A sudden sneeze or laughter can cause it to happen.   25 million people in the U.S., 25% of men and 75% of women have it.  What can it be?  Urinary incontinence or loss of bladder control. Too often, people will wait years before seeing a health care provider for incontinence.  But with diagnosis and treatment, urinary incontinence can be controlled and you can get back to doing what you love.

What is Urinary Incontinence?

Essentially, urinary incontinence is loss of bladder control.  Although it is most common in adults over 50, sometimes younger people, like women who have just given birth, may experience leakage. Each individual’s experience is different; some may experience occasional leakage, while others have uncontrolled wetting. The problem can be embarrassing causing people to avoid social situations, family and friends.


Symptoms may vary for each individual, but in general if you experience one of more of the following symptoms, talk to your doctor.

  • Leaking urine on a daily basis.
  • Feeling the need to go urgently or suddenly.
  • You leak urine occasionally when you laugh, sneeze or try to lift an object.
  • You are treating the issue with Kegel or bladder training.

Types of Incontinence

If you think you may have urinary incontinence a visit to your doctor is the first step.   Your provider will diagnose the type of incontinence you may have and offer treatment options. According to the American Academy of Family Practice1, there are five types of urinary incontinence:

  • Stress incontinence
    • Occurs most often in women
    • When pressure on the lower stomach (laughing, coughing or lifting) causes urine to leak.
    • May be caused by a weakened pelvic muscle due to pregnancy and childbirth.
  • Urge incontinence
    • The need to “go” urgently comes on suddenly
    • Often you have only a few seconds or minutes to get to a restroom
    • Common in elderly individuals who may suffer from overactive bladder or an infection
  • Overflow incontinence
    • Often occurs in men
    • Leakage occurs in small amounts
    • Can be caused by a blockage in urine flow due to enlarged prostate or tumor.
    • Diabetes and certain medications may also cause this type of incontinence
  • Functional incontinence
    • Normal urinary function but the individual has other medical or mobility issues which cause a delay in reaching a restroom in time.
  • Mixed incontinence
    • More than one type of incontinence present in an individual


There are several treatments for urinary incontinence.  You and your physician will work together to find the best option for your type of incontinence and lifestyle.  Your options may include one or more of the following:

  • Bladder training and/or exercises
  • Medication
  • Surgery

Download ADC’s Urinary Incontinence flyer (PDF) and share with friends or family.  You don’t have to endure loss of bladder control, talk to your internist, family practitioner, ob/gyn or urologist for more information.  

Urinary Incontinence flyer



How does gestational diabetes affect you and your baby?

Dr. Kiran Mechineni, an Ob/Gyn specialist with The Austin Diagnostic Clinic in North Austin discusses risk factors, its affect on mom and baby and what you can do if you are diagnosed with gestational diabetes.

What is it?

It’s diabetes that occurs in pregnancy. This causes high blood-glucose levels, which can negatively affect the pregnancy and the well-being of the baby.

Risk Factors 

If women eat a lot of carbs, about 50-60% of their diet is carbohydrates, they are at an increased risk. If they are obese and also they have a sedentary life. Those are the risk factors that increase gestational diabetes.

According to the American College of Gynecology, gestational diabetes is more likely in women who

  • are older than 25 years
  • are overweight
  • have had gestational diabetes before
  • have had a very large baby
  • have a close relative with diabetes
  • have had a stillbirth in a previous pregnancy
  • are African American, American Indian, Asian American, Hispanic, Latina, or Pacific Islander

How can it affect my baby and me?

Gestational diabetes can increase the risk of gestational hypertension, preeclampsia and also the babies are big so increased risk of cesarean deliveries or operative deliveries in the women. And, in the baby, they can cause, because there is high sugar levels, the babies grow bigger and they are called macrosomic babies. Also, the fluid around the baby increases, called polyhydramnios, and at the time of delivery, there is increased risk of operative delivery like vacuum, forceps or cesarean deliveries. Also, there is increased risk of unexplained fetal deaths. And after delivery, there is increased risk of the babies having hypoglycemia, jaundice and later on, they may become obese and diabetic too.

What can I do?

Women with gestational diabetes have to change how they eat and they mainly should eat less carbs. Carbohydrates should be around 30-40% of their diet and 20% of protein and 40% of fat. And in the carbs too, they have to eat low glycemic index foods and switch from simple carbs to complex carbs like from white rice to brown rice, quinoa, all those things, oats. From white bread to brown bread, things like that and also increase their fiber intake so that way, the diet is controlled. And also, do moderate exercise.


American College of Gynecology (ACOG) Gestational Diabetes Overview

One in ten women will be diagnosed with endometriosis.

Endometriosis is a disease that is also a condition where the cells inside the uterus begin growing outside the uterus, says Dr. Patricia Gunter, Menopause and Osteoporosis specialist with The Austin Diagnostic Clinic.   In an interview with KXAN’s Gigi Barnett, Dr. Gunter explains that women with endometriosis may have these endometrial cells growing on their fallopian tubes, bladder and bowels.  Although, research has and continues to be done, there are many theories as to why this occurs but no one specific reason.


The most common symptoms for endometriosis are:

  • Pain: either with your period or during intercourse
  • Difficulty getting pregnant

Although, Dr. Gunter says, couples who have difficulty achieving pregnancy will work with their doctor to rule out the following:

  • Ruling out issues with the male
  • Ovulation issues
  • Endometriosis would be considered following testing for the aforementioned concerns

At what age is it most prevalent?

Anyone of reproductive age may get endometriosis (from teenagers to women in their 50s), and the chances may increase with the onset of menopause.   The disease is may also present in women of all ethnicities.   There is still a lot of ongoing research for the cause of this disease.

What can you do if you suspect endometriosis?

  • Make an appointment with your Ob/Gyn


Depending on the patient’s desire to get pregnant, Dr. Gunter says there are many treatment options for patients including medications and sometimes surgery.  For additional information, we’ve attached an FAQ from the American College of Gynecology below under resources.   If you wish to see an ADC Ob/Gyn call us at 512-901-4063 or visit the Ob/Gyn page to request an appointment.


ADC Ob/Gyn specialist Kiran Mechineni, MD explains the importance of prenatal care in this video.   From genetic testing to understanding what to expect during your pregnancy, Dr. Mechineni gives a broad view of prenatal care with your Ob/Gyn.

Transcript below:

What is prenatal care?

Prenatal care consists of maternal and fetal health starting from preconception (before pregnancy) through postpartum care.

When should a patient make a preconception appointment?

At least, three to six months ahead because we want her to start taking prenatal vitamins, and see if there are any other problems in her family.
Then we can get all the medical conditions up to date and get her ready for having a baby.

What sort of tests do you do during preconception visits?

We test for any high blood pressure, diabetes, thyroid, um and to give also there is genetic testing available. So we can test them for any recessive carriers in her, and if she is positive then we can test her spouse so we’ll know ahead if they have any genetic problems.

What to expect during your first prenatal visit.

The first visit, you know we’ll teach them everything like what to eat, what not to eat, what drugs they can take, what medications, what chemicals they should avoid and what to anticipate going further. All about the pregnancy, how frequent visits they come for. From the first to the last visit you will see your ADC physicians, that is very good continuation of care.

Can a woman exercise during pregnancy?

We normally advise them, that if they were exercising before they can continue to do so. Swimming, walking, running, yoga, prenatal yoga is very good, but if they are not , they are sedentary, I would advise them to start walking at least 10-20 minutes every day and slowly go up to like half an hour.

What should a woman avoid during pregnancy?

Main restriction is on fish, salt-water fish, which has mercury, so they should avoid that. And dairy, milk and milk products should all be pasteurized. Quit smoking and alcohol if they use it, that kind of thing.

What is the best advice for your patients?

Earlier they come in the better. The earlier they come for preconception and then so they know a little more, like what to expect what to start, what to stop. But it’s okay if they are pregnant, they can come in as early as possible.

About our doctor:  Dr. Kiran Mechineni is a board certified Ob/Gyn and DaVinci Robotic trained surgeon performing hysterectomy, bilateralsalpingooperectomy (total hysterectomy) and ovarian cyst removal.   She is also trained to perform single-site robotic assisted surgery and labiaplasty.  She sees patients at ADC’s North Clinic.  For more information or to make an appointment call 1-512-901-1111.


Pregnant woman making a heart with hands

Source: Thinkstock

Prenatal Care

When you’re expecting, regular prenatal visits can ensure your pregnancy is progressing as it should and that your growing little one is developing as appropriate so you can welcome him or her in nine months.

One of the most exciting prenatal visits is the first one. This usually doesn’t happen quite as fast as you may think. When you have taken a positive pregnancy test, call your obstetrician to let him or her know that you are expecting. Your doctor will typically recommend making an appointment when you are about eight weeks’ pregnant or eight weeks after the first day of your last menstrual period. If you’re unsure when that time would be or if you have had pregnancy complications in the past, your doctor may have you come in earlier.

The Eight-Week Visit

While the average first trimester visit can vary, there are a few typical events that can occur during the first visit. These include:

Taking your health history.

Your doctor will use the first day of your last period to estimate your baby’s due date. You’ll also need to disclose any chronic health conditions you may have, medications you currently take, and any past surgeries or hospital stays you may have had.

Educating on healthy steps to take.

The first trimester is often the most pivotal time in a baby’s development. For this reason, your doctor will discuss with you important healthy practices to follow. These include avoiding smoking and drinking alcohol as well as refraining from taking many medications known to harm developing babies.

Your doctor will also talk about pregnancy symptoms and what to expect during the remainder of your first trimester. He or she will review symptoms you should call your doctor if you experience. This is a good time to ask your doctor any questions about pregnancy issues, such as morning sickness.

Taking blood tests.

A number of blood tests are available to test for genetic disorders in your baby. Some of these can happen as early as 10 to 12 weeks. While they aren’t always done as a rule, your doctor may recommend them if you have a history of genetic disorders in your family.

Your doctor will draw your blood to test for the following:

  • Your blood type
  • Your hemoglobin level
  • Testing for the presence of certain medical conditions, such as hepatitis B and syphilis.

Conducting Imaging Studies

Your doctor may use imaging technologies to help you hear and/or visualize your baby. An example is an ultrasound. An ultrasound provides a two-dimensional (flat) image of your baby. While your baby is developing arm and leg buds at this time, later ultrasounds will likely reveal images that look more like a baby. Your doctor may also use a Doppler device to allow you to listen to your baby’s heartbeat. This is a special moment that can start to make your pregnancy feel even more “real.”

After this visit, you’ll return in about a month to see more of your growing baby.

The Austin Diagnostic Clinic is proud to provide obstetric care to expectant moms. For more information about our services or Dr. Matthew Romberg, please visit ADC Obstetrics and Gynecology or call (512) 901-1111.

Only fresh and healthy food for my baby.

According to the CDC, “each year in United States approximately 3,000 pregnancies are affected by serious defects of the spine and brain called neural tube defects (NTDs). Hispanic women have a 30-40 percent higher risk of having babies with these birth defects. “

One of the easiest ways to prevent these birth defects is by taking folic acid.  Folic acid, also known as folate, is a B vitamin that everyone needs to take in order to have optimum cellular health and growth.   

Who should take folic acid?

All people need folic acid. However, folic acid is very important for women who are between 15 and 45 years of age, even if they are not currently trying to get pregnant.  According to the American College of Obstetricians and Gynecologists, the current recommendation is for  pregnant women get at least 600 micrograms of folic acid daily from all sources.  However, Dr. Yvette Guitterez-Schieffer, ADC OB/Gyn, recommends 1000 micrograms a day for pregnant patients and those trying to get pregnant.   Dr. Gutierrez-Schieffer also recommends that those women with a family history of neural tube defects should take 2-4 mgs a day.

Why is folic acid important?

Folic acid when taken before and during early pregnancy has been found to decrease birth defects of the brain and spine called neural tube defects (NTDs).  These neural tube defects include Spina Bifida and Anencephaly.  

Where can you find folic acid?

It may be hard to get the recommended amount of folic acid from food alone.  There are two easy ways to ensure you get enough folic acid in your daily diet.  

  • First is by taking either a multivitamin, or a prenatal vitamin, that has at least 800 micrograms of folic acid.  
  • Secondly, most breakfast cereals in the United States are fortified with 100% of the daily allowance of folic acid.  

Are there any natural ways to get folic acid?

There are many foods that have folate in them, however it can be hard to get the necessary amount of folic acid from food alone. So even if you eat foods that have folic acid in them, take your multivitamin each day, too.

Food sources for folate can be found in:

  • Leafy green vegetables like spinach, collard greens and romaine lettuce
  • Brussel Sprouts
  • Broccoli
  • Asparagus
  • Beans and Lentils
  • Citrus fruit, like oranges and grapefruit

Are there other benefits from taking folic acid?

Since folic acid is a key nutrient in cell health it’s important for everyone to get at least 400 mcg per day.  Folic acid has been shown to help with heart health as well as help those who may suffer from anemia.  


American College of Obstetricians and Gynocologists

Centers for Disease Control and Prevention

ADC Ob/Gyn Kiran Mechineni, MD shares the advantages of cord blood banking at the time of delivery with KXANs Erin Cargile.

It’s a once in lifetime opportunity that many parents may not know about.  July is Cord Blood Awareness Month and a great time to learn more about this possible life-saving procedure.

What is cord blood?

Cord blood is the blood remaining in the umbilical cord and placenta after giving birth.  Parents have the opportunity at that time to have their infant’s cord blood banked.  If not, the cord blood is discarded.  Dr. Mechineni, says parents who know about this option often say “yes” because of the medical advantages for their child and possibly other family members in the future.

Parents often make this decision for when putting together their delivery plan at 28-32 weeks. However, if the delivery occurs in a hospital that offers cord banking, then the decision may be made at the time of delivery as well.

How is it used?

Rich in nutrients and stem cells, cord blood can be used for transplants and even as an alternative to bone marrow.  It is important to know that the cord blood stem cells are not the same as embryonic stem cells.  Stems cells harvested from cord blood may also be used for medical therapies for blood disorders, cancers and genetic and metabolic disorders.  There are currently trials for use for individuals with autism and type 1 diabetes.  Experimental trials for those with spinal cord injuries and traumatic brain damage are also being conducted.

What is the difference between private and public cord banking?

According to Dr. Mechineni, privately banked cord blood may be used by the child, their siblings or any genetically related family member.  Their is a cost associated with private banking and a specific kit will be available at the time of birth.  Donated cord blood to public banks may be used by anyone with genetic match.  This option is free.

For more information about cord blood banking, select one of the resources below.


Cervical cancer rates have dropped, but frequent screening needed

Over the past 30 years, deaths from cervical cancer has dropped over 50 percent. This drop is mainly in part to increased use of the Pap test. However, even with the significant decrease, the American Cancer Society estimates that in 2015, over 12,000 new cases will be diagnosed and over 4,000 women will die in America from cervical cancer.

Early detection is your best defense against cervical cancer. In 2012, the guidelines for cervical cancer screening in the form of a Pap test was changed for healthy adult women.

    • Women aged 21–29 years should have a Pap test every three years.
    • Women aged 30–65 years should have a Pap test and HPV test (co-testing) every five years.

Why have cervical cancer screening guidelines changed?

“Clinical evidence indicates women who have low or no risk factors do not need to have frequent screening,” said Dr. Wendy Cutler, ADC OB/Gyn.  “Co-testing with HPV has given us more reassurance.”

Dr. Cutler explains that some patients would still need annual pap screens. Those patients would include anyone with “compromised immunity such as Lupus, Rheumatoid Arthritis,HIV infection or history of abnormal pap smears.”

The major risk factor for cervical cancer is HPV (Human Papilloma Virus) infection.  Other risks such as compromised immune system, HIV infection, cigarette smoking or prior abnormal pap smear can also increase the risk for cervical cancer.

HPV is common among the general population. However, Dr. Cutler says just because you have one or two risk factors does not mean you will get cervical cancer. It’s reported that 80 to 90 percent of the women who contract HPV will recover within the first 8 months. Patients should discuss risks with their doctor.

Dr. Cutler recommends the HPV vaccine for female or male patients who are 9 to 26 years of age.  This vaccine will give you immunity to high risk HPV 16 and 18 which contribute to 70 percent of abnormal pap smears and cervical cancer.

Most women with precancerous cells and early stages of cervical cancer do not show any signs or symptoms. Most symptoms appear once the cancer has spread to surrounding tissue. These symptoms can include pain during intercourse, abnormal bleeding (postmenopausal, after intercourse or between regular periods) and unusual discharge.

Dr. Cutler explains that there are four stages of cervical cancer. Each stage is then subdivided into more detailed stages. Some of the very early stage of cancer can be treated with a cutting procedure of the cervix called CKC or a hysterectomy.  However, once the cancer cells started to spread, radiation and chemotherapy are needed.

Dr. Cutler says it is important to emphasize the pap screen guidelines are not for everybody. The pap smear is only one part of your gynecological exam.  It is still recommended to see your doctor annually for a pelvic exam to make sure the uterus and ovaries or other female organs are normal.


American College of Obstetricians and Gynecologists
American Society of Clinical Oncology
Healthy Women

High blood pressure during pregnancy can put baby at risk. Here’s what moms-to-be can do.

Doctor taking blood pressure from pregnant woman

Image source: Thinkstock

Hypertension or high blood pressure is a fairly common condition, affecting about 7 percent of all pregnancies. Many women have varying degrees of high blood pressure prior to becoming pregnant, and some women develop high blood pressure during pregnancy.

How do you tell if a woman has high blood pressure?

A woman is considered to have high blood pressure if she has multiple systolic blood pressure readings greater than 140 or diastolic readings greater than 90. Blood pressure is considered to be severely elevated if the systolic levels are greater than 160 or diastolic levels greater than 110.

How to prevent or reduce the risk of hypertension

The timing and the severity of these conditions will determine how they are managed. Although high blood pressure can not be completely prevented, there are several ways to reduce the risk of complications that can be associated with high blood pressure in pregnancy.

Manage high blood pressure before becoming pregnant.

If a woman has a known history of high blood pressure, she needs to focus on optimizing management, prior to becoming pregnant. Management should start with a pre-conception visit with her physician that is managing this condition. Sometimes blood pressure that is only mildly elevated, may not require medication during pregnancy, but will need to be followed closely.

Lifestyle changes

There are several lifestyle changes that can promote healthy blood pressure levels.

  • Diet and exercise — with the goal of maintaining a normal body mass index prior to pregnancy — can greatly decrease the risk of complications during pregnancy. Sometimes it can be helpful to consult a nutritionist or personal trainer to help make these changes safely. Certain exercise regimens, such as Yoga, can be modified, but continued throughout the pregnancy.
  • Smoking cessation and management of other medical conditions, that can aggravate high blood pressure, such as diabetes and kidney disease, can also decrease the risks associated with high blood pressure in pregnancy.


Sometimes medications are necessary to optimally control high blood pressure, before and during pregnancy. It is very important to make sure that these are appropriately dosed prior to pregnancy, and that medications that are safe in pregnancy are utilized in women considering pregnancy.

A few medications that are utilized to manage high blood pressure can have negative effects on a developing baby, so it is important to try to change to one of the medications that are safe in pregnancy. If you are on a blood pressure medication and become pregnant unexpectedly, you should contact your physician immediately to determine if the medication you are taking is safe to continue.

You should not wait until your first prenatal visit, which may not be until 6-8 weeks, to alert your physician about medications you are taking. At the same time, you should not abruptly discontinue any medications, without first consulting your physician.

What to do if you develop hypertension

Hypertension that is present prior to pregnancy, or that presents during the first 20 weeks, is termed “chronic hypertension.”

Sometimes women with no prior history of high blood pressure will develop hypertension in the second half of pregnancy. This can either be due to “gestational hypertension” or “preeclampsia.” These conditions require close monitoring to ensure both mom and baby’s health.

Although preeclampsia can be more common in women with chronic hypertension, sometimes it can develop with little or no warning. It is more common in women who are under 20 years old or over 40 and in women carrying more than one baby.

Regular prenatal care

In order to ensure prompt diagnosis of these conditions it is very important to get regular prenatal care. The frequency of these visits will be determined by your physician and is based on your history and unique set of risk factors.

High risk specialist

You may also be referred to a high risk specialist, who utilizes ultrasounds to monitor the well being and growth of your baby. Your blood pressure should be checked at each prenatal visit, and if you have a history of elevated blood pressure, it may also be beneficial to get a blood pressure monitor, to check your blood pressure between visits.

Watch for symptoms between visits

It is also important to be aware of possible symptoms of preeclampsia, in case they develop in between your routine appointments. Although not always associated with preeclampsia, if you develop headaches, that do not resolve with measures such as rest or Tylenol, you should alert your physician.

Sometimes these headaches can be mild. Sometimes they are associated with visual changes. Other possible symptoms are rapid swelling of the hands and face and significant weight gain in a short period of time, which can be due to abnormal fluid retention.

Unfortunately, sometimes preeclampsia can occur even in the healthiest of pregnancies and when severe, often requires delivery to manage. However, taking precautions prior to and during pregnancy will almost always allow for healthy babies and moms.

If pregnancy is in your near future, you may want to schedule an appointment with your doctor.

Dr. Allison Devine, an ADC OB/GYN, appeared on KVUE’s FYI Austin segment to talk about why couples should consider preconception counseling and how it can benefit a happy, healthy pregnancy.

It is true what they say these days, if you need something, “there is probably an app for that.”

hands on iPhone

Image source: Thinkstock

Women’s health is no exception.

There are several apps available for tracking one’s cycle, to either assist with conception or to help avoid pregnancy until ready.  These same apps can be very helpful for women with any kind of menstrual irregularities, to provide their physicians with this valuable data, when they are being evaluated.

There are also several apps to help track the progress of pregnancy, make diet and exercise recommendations during pregnancy and track the progress of contractions during labor.

Then there are some just plain fun apps to use while pregnant — some to announce your pregnancy to friends and family, track the progress of your growing belly or even plan the perfect nursery.

A recent online article listed their “10 must- have apps for conception and pregnancy,” so I decided to head to the app store to check them out.

The first and second apps on the list are both apps to help women track their cycles and determine their most fertile days.  They are both free to download, with potential up-grades for minimal fees, to be added later.  They both seem to have fairly user friendly interfaces and get high marks on their customer reviews.

Pregnancy and conception apps

  1. Ovuline
    The description states that this app was “developed by Harvard scientists to help women conceive faster.”  It not only tracks one’s cycle, but also analyzes the data to help women better predict exactly when conception is most likely.  It also gives daily reminders of things women can do to promote fertility.  I like that this app also has a pin login to help keep this information private.
  2. My Days
    This is the second app recommended to track one’s cycle.  I downloaded it and found it was very easy to input the data.  It not only lets you input your cycle days, but also your basal body temp and info on the quality of cervical mucous.  This app also had a lot of positive reviews from users.
  3. Pregnancy ++
    This app follows the progress of your pregnancy from the very first week.  It gives detailed descriptions about the size and weight of babies each week and also has images of what the baby looks like in utero.  It has a place to keep track of prenatal visits and what was discussed.  It even has a place to make a hospital bag packing list.
    I think this app is a good way for women to connect with their pregnancy and share their progress with friends and family.  It also has some good info on diet and exercise.  It also has a place to keep count of babies kicks and to track timing and frequency of contractions.  This app is a fairly good value at $2.99, since it contains so much good info and images.
  4. Belly Snaps
    This app is 99 cents.  With more and more people announcing their pregnancies, babies gender and birth online, this seems like a fun accessory.  It allows one to upload pics of their pregnant belly, ultrasound pics or first baby pics, with fun borders/banners for added cuteness.  Despite some of the hard parts of pregnancy, it is an amazing time, and an app like this can be a good reminder of the fun side of pregnancy.
  5. CineMama
    This is another free app created by the March of dimes.  I wish I had something like this during my pregnancies.  It is a very user-friendly interface, which allows women to track the growth of their belly on a weekly basis.  In the end it creates a cool stop/start video of Mom’s belly growing over the 9 months.  It even allows one to add a fun sound track.  I also like the diary feature, which allows Mom’s to easily keep track of memorable events during their pregnancy.  I noted that this app has a lot of positive reviews, but some people didn’t like that it requires you to connect to it using your Facebook account.
  6. Pregnancy Food Guide
    According to the article this app is $2.99 for Android phones, but when I looked in the iPhone app store it was $7.99.  This seems a little expensive for what it is.  In general I think most women just need to follow a healthy, balanced diet during pregnancy and listen to their doctors regarding what foods to avoid.  I did like the section recommending certain pregnancy “superfoods,” such as avocados.  It then gives recipe ideas to use these foods, which is always helpful.
  7. Sculpt My Pregnancy 
    On the other hand, at $3.99, this app looks like a fairly good value.  It gives suggestions for appropriate exercises that can be done each month of pregnancy.  It not only describes the exercises, but also has video demonstrations.  It focuses on appropriate exercises to stay fit, but also specifically addresses ways to be in the best shape to manage labor.  I will definitely be recommending this app for my patients.
  8. Baby Names
    No more need for bulky baby name books with this free app available.  It allows you to check the origin and meaning of names and also allows you to check their popularity by year.  This database of names appears very extensive, so most likely you will find your choice here.  It has a nice feature that allows you to save and rank your favorite names.
  9. Houzz Kids
    This is another fun app that is free to download.  This is great for first time moms who are trying to get ideas for the perfect nursery, or to plan rooms for toddlers or older children.   It has an extensive database of images that can help you choose everything from color schemes, furniture, wall hangings and toys.  It is probably best to just use this app for ideas, rather than to purchase the items, since you can probably find better deals in the stores, but it will allow you to keep all your design ideas in one place to access when you are out shopping.
  10. Full Term – Labor Contraction Timer
    When that day finally comes and labor starts, it can be both a time of excitement and anxiety.  This is a great app to help partners and labor coaches get involved and feel a part of the labor process.  Keeping track of the contractions can be valuable info when calling your doctor or going to the hospital to be evaluated.  This app stores the information regarding the length and timing of contractions and also allows you to input information on the strength/quality of the contractions.  This app seems very user friendly since someone just has to press start and stop with each contraction, it will then calculate the duration and frequency of the contractions.

Overall, I think most of these apps are a great way to not only promote a healthy pregnancy, but also to have fun with pregnancy.  It is an amazing time to be remembered and enjoyed.

“As an OB/GYN, I really wanted to truly experience every aspect of my delivery.”

Mother and child hands

Image source: Thinkstock

I had been delivering babies myself for almost seven years, when I became pregnant with my first child.

Several experiences had influenced me to want to attempt having a natural delivery, with as little intervention as possible. I was inspired by knowing that my own mother had delivered her children without the intervention of pain medication.

From attending many births I knew that natural childbirth was definitely a reasonable goal, with adequate preparation. I decided to pursue hypnobirthing in order to prepare for my delivery. I had been present at several births where hypnobirthing techniques were used, and I noticed that these patients seemed to be in a truly calm and relaxed state, even during the active and pushing stages of labor.

Support staff in the room for these deliveries would often assume that these patients had epidurals, because they were so quiet and focused.

Several colleagues at the time — who had not witnessed hypnobirthing deliveries — questioned why I would want to attempt an un-medicated birth, when I could just have an epidural.

I would reply that I would be happy to get an epidural if I felt it was necessary.

As an OB/GYN, I just really wanted to truly experience every aspect of my delivery. I can’t say I was ever 100 percent certain that I would be successful before the delivery, but I knew I would at least like to try.

Learning about hypnobirthing

I started my hypnobirthing education by reading the hypnobirthing handbook, Hypnobirthing – The Mongan Method.

One of the main themes that was highlighted was the concept of using self meditation to release any fears or negative thoughts surrounding the idea of giving birth. Having been present for and actively involved in many emergent situations during my patients’ deliveries, I knew this was going to be a vital part of me having a successful natural delivery.

Next I signed up for a five-week hypnobirthing class. During these classes my husband and I learned several techniques for self-hypnosis, which is basically a form of deep meditation. In between the classes we reinforced what we were learning by listening to self-hypnosis or guided meditation CDs.

During the classes the instructor used videos of people delivering using hypnobirthing, to reinforce the idea that labor and delivery can be accomplished in a calm, relaxed and pain-free way.

Labor & delivery with hypnobirthing

On Nov. 9, 2008, I went into labor. I was 39 weeks pregnant. My water broke in the afternoon and within a few hours I started having regular uterine contractions. I started listening to my birth affirmation CD to get in a positive state of mind.

By the evening, I decided to go to the hospital. I was not experiencing any painful contractions, but I was leaking a lot of fluid with each contraction, so I felt I should be evaluated. I also wanted to get settled in at the hospital, so I could continue my self hypnosis when the more intense part of labor started.

By the time my doctor, who was my partner at the time, arrived and evaluated my cervix for the first time, I was close to needing to begin pushing.

I delivered my daughter – a healthy 8 1/2 lbs – shortly after midnight.

It never crossed my mind during the labor to get an epidural or IV pain meds, I simply didn’t need it. I don’t consider myself to have an exceptionally high pain tolerance, but I have always believed that pain is your mind’s interpretation of a physical sensation. If you can train your mind to see a sensation and normal and positive, then your body will naturally relax and the sensation will not be interpreted as pain.

I often use the analogy with my patients that having a natural delivery is like preparing to run a marathon. You can not just show up and expect to run the race if you haven’t prepared, but for those who put in the time to be both physically and mentally in shape, they will almost always cross the finish line.

For those who have no desire to have an un-medicated labor, the good news is that epidurals are available and are very effective at controlling the pain of labor. However, I often encourage my patients to pursue some type of child birth preparation, even if they know they want to get an epidural.

This preparation can be very helpful to manage the discomfort of early labor and again, can help release some of the anxiety that many women feel about giving birth.

Preparing for the unexpected

When I was pregnant with my second child, I was excited to again have the opportunity to use my hypnobirthing techniques to have an un-medicated delivery. I figured that the second labor would likely be even faster and therefore even easier.

At 36 weeks I was reminded that even when prepared, labor can sometimes be an unpredictable experience. I woke up in the morning to find that my water had broken. I was not having painful contractions, but quickly made my way to the hospital, knowing that second labors can often progress fast. When I was examined at that hospital I was found to be 8 cm dilated, but my daughter was trying to arrive with her feet first. I was quickly prepped for an emergency c-section.

Luckily the anesthesiologist was able to place a spinal block, with me lying on my side, so I did not have to be put under general anesthesia. I was very grateful to be awake to hear my daughter’s first cries as she was delivered. Even though the spinal prevented me from feeling any pain during the surgery, it was my hypnobirthing techniques that allowed me to remain in a state of calm during the delivery.

I think it is important for every woman to prepare for her delivery in the way that makes most sense for them.

Hypnobirthing was a technique that worked well for me for both my deliveries, despite being vastly different experiences.

This technique has been growing in popularity in Austin and around the country and there are several options for instructors in the area.

More information on hypnobirthing

Here are important facts all people should know about pregnancy and high blood pressure.

mother's hand on pregnant belly

Image source: Thinkstock

Expectant mothers may often spend a lot of time worrying about potential health problems like down syndrome and other genetic disorders in their unborn children. Yet a serious and more common health condition can harm both mother and child if left untreated or undiagnosed: high blood pressure.

Dr. Allison Devine, ADC OB/GYN, says high blood pressure — hypertension — is a health risk that can be present in women before, during, or after pregnancy.

“Expectant mothers should make sure they fully understand the type of high blood pressure they have to help ensure their own health and safety, as well as their child’s safety,” Dr. Devine said.

Understanding high blood pressure

Blood pressure is defined as the amount of force exerted by the blood against the walls of the arteries. If the blood pressure in a pregnant women becomes too high, it can lead to very serious health risks for both the mother and child, according to Dr. Devine.

“The main health risks of high blood pressure during pregnancy include a decreased flow of blood to the placenta, which can slow the development of the baby and increase the risk of a low birth weight,” Dr. Devine said. “High blood pressure can also cause dangerous internal bleeding in the mother and result in stillbirth.”

High blood pressure problems happen in about 6 percent to 8 percent of all pregnancies — most of them in first-time pregnancies, according to the National Institutes of Health.

Types of high blood pressure

Dr. Devine says there are three different types of high blood pressure than can occur during pregnancy.

One type is called chronic hypertension. If women had high blood pressure before becoming pregnant, developed it during the first 20 weeks of pregnancy, or have high blood pressure lasting more than 12 weeks after delivery, it’s considered chronic hypertension.

“Another type is gestational hypertension, when high blood pressure develops after 20 weeks of pregnancy,” Dr. Devine said. “But usually this type of hypertension goes away after delivery.”

She says preeclampsia is the third and most dangerous form of high blood pressure during pregnancy.

Preeclampsia happens when women with chronic or gestational hypertension develop high blood pressure and a protein in the urine after 20 weeks of pregnancy. It can also take place in women with no prior history of high blood pressure.

Preeclampsia can lead to serious and even fatal complications for mother and baby if left undiagnosed, says Dr. Devine.

“Preeclampsia affects the placenta and it can affect the mother’s kidney, liver, and brain,” Dr. Devine said. “It may cause seizures in the mother — called eclampsia — which is the second leading cause of maternal death, and may lead to other complications such as low birth weight, premature birth, and stillbirth.”

Keeping mother and baby healthy

If you do develop hypertension during pregnancy, you may need to take blood pressure medication and have more frequent prenatal doctor visits.

“Some blood pressure medication can’t be prescribed during pregnancy,” said Dr. Devine, “but we do have alternatives that are safe for mother and baby.”

Women with chronic or gestational hypertension can also help control their blood pressure through exercise and reducing sodium, she said.

For preeclampsia, however, there is no proven means of prevention. Most women who develop preeclampsia will be closely monitored to lessen or avoid health problems, said Dr. Devine.

“If you experience persistent headaches, experience blurred vision or other changes in vision, or have upper abdominal pain, these could be indications of preeclampsia and you should check with your physician or call 911 immediately,” she said.

In some cases, your doctor may prescribe bed rest if you have preeclampsia. In other cases, early delivery of the baby may be required to protect the health of the mother and child.

“The most important thing you can do for you and your baby is to get early and regular prenatal care,” Dr. Devine said. “It’s the best way to help ensure a safe, happy, and healthy delivery.”


Mothers are advised to avoid drinking because of damaging effects of alcohol during pregnancy.

Woman pours wine into glass

Image source: Thinkstock

Thinking about pouring a glass of wine for yourself when you’re pregnant?

Don’t, advises Dr. Angela Meyer, OB/GYN at The Austin Diagnostic Clinic, no matter what you may have heard otherwise.

“I personally advise my patients not to drink any alcohol during pregnancy.  Alcohol consumption during pregnancy can lead to fetal alcohol syndrome,” she said

What is fetal alcohol syndrome?

Fetal Alcohol Syndrome is not a single disorder, but instead it’s characterized by a cluster of metal and physical defects in a child that has been exposed to alcohol in the uterus.

A fetus metabolizes alcohol much more slowly than an adult, so when alcohol crosses the placenta, blood alcohol concentrations can be high in the developing fetus. Alcohol can interfere with how oxygen and nutrients are delivered to the fetus’ tissues and organs.

The main effect is permanent damage to the central nervous system, which can cause brain damage and cognitive and functional disabilities.

Characteristics of fetal alcohol syndrome are

  • Metal retardation
  • Growth and behavioral disturbances
  • Atypical facial features
  • Deformities in joints, limbs and fingers

Some studies have concluded that light drinking use may be safe, but Dr. Meyer cautions against drinking during pregnancy.

“The problem is that we don’t have the information as to how much alcohol and at what gestational age could possibly be safe without damaging the fetus,” Dr. Meyer said. “There is no research study that accurately addresses those questions.”

She is not alone in her recommendations.

The Surgeon General of the United States issued a new advisory in 2005 that advises women to completely abstain from drinking alcohol during pregnancy or even if they are considering becoming pregnant.

Damage can happen to a fetus at any stage of pregnancy – even before a woman knows she is pregnant.

Dr. Meyer says it’s important to follow your doctor’s recommendations.


My name is Dr. Yvette Gutierrez-Schieffer. I am an OB-GYN at ADC.

Every morning, for the past 20 years, I have gone to my office at ADC to work hard — making rounds, seeing patients, doing surgery, delivering babies and bringing new ADC patients into the world.

I love my job, my partners and ADC.

Why am I still here after 20 years?

The clinic’s mantra — Let Our Family Take Care of Your Family — has never been truer for any Austin family than mine.

An ADC family

My family’s history with ADC predates me. My father was a 20-year-old junior at the UT pharmacy school in 1961. He was far away from his family in Rio Grande City, TX.

He got really sick one day with nausea, fever and abdominal pain. He knew four doctors had an office on Seton Avenue not too far from his apartment. They were called The Austin Diagnostic Clinic and were within walking distance. So he walked in without an appointment and was seen by Dr. Renfert.

Dr. Renfert diagnosed him with appendicitis and sent him over to Seton Hospital right away. My father survived and went back to school, earned his pharmacy degree and has had his own pharmacy in Austin for over 40 years.

My first memories of ADC

Yvette Gutierrez-Schieffer

Dr. Yvette Gutierrez-Schieffer

My first memory of ADC was in late 1967. I was almost 5 — very shy and quiet. I was just starting to learn to speak English at an Austin Montessori Kindergarten. We only spoke Spanish at home. My mother’s extended family had emigrated from Mexico in the mid 1950’s. Her grandmother – my “Grande Califa” – was very sick.

I remember going to my grandmother’s house late one night. The house was very dark and quiet. Everyone was whispering that they had called the doctor and he was coming to the house. I was watching and listening to everything.

Soon, a thin man in a suit and tie came in with his doctor bag — just like Marcus Welby, MD and “Doc” on Gunsmoke. His name was Terri Collier. He was a new, young doctor with ADC. All I know was that he was very important and that he had come to take care of my Grande.

That event made a big impression on me.

After that night, almost every adult in my family became Dr. Collier’s patient — my grandparents, my parents, and the rest of the adults in the family. They all continued to see him until he retired. We all have continued to see ADC doctors since then — including my children, brothers and sisters, nieces and nephews.

Continuing the tradition

So I decided to be a doctor.

I graduated from UT, went to UT Southwestern, got married, and then decided to go into OB/GYN instead of a “less disgusting specialty like eyes” as my other grandmother suggested.

I was finishing residency in San Antonio and wanted to come back to Austin to practice. My mother asked Dr. Collier, “Do you know of any OB/GYNs looking for a partner?”

It just so happened that in 1993 ADC had just added an OB/GYN section. Wow! I could actually possibly work at ADC just like Dr. Collier. You don’t know how excited I was when my mother told me the news. I sent in my application and the rest is history.

I started at an office by myself, sharing with a family practitioner.  Anytime I had to be on call or perform a delivery, I had to cancel patients and drive to St. David’s or Brackenridge Hospital.

But life was good. I was working in my hometown – at the place that had always taken care of my family. I walked around in awe the first few months.

Eventually we moved to our current main location and my practice grew. I have never had to worry about who to refer my patients to or if my patients will get good care.

I recently celebrated a half-century of my life. Reflecting on it, I realized that the shy, quiet, hardworking little girl had pretty much grown up with ADC.

Who knows how long I’ll be here? Remember, my grandmother is going strong, and my Dad says he’s never going to retire.

As you can see I have no choice. I will always be loyal to ADC, and because of that I want my ADC family to stay around and take care of other families like mine for another 60 years and beyond.

It’s now possible to screen for several genetic conditions.

If you’re thinking about having a baby, now is the best time to talk with your OB/GYN about your plans. The preconception counseling visit will help you and your doctor identify anything that could prevent you from having a healthy pregnancy.

Genetic screening options may be among the things your doctor talks about.

“We will take a detailed family history of a couple and find out what genetic conditions they may be at risk for,” said Dr. Allison Devine, ADC OB/GYN.

DNA genetic screening

Why undergo genetic screening?

You or your partner may have a family history of a genetic disorder that could be passed on to your baby. Also, genetic testing could be helpful if you are in an ethnic group at high risk for a certain genetic disorder.

According to the Centers for Disease Control and Prevention, one out of every 33 babies is born with a birth defect. Some defects are caused by genetic disorders.

Testing for genetic conditions can help you and your partner consider all of your options. It can also help reduce the potential risks to you and the baby.

Carrier testing for genetic conditions

Dr. Devine says all women should be screened for certain genetic disorders that have high carrier rates in the general population. They include:

Other screening tests will depend on your family history or ethnicity. These include tests for:

  1. Sickle cell anemia
  2. Tay-Sachs disease (TSD)
  3. Fragile X syndrome
  4. Canavan disease
  5. Familial dysautonomia

Results from the screening tests will be used to figure out your chance for having a baby with a genetic disorder. Your doctor may suggest undergoing genetic counseling for you and your partner so you can learn and consider your options.

Will the genetic results be used against me?

The Genetic Information Nondiscrimination Act (GINA) prohibits health insurers from requiring genetic tests or using results that will affect your health insurance coverage and rates. It’s also illegal for employers to use genetic information to make any decisions about a person’s employment.


If you’re thinking about getting pregnant, you may want to check in with your OB/GYN.

Talking with your doctor about your plans to get pregnant – a preconception counseling visit – can help you decide when to conceive your baby as well as make sure you have a healthy pregnancy right from the start.

Your OB/GYN will sit down with you and your partner to talk about just about anything that could affect your pregnancy.

He or she will want to understand your medical history, your lifestyle, diet, medications and genetic conditions. Then they can advise you on what you can do to increase your chances of conceiving and how to take care of yourself and your baby through delivery.

When to schedule a preconception appointment

The best time to see your OB/GYN is three to six months before conception, according to Dr. Allison Devine, ADC OB/GYN.

“I recommend this for all of my patients who are either actively trying to conceive or even considering pregnancy in the near future,” Dr. Devine said.


Before you become pregnant is the time to address medical conditions that could affect your baby. You also want to become as healthy as you can before conceiving, so your body can make itself ready for such a huge physical and emotional change.

“This can be especially important if patients have already identified a potential barrier to their fertility or if they have any medical conditions that could potentially put them in a higher risk category with pregnancy,” Dr. Devine said.

What to talk about during a preconception appointment

Cropped image of woman holding pregnant belly

Your OB/GYN will need to know as much about you and your partner as possible. It’s also a great opportunity to ask your doctor any questions you have about pregnancy.

Here are some of the topics you will talk about:

Medical history

This includes your reproductive history, surgeries, hospitalizations, and any health conditions you have had.

Family health history

Do any health conditions run in your family? Do twins tend to run in your family?

Current medications

Your doctor will want to know what medications. Some may be risky to your baby, and you may need to avoid them or make substitutions.

“A lot of times we either just need to adjust the dose or potentially substitute another medication that may be safer for pregnancy,” Dr. Devine said. “It’s really important that patients don’t just abruptly stop taking medications that they may be taking – that they contact their physician so we can go over the most appropriate way to do that.”

Any supplements?

Don’t forget to tell you doctor about supplements or herbal remedies you are taking.

ADC OB/GYN Dr. Angela Meyer says that even includes facial and body creams. Some ingredients in lotions, such as Retin-A, are contraindicated in pregnancy, so it’s important to let your OB/GYN know if you are taking them.

Your lifestyle

Do you exercise? What are you eating and drinking? Are you overweight? Do you smoke?

Your doctor may advise you to make lifestyle changes in order to get your body in tip-top shape for pregnancy.

Next steps

The pre-conception appointment focuses on learning as much about you as possible, but counseling you is just part of the process.

After talking with you, your OB/GYN may also do a physical exam, chart your menstrual cycle, check your vaccinations, and discuss genetic counseling.


ADC’s OB/GYN doctors certified to prescribe Intone, a non-surgical device used to help women overcome incontinence or bladder leakage.

Intone Bladder device

Intone bladder device helps women overcome bladder leakage.

Yvette M. Schieffer, M.D., Wendy Cutler, M.D., Stephanie McNelis, M.D., Allison Devine, M.D. and Kiranmayi Mechineni, M.D., can prescribe InTone for women with bladder leakage.

InTone, developed by InControl Medical, LLC, is a medical device available by prescription. It is indicated to treat stress incontinence, urge incontinence or mixed (stress and urge) incontinence. InTone combines a daily program of volitional exercises, voice-guided instruction, biofeedback and micro-current stimulation to strengthen muscle tone in the pelvic floor.

Stress incontinence can occur when lifting, sneezing, coughing, laughing or exercising. Urge incontinence is the unwanted and sudden need to urinate. Both can be caused or exacerbated by childbirth, obesity, excessive exercise, lack of exercise, age or trauma.

According to the National Association for Continence, up to 30 million women in America have experienced bladder leakage issues. About one in four new mothers experience “leaking” following normal delivery, and about one in six following cesarean section.

Up to two-thirds of women who “leak” have never mentioned it to their physicians, and up to two-thirds of women do not use any treatment or product to manage their bladder leakage.

Until now, available options had mixed results. Absorbent pads and diapers do nothing to treat the condition. Medications, if prescribed, can cause side effects and are not always effective. Surgery, if performed, is a more invasive option, and is not always effective. Research has shown that even when properly taught how to perform pelvic floor, or Kegel, exercises, about half of all women do them incorrectly.

After prescribing InTone, the physician customizes the settings for InTone and the patient is shown how to use it at home. A sensor in the unit measures pressure to determine if the patient is doing the exercises properly. The biofeedback unit uses voice-guided instruction to take her through the routine and reports her muscle isolation and strength. Each daily session takes about ten minutes, and data from each session is recorded. After two weeks or so, the physician analyzes the recorded data and adjusts InTone based on the patient’s progress, and at-home treatment sessions continue. Most patients should experience progress in a few weeks, and most patients should experience effective relief in 90 days.

Intone biofeedback form

Biofeedback from Intone device

InTone is available in the United States. InControl Medical provides specialty medical products for women’s health, and is sourced and manufactured entirely in the United States. More information on InTone can be found at www.incontrolmedical.com.

To make an appointment to see if Intone is right for you, contact ADC’s OB/GYN department at 512-901-4013.

Flu in pregnancy a dangerous combination, doctors say

flu during pregnancy can be severe

Pregnant women should receive the flu vaccine, but not necessarily because of results from a study tentatively linking autism with flu in pregnancy, OB/GYNs at The Austin Diagnostic Clinic say.

The new Danish study found that children whose mothers had the flu during pregnancy were slightly more likely to be diagnosed with a form of autism before they turned three. But the overall risk for autism was not higher than other kids.

The study’s authors say their work is early, and were quoted as saying the findings are not something people should worry about.

However, the flu is still a dangerous disease, and doctors say everyone should take steps to protect themselves from the flu virus.

Dr. Yvette Gutierrez-Schieffer, an OB/GYN at ADC, says flu during pregnancy is already risky because of the potential complications.

Pregnant women are among the groups identified as high-risk by the Centers for Disease Control and Prevention. Body changes in women when they are pregnant make them more prone to severe illness. There is also a higher chance of complications for the unborn baby.

In fact, flu during pregnancy is 5 times more likely to cause severe illness and it can also increase the risk of premature labor and delivery.

Dr. Gutierrez-Schieffer says women who are pregnant should get the flu vaccine as well as anyone who will be around an infant when they are born.

Flu vaccine is safe during pregnancy. It’s been given to millions of pregnant women over the past 10 years, and it is not known to cause any harm to pregnant women or their babies.

In fact, recent research shows:

  • Flu vaccine during pregnancy can protect newborns for several months after they are born
  • Flu shots do not cause miscarriage

The vaccine can be given during any trimester, but pregnant women should only receive inactivated vaccine (flu shot) not the live attenuated vaccine (nasal spray).


Live Twittercast: Da Vinci Laparoscopic Supra-Cervical Hysterectomy

Warning: Graphic images!Dr. Wendy Cutler, an OB/GYN with ADC, and a patient invited us to learn more about a procedure using the Da Vinci robotic surgical tool. Out of respect for patient privacy and the wishes of the patient, we do not reveal any private health information.

Storified by AustinDiagnostic · Thu, Oct 25 2012 11:04:21

Cindy & Sally here getting ready for a live twittercast w/ Dr. Cutler, Ob/gyn @ 12. Join us! http://yfrog.com/nxka0wgjAustinDiagnostic
In about 15 minutes we will begin our live twittercast of the di Vinci laproscopic supracervical hysterectomy with Dr. CutlerAustinDiagnostic
This is Sally, I’ll be doing the tweeting during the procedure. Im going to shorten the procedure to LSH to save my sanity #askADCAustinDiagnostic
We are just waiting on Dr Cutler. The patient is currently being prepped in the ORAustinDiagnostic
Have a question for Dr Culter or about the LSH procedure? Let’s us know! We will try to answer them during/after the procedure #AskADCAustinDiagnostic
Worst part about surgical masks? My glasses fogging up!! #ORproblemsAustinDiagnostic
Dr Cutler is scrubbing in! We are about to beginAustinDiagnostic
We are in th OR! Surgical team is prepping the patient.AustinDiagnostic
Dr Cutler is prepping the patient http://yfrog.com/j2mz3zwj #adcobgynAustinDiagnostic
Dr Cutler is beginning the LSH #askADC http://twitpic.com/b71uf6AustinDiagnostic
Here comes the di Vinci machine! #askADC #divinci http://twitpic.com/b71vbmAustinDiagnostic
Dr Cutler is starting on the left side. Everything is looking good. #askADCAustinDiagnostic
View of the uterus from da Vinci camera http://yfrog.com/h2zinlwjAustinDiagnostic
Dr Cutler is being joined by Dr Yvette Guitierrez-Schieffer at this momentAustinDiagnostic
My view from the corner of the OR. The monitor to the right is the camera view. #askADC http://twitpic.com/b71wwpAustinDiagnostic
Dr Guitierrez-Schieffer scrubbed in! http://twitpic.com/b71xsyAustinDiagnostic
Dr Cutler has done hundreds of cases using the di Vinci robot. Much less invasive than traditional hysterectomies. #askADCAustinDiagnostic
I wish my camera conveyed just how cool this is!AustinDiagnostic
Dr Schieffer at front. Dr Cutler is on the other side of the robot http://twitpic.com/b71zcbAustinDiagnostic
Dr Cutler is cauterizing the uterine artery preparing for removal of the uterus. Almost zero blood! #askADCAustinDiagnostic
Photo from #davinci camera of uterus #lsh #askadc http://yfrog.com/gzwh1wcjAustinDiagnostic
Dr Culter is detaching the uterus from the cervix. Remind me to ask how common it is to keep the cervix intact. #askADCAustinDiagnostic
The docs have a hi-def view to do surgery. #askadchttp://yfrog.com/mnkypqojAustinDiagnostic
My cohort, @CindyBrummer is getting video of the procedure Dark OR and iPhone camera doesn’t help capture the monitors wellAustinDiagnostic
Uterus is detached!! Dr Cutler pointed out endometriosis on the monitor #askADCAustinDiagnostic
Dr Cutler say this material will help prevent bleeding #askadc http://pic.twitter.com/T18Mhkx3AustinDiagnostic
Dr Cutler is using a product called SurgiSeal to help seal off sutures and prevent any complications #askADCAustinDiagnostic
And we are done! Just time to close up incision sites and head to recovery http://twitpic.com/b72antAustinDiagnostic
Thanks to Dr Wendy Cutler for allowing us to participate in today’s surgery. #askADCAustinDiagnostic
ADC ob/gyns finishing #lsh http://pic.twitter.com/VDz6q8onAustinDiagnostic
Drs Cutler & Schieffer wrapping this surgery up #lsh #adcobgyn http://pic.twitter.com/IcrLu34dAustinDiagnostic
Dr Cutler closing patient #adcobgyn http://pic.twitter.com/C2nRGiiYAustinDiagnostic
Just verified the bladder is intact. All good! #adcobgyn http://pic.twitter.com/TSDcyRRAAustinDiagnostic
All done! Thanks Dr Cutler! #lsh #adcobgyn http://pic.twitter.com/77tDNdeDAustinDiagnostic

Baby asleep in car seat

Photo courtesy: Thinkstock

Parents busy preparing to bring a new baby home need more than a crib. It’s also important to know how to safely carry babies in the car, put them to sleep and what to do in an emergency.

The Austin Diagnostic Clinic’s OB/GYN doctors are working with Austin Travis County EMS to offer a child safety class for new parents.

The three-hour class covers general guidelines and laws about passenger safety, how to make sure infants are safe when they sleep, and how to perform CPR or help your child if they choke.

Parents will also review how to install a car seat correctly.

The class is for expectant parents and those with children under a year old. The class is free, but space is limited.

For information on how to register, go to the event page.

Allison Devine, MD, talks about new dads

Dr. Allison Devine, OB/GYN with The Austin Diagnostic Clinic sat down with KXAN to talk about what new father’s may expect before and after baby comes home. Advice ranging from how dads can become more involved in the day-to-day care for baby, supporting their partner and how to recognize signs of paternal post-natal depression.

The doctor has removed either a piece of tissue from (LEEP) or frozen (CRYO) your cervix. Results of this test will be available in 1-2 weeks. You can expect a heavy vaginal discharge for 1-2 weeks.

Please avoid intercourse, tampons, douching, and swimming for 2 weeks.

Please call our office if you experience:

  • Fever greater than 101.0 degrees Fahrenheit.
  • Excessive bleeding (greater than one pad per hour).
  • Pain not controlled by over-the-counter medications.

The doctor may want to see you for a post procedure check. Another pap smear will be needed in about 3 months.

Cryo Surgery us a method of destroying diseased tissue by freezing. As applied to problems of the cervix, it is performed by the doctor in the office using a probe with a silver tip. The tip is placed against the tissue and the freezing is started. Only the tip reaches the low temperature required to treat the area. You may notice as sound of air passing through the probe. This is normal and is the sound of the refrigerant gas which cools the tip.

Is it painful?

Generally, no pain is felt, but occasionally some patients experience a mild cramping depending on the location and size of the area to be treated.

Why Cryo-Surgery?

The doctor feels that in your case Cryo-Surgery is the best method to use. In addition to the absence of pain associated with this treatment, other benefits include:

  • Absence of scarring and stenosis, thus avoiding complications during subsequent childbirths.
  • Absence of unpleasant odors associated with burning tissue found in other methods of treatment.
  • Almost non-existent post-treatment infection.
  • Treatment can be conducted with an I.U.D. in place.

What precautions must I take after treatment?

  • No sexual intercourse for at least 2 weeks.
  • A heavy flow of watery discharge may be expected to occur for the first 10-14 days, tapering off as healing proceeds, which can be as long as 6-8 weeks. Change pads frequently, but do not use tampons.
  • Slight spotting may occur, but no profuse bleeding.

Is it covered by insurance?

Most insurance companies will pay for this type of surgery according to the existing policy. Your doctor or his staff can further advise you on this.

Little care for a circumcised penis is necessary. Rinse the circumcised area at each diaper change by squeezing warm water over the tip of the penis. You may use Vaseline on the tip of the penis with each diaper change for the first few days after the circumcision. This is not necessary, but may prevent the circumcision site from sticking to the diaper. After the circumcision is healed, you can bathe your baby in a tub without fear of harming the circumcision or penis.

There should be no bleeding. The head of the penis may show signs of irritation and appear whitish or yellowish in places as it heals.

If used, the plastibell will fall off in 3-5 days. The rim of the skin in front of the string will turn black and come off with the bell. Do not pull the plastibell off even if it’s barely on — the plastibell will come off by itself. You will probably find it loose in your baby’s diaper.

Call your child’s pediatrician:

  • If the penis becomes red or swollen
  • Your baby does not pass urine for longer than 8 hours
  • Any green drainage
  • Increased temperature

You have a had an abnormal pap smear. It is important to determine what has caused it to be abnormal. Many abnormal pap smears that are not treated may eventually turn into cancer. To determine why your pap smear is abnormal, your doctor has recommended that you have a special examination called a colposcopy.

What is a Colposcopy?

A colposcopy is a way the doctor has of looking at your cervix (the mouth of the womb) to where the abnormal cells are. The examination is done with a machine called a colposcope that magnifies the cervix, like a microscope. After inserting a speculum into your vagina (like for a pap smear), the doctor looks into the colposcope. This allows the doctor to examine your cervix very carefully to see exactly where the abnormal cells are. If the doctor sees abnormal cells through the colposcope, a small sample of those cells are taken (called a biopsy). The sample is sent to the laboratory for examination and diagnosis.

The colposcopy take about 15-20 minutes. You may feel a pinch or some mild cramping when the biopsy is taken.

Instructions following a colposcopy

  • Do not put anything in your vagina for one week. This means no sex, no douching, and no tampons. Putting anything in your vagina may cause bleeding or an infection.
  • You may have a gritty discharge caused by the medicine used to control bleeding from the biopsy site. This is normal and you do not need to do anything for it.
  • Your results should be available in about one week. The nurse will contact you by phone after the doctor has reviewed the report.

Notify the clinic if any of the following occur within two weeks after the biopsy.

  • You have any bleeding and you are not on your period.
  • You have severe abdominal pain.
  • You have a fever greater than 101 degrees.

Circumcision is cutting away the foreskin, the skin that covers the glans, or the head of the penis. It is elective surgery- this means that it is not necessary. Parents make the choice whether or not to have their son circumcised.

Some of the factors that affect your decision are:

  • Cleanliness – In uncircumcised males, a substance called smegma gathers under the foreskin. This can lead to odor or infection if the penis is not cleaned regularly. In circumcised males, the foreskin is gone, so smegma cannot build up. An uncircumcised boy can be taught to wash his penis to get rid of the smegma as part of his daily bathing routine.
  • Tradition – Sometimes circumcision is chosen because parents want their son to look like his circumcised father or older brothers. Some parents may also be concerned that their child not be physically different physically from his peers during their teen years.
  • Cancer prevention – Some believe that circumcision prevents cancer of the penis and prostate in old age. There is no evidence that circumcision protects against cancer of the prostate. When the penis is not cleaned regularly and properly, smegma can build up. It is thought that this smegma may contain a carcinogen, a cancer-causing agent. Higher rates of penile cancer have been found in uncircumcised males who have very poor hygiene. Uncircumcised men who have very good hygiene, though, have very low rates of this cancer.
  • Prevention of infection and inflammation
  • Prevention of sexually transmitted diseases – Some studies show uncircumcised males may have a higher risk for certain sexually transmitted diseases, such as gonorrhea and syphilis. Other studies, though show no such increased risk.
  • Personal considerations

The Procedure

Although circumcision can be done at any time in a male’s life, it is usually done soon after birth-before the mother and baby leave the hospital. The baby will not be fed beforehand, because he may vomit afterwards if his stomach is full. The infant is held with straps on a special circumcision tray. A local anesthetic may be used. Various surgical techniques are used, but they generally follow the same procedure:

  1. The surgical area is cleaned.
  2. The foreskin is removed after a special instrument or plastic ring is applied. There is minimal bleeding, and it is easily controlled.
  3. Ointment and gauze may be placed over the cut to protect it from rubbing against the diaper.

The baby will cry during the procedure and for a short period afterward.


Any surgery carries risks. Although rare, hemorrhage (excessive bleeding), infection, and injury to the penis, scrotum (which contains the testes), or urethra (through which urine is emptied)

Long-term complications include deformity and scarring. These problems are uncommon.

Reasons to delay or not to opt for circumcision

Certain infants should not be circumcised; for others, it should be delayed. Some reasons for not doing or delaying circumcision include:

  • Prematurity (born before 37 weeks)
  • Illness
  • Signs of distress at birth
  • Hemophilia (a “bleeder”)
  • Abnormalities in the area of the penis