What Happens After Birth? Placenta Delivery and the Third Stage of Labor Explained
Many birth plans focus on contractions, pushing, pain management, and meeting the baby. Those are important parts of preparation, but they are not the full story. After your baby is born, your body still has one more stage of labor to complete: delivering the placenta. If you have searched how long does it take to deliver a placenta, you are not alone. The third stage of labor is brief for many patients, but understanding it ahead of time can make the delivery room feel less surprising and more manageable. What Is the Third Stage of Labor? The placenta is the organ that supplies oxygen and nutrients to your baby during pregnancy through the umbilical cord. After a vaginal birth, the placenta is delivered through the vagina after the baby is born. This is called the third stage of labor. During this stage, your uterus continues to contract. These contractions help the placenta separate from the uterine wall and move down for delivery. Some patients feel mild cramping or pressure, while others are mostly focused on holding their baby and may barely notice the process. How Long Does It Take to Deliver a Placenta? The timing depends partly on how the third stage is managed. Tommy’s, a pregnancy and baby charity, explains that patients generally have two options after vaginal birth: active management with medication or physiological management that allows the placenta to deliver on its own timeline. Approach What it means Typical timing discussed in patient education Active management A medication such as oxytocin is given to help the uterus contract The placenta usually delivers within 30 minutes. Physiological management The placenta is delivered without an oxytocin injection The process can take up to one hour for some low-risk patients. With a cesarean birth, your medical team delivers the placenta through the uterine incision after the baby is born. Why Providers Pay Close Attention Your care team monitors the third stage because retained placenta and heavy bleeding can be serious. A retained placenta means the placenta stays in the uterus longer than expected. Tommy’s explains that this may be diagnosed if the placenta is not delivered within 30 minutes with active management or within one hour with physiological management. Active management may reduce the chance of heavy bleeding after birth, also known as postpartum hemorrhage. Your provider will consider your birth circumstances, medical history, bleeding risk, and preferences when discussing options. What You May Notice During Placenta Delivery After the baby is born, your provider may watch for signs that the placenta has separated. You may feel additional contractions, pressure, or a need to push gently. Your provider may massage your uterus externally or ask you to push. If active management is used, medication helps the uterus contract. It is common for patients to have questions about what the placenta looks like, whether the process hurts, and whether anything is wrong if it takes more than a few minutes. Your provider can talk you through what is happening in real time. Many patients find it reassuring to know that the team is watching closely for bleeding, uterine tone, and complete delivery of the placenta. Questions to Ask During a Prenatal Visit The best time to discuss placenta delivery is before labor begins. You do not need to make every decision alone, and you can always ask your provider how recommendations might change depending on your delivery. Question Why it is useful What is your usual approach to the third stage of labor? Helps you understand what to expect in the delivery room Do I have any risk factors for heavy bleeding after birth? Allows your provider to explain individualized recommendations What happens if the placenta does not deliver on time? Reduces fear by clarifying the next steps before they are needed Can my preference be included in my birth plan? Encourages shared decision making with your care team When to Schedule a Conversation With Your ObGyn Bring up third-stage labor if you are writing a birth plan, if you had a retained placenta or postpartum hemorrhage in a previous birth, or if you are anxious about what happens after delivery. You should also ask questions if you are considering delayed cord clamping, have a high-risk pregnancy, or simply want a clearer picture of the minutes after birth. Labor preparation is not only about getting through contractions. It is also about understanding the sequence of care, the reasons behind common recommendations, and how your team protects you and your baby. If you are preparing for birth and want to discuss your labor plan, schedule an appointment with Women’s Integrated Healthcare in Southlake or Fort Worth. References [2] Tommy’s, Delivering the Placenta
Summer Pregnancy Safety: Heat, Hydration, and When to Call Your ObGyn
A North Texas summer can be uncomfortable for anyone, but pregnancy can make hot weather feel more intense. Your body is already working hard to support your growing baby, and high temperatures can add extra stress. The CDC notes that pregnancy can make you more likely to develop heat exhaustion, heat stroke, or another heat-related illness sooner than someone who is not pregnant because your body must work harder to cool both you and your developing baby. That does not mean you need to stay indoors all summer. It does mean that pregnancy heat safety deserves a plan. With the right habits, you can reduce your risk of overheating, recognize symptoms early, and know when to reach out to your ObGyn for guidance. Why Heat Can Feel Different During Pregnancy Pregnancy can increase your risk of dehydration, and dehydration can make it harder for your body to cool itself through sweating. When temperatures are high, especially during outdoor activity or long periods in direct sun, your internal body temperature may rise. The CDC explains that in some cases, increased internal temperature and fever during pregnancy have been linked to birth defects and other pregnancy complications. In practical terms, you may notice that activities you tolerated before pregnancy feel more draining now. A walk, errands, a pool day, or a child’s outdoor sports event may require more rest breaks, more fluids, and more attention to how your body feels. Summer situation Pregnancy safety tip Why it matters Running errands in the afternoon Park in shaded areas when possible and bring water with you Cars and pavement can intensify heat exposure quickly Outdoor exercise Choose early morning or evening and avoid strenuous activity in peak heat Pregnancy can make heat illness occur sooner than expected Pool or lake day Reapply sunscreen, rest in the shade, and drink fluids regularly Swimming can feel cool while your body still loses fluid Travel or day trips Plan extra bathroom breaks and keep water accessible Hydration needs may be higher during pregnancy Hydration Is More Than Drinking Water Once You Feel Thirsty Thirst is helpful, but it should not be your only cue. During pregnancy, a better approach is to drink steadily throughout the day. Keep a refillable bottle nearby, start hydrating before you go outside, and continue after you come back indoors. If you are sweating heavily, the CDC recommends talking with your doctor about how to safely replace salt and minerals lost through sweating. You may also support hydration with water-rich foods such as watermelon, berries, cucumbers, oranges, and soups. If nausea, vomiting, diarrhea, or food aversions make it hard to keep fluids down, call your ObGyn. Those symptoms can increase dehydration risk, and your care team can help you decide what to do next. Watch for Heat-Related Warning Signs Heat illness can begin with mild symptoms, but it can become serious if ignored. Pay attention to your body and move to a cooler place if you begin to feel unwell. The CDC recommends seeking medical care immediately if symptoms of heat-related illness occur. Symptom What to do Dizziness, weakness, or feeling faint Stop activity, get to a cooler area, drink fluids if you can, and call for help if symptoms do not improve Headache or nausea in hot weather Rest in air conditioning or shade and contact your provider if symptoms persist Heavy sweating followed by feeling very hot or confused Seek urgent medical care Contractions, vaginal bleeding, leaking fluid, or decreased fetal movement Call your ObGyn or follow your pregnancy care instructions right away It is always better to ask than to wait when something feels off. Your provider would rather help you sort through symptoms early than have you worry at home. Make a Heat Plan Before the Day Gets Busy A simple plan can make summer safer. Check the local forecast before outdoor plans, including heat and air quality alerts. The CDC recommends checking local HeatRisk and air quality so you can plan your week with your health in mind. For many pregnant patients, that may mean moving walks indoors, changing a picnic to a morning time slot, or choosing an air-conditioned activity during the hottest part of the day. If you work outdoors or in a hot environment, talk with your ObGyn about your specific situation. You may need more frequent breaks, access to fluids, shade, or other accommodations. If you have a high-risk pregnancy, blood pressure concerns, a history of preterm labor, or other medical conditions, individualized advice is especially important. When to Call Women’s Integrated Healthcare Call your ObGyn if you have symptoms that concern you, if you cannot stay hydrated, or if heat exposure is followed by cramping, contractions, vaginal bleeding, leaking fluid, severe headache, fainting, or decreased fetal movement. You should also bring up summer plans during prenatal visits, especially if you will be traveling, attending outdoor events, or exercising in the heat. Pregnancy does not have to stop you from enjoying summer, but it should change how you prepare. A few thoughtful adjustments can help you stay comfortable, protect your health, and feel more confident in the heat. If you are pregnant and have questions about summer safety, hydration, or symptoms, schedule an appointment with Women’s Integrated Healthcare in Southlake or Fort Worth. References [1] CDC, Heat and Pregnancy
Your Second Trimester: What’s Actually Happening and What to Expect
Sarah woke up on a Tuesday morning and realized something was missing. The persistent, low-grade nausea that had defined her last two months was gone. She actually wanted coffee. She had energy to walk the dog. “Is it supposed to just stop like this?” she asked at her 14-week appointment. “I feel almost normal again.” For many women, the transition into the second trimester—which spans weeks 14 through 27—feels exactly like this. The intense fatigue and morning sickness of the first trimester often lift, replaced by a renewed sense of well-being. It is frequently called the “honeymoon phase” of pregnancy. But “feeling normal” doesn’t mean nothing is happening. The second trimester is a period of rapid, complex fetal development and significant physical changes for you. Here is what is actually happening during these crucial weeks. The Physical Shift: Your Body in the Second Trimester As your hormone levels stabilize, the early pregnancy symptoms typically subside. However, your body is now accommodating a rapidly growing uterus. This physical expansion introduces a new set of symptoms. You will likely notice your abdomen beginning to show, though the timing varies widely depending on your height, core strength, and whether this is your first pregnancy. As your uterus grows upward and outward, the ligaments supporting it stretch. This can cause round ligament pain—sharp, sudden jabs of pain in your lower abdomen or groin, particularly when you change positions quickly or cough. [1] Skin changes are also common. Increased melanin production can cause a dark line to appear down the center of your abdomen (linea nigra) or darker patches on your face (melasma). [2] You may also experience increased nasal congestion or occasional nosebleeds. This is not necessarily a cold; pregnancy hormones increase blood flow to all your mucous membranes, causing them to swell. Fetal Development: From Plum to Papaya While you are feeling better, your baby is working harder than ever. At the start of the second trimester, your baby is roughly the size of a plum. By the end of week 27, they will be the size of a papaya and weigh nearly two pounds. [3] The developmental milestones during this phase are remarkable. Around week 16, your baby’s eyes can make slow movements, and their ears are close to their final position. By week 20, they are developing a sleep-wake cycle. [3] They are also growing hair, eyebrows, and eyelashes, and their skin is covered in a fine, downy hair called lanugo, which helps regulate their body temperature. Perhaps the most exciting milestone of the second trimester is quickening—the first time you feel your baby move. For first-time mothers, this usually happens between 18 and 22 weeks. It often feels like a subtle fluttering or gas bubbles. If you have been pregnant before, you may recognize the sensation earlier, around 16 weeks. [2] Prenatal Care: The Anatomy Scan and Beyond Your prenatal visits will continue every four weeks during the second trimester. These appointments are critical for monitoring your blood pressure, tracking your weight gain, and measuring your fundal height (the size of your uterus) to ensure your baby is growing appropriately. [4] The centerpiece of second-trimester prenatal care is the anatomy scan, typically performed between 18 and 22 weeks. [5] This detailed ultrasound is not just for determining the baby’s sex, though that is often an option. The primary purpose is a comprehensive medical evaluation. The sonographer will examine your baby’s heart, brain, spine, kidneys, and limbs to ensure they are developing correctly. They will also check the position of your placenta and the volume of your amniotic fluid. Between weeks 24 and 28, you will also undergo a glucose screening test to check for gestational diabetes, a condition that affects how your cells use sugar during pregnancy. [4] When to Call Your Provider While the second trimester is generally the most comfortable phase of pregnancy, certain symptoms require immediate medical attention. You should contact your provider if you experience: Do not rely on internet searches if something feels wrong. That is exactly what your obstetric team is here for. The second trimester is a time of visible progress and, for most women, increased comfort. Enjoy the return of your energy, celebrate the milestones like the anatomy scan and the first kicks, and continue prioritizing your health. Are you entering your second trimester and looking for comprehensive, supportive prenatal care? Schedule an appointment with Women’s Integrated Healthcare to ensure you and your baby are on the right track. References [1] Mayo Clinic. (2025). 2nd trimester pregnancy: What to expect. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20047732 [2] Mayo Clinic. (2025). Pregnancy week by week: Second trimester. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/basics/second-trimester/hlv-20049471 [3] Mayo Clinic. (2025). Fetal development: The 2nd trimester. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-development/art-20046151 [4] Mayo Clinic. (2024). Prenatal care: Second trimester visits. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044581 [5] National Center for Biotechnology Information. (2023). Sonography 2nd Trimester Assessment, Protocols, and Interpretation. https://www.ncbi.nlm.nih.gov/books/NBK570574/
Pelvic Floor Health: What It Is, Why It Matters, and When to Get Help
“I just thought leaking when I sneezed was the price of having three kids,” Sarah admitted during her annual well-woman exam. She was 38, active, and otherwise healthy. But for the past four years, she had stopped running, avoided jumping jacks at the gym, and carried a spare pair of underwear in her purse. “My mom did it. My friends joke about it. I figured it was just normal.” It is incredibly common. But it is not normal. The normalization of pelvic floor dysfunction—whether it is urinary incontinence, pain during intercourse, or a constant feeling of heaviness—prevents millions of women from seeking treatment for highly correctable conditions. Your pelvic floor is a complex, vital muscle group. When it stops functioning correctly, it impacts your daily life, your confidence, and your physical activity. Here is what you need to know about your pelvic floor, how to recognize when it is struggling, and why you do not have to simply live with the symptoms. What Is the Pelvic Floor? Your pelvic floor is a hammock-like group of muscles, ligaments, and connective tissues that stretch across the base of your pelvis. [1] These muscles serve several critical functions. They support your pelvic organs, including your bladder, uterus, and bowel, keeping them in their proper positions. They control the release of urine and feces by wrapping around the urethra and rectum. They also play a significant role in sexual function and core stability. Like any other muscle group in your body, your pelvic floor muscles can become too weak (hypotonic) or too tight (hypertonic). Both extremes cause dysfunction, but they present with very different symptoms. Recognizing Pelvic Floor Dysfunction Pelvic floor dysfunction occurs when you are unable to correctly coordinate the contraction and relaxation of these muscles. [2] The symptoms are often dismissed as inevitable consequences of aging, childbirth, or menopause. If your pelvic floor muscles are too weak, they cannot adequately support your pelvic organs or control your sphincters. Symptoms of a weakened pelvic floor include: Conversely, if your pelvic floor muscles are too tight or in a state of chronic spasm, they cannot relax enough to allow for normal function. Symptoms of a hypertonic pelvic floor include: It is entirely possible to experience a combination of these symptoms. For example, a woman with a hypertonic pelvic floor may experience urinary urgency because the tight muscles are constantly irritating her bladder. Why Does Dysfunction Happen? The pelvic floor is subjected to significant stress throughout a woman’s life. Pregnancy and vaginal childbirth are the most common catalysts for pelvic floor dysfunction, as the muscles and connective tissues are stretched and sometimes torn. [4] However, you do not have to have been pregnant to experience these issues. Other common causes include: The Role of Pelvic Floor Physical Therapy If you are experiencing symptoms of pelvic floor dysfunction, the first step is a comprehensive evaluation by your gynecologist to rule out infections or other medical conditions. Once a diagnosis is confirmed, the most effective, evidence-based, first-line treatment is often pelvic floor physical therapy (PFPT). [6] Pelvic floor physical therapy is not just about doing Kegels. In fact, if your pelvic floor is already too tight, doing Kegels can actually worsen your symptoms. [7] A specialized pelvic floor physical therapist will assess your muscle tone, strength, and coordination. If your muscles are weak, they will teach you how to properly isolate and strengthen them, often using biofeedback to ensure you are engaging the correct muscles. If your muscles are too tight, the therapist will use internal and external manual release techniques, trigger point therapy, and relaxation exercises to lengthen the muscles and relieve pain. [8] PFPT has robust evidence supporting its effectiveness. Studies show that targeted pelvic floor muscle training can significantly improve or resolve urinary incontinence in up to 59 percent of women. [9] It is a conservative, non-surgical approach that addresses the root cause of the dysfunction rather than just managing the symptoms. You Do Not Have to Live With It Leaking when you laugh is not a punchline. Pain during intimacy is not something you should endure. A constant feeling of pelvic pressure is not a normal part of aging. If you are modifying your life, your wardrobe, or your activities because of your pelvic floor, it is time to seek help. Schedule a consultation with Women’s Integrated Healthcare to discuss your symptoms. We can provide a thorough evaluation, discuss your treatment options, and connect you with the specialized care you need to regain control and comfort. References [1] Cleveland Clinic. (2025). Pelvic Floor Muscles: Anatomy, Function & Conditions. https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles [2] Cleveland Clinic. (2024). Pelvic Floor Dysfunction: What It Is, Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction [3] American College of Obstetricians and Gynecologists. (2024). Pelvic Support Problems. https://www.acog.org/womens-health/faqs/pelvic-support-problems [4] National Institute of Child Health and Human Development. (2025). What are the symptoms of pelvic floor disorders (PFDs)? https://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo/symptoms [5] American Academy of Family Physicians. (2021). Chronic Pelvic Pain in Women: ACOG Updates. https://www.aafp.org/pubs/afp/issues/2021/0201/p186.html [6] PubMed. (2019). Pelvic floor physical therapy in the treatment of pelvic floor disorders. https://pubmed.ncbi.nlm.nih.gov/31609735/ [7] Johns Hopkins Medicine. (2024). Pelvic Floor Therapy. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pelvic-floor-therapy [8] APTA Pelvic Health. (2024). Benefits of Pelvic Health Physical Therapy. https://www.aptapelvichealth.org/info/the-benefits-of-pelvic-health-physical-therapy [9] National Center for Biotechnology Information. (2023). Effectiveness of Pelvic Floor Muscle Training on Quality of Life. https://pmc.ncbi.nlm.nih.gov/articles/PMC10301414/
Your 6-Week Postpartum Visit: What to Expect and Why It Matters More Than You Think
For nine months, you saw your obstetrician constantly. You had your blood pressure checked, your belly measured, and your questions answered every few weeks. Then, you had your baby. Suddenly, the intense medical focus shifted entirely to your newborn, and you were sent home with a tiny human, a peri bottle, and instructions to come back in six weeks. The “fourth trimester”—the 12 weeks following birth—is a period of immense physical and emotional transition. Yet, many women feel adrift during this time, assuming that if they are surviving, they are recovering. Your 6-week postpartum visit is not just a formality to get cleared for exercise and sex. It is a comprehensive evaluation of your physical healing, your mental health, and your transition into motherhood. Here is what actually happens at this appointment and why it is one of the most important visits of your pregnancy journey. The Physical Recovery Check The most immediate focus of your postpartum visit is ensuring your body is healing correctly from childbirth. Your provider will perform a physical exam, which typically includes: This is also the time to discuss any lingering physical symptoms. Are you still experiencing vaginal bleeding or unusual discharge? Are you having pain during urination or bowel movements? Are you dealing with hemorrhoids or pelvic pressure? These are common, but they are not things you simply have to endure. Mental Health: The Invisible Recovery May is Maternal Mental Health Awareness Month, making it the perfect time to emphasize that your emotional recovery is just as critical as your physical healing. The “baby blues”—feelings of sadness, anxiety, or mood swings—are incredibly common in the first two weeks after birth, affecting up to 80 percent of new mothers. However, if these feelings persist beyond two weeks, or if they are severe enough to interfere with your ability to care for yourself or your baby, it may be postpartum depression (PPD) or postpartum anxiety (PPA). [5] During your 6-week visit, your provider will screen you for postpartum depression. [6] This is not a test you can fail; it is a tool to get you the support you need. Be honest about how you are feeling. If you are struggling with intrusive thoughts, overwhelming anxiety, or a persistent sense of hopelessness, tell your provider. Postpartum mood disorders are highly treatable with therapy, medication, or a combination of both. Discussing Your Future: Contraception and Beyond Even if you are exclusively breastfeeding, and even if your period has not returned, you can still get pregnant very soon after giving birth. Your 6-week visit is the ideal time to discuss your family planning goals and choose a contraceptive method that fits your needs. [7] Your provider will review your options, which may include: This is also the appointment where you will typically be cleared to resume sexual intercourse and moderate exercise. However, “cleared” does not mean you have to be ready. If you are experiencing pelvic pain, vaginal dryness (common if you are breastfeeding), or simply a lack of desire, discuss this with your provider. They can offer solutions, such as estrogen cream or a referral to a pelvic floor physical therapist. [8] Don’t Skip This Visit The American College of Obstetricians and Gynecologists (ACOG) now recommends that postpartum care be an ongoing process, rather than a single encounter, with a comprehensive visit occurring no later than 12 weeks after birth. [9] You are exhausted. You are busy. Finding childcare or bringing a newborn to a doctor’s appointment is challenging. But your health matters just as much as your baby’s. If you are approaching your 6-week mark, or if you are currently pregnant and planning ahead, ensure your postpartum checkup is on the calendar. Schedule your appointment with Women’s Integrated Healthcare to ensure your recovery is on track and you have the support you need for the fourth trimester. References [1] American College of Obstetricians and Gynecologists. (2024). What to Expect at a Postpartum Checkup. https://www.acog.org/womens-health/experts-and-stories/the-latest/what-to-expect-at-a-postpartum-checkup-and-why-the-visit-matters [2] March of Dimes. (2024). Your postpartum checkups. https://www.marchofdimes.org/find-support/topics/postpartum/your-postpartum-checkups [3] Columbia University Irving Medical Center. (2021). A Mother’s Guide to the Fourth Trimester. https://www.cuimc.columbia.edu/news/mothers-guide-fourth-trimester [4] The Vag Whisperer. (2021). Your 6 Week Postpartum Checkup Explained. https://thevagwhisperer.com/2021/12/23/six-week-appointment/ [5] American Academy of Family Physicians. (2019). Postpartum Care: An Approach to the Fourth Trimester. https://www.aafp.org/pubs/afp/issues/2019/1015/p485.html [6] American College of Obstetricians and Gynecologists. (2018). Optimizing Postpartum Care. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care [7] American College of Obstetricians and Gynecologists. (2024). My Postpartum Care Checklist. https://www.acog.org/womens-health/health-tools/my-postpartum-care-checklist [8] Optum. (2023). What to expect at your postpartum check-up. https://east.optum.com/blog/what-to-expect-at-your-postpartum-check-up/ [9] National Center for Biotechnology Information. (2024). Postpartum Care of the New Mother. https://www.ncbi.nlm.nih.gov/books/NBK565875/
BV vs. Yeast Infection: How to Tell the Difference and Why It Matters
You notice an uncomfortable itch. Then, a change in your vaginal discharge. Your first instinct is probably to head to the pharmacy for an over-the-counter yeast infection treatment. It is what most women do. But what if it is not a yeast infection? Bacterial vaginosis (BV) and yeast infections are the two most common causes of vaginitis (vaginal inflammation). [1] Because they share some overlapping symptoms—like itching, irritation, and abnormal discharge—they are frequently confused. However, they are caused by entirely different organisms and require completely different treatments. Treating BV with a yeast infection cream will not work, and it can actually make your symptoms worse by further disrupting your vaginal microbiome. Here is how to tell the difference between the two and why getting an accurate diagnosis matters. The Root Cause: Bacteria vs. Fungus Your vagina is home to a complex, delicate ecosystem of microorganisms. In a healthy state, “good” bacteria (primarily lactobacilli) keep “bad” bacteria and yeast in check by maintaining a slightly acidic environment. [2] A yeast infection (candidiasis) occurs when there is an overgrowth of a fungus called Candida. This fungus naturally lives in your vagina in small numbers, but factors like antibiotic use, pregnancy, uncontrolled diabetes, or a weakened immune system can cause it to multiply rapidly. [3] Bacterial vaginosis (BV), on the other hand, is not caused by a fungus. It happens when the normal balance of bacteria in your vagina is disrupted, and certain types of “bad” bacteria (often Gardnerella vaginalis) overgrow and outnumber the good lactobacilli. [4] BV is the most common vaginal infection in women ages 15 to 44. [5] How to Tell the Difference: The Symptoms While both conditions cause discomfort, the specific symptoms are usually distinct enough to tell them apart if you know what to look for. The Discharge This is often the most reliable indicator. The Odor The Discomfort Why Accurate Diagnosis Matters If you have had a yeast infection before and recognize the classic “cottage cheese” discharge and intense itching, an over-the-counter antifungal cream is often a reasonable first step. However, if your symptoms are ambiguous, if you have that distinct fishy odor, or if the OTC treatment does not work within a few days, you need to see your provider. BV cannot be cured with over-the-counter medications. It requires prescription antibiotics, either oral pills (like metronidazole) or a vaginal gel or cream. [9] Leaving BV untreated is not just uncomfortable; it carries real health risks. Untreated BV increases your susceptibility to sexually transmitted infections (STIs), including HIV, chlamydia, and gonorrhea. [10] If you are pregnant, untreated BV is linked to an increased risk of premature rupture of membranes, preterm birth, and low birth weight. [11] Prevention and Next Steps Both BV and yeast infections are signs that your vaginal microbiome is out of balance. To help maintain a healthy environment: If you are experiencing vaginal discomfort, abnormal discharge, or a noticeable odor, do not guess in the pharmacy aisle. Schedule an appointment with Women’s Integrated Healthcare. We can quickly and accurately diagnose the cause of your symptoms and prescribe the correct treatment to get you back to feeling comfortable and confident. References [1] American College of Obstetricians and Gynecologists. (2024). Think You Have a Vaginal Infection? Here’s What You Need to Know. https://www.acog.org/womens-health/experts-and-stories/the-latest/think-you-have-a-vaginal-infection-heres-what-you-need-to-know [2] Office on Women’s Health. (2022). Bacterial vaginosis. https://womenshealth.gov/a-z-topics/bacterial-vaginosis [3] American College of Obstetricians and Gynecologists. (2024). Vaginitis. https://www.acog.org/womens-health/faqs/vaginitis [4] Centers for Disease Control and Prevention. (2023). About Bacterial Vaginosis (BV). https://www.cdc.gov/bacterial-vaginosis/about/index.html [5] Centers for Disease Control and Prevention. (2021). Bacterial Vaginosis – STI Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/bv.htm [6] Healthline. (2019). Bacterial Vaginosis vs. Yeast Infection: Symptoms, Treatment, More. https://www.healthline.com/health/bacterial-vaginosis-vs-yeast-infection [7] Roswell Ob/Gyn. (2026). Yeast Infection vs. BV Differences. https://roswellobgyn.org/yeast-infection-vs-bv-how-to-tell-the-difference/ [8] Advanced Gynecology. (2024). Bacterial Vaginosis Vs. Yeast Infections: Differences and Similarities. https://advancedgynecology.com/blog/bacterial-vaginosis-vs-yeast-infections-differences-and-similarities [9] Mayo Clinic. (2023). Bacterial vaginosis – Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285 [10] World Health Organization. (2025). Bacterial vaginosis. https://www.who.int/news-room/fact-sheets/detail/bacterial-vaginosis [11] Centers for Disease Control and Prevention. (2024). Bacterial Vaginosis – CDC Fact Sheet. https://stacks.cdc.gov/view/cdc/32737/cdc_32737_DS1.pdf [12] New York State Department of Health. (2024). Bacterial Vaginosis: What Women Need to Know. https://www.health.ny.gov/publications/3831/
Preconception Planning in Spring: The Best Time to Prepare Your Body
Spring has a way of making people think about new beginnings. If starting a family is on your mind this year, you’re probably focused on ovulation tracking apps and prenatal vitamins. Those things matter — but the most important step most women overlook is a preconception visit before they start trying. The three months before conception are one of the most influential windows in a future pregnancy. What you do — and don’t do — during this time affects egg quality, early fetal development, and your body’s readiness for the demands ahead. Here’s what actually matters. Start With a Preconception Visit A preconception checkup is different from a routine annual exam. Your provider will review your health history, assess any chronic conditions, evaluate medications that may need to be switched to pregnancy-safe alternatives, and make sure your vaccinations are current. Some vaccines require a waiting period before you can safely try to conceive, so timing matters. Blood work at this visit typically checks for anemia, thyroid function, immunity to rubella and chickenpox, and blood sugar. If you or your partner have a family history of genetic conditions, this is also the time to discuss carrier screening. Don’t wait until you’re already trying to schedule this visit. Many of the adjustments that make the biggest difference — starting folic acid, switching medications, treating an undiagnosed thyroid issue — need several weeks to take effect. Folic Acid: Start Now, Not After a Positive Test Neural tube defects occur in the first 28 days of pregnancy, often before a woman knows she’s pregnant. The American College of Obstetricians and Gynecologists recommends beginning folic acid supplementation — at least 400 to 800 mcg daily — at least one month before trying to conceive, and ideally three months ahead. A prenatal vitamin with adequate folic acid is the simplest way to cover this. Start taking one now, regardless of how soon you plan to begin trying. What to Eat, What to Limit Fertility nutrition isn’t about a strict diet — it’s about consistency. Focus on leafy greens, colorful vegetables, lean proteins, healthy fats, and whole grains. Limit caffeine to under 200mg daily (roughly one 12-ounce coffee). Cut back on alcohol; no amount is proven safe during the conception window or early pregnancy. High-mercury fish — shark, swordfish, king mackerel, and tilefish — should be avoided both during pregnancy and when trying to conceive. Salmon, sardines, and shrimp are low-mercury options with beneficial omega-3s that support hormone production. Address Lifestyle Factors That Affect Fertility Moderate exercise improves fertility outcomes. Aim for 30 minutes of moderate activity most days — walking, swimming, cycling, yoga. Very high-intensity training can disrupt ovulation in some women, so balance is important if you train heavily. If you smoke, quitting is the single most impactful change you can make before trying to conceive. Smoking damages eggs, reduces fertility, and significantly increases miscarriage risk. Your provider can connect you with cessation resources. Chronic stress disrupts hormonal signaling and can affect cycle regularity. Spring is a natural moment to evaluate what’s draining your energy and build in more restoration — not as a luxury, but as part of your preconception plan. Understanding Your Cycle Start tracking your menstrual cycle now if you aren’t already. Note cycle length, any spotting, and changes in cervical mucus. This data helps you identify your fertile window, flags potential irregularities worth discussing with your provider, and gives baseline information that’s useful if conception takes longer than expected. If your cycles are irregular or you’ve had prior pregnancy losses, mention this at your preconception visit rather than waiting to see what happens. The Bottom Line Preconception planning isn’t about perfection — it’s about giving yourself the best possible foundation before you begin. A single visit, a prenatal vitamin, and a few consistent habits can make a meaningful difference. Spring is a good time to begin. Schedule a preconception consultation to review your health, address any concerns, and create a personalized roadmap for your path to pregnancy. Sources
Why PCOS Is Hard to Diagnose — And What to Do If You Suspect It
Morgan had been to three different doctors before anyone put the pieces together. A dermatologist for her jawline acne. An endocrinologist for her blood sugar. Her OB-GYN for cycles that came every 45 days — when they came at all. “Everyone kept treating the symptom in front of them,” she said. “Nobody ever asked if they might be connected.” They were. Morgan has PCOS — polycystic ovary syndrome — one of the most common hormonal conditions affecting women of reproductive age, and one of the most frequently missed. Why Diagnosis Takes So Long PCOS affects approximately one in ten women, yet the average time from first symptoms to diagnosis is seven to ten years. Several factors drive that delay. First, the symptoms are varied enough that they’re easily attributed to other causes or dismissed entirely. Irregular periods might be chalked up to stress. Acne to diet. Weight gain to lifestyle. Hair thinning to aging. When each symptom gets treated separately, no one sees the full picture. Second, there’s no single definitive test. Diagnosis is based on meeting at least two of three criteria: irregular or absent ovulation, elevated androgen levels (through blood work or visible signs like excess hair growth), and polycystic ovaries on ultrasound. Notably, you don’t need to have ovarian cysts to be diagnosed with PCOS — the name is misleading. Third, symptoms vary significantly between women. Some have classic presentations. Others have only mild irregularities that don’t raise obvious flags at routine visits. The Full Symptom Picture Irregular periods are the most recognized PCOS symptom, but the condition affects multiple body systems. About 70 percent of women with PCOS have insulin resistance, regardless of body weight — which causes difficulty managing blood sugar, intense carbohydrate cravings, and darkened skin patches in body creases. Elevated androgens drive the skin and hair changes many women notice: persistent acne especially along the jawline and chin, excess facial or body hair, and thinning hair at the scalp. These symptoms can appear even in women whose blood androgen levels fall within the “normal” range on standard testing. Mood and mental health are also affected. Women with PCOS have higher rates of anxiety and depression than the general population — a connection that’s hormonal, not coincidental. What Diagnosis Involves If you suspect PCOS, a thorough evaluation includes a detailed symptom history, blood work to assess hormone levels (including testosterone, LH, FSH, and insulin), and a pelvic ultrasound. Your provider should ask not just about your periods but about your skin, hair, weight patterns, energy, and mood — because PCOS is a whole-body condition. Treatment Is Individualized There’s no single PCOS treatment, because PCOS doesn’t look the same in every woman. Treatment goals are shaped by your priorities: managing symptoms, protecting long-term metabolic health, or supporting fertility. For cycle regulation and androgen-related symptoms, combined hormonal contraceptives are often first-line. Metformin improves insulin sensitivity and can restore more regular ovulation. Anti-androgen medications like spironolactone address excess hair and acne directly. For women trying to conceive, ovulation induction with medications like letrozole is typically the starting point. Lifestyle changes — specifically a low-glycemic diet and regular exercise — improve insulin sensitivity and can meaningfully reduce symptoms independent of weight change. These aren’t alternatives to medication; they work best in combination. Long-Term Health Implications PCOS is a metabolic condition, not just a reproductive one. Women with PCOS face higher lifetime risks of type 2 diabetes, cardiovascular disease, and endometrial cancer if cycles remain very irregular long-term. Early diagnosis and consistent management reduce these risks significantly. If you’ve been experiencing symptoms that feel connected — irregular periods, acne, hair changes, difficulty managing weight — and haven’t received a clear explanation, it’s worth pursuing a comprehensive evaluation. Schedule a PCOS consultation to discuss your symptoms, get appropriate testing, and build a treatment plan that addresses your specific presentation. Sources
Endometriosis and Spring Activity: Managing Flares When You Want to Be Moving
For women with endometriosis, spring presents a particular tension. Warmer weather, longer days, and the pull to be outside and active — alongside a condition that can make movement feel impossible during flares. If you’ve spent a beautiful April day curled up in pain instead of outside, you’re not alone, and you’re not overreacting. Managing endometriosis through active seasons takes strategy. Here’s what helps, what doesn’t, and when to revisit your treatment plan. Why Flares Feel Worse When You Push Through Endometriosis causes tissue similar to the uterine lining to grow outside the uterus — on the ovaries, bowel, bladder, and surrounding structures. This tissue responds to the same hormonal signals as the uterine lining, thickening and breaking down with each cycle. Because it has nowhere to go, it causes inflammation, scarring, and nerve irritation. High-intensity exercise during a flare increases intra-abdominal pressure and can temporarily worsen pain — not because exercise is harmful, but because inflamed tissue is more reactive to physical stress. The frustrating part is that staying completely sedentary doesn’t help either. The goal is finding the approach that works with your body rather than against it. What the Research Actually Shows Regular, moderate exercise is genuinely beneficial for endometriosis management. Research published in the Journal of Endometriosis and Uterine Disorders suggests that consistent aerobic activity reduces circulating estrogen levels, which may slow the growth of endometrial tissue over time. Exercise also reduces systemic inflammation and improves pain tolerance through endorphin release. The key word is moderate. Walking, swimming, yoga, and cycling are consistently reported as tolerable and beneficial by women with endometriosis. High-impact activities — running, jumping, heavy lifting — are better tolerated between flares than during them. Listening to your body on high-pain days isn’t giving up; it’s smart symptom management. Pelvic Floor Physical Therapy: Underused and Effective One of the most effective and underutilized treatments for endometriosis-related pain is pelvic floor physical therapy. Endometriosis frequently causes pelvic floor muscle dysfunction — tight, guarded muscles that create additional pain beyond the inflammation itself. A pelvic floor physical therapist can assess muscle function, provide internal and external treatment, and teach techniques to reduce the muscular component of pain. If you haven’t been referred for pelvic floor PT as part of your endometriosis management, it’s worth asking about. For many women, it significantly expands what’s possible — including physical activity. Pain Management on Active Days NSAIDs like ibuprofen and naproxen are first-line for endometriosis pain and work best when taken preventively — starting a day or two before your period rather than waiting until pain is severe. Heat therapy (a heating pad or warm bath) helps relax pelvic floor muscles and can be used alongside medication. If over-the-counter options aren’t controlling your pain adequately, or if you’re modifying your activities more than you’d like to, that’s important information for your provider. Pain that interferes with daily life — including the activities you want to do in the spring — is not something to simply manage around. It warrants a treatment review. When to Revisit Your Treatment Plan Endometriosis is a chronic condition, and treatment needs evolve. If your current plan isn’t giving you adequate quality of life, if your symptoms are worsening, or if you’re approaching a decision about fertility, a specialist consultation is appropriate. Treatment options include hormonal management (continuous birth control, progestin-only methods, GnRH agonists), surgical intervention to remove endometrial tissue and adhesions, and integrative approaches including anti-inflammatory nutrition and stress management. The right combination depends on your current symptoms, fertility goals, and what you’ve already tried. You don’t have to choose between managing pain and staying active. With the right treatment plan, both are possible. Schedule a consultation to review your endometriosis management, discuss your symptoms, and explore options that give you back the quality of life you deserve — including spring days spent moving. Sources
Medication Safety in Pregnancy: What Changed, What Didn’t, and How to Know the Difference
One of the most common calls we receive from pregnant patients starts the same way: “I took something before I knew. Am I okay?” The second most common: “I have a terrible cold and I don’t know what I’m allowed to take.” Both are completely valid concerns — and both deserve a real answer rather than a panicked Google search at midnight. Medication safety in pregnancy is genuinely complicated. Guidelines shift as new research emerges. The same drug may be safe in one trimester and riskier in another. And the information online ranges from overly cautious to outdated. Here’s a current, practical guide. The Trimester Timing Question The first trimester — weeks one through twelve — is the most critical period for organ development. This is when major structural birth defects can occur if embryonic development is disrupted, which is why medication avoidance is most important during these weeks. Many providers recommend limiting medications to what’s truly necessary until the end of the first trimester. The second trimester generally has a more favorable safety profile for common medications. However, this is also when some medications become riskier that were acceptable earlier — NSAIDs are the clearest example. After 20 weeks, ibuprofen and naproxen (common anti-inflammatory pain relievers) should be avoided. Research has linked NSAID use in the second half of pregnancy to reduced amniotic fluid, kidney problems in the developing baby, and premature closure of a fetal blood vessel. Acetaminophen (Tylenol) remains the appropriate option for pain and fever throughout pregnancy. What’s Safe for Common Complaints For pain and fever: Acetaminophen is safe throughout pregnancy at recommended doses. Avoid ibuprofen, naproxen, and aspirin unless specifically directed by your provider. For allergies and colds: Saline nasal spray and rinses are safe at any point and more effective than many people realize. Loratadine (Claritin) and cetirizine (Zyrtec) have good safety data and are generally considered acceptable throughout pregnancy. Diphenhydramine (Benadryl) is safe but causes drowsiness. Pseudoephedrine should be avoided in the first trimester and used cautiously later only with provider guidance. For products like Zicam: Zicam nasal spray should be avoided in pregnancy. Oral zinc lozenges are lower risk but should be monitored for total zinc intake — your prenatal vitamin already contains zinc, and combined intake should stay under 40mg daily. Saline rinses, rest, hydration, and acetaminophen for fever are safer and effective alternatives for cold symptoms. For heartburn: Calcium carbonate antacids (Tums, Rolaids) are safe. Famotidine (Pepcid) is acceptable. Proton pump inhibitors like omeprazole are generally used when other options don’t provide relief. For constipation: Fiber supplements and Colace (docusate) are safe. MiraLAX is generally acceptable. Avoid castor oil, which can trigger uterine contractions. What to Do If You Took Something Before You Knew Don’t panic. Very early in pregnancy — before implantation and in the first days after — there’s an “all or nothing” effect where exposures either cause no effect or affect the pregnancy entirely. Most common medication exposures in early pregnancy cause no harm. Bring a list of everything you’ve taken to your first prenatal appointment and review it with your provider. In the vast majority of cases, the answer is reassuring. Prescription Medications: Don’t Stop Without Guidance If you take medication for a chronic condition — thyroid disease, asthma, depression, epilepsy, high blood pressure — do not stop it when you learn you’re pregnant without speaking to your provider first. Uncontrolled chronic conditions are often riskier to a pregnancy than the medications used to treat them. Your provider can assess whether your current regimen is appropriate or whether adjustments should be made. The same applies to antidepressants. Untreated depression and anxiety during pregnancy carry real risks. The decision about whether to continue, adjust, or switch medications should be made thoughtfully with your provider — not made unilaterally out of fear. When in doubt about any medication during pregnancy, call before you take it. That’s always the right call. Schedule a prenatal appointment to discuss medication safety, review your current regimen, and get personalized guidance for your specific situation and trimester. Sources
