Women's Health Center

Women are special people with special needs. At Martha Jefferson Hospital, we've listened to what women want in a healthcare system, and we've responded. Together with our excellent medical staff we provide women with comprehensive primary care and specialty medicine, state-of-the-art diagnostic and treatment services and comfortable, welcoming settings. Family Centered Maternity Care NEW! Growing Family WebNursery Prenatal Diagnosis Center Midlife Care Breast Health Services Incontinence, Constipation & Pelvic Pain Osteoporosis Information About Labor Epidural Analgesia (LEA)

Family Centered Maternity Care

At Martha Jefferson Hospital we believe that giving birth is the experience of a lifetime - and we understand that it's uniquely yours. We use our skills, technology and understanding to help you have the experience of your lifetime. From The Start From the start we can help you prepare, with a wide range of classes that teach you what to expect during childbirth, how to care for a newborn and helpful parenting skills. We also offer Maternity Case Management for first-time mothers or women who desire extra support during a subsequent pregnancy. For information on our maternity care programs, go to our Community page. Our Physicians And Staff Along with your Obstetrician, Family Physician or Certified Nurse Midwife, our nursing staff ensures that you receive the best possible care during labor and delivery and that your birthing plan is respected. A board-certified Anesthesiologist is available 24 hours a day for prompt attention to your needs. For information on our excellent obstetrical medical staff, go to our online Physicians Directory. Our dedicated Newborn nurses are all certified in advanced techniques of caring for newborn babies. Even after you go home, they're available by phone. Amenities Every comfort, every amenity, every special touch that can make your childbirth a truly memorable experience is included. Here's just a sampling of amenities: Five private birthing suites with jacuzzis, where you can labor, deliver and recover in the same warm, attractive room. Even though our birth suites may look and feel like home, they are equipped with state-of-the-art technology should you or your baby need it. Private postpartum rooms, where having the father spend the night is just one of your options. Our Obstetric and Newborn Unit is private and secure, located adjacent to our women's medical-surgical unit reserved for female patients only. For more information on Family Centered Maternity Care at Martha Jefferson Hospital, send us an e-mail or call us at 804-982-7009 or toll-free, 888-652-6663. [Back to Top]

Prenatal Diagnosis Center

Siva Thiagarajah, M.D., is medical director of Martha Jefferson Hospital's Prenatal Diagnosis Center. An expert in maternal and fetal medicine, his medical education includes an Endocrinology and Infertility fellowship at the University of Virginia, completed in 1970, and a residency in Obstetrics/Gynecology, completed there in 1974. In 1981, he completed a fellowship in Maternal and Fetal Medicine at U.Va. He is board certified in Obstetrics/Gynecology and also in Maternal and Fetal Medicine. Under the guidance of Dr. Thiagarajah, The Prenatal Diagnosis Center offers the earliest screening available for Down Syndrome and other abnormalities in an unborn baby. Dr. Thiagarajah performs first trimester screenings between 11 and 14 weeks of gestation. The screening will detect 80-90 percent of chromosome abnormalities. Dr. Thiagarajah also performs second trimester ultrasounds to evaluate for abnormalities. Couples referred to the Prenatal Diagnosis Center may receive genetic counseling. Jennifer M. Boner, who has a master's degree in the field, meets with couples who are at increased risk for fetal abnormalities. Prior to their scheduled ultrasound procedure, she takes a detailed family and medical history and gives an idea of what the ultrasound examination and other possible tests will be like. She also discusses abnormal results and options with the families. For more information about the Center, talk with your healthcare provider. [Back to Top]

Midlife Care

When we asked women what is most important to them during these years, there was no hesitation in their answers: education, support and convenient access to healthcare providers and services. That's why you won't find our midlife care in just one building -- instead, services are located throughout our service area. We take services to the locations that are convenient to you. So in addition to a highly experienced medical staff, we offer the highest quality services designed for maximum comfort and convenience -- this is Our Caring Tradition. Click below on a topic to find out more: Breast Health Services Incontinence, Constipation & Pelvic Pain Osteoporosis. [Back to Top]

Breast Health Services

Martha Jefferson Hospital is dedicated to providing women with the best in breast health services. From free breast self-examination clinics to our state-of-the-art stereotactic breast biopsy instrumentation, we are here with a comprehensive program of education, diagnosis and treatment. In addition, we have dedicated a nursing position to assist women through the diagnostic phase of breast disease. Education Mammography Breast Health Center: Breast Disease Diagnosis If It's Cancer Education Each woman has a lead role to play in ensuring her health, with exercise, good nutrition and regular check-ups by a physician. In combination with her physician's expertise, a woman's knowledge of her own body provides important information when physical changes occur. That's why we offer free breast self-examination clinics and free breast cancer screenings throughout the year. Many of our health education programs focus on lifestyle issues that promote good health and can help in the reduction of risk factors for cancer and other diseases. Mammography In addition to yearly exams by a physician and monthly self-breast exams, women should follow the recommended guidelines for regular mammograms. Woman can have a mammogram at Martha Jefferson Hospital, at our Outpatient Care Center facility, 3rd floor on Pantops Mountain, or at one of the many convenient sites our mobile mammography service visits. No matter which location you choose, rest assured that Martha Jefferson uses the latest low-radiation-dose equipment and our female Radiologic Technologists are experts in its use. Your mammogram will be interpreted by a board-certified Radiologist, who'll send a report to your physician within 24 hours. For information or to make an appointment, send us an e-mail or call us at 804-982-7009 or toll-free, 888-652-6663. Breast Health Center: State of the art breast disease diagnosis The Hospital's Breast Health Center focuses on breast health, education, screening, and diagnostic mammography and ultrasound. By facilitating quicker appointment times in the diagnostic phase of care, the Center means less waiting time for women facing the anxiety of a potential cancer diagnosis. The Center is designed for comfort, confidentiality, supportive care, ease of accessibility, and aesthetics. Reception staff greet you upon arrival. Patient registration interviews are conducted in the Center, providing privacy and promoting confidentiality. Adjacent to the waiting room is a Consultation Room where patients can obtain support and education about their procedures. And mammography, ultrasound and areas where Radiologists interpret the films are all located in the Center, which speeds up communication of test results. If It's Cancer When services of the Cancer Care Center are required, the staff of the Women's Health Center works with the Cancer Care Center to ensure that women patients receive the kind of information and support they need, with access to the latest cancer treatments. Visit our Cancer Care Center site for more information. [Back to Top]

Incontinence, Constipation & Pelvic Pain

Problems with pelvic floor muscles can result in incontinence, constipation and even pelvic pain. Studies show that more than 20 million Americans of all ages suffer from bladder and bowel problems. The good news is there are a variety of effective treatments including physical therapy, medication and surgical intervention when necessary. Martha Jefferson Hospital offers a comprehensive range of services. Talk with your doctor about which is best for you, send us an e-mail or call us at 804-982-7009 or toll-free, 888-652-6663 for more information on our programs. [Back to Top]

Osteoporosis

Osteoporosis is a disease that results in a loss of bone density, which can make bones more susceptible to breaking. Although osteoporosis can affect any bone, fractures occur most commonly in the spine, hip or wrist. According to the National Osteoporosis Foundation, one out of every two women will sustain a fracture related to osteoporosis. Martha Jefferson offers programs that address prevention, diagnosis and treatment of osteoporosis, including: Free Osteoporosis Screenings Osteoporosis Diagnostics: Martha Jefferson offers state-of-the-art diagnostic services. For more information, talk with your physician. Need to find a physician? Click here. Osteoporosis Education. [Back to Top]

Information About Labor Epidural Analgesia (LEA) This information was written by the Maternity Education Department of Martha Jefferson Hospital under the direction of Burkhard Spiekermann, MD, anesthesiologist. 1. What is LEA? LEA, more commonly called a "labor epidural," or simply an "epidural" is one of many options for pain control (analgesia) during labor. It is achieved by injecting pain medicine directly into the epidural space of the lower back via a small plastic catheter, which is typically left in place so that additional medication can be administered through it throughout labor.   2. What is the difference between a spinal and an epidural? Although they are very similar means of administering pain medication, a spinal and an epidural have important differences that dictate when and why they should be used. Because the epidural's catheter allows for a continuous infusion of analgesic over time, this procedure is typically chosen for pain relief during the course of labor. A spinal however, usually involves a single, one-time, dose of anesthetic, which is injected beyond the epidural space into the subarachnoid space. Whereas an epidural takes effect gradually over a 10-15 minute period, and lasts throughout labor, a spinal takes effect almost immediately but is shorter acting. There is one type of spinal, called a saddle block that can be used just before the delivery of your baby for effective short-term pain relief. 3. What is a "walking epidural" and can I get one at Martha Jefferson? A walking epidural (sometimes called "CSE,"- combined spinal epidural analgesia) is the combination of a spinal injection of a narcotic drug with the placement of an epidural catheter. It can be used in the early stages of labor, when walking may help ease the discomfort of contractions. The spinal narcotic treats contraction pain early on, but, unlike the medication of a traditional epidural, will not weaken your leg muscles or cause uncoordination, thus allowing you to walk safely. Currently, most of the epidurals placed at MJH are traditional. You should talk to your anesthesiologist before the onset of labor if you are interested in a walking epidural. 4. If I have had other pain medication during labor, can I still get an epidural? Yes. It is very common to have received intravenous or intramuscular pain medication before an epidural. 5. Are there physical or medical conditions that would prevent someone from getting a labor epidural? Yes. Underlying back problems like spina bifida or spina bifida occult are absolute contraindications to LEA. Previous lower back surgery and severe scoliosis can make placement of LEA more complicated and, in some cases, impossible. Other contraindications for LEA include; brain tumors or conditions that cause an increase in intracranial pressure, infection at the intended puncture site, allergies to a specific class of local anesthetics, certain blood thinner medications (excluding aspirin or ibuprofen-like drugs), and certain medical conditions that prevent your blood from clotting properly. Chronic back pain, progressive neurological diseases (for example multiple sclerosis), blood infection, and preexisting neurological deficits in your back or legs could also be contraindications to LEA. Your anesthesiologist will take your complete medical history and any questions you have about specific medical problems and LEA. 6. Is there a "window of opportunity" for getting an epidural or can I get one any time? The "window of opportunity" depends mostly on your obstetrician, family doctor, or nurse midwife. In general, if you already have your mind set on wanting LEA for pain control, it makes sense to place it as soon as a regular active labor pattern is established. Even if the labor pain is still tolerable at this point, once the LEA is in place and you become more uncomfortable, it is fairly easy to dose the catheter appropriately to your comfort. If you are unsure whether you want LEA or not, you can wait and see how you feel with progression of labor. Most often catheters are placed before your cervix is more than 6 cm dilated. However, even in the late stages of cervical dilation, especially if this is your first baby and the actual pushing phase of labor may take longer, it is possible to place an epidural. 7. What kind of relief can I expect from a labor epidural? A labor epidural is designed to give you relief from the pain caused by your contractions and the pain of delivering your baby, as it moves through the birth canal. Once the LEA takes effect, a few contractions after insertion, most women describe their contractions as "pressure" sensations rather than pain. At times, the LEA may be more effective on one side of your body than the other. Some women may have a "hot spot," which is a circumscribed area, usually on one side of your lower abdomen that is not completely comfortable. Usually, additional small doses of local anesthetic or short-acting narcotic drug delivered via the epidural catheter will improve these areas of discomfort. There are times though, when, for no apparent reason, a "perfectly good" LEA does not provide effective pain relief. In rare instances the epidural catheter may work itself out of the epidural space and need to be replaced. 8. Can an epidural affect my ability to push? Under certain circumstances, pushing may not be as effective. First, let me say that discussions concerning the effect of LEA on pushing ability, prolongation of labor, instrument-assisted vaginal delivery, and rates of Cesarean section are ongoing and very controversial, and the research is inconclusive. The circumstances which most people agree to that may affect your ability to push are: a) if the medication makes you too comfortable so that you can't feel your contractions at all, it may be hard to coordinate your pushing efforts with your contractions. b) if too much local anesthetic is administered, your pelvic and abdominal muscles may become somewhat weakened, and less effective at pushing. These are the reasons why the effectiveness and the degree of anesthesia from LEA are frequently reassessed throughout labor. 9. What are the potential side effects and complications for myself from an epidural? The most common side effect is the transient soreness you may feel in your back where the epidural was placed. This is similar to the discomfort you may have from the IV needle in your arm. The procedure is done in a sterile fashion and the infection rate is extremely low. Any significant bleeding from LEA is rare. There is a 1-3% incidence of what's often called a "spinal headache" after LEA. A spinal headache usually occurs the next day and it worsens whenever you try to sit up or stand. Most spinal headaches get better on their own or can be treated with ibuprofen, intravenous fluids, and caffeine. Infrequently, some patients with severe or persistent headache may require an "epidural blood patch", in which a small amount of the patient's own blood is injected through an epidural needle into the epidural space. LEA often causes a small transient drop in blood pressure, which is normal. If your blood pressure changes too much, you may start to feel dizzy or nauseated. This is infrequent and your blood pressure will be monitored closely during the procedure. If it decreases significantly your anesthesiologist will treat it with medication. Up to 15% of women may develop a fever during labor. The reason for this is unclear and may be related to dehydration. The temperature elevation is not associated with an increased risk of infection in both the mother and the child. Allergic reactions to local anesthetics or the narcotic used for LEA are rare (less than 1%). Sometimes the narcotic in the LEA can cause you to have itching. At times, women become dizzy or feel like they are passing out when the LEA is placed because of hyperventilation with contractions or nervousness about the procedure. The best protection from this reaction is proper communication between you, your nurse, and your anesthesiologist. Rare complications are: a. Too much of the local anesthetic is accidentally injected into a blood vessel. You may feel lightheaded, develop a seizure, (incidence less than 1 in 9.000) or have problems with heart rhythm irregularities (incidence less than 1 in 10.000). This is why your anesthesiologist is very careful when injecting the medication and why he/she only injects small amounts at a time. b. The local anesthetic goes into the spinal space instead of the epidural space and you may have an "accidental spinal block". If this is not recognized, breathing problems may develop from a high spinal block. Again, this is an extremely rare complication (incidence less than 1 in 8000). c. Nerve injuries after LEA are extremely rare and have not been reported at MJH (less than 1 in 40.000 to 1 in 200.000 in large studies). Transient nerve injuries after vaginal delivery are likely due to the birthing process itself. 10. If a needle is going in my back, could I be paralyzed for life? For good reason, one of the biggest concerns involves being "paralyzed for life" when having LEA. However, the catheter is placed in an area of your back below the termination of your spinal cord. Even if the epidural needle should go too far into your back, it would not contact your spinal cord. If a blood clot should develop in your epidural space and go unrecognized, the pressure from the blood clot could be cause for nerve damage. Because such an epidural hematoma is a potentially troublesome complication, LEA is contraindicated in anyone whose blood does not clot properly (see question #5). Your anesthesiologist reviews your chart carefully and looks for any laboratory reports that indicate such a problem. In addition, when talking to you, she/he will probably ask you if you bruise or bleed easily. An epidural abscess from an infection could potentially also cause spinal cord or nerve damage but again, this is extremely unlikely. Overall, spinal cord or nerve injuries from epidurals are a rare occurrence (see question #9). Most reported cases occurred in patients with severe underlying medical problems and risk factors. 11. I have heard that you can get permanent back pain from an epidural. Is that true? No. Although it seems logical to ascribe back pain following an epidural to the "needle in your back", the incidence of prolonged back pain after vaginal delivery is the same both in patients who had LEA and in those who did not. Back pain is most likely the result of pregnancy and the delivery process. 12. What effect does the epidural have on my baby? There should be no negative effects on the baby. The amount of medication needed for LEA is small and the drug concentration in your bloodstream very low. Only very minute quantities of the medication will cross the placenta and enter the baby's circulation. Some researchers are actually suggesting there may be a positive effect of LEA on the baby: with good pain control and a therefore a "relaxed" mother, blood flow to the placenta can increase which in turn means oxygen supply to the baby is improved. If complications related to LEA adversely affect the mother (see above), secondary effects may also be seen in the baby. 13. I have heard that there are problems with breastfeeding after an epidural. Is this true? Opinions on this differ. Although there are some studies that suggest LEA may cause a decrease in the amount of breastfeeding in the first 24 hours and lactation consultants may feel that LEA influences breastfeeding, several other studies did not support these results. On the other hand, research consistently shows that the intravenous administration of pain medication during labor does seem to decrease the amount of breastfeeding during the first hours after birth. Selected References: 1. Welcome to pain free childbirth - Labor epidural anesthesia: www.painfreebirthing.com 2. Epidural Pain Relief During Labor Does Not Increase Chance of Cesarean Delivery: www.nichd.nih.gov/new/releases/epidural.cfm 3. PRO/CON Clinical Forum-Epidural Anesthesia and Labor Outcome: www.soap.org/archives/epilabor.html 4. Old Pueblo Anesthesia Home Page: www.opatucson.com/mo_labr.html 5. Medical Progress: Regional Anesthesia and Analgesia for Labor and Delivery. Eltzschig H. K., Lieberman E. S., Camann W. R. N Engl J Med 2003; 348:319-332, Jan 23, 2003. [Back to Top]

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