County OB/GYN Blog

World Mental Health Day

October 10, 2021

Postpartum Depression

Postpartum depression can affect any woman after having a baby. 1 out of every 7 women with newborns experiences postpartum depression. Postpartum depression can happen regardless of a women’s age, race, ethnicity, economic status. Having a baby changes your body and your life in ways that are hard to predict. Feeling sad, moody, or tired is common after childbirth. This is often referred to as ‘baby blues’. These baby blues affect up to 75% of new mothers during the first week or so after delivery. Postpartum depression is different. The symptoms of postpartum are not mild like the baby blues and they last much longer. Postpartum depression can interfere with your ability to take care of yourself and your family. While postpartum depression commonly begins about four to six weeks postpartum, it can happen anytime within the first year after your baby is born.

Risk Factors

Some women are at greater risk for postpartum depression. These factors include:

  • Depression during pregnancy or after a previous pregnancy.
  • History of depression, anxiety, or bipolar disorder.
  • A stressful life event during pregnancy or shortly after birth.
  • Medical complications during the pregnancy, birth, or after the delivery.
  • A lack of strong emotional support can also be a factor.


The symptoms of postpartum depression are not the same for every woman. The most common symptoms include:

  • Feeling sad, hopeless, empty, or overwhelmed
  • Crying more often than usual
  • Worrying or feeling overly anxious
  • Feeling moody, irritable, or restless
  • Oversleeping or not being able to sleep
  • Trouble concentrating or making decisions
  • Frequent feelings of anger or rage
  • Losing interest in activities that usually would find enjoyable
  • Eating too much or not eating enough
  • Avoiding family and friends
  • Having trouble bonding with your baby, or persistently doubting your ability to take care of your baby
  • Thinking about harming oneself or the baby

If at any time you experience symptoms that you feel put you or your baby in danger you should call 211 or 911 and seek emergency assistance. Many times the pressure of wanting to be the perfect mom can keep us from sharing feelings of sadness and anxiety. Postpartum depression is not a negative reflection of parenting skills and is biological in most cases. It also happens to be one of the most common complications after childbirth. The good news is there’s help for postpartum depression. Some treatment options include anti-anxiety or antidepressant medicines, psychotherapy, and support group participation. There are antidepressant medicines that can be taken even while breastfeeding. At County Ob/Gyn we encourage you to have an open and honest conversation with one of our midwives or doctors while you are pregnant and after delivery, if you have any concerns. Together we can break the silence.

On this World Mental Health Day, we hope to raise awareness of mental health issues as well as show our support. Visit for more information on how to get involved.

National Midwifery Week at County Ob/Gyn

October 4, 2021

National Midwifery Week at County Ob/Gyn

It is National Midwifery Week which means it is time to recognize the astounding contributions that midwives make to the world. Here at County Ob we have four full-time certified nurse midwives ready to help you navigate pregnancy, labor, birth, as well as your gynecological health needs. Learn all about midwifery care below from our very own Michelle Plyler, MSN, CNM.

Michelle, why is National Midwifery week important?

“National midwifery week gives us as midwives a chance to educate people about midwifery. A lot of people have the misconception that midwives only take care of pregnant women, or just deliver babies. While we do provide obstetrical care during pregnancy and delivery, we also provide gynecological care. Midwifery week gives us the chance to shine the light on what midwives do so people can get a better understanding.”


What is the role of a midwife?

“The word midwife means ‘with women’ and for me, that is what a midwife does. We are with women when they are in labor, as we are giving them support, but we are with women during other times in their lives as well. For someone coming to their first visit, it is so important to build trust and relationships. This can allow them to have a more positive view of their gynecological care instead of it being something that is overwhelming. We are with women all throughout their lives. We see women who are post-menopausal and we can definitely help them identify with their symptoms. For me, it is about listening to women and giving them a chance to have their voices heard.”


What does midwifery care look like at County Ob?

“Midwifery care at County Ob has two parts: at the office and at the hospital. In the office, we are functioning independently. There are many times of course where we might consult or collaborate with the doctor. If someone needs surgery, that would require referring them over to the doctor at that point. In the hospital, the doctor and the midwife work together as a team. At the hospital, the midwife is the person the patient is frequently interacting with. We are giving the doctor updates as things go along. Many times things go normal and fine and perfect, but sometimes things don’t. If things are becoming abnormal, the doctor becomes more involved.”


What are your favorite parts about being a midwife, Michelle?

“One of my favorite parts is delivering babies. I love it, it’s in my blood, and it’s who I am. It is such an amazing thing to be a part of. For most people, this is one of the most important days of their life. I get to be a part of that which is such an overwhelming honor. Another aspect that has become very important to me is taking care of young women, especially teenagers and women in their early 20s. I always try to make them feel comfortable and heard. I try to help them have a good experience and getting to be a part of that is something I greatly enjoy.”

Cristina Gioioso, MD: Pregnancy During Covid-19 (FAQs)

September 23, 2021

Dr. Gioioso answers frequently asked questions about pregnancy during the Covid-19 pandemic. Learn about what preventative measures we encourage you to take and what we are doing at County Ob to protect our patients, providers, and staff.


Irregular Periods

September 20, 2021

Have you ever wondered what causes irregular periods, and why the length of cycles varies from woman to woman?  There are many factors that have the impact to alter your period cycle.  The length of a regular menstrual cycle is anywhere between 24 to 35 days.  When a length of a cycle falls out of this range, it is considered to be irregular.  Tracking your menstrual cycles is important as it can help you become familiar with your cycle, track abnormal symptoms and it can also indicate other medical problems you may be experiencing.

Factors that may influence your cycle:

  • Puberty:  It is common for girls who are going through puberty to have irregular cycles for the first few months or even up to the first couple of years after their first period.
  • Perimenopause:  During this time, your body is fluctuating in estrogen levels which can cause your menstrual cycles to either become longer or shorter.
  • Pregnancy:  When you are pregnant, abnormal bleeding or missed periods may occur.
  • After giving birth:  Women who are breastfeeding typically do not have a period until their baby is approximately 6 months old.  This is because the hormone prolactin (which allows you to produce milk) prevents you from having your period.
  • Stress:  Stress can be a big factor when it comes to your menstrual cycle.  Stress can control the hormones that regulate your cycle.
  • Excessive exercise:  It has been found that female athletes and women who participate in intensive physical activities often develop amenorrhea, which is the medical term for missed or stopped periods.
  • Birth control:  Birth control pills may cause spotting between periods and result in much lighter periods.  An IUD can cause irregular bleeding for the first three months, but many times your periods can be lighter as time goes by.
  • Extreme weight loss or weight gain:  Maintaining a healthy lifestyle by regularly exercising and eating a healthy diet can help reduce the chances of having irregular period cycles.
  • Thyroid problems or other illnesses can also cause irregular cycles.


Tracking your menstruation cycle

To determine if your menstruation schedule is normal, you can track your cycles. You can manually track your cycles by counting from the first day of your last period to the day before you get your next one. If your period is within the 24-to-35-day range, you have a regular cycle. Keep track of this in a journal and repeat this for at least three months. There are also a variety of apps you can download on your phone or tablet which help track your cycles. It is useful for you to track how many pads you are using, if you are passing large clots, or if you are experiencing bleeding between periods.


When to call your healthcare provider

  • If you miss your period for more than 3 months and you are not pregnant
  • If you experience a period that lasts longer than 7 days
  • If you need to replace your pad once every hour throughout the day
  • If you experience spotting between periods
  • If you experience other symptoms, such as severe pain, severe mood changes, unusual discharge, or develop a fever





Shaving: Helpful Tips and Recommendations

August 18, 2021

Shaving – Helpful Tips and Recommendations

Grooming your bikini area is a very personal decision.  If you choose to shave, we would like to present several helpful facts and recommendations to make it safer.

Did you know the skin in the genital area is much more sensitive than the skin on your leg or arm?  Because of this, it is common for ingrown hairs and irritation to form as a result of shaving. Eventually, a small bump or cyst can develop resulting in a lot of pain and infection.

The only way to fully prevent ingrown hairs would be to stop hair removal altogether.  However, if you wish to continue using a razor there are proper shaving techniques that can decrease the chances of ingrown hairs, irritation, and folliculitis.

We recommend you:

  • Replace your razor often: Replacing your razor frequently ensures that your razor remains bacteria-free and has a sharp blade.  It is recommended to use a sharp razor blade when shaving as dull razors tug at the skin and can cause cuts and irritation.


  • Properly store your razor in a dry area: If you keep your razor in the shower, it can develop bacteria between the blades.  It is important for you to disinfect it with hot water and soap or clean it with rubbing alcohol and a cotton ball prior to every use.  Try to store your razor in a dry area instead of the shower to avoid bacteria growth.


  • Do not share your razor: It is also important to remember not to share your razor as you are putting yourself at risk for infection.


  • Other recommendations to consider: Always shave in the direction of the hair, use warm (not hot) water when shaving, and use shaving cream or gel before shaving.  If ingrown hairs become a frequent occurrence, you may want to consider washing the area prior to shaving with an antibacterial wash, like Phisoderm.  You can also consider other forms of hair removal such as laser hair removal.

Please contact a healthcare professional if you develop increased redness, odor, pus, swelling, or fever sooner rather than later.  This will help your provider to act quickly on treating a possible infection that can be painful and/or serious.

National CNM Week: Midwives for Equity

October 12, 2020

Last week, County Ob/Gyn celebrated National Midwifery Week!

County is lucky enough to have four certified nurse midwives at our practice, who serve as licensed independent healthcare providers with advanced training and credentials. Nurse-midwifery encompasses a full range of primary health care services for women from adolescence through and beyond menopause.

Hear from all four of our midwives as they talk about the importance of CNM week, the full range of care midwifery provides, and why they love being a midwife at County Ob/Gyn.





Welcome Joanie Messner, CNM to the County OB/GYN Family!

June 2, 2020

County OB/GYN is thrilled to announce the arrival of Joanie Messner, CNM, to our practice!

Joanie is a seasoned midwife who has been practicing in the Greater New Haven and Shoreline area for the past 20 years. She loves full-scope midwifery; she provides GYN care to women of all ages in addition to laboring with patients and bringing babies into the world.

Joanie joins our team this summer and she will rotate through our offices for our OB and GYN patients. We are very pleased to introduce her to our patients. Please join us in welcoming Joanie to the County OB/GYN family!


2019 Healthcare Hero Award Goes to Anna Tirado, MD FACOG

July 12, 2019

Connecticut Hospital Association has presented our Anna Tirado, MD, FACOG, with a 2019 Healthcare Hero Award. Congratulations, Anna!

Our Branford Location has Moved!

April 23, 2018

We have moved to our new location at 103 North Main Street in Branford. Stop by and check out our new location when you get a chance!

Outside the new location:

Front reception area:

Help Protect Our Patients This Flu Season!

January 24, 2018

Are you too ill with the flu, flu-like symptoms or a bad cold?  As this is the height of the flu season, we ask that you are seen by your Primary Care Provider if you are not feeling well.  We want to protect the other patients in the office as well as our staff.  Please see below to help stop the spread of germs!