County OB/GYN Blog
Summertime is here and while many people have been eagerly anticipating the warm weather, the heat can make a summer pregnancy challenging and uncomfortable. We’ve provided a few tips to help alleviate discomfort and keep you safe and cool while pregnant in the summer.
Staying hydrated in the summer is important especially for pregnant women. During pregnancy you should drink at least eight, 8 ounce glasses of water (2 liters) each day. Staying hydrated can prevent common problems in pregnancy such as hemorrhoids, constipation and bladder infections. Your baby also benefits as it aids in forming the amniotic fluid around the fetus and helps carry nutrients to the fetus. During the hot summer weather, you might enjoy ice cold popsicles and cold fruit or melon to increase your water consumption and keep you cool. Be sure to drink water if you begin to experience symptoms of dehydration which may include headache, dizziness, fatigue or dark urine.
High temperatures and strong UV rays can drain you of energy and make you feel tired. This summer, make sure to take time to rest in a cool area. Many patients experience swelling especially lower extremity or leg swelling. This is not a worrisome sign but due to vasodilation from heat. To reduce swelling, keep your legs elevated while resting.
Going for a swim is a great way to relax, cool down and exercise during pregnancy. The weightlessness in the water can help relieve pressure or pain you may be experiencing. For days when the UV rays are powerful, find a spot in the shade to cool off or head indoors to air conditioning to avoid overheating. Utilize hats and umbrellas to create extra shade and stay cool in the sun.
While enjoying time outdoors, it’s crucial to use sunscreen. Look for a broad-spectrum sunscreen which provides protection against UVA and UVB rays and contains an SPF of 30 or greater. Due to increased hormone levels, skin sensitivity increases during pregnancy causing pregnant women to be more susceptible to sunburns. Be sure to reapply your sunscreen every two hours, and especially after swimming or sweating to avoid sunburn and sunspots.
Wear lightweight & loose clothing
Choosing the right kind of clothing, such as lightweight material and loose-fitting clothes, can help you stay cool and comfortable during a summer pregnancy. Linen, cotton and silk, are examples of lightweight clothing that can help you from overheating and wick away moisture. Light colored clothing, especially white, can help to reflect the sun rays and keep you cool.
Plan your physical activities
Regular exercise is important during pregnancy and it’s recommended that you get 3 to 4 hours of total exercise weekly. Great exercises during pregnancy include walking, swimming, low impact aerobics and yoga. With the hot summer temperatures, plan your physical activity for the mornings while the temperatures are cooler to avoid heat exhaustion. Staying active during pregnancy provides numerous benefits such as:
- Reduces back pain
- Better mood
- Increases energy
- Less stress
- Eases constipation
- Promotes healthy weight gain during pregnancy
- May decrease risk of gestational diabetes, preeclampsia and cesarean birth
- Improves overall fitness
Signs of heat exhaustion:
Heat exhaustion symptoms may include dizziness, fatigue, muscle cramps, excessive sweating, weak rapid pulse, headache or nausea. Symptoms may start suddenly or progress overtime. If you are experiencing any symptoms of heat exhaustion, move to a cool place, rest and drink water. If symptoms get worse or don’t alleviate within one hour, contact your provider at County Ob/Gyn.
County Ob/Gyn offers comprehensive healthcare for women. Schedule an appointment with your provider through your MyChart Portal or by calling us at (203) 488-8306.
Menstrual cups have recently gained popularity but have been around since the 1930s. At first glance, menstrual cups may look strange and intimidating, but were here to help explain what they are, the pros and cons, and how to use them.
What is a menstrual cup?
A menstrual cup is a reusable feminine hygiene product that can last up to 10 years. It’s a flexible funnel shaped cup made of rubber or silicone that’s safe to use and just as effective as pads and tampons. The cup is inserted into your vagina to catch and collect period fluid and can be worn for 8 to 12 hours. Menstrual cups can hold about twice the amount of blood that pads and tampons can, making them an eco-friendly and cost-effective alternative.
Pros and Cons
- Eco-friendly and cost effective: reusable menstrual cups provide long-term use allowing you to save money on pads and tampons, which means less waste in landfills and less trips to the drugstore.
- Odorless: Odor occurs when menstrual fluid is exposed to air and the airtight seal from menstrual cups prevents leaks, unlike pads and tampons.
- Safer: no risk of toxic shock syndrome.
- More time in between changes: menstrual cups can hold more blood and be worn for 8 to 12 hours, depending on your flow.
- Eliminates irritation and dryness.
- Messier: emptying the cup can be messy and spills may be unavoidable but improves with practice.
- Can be difficult to insert or remove: you may find yourself having a difficult time getting the right fold to insert the cup or a having a hard time pinching the base of the cup to remove it.
- Can be hard to find the right fit: menstrual cups are available in sizes small and large, but proper use of the cup can be difficult due to individual anatomy. Talk with your provider to find out which size would be right for you.
- Regular sterilization is required: after each menstrual cycle, the cup must be sterilized in boiling water for 3-5 minutes.
- Potential allergies: menstrual cups are made of silicone or rubber which means that they’re safe to use in the body, but some people may have an allergic reaction to the material.
- There can be an increased risk of infection: to avoid infection, be sure to wash your hands before inserting and removing the cup. Rinse the cup thoroughly after removal to prepare for next insertion and sterilize the cup after each cycle.
How to insert
- Wash your hands thoroughly.
- Apply a thin layer of water-based lube or water to the rim of cup.
- Fold the menstrual cup tightly in half to create a C shape.
- Insert the cup into your vagina, like you would a tampon, with the rim facing up.
- Rotate the cup once it’s in your vagina to fully open the cup. This will create an airtight seal to prevent leaks. If inserted correctly, you shouldn’t be able to feel it.
How to remove
- Wash your hands thoroughly.
- Using your index finger and thumb, pinch the base of the cup to break the seal and gently pull down.
- Empty the cup into your toilet.
- Rinse cup with water and gentle, fragrance-free soap. Once it’s clean, you can reinsert the cup.
Sterilizing the cup at the end of your cycle
Rinsing the cup after removal removes some surface bacteria, odor, and buildup, while sterilizing after your cycle ends, completely removes bacteria.
- Rinse the cup thoroughly.
- Boil the cup in water for 3 to 5 minutes.
- Allow the cup to completely dry off and cool down.
- Store the cup in breathable pouch when not in use in a cold, dry location.
Is a menstrual cup right for you?
You and your provider will consider:
- Length of your cervix
- Your age
- If you’ve given birth vaginally
- Menstrual flow
- Strength of pelvic floor muscles
To schedule an appointment, call (203)-488-8306 or through your MyChart Portal.
Additional ways to fold a menstrual cup:
PreMenstrual Syndrome occurs days before menstruation when a woman feels physical or mood changes.
According to the Mayo Clinic, there is no exact cause for premenstrual syndrome, though factors such as changes in hormones, chemical changes in the brain, and even undiagnosed depression may contribute to the condition.
Symptoms of PMS
There is a variety of symptoms for PMS and no two people are exactly the same. Emotional symptoms can range from depressed mood, irritability, anger, mood swings to crying spells, insomnia and change in libido. And while the physical symptoms usually include bloating, weight gain, breast tenderness, there can also be acne flare-ups, joint or muscle pain, headache, and digestive issues.
A more severe type of PMS is called premenstrual dysphoric disorder (PMDD). PMDD occurs when PMS symptoms are more severe and cause problems with work or personal relationships. PMDD is treated with drugs called selective serotonin reuptake inhibitors (SSRIs) which are used to treat depression.
How to ease symptoms of PMS
Symptoms of PMS that are mild to moderate often can be relieved through lifestyle changes but when symptoms disrupt your life, you may want to make an appointment with your healthcare provider. These tips may help ease PMS symptoms:
Aerobic exercise has numerous benefits for your overall health and can help reduce the symptoms of PMS, fatigue and depression. Examples of aerobic exercise includes running, brisk walking, swimming and cycling. It’s recommended that you get at least 30 minutes of exercise, five days a week.
Stress can negatively affect your health, including PMS symptoms. By reducing stress, you can help improve your health and ease symptoms of PMS. To combat stress, try:
- Breathing exercises
- Getting enough sleep
Try the following diet changes to help ease PMS symptoms:
- Avoid caffeine and alcohol.
- Reduce your intake of salt, sugar and fat.
- Include foods high in calcium in your diet along with vitamin D to allow your body to absorb the calcium.
- Eat complex carbohydrates rather than processed simple carbohydrates. Complex carbohydrates include whole grain, fruits, and vegetables.
- Eat frequent small meals rather than three large ones.
Some vitamin supplements can help reduce the physical and mood symptoms of PMS. Examples of supplements that may help are:
- Vitamin E
If lifestyle changes don’t help ease symptoms enough, your healthcare provider may suggest medication or over the counter meds.
- Antidepressants: in some women, these drugs can be helpful in treating PMS and lessen mood symptoms. There are many types of antidepressants. If one doesn’t work for you, your doctor may prescribe a different one.
- Hormonal birth control: may help lessen physical symptoms. Hormonal birth control prevents ovulation, which may help decrease intensity of symptoms and make your menstrual cycle more regular. You may need to try numerous before finding the one that works for you.
- Nonsteroidal anti-inflammatory drugs (NSAIDS): the most common over the counter pain relievers such as ibuprofen.
County Ob/Gyn offers comprehensive healthcare for women and can help with issues related to your menstrual cycle, including PMS. If after making certain lifestyle changes doesn’t improve your symptoms enough, schedule an appointment with your provider at County Ob/Gyn. You can schedule an appointment through your MyChart Portal or by calling us at (203) 488-8306.
Your first pap smear can be scary and intimidating when you’re not sure what to expect. In this video, Dr. Tania Aziz discusses what a pap smear is, who needs the screening test done, what the results mean, and a walkthrough of the exam.
By Madison Diglio
Valerie and Dr. Aziz
On January 12, 2023, two staff members of County Ob/Gyn, traveled to Roger Williams Park Zoo in Providence, RI, to treat an extraordinary patient; Finley, an 8-year-old multiparous female howler monkey who was in need of gynecologic help. Tania Aziz, MD, and Valerie Ciavaglia, sonographer, were happy to assist the veterinary staff at the zoo. Dr. Jessica Lovstad, a veterinarian on staff, posted looking for assistance from an Ob/Gyn in a private One Health Facebook group. Dr. Aziz reached out to Dr. Lovstad explaining how County Ob/Gyn would be more than happy to help find the reason for Finley’s recurrent vaginitis.
Courtesy of Roger Williams Park Zoo
In December 2021, Finley had a possible pseudo pregnancy with suspected endometritis/vaginitis. Endometritis is inflammation of the endometrium, the inner lining of the uterus, while vaginitis is an inflammation of the vagina that causes symptoms such as itching, burning, odor, and large amounts of discharge. Between April and November of 2022, Finley had 4 instances of suspected urinary tract infections and vaginal infections. Dr. Lovstad performed a pelvic exam and obtained vaginal cytology and cultures, and it grew numerous bacteria. She treated Finley with antibiotics for 30 days and the discharge cleared. However, due to the numerous strains of bacteria growing on culture and Finley’s complex history, the veterinary team at Roger Williams Park Zoo was interested in having a second opinion to help them look for any abnormalities in the vagina as well as perform a uterine ultrasound.
Once Dr. Aziz and Valerie arrived at the veterinary hospital, Finley was put under anesthesia for the exam. Valerie set up the ultrasound machines using both the ultrasound owned by the hospital and a portable ultrasound from County Ob/Gyn. While Valerie was preparing for the ultrasound exam, Dr. Aziz performed a breast exam on Finley and the results were normal. Valerie then scanned to assess the anatomy of the ovaries, uterus and bladder. From the beginning of the exam, Valerie could see that the uterus looked abnormal as it was vascular and mass like. Her sonographic findings concluded Finley’s ovaries, adnexa and cul de sac appeared unremarkable as did the bladder.
Valerie, Dr. Aziz and Dr. Lovstad looking at Finley’s ultrasound on County Ob/Gyns portable ultrasound machine
Dr. Aziz began her exam on Finley by first looking at the external genitalia and she concluded it to be normal. Interestingly enough, the anatomy of a female howler monkey is the same as a human female but smaller. Due to the smaller anatomy, Dr. Aziz used a pediatric speculum which is narrower and shorter than other speculums, making it the most appropriate for Finley’s exam. Once the speculum was placed, Dr. Lovstad confirmed it was not a normal appearance of a monkey’s cervix and Dr. Aziz and the veterinarian team could see a polypoid mass was present. It was unclear if the mass was cervical or endometrial in origin and Valerie assisted by performing a uterine ultrasound. Dr. Aziz also took a yeast culture to detect the presence of a yeast infection.
Drs. Aziz, Lovstad and Valerie observing the cervical mass in Finley
Dr. Aziz performed a biopsy and obtained a 2mm tissue sample. Valerie scanned Finley post biopsy to ensure stability and the results were unremarkable. This concluded the exam on Finley.
Dr. Aziz taking a biopsy
In regards to the cervical mass, Dr. Aziz recommended a total hysterectomy as there is no need for future fertility since Finley has already had three babies, Tucker, Ryder and Piper. If the yeast culture is positive, a dose of Diflucan, the same drug used in human females, should clear it.
Dr. Aziz and Valerie in front of the rainforest exhibit
The staff at the zoo were extremely welcoming and kind to Dr. Aziz and Valerie and made the visit an unforgettable experience. After the exam, a tour of their beautiful facility was given. They were treated to meeting southern tamanduas and a giant anteater. Roger Williams Park Zoo opened in 1872, making it the country’s third oldest zoo, and is home to 121 unique and captivating species from around the world. At the core of their mission is conservation and environmental stewardship and each visit supports RWPZ ongoing animal care, educational programs and conservation conservatives. Each day, they strive to contribute to a healthier planet for us all by using the best practices in every operation. It truly was an excellent adventure for our staff.
County Ob/Gyn sends our very best to Finley in hopes she is recovering well! We were extremely honored to be asked to offer our opinion in helping Finley and the veterinary team.
Symptoms of a UTI (urinary tract infection) can range from very mild to having visible blood in the urine. This guide is a good introduction to UTI’s and what can be done to lessen the symptoms.
Your urinary tract is made up of your kidneys, bladder, ureters and urethra. A UTI occurs when bacteria enter through the urethra and travel into the bladder. The most common form of UTI occurs in the lower urinary tract, which include the bladder (cystitis) and the urethra (urethritis).
Women are at a higher risk of developing a UTI simply because of their anatomy. Females have a shorter distance from the opening in the urethra to the anus compared to males, making it easier for bacteria to reach the bladder. The most common cause of urinary tract infection is from gastrointestinal bacteria, E. coli.
About 50-60% of women will experience a urinary tract infection in their lifetime. Certain lifestyle choices and medical conditions can increase your chances of developing a UTI, which include:
- Being sexually active
- Are pregnant
- Going through menopause
- Have kidney stones causing a urinary tract blockage
- Have diabetes mellitus
- Have had a UTI before
- Use spermicide
- Have recently had a urinary catheter
- Poor hygiene
Common symptoms to any type of urinary tract infection include:
- Strong and frequent urge to urinate
- Sharp pain or burning when urinating
- Passing small amounts of urine
- Soreness in the lower abdomen, back or sides
- Urine may look cloudy or contain blood
Diagnosis & Treatment
Standard diagnosis at County Ob/Gyn is via culture, which takes 24-48 hours to result. Providers will select an appropriate antibiotic based on the urine analysis, which is read rapidly. The culture will indicate if there is an unusual or resistant bacteria present that requires a change of medication. Providers wouldn’t know this information without a culture, which is why they strongly discourage treatment based only on symptoms or the urinalysis alone. It’s important to finish all of the medication prescribed by your provider, even after symptoms are no longer present, to kill all unwanted bacteria. If left untreated, an infection can spread from your bladder to kidneys, which can cause serious health problems.
To lower your risk of developing a UTI, try to:
- Urinate after intercourse to flush out bacteria
- Drink plenty of fluids including water to flush out bacteria
- Drink cranberry juice
- Wash skin around the anus and genital area
- Wipe from front to back
- Urinate when you feel the urge to
- Change your birth control method if needed
If you are pregnant and think you have a UTI, contact us immediately. It’s important to treat UTIs early to avoid potential problems for both you and your baby.
County Ob/Gyn offers comprehensive healthcare for women. If you are experiencing any of the symptoms listed above, schedule an appointment with your provider by either calling us at (203) 488-8306 or emailing us on our secure server at firstname.lastname@example.org.
At County Ob/Gyn we have 3 board-certified sonographers. They are highly-skilled professionals who use specialized equipment to create images of your baby from the very beginning to the end of your pregnancy. County Ob/Gyn is AIUM accredited, which means we meet or exceed nationally recognized standards in the performance and interpretation of diagnostic ultrasound examinations.
During your 1st trimester of pregnancy, you should expect to come in for a 30-minute ultrasound appointment. We will do a transvaginal ultrasound during this appointment. A transvaginal ultrasound allows us to see the early gestation of only about a centimeter. We look at your anatomies such as uterus, cervix, and ovaries during your ultrasound visit. We take a close look at the gestation and can show you the beginning of early pregnancy. You and your partner can see everything on a monitor in the exam room. Once we finish the ultrasound we can provide digital copies of the images and if you would like hard copies, we can print a few copies in the office.
In your 2nd trimester ultrasound, we will do an anatomy scan in which we look at the fetus from head to toe, the placenta, the amniotic fluid, the surrounding tissue, the uterus, and the ovaries as well. You can expect the ultrasound visit to be about an hour. We will use a curved probe that goes on top of the stomach. This gives us a broad view in which we can see through the fetus and evaluate the anatomy. Your 3rd trimester ultrasound could be a fluid check, growth scan, or position check depending on what the doctor orders for you.
At County Ob/Gyn we are here for you during every stage of pregnancy. Our physicians and staff would be happy to answer any questions you may have about these tests.
World Immunization Week, celebrated in the last week of April, aims to highlight the collective action needed and to promote the use of vaccines to protect people of all ages against disease.
If you are pregnant or planning on pregnancy you will need certain vaccinations. The vaccines you receive will not only protect your own health but will safeguard your baby’s health, as well. While you are pregnant, your immunity is your unborn child’s first line of defense to combat certain serious illnesses. Whether you’re pregnant now or planning for pregnancy, take the time to ensure your immunizations are current.
During pregnancy, what vaccinations should women receive?
During pregnancy, women should receive the flu vaccine, during Flu season as soon as possible. The flu vaccine is completely safe to receive, and will not cause any harm to a developing fetus.
The Tdap vaccine is another vaccine for all pregnant women and is generally given between 28 and 36 weeks gestation. By receiving this vaccine during the third trimester of pregnancy, some immunity is conveyed to your baby, providing them with protection during the first few months of their lives, before they can be vaccinated.
If you haven’t already received all eligible COVID-19 vaccines and booster doses, we strongly recommend doing so. The COVID-19 vaccine reduces the risk of infection, severe illness, and death from COVID-19 among people who are pregnant. There is evidence that some immunity is passed to your baby as data demonstrate that antibodies are passed to the fetus when a pregnant person is vaccinated. Vaccination may be received during any trimester.
Vaccinations are one of our best defenses against infectious diseases, and we should take every necessary measure to protect ourselves and our family members against vaccine-preventable diseases. Talk to your physician at County Ob/Gyn to learn more about the safety of vaccination before, during, and after pregnancy.
Dr. Susan Richman is committed to helping others. Besides her private practice experience, she is an active volunteer in her community and beyond. In the past, she has volunteered for the Indian Health Service (IHS). IHS provides a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives. Dr. Richman was a volunteer for The Navajo Area Indian Health Service (NAIHS) in New Mexico, and in addition, has participated in medical mission work in Ecuador.
Dr. Richman is always looking for new ways to give back. Recently, she is working with The Shoreline Interfaith Coalition as they are a co-sponsor with Integrated Refugee and Immigrant Services (IRIS). IRIS is the largest resettlement agency in Connecticut. Their mission is to connect clients to the resources they need to thrive in their communities. IRIS has many different working teams including housing, apartment set-up, healthcare, education, finance, transportation, employment, and fundraising. Dr. Richman is a part of the healthcare committee, which makes up roughly 30 individuals including doctors, nurses, and social workers. The committee is currently working with a family of two parents and their 13 children.
Dr. Richman explains:
“Our job is to get together and review the medical history and find out what needs there are for each family member. Not all needs are physical. There are emotional needs as some could be traumatized and needed to see a therapist. There are also physical needs as every child needed to see a pediatrician to catch up with vaccinations. We went through each person’s medical history to gather as much information as we could with one of the family members translating. Our job is to listen and make medical appointments accordingly.
This family is experiencing a new language, a new culture, new weather, new everything. With a new environment and new schools, I can only imagine how overwhelming it can be for the children but they seem very happy and are very friendly. Whenever I stop by the house the family always offers us something to eat. Hospitality is very important. In return I make sure when I visit, I bring something for them.”
Dr. Richman spends time driving the family to their medical appointments. She assists with translation, makes any additional appointments necessary, and handles any pharmaceutical needs. The medical team’s goal is to assist and help clients learn to navigate the system independently.
Healthcare support is one of many elements of support this family receives. Dr. Richman explains how one day she was taking one of the kids back from an appointment and she met another volunteer from the education committee. It was school vacation week and she had volunteered to do homeschooling. Just one example of how many are involved.
“When all the volunteers first met, everyone went around and shared their story and why they thought it was important to volunteer. Many had grandparents that came to America, spent weeks on Ellis Island, found work and lived on the lower east side, and now a doctor or a nurse two generations later. You always want to help up the next person to come.”
To learn more about IRIS and ways to get involved please visit: http://irisct.org/volunteer
Dr. Chelouche discusses in-office IUD placement at County Ob/Gyn and compares the different IUD options available.