best OB/GYN doctors

Breastfeeding after a C-section may help manage pain

Breastfeeding after a cesarean section (C-section) may help manage pain, with mothers who breastfed their babies for at least 2 months after the operation three times less likely to experience persistent pain compared to those who breastfed for less than 2 months, according to new research being presented at this year’s Euroanaesthesia Congress in Geneva (3-5 June).

C-sections account for around a quarter of all births in the UK, USA, and Canada. Chronic pain (lasting for more than 3 months) after C-section affects around 1 in 5 mothers. It is widely accepted that breast milk is the most important and appropriate nutrition in early life, and WHO, the UK Department of Health, and US Department of Health and Human Services all recommend exclusive breastfeeding up to 6 months of age. But until now, little has been known about the effect of breastfeeding on a mother’s experience of chronic pain after C-section.

The study, by Dr Carmen Alicia Vargas Berenjeno and colleagues from the Hospital Universitario Nuestra Señora de Valme in Sevilla, Spain, included 185 mothers who underwent a C-section at the hospital between January 2015 and December 2016. Mothers were interviewed about breastfeeding patterns and the level of chronic pain at the surgical site in the first 24 and 72 hours after C-section, and again 4 months later. The researchers also looked at the effect of other variables on chronic pain including surgical technique, pain in the first 24-72 hours, maternal education and occupation, and anxiety during breastfeeding.

Almost all (87%) of the mothers in the study breastfed their babies, with over half (58%) reporting breastfeeding for two months or longer. Findings showed that around 1 in 4 (23%) of the mothers who breastfed for two months or less still experienced chronic pain in the surgical site 4 months post-op compared to just 8% of those who breastfed for 2 months or longer. These differences were notable even after adjusting for the mother’s age. Further analysis showed that mothers with a university education were much less likely to experience persistent pain compared to those who were less well educated. The researchers also found that over half (54%) of mothers who breastfed reported suffering from anxiety.

The authors conclude: “These preliminary results suggest that breastfeeding for more than 2 months protects against chronic post-cesarean pain, with a three-fold increase in the risk of chronic pain if breastfeeding is only maintained for 2 months or less. Our study provides another good reason to encourage women to breastfeed. It’s possible that anxiety during breastfeeding could influence the likelihood of pain at the surgical site 4 months after the operation.”

The authors are currently analyzing additional data from women interviewed between November 2016 to January 2017, which, when combined with data from all the other women, shows that anxiety is associated with chronic post Cesarean pain in a statistically significant way.


Story Source:

Materials provided by ESA (European Society of Anaesthesiology). Note: Content may be edited for style and length.


Read this article on Science Daily: (European Society of Anaesthesiology). “Breastfeeding may protect against chronic pain after Caesarean section.” ScienceDaily. ScienceDaily, 4 June 2017. www.sciencedaily.com/releases/2017/06/170604115807.htm

Good outcomes for older women who give birth at home or in a birth center

Women with some characteristics commonly thought to increase pregnancy risks — being over age 35; being overweight; and in some cases, having a vaginal birth after a cesarean section — tend to have good outcomes when they give birth at home or in a birth center, a new assessment has found.

However, women with some other risk factors, a breech baby and some other cases of vaginal birth after cesarean or VBAC, may face an increased risk of poor outcomes for themselves or their babies, researchers at Oregon State University have found. The study is believed to be the first to examine these risks and the outcomes. About 2 percent of all births in the U.S., and about 4 percent in Oregon, occur at home or in a birth center, rather than in a hospital setting. Generally, women who are considered “low-risk” are good candidates for home or birth center births, also referred to as community births, if they are attended by a midwife or other trained provider and timely access to a hospital is available.

However, there is little agreement among health providers on what should be considered low- or high-risk, and some women choose to have a community birth despite potential risks, said Marit Bovbjerg, a clinical assistant professor of epidemiology at Oregon State University and lead author of the study.

Medical ethics and the tenets of maternal autonomy dictate that women be allowed to decide where and how they wish to give birth. That’s why it’s important to have as much information as possible about potential risks, said Bovbjerg, who works in the College of Public Health and Human Sciences at OSU.

There are also risks associated with hospital births, such as increased interventions, which means there aren’t always clear answers when it comes to determining the best and safest place to give birth, said Melissa Cheyney, a medical anthropologist and associate professor in OSU’s College of Liberal Arts.

The goal of the research was to better understand the outcomes for women and babies with some of the most common pregnancy risk factors, to see how those risk factors affected outcomes.

“There’s a middle or gray area, in terms of risk, where the risk associated with community birth is only slightly elevated relative to a completely low-risk sample,” Cheyney said. “We’re trying to get more information about births that fall in that middle zone so that clinicians and pregnant women can have the best evidence available when deciding where to give birth.”

The findings were published recently in the journal Birth. Other co-authors are Jennifer Brown of University of California, Davis; and Kim J. Cox and Lawrence Leeman of the University of New Mexico. Using birth outcome data collected by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats, the researchers analyzed more than 47,000 midwife-attended community births.

They looked specifically at the independent contributions to birth outcomes of 10 common risk factors: primiparity, or giving birth for the first time; advanced maternal age, or mother over age 35; obesity; gestational diabetes; preeclampsia; post-term pregnancy, or more than 42 weeks gestation; twins; breech presentation; history of both cesarean and vaginal birth; and history of only cesarean birth.

The last two groups are both considered VBACs and hospital policies and state regulations for midwifery practice usually make no distinction between the two types. However, the researchers found a clear distinction between the two groups in terms of community birth outcomes.

Women who delivered vaginally after a previous cesarean and also had a history of previous vaginal birth had better outcomes even than those women giving birth for the first time. On the other hand, women who had never given birth to a child vaginally had an increased risk of poor outcomes in community birth settings.

“That finding suggests that current policies that universally discourage VBAC should be revisited, as the evidence does not support them,” Bovbjerg said. “Women who in the past have successfully delivered vaginally seem to do just fine the next time around, even if they have also had a previous C-section. That’s really important because some medical groups totally oppose VBACs, even in hospital settings, and many hospitals don’t offer the option of a VBAC at all.”

Researchers also found that women whose babies were in breech position had the highest rate of adverse outcome when giving birth at home or in a birth center.

There was only a slight increase in poor outcomes for women over age 35, or women who were overweight or obese, compared to those without those risk factors. In some categories, there were not enough births in the data set to properly evaluate a risk’s impact, such as with gestational diabetes and preeclampsia.

“As is appropriate, women who face high complication risks such as preeclampsia tend to plan for and choose a hospital birth, rather than a community birth,” Bovbjerg said. “But even for these women, it’s important to remember that they can choose a community birth if their faith, culture or other considerations dictate that is the best choice for them.”

The researchers emphasized that the new information about risks and outcomes can serve as an important tool in decision-making for families making very personal choices about where to give birth. “These findings help us to put information and evidence, rather than fear, at the center of discussions around informed, shared decision-making between expectant families and their health care providers,” Cheyney said.

Researchers next plan to examine how the healthcare culture and standards of care in different locations within the U.S. affect outcomes of home and birthing center deliveries.


Story Source:

Materials provided by Oregon State University. Note: Content may be edited for style and length.


Journal Reference:

  1. Marit L. Bovbjerg, Melissa Cheyney, Jennifer Brown, Kim J. Cox, Lawrence Leeman. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. Birth, 2017; DOI: 10.1111/birt.12288

Read this article on Science Daily: www.sciencedaily.com/releases/2017/04/170413154439.htm.

Most Women of Child Bearing Age Lack Knowledge of Healthy Diet Says New Study

Dr. Lela Emad of the Women’s OB/GYN Medical Group discusses the latest findings on diet and nutrition among women and offers some guidelines for women planning for pregnancy.

A new study by the University of Pittsburgh Schools of the Health Sciences uncovers a national trend toward a less than optimal diet among women prior to pregnancy. “This information is particularly concerning for women who intend to conceive,” says Dr. Lela Emad of the Women’s OB/GYN Medical Group of Santa Rosa. “It’s imperative that prior to pregnancy, women follow a higher standard of nutrition for several reasons; to ensure healthy growth of the fetus, to reduce risks associated with premature birth, and to avoid the possibility of preeclampsia and maternal obesity – both of which carry added risks to the mother and baby.”

The study, published in the Journal of the Academy of Nutrition and Dietetics, assessed more than 7,500 women participants using the Healthy Eating Index-2010, measuring quality of diet including the intake for key food groups, while also measuring the consumption of less desirable aspects of a typical American diet such as refined grains, salt and calories from solid fats and sugars from food as well as from alcohol consumption.

Ultimately, more than a third of the calories the women in the study consumed came from ‘empty calories’ from such things as;

  • sugar-sweetened beverages,
  • pasta dishes
  • grain desserts
  • Soda
  • beer, wine and spirits

“This list consists of just about everything we would recommend a woman who was in a preconception phase to avoid,” Dr. Emad points out. “A healthy diet goes a long way toward ensuring a healthy pregnancy, and planning ahead for pregnancy by participating in a Preconception Healthcare Plan is one of the best things a woman can do both for her baby and for herself.”

What is Preconception Healthcare

Preconception healthcare describes medical care provided to a woman that is designed to increase the chances of having a positive pregnancy experience and a healthy baby. Preconception healthcare is uniquely designed for every individual, customized for personal needs and circumstances. It typically offers an introduction to guidelines for a healthy diet as part of the overall education and planning process.

“We encourage parents – that is, both parents – to begin making healthy lifestyle changes up to one full year prior to trying to get pregnant,” explains Dr. Emad. “This process improves a woman’s chances of becoming pregnant and prepares her body so it can provide the best environment for her infant.” During a preconception care visit, the OB/GYN healthcare provider will focus on lifestyle, medical and family history, previous pregnancies and currently prescribed medications. In addition to diet and exercise, topics may include alcohol, tobacco, and caffeine use; recreational drug use, birth control, family histories, genetics as well as health issues and other concerns (diabetes, high blood pressure, depression, obesity, etc.)

Healthy Diet and Supplements

“We also encourage our patients and their families to adopt a nutrient rich and calorie conscious diet prior to and during pregnancy. This is the best way to prevent excessive weight gain and cut the potential risk of obstetric complications,” says Dr. Emad. “Planning ahead and taking steps to ensure optimal pre-pregnancy health is a great way to create a healthy family.”

Learning how to make smart food choices as well as being mindful about food preparation is important, as is knowing which foods to avoid or limit during pregnancy. Foods that contain sources of folic acid (vitamin B9) are important nutritional elements to incorporate into both the preconception and pregnancy diet. Folic acid helps to prevent some birth defects – particularly those affecting the brain and spinal cord. Folic acid is best taken before pregnancy and in the very early stages of pregnancy.

Although the bulk of nutrients should ideally come from eating fresh healthy foods, it is generally recommended that women start taking a prenatal vitamin supplement before pregnancy. Prenatal vitamin supplements are specifically formulated to contain all the recommended daily vitamins and minerals needed before and during pregnancy.

About Women’s OBGYN Medical Group

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. To learn more about these fine physicians and the many services provided by the Women’s OB/GYN Medical Group visit the website. Call for an appointment at (707) 579-1102.

Good news for mature women: weight loss is possible after menopause

Talk to a woman in menopause and you’re likely to hear complaints about hot flashes and an inability to lose weight, especially belly fat. A new study shows how regular exercise can help reduce weight and control bothersome symptoms such as hot flashes, even in women who previously led sedentary lifestyles. The study outcomes are being published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Decreased estrogen levels during the menopause transition often create an array of physical and mental health issues that detract from a woman’s overall quality of life. The article “Improvements in health-related qualify of life, cardio-metabolic health, and fitness in postmenopausal women after a supervised, multicomponent, adapted exercise program in a suited health promotion intervention: a multigroup study” reports on 234 Spanish postmenopausal women aged 45 to 64 years who had at least 12 months of sedentary behavior and engaged in a supervised 20-week exercise program for the study. After the intervention, the participants experienced positive changes in short- and long-term physical and mental health, including significant improvements in their cardiovascular fitness and flexibility. In addition, they achieved modest but significant reductions in their weight and body mass index, and their hot flashes were effectively managed. This is especially good news for women who are reluctant to use hormones to manage their menopause symptoms and are looking for safe but effective nonpharmacologic options without adverse effects.

“Growing evidence indicates that an active lifestyle with regular exercise enhances health, quality of life, and fitness in postmenopausal women,” says Dr. JoAnn Pinkerton, NAMS executive director. “Documented results have shown fewer hot flashes and improved mood and that, overall, women are feeling better while their health risks decrease.


Story Source:Materials provided by The North American Menopause Society (NAMS). Note: Content may be edited for style and length.


Read this article on ScienceDaily:

The North American Menopause Society (NAMS). “Weight loss actually possible after menopause.” ScienceDaily. ScienceDaily, 15 February 2017. <www.sciencedaily.com/releases/2017/02/170215084052.htm>.

Dr. Susan Logan Recognized as Among the “Top Doctors” in the Bay Area by San Francisco Magazine

Susan Logan, M.D. of NCMA Women’s OB/GYN Medical Group has been selected by the San Francisco Magazine as among the top Obstetrics and Gynecology doctors for 2017.

San Francisco Magazine recently queried area doctors to nominate their choice of best physicians in eight Bay Area counties for 2017. Almost 1,000 nominations were submitted and a little over 500 physicians were selected by the healthcare research company managing the award process. Results were announced the magazine’s January 2017 issue.

Under the category of Obstetrics and Gynecology, Women’s OB/GYN Medical Groups physician Dr. Susan Logan has been selected for this honor by San Francisco Magazine for two years consecutively.

Dr. Lela Emad of the Women’s OB/GYN Medical Group says, “Dr. Susan C. Logan is a respected, caring OB/GYN certified by the American Board of Obstetrics and Gynecology. She has been a part of our group since the early 90s, and has played an integral role in building the practice. We are honored to have her among our providers and her patients are lucky to have someone so knowledgeable to deliver such quality caring support for their healthcare needs.”

Dr. Logan also serves as Antepartum Testing Medical Director at Santa Rosa Memorial Hospital, as well as the Medical Director of the Sweet Success Program.

About the Women’s OB/GYN Medical Group

With a team made up of compassionate, expert doctors, midwives, nurses and medical assistants aimed at providing unmatched care to patients, the Women’s OB/GYN Medical Group offers a full range of obstetrics and gynecology services to women in the North Bay region.  Services offered include;

  • general gynecological health screenings
  • state-of-the-art diagnostics
  • comprehensive pregnancy and postpartum care
  • full mid-wifery services
  • minimally invasive laparoscopic surgery
  • uro-gynecological procedures
  • incontinence care
  • menopause care
  • laser hair reduction, skin care and Botox Cosmetic

Women’s OB/GYN Medical Group’s staff of physicians include; Lela Emad, MD, Shazah Khawaja, MD, Amita Kachru, MD, and Susan Logan, MD. Together, these doctors share a unique whole-body approach to medicine as they strive to find the underlying causes of a woman’s health problems, rather than simply treating the symptoms.

The team of health professionals at Women’s OB/GYN is committed to both alleviating short-term ailments and maximizing long-term health. The practice partnered with Northern California Medical Associates (NCMA) in 2014 to strengthen its network of experienced healthcare providers, directly benefitting patient access to healthcare specialists in the area.

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. To learn more about these fine physicians and the many services provided by the Women’s OB/GYN Medical Group visit the website. Call for an appointment at (707) 579-1102.