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Health Information An Expert Opinion: You and Your Ob/Gyn (Part 2)

Discussing sensitive issues will strengthen the doctor-patient relationship.

In the November Discover Rush Online, Ranoo Sabnis, MD, an ob/gyn at Rush University Medical Center, shared her advice on how to find the right ob/gyn and establish a more meaningful doctor-patient relationship. In part two of the interview, Sabnis talks about how to approach sensitive issues with your ob/gyn — from C-sections and epidurals to menopause to seeking a second opinion.

Q: When it comes to pregnancy, women often have strong feelings about issues such as C-sections vs. natural childbirth. How can you ensure that your ob/gyn will respect your wishes?

A: As with your gynecologist, you want to feel comfortable discussing any issue with your obstetrician. But every OB obviously has his or her own personal point of view. So at the first visit, or definitely one of the visits fairly early in your pregnancy, you should discuss your wishes. Everything changes once you're in labor, but you should at least have some ideas of what you want your pregnancy and labor experiences to be. You'll want to ask how long pastyour due date the doctor will let you go before inducing. It's also important to know how long your doctor will let you labor before doing a C-section. I have a general idea of what would make me lean toward a C-section, and I'm willing to talk about it with patients well in advance.

A lot of women also ask about epidurals, whether or not they should get one. There are women who are very adamant that they don't want them, and it's definitely something you should bring up early. Even though these things won't be an issue for months, we can have an ongoing conversation through the prenatal visits. The last thing you want is to be in your 37th week and not see eye-to-eye with your obstetrician.

Q: But even if you do agree on a course of action, things may not go as planned.

A: Unfortunately, that's true. That's why we always go over all of the possibilities with the parents beforehand. Things happen in the delivery room, and sometimes we end up having to do a C-section even though the parents feel strongly about natural childbirth. We want parents to understand that we’ll always do our best to honor their wishes, but we have to make sure both mom and baby are safe. That's our first priority.

Q: At what age should you start talking to your gynecologist about reproductive health?

A: Ideally, you'll start having these discussions when you're still in your teens, because even though you're probably not thinking about having children, there are things you can do to protect yourself from fertility problems down the road.

I think sexually transmitted disease screening is the most important thing, because even silent infections can cause infertility later — and not just infertility, but chronic pelvic pain and ectopic pregnancy. I also talk to my teenage patients about maintaining a healthy lifestyle and preventing diabetes, which will help not only with fertility, but with having a healthy pregnancy once you do get pregnant. Of course, getting your PAP smears regularly is crucial; we’re seeing more and more cervical cancer in younger women because of the prevalence of the human papillomavirus (HPV). We’re offering HPV vaccinations now, so that's something you should definitely ask your gynecologist about.

Teens and women in their 20s should also talk to their doctor if they're having irregular menstrual cycles, unusually heavy or painful periods, or pelvic pain. If we don't catch and address issues like endometriosis and fibroids early, they can have repercussions when you are ready to have children.

Q: Menopause can be a difficult time for many women. How can women work with their gynecologists to prepare for the transition?

A: I would say talk to your gynecologist about the symptoms, about what to expect. Hot flashes, mood swings, vaginal dryness — all of those things are common, and you may be reassured to know that other women experience them too. Your gynecologist will be able to recommend natural remedies and over-the-counter products or prescribe products (if appropriate) to help alleviate some of your symptoms. Just being prepared, knowing what to expect, can make the menopausal transition a little easier to face when it starts.

Hormone replacement therapy is a big issue. A lot of women are worried about going on it since the Women’s Health Initiative's postmenopausal hormone therapy trials revealed that women who took oral hormone therapy that combines estrogen and progesterone had an increased risk for heart attack, stroke and breast cancer; that oral estrogen alone increased women’s risk for stroke; and that estrogen therapy on its own is associated with an increased risk of endometrial cancer. However, women who are relatively healthy and are close to menopause are often good candidates for hormone replacement therapy, so it's definitely something you’ll want to talk to your gynecologist about. Your doctor can help determine whether it's right for you based on your health and personal risk factors.

Q: Even if you have a great relationship with your gynecologist or obstetrician, is it OK to get a second opinion?

A: Yes, it's always OK. I have patients who come to me for second opinions, and I have patients who I send to other doctors for second opinions. For instance, one of the physicians within our practice is a specialist in minimally invasive surgery, so while we all do it, if it's a more complicated procedure, I would probably send the patient to him. As a gynecologist, I'm able to handle most issues, and for conditions where there are multiple treatments, such as fibroids or endometriosis, I can go through all the options and offer you a whole range of treatments, from the most conservative to the most radical. But if you find another doctor who has more experience with a certain procedure, I'm OK with that. Your gynecologist wants you to get the best possible care, and that means that you're participating in the decision and doing what feels right for you.

Q: What advice would you give to women who aren't happy with their ob/gyns?

A: I think it would depend on what they're not happy with. Is it that your gynecologist isn't asking you the appropriate questions or answering your questions to your satisfaction? If this is the case, I would recommend coming to your appointments with a list to make sure you're getting everything answered and following up on those issues that don't get resolved during your visits. If the problem is that you're simply not comfortable asking your doctor questions, then you should try to find someone you’ll feel more comfortable with. But before you consider looking for another doctor, see if there’s anything you can do to create a better relationship with the doctor who already knows you.


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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

If you enjoyed this article and are not already a subscriber, subscribe today to Discover Rush Online. You'll receive health information, breaking medical news and helpful tips for maintaining your health via e-mail. To subscribe, send an e-mail to DiscoverRushOnline@rush.edu.

December 2012-January 2013 


 

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