Can acupuncture help me get pregnant?

Acupuncture and fertility: Princeton Womens Health Blog
 New study suggests that acupuncture does not improve pregnancy rates.

Lots of women seek out acupuncture to help them get pregnant, but does it really help?

Complementary and alternative medical treatments have become very popular for treating and preventing diseases, including the treatment of infertility. This may including vitamins and herbs and treatments such as acupuncture.

A number of researchers have found that acupuncture does improve fertility, at least in women who are undergoing IVF treatment, but some have not.

In order to figure out what it really going on, a group of doctors in Australia studies 824 women undergoing in vitro fertilization at their clinic. Half got real acupuncture (meaning the needles were placed in the right place according to acupuncture practice guidelines) and in the other half of patients, the needles were placed in locations that were not expected to have any effect. We call this last treatment "sham" acupuncture. They compared outcomes between the two groups.

They found out that women who had sham acupuncture were no more likely to get pregnant than those who had acupuncture done correctly. The pregnancy rates in these two groups were almost identical.

So what does this mean?

It is likely that acupuncture does not improve the chances for success with IVF, and if it does, the benefit is likely very small.

Were there any benefits to acupuncture in these women?

Yes. Women who received acupuncture were more relaxed and had a better sense of well being that those who had only sham acupuncture. This is not a small issue since IVF treatment is very stressful to the couples who are going through it.

Knowing this, should I still get acupuncture done?

Acupuncture is safe and comforting even if it may not be effective in IVF treatment. Other than the cost if it is not covered, there is really no risk to trying it.

Can I dye my hair during pregnancy?

 Is it OK to use hair dyeing products when pregnancy?

This is a question most OBs and midwives get asked on a regular basis.

And the answer to this questions is no so straightforward.  Recently, the Huffington Post interviewed several experts in women's health and dermatology, and these are the some of the comments they heard back:

  • “It just does not stay in contact with your skin long enough to absorb into the blood stream in a way that is harmful to a growing fetus, My vote is that hair dye is completely fine.”
  • “Intact scalp skin should absorb very little dye, a cut or scrape can increase absorption. That means if you have any open cuts on your head, you may absorb more product."
  • “If you want to be ultra-conservative, for any situation, any medication exposure, waiting until after the first trimester is something you can do, but there’s really no reason from expert consensus to do that.” 

To dye or not to dye?

The best thing you can is ask your doctor or midwife even if the answer is not clear.

 

Can I exercise when I'm pregnant?

Is working out a problem during pregnancy: Delaware Valley OBGYN blog
excercise-ok-during-pregnancy.jpg

Yes, actually it's a great idea to exercise when you're pregnant.

Many women are afraid to work out when they are pregnant, concerned that it can be harmful to the baby, but their fears are largely unfounded. In fact, exercise can actually help you and your baby get through labor.

Researchers in Madrid, Spain compared women who did aerobic exercise during pregnant to those who did not and they found some very interesting things including...

  • Women who exercised while pregnant had faster labors

  • Women who exercised while pregnant were less likely to need an epidural

  • Women who exercised while pregnant were less likely to deliver a very large baby

So, should all women exercise during pregnancy?

There are of course exceptions so your should check with your Obstetrician or Midwife first since  some high risk patients are advised to avoid exercise while pregnant. 

It's Endometriosis Awareness Month

Endometriosis Awareness Month: Delaware Valley OBGYN blog

March is Endometriosis Awareness Month

A few facts about endometriosis:

  • Endometriosis affects 1/10 women.

  • It is a disease that occurs when tissue similar to endometrium (the lining of the uterus) grows in places other than where it normally belongs.

  • The symptoms of endometriosis include pelvic pain, pain with intercourse and painful periods, and are usually cyclic, fluctuating with your menstrual cycle.

  • Even though endometriosis can usually not be cured (except with menopause), it can be readily treated with either medications or surgery.

  • Endometriosis can affect your fertility but it does not always do so.

Why Midwives Are Fast Becoming More Popular Than OBGYNs

Why more women are chosing midwives: Delaware Valley OBGYN blog
midwife-Brunswick-NJ

and Natalie Daher in her recent article on the Daily Beast asks why. 

Midwifery has been around for a long time, but the time for midwives to move to the forefront may have come.

Today, midwives are oftentimes sought out by highly educated, well-to-do women who seek out a more natural patient-centered experience, but that was not always the case.

Before the advent of modern obstetrics, the midwife played a central role in a woman's childbirth and reproductive experience. This was not just in mid-20th century Britain as popularized in the series "Call the Midwife," but throughout  much of human history. Given the current problems in our health care system, it may be that midwives may be able to make an even greater impact that they do now. 

There are a number of gaps in the women's healthcare in US that midwives may be able to fill:

Accessibility to pregnancy care

There is a shortage of obstetricians, particularly in underserved areas, to some extent in the inner cities and an even larger problem in rural areas. Midwives can help make up for that shortage.

Reduced Costs

Midwives provide care at less cost than OBs, with fewer invasive procedures such as cesarian sections.

Excellent Quality Care

Despite, lowering the cost and invasiveness of pregnancy-related healthcare, studies in multiple countries have shown that midwifery care leads to excellent pregnancy outcomes.

Patients Satisfaction

Women who chose midwives to deliver their child are usually very happy with their experience. Why? It could be because midwives treat childbirth as a natural experience, a family event, not a disease.

 

Want to learn more about midwifery care for your next pregnancy? Set up an appointment with one of our certified nurse midwives.

Fertility and the Economy

Fertility rates go up and down with economy: Delaware Valley OBGYN blog
 A rise in fertility rate and birth rate preceeds economic booms and a decrease precedes recessions

Can a busy waiting room in your OBGYN  doctor's office or the fertility clinic mean the economy is going to boom?

Actually it may.

Some of us who practice in reproductive health care have noticed that the number of women getting pregnant or attempting pregnancy seems to wax and wane over time. It certainly makes sense that couples would be more likely to plan a family when times are good and avoid pregnancies when the economy goes south, but in the in end it was just an observation with any real information to support that hunch. That is until now.

The National Bureau of Economic Research (NBER) reported recently that fertility rates, in this case the birth rates more specifically, go up and down with the cycles in the economy.

What is even more interesting is that the birth rate changes proceeded the upswings and downswings in the economy.

  • A drop in birth rates can predict an upcoming recession.

  • A risk in birth rates can predict upcoming economic boom.

     

Somehow, the national mood, how confident people were in the future not only predicted how the economy would do but how many couples would be trying to have a baby.

Doctor, can I fly during pregnancy?

 Answers to questions about flying during pregnancy
Is it OK to fly during pregnancy: Delaware Valley OBGYN blog

Everyone, or almost everyone, likes to get away from town for a while. It could be a vacation, a business trip or a family emergency. Either way, getting on airplane is a cause for anxiety for many pregnant women (and their partners).  Questions about flying during pregnancy are among the most common questions that Obstetricians and Midwives are asked. 

It is always a good idea to ask your OB or midwife for advice. This website is not a substitute for good medical advice. 

Here are answers to some basic questions about airplane travel during pregnancy.

Is it OK to get on airplane during pregnancy?

Generally yes. It is probably not a good idea to go to far away from home as you get close to your due date, and it is likely your airline carrier will not allow you to board if you are too far along. It is probably a good idea to stay close to home as well early in pregnancy if you are at risk for miscarriage or an ectopic (tubal) pregnancy.

Are there risks to my health if I fly during pregnancy?

Everyone who flies is at risk for developing blood clots in the veins, and women who are pregnant are at an even higher risk. Keeping well hydrated and keeping your legs moving are important to keep that risk to a minimum. There is also exposure to radiation which is higher in the upper atmosphere than it is at sea level. Flying exposes you to a similar amount of radiation as an x-ray study, but it is unclear if there is any risk to you or your unborn baby.

Are there particular types of airplanes to avoid?

Most modern jets have pressurized cabins so the amount of oxygen makes them safe to travel in when pregnant. Small prop planes without pressurized cabins should be avoided.

Are there places that I should not fly when pregnant?

This is a discussion you should have with your OB or Midwife, and if you are going to a more exotic location, with a travel medicine or infectious disease specialist as well. Many parts of the world have endemic diseases that affect your health and your unborn baby's health. Many less exotic, tropical or subtropical areas have a problem with the Zika virus, and you should avoid these areas. The CDC has more information.

 

A Very Special Birthday

Three generations, one birthday: Delaware Valley OBGYN blog

Three generations, one birthday

 Clara Gregory, Theresa Dunn and Micah Dunn, 3 generations with the same birthday

Our very own Dr. Eugene Gamburg had the opportunity to participate is a very special childbirth.

As reported by the University Medical of Princeton at Plainsboro, NJ.com and the Associated Press, Dr.  Gamburg delivered a patient of our group, Delaware Valley OBGYN and Infertility Group on her own birthday. Not only that, but the patient herself also shared the same birthday with her mother.

What an amazing alignment. While we are not able share all the details, the story of Micah's birth, you can learn more by clicking on the links above.

Meet our nutritionist

Alka Sheth, MS, RDN

Our registered dietician and nutritional counselor can help improve your health and wellness particularly for women with diabetes, gestational diabetes, PCOS, infertility and weight management issues.

Click here to visit our nutrition page to learn more about the nutritional/ dietary services we offer at our office.

The vegan pregnancy

The Vegan Diet: Delaware Valley OBGYN blog
 Is is it safe to follow a vegan or vegetarian pregnancy?

Is is safe for my baby to continue my vegan diet when pregnant?

Yes and no. It is quite possible to have a safe, healthy pregnancy while maintaining a strict vegan diet according to reputable organizations such the American College of Obstetricians and Gynecologists and the Academy of Nutrition and Dietetics. That it is of course, you plan to make up for the nutrients missing in a diet that avoids animal products. Many of our patients are vegan or vegetarian.

What kind of problems can arise if I continue my vegan diet during pregnancy?

The biggest issue is a vitamin deficiency. Vitamin B12 and iron are most likely to be an issue, and both are important for your unborn baby. It may be difficult to get enough iron with a plant based diet alone and without vitamins you will not get enough vitamin B12. Adequate vitamin supplementation is essential. Nausea and vomitting in pregnancy, and changes in your cravings may challenge your desire to avoid animal based products.

How do I plan for pregnancy if I am vegan?

See your doctor or midwife before you conceive. They can discuss the proper vitamins and supplements to maximize your chances for a healthy pregnancy.

Are there any advantages to a vegan diet in pregnancy?

While a balanced diet is advised during pregnancy, women who follow a vegan diet are less likely to excess weight gain during the pregnancy.

 

Essential facts about midwives

Essential facts about midwives: Delaware Valley OBGYN blog
Princeton-NJ-midwives.jpg

Certified nurse midwives provide care for pregnancy and well woman care beyond pregnancy. Here are a few interesting facts about midwifery in the US from the American College of Nurse Midwives.

There are thousands of midwives in the US delivering hundreds of thousands of babies a year.

  • There were 11,194 CNMs (certified nurse midwives) and 97 CM (certified midwives without a nursing degree) in the country as of May 2014.
  • There were In 2014,  332,107 midwife-attended births in the US, slightly more than in  2013. The vast majority ( > 90%) were attended by CNMs.
  • Midwives account for 12.1% of all vaginal births, and 8.3% of total US births.

Midwives also provide womens health care outside of pregnancy

  • CNMs are independent health care practitioners who are licensed and able to write prescriptions in all 50 states, including  DC, Samoa, Guam and Puerto Rico.
  • Federal law considers CNMs to be primary care providers
  • Over half of midwives considered reproductive health care to be their primary responsibility and a third consider primary care as their main role.

Most midwives work in a hospital setting in collaboration with obstetricians

  • Over 94% of midwife attended births occur in hospital settings
  • Over half of midwives are employed by physician groups or hospitals

Midwifery care is usually covered by health insurance 

  • Medicaid programs as well as most states are required to cover deliveries attended by midwives 

Midwives hold graduate degrees and are required to go through an accreditation process

  • There are 39 training programs for nurse midwives in the US and they receive their accreditation from the Accreditation Commission for Midwifery Education (ACME).
  • 82% of CNMs hold a master’s degree; a graduate degree has been an entry requirement into midwifery since 2010.
  • Almost 5% of CNMs hold doctoral degrees, the highest proportion of all groups of advanced practice nurses.

Dr. Gamburg talks about endometriosis surgery

Robotic surgery for Endometriosis: Delaware Valley OBGYN blog

Princeton NJ gynecologist discusses endometriosis surgery with the daVinci robotic device.

In the video above, one of Dr. Eugene Gamburg's patients describes her experience undergoing a combined robotic surgical procedure with a surgeon at the University Medical Center of Princeton at Plainsboro, and how it saved her wedding day.

 

Dr. Seth Derman, our practice's fertility specialist also answers some frequently asked questions  about this disease.

What is endometriosis?

Endometriosis is a disease in which tissue similar to the endometrium is located in places in the body where it normally does not belong. Endometrium is the layer of tissue that lines the uterus. It is where a pregnancy will implant, and part of it sheds monthly during the menstrual period. Endometriosis is typically found on the surfaces of organs near the uterus, the ovaries, the fallopian tubes, bladder and intestines, although it may also be been seen in distant parts of the body.

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are pelvic pain, painful menstrual periods and painful intercourse. Because the implants of endometriosis respond to hormones similarly to normal endometrium, which fluctuate throughout the month, the symptoms of this disease are are often cyclic.

How is endometriosis diagnosed?

Endometriosis can only properly be diagnosed using surgery to directly inspect for it, and possibly confirm the diagnosis by biopsy. Routinely subjecting women to laparoscopy or other surgery is not practical, so oftentimes, the diagnosis of endometriosis is presumed without confirming the diagnosis.

How is endometriosis treated?

Your doctor may treat endometriosis in a number of ways. Sometimes this involves surgery, but it usually involve medications that suppress ovulation cause the implants to shrink down. This may include progesterone like drugs (progestins) and birth control pills that create a pregnancy-like hormone environment or drugs like Lupron, the create a temporary menopause-like situation. These medications often work because Endometriosis symptoms typically improve with pregnancy and menopause.

What is daVinci robotic surgery about?

Laparoscopy which involves a inserting a telescope into the abdomen is commonly used to diagnose and treat endometriosis. The daVinci surgical robot is a device often used to complete surgeries laparoscopically that are difficult to do without open surgery. Because it enables the surgeon to see far greater detail and operate with greater precisions, many gynecologists will use robotic surgery to treat the disease. Our team of gynecologic surgeons is among the most experience in DaVinci and minimally invasive surgery in the area.

Does endometriosis affect fertility?

This answer to the this question is a bit more complicated. Advanced staged endometriosis (stages 3 and 4) can clearly cause infertility. With early stage endometriosis (stages 1 and 2), it is a little less straightforward. While there is reasearch to suggest that treating early stage disease helps to improve pregnancy rates, there are other data which shows women with early stage endometriosis have similar outcomes to those with unexplained infertility. Either way, it is important to understand that even in couples with endometriosis-related infertility, there may be other reasons for not conceiving, so it is still important to see a fertility specialist for a testing.

 

Dr. Pierce brings minimally invasive procedure to Princeton

YOUR HEALTH: Princeton Doctor performs single-site robotic hysterectomy

By Stephanie Vaccaro

robotic-surgeon-hysterectomy-single-site.jpg

This article previously appeared in the Princeton Packet  

Single site robotic hysterectomy in Princeton NJ

Dr. Bruce Pierce, the medical director of the robotic surgery program at Princeton HealthCare System, was the first doctor in the northeast to do a single-site robotic hysterectomy with the da Vinci Xi system robot. The surgery involved removing the uterus and both tubes and ovaries.   This surgery is frequently done with a larger incision that is similar to that of a C-section.   ”And that requires a two- to three-day hospital stay followed by a six-week recovery period,” Dr. Pierce said. “Since I do it minimally invasively with the robot, I’m able to make one tiny incision in the belly button and because of that, my patient goes home the same day. And basically in two weeks they’re back to work. They’re back to their normal routine.”

The benefits of robotic surgery 

The value of robotic surgery is clear.   ”Basically, it’s using technology to make a major surgery into a minimally invasive procedure, with the focus on quicker recovery,” Dr. Pierce said, adding that it involves less scarring. “Ninety percent of these surgeries can be done as outpatient.”   Earlier this year, a large study was published in the “Journal of International Gynecology & Obstetrics,” with thousands of patients with a variety of hysterectomies. “They found in surgeons who were experienced with robotics, meaning they had more than 60 cases under their belt, they found the robotic hysterectomy has less complications, less need for re-operation, less need for readmission, and less bleeding and infection,” Dr. Pierce said. “The main thing was the surgeons needed to be experienced.”   What makes a patient a good candidate for robotic surgery? “It depends on the surgeon’s level of experience,” Dr. Pierce said.   He also said that it’s important to note that there is a learning curve with robotics.

The importance of using an experienced robotic surgeon

   "It’s not perfect right out of the gate," he said. “With a beginning surgeon, you basically have to pick the easiest candidate, meaning somebody who is not overweight, somebody who has not had a lot of previous surgery, somebody whose uterus is small, a non-complex surgery. But the more experienced you get with the new technology, you’re able to expand the patient base to a more complex patient. So, all of a sudden these patients who used to be not candidates for robotics are now candidates with experienced robotics surgeons.”   How will this technology develop? “The future though lies with more women becoming candidates and more complex cases being done in a minimally invasive manner,” Dr. Pierce said.   What about the naysayers? “The detractors of robotics say it’s too expensive,” Dr. Pierce said, but he pointed out considerations as fewer hospital stays, and returning to a work a month earlier.   Dr. Pierce has done hundreds of robotic surgeries for the past eight years. He has also taught other physicians how to do it for many years now. When considering robotic surgery, experience matters, he said, “I want to emphasize that an experienced surgeon is crucial to improved outcomes."

 

Bed rest and pregnancy

 Article in Harper's Magazine questions whether bed rest is helpful in pregnancy.

Is bed rest helpful or harmful for pregnant women?

For years, obstetricians and midwives (as well as grandmothers-to-be) have recommended bed rest to treat a variety of pregnancy related problems including premature birth, preventing miscarriage, poor fetal growth (IUGR) high blood pressure and pre-eclampsia (toxemia).  Even fertility doctors have gotten in on the game, recommending bed rest to improve IVF pregnancy rates. The question that pregnancy researchers have been trying to answer and the impetus for article above, recently published in Harper's magazine: is does bed rest help?

The science behind bed rest and pregnancy

The idea that bed rest is beneficial for pregnant women certainly makes sense to most people including most womens' health care professionals recommend bed rest. Most obstetricians and midwives have been trained to use bed rest as a treatment but now in the age of evidence based medicine that therapy is being called into question.The problem is that there are few if any studies that show any benefit to bed rest during pregnancy. To be fair, there is also little evidence to suggest that it is not helpful either.

In contrast, there are are a number of studies showing the benefits of exercise for pregnant women, and moderate exercise is now encouraged in healthy pregnant women by organizations such as the American Congress of Obstetricians and Gynecologists

So, why care about bed rest in pregnant women since it is harmless?

Bed rest is not harmless. Bed rest increases the risks of a number of complications including:

  • Blood clots
  • Depression
  • Low birth weight
  • Slower recovery from childbirth
  • Loss of bone and muscle mass
  • Loss of income
  • Stress at home

In fact the more strict the bed rest, the higher the risk and severity of these side effects are.

Discussing bed rest with your OB

Making decisions about your medical care is an individualized decision a woman should have with her Obstetrician or Midwife, and bed rest is no exception. Bed rest is neither a cure all for pregnancy complications nor something to be avoided at all costs. 

More confusion over mammography

The American Cancer Society changes mammography recommendations yet again

Mammograms, x-rays of the breast are routinely performed on women for the purpose of diagnosing breast cancer at its early stages when the chances for a cure are highest. While that goal certainly makes a lot of sense, the science behind mammography and its usefulness are turning out to be a moving target.

It seems that every year, mammography recommendations continue to change as we learn more about what breast imaging can and cannot achieve. Just this month, American Cancer Society has changed its mammography recommendations once again.

The new ACS Mammography guidelines are as follows:

  • 40-44: annual mammography optional
  • 45-54: annual mammography recommended 
  • 55+: mammography every 1-2 years
  • Screening should continue for as long as a woman is expected to live at least 10 more years
  • All women should learn about the risks, benefits and limitations of screening and learn their own normal breast anatomy through self examination.

So, does that mean my doctor (OR MIDWIFE) and I should cut back on how often I get my mammograms?  maybe, maybe not.

  • There is really no consensus. Other organizations that issue mammogram recommendations such as the American Congress of Obstetricians and Gynecologists (ACOG) and the US Preventative Health Task Force either have not changed their guidelines or offer different recommendations.
  • ACOG continues to recommend offering annual mammography after age 40
  • Women at high risk such as those who carry BRCA gene mutations and those with an extensive family histories of breast cancer (particularly at a young age) are usually advised to start screening much sooner.