"PAP" Series part 3: What the PAP?

***In order to keep this series light-hearted and easy to read I am not going to quote or site any sources except the knowledge of what I have learned through conferences, school, from pathologists and others who have gone on before me. THIS IS NOT TO REPLACE ANYTHING YOUR DOCTOR/NURSE PRACTITIONER/MIDWIFE/PA etc IS TELLING YOU. This is just some easy to read information***

ps- there is a diagram of a cervix on this page- just a warning. I found the image HERE

So what exactly is a pap smear? and why is it called that?? I really have no idea why it is called that- and I don't want to look on Wikipedia for the answer- so let's just say some it is named after some man named Dr Pap Smear (ugh- I couldn't help myself- I looked on wikipedia and the guy's name is Georgios Papanikolaou.)

A pap is a collection of a small sample of cells about 5 million cells- eh- no biggie) on your cervix (the entrance to your uterus). It is called a "smear" because we used to take those cells, smear them onto a slide, and look at them under a microscope (like 15 years ago). Now we just take the sample of cells- deposit them into a container of liquid and send it off to the lab for them to evaluate. So that is the reason why it kind of pinches when it happens... We are scraping off cells from a very sensitive area of your body. This is also why you might have a little spotting or cramping after your exam.

Bleeding after your pap smear doesn't mean your cells are abnormal or not... it doesn't mean you have an infection... it just means your cervix sometimes bleeds with a pap smear. About 50% of the pap smears I do a day have a little bleeding.

Anyway, a pap smear is a screening test for cervical cancer. SCREENING. It does not show if you have cancer of your cervix.

Then why get a pap smear? Well, a pap smear gives us an indication on which women need to have further evaluations or a DIAGNOSTIC procedure. To diagnose if there is cervical cancer or even any precancer cells.

other couple other examples of this:

-glucose test in pregnancy- if this screening test is elevated you do a 3 hour test as a diagnostic procedure to see if you actually have diabetes in pregnancy.

-Mammogram- if you have abnormal breast tissue you do a diagnostic breast biopsy in order to see if you actually have breast cancer

-AFP testing in pregnancy- a screening test to find out if there is a risk of your baby having downs, spina bifida, etc. The diagnostic test is an amniocentesis.

Like any of these tests there are false negatives and false positives. The pap smear could indicate you have abnormal cells, and then we do a diagnostic test and you don't have any. It could also show that there are no abnormal cells, when in all reality you may have them. However, this is the best we have currently. Since there are really no signs on cervical cancer- no pain, weird bleeding (unless far progressed) it is important to have your pap smears done.

Stay tuned for the current guidelines of when and how often to get your pap smear done.

Dr. Levy's Humanitarian Trip to South Africa

Starting today through Sunday, March 18, 2012 9pm pacific time... for every new "like" we have on our Facebook page, LaborLooks will donate $1 to Dr. Levy's trip to South Africa with RSAA (Rebuilding South Africa Association).

Dr. Levy is an OBGYN with Napa Obstetrics and Gynecology Medical Group. Dr. Solomon founded this group in 1978. It was the first OBGYN group in Napa to offer Nurse-Midwifery care. When I was pregnant with my daughter, I wanted to have a midwife for my prenatal care and delivery. I love the idea of midwives in general and enjoyed working (as a L&D nurse) with midwives. During one of my early prenatal appointments, my midwife was called for a delivery at the hospital and I saw Dr. Levy instead. Dr. Levy was new to this practice - I hadn't even met her at work yet. I was immediately impressed. Dr. Levy was kind, warm, honest, direct, professional and took plenty of time to address my questions and concerns. I continued to see Dr. Levy and the midwives for the rest of my prenatal care. In fact, I saw Dr. Levy 2 weeks ago for my annual pap smear.

LaborLooks is very excited about this opportunity to raise money, hopefully encourage some donations (100% tax deductible) and just show our support.

I asked Dr. Levy a few questions about this trip.

How did you find out about this opportunity?

It was actually my dentist, Dr Adrian Fenderson, who goes on a humanitarian mission (or two) every year. He asked if I might be interested, because anywhere they go they always need gynecologists, and he thought a woman would be ideal.

Tell us a little about what your trip will be like?

We will be flying to Johannesburg, and we will be traveling to different areas (2-4 hours away) where we will set up clinics for people who don't get the opportunity to see the Dr or the dentist much. I will be doing a lot of teaching (women's health--how to examine yourself, what is normal, abnormal, etc) doing biopsies, pap smears, treating people for infections, etc. We will be in a hospital setting for about 5 days, so I am probably going to be doing deliveries, repairing old perineal scars, and anything else that they can use my expertise for.

What have you collected so far for the trip and what do you plan on using additional funds that you receive for?

So far I have collected lots of sutures, anesthetics, bandages, drapes, gloves, instruments. I still need more medications, especially antibiotics, pain medication, topical anesthetics, a Doppler, a blood pressure cuff, and a good portable light.


We will keep you all posted as we gain new likes throughout the weekend... share this post and our facebook updates with your family, friends, facebook groups, etc. We will also do our best to post another interview with Dr. Levy when she returns from her trip so you can see first hand how your contributions have helped.

"PAP" series part 2: At the office

***In order to keep this series light-hearted and easy to read I am not going to quote or site any sources except the knowledge of what I have learned through conferences, school, from pathologists and others who have gone on before me. THIS IS NOT TO REPLACE ANYTHING YOUR DOCTOR/NURSE PRACTITIONER/MIDWIFE/PA etc IS TELLING YOU. This is just some easy to read information***

When you show up at the office for your pap smear here are a couple tips for you.

1. The paperwork they make you fill out is not because they want to torture you. It has a purpose. Either insurance verification, change in health history, change in family history, or whatever, it is important and we do look at those papers. If you have questions about any of it, ask someone.

2. Expect to pay a co-pay. The girls at the front desk who are asking for your money aren't doing it to be mean. So don't get mad at them. If you have a co-pay and they don't collect it from you they could potentially get in trouble with the insurance contracts because your insurance expects the provider to follow the rules that they set out for you.

One of the fabulous things about president Obama is that he has made some healthcare reforms. A lot of insurance companies now cover well woman care (usually pap smears!!) 100%. Even if you have a high deductible it usually covers it 100%. Thank you, thank you for making this important health screening tool more accessible to women everywhere.

However, if your insurance plan hasn't hopped on board with this, or if you are at the office because you have a history of abnormal pap smears, then you may still have to pay a co-pay.

3. If you have to pee, leave a urine sample. I have no idea if anything will happen with it, but nothing is worse than going to the bathroom and then 20 minutes later someone telling you that you have to leave a sample and you can't. The medical assistants might look at you like you are crazy, but just tell them "I left one just in case the doctor/midwife/PA/ Nurse practitioner needed one."

4. When you are called back, expect to be weighed and have your blood pressure taken. This is standard. You may think it is to torture you, but we really do care how your weight has changed or not over the past year. This is another part of your well care. Do we need to discuss risk for diabetes? Do we need to ask about a diet or congratulate you on a well done job? I know you don't want to go to talk about your weight, but it is a part of your overall health, so suck it up, suck it in, and get weighed.

5. When the medical assistant looks at you and hands you a drape or a paper gown just smile. If your medical assistant hands you a laborlooks gown, jump up and down and scream thanks!! Just joking. Most offices have paper drapes and covers. The paper gown for your top half can either open to the front or the back. If you feel more comfortable with it opening to the back then just know when we do your breast exam we will have to bring the paper drape up and it kind of goes into your face. However, if you have the top with the opening in the front, then we can gently slide it to the side and still talk with you as we are doing our exam. The provider preference is to have it open to the front, but we work with whatever way you put it on.

6. You see those stirrups in the picture at the top. They don't have covers on them. Trust me... this may be cold, but much more sanitary. After every patient we clean these. When there are fabric covers you are lucky if these get washed weekly. So about 100 patients may put their feet on these before you get your feet on them. If you are worried, wear your socks! I always wear my socks...

up next.... what actually is a pap smear??

"PAP" series part 1: The Pap Prep

***In order to keep this series light-hearted and easy to read I am not going to quote or site any sources except the knowledge of what I have learned through conferences, school, from pathologists and others who have gone on before me. THIS IS NOT TO REPLACE ANYTHING YOUR DOCTOR/NURSE PRACTITIONER/MIDWIFE/etc IS TELLING YOU. This is just some easy to read information.***

Image via HERE

So this mini series I am going to write is all about Pap Smears. The majority of the patients that come to my office have no idea why we do a pap smear, all they know is that they have to get it done in order to get birth control. They know it is supposed to happen once a year but really, what the heck is a freakin pap smear??

We will get there... but today I am going to give you a few tips about how to prepare for this visit.

1. If you normally wax or shave or laser or go hairless for some reason or another- no problem, keep it that way. However, if you do not normally do this... Please DON'T do it for me. I often see patients with irritated skin, cuts, chafing, and I feel so bad that they went to all that trouble when it doesn't matter either way if it is done or not.

Sometimes cuts or bumps from shaving can be confused with herpes outbreaks, bad yeast infections, warts, or cysts. We don't want to alarm you and you sure don't want to alarm us.

I promise. If you are unshaven it doesn't make our job easier or harder. We don't notice one hairless or not patient from the next. Do whatever you are comfortable with. Please don't be embarrassed. If someone ever makes you or has made you feel uncomfortable in the past do not return to that provider. Shaven or not is none of our/their business and it is not appropriate to comment on that or make you feel self conscious.

2. If you are on day one or two of your period, call ahead and let us know. Sometimes we are perfectly find doing a pap smear when you are bleeding, we wipe away the blood- get the pap smear and then you go on your merry way. If you are bleeding HEAVY please call to reschedule, don't just not show up. Common courtesy. If you call and cancel early in the morning or the day before we will fill your slot with someone who needs to be seen that day, if you don't call, we will sit around and wait, which wastes everyone's time.

3. Don't have intercourse right before your pap smear. If your husband/boyfriend/partner has some sort of fantasy about you being at the gyno- tell them you will replay it after your appointment. The semen on the pap can interfere with the results and we don't want you to have a false abnormal result.

4. Know your insurance. Some insurance companies pay for a pap smear once every year- like 2011, 2012, 2013- any time during the year. Other companies pay for one no sooner than every 365 days. We will try to verify insurance before your pap smear, but double check- just in case.

5. If you have a whole list of problems- your practitioner may not be able to cover them all in the allotted time slot. Please tell the scheduler if you have more concerns so that they can schedule the right amount of time for you. If you want blood work, come fasting; if you want an STD check, let them know; if you need birth control, ask for it. We aren't mind readers even if we have your chart in front of us.

6. Let us know if you have had an abnormal pap smear in the past, it can change if we add extra testing to your pap smear. If you are unclear what this means, let us know so we can discuss it with you (or stay tuned for the rest of the mini series by me..haha).

7. Last but not least- know that we are trying to be sensitive. We don't do this to intentionally inflict pain. We don't want it to be uncomfortable for you, but sometimes it will be. Let us know if you have had a hard time with pap smears in the past, or if you have a history of sexual abuse because both of these things can make pap smears more difficult for you and we want to understand how we can help you better.

Stay tuned...

Labor Comfort Measures

I stumbled across this wonderful article via Childbirthconnection.org

http://www.childbirthconnection.org/article.asp?ck=10421&ClickedLink=509&area=27

Quick, easy read, simple instructions. Love it. What helped you during labor?

What are examples of comfort measures used for labor pain relief, and do you have pictures?

Comfort measures for labor pain relief vary, and include many options. Pictures of some labor pain relief comfort measures are provided below:

Create a Calm Environment

Dim lights, peaceful surroundings, privacy, warmth.

Increase Physical Comfort

Walking, slow dancing with partner, pelvic rocking, positioning pillows for comfort, sitting and swaying on birth ball (a large physiotherapy ball), lifting up the abdomen, rocking in a rocking chair.

Walking during labor click to enlarge	Walking with a doula during labor click to enlarge	Slow dancing during labor click to enlarge
Sitting and swaying on birth ball during labor click to enlarge	Kneeling on birth ball during labor click to enlarge	Standing on birth ball during labor click to enlarge
Pelvic tilt during labor click to enlarge	Stair climbing during labor click to enlarge	Rocking in a rocking chair during labor click to enlarge

Use Touch

Massage, stroking, cuddling, counter pressure against the lower back, acupressure.

Leaning back for massage during labor click to enlarge	Counter pressure against lower back during labor click to enlarge	Knee press woman sitting during labor click to enlarge
	Knee press woman side-lying during labor click to enlarge

Apply Heat (with or without water)

Deep tub bath, shower, heating pad on groin or back, heated blanket.

Hydtrotheropy Birth Pool during labor click to enlarge

Sitting on Chair in Shower during labor click to enlarge

Hydrotheropy Shower with Telemetry Monitor during labor click to enlarge

Apply Cold

Ice pack on lower back, cool cloth to wipe face.

Strap-on Cold Pack during labor click to enlarge

Rolling a Cold Soda Can during labor click to enlarge

Use Aromatherapy

"Essential" oils, scented objects.

What are the effects of comfort measures on labor pain?

As the name suggests, comfort measures increase comfort. They may ease labor pain directly or indirectly by soothing and relaxing you.

What is needed to use comfort measures?

Comfort measures may require nothing more than adjusting the lighting or a pair of willing hands to rub your back. They may also be as elaborate as a temperature-controlled tub big enough to move around in and deep enough to immerse you to your shoulders when seated. Many items are inexpensive and can easily be brought with you such as massage oil, massage tools, or frozen gel packs. Others can be improvised on site such as making a cold pack by putting ice chips in an exam glove and tying it off.

One of the major advantages in hiring a doula to provide labor support is that she knows many comfort measures. Most doulas bring comfort-related items with them to the birth.

What are the advantages of comfort measures?

Comfort measures:

• offer lots of possibilities for relieving labor pain and can be combined with each other and with other types of techniques to suit every need
• have short or no lag time between deciding to use one and doing so (with the possible exception of deep tub baths)
• do not interfere with labor progress and in some cases can enhance progress or the effectiveness of pushing
• promote a sense of accomplishment and capability, which can be more critical to a satisfying childbirth experience than pain relief in and of itself
• have no effect on your state of consciousness
• may enable you to avoid labor pain medications and their possible adverse effects
• may enable you to delay or limit the use of medications and limit adverse effects
• unlike pain medications, can be discontinued immediately if they don't help or in the unlikely event that they cause a problem.

What are the drawbacks of comfort measures?

Comfort measures:

• comfort measures may not provide adequate labor pain relief
• comfort measures may require equipment
• deep tub baths may slow labor if taken too early in labor
• deep tub baths may cause maternal fever if the water temperature exceeds body temperature.

Kindergarten Orientation

This is all happening too fast.

I remember when you first starting sitting up. Or when you crawled for that first time at church to try and get a cheerio off the ground.

or that time you ate a cricket...uck.

But seriously, I remember your first itty bitty steps, the first 10 days you spent away from me (and with Grandma!) while I was doing intense training for my midwife school.

I remember your big cloth diaper bum. How you always sucked your thumb (oh wait- you still do!), and how you LOVED to sleep on your tummy.

I remember bringing home your baby sister, and you looked SOOO big compared to her tiny little body.
And here you are, sitting pretty in your pigtails at kindergarten orientation. You met the principal. You politely shook her hand and said, "my name is Ryann Paige Hamilton" with a grin. You took a tour of the school where you will learn and grow and someday reach the stars.

I think I need a tissue.

New Stethoscope

I am so excited about my new Stethoscope I got recently. It is an MDF 3 in 1 Cardiology stethoscope. No I am not a cardiologist, nor am I diagnosing heart murmurs... but I do listen to heart and lung sounds every day on adults and on newborns.
So what is the big deal? Um.... It has interchangeable heads!! It turns into an adult, pediatric or neonatal stethoscope in the blink of an eye. Super cool belt clip to keep them all together, and it has a lifetime guarantee and all that good stuff.
All it needs it a fetoscope and it is a midwife's dream! Haha. But really I am in love. It is so much fun to use and play with and I don't have to have both stethoscopes around my neck all the time.
Plus I look really good in blue.

I'm just sayin...

AFP Question

I need a little input- I will be putting this out on facebook so I can get responses as well, but this is a topic I have no personal experience with.

Between 15-20 weeks there is a blood test that pregnant women can do that tests for the risk of trisomy 18, trisomy 21, and open neural tube defects. It is known as the "AFP test" or "downs syndrome test" and sometimes referred to as "triple screen" or "quad screen."

I have never had this test done in either of my pregnancies. This is a very personal decision and I don't think it is right or wrong. I just feel that I didn't need to have the test done.

But that is not what I am talking about, is it right or wrong. I am wondering how much do you think about the test? For those mothers who had the test done in pregnancy, did it weigh on your mind? Did your provider call and tell you the negative or positive results? Or just wait until the next visit.

In my office we only call if the levels are abnormal. We don't call to tell people their results were normal. We wait until their next visit to let them know. This is usually 4 weeks after the blood test was drawn. We get the results in the office within 2-3 days, but our patients wait 4 weeks for the answer. Is this okay? I don't really have time to call all the normal labs because of the amount of patients I have, but I could figure out a way.

It is okay that no news is good news? Or do you feel you need to know? Did you sit and wonder what the results were? Or did you not think about it again until the next visit?

I honestly don't know because I never had the test done. Please let me know your input so that I can better serve my patients.