrt made by special compounding pharmacies. There are also herbal and over-the-counter products available that may help you. We would be pleased to help you decide what is best for you.

How you will feed your baby is one of the many decisions that you will make during your pregnancy. Think about it carefully. Choose what is right for you, your baby, and your family.

Why do women breastfeed?

1. Breastfeeding provides the best food for your baby. Mother’s milk contains all the nutrients needed by your baby and in the right amounts.
2. Breastfed babies have fewer allergies. Human milk produces fewer allergies in human beings than does formula based on cow milk.
3. Breastfed babies have fewer illnesses. Human milk contains antibodies, white blood cells, and other factors which help protect your baby from disease.
4. Breastfeeding is economical. It costs less to breastfeed than to bottle feed. You can spend money on your own food, not formula, bottles, and sterilizing equipment.
5. Breastfeeding is convenient. Breast milk is always ready. There is nothing to buy, carry, heat, or measure.
6. Breastfeeding can help you lose weight. While not everyone loses weight during breastfeeding, you are using a lot of calories to make milk and this can help. It also helps your uterus go back to its non-pregnant size.
7. Breastfeeding is enjoyable for mother and baby! Many women comment that breastfeeding makes them feel very close to their babies. The hormones that your body produces during breastfeeding plus the skin-to-skin contact help make you feel close to your baby.

If you decide to breastfeed, please consider taking the breastfeeding class offered at the South Shore Hospital. Please call 340-8332 for further information.

The recommended weight gain during pregnancy is 25 to 35 pounds. If you are underweight when you become pregnant, you can gain more, if you are overweight, plan on less.

Please feel free to discuss your questions about weight gain with your healthcare provider.

We advise limiting caffeine intake to one serving per day. Alcoholic beverages should be avoided.

The prenatal vitamin we prescribe for you at the beginning of your pregnancy contains 1 mg of Folic Acid, the amount recommended for pregnant women. If you are unable to tolerate the vitamins, please inform your healthcare provider so we can change your vitamin, or prescribe Folic Acid for you.

Calcium requirements are 1200-1500mg/day. Dairy products are rich in calcium. There are 300 mg of calcium in one 8 oz glass of milk, 400 mg in one cup of yogurt. If you are unable to tolerate dairy products, Tums EX contains 500 mg per tablet, and Tums Ultra contains 800 mg per tablet. There are also many calcium supplements available to you over the counter to help you reach the recommended daily amount.

Most pregnant women eat 2 snacks in addition to their 3 regular meals. It is best to avoid consumption of empty calories such as candy, soda, cookies, donuts, pastries and junk foods. Healthy snack ideas include fruit, vegetables, yogurt, cheese and crackers, and plain popcorn.

Pregnant women need 8-10 glasses of liquid per day. Water is the best choice. Although juice is a healthier choice than soda, excessive juice intake (beyond 1-2 glasses/day) can result in unnecessary weight gain.

The Massachusetts Department of Public Health has issued a statement advising pregnant women to avoid consuming fish caught in fresh water in Massachusetts. For further information, please contact: The Massachusetts Department of Public Health, 250 Washington Street, 7th floor, Boston, MA 02108 (617) 624-5757.

Listeria is an organism that contaminates foods processed or packaged in unsanitary conditions. It can have potentially harmful effects upon pregnant women and their unborn infants. The Center for Science in the Public Interest (CSPI) advises that pregnant women avoid soft cheeses, rare meats and poultry, foods containing raw eggs, pates, raw shellfish, unpasteurized milk and juices. It is further advised that pregnant women avoid eating ready to eat meats such as hot dogs and luncheon meats unless they have been heated to steaming.

A list of potentially hazardous foods for pregnant women and young children is as follows:

• Hot Dogs, Sausage, and Deli Meats like Bologna
• Brie, Camembert, Feta, Mexican-style, and Blue-veined cheeses
• Meat and Poultry, cooked rare
• Pate
• Cold ready to eat seafood products
• Cold leftovers
• Unpasteurized mild and milk products
• Unwashed fruits and vegetables
• Unpasteurized fruit juices and ciders
• Raw eggs and raw egg dishes
• Raw shellfish

Eat frequent small meals every 1 1/2 to 2 hours throughout the day.

Have a few crackers before arising from bed in the morning if you are troubled with morning sickness.

Many women find relief with starchy foods such as pasta, potatoes, crackers and bread until the first trimester is completed. Avoid spicy foods.

Ingest fluids separately from solids; drink liquids between meals instead of with them.

Take vitamin B6 100mg by mouth in the morning. If you are without improvement after four to five days, add 100mg by mouth in the evening.

Take your prenatal vitamin at bedtime instead of in the morning.

‘Sea Bands’ - accupressure bands marketed for sea/motion sickness have been helpful for some women.

If you are vomiting multiple times per day, or are unable to retain food or fluids, or are having reduced urinary output, please call the office so we can evaluate you.

During a normal, healthy pregnancy, it is important to stay active and get some exercise. Exercise helps control weight gain, improves overall sense of well being, allows a woman to feel more in control of her body, and prepares her for labor. Walking, swimming, and prenatal exercise classes are excellent ways to exercise. Working with light weights is great for muscle tone. Avoid activities that are too jarring or that might lead to a fall. Also avoid lying flat on your back. Remember that your sense of balance may be off and your center of gravity is changing. Do not over exercise which can lead to dehydration, cramping, and even hyperthermia (especially in warm weather). Drink plenty of water and watch your pulse to make sure it stays at 120 beats per minute or less. Do not push yourself to do activities that feel uncomfortable.