Women's Healthcare Resources in Chattanooga, TN

Cuando los senos se llenan con cantidades abundantes de leche, sangre y líquido linfático se hace lo que se llama la congestión de los senos sucede . Algunas madres experimentarán solamente una ligera sensación de hinchazón, mientras otras sentirán los senos muy llenos, adoloridos y con abultamientos. La congestión de los senos puede causar que el pezón que se aplane, Y puede hacer difícil que el bebé succione y amamante bien. Generalmente la congestión de los senos se alivia a las 24 a 48 horas, pero las siguientes sugerencias pueden ayudarle te a mejorar un poco más pronto.

• Amamante al bebé por lo menos de 15 a 20 minutos una vez que ya haya “bajado” la leche. Los senos deberán sentirse más suaves después de amamantar.
• Permita que su bebé “termine” su primer seno antes de ofrecerle el segundo.
• Amamante a su bebé frecuentemente (cada 2 a 2 ½ horas o menos); no deje que su bebé pase más de 3 horas sin comer durante la primera semana de vida.
• Después de amamantar, ponga compresas frías sobre los senos por 20 minutos y una vez cada hora entre cada sesión de alimentación. (las compresas pueden hacerse si moja un pañal desechable con agua y lo congela). No aplique hielo directamente sobre el seno, coloque una toalla entre el paquete de hielo y la piel.

1.Las hojas de col o repollo frescas pueden aplicarse para disminuir la hinchazón.

Lave las hojas de col o repollo y macháquelas con la mano o enróllelas para romper las venas de las hojas.

2.Aplique suficientes hojas de col para cubrir el seno y el área de la axila completamente.

3.Retire las hojas de col cuando estén calientes y marchitas; aplique hojas nuevas si la congestión de los senos todavía está presente.

4.Recuéstese en una posición inclinada de tal forma que sus senos estén más elevados que su corazón. Los paquetes de hielo pueden aplicarse sobre las hojas de col.

*** Cuidado!, úselas solamente hasta que usted se sienta cómoda, ya las hojas de col pueden “secar la leche” si se usan aún después de que la congestión de los senos se ha aliviado.

• Extraiga la leche usando la mano o la bomba de extracción para suavizar la aureola si el bebé está teniendo problemas para amamantar.
• Calor tibio y humedo puede aplicarse a los senso por 3 a 5 minutos justo antes de amamantar al bebé para ayudar a que la leche “baje”.

Podria tomar Tylenol o Motrin so lo necesita para las molestias

Llame a su doctor o consejera de lactancia materna si no hay mejoría en 24 horas.

For most women, the early part of labor, before active labor, is best spent at home. During this time it is important to save your energy for later by resting, eating and drinking plenty of fluids. These are some suggestions that have helped other women:

• Drink/eat at least 16 ounces of fluids with energy each hour (juice, popsicles, broth, Gatorade, soda without caffeine).
• Snack on small amounts of light, easily digested foods.
• Alternate walking with the shower and resting
• Some women may feel nauseous and even vomit during labor, this is normal. Wait a short while and continue to drink.
• If your contractions allow, try to sleep. Sometimes a warm bath or using a heating pad will help relax you enough to fall asleep for a short while.
• Remember that your coach should also rest, eat and drink, too!

Labor contractions feel like very painful (you can’t walk or talk during them) menstrual cramps in the low abdomen, pelvis, hips, low back and upper thighs. They build to a peak and then they ease and go away. To time how often your contractions are coming, start at the beginning of one contraction and time until the beginning of the next contraction. Duration of your contraction is the time each contraction lasts (the start to the end of one contraction).

YOUR CONTRACTIONS ARE PAINFUL AND REGULAR:

• coming every 3 to 5 minutes, lasting 60 seconds for an hour for a first labor
• coming every 5 to 7 minutes, lasting 60 seconds for an hour for all other labors

OTHER REASONS TO CALL YOUR DOCTOR:

• Big gush or steady trickle of watery like discharge from your vagina. ( your bag of waters may have broken )
• Heavy, bright red bleeding like a period.
• A small amount of red, pink or brown blood or “bloody show” is normal, especially after a vaginal exam.
• Continuous, severe, sharp abdominal pain that doesn’t stop after 3 – 5 minutes.
• Absent or decreased fetal movement.
• If you can’t eat or drink, are exhausted, can’t cope with the pain or have questions or concerns call you medical professional right away.

Contact your doctor office if you have any concerns

WHAT IS FETAL MOVEMENT COUNTING?

It is normal for your healthy, growing fetus to move frequently in your womb. You can help look out for the health of your baby by recording a count of the number of times your baby kicks, twists, or turns. Doing this is called fetal movement counting, or “Kick Counts.” You will usually feel your baby move by the 20th week of pregnancy.

WHEN DO I DO KICK COUNTS?

Your obstetrician or nurse-midwife may ask you to keep a record of how long it takes your baby to move five times.

Count fetal movements twice each day at the baby’s “busy times.” This is usually in the evening, around bedtime, after meals and after exercise.

HOW DO I DO KICK COUNTS?

• Get relaxed and comfortable. Loosen tight clothing. Lay down on your side or sit with your feet propped up. You may find it easier to concentrate with the TV off.
• Note the time you start. Count movements until you reach at least five. Each roll, kick, or punch or twist counts as 1 fetal movement.
• On the “My Baby Movement’s” counting sheet, put a check mark on the line for each movement you feel. Note the time you finish.
• If the baby is quiet, drink a glass of cold juice and start over.

WHAT DO I DO IF I DON’T FEEL 5 MOVEMENTS IN AN HOUR?

If the baby does not move five times in one hour, please call your heath care provider and follow their recommendations.

Contact your doctor office if you have any concerns.

Engorgement is a common and usually temporary condition where the breasts are tender, swollen, firm and warm to the touch. It is most common in the first two to four days of breastfeeding. Before the need for milk and milk production have coordinated.

• Notify doctor or nurse-midwife if engorgement has not improved within 24 hours.
• Nurse or express frequently, at least eight times each 24-hour period.
• Alternate position of infant at each feeding until breasts are no longer engorged. Warm compresses on the breast for five minutes right before nursing may relieve discomfort and help the baby to empty the breast more easily.
• If fever (>100.4° F) and chills develop, notify doctor or nurse-midwife.
• Use cold packs, cold gel packs or cold cabbage leaves applied to breast right after nursing or expression.
• Use hand expression or a fully automatic intermittent breast pump until infant is able to latch and engorgement is relieved.
• Limit pumping time to 10 minutes if breast is extremely engorged (10 minutes every two hours).
• Use Tylenol or Motrin to relieve pain.

Contact your doctor office if you have any concerns.

Pregnancy is a time of many changes, both physical and emotional, for almost all women. Some women find that they are more anxious or depressed during pregnancy. This can be especially true for women who have had anxiety or depression in the past, have had a prior pregnancy loss, who are going through a high-risk pregnancy or in a stressful time with relationships, finances or work. If you feel you are seriously depressed or anxious, please tell your health care provider.

The following are suggestions that have helped other women with depression and anxiety during  pregnancy:

• Read You, Your Baby, and Us. Pay particular attention to the sections on normal changes during pregnancy and common discomforts (and what to do about them).
• Attend childbirth classes and infant care classes.
• Start planning for the postpartum period now. Identify your positive support people and ask them to plan to help once the baby is here. Give them specific and practical jobs to do.
• Plan to join a new mother’s support group. If you plan to breastfeed, this can be a breastfeeding mom’s support group.
• Remember to take good care of yourself, physically and emotionally. The single most important thing you can do for your baby is to be healthy.
• Identify the positive and helpful people around you. This can be your partner, a family member, a friend or your health care providers. Talking things over with a person  you trust can be a very helpful way to deal with stress. They can also help you decide if you should get professional help.

Contact your doctor office if you have any concerns.

Quickening or the first feeling of fetal movement usually happens around 20 weeks in first pregnancies and about 16 weeks in later pregnancies. Once quickening occurs it’s typical to not feel regular movement until 24 weeks. After 24 weeks, a healthy fetus should move 5 times per hour during a “busy time.”  A sudden absence of fetal movement after 24 weeks, or a significant decrease in the amount or strength of fetal movement can sometimes be a sign of fetal distress. Contact your health care provider with concerns or questions.

It is important to remember there are many factors that can influence fetal movement, for expamle , time of day, smoking, last meal or fluids, also maternal medications or maternal anxiety can play an important role.

Contact your doctor office if you have any concerns.

A D&C (dilatation and curettage) is a procedure that involves scraping the uterine cavity to remove tissue. It is often done to remove retained pieces of placenta after delivery. Following a D&C you may have bleeding from the uterus for a few days, cramping, and some back or pelvic pain. This is considered normal.

INSTRUCTIONS

• Do not douche, use tampons, or have sexual intercourse for two weeks or until you have been cleared by your health care professional.
• You may go back to work or resume normal activities in two to four days.
• You may begin eating or drinking as soon as you feel up to it.
• Please call your doctor at if you notice any of the following:

1. Severe pain unrelieved by medication.

A temperature greater than 100.4 °F (38°C).

2. Heavy vaginal bleeding (saturating one or two maxi pads in one hour) that gets worse instead of better.

3. A vaginal discharge that smells foul and unpleasant.

4. Signs of infection such as headache, muscle aches, dizziness, or general ill feeling.

5. Your caregiver may prescribe medications to help with cramping, bleeding and the prevention of infection.

Contact your doctor office if you have any concerns.

CARE IN THE HOSPITAL

Immediately after the circumcision, a double diaper (one cloth diaper inside the disposable diaper) with petroleum jelly (Vaseline) applied to the front will be placed on you baby and remain on for about two hours. This double diaper will aid in preventing any bleeding. The petroleum jelly will protect the tip of the penis from burning when the baby urinates. It will also keep it from drying and sticking to the diaper.

Your nurse will be checking on your baby for bleeding and pain. If you need help changing your baby or have any questions, please ask your nurse and/or midwife.

At first, the tip of the penis is swollen and bright red. Within one or two days, you will notice a decrease in the swelling and may see a yellow covering of the tip of the penis. This is normal new tissue growth.

Your baby may be given acetaminophen (Tylenol) after the circumcision for pain control with your permission.

CARE AT HOME

After the initial two-hour period, you may diaper your baby normally, using about one tablespoon of petroleum jelly every diaper change until the penis is healed. The healing will occur in three to four days. The healing is complete when the tip of the penis is no longer yellow and is pink like the rest of the skin.

For cleaning the penis for the first two or three days, pouring warm (not hot) water over it should be sufficient. If it is necessary, you may also use a mild soap.

CALL YOUR BABY’S DOCTOR

If the penis becomes swollen and reddened and has a greenish-yellow, foul smelling discharge, this could be a possible infection.If this should occur, contact your baby’s doctor immediately.

It is normal to have some blood spots on the diaper for the first couple days. If you notice any active blood dripping from the penis, call your baby’s doctor immediately.

If you baby does not urinate once within 24 hours after the circumcision, call your baby’s doctor immediately.

Contact your doctor office if you have any concerns.

Bringing a new baby home from the hospital can be a wonderfully exciting time. However, hormone changes, fatigue, stress from major changes, and the lack of support in a woman’s life can cause many women to experience major mood swings. It is common for a new mom to be joyful one minute and crying the next. She may be irritable, anxious, confused, forgetful, and have headaches. These feelings can last up to three weeks after the baby is born. Here are some suggestions that have helped other new moms get through this wonderful but trying period:

• Avoid extreme fatigue  sleep when your baby is sleeping. Let your partner or other support person feed the baby occasionally, so you can get extra rest.
• Share your feelings and frustrations with your partner or close friend. Remember that it is normal to feel resentful, overwhelmed, guilty, and confused at this time.
• Eat well and drink plenty of fluids.
• Concentrate on yourself and the baby. Let others help with housework, laundry, cooking, shopping, etc.
• Get out of the house every day. Go for a walk or meet with a friend. Treat yourself to something you enjoy doing.

THE FOLLOWING SYMPTOMS ARE NOT NORMAL.

• If your feelings last longer than three weeks and are interfering with caring for yourself and the baby you may be experiencing postpartum depression “Baby Blues” or an anxiety disorder.
• Other symptoms of depression or anxiety disorders are:

1. Unable to sleep or sleeping all the time

2. Loss of appetite

3. Feeling down most of the time

4. Feeling that even the smallest tasks seem to take too much effort

5. Feeling very critical of yourself and others

6. Worrying constantly about the baby

7. Having thoughts of harming yourself or the baby.

IF YOU EXPERIENCE ANY OF THESE SYSTOMS, PLEASE CALL YOUR DOCTOR AS SOON AS POSSIBLE.

• KEEP YOUR PERINEAL AREA CLEAN AND DRY.
• Use the spray bottle filled with warm water each time you urinate or have a bowel movement.
• Use Dial Bar (yellow kind only) to clean that area until healed
• Use blow dryer on cool setting to dry the area after bathing
• Pat dry, gently, from front to back, with tissue.
• Change your pad each time you use the bathroom.
• Wear loose cotton underwear or go without underwear when possible.

Soak in the tub or use the Sitz bath three times a day, at least.

• PROMOTE HEALING.
• Get lots of rest.
• Drink at least 8 glasses of water daily.
• Eat lots of protein (meat, fish, cheese, eggs, legumes), vegetables and fruit.
• Take your prenatal vitamin daily
• Take your pain medication as needed for comfort and to allow you to care for yourself and your baby.

Call your doctor or nurse-midwife if you experience any of the following:

• You have a fever greater than or equal to 100.4.
• You have hard or infrequent bowel movements.
• You notice foul-smelling lochia (vaginal discharge and bleeding) or uterine tenderness (below your belly button).
• Your perineum is not improving after 48 hours.

Contact your doctor office if you have any concerns.

WHAT IS A TRANSOBTURATOR TAPE PLACEMENT?

Transobturator tape placement (TOT) is when mesh (prolene) tape is placed underneath the urethra. It acts as a layer of support so the urethra is closed off when there is laughing, coughing, sneezing and exercising.

WHEN IS THIS SURGERY USED?

To treat stress urinary leakage, such as a loss of urine with coughing, sneezing, laughing or exercise.

HOW DO I PREPARE FOR SURGERY?

• Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery.
• Some medications need to be stopped before the surgery.
• Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor can order a nicotine patch while you are in the hospital.
• You will be told at your pre-op visit whether you will need a bowel prep for your surgery and if you do, what type you will use. The prep to clean your bowels will have to be completed the night before your surgery.
• You will need to shower at home before surgery. Instructions will be provided at your pre-operative appointment.
• Do not wear makeup, nail polish, lotion, deodorant, or antiperspirant on the day of surgery.
• Remove all body piercings and acrylic nails.
• If you have a “Living Will” or an “Advance Directive,” bring a copy with you to the hospital on the day of surgery.
• Most women recover and are back to most normal activities in four to six weeks. You may need a family member or  friend to help with your day-to-day activities for a few days after surgery.

WHAT CAN I EXPECT DURING THE SURGERY?

• Once in the operating room, you will be given either a spinal or general anesthesia before the surgery to keep you from feeling pain. The choice of anesthesia is a decision that will be made  based upon your history and your wishes.
• If a general anesthesia is given, after you are asleep and before the surgery starts:

1. A tube to help you breathe will be placed in your throat.

2. Another tube will be placed in your stomach to remove any gas or other contents to reduce the likelihood of injury during the surgery. The tube is usually removed before you wake up.

3. A catheter will be inserted into your bladder to drain urine and to monitor the amount of urine coming out during surgery. The catheter will stay in until the next day.

4. Compression stockings will be placed on your legs to help prevent blood clots in your legs and lungs during surgery.

• The inside of the bladder will be examined with a camera after the surgery, to be certain there were no bladder injuries.

WHAT ARE POSSIBLE RISKS FROM THIS SURGERY?

Problems can occur, even when things go as planned. You should be aware of these possible problems, how often they happen, and what can be done to correct them.

POSSIBLE RISKS DURING SURGERY INCLUDE:

Bleeding: If there is excessive bleeding, you will be given a blood transfusion unless you have personal or religious reasons for not wanting blood.

Conversion to an open surgery requiring an up and down or Bikini incision. If a bigger open incision is needed during your surgery, you may need to stay in the hospital for one or two nights.

Damage to the bladder, ureters (the tubes that drain the kidneys into the bladder), and to the bowel: Damage occurs in less than 1% of surgeries. If there is damage to the bladder, ureters, or to the bowels they will be repaired while you are still in surgery.

Death: All surgeries have a risk of death.  Some surgeries have a higher risk than others.

WHAT HAPPENS AFTER THE SURGERY?

You will be taken to the recovery room and monitored for one hour before going to your hospital room. Depending on the length of your surgery, you may not be able to eat or drink anything until the next morning or you will be started on a liquid diet.

You may have cramping, or feel bloated.

YOU WILL:

Be given medications for pain and nausea as needed.

Still have the tube in your bladder.  The tube will be left in until the next morning.

If you are at a high risk for blood clots, a blood thinning medication may be given to you during your hospital stay.

Have the compression stockings on your legs to improve circulation. The stockings will stay on until you are actively walking. 

 Start walking as soon as possible after the surgery to help healing and recovery.

Be restarted on your routine medications. Be instructed to use a small plastic device at your bedside to help expand your lungs after surgery. 

Stay in the hospital for one to two days.

POSSIBLE RISKS THAT CAN OCCUR DAYS TO WEEKS AFTER SURGERY:

Blood clot in the legs or lungs: Swelling or pain, shortness of breath, or chest pain are signs of blood clots.

Infection:  Bladder or surgical site infection.  This may cause fever, redness, swelling or pain. 

Urinary symptoms:  Failure to cure the bulge, develop urine leakage, and inability to urinate without a catheter.

Bowel obstruction:  A blockage in the bowel that causes abdominal pain, bloating, nausea and/or vomiting

Scar tissue: Tissue thicker than normal skin forms at the site of surgery

Pain: Pain with intercourse.

CALL YOUR DOCTOR RIGHT AWAY IF YOU EXPERIENCE ANY OF THE FOLLOWING :

Develop a fever over 100.4°F (38°C)

Have nausea and vomiting

Develop a rash

Have pain with urination

Start bleeding like a menstrual period or (and) are Changing a pad every hour

Have severe pain in your abdomen or pelvis that the pain medication is not helping

Have heavy vaginal discharge with a bad odor

Have chest pain or difficulty breathing

Leak fluid or blood from the incision or if the incision opens

Develop swelling, redness, or pain in your legs

You may need menstrual pads at home, due to some bleeding and spotting that will occur after the surgery.

Bleeding:

Spotting is normal. Discharge will change to a brownish color followed by yellow cream color that can continue for up to four to eight weeks.

It is common for the brownish discharge to have a slight odor because it is old blood.

Urination:

Your urine stream may be slower. Some women are temporarily unable to empty the bladder completely. If you are unable to empty your bladder after surgery we will teach you how to do so before you go home, or you may go home with a catheter tube in place. If the catheter is left in place, you will need to discuss with your doctor when the catheter can be removed.

Medications:

Pain: Medication for pain will be prescribed for you after surgery. Do not take it more frequently than instructed.

Stool softener: Narcotic pain medications may cause constipation. A stool softener may be needed while taking these medications.

Activities:

Energy level:  It is normal to have a decreased energy level after surgery. Once you settle into a normal routine at home, you will slowly begin to feel better.  Walking around the house and taking short walks outside can help you get back to your normal energy levels more quickly. 

Climbing: Climbing stairs is permitted, but you may require assistance when you first return home. 

Lifting: For six weeks after your surgery you should not lift anything heavier than a gallon of milk. This includes pushing objects such as a vacuum cleaner and vigorous exercise.

Showers: Showers are allowed within 24 hours after your surgery.  Tub baths are encouraged 24 hours after surgery.

Intercourse:  No sexual activity for eight weeks after surgery. 

Driving: The reason you are asked not to drive after surgery is because you have be given pain medications.  Even after you stop taking pain medications; driving is restricted because you may not be able to make sudden movements due to discomfort from surgery.

Exercise: Exercise is important for a healthy lifestyle.  You may begin normal physical activity within hours of surgery.  Start with short walks and gradually increase the distance and length of time.

Work: Most patients can return to work in 6 weeks after surgery. 

Please contact your doctor if you have any questions or concerns before or after your surgery.

WHAT IS A TOTAL VAGINAL HYSTERECTOMY WITH AN ANTERIOR AND POSTERIOR REPAIR?

The removal of the uterus and cervix through the vagina. Removal of the ovaries and tubes depends on the patient. Your doctor will decide whether or not you are a candidate for a vaginal hysterectomy.

These are procedures to correct vaginal prolapse. Normally, the vagina is held in place by ligaments and muscles.  An incision is made on the anterior (top) or posterior (bottom). The muscular tissue underneath the vaginal skin are put together to better support the bladder or the rectum.

WHY ARE THESE SURGERIES USED?

To treat diseases of the uterus.

• Prolapse of the uterus
• Abnormal vaginal bleeding
• Overgrowth of tissue in the lining of the uterus
• Cystocele is a fallen bladder
• Rectocele is a fallen rectum

HOW DO I PREPARE FOR SURGERY?

• Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy enough for surgery..
• Some medications need to be stopped before the surgery. A list of medications will be provided.
• You will be told at your pre-op visit whether you will need a bowel prep for your surgery and if you do, what type you will use. The prep to clean your bowel will have to be completed the night before your surgery.
• Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor may order a nicotine patch while you are in the hospital.
• You will need to shower at home before surgery.
• Do not wear makeup, nail polish, lotion, deodorant, or antiperspirant on the day of surgery.
• Remove all body piercings and acrylic nails.
• If you have a “Living Will” or an “Advance Directive”, bring a copy with you to the hospital on the day of surgery.
• Most women recover and are back to most activities in 4-6 weeks. You may need a family member or a friend to help with your day-to-day activities after surgery.

WHAT CAN I EXPECT DURING THE SURGERY?

• Once in the operating room, you will be given either a spinal or general anesthesia before the surgery to keep you from feeling pain. The choice of anesthesia is a decision that will be made based upon your history and your wishes.
• If a general anesthesia is given, after you are asleep and before the surgery starts:

1. A tube to help you breathe will be placed in your throat.

2. Another tube will be placed in your stomach to remove any gas or other contents to help reduce the likelihood of injury during surgery. The tube is usually removed before you wake up.

3. A catheter will be inserted into your bladder to drain urine and to monitor the amount of urine coming out during surgery. The catheter will stay in until the next day.

• Compression stockings will be placed on your legs to help prevent blood clots in your legs and lungs during surgery.
• After you are asleep the doctor will remove the uterus, cervix, and possibly the ovaries and tubes through a vaginal incision. The vaginal opening is then closed with suture.
• If the vaginal support for the bladder or rectum is found the anterior/ posterior repair will be done.
• The inside of the bladder will be examined with a camera after the surgery, to be certain there were no bladder injuries.

WHAT ARE THE POSSIBLE RISKS FROM THIS SURGERY?

Although there can be problems that result from surgery, we work very hard to make sure it is safe as possible. However, problems can occur, even when things go as planned.  You should be aware of these possible problems, how often they happen, and what van be done to correct them.

POSSIBLE RISKS DURING SURGERY INCLUDE:

• Bleeding: If there is excessive bleeding, you will be given a blood transfusion unless you have personal or religious reasons for not wanting blood. This should be discussed with your doctor prior to the surgery.
• Damage to the bladder, ureters (the tubes that drain the kidneys into the bladder), and to the bowel: Damage occurs in less than 1% of surgeries. If there is damage to the bladder, ureters, or to the bowels they will be repaired while you are still in surgery.
• Death: All surgeries have a risk of death.  Some surgeries have a higher risk than others.

WHAT HAPPENS AFTER THE SURGERY?

You will be taken to the recovery room and monitored for one hour before going to your hospital room. Depending on the length of your surgery, you may not be able to eat or drink anything until the next morning or you may be started on a liquid diet.

You may have cramping, or feel bloated.

You will:

• Be given medications for pain and nausea as needed.
• Still have the tube in your bladder.  The tube will be left in until the next morning.
• Have the compression stockings on your legs to improve circulation. The stockings will stay on until you are actively walking.  
• If you are at a high risk for blood clots, a blood thinning medication may be given to you during your hospital stay.
• Be restarted on your routine medications.
• Be instructed to use a small plastic device at your bedside to help expand your lungs after surgery. 
• Start walking as soon as possible after the surgery to help healing and recovery.
• Stay in the hospital for one to days.

POSSIBLE RISKS THAT CAN OCCUR DAYS TO WEEKS AFTER SURGERY:

• Blood clot in the legs or lungs: Swelling or pain, shortness of breath, or chest pain are signs of blood clots.
• Bowel obstruction:  A blockage in the bowel that causes abdominal pain, bloating, nausea and/or vomiting
• Urinary symptoms:  Failure to cure the bulge, develop urine leakage, and inability to urinate without a catheter.
• Infection:  Bladder or surgical site infection.  This may cause fever, redness, swelling or pain. 
• Scar tissue: Tissue thicker than normal skin forms at the site of surgery
• Pain: Pain with intercourse.

CALL YOUR DOCTOR RIGHT AWAY IF YOU EXPERIENCE ANY OF THE FOLLOWING:

• Develop a fever over 100.4°F (38°C)
• Have pain with urination
• Have nausea and vomiting
• Develop a rash
• Start bleeding like a menstrual period or (and) are changing a pad every hour
• Have severe pain in your abdomen or pelvis that the pain medication is not helping
• Have heavy vaginal discharge with a bad odor
• Have chest pain or difficulty breathing
• leak fluid or blood from the incision or if the incision opens
• develop swelling, redness, or pain in your legs
• You may menstrual pads at home, due to some bleeding and spotting that will occur after the surgery.

BLEEDING:

• Spotting is normal.

1.Discharge will change to a brownish color followed by yellow cream color that can continue for up to four to eight weeks.

2.It is common for the brownish discharge to have a slight odor because it is old blood.

Urination:

• Your urine stream may be slower. Some women are temporarily unable to empty the bladder completely. If you are unable to empty your bladder after surgery we will teach you how to do so before you go home, or you may go home with a catheter tube in place. If the catheter is left in place, you will need to discuss with your doctor when the catheter can be removed.

Medication:

Pain: Medication for pain will be prescribed for you after surgery. Do not take it more frequently than instructed.

Stool softener: Narcotic pain medications may cause constipation. A stool softener may be needed while taking these medications.

Activities:

Energy level:  It is normal to have a decreased energy level after surgery.   Once you settle into a normal routine at home, you will slowly begin to feel better.  Walking around the house and taking short walks outside can help you get back to your normal energy levels more quickly. 

Showers: Showers are allowed within 24 hours after your surgery.  Tub baths are encouraged 24 hours after surgery. 

Climbing: Climbing stairs is permitted, but you may require assistance when you first return home. 

Lifting: For six weeks after your surgery you should not lift anything heavier than a gallon of milk. This includes pushing objects such as a vacuum cleaner and vigorous exercise.

Driving: The reason you are asked not to drive after surgery is because you may be given pain medications.  Even after you stop taking pain medications; driving is restricted because you may not be able to make sudden movements due to discomforts from surgery.

Exercise: Exercise is important for a healthy lifestyle.  You may begin normal physical activity within hours of surgery.  Start with short walks and gradually increase the distance and length of time that you walk.

Intercourse:   No sexual activity for eight weeks after surgery. 

Work: Most patients can return to work in six weeks after surgery. 

Please talk to your doctor with any other questions or concerns for before and after your surgery.

WHAT IS A TOTAL LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY?

Is the removal of the uterus and cervix through the vagina and in addition to four small (1/2’- 1’) abdominal incisions. Removal of the ovaries and tubes will depend on the patient. Your doctor will decide if you are a candidate for a vaginal hysterectomy.

WHY IS THIS SURGERY USED?

TO TREAT DISEASES OF THE UTERUS

• Fibroids
• Abnormal vaginal bleeding
• Pelvic pain
• Endometriosis
• Infection in the ovaries or tubes
• Overgrowth of tissue in the lining of the uterus

HOW DO I PREPARE FOR SURGERY?

• Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy enough for surgery.
• Some medications need to be stopped before the surgery. A list of medications will be provided at your pre-operative appointment.
• Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor may order a nicotine patch while you are in the hospital.
• You will be told at your pre-op visit whether you will need a bowel prep for your surgery and if you do, what type you will use. The prep to clean your bowels will have to be completed the night before your surgery.
• You will need to shower at home before surgery.
• Do not wear makeup, nail polish, lotion, deodorant, or antiperspirant on the day of surgery.
• Remove all body piercings and acrylic nails.
• If you have a “Living Will” or an “Advance Directive”, bring a copy with you to the hospital on the day of surgery.
• Most women recover and are back to most activities in 4-6 weeks. You may need a family member or friend to help with your day-to-day activities for a few days after your surgery.

WHAT CAN I EXPECT DURING THE SURGERY?

• Once in the operating room, you will be given either a spinal or general anesthesia before the surgery to keep you from feeling pain. The choice of anesthesia is a decision that will be made based upon your history and your wishes.
• If a general anesthesia is given, after you are asleep and before the surgery starts:

1.A tube to help you breathe will be placed in your throat.

2.Another tube will be placed in your stomach to remove any gas or other contents to reduce the likelihood of injury during the surgery. The tube is usually removed before you wake up.

3.A catheter will be inserted into your bladder to drain urine and to monitor the amount of urine coming out during surgery. The catheter will stay in until the next day.

4.Compression stockings will be placed on your legs to help prevent blood clots from forming your legs and lungs during surgery.

• After you are asleep the laparoscope is inserted into the abdomen and carbon dioxide gas is blown into the abdomen to inflate the belly wall away from the internal organs.
• After you are asleep the doctor will remove the uterus, cervix, and possibly the ovaries and tubes through the vagina 4 small abdominal incisions. The vaginal opening is then closed with suture.

WHAT ARE POSSIBLE RISKS FROM THIS SURGERY?

Although there can be problems that result from any surgery, we work very hard to make sure it is as safe as possible. However, problems can occur, even when things go as planned. You should be aware of these possible problems, how often they happen, and what will be done to correct them.

POSSIBLE RISKS DURING SURGERY INCLUDE:

• Bleeding: If there is excessive bleeding, you will be given a blood transfusion unless you have personal or religious reasons for not wanting blood. This should be discussed with your doctor before the surgery.
• Conversion to an open surgery requiring an up and down or Bikini incision: If a bigger open incision is needed during your surgery, you may need to stay in the hospital for one or two nights.
• Damage to the bladder, ureters (the tubes that drain the kidneys into the bladder), and to the bowel: Damage occurs in less than 1% of surgeries. If there is damage to the bladder, ureters, or to the bowels they will be repaired while you are in surgery.
• Death: All surgeries have a risk of death. Some surgeries have a higher risk than others.

POSSIBLE RISKS THAT CAN OCCUR DAYS TO WEEKS AFTER SURGERY:

• Blood clot in the legs or lungs: Swelling or pain, shortness of breath, or chest pain are signs of blood clots.
• Bowel obstruction: A blockage in the bowel that causes abdominal pain, bloating, nausea and/or vomiting.
• Hernia: Weakness in the muscle at the incision that causes a lump under the skin.
• Incision opens: The abdominal or vaginal incision.
• Infection: Bladder or surgical site infection. This may cause fever, redness, swelling or pain.
• Scar tissue: Tissue thicker than normal skin forms at the site of surgery.

WHAT HAPPENS AFTER THE SURGERY?

• You will be taken to the recovery room and monitored for a short time before going to the observation unit.
• Depending on the length of your surgery, you may not be able to eat or drink anything until the next morning or you will be started on a liquid diet. When you are feeling better you may return to a regular diet.
• You may have cramping, feel bloated, or shoulder pain.
• You may have a scratchy or sore throat from the tube used for your anesthesia.
• You will: 

1.Be given medications for pain and nausea if needed.

2.Still have the tube in your bladder. The tube will be left in until the next morning.

3.Have the compression stockings on your legs to improve circulation.

4.Be restarted on your routine medications.

Be given a small plastic device at your bedside to help expand your lungs after surgery.

5.Start walking as soon as possible after the surgery to help healing and recovery.

6.Stay in the hospital for 24 hours.

CALL YOUR DOCTOR RIGHT AWAY IF YOU EXPERIENCE ANY OF THE FOLLOWING:

• develop a fever over 100.4°F (38°C)
• have pain with urination
• start bleeding like a menstrual period or are changing a pad every hour
• have severe pain in your abdomen or pelvis that the pain medication is not helping to relive
• have heavy vaginal discharge with a bad odor
• have nausea and vomiting
• have chest pain or difficulty breathing
• leak fluid or blood from the incision or if the incision opens
• develop swelling, redness, or pain in your legs
• develop a rash

CARING FOR YOUR INCISION:

• Vaginal Bleeding: Spotting is normal.
• Discharge will change to a brownish color followed by yellow cream color that can continue for up to four to eight weeks.
• It is common for the brownish discharge to have a slight odor because it is old blood.
• Menopausal Symptoms: Once your ovaries are removed you will be in surgical menopause. Symptoms of menopause can include hot flashes, vaginal dryness, mood changes, and vaginal discomfort with intercourse.
• If these symptoms cause you discomfort, please talk with your doctor.
• Before the age of 45 there is a greater risk of thinning and broken bones after your ovaries are removed. It is important to get the right amount of calcium and vitamin D from your diet or a supplement. Your doctor may want you to have a bone density scan to evaluate your bone health.

MEDICATIONS:

• Pain: Medication for pain will be prescribed for you after surgery. Do not take it more frequently than instructed.
• Stool softener: Narcotic pain medications can cause constipation. A stool softener may be needed while taking these medications.

ACTIVITIES:

• Energy level: It is normal to have a decreased energy level after surgery. During the first week at home, you should minimize any strenuous activity. Once you settle into a normal routine at home, you will slowly you will begin to feel better. Walking around the house and taking short walks outside may help you get back to your normal energy levels more quickly.
• Showers: Showers are allowed 24 hours after your surgery.
• Climbing: Climbing stairs is permitted, but you may require assistance when you first return home.
• Lifting: For 4-6 weeks after your surgery you should not lift anything heavier than a gallon of milk. This includes pushing objects such as a vacuum cleaner and vigorous exercise.
• Driving: The reason you are asked not to drive after surgery is because you may be prescribed pain medications. Even after you stop taking pain medication; driving is restricted because you may not be able to make sudden movements due to discomforts from surgery.
• Exercise: Exercise is important for a healthy lifestyle. You may begin normal physical activity within hours of surgery. Start with short walks and gradually increase the distance and length of time that you walk. To allow your body time to heal, you should not return to a more difficult exercise routine for 4-6 weeks after your surgery. Please talk to your doctor about when you can start exercising again.
• Intercourse: No sexual activity for 8 weeks after surgery.
• Work: Most patients can return to work between 4-6 weeks after surgery. You may continue to feel tired for a couple of weeks.

If you have further questions or concerns about getting ready for surgery,  surgery itself, or after surgery, please talk with your doctor.

WHAT IS A HYSTEROSCOPY?

This is a procedure where a doctor uses a thin tube with a camera to look inside the uterus.  Saline solution is used to expand the uterus in order to look inside of the uterus. There are no incisions.

WHEN IS THIS SURGERY USED?

This procedure allows us to see any abnormalities in your uterus.

TO EVALUATE AND OR TREAT DISEASES OF THE UTERUS

• Recurrent miscarriages
• Lost or retained IUD, will be removed if seen.
• Heavy or irregular vaginal bleeding, a scraping will be obtained.
• Inability to obtain an office endometrial sampling will be obtained.
• Scar tissue inside the uterus, will be cut out or use electrical energy to remove
• Endometrial polyps will be removed using electrical energy or cut out.
• Sub mucosal fibroids, will be removed using electrical energy or cut out.
• Permanent sterilization (Essure), these devices will be placed into the openings of the Fallopian tubes.

HOW DO I PREPARE FOR SURGERY?

• Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery.
• Some medications may need to be stopped before the surgery. A list of medications will be provided at your pre-operative appointment.
• Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor may order a nicotine patch while you are in the hospital.
• You will be told at your pre-op visit whether you will need a bowel prep for your surgery and if you do, what type you will use. The prep to clean your bowel will have to be completed the night before your surgery.
• You will need to shower at home before surgery. Instructions will be provided at your pre-operative appointment.
• Do not wear makeup, nail polish, lotion, deodorant, or antiperspirant on the day of surgery.
• Remove all body piercings and acrylic nails.
• If you have a “Living Will” or an “Advance Directive”, bring a copy with you to the hospital the day of surgery.
• Plan for your care and recovery for after your surgery is complete . Most women recover and are back to most activities in 1-2 days.

WHAT CAN I EXPECT DURING THE SURGERY?

• In the operating room, you will be given either a general ,  spinal , or a local anesthesia. The choice of anesthesia is a decision that will be made by the anesthesiologist based upon your history and wishes.
• If a general anesthesia is given, after you are asleep and before the surgery starts:

1.A tube to help you breathe will be placed in your throat.

2.Another tube will be placed in your stomach to remove any gas or other contents to reduce the likelihood of injury during the surgery. The tube is usually removed before you wake up.

3.A catheter will be inserted into your bladder to drain urine and to monitor the amount of urine coming out during surgery. The catheter will stay in until the next day.

• Compression stockings will be placed on your legs to prevent blood clots in your legs and lungs during surgery.
• Your cervix will be dilated and then the hysteroscopy is placed through the cervix into the uterus. Fluid is instilled into the uterus for better visualization.
• A dilation and curettage is often performed at the same time to remove tissue for any further testing.
• Photographs may be taken during the surgery and placed in your medical records for future reference.

WHAT ARE POSSIBLE RISKS FROM THIS SURGERY?

Although there can be problems that result from any surgery, we work very hard to make sure it is as safe as possible. However, problems can occur, even when things go as planned. You should be aware of these possible problems, and what will be done to correct them..

POSSIBLE RISKS DURING SURGERY INCLUDE:

• Bleeding: If there is excessive bleeding, you will be given a blood transfusion unless you have personal or religious reasons for not wanting blood. This should be discussed with your doctor prior to the surgery.
• Damage to the bladder, ureters the tubes that drain the kidneys into the bladder), uterus, and to the bowel: Damage can occur in less than 1% of surgeries. If there is damage to the bladder, ureters, uterus, or to the bowel they will be repaired while you are still in surgery.
• Death: All surgeries have a risk of death. Some surgeries have a higher risk than others.

POSSIBLE RISKS THAT CAN OCCUR DAYS TO WEEKS AFTER SURGERY:

• A blood clot in the legs or lung: Swelling or pain, shortness of breath, or chest pain are signs of blood clots. Call you doctor immediately if any of these occur.
• Bowel obstruction: A block in the bowels that results in not being able to pass stool or gas. May cause stomach pain, bloating or vomiting.
• Scar tissue: Tissue thicker than normal skin forms at the cervix or uterus.
• Infection: Fever, redness, swelling or pain at the site of surgery.

WHAT HAPPENS AFTER THE SURGERY?

• You will be taken to a recovery room and monitored for a short time before going home.
• You will be given medications for pain and nausea as needed.
• You will have the compression stockings on your legs to improve circulation and to help prevent the formation of blood clots.
• You may have some vaginal spotting of bright red, brown, or black discharge. This is normal.
• You may have a scratchy throat if a general anesthetic was used.
• You will start walking as soon as possible after the surgery to help the healing and recovery process.

AT HOME AFTER SURGERY

CALL YOUR DOCTOR RIGHT AWAY IF YOU EXPERIENCE :

• develop a fever over 100.4°F (38°C)
• have pain with urination
• start bleeding like a menstrual period or (and) are changing a pad every hour
• have heavy vaginal discharge with a bad odor
• have severe pain in your abdomen or pelvis that pain medication is not helping
• have nausea and vomiting
• develop swelling, redness, or pain in your legs
• develop a rash
• have chest pain or difficulty breathing

OTHER SYMPTOMS:

• Vaginal Bleeding: You may have some vaginal spotting of a watery bright red, brown, or black discharge for up to 3-4 weeks. You may have abdominal cramping for 48 hours.
• Diet: You will continue with your regular diet.
• Medications:
• Pain: Medication for pain will be prescribed for you after surgery. Do not take it more frequently than instructed.
• Nausea: Anti-nausea medication is not typically prescribed.  Tell your doctor if you have a history of nausea with general anesthesia.
•  Activities: 

1.Energy level: It is normal to have a decreased energy level after any surgery. After you are home, you should minimize any strenuous activity for the first day or two. It is very important not to overdo, but once you settle into a normal routine at home, you will find that you slowly begin to feel better. Walking around the house and taking short walks outside can help you get back to your normal energy level quicker.

2.Showers are allowed within 24 hours after your surgery.  Do not take baths for at least 1 week after surgery.

3.Climbing: Climbing stairs is permitted, but you may require assistance initially.

4.Lifting: For 1-2 days after your surgery you should not lift anything heavier than a gallon of milk. This includes pushing objects like a vacuum cleaner and vigorous exercise.

5.Driving: The reason you are asked not to drive after surgery is because you may be prescribed medications that may impair your ability to drive. You should not drive or operate heavy machinery for 24 hours after surgery.

6.Exercise: Exercise is important for a healthy lifestyle. You may resume normal physical activity within hours of surgery. Start with short walks and gradually increase the length of time and distance that you walk. To allow your body enough time to heal, you should not return to a more difficult exercise routine until 2 days after your surgery.  Please talk to your doctor about when you can begin exercising again.

7.Intercourse: No sexual activity for 2 weeks after surgery.

8.Work: Most patients can return to work between 1-2 days after surgery. You may continue to feel tired for a couple of weeks.

Contact your doctor office if you have any concerns.

A D&C (dilatation and curettage) is a procedure that involves suctioning the uterine cavity to remove tissue. It is often done to treat an incomplete miscarriage. Following a D&C you may have bleeding from the uterus for a few days, cramping, and some back or pelvic pain. This is considered normal.

• INSTRUCTIONS.
• Do not douche, use tampons, or have sexual intercourse for 2 weeks or until your caregiver tells you that you are cleared by a medical professional.
• You may begin eating and drinking as soon as you feel up to it.
• You may go back to work or normal activities in 2 to 4 days.
• It is normal to have painful feelings of grief after a miscarriage. You may even cry or feel very sad. Talking with friends, family , or a counselor about your feelings is helpful. Don’t blame yourself for the miscarriage.

Please call your doctor or nurse if you notice any of the following:

• Severe pain that is not relived by medication.
• A temperature more than 100.4 °F (38°C).
• Heavy vaginal bleeding (saturating 1 or 2 maxipads in 1 hour) that gets worse instead of better.
• A vaginal discharge that smells unpleasant.
• Signs of infection such as headache, muscle aches, dizziness, or general ill feeling.

Contact your doctor office if you have any concerns.

WHAT IS ESSURE?

Essure is a permanent birth control procedure. This is a procedure where a doctor will place a small flexible coil into each of the Fallopian tubes. The doctor will first use a thin tube with a tiny camera  to look inside the uterus and identify the Fallopian tubes. There are no incisions.

WHY IS THIS PROCEDURE USED?

The procedure is a form of permanent birth control it is 99.8% effective against pregnancy. However, a back-up method of birth control should be used for up to 3 months after insertion.

HOW DO I PREPARE FOR PROCEDURE?

• The best time to perform this procedure is within 7 days after your period ends.
• The Hysteroscopy cannot be performed during your menstrual cycle or if you are pregnant.
• There are no restrictions on activity or diet before the Hysteroscopy unless otherwise instructed by your doctor.
• Unless otherwise instructed by your doctor, you may take 600 mg of Motrin 1-2 hours prior to the procedure and every 6 hours following the procedure if necessary.  Most women tolerate the Hysteroscopy without any medication.

WHAT CAN I EXPECT DURING THE PROCEDURE?

• Hysteroscopy typically lasts 5 minutes or less.
•  Anesthesia is not normally used for this office procedure.
• A speculum is placed in the vagina just like during a routine pelvic exam.  The cervix is cleaned with iodine or another cleansing solution.  The thin tube with a tiny camera is inserted through the cervical opening into the inside of the uterus. If you wish, you can watch the procedure on a television monitor.  Any findings will be explained to you during the procedure.
• If you have problems with pelvic exams, please talk with your referring doctor before scheduling an appointment for hysteroscopy.  The doctor who recommended hysteroscopy can contact our office to determine if this procedure can be done in the office.
• Most patients experience little or no discomfort.

POSSIBLE RISKS DURING SURGERY INCLUDE:

• Pain
• Dizziness/light-headedness
• Bleeding/spotting
• Damage to the vagina, cervix, or uterus.
• A blood clot in the legs or lung: Swelling or pain, shortness of breath, or chest pain are signs of blood clots. Call your health care provider immediately if any of these occur.

POSSIBLE RISKS THAT CAN OCCUR DAYS TO WEEKS AFTER SURGERY:

• Infection: Fever
• Scar tissue: Tissue thicker than normal skin forms at the cervix or uterus.

WHAT HAPPENS AFTER THE PROCEDURE?

• You may experience mild cramping which should end when the procedure is finished.
• You may experience spotting or watery discharge following the procedure.

Contact your doctor office if you have any concerns.