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Pregnancy and Anemia
What is anemia?
Anemia is a decrease in red blood cells in the blood, which can lead to a lack of oxygen-carrying ability and causing unusual tiredness. The deficiency occurs either through the reduced production or an increased loss of red blood cells. Red blood cells are produced in the bone marrow, and their average life expectancy is about 120 days.
To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anemia will develop.
- Poor intake of iron in diet. Iron is needed to make red blood cells. When women loose blood, they also loose iron. This happens in pregnancy due to the fact that the woman must supply iron to both herself and her baby. Iron is replaced by vitamin supplements or the diet.
- Folic acid deficiency. Folic acid is a Vitamin B, which is needed to produce red blood cells.
- Chronic illness
- Blood Loss from bleeding hemorrhoids or gastrointestinal bleeding
- Even if iron and folic acid intake are sufficient, a pregnant woman may become anemic because pregnancy alters the digestive process. The unborn child consumes some of the iron or folic acid normally available to the mother’s body.
Signs & Symptoms
The symptoms such as tiredness and general weakness will be similar to those of any other type of anemia. In severe cases, the woman will be short of breath even at rest.
If the anemia is prolonged, other signs of iron-deficiency anemia may develop such as a smooth shiny tongue and tenderness of the skin at the corners of the mouth. However, these advanced signs are rare.
In the case of iron deficiency anemia, routine blood tests during antenatal care show low hemoglobin concentration as well as the characteristic small, pale red blood cells under the microscope.
The diagnosis of iron deficiency anemia can be confirmed by measuring the amount of storage iron as well as the levels of iron-binding proteins in the blood. The diagnosis of folate deficiency is confirmed by estimating the red blood cell folate levels.
Course of anemia
Patients with severe anemia are more likely to deliver early and have small babies. Women with severe anemia may have symptoms such as weakness, fatigue, shortness of breath and headaches.
Birth is also associated with blood loss. Therefore, if a woman is anemic, she should take iron for several months after delivery in order to help the body replace the lost blood cells and iron stores.
Breastfeeding women may also need to take iron because iron is lost in breast milk.
As long as the anemia is treated and corrected, there should be no problems.
A well-balanced diet is always recommended but iron and folate supplementation is indicated in pregnancy.
When the anemia is caused by lack of iron, it is treated with iron supplements, preferably ferrous sulfate tablets. These supplements should not be taken more than twice daily since the side effects of iron are increased in doses of more than two daily. The side effects are stomach upsets and constipation, which are problematic in pregnancy.
If the anemia is due to folic acid deficiency, it is treated with folic acid supplements.
During the first 3 months of pregnancy, or the first trimester, there are many changes happening to you. As your body adjusts to the growing baby, you may experience nausea, fatigue, backaches, mood swings, and stress. Just remember that these things are normal during pregnancy. Most of these discomforts will go away as your pregnancy progresses, so try not to worry about them. Just as each woman is different, so is each pregnancy. When you are tired, get some rest. If you feel stressed, try to find a way to relax. Accept that your normal routine is changing.
Visiting your doctor is very important during these early stages. Your doctor will perform several tests to check the health of both you and your baby. He/she will also be able to answer questions about any concerns or fears you might have, and he will tell you what you can do to make your pregnancy as easy as possible. You’ll need to know what types of exercises you can do, what you should eat for good nutrition, and what you might need to avoid during this time. Pay attention to what your body is telling you and listen to your doctor’s advice. This is an exciting time, and it is important to understand what you should expect during your pregnancy.
Most women find the 2nd trimester of pregnancy to be easier than the 1st trimester. By the 26th week, your baby will weigh almost 2 1/2 pounds and be about 9 inches long. With this growth comes the development of your baby’s features, including fingers, toes, eyelashes and eyebrows.
Morning sickness, fatigue, and many other things that might have bothered you during the first 3 months might disappear as your body adapts to the growing baby. Your abdomen will expand as you gain weight and the baby continues to grow. Before this trimester is over, you will feel your baby beginning to move. Most women feel movements before 22 completed weeks.
You should be gaining about 1/2 to 1 pound per week during the 2nd trimester. With this weight gain, you might notice that your posture has changed or that you are having backaches. During your visits your doctor will be able to hear your baby’s heartbeat, see the baby’s development and determine the baby’s age. You might be given several kinds of tests at this time, including ultrasound, which allows the doctor to see your baby and possibly even determine your baby’s sex. Other testing (amniocentesis, chorionic villus sampling, alpha-fetoprotein screening) includes ways to determine if the baby is healthy or if you are at risk for any complications and need to be more closely monitored. These tests help to determine the type of care you will be receiving for the rest of your pregnancy.
Your baby is still growing and moving, but now it has less room. You might not feel the kicks and movements as much as you did in the 2nd trimester. You will also notice that you may have to go to the bathroom more often or that you find it hard to breathe. This is because the baby is getting bigger and it is putting pressure on your organs. Don’t worry, your baby is fine and these problems will subside once you give birth.
Your baby is finally here! The joys and challenges of motherhood are about to begin. It is important to remember to take care of yourself as well as your new baby. Caring for a new baby can be fun but it is also hard work. How much and how often you should feed the baby? What do you do when the baby is crying, or sick? How do you prevent accidents? These questions can be overwhelming at first, but you will quickly adjust. A new baby needs constant care, but you will be skilled at taking care of your child in no time. There are people out there, including your family, friends, doctor, and support groups, which will help you get through it. You are not alone.
You have experienced nine months of changes in your body. Those changes will continue in the next couple of months as you decide whether or not to breastfeed and as your body starts to recover from having the baby. It is important to take care of yourself during this time. Make sure to rest when you can and don’t try to do too much.
In addition to the physical changes to your body, you may feel depressed. This can be a very normal phase following childbirth. 50% to 75% of new mothers feel a little sad or depressed after giving birth. These feelings can range from very mild to serious, but there is help. Be aware of your feelings and continue to talk with your family, friends, and your doctor. Sometimes this depression will go away on its own, but medication or therapy may be needed. Both can help you feel better and get back to enjoying your new baby.
Polycystic Ovarian Syndrome
Polycystic ovarian syndrome (PCOS) is a condition of unknown cause. It is associated with problems such as irregular (usually less frequent) menstrual cycles, excessive hair growth, acne, obesity, infertility, and the possible development of diabetes and osteoporosis. Treatment for PCOS depends on the associated problems and can include weight reduction, hormones or – in some cases – surgery.
Normally the ovary produces large amounts of the female hormone estrogen, lesser amounts of the male hormone testosterone, and the pregnancy hormone progesterone (which is only produced in greater amounts after ovulation and during pregnancy). In PCOS, testosterone levels may be mildly increased.
Causes of PCOS
The causes of PCOS are unknown. In some cases, it seems to run in the family; for other women, the condition only occurs when they are overweight. Recent research suggests that PCOS is related to insulin resistance and the development of diabetes, especially in women who are overweight.
Women who have PCOS may have problems such as:
- Irregular menstrual cycles – menstruation may be less frequent due to less frequent ovulation, and may be either heavier or lighter than average.
- Amenorrhea – some women with PCOS do not menstruate, in some cases for many years.
- Obesity – the cause of this is unclear.
- Excessive hair growth – may be due to increased testosterone.
- Acne – the cause is unclear, but may also be due to increased testosterone.
- Infertility – related to less frequent or absent ovulation.
There may also be long-term health risks. Some women with PCOS develop diabetes, especially if overweight. Women with infrequent periods are at risk of osteoporosis and uterine cancer.
Diagnosing polycystic ovarian syndrome
PCOS is usually diagnosed based on the woman’s history and an examination. It may be confirmed by ultrasound and by measuring hormone levels in the blood. Early diagnosis is important, as it will allow symptoms to be managed and may prevent long-term health problems from developing.
It is important that a broad approach (by a general practitioner with interest or expertise in this area, or perhaps involving several specialists – for example, an endocrinologist or a gynecologist) be used to manage and treat PCOS. If only one or two symptoms are addressed on a short-term basis, the woman may be left with long-term clinical problems.
The treatment for PCOS will depend on the problems the woman is experiencing. For example, if the woman is suffering from irregular, heavy periods, the oral contraceptive pill is often prescribed to regulate the cycle and prevent the lining of the womb from overgrowing. If the woman has infrequent periods, the oral contraceptive pill is used to reduce the risk of osteoporosis. Weight loss is very important, as it will reduce the risk of diabetes and may lead to the resumption of normal menstrual cycles.
Pelvic Inflammatory Disease
What is pelvic inflammatory disease?
Pelvic inflammatory disease (PID) is infection of the reproductive organs of women. This may include infection of:
- The Uterus (womb)
- The Cervix (the opening of the womb into the vagina)
- The fallopian tubes (the tubes between the ovary and the womb – eggs released by the ovary pass through these tubes) the ovaries
- The infections that can cause PID include:
- Other bacteria
PID can cause severe illness in a woman, requiring treatment in hospital. However, sometimes PID can occur without causing any signs or symptoms. That is, the woman may not feel sick and may not notice any change in her body. PID is a very serious disease because it can lead to long term problems.
PID is one of the leading causes of infertility in women. Women who have had PID may have difficulty becoming pregnant.
The primary risk factor for PID is infection with a sexually transmitted infection (STI) –in particular, Chlamydia and gonorrhea.
Risk factors for these STIs include:
- Engaging in unprotected sex
- Having sex with more than one partner
- Being in a sexual relationship with someone who has multiple sex partners
Women can have PID without any signs or symptoms. Women may notice:
- Pain low in the abdomen
- Pain during sex
- Abnormal periods (women on the pill may notice this too)
- Bleeding after sex
- Abnormal discharge
- Some women become very sick and have severe pain
If you have symptoms suggestive of an STI or think you may have been exposed to one, you should seek medical attention immediately.
Avoiding risky sexual behaviors can prevent infection with PID. To reduce your risk:
- Use latex or polyurethane condoms during sex
- Limit your number of sex partners
If you have recently been treated or are being treated for an STI, you must make sure your sex partner(s) also receives treatment in order to prevent getting infected again. Sex partners should receive treatment even if they do not have any symptoms.
- PRACTICE SAFE SEX. Always using condoms when you have vaginal or anal sex is the best way to avoid getting PID. Using a water-based lubricant with condoms is recommended. This reduces the risk of the condom breaking and increases both partners’ enjoyment of sex. Oil-based lubricants (such as Vaseline) should not be used. They weaken the condom and may cause it to break. If you are giving a man oral sex (his penis in your mouth) then he will need to wear a condom. It does not matter whether you are male or female if you put your mouth in contact with your partner’s anus or vulva while having sex you will need to use a dental dam.
- If you are having unprotected sex, talk to your sexual partner about the risks involved (while some sexually transmitted infections can be cured, others cannot – don’t forget that by having unprotected sex you are at risk of being exposed to HIV). From a good discussion with your partner, you may be able to come to a clear agreement about using condoms.
- There are lots of ways to enjoy physical intimacy with your partner. Explore other ways to be intimate, which do not put you at risk of sexually transmitted infections or an unintended pregnancy.
- If you tend not to use condoms after drinking alcohol or taking other drugs it may be time to have a think about this and the risks involved. While for some it may be unrealistic to think of not enjoying a drink, there are many ways of cutting down so that you stay in control and can make more rational choices about your sexual contact.
- Remember that using condoms not only protects you from STIs, it also is an effective form of contraception. If you do use other forms of contraception (like the pill, diaphragm and IUCD etc.), use condoms as well.
If you or your partner have more than one sexual partner and do not use condoms, have regular sexual health checkups.
If you think you may have been at risk of getting a sexually transmissible infection, you may be at risk of having PID. Have a sexual health check to be sure.
The doctor can test for PID by:
- Examining and taking swabs from your vagina and cervix
- Testing urine for Chlamydia and Gonorrhea
- Feeling the cervix, uterus, and ovaries for any sign of tenderness or pain
- Doing blood tests
If you find out that you do have PID, anyone you have had sex with in the past few months will need to be tested and treated also. This is to make sure that they are cleared of the infection and to prevent you from getting the infection again and needing treatment all over again. If you feel uncomfortable or embarrassed about telling your partner or partners, the doctor or nurse can contact them. This is a confidential process and your name will not be mentioned. This is very important for your health, for your partner’s health, and the health of other people they have sex with.
How can you be treated for pelvic inflammatory disease?
PID is treated with antibiotics. Sometimes three different antibiotics are given.
To ensure the infection has been cured:
- It is important to take all the tablets – otherwise the infection may not be properly cured
- You will be asked to return to Obstetrical and Gynecological Associates or clinic for follow-up appointments – this will include checking that signs of infection are settling. After you have finished the treatment there will be tests to check the infection is cured.
- It is best not to have sex until the tablets are finished and you have been tested to check the infection is cured (even if you feel better)
Sexual partners who have the infection should be treated at the same time – otherwise, you may get the infection again.
If a woman is very sick with PID, she may need to be admitted to hospital for treatment.
What is a Pap test?
The Pap test (also called a Pap smear) checks for changes in the cells of your cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can tell if you have an infection, abnormal (unhealthy) cells, or cancer.
Why do I need a Pap test?
A Pap test can save your life. It can find cancer of the cervix – a common cancer in women – before it moves to other parts of your body (becomes invasive). If caught early, treatment for cancer of the cervix can be easier and the chances of curing it are far greater. Pap tests can also pick up infections and inflammation, and abnormal cells that can change into cancer cells.
Do all women need Pap tests?
It is important for all women to have pap tests, along with pelvic exams, a part of their routine health care. You need to have a Pap test if you are over 18 years old. If you are under 18 years old and are or have been sexually active, you also need a Pap test. There is no age limit for the Pap test. Even women who have gone through menopause (the change of life, or when a woman’s periods stop) need to get Pap tests.
My friend had a hysterectomy – does she still need a Pap test?
Women who have had a hysterectomy (surgery to remove the uterus) should talk with their doctor about whether they need to continue having routine Pap tests. It is important for all women who have had a hysterectomy to have regular pelvic exams. In most cases a pap smear should still be collected yearly.
How often do I need to get a Pap test?
It depends on your age and health history. Talk with your doctor about what is best for you. Most women can follow these guidelines:
- If you are younger than 30 years old, you should get a Pap test every year.
- If you are age 30 or older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 2 or 3 years.
- If you are ages 65 to 70 and have had at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years, ask your doctor if you can stop having Pap tests.
You should have a Pap test every year no matter how old you are if:
- You have a weakened immune system because of organ transplant, chemotherapy, or steroid use
- Your mother was exposed to diethylstilbestrol (DES) while pregnant
- You are HIV-positive
Women who are living with HIV, the virus that causes AIDS, are at a higher risk of cervical cancer and other cervical diseases. The U.S. Centers for Disease Control and Prevention recommends that all HIV positive women get an initial Pap test, and get re-tested 6 months later. If both Pap tests are normal, then these women can get yearly Pap tests in the future.
Is there anything special I need to do before going for a Pap test?
For two days before the test, you should not douche or use vaginal creams, suppositories, foams or vaginal medications (like for a yeast infection). It is also best to not use any vaginal deodorant sprays or powders for two days before your test. And, do not have sexual intercourse within 24 hours of your test. All of these can cause inaccurate test results by washing away or hiding abnormal cells. You should not have a Pap test when you have your period. The best time to have one is between 10 and 20 days after the first day of your last period.
How is a Pap test done?
Your doctor can do a Pap test during a pelvic exam. It is a quick test that takes only a few minutes. You will be asked to lie down on an exam table and put your feet in holders called stirrups, letting your knees fall to the side. A sheet will cover your legs and stomach. The doctor will put an instrument called a speculum into your vagina, opening it to see the cervix and to do the Pap test. She or he will use a special stick, brush or swab to take a few cells from inside and around the cervix. The cells are placed on a small glass slide, and then checked by a lab to make sure they are healthy. While painless for most women, a Pap test can cause discomfort for some women.
What happens after the Pap test is done?
If the cells are okay, no treatment is needed. If an infection is present, treatment is prescribed. If the cells look abnormal, or not healthy, more tests may be needed. A Pap test is not 100% right all the time, so it is always important to talk to your doctor about your results.
What do abnormal Pap test results mean?
A doctor may tell you that your Pap test result was “abnormal.” Cells from the cervix can sometimes look abnormal but this does not mean you have cancer. Remember, abnormal conditions do not always turn into cancer. And, some conditions are more likely than are others to turn into cancer. If you have abnormal results, be sure to talk with your doctor to find out what they mean and what you need to do (if anything) about it.
What will happen if my Pap test finds something that is not normal?
If the Pap test shows something confusing or a minor change in the cells of the cervix, the test may be done again. If the test shows a major change in the cells of the cervix, the doctor may perform a colposcopy. This is a procedure done in an office or clinic with an instrument (called a colposcope) that acts like a microscope, allowing the doctor to closely see the vagina and the cervix. Doctor may also take a small amount of tissue from the cervix (called a biopsy) to examine for any abnormal cells, which can be a sign of cancer.
My doctor told me my Pap test result was a false positive. What does this mean?
Is there such a thing as a false negative Pap test result? Pap tests are not always 100 percent accurate. False positive and false negative results can happen. This can upset and confuse a woman. Knowing what these types of results mean can help a woman to better protect her health.
A false positive Pap test happens when a woman is told she has abnormal cells (on and around her cervix), but the cells are in fact normal. A false positive result means that there is no problem. A false negative Pap test happens when a woman is told her cells are normal, but in fact, there is a change in the normal, healthy cells. This means there may be a problem and there may be a need for more tests. There are many things that can interfere with accurate Pap test results. This is why women need to be sure to get regular Pap tests. Having regular Pap tests increases a woman’s chances that any problems will be picked up over time.
Do sexually transmitted diseases (STDs) cause cancer of the cervix?
One type of STD, called HPV, or the human papilloma virus, has been linked to cancer of the cervix. HPV can cause wart-like growths on the genitals. When it is not treated or happens frequently, HPV can increase a woman’s chances of developing cancer of the cervix. HPV is a very common STD, especially in younger women and women with more than one sexual partner.
What increases a woman’s risk for cancer of the cervix?
Any woman can get cancer of the cervix. But, the chances of getting cancer of the cervix increase when a woman:
- Starts having sex before age 18.
- Has many sexual partners.
- Has sexual partners who have other sexual partners.
- Has or has had Human Papilloma Virus (HPV) or genital warts.
- Has or has had a sexually transmitted disease (STD).
- Is over the age of 60.
Morning sickness is nausea or vomiting that usually occurs during the first trimester of pregnancy. Despite its name, you may feel nauseated or vomit at any time of day.
It is not understood why some women develop morning sickness, but certain factors such as hormones are involved. Women with high levels of pregnancy hormones tend to develop this condition and have it with subsequent pregnancies.
More than half of pregnant women have morning sickness during the first trimester. It usually goes away by the second trimester.
When morning sickness is severe, it is called hyperemesis gravidarum.
Please do not take any medications without notifying our doctors, as some medications cross the placental barrier and may cause undue effects on the growing baby.
These steps may help:
- Eat snacks that are high in protein, don’t have rich, fatty foods
- Avoid foods if their taste, smell or appearance is not suitable to you
- Have frequent small snacks instead of full meals; being hungry can make it worse
- Eat a nourishing snack before you go to bed at night
- Increase intake of fluids such as water, fruit juice, and clear soups, particularly if you are vomiting
- Take it easy, especially in the mornings, as rushing about will make the nausea worse
- Try and avoid time spent in kitchen, as the smell of food can make you nauseous
- Try to avoid eating while you are active as movement often makes morning sickness worse
- Try eating a biscuit or something light before you get out of bed in the morning
- Seek medical help, before it can get worse
Moderate morning sickness may require:
- Medication to reduce nausea and vomiting
- Intravenous fluid treatment to relieve dehydration
Our doctors will explain the side effects and risks of any medication prescribed.
Severe hyperemesis gravidarum may require:
- Not eating or drinking anything, then slowly introducing food into your diet
- Lab tests of blood and urine
- Intravenous treatment to balance the electrolytes in your blood
- Ultrasound examination of the pregnancy
Menopause is that time in a woman’s life when the ovaries stop producing estrogen and she stops having periods. Menopause is a natural biological process, not a medical problem. Although it’s associated with hormonal, physical and psychosocial changes in your life, menopause isn’t the end of your youth or your sexuality.
Menopause is usually a natural process, but certain surgical or medical treatments can bring on menopause earlier than expected. These include:
- Surgical removal of ovaries.
- Chemotherapy and radiation therapy. These cancer therapies can induce menopause. But they usually do so gradually, and you may have months or years of perimenopausal symptoms before you actually reach menopause.
Menopause does not occur overnight. It is gradual and most people reach menopause between the ages of 45 and 55, the average being around 51. This depends on the individual body development and hormone levels. As you approach menopause, the production of hormones (for example estrogen) by the ovaries starts to slow down. As this process accelerates, hormone levels fluctuate more, and often a woman notices changes in her menstrual cycle:
- Cycles may become longer, shorter or totally irregular.
- Bleeding may become lighter.
- Bleeding may become unpredictable and heavy.
Eventually, the hormone levels will fall to a level where menstruation (periods) will cease altogether and the menopause is reached. Menopause is defined as one year without menstrual periods.
Other signs and symptoms
- Hot flashes – As your estrogen level drops, your blood vessels may expand rapidly, causing your skin temperature to rise.
- Decreased fertility – When ovulation begins to fluctuate, you’re less likely to become pregnant. Until you haven’t had a period for a year, however, pregnancy is still possible.
- Vaginal changes – As your estrogen level declines, the tissues lining your vagina and urethra — the opening to your bladder — become drier, thinner and less elastic. With decreased lubrication, you may experience burning or itching, along with increased infections of the urinary tract or vagina. These changes may make sexual intercourse uncomfortable or even painful.
- Sleep disturbances and night sweats – Night sweats are often a consequence of hot flushes. You may awaken from a sound sleep with soaking night sweats followed by chills. You may have changes in appearance. After menopause, the fat that once was concentrated in your hips and thighs may settle above your waist and in your abdomen. You may notice emotional changes. As you go through menopause, you may experience mood swings, be more irritable or be more prone to emotional upset.
However, women sometimes experience several of these symptoms:
- Aches and pains
- Crawling or itching sensations under the skin
- Lack of self-esteem
- Reduced sex drive (libido)
- Urinary frequency
Several chronic medical conditions tend to appear after menopause. By becoming aware of the following conditions, you can take steps to help reduce your risk:
- Osteoporosis. During the first few years after menopause, you lose calcium from your bones at a much faster rate, which increases your risk of osteoporosis. Osteoporosis causes bones to become brittle and weak, leading to an increased risk of fractures. It’s important to engage in regular, weight-bearing exercise to keep your bones strong, as well as ensure adequate intake of calcium and Vitamin D
- Cardiovascular disease. At the same time, your estrogen levels decline, your risk of cardiovascular disease increases
- Stress urinary incontinence. As the tissues of your vagina and urethra lose their elasticity, you may experience stress urinary continence — a condition that may cause you to leak urine during coughing, laughing or lifting — for the first time, or it may worsen
- Weight gain. As your body’s metabolism — the rate at which you burn calories — slows and estrogen levels decline, your body weight and shape will likely change. You may need to cut down your food intake — perhaps as much as 200 to 400 fewer calories a day — and exercise more, just to maintain your current weight. Exercise also helps in prevention of osteoporosis
Manage menopause with a healthy lifestyle
Often, if you improve your lifestyle habits, unpleasant symptoms of the menopause will be greatly reduced, so try these first:
- Healthy diet
- Choose a wide variety of foods, including plenty of fresh vegetables, fruits, cereals, whole grains and small portions of lean meat, fish or chicken several times per week.
- Increase fluids and eat low-fat dairy foods with high calcium content
- Decrease caffeine and limit alcohol (1-2 standard glasses or less, per day)
- Regular exercise – at least 45 minutes three times per week
- Avoid smoking
- It’s important to avoid smoking because of the associated risk of osteoporosis, coronary artery disease, and lung cancer.
- Regular Pap smear and breast checks
- You should have:
- Yearly gynecologic exam
- Yearly mammogram
Hormone replacement therapy
Hormone replacement effectively reduces many of the unpleasant effects of symptoms of the menopause. Discuss the advantages and disadvantages of hormone replacement with your own doctor.
Our doctors respect a woman’s right to choose the method of her delivery. If you wish to aim for a vaginal birth then he will support you fully in this choice. Similarly, if you choose to have an elective Caesarean Section he will support you fully in this choice.
It is important to recognize the signs of labor so that you will know when you are experiencing the “real thing.” If this is your first baby, you will most likely experience lightening (the descent of the baby’s head into your pelvis) sooner than women who have already had other children. Typically, the signs of labor include uterine contractions, tightening of your stomach, and cramps in your low back. About two-thirds of women experience these tightening before their waters break. About one-third will notice fluid leaking out first. If you are unsure about what is happening, contact your doctor’s office.
You may also be interested in taking childbirth preparation classes, which teach coping methods for labor and delivery, and help guide new parents in the many decisions they will make before and during the birth process. One of the things you may be most concerned with is the amount of pain you may experience during labor. Childbirth is different for all women, and no one can predict how much pain you will have. During the labor process, our doctors and nurses will ask you if you need pain relief and will help you decide what option is the best for you. Your options may include a local or intravenous analgesic (pain relieving drug), an epidural (injection which blocks pain in the lower part of your body), or a pudendal block (numbs the vulva, vagina, and anus during the second stage of labor and during delivery).
Infertility is usually defined as not being able to get pregnant despite trying for one year. A broader view of infertility includes not being able to carry a pregnancy to term and have a baby.
Pregnancy is the result of a chain of events. A woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus (womb). A man’s sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus.
While this may seem simple, in fact, many things can happen to prevent pregnancy from occurring.
It is a myth that infertility is always a “woman’s problem.” About one-third of infertility cases are due to problems with the man (male factors) and one-third are due to problems with the woman (female factors). Other cases are due to a combination of male and female factors or to unknown causes.
Infertility in men
Infertility in men is often caused by problems with making sperm or getting the sperm to reach the egg. Problems with sperm may exist from birth or develop later in life due to illness or injury. Some men produce no sperm or produce too few sperm. Lifestyle can influence the number and quality of a man’s sperm. Alcohol and drugs can temporarily reduce sperm quality. Environmental toxins, including pesticides and lead, may cause some cases of infertility in men.
Infertility in women
Problems with ovulation account for most infertility in women. Without ovulation, eggs are not available to be fertilized. Signs of problems with ovulation include irregular menstrual periods or no periods.
Simple lifestyle factors – including stress, diet, or athletic training – can affect a woman’s hormonal balance. Much less often, a hormonal imbalance from a serious medical problem such as a pituitary gland tumor can cause ovulation problems.
Aging is an important factor in female infertility. The ability of a woman’s ovaries to produce eggs declines with age, especially after age 35. About one-third of couples where the woman is over 35 will have problems with fertility. By the time she reaches menopause, when her monthly periods stop for good, a woman can no longer produce eggs or become pregnant.
Other problems can also lead to infertility in women. If the fallopian tubes are blocked at one or both ends, the egg can’t travel through the tubes into the uterus. Blocked tubes may result from pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy.
How is infertility tested?
If you have been trying to have a baby without success, you may want to seek medical help. If you are over 35, or if you have reason to believe that there may be a fertility problem, you should not wait for one year of trying before seeing a doctor. A medical evaluation may determine the reasons for a couple’s infertility. Usually, this process begins with physical exams and medical and sexual histories of both partners. If there is no obvious problem, like improperly timed intercourse or absence of ovulation, tests may be needed.
For a man, testing usually begins with tests of his semen to look at the number, shape, and movement of his sperm. Sometimes other kinds of tests, such as hormone tests, are done.
For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. For example, she can keep track of changes in her morning body temperature and in the texture of her cervical mucus. Another tool is a home ovulation test kit, which can be bought at a pharmacy.
Checks of ovulation can also be done in the doctor’s office, using blood tests for hormone levels or ultrasound tests of the ovaries. If the woman is ovulating, more tests will need to be done.
Some common female tests include:
- Hysterosalpingogram: An x-ray of the fallopian tubes and uterus after they are injected with dye. It shows if the tubes are open and shows the shape of the uterus.
- Laparoscopy: An exam of the tubes and other female organs for disease. An instrument called a laparoscope is used to see inside the abdomen.
Depending on the test results, different treatments can be suggested. 85 to 90 percent of infertility cases are treated with drugs or surgery.
Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug’s benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women.
If needed, surgery can be done to repair damage to a woman’s ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.
Assisted reproductive technology (ART)?
Assisted reproductive technology (ART) uses special methods to help infertile couples. ART involves handling both the woman’s eggs and the man’s sperm. Success rates vary and depend on many factors. ART can be expensive and time-consuming. But ART has made it possible for many couples to have children that otherwise would not have been conceived.
In vitro fertilization (IVF) is a procedure made famous with the 1978 birth of Louise Brown, the world’s first “test-tube baby.” IVF is often used when a woman’s fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man’s sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman’s uterus, thus bypassing the fallopian tubes.
Gamete intrafallopian transfer (GIFT) is similar to IVF but used when the woman has at least one normal fallopian tube. Eggs are placed in the fallopian tube, along with the man’s sperm, for fertilization inside the woman’s body.
Zygote intrafallopian transfer (ZIFT) also called tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the woman’s ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus. ART procedures sometimes involve the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby.
Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes is a form of diabetes that some women develop during the 24th – 28th week of their pregnancy. It usually disappears after the birth and does not mean that the baby will be born with diabetes.
Diabetes Mellitus is a condition when the pancreas (the organ responsible for producing insulin) is either unable to make insulin, or the insulin is unable to work effectively. The function of insulin is to keep the glucose levels within normal limits. With inadequate insulin, glucose builds up in the blood leading to high blood glucose levels causing health problems.
The definite cause of Gestational diabetes is not known, but it is assumed that as pregnancy progresses, the mother’s energy needs increase. Also, placental hormones that help the baby grow and develop, block the action of the mother’s insulin. This is called insulin resistance. The pregnant woman needs extra insulin so the glucose can get from the blood into the cells where it is used for energy. If the body is unable to meet this requirement, then diabetes develops. When the pregnancy is over and the insulin needs return to normal, the diabetes usually disappears.
Women who develop gestational diabetes have a greater risk of developing Type II diabetes later on.
Diabetes often has no symptoms, which is why all pregnant women are routinely tested.
If symptoms occur, they may include:
- Unusual thirst
- Excessive hunger
- Excessive urination
- Frequent infections
- High blood pressure
Any pregnant woman can develop gestational diabetes, but risk factors that increase susceptibility include:
- Being overweight
- A family history of diabetes
- Women with hypertension (high blood pressure)
- Being over the age of 30 years (everyone’s tendency to develop diabetes increases with age)
- Previous babies were large at birth (8 pounds and over)
Tell your doctor:
- If you have had gestational diabetes in a previous pregnancy
- If you have a family history of gestational diabetes or diabetes
- If you have given birth to a baby weighing 8 pounds or over
Course of Illness
Although gestational diabetes usually goes away after the birth (when hormone levels return to normal), it still needs to be taken seriously.
The main concern is that it can increase the baby’s weight, and have other health effects on the unborn baby. If the baby becomes very large it may be necessary for the woman to have a Caesarean delivery. Women who develop gestational diabetes have about a 50% risk of developing Type II diabetes later on. Type II Diabetes, which is increasingly common in people over the age of 40, is a chronic disease, which has to be carefully managed with healthy eating and regular physical activity. Sometimes long-term medication is also needed. If Type II diabetes isn’t controlled it can cause serious health problems including heart and kidney disease, and eye problems.
Pregnant women are routinely checked for gestational diabetes between the 24th and 28th weeks of their pregnancy. Women at increased risk are usually tested earlier. The glucose challenge test involves taking a glucose drink, waiting for one hour and then having a blood test. If your glucose level is high, you will have additional glucose tolerance test to confirm the diagnosis. This involves fasting the night before the test, drinking a stronger glucose solution, and being blood tested each hour for 3 hours.
Managing Gestational Diabetes
A woman with gestational diabetes needs careful monitoring for the remainder of her pregnancy.
Management is mainly aimed at changing to a healthy eating plan, increasing physical activity, and monitoring blood glucose levels. Specific management strategies include:
- Eating regular meals. Hospital dietitians can advise on which foods to eat and which foods to avoid, and how often to eat
- Regular exercise to help reduce insulin resistance
- Dietary modifications, such as switching to a low fat, high fiber diet with plenty of fresh foods
- No alcohol or cigarettes
- Regular blood tests performed at home to check glucose levels
- Some women may need to take medications, these may include tablets to insulin injections
Fibroids, also called myomas, fibromyomas or leiomyoma, are non-cancerous tumors of the uterus that appear during your childbearing years. Fibroids can appear on the inside or outside lining of your uterus, or within its muscular wall. They usually develop from a single smooth muscle cell that continues to grow. Fibroids often cause no problems, but may occasionally be associated with infertility, miscarriage and premature labor. Other possible problems include heavy, lengthy and painful periods. Treatment depends on the size, number, and location of the fibroids, but may include drugs and surgery. Fibroids rarely turn cancerous.
In many cases, fibroids are asymptomatic. Symptoms may include:
- Heavy periods
- Lengthy periods
- Pelvic pain
- Difficulty getting pregnant
- Spotting between periods
- Painful intercourse
- A sensation of heaviness or pressure in the back, bowel and bladder
- Frequent urination
- A lump or swelling in the lower abdomen
Fibroids are categorized by their location, which includes:
- Intramural – growing in the uterine wall. Intramural fibroids are the most common variety.
- Submucosal – growing in the uterine lining (endometrium). This type tends to cause excessive menstrual bleeding and period pain
- Subserosal – growing on the exterior wall of the uterus. They sometimes appear like balloon on a stick
Fibroids can cause a variety of complications, including:
- Anemia – excessive menstrual blood loss can cause anemia, a disorder characterized by the body’s inability to carry sufficient oxygen in the blood. Symptoms of anemia include breathlessness, fatigue, and paleness
- Urination problems – large fibroids can bulge the uterus against the bladder, causing a sensation of fullness or discomfort and the need to urinate often
- Infertility – the presence of fibroids can interfere with implantation of the fertilized egg in a number of ways.
- Miscarriage and premature delivery – fibroids can reduce blood flow to the placenta, or else compete for space with the developing baby
Methods of Diagnosis
Fibroids can be detected using an ultrasound, where sound waves create a two-dimensional picture. The inside of the uterus can be examined with a hysteroscope, which is a thin camera passed through the cervix (neck of the womb). The outside of the uterus can be viewed via laparoscopy, where a thin camera is placed in the abdominal cavity through the belly button. Imaging such as MRI can be used as well.
Most fibroids do not cause symptoms and do not require treatment. A ‘wait and see’ approach is sometimes adopted.
Fibroids may require treatment in the following circumstances:
- Fibroids are growing large enough to cause pressure on other organs, such as the bladder
- Fibroids are growing rapidly
- Fibroids are causing abnormal bleeding
- Fibroids are causing problems with fertility
Treatment depends on the location, size, and number of the fibroids, but may include:
- Medications – such as hormones, used in combination to shrink the fibroids prior to surgery or alone to improve symptoms.
- Hysteroscopy – the fibroids are removed via the cervix, using a hysteroscope
- Laparoscopy – a thin tube is inserted through the abdomen to remove the fibroids
- Open surgery – larger fibroids need to be removed via an abdominal incision. This procedure weakens the uterine wall and makes Caesarean sections for subsequent pregnancies more
- Hysterectomy – the surgical removal of some, or all, of the uterus. Pregnancy is no longer possible after a hysterectomy
A polyp is a small protrusion that looks like a tiny ball on the end of a slim stalk. Endometrial polyps can also contribute to menstrual problems, such as excessive bleeding and pain.
The uterus is made up of three layers of tissue and muscle. The innermost layer is called the endometrium, the second layer– myometrium and the third layer– the serosa.
Endometriosis is a condition where the innermost layer of the uterus (endometrium), grows in locations outside the uterus such as on the pelvic side-wall, ovary, bladder, or bowel. Endometriosis may cause adhesions on the uterus. The uterus can become stuck to the ovaries, fallopian tubes, and bowel. Although many patients experience extreme pain, some women with endometriosis do not experience any symptoms (asymptomatic). Usually, it causes pain around the time of the menstrual period but, for some women, the pain is almost constant.
The symptoms of endometriosis vary widely from woman to woman and the severity of symptoms is not necessarily related to the severity of the endometriosis. Symptoms depend on the extent and location of the endometrial implants and the affected structures. While some women have few or no symptoms, others experience severe and incapacitating pain that recurs each month for many years.
Many women think that painful periods are normal. If you have bad period pain, you should see your doctor.
- Period pain (dysmenorrhoea)
- Pain during sexual intercourse (dyspareunia)
- Pelvic and abdominal pain outside of menstruation
- Abnormal bleeding – including heavy bleeding, clotting, prolonged bleeding, irregular bleeding, premenstrual spotting
- Bowel disturbances – including painful bowel motions, diarrhea, constipation, bleeding from the bowel
- Difficulty in getting pregnant
- Painful urination
- Lower back, thigh and/or leg pain
- Premenstrual syndrome
The anticipation of recurrent pain or discomfort each month may also lead to feelings of anxiety, stress, and depression. It is important to acknowledge these emotional difficulties that may arise from endometriosis.
Special tests to diagnose endometriosis
The tests used to help diagnose endometriosis are:
- Laparoscopy – a medical instrument with a video camera attached is used to examine your uterus and pelvis.
- Ultrasound – instrument which uses sound waves to create a video image
- Colonoscopy – a medical instrument with a video camera attached is used to examine your bowel. This is done if it is thought that the endometriosis could also be affecting your bowel
Treatment for endometriosis depends on a number of factors including:
- The severity of symptoms
- The extent of the endometriosis
- The woman’s age and
- Her treatment goals (e.g. reduction in pain, improved fertility)
No treatment can absolutely prevent endometriosis from recurring but a combination of regular medical follow-up, hormone medication and/or surgery can control the condition.
Having a baby may improve the condition. While endometriosis is suppressed during pregnancy, symptoms may recur in time, even as early as a few months after giving birth.
Medical treatment is essential for this condition. Hormones can usually treat endometriosis, and sometimes surgery may be indicated.
Drugs used to treat endometriosis include:
- The oral contraceptive pill
- Anti-inflammatory medications
- Pain medications
- Hormonal treatments (for example, Danazol, Lupron, Provera and Zoladex. Side effects of these drugs may include depression, hot flushes, mood swings, night sweats, loss of libido and headaches)
Surgical options for endometriosis treatment include:
- Laparoscopic surgery – is performed to diagnose endometriosis. Laser surgery may be used to try and remove the adhesions. This may be done to reduce pain and to improve the chances of you becoming pregnant
- Laparotomy – is used to cut out or burn tissue, or remove cysts
- Bowel resection – for example, if the bowel has also developed endometriotic adhesions
- Hysterectomy – may be an option if endometriosis prevents you from having a normal life and other treatments have not worked
Breastfeeding offers many benefits for both mother and baby. A healthy baby can benefit from breast milk, infant formula or a combination of the two. Breast milk is extremely nutritious and contains carbohydrates, proteins, and fats essential for a baby’s health. Breastfeeding, apart from helping babies get proper nutrition and can help mothers recover from pregnancy and delivery.
Potential benefits of breastfeeding
- Can promote a “bond” between mother and baby.
- It is natural and specially made for your baby
- There are lots of things in breast milk that are good for your baby, but are not found in formula milk.
- It is safe for your baby, and easily digested.
- It contains all the minerals and nutrients that your baby needs for the first six months of life. Together with other foods, it is very good for the next six months or more as well.
- It is always ready when your baby needs it.
- Breast milk also contains antibodies that help prevent infections and allergies. Your baby will be less likely to get infections, allergies and many other diseases.
- Breast fed babies have less chance of obesity.
- It helps you and your baby feel close to each other.
- Breastfeeding releases hormones, which cause the uterus to shrink after delivery and also decreases bleeding. It helps your body return to normal more quickly after the birth
- Mothers who breastfeed typically have an easier time losing weight after pregnancy.
- It does not cost anything and does not take time to prepare.
Expecting mothers planning to nurse should discuss breastfeeding with a doctor, nurse, or certified lactation consultant before giving birth. Although breastfeeding is a natural thing to do, most of us need to learn how.
If a mother does decide to breastfeed her children, she should understand that breastfeeding is a major responsibility that requires her to maintain excellent nutrition and health. Women who breastfeed should eat well-balanced, nutritious meals. Generous portions of whole grain breads and cereals, fruits and vegetables, and dairy products with an abundance of calcium are recommended. It will take time for both of you to learn this new skill of breastfeeding. The nurses in the hospital will help you and your baby start breastfeeding.
Breastfeeding and Coffee
Most physicians agree that it is safe for breastfeeding mothers to consume small amounts of caffeine (equivalent to one to two cups of coffee per day), though larger amounts of caffeine may interfere with a baby’s sleep or cause him or her to become fussy.
Breastfeeding and Alcohol
Breastfeeding mothers should avoid alcohol because it can be passed through the breast milk to the baby. An occasional drink (no more than four ounces of alcohol) is probably safe.
Colposcopy is a procedure that uses a special microscope (called a colposcope) to look very closely at the cervix (the opening to the uterus, or womb).
The colposcope magnifies or enlarges, the image of the outer portion of the cervix. Sometimes a small sample of tissue (called a biopsy) is taken for further study. The tissue samples help the doctor to figure out how to treat any problems found. If cancer of the cervix is found early, or a precancerous change of cells is found, it can be treated and almost always can be cured. Also, for precancers and early cancers of the cervix, sometimes removal of part of the cervix may be the only treatment needed.
Why would a woman need a colposcopy?
Colposcopy is usually done when a woman has an abnormal Pap test. (Pap tests are done on a regular basis to screen for cancer of the cervix and other problems.) Other reasons a woman may need a colposcopy is when, during a pelvic exam, the cervix, vagina, or vulva looks abnormal to the doctor.
When you have a colposcopy, you will lie on an exam table just like you do when you have a regular pelvic exam. The doctor uses an instrument called a speculum to spread the walls of the vagina apart. She or he then places the colposcope, which is like a microscope with a light on the end, at the opening of the vagina. The colposcope does not enter the vagina. The doctor will look inside the vagina to locate any problem areas on the cervix (opening to the uterus, or womb) or in the vagina. If any areas are of concern, the doctor may take a biopsy. When this is done you may feel a slight pinch or cramp. The tissue is then sent to a lab for further study.
Our doctor will talk with you about what he saw inside your vagina and cervix. If a sample of tissue was taken from your cervix (biopsy), the lab results should be ready in 1-2 weeks.
Most women feel fine after a colposcopy. You may feel a little lightheaded and if you had a biopsy, you may have some light bleeding. Talk to your doctor about how to take care of yourself after the procedure and when you need to return for a checkup.
Risks of Colposcopy
There is a very small risk of infection when you have a colposcopy. You may have mild pain and cramping during the procedure and light bleeding afterward. This most often happens when a biopsy is done. If you have heavy bleeding, a fever, or severe pain after the procedure, you should contact your doctor right away.
Further information can be found on the following web sites. Always remember that all information may be subject to some bias; please ask us if you have any queries.
- Texas Department of State Health Services
- Your Custom Hereditary Cancer Quiz www.hereditarycancerquiz.com/drtharappe
- Hereditary Cancer Quiz Implementation Guide www.s3.amazonaws.com/myriad-library/FHT/
- Your Custom Family History Tool https://fht.myriad.com/drtharappe
- Fertility Friend
- Medscape Women’s Health
- National Library of Medicine’s
- American College of Obstetricians and Gynecologists
This official Web site of the American College of Obstetricians and Gynecologists provides a physician directory, health columns, post-graduate courses and much more.
- American Heart Association
The American Heart Association Women’s Web site gives women of all ages the facts on women’s heart disease and stroke.
- American Medical Association
The official Web site of the American Medical Association.
- American Psychological Association
The official Web site of the American Psychological Association.
- Mayo Clinic Health Oasis
This online information source has an extensive women’s health section. National Alliance of Breast Cancer Organizations www.nabco.org The official site of the National Alliance of Breast Cancer Organizations.
- National Institutes of Health
- National Library of Medicine
The National Library of Medicine Web site provides diverse health information.
- National Ovarian Cancer Coalition
The National Ovarian Cancer Coalition seeks to raise awareness and promote education about ovarian cancer.
- The North American Menopause Society
The North American Menopause Society (NAMS) is a nonprofit organization that provides a forum for a multitude of scientific disciplines with an interest in the human female menopause.
In-depth medical information, health tips, a free e-mail newsletter and access to the powerful Health Tracker.
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Cord Blood Banking
Why more and more doctors recommend preserving your baby’s umbilical cord blood:
Your baby’s cord blood contains a life-saving resource called stem cells. Collected in a safe, painless procedure after birth, your baby’s cord blood stem cells can provide your family with distinct advantages in fighting certain diseases. In fact, many doctors and scientists believe that in the future, stem cells may also be used to treat brain damage and spinal cord injuries.
Here are some of the currently known benefits of cord blood stem cells:
- Cord blood stem cells have been used as part of the treatment therapy for nearly 40 life-threatening diseases, including Leukemia and other cancers, genetic diseases and immune system deficiencies.
- Researchers are now looking to cord blood for answers to Heart Disease, Stroke, Diabetes and Muscular Dystrophy.
How to determine the quality of a cord blood company:
You only get one chance to preserve your baby’s cord blood. That’s why it’s critical to select a high-quality cord blood company. Here are key questions to ask before selecting a cord blood company:
- What is their “transplant success” rate?
(Above all, make sure their stored blood has a proven success record.)
- Does the company adhere to the highest industry standards?
- (Is the company AABB-accredited and, more importantly, is their laboratory CLIA-certified and registered with the FDA?)
- Does their service include bedside pick-up by a Private Medical
Courier? (Some companies ship their cord blood via common package delivery companies.)
- Is the company committed to the future of cord blood? (Do they offer a Quality Guarantee? Are they committed to discovering new uses for cord blood by investing in their own research and development?)
Preparing for Surgery
Once you and your surgeon decide that surgery will help you, you’ll need to learn what preparing mentally and physically for surgery is an important step toward a successful result. Understanding the process and your role in it will help you recover more quickly and have fewer problems.
Working with Your Doctor
Before surgery, your surgeon will give you a complete physical examination to make sure you don’t have any conditions that could interfere with the surgery or its outcome. Routine tests, such as blood tests and X-rays, are usually performed a week before the surgery.
Discuss any medications you are taking with your doctor and your family physician to see which ones you should stop taking before surgery.
Discuss with your doctor options for preparing for potential blood replacement, including donating your own blood, medical interventions, and other treatments, prior to surgery.
If you are overweight, losing weight is advisable. However, you should not diet during the month before your surgery.
If you are taking aspirin or anti-inflammatory medications, you will need to stop taking them one week before surgery to minimize bleeding. If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery.
Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection later.
Eat a well-balanced diet, supplemented by a daily multivitamin with iron. Report any infections to your doctor. Surgery cannot be performed until all infections have cleared up.
Arrange for someone to help out with everyday tasks like cooking, shopping and laundry.
Put items that you use often within easy reach before surgery so you won’t have to reach and bend as often.
Remove all loose carpets and tape down electrical cords to avoid falls.
Make sure you have a stable chair with a firm seat cushion, a firm back and two arms.
Preparing for Procedure
If you are having Day Surgery, remember the following:
Have someone available to take you home, you will not be able to drive for at least 24 hours.
Do Not drink or eat anything in the car on the trip home. The combination of anesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours.
Take your pain medicine as directed. Begin the pain medicine as you start getting uncomfortable, but before you are in severe pain. If you wait to take your pain medication until the pain is severe, you will have more difficulty controlling the pain.