Category Archives: Women’s Health

What to Consider When Selecting an Ob/Gyn

Your relationship with your obstetrician/gynecologist is one of the most intimate professional relationships you may have.  Although it can take time for this relationship to develop, you should feel comfortable with this person and should be able to trust your obstetrician/gynecologist with your most private concerns.

Important questions to consider when selecting an obstetrician/gynecologist include:

1.Does she/he have experience caring for and delivering high risk pregnancies?

None of us want to experience a complicated, high risk pregnancy. However, an attending of mine in my training used to remind us at the beginning of every call night, “The sickest patient will be the one you least expect.” Even if you consider yourself to be healthy, pregnancy and labor can unexpectedly become risky to mother and baby. You want to make sure that your obstetrician has the training and experience to handle any surprises from severe pre-eclampsia to acute hemorrhage. If you live in a major metropolitan area, you also want to know if your obstetrician delivers at a level 3 center with in-house anesthesia and an experienced NICU. Hopefully you don’t need those services, but if you or your baby were in grave danger, you would want to feel confident that your obstetrician can manage your care and that she/he has the resources needed to do so.

2.How will she/he manage a pregnancy that goes beyond the due date? At what point will she/he insist on induction?

These questions tell you a lot about your obstetrician’s medical beliefs and style of practice. Some providers believe that babies should be delivered as soon as possible while others may take a wait and see approach. A seasoned obstetrician may tell you that the answer is not easily defined because she/he will need to consider multiple factors specific to your situation in deciding when and how to recommend an induction.

3.What are her/his views about the use of doulas?

Again, this question tells you a lot about your obstetrician, whether she/he is open to a holistic approach and whether she/he is going to help create a supportive environment. Doulas are labor companions who can help ease anxiety during labor and offer emotional support. A great doula may be someone you hire or it may be a family member or friend. In any case, knowing your obstetrician’s opinion will give you insight into their practice style and if it matches with yours.

4.Will she/he deliver my baby?

No one physician can be on-call 24 hours a day/ 365 days a year. Most obstetricians share call with other doctors in their practice or community. You should know who the other doctors in the call group are and how the call rotation works. Some groups are extremely large so you may not have an opportunity to get to know all of the doctors who may attend your delivery. Other groups are smaller and may have a system in place for you to meet the other doctors who may deliver your baby. Also, in many communities ob/gyn’s perform circumcisions upon request. If this is relevant to you, don’t forget to inquire about it and whether or not she/he uses anesthesia.

5. What is the practice’s policy for handling emergencies?

For example, will your doctor be able to see you on a regular office day or will you have to wait for an opening or see a mid-level provider? Who can you reach by phone during office hours or after hours for an emergency? How long does it typically take for the doctor or a nurse to return your call? Many large groups utilize a nurse telephone triage system, while in a small group you may be able to reach your doctor or nurse directly.

Thankfully routine pregnancy is only 40 weeks, give or take a little bit, so you should also consider your gynecological needs when selecting an ob/gyn. Consider some of the following:

1. How far in advance do I need to schedule a routine annual if I want to see my doctor?

This gives you insight into how accessible the doctor really is. As a mother and working woman myself, I want a physician I can actually see even if nothing is wrong and I am not pregnant. Everyone’s schedule is different so consider how important this is to you. I have had friends tell me they haven’t seen their doctor in years because they cannot get an appointment scheduled for months.

2. Does she/he prescribe birth control?

There are many patients and physicians who do not believe in the personal use of contraception, and this is to be respected. As a woman’s health care provider, however, I believe that an ob/gyn should be comfortable and knowledgeable discussing the factual pros and cons of all methods of contraception. Some birth control regimens may not be suited for women with certain medical conditions. On the other hand, some providers will not place IUD’s in women who have not had children. Be sure that the ob/gyn you choose is able to meet your individual needs.

3. Are you comfortable with the ob/gyn?

I think this is crucial. If you need to discuss STD testing, vaginal dryness and hot flashes or …something smelling badly down there, you need to feel able to do so. Moreover, if you are going to have surgery you need to feel confident that your surgeon is going to take good care of you. You should also consider your own value system and lifestyle. She/he may not live exactly as you do, but your healthcare relationship will be more comfortable if there is understanding and respect.

For additional information about a prospective physician, you can verify licensure with your state’s medical board. You can also verify that your physician is board certified through the American College of Obstetricians and Gynecologists. Both will offer information on a public website.

You can also contact Capital Ob/Gyn Associates of Texas directly at 512-83-OBJEN or visit our website www.capobgyn.com.

Diva Night

The ladies of Capital Ob/Gyn Associates of Texas will be attending Diva Night on Wednesday January 25th from 7:00 – 9:00pm at Texas Running Company Downtown.  This is a great opportunity for any woman with an interest in a healthy 2012!

Upbeat Marketing and Texas Running Company are joining forces to bring the women of Austin a night of wellness, networking and shopping. Austin’s brightest, most passionate healthcare providers will be gathered in one place for an expo-style event to help women better understand and embody wellness! Diva Night will be a casual setting with shoe and bra fittings, complimentary chair massage, food and beverages, and of course fabulous vendors.

Admission is COMPLIMENTARY.  Each attendee will receive a Healthy Diva Goodie Bag and entry into our event raffle. Ladies of all backgrounds and interests are invited to come as they are and bring their friends – post-work, post-workout or pre-night out!

The Prima-Vendors Include Nike, CW-X , MyFitList, CryoStudio, iGnite Your Life, Austin BodyWorker, Austin Woman Magazine, Capital OB/GYN Associates of Texas, Austin Family and Sport Chiropractic and My Fit Foods.

Make sure you stop by on January 25th, 2012 from 7-9pm at Texas Running Company Downtown located at 1011 W. Fifth Street, Suite 110, Austin, Texas 78703 to see Dr. Mushtaler and Dr. Browne.  We look forward to seeing you there!

Daily Rx Recap: Mother-Infant Separation is Stressful

Dr. Jennifer Mushtaler, affectionately known as OB JEN, was recently quoted in the Daily Rx regarding separation between mother and infact following birth.  Read below to see Dr. Mushtaler’s comments, or click here to view the full article on www.dailyrx.com.

Mother-Infant Separation is Stressful
Newborns fare best when kept with mother after birth

(daily Rx) It’s long been the traditional hospital procedure; after a baby is born, it is whisked away by medical staff to be measured, cleaned and swaddled. Until recent years, newborns were often kept in the nursery away from their mothers.

Still today, there is much separation between babies and their mothers in hospitals directly after birth. And researchers say that isn’t good for either.

Newborn babies need their mothers.

Barak E. Morgan, Ph.D. of the University of Cape Town, led a recent study of maternal-neonate separation (MNS), which is a Western norm in medical practice. Morgan and his colleagues measured heart rate variability in 16 full-term newborns at two days old, to determine their stress levels. The babies’ heart rates were measured for one hour when sleeping in skin-to-skin contact with their mothers, and when sleeping alone, before discharge from the hospital.

The babies showed a 176 percent increase in anxious autonomic activity and an 86 percent decrease in quiet sleep when separated from their mothers, compared with skin-to-skin contact. Researchers concluded that mother-baby separation is associated with a dramatic increase in physiological stress response in infants, and has a profoundly negative impact on their quiet sleep duration.

“There is good research to support that separation of mother and infant has deleterious side effects on both mommy and baby,” says Jennifer Mushtaler, M.D., an obstetrician in Austin, Texas. “I encourage my mothers to have skin-to-skin contact immediately following birth including birth by cesarean section.”

She adds that skin-to-skin contact not only when nursing or sleeping, but also at other times, is highly beneficial. “Most experienced mothers will attest to the benefits of swaddling their infant to their bodies when they go about their day and for soothing a colicky or crying baby.”

The research findings were published in the journal Biological Psychiatry, and reported in the Wall Street Journal.

To schedule an appointment with Dr. Jennifer Mushtaler, please visit www.capobgyn.com or call 512-83-OBJEN.

Please Welcome Dr. Browne to Cap Ob/Gyn!

Cap Ob/Gyn Associates of Texas is pleased to announce the addition of a new physician to our team, Dr. Catherine Browne! Dr. Browne comes to us with 10 years of experience in gynecology and obstetrics from the beautiful state of New Mexico. Dr. Browne is a Board Certified Ob/Gyn with the American Board of Osteopathic Obstetricians & Gynecologists. She served 7 years in the U.S. Army providing medical care to active duty women and military wives and devoted 2 years to serving the indigent and uninsured in Montgomery, Texas.

Dr. Browne went into women’s medicine in 2000 because as a woman, she wanted to connect with female patients to provide compassionate, comprehensive and up-to-date medical care. She majored in chemistry at University of Puget Sound in Tacoma, WA, where she taught workshops on alcohol awareness and date rape awareness while working two or three side jobs. Additionally, she coordinated campus-wide food drives and tutored inner-city elementary aged kids.

After college, Dr. Browne worked in organic chemistry at the Los Alamos National Laboratory in Los Alamos, NM and later at an allergy and asthma research center, while saving money for medical school. Dr. Browne then went to medical school at the Chicago College of Osteopathic Medicine in Downers Grove, IL. After graduating, she went into the field of obstetrics and gynecology, completing her internship and residency at Tripler Army Medical Center in Honolulu, HI. She has recently moved to Austin, TX, with her husband and their two young children, ages 2 years-old and 6 years-old.

Like most women, Dr. Catherine Browne is a daughter, a mother, a spouse and a friend. As a career woman, she juggles home life and work life, blending her love of family with her love of teaching and medicine. We know that you will find Dr. Browne’s gentle and reassuring manner to be a great fit with the rest of the staff at Capital Ob/Gyn Associates of Texas!

Please extend a warm Austin, Texas hello and howdy to Dr. Catherine Browne!

To schedule an appointment with Dr. Catherine Browne, please contact Capital Ob/Gyn Associates of Texas at 512-836-2536 or visit our website www.capobgyn.com. Dr. Browne is currently accepting new patients and looks forward to helping you with your most intimate of health needs.

The Vitamin D Deficiency Pandemic – Not so Fast!

Some researchers have warned that vitamin D deficiency is akin to a silent epidemic. However, recent data from the Institute of Medicine reveals that the majority of people are getting enough vitamin D and calcium. Although quite plausible, there is not enough data to support claims that vitamin D can help
protect against cancer, heart disease, diabetes, MS or pre-eclampsia of pregnancy to name a few.

What are the recommendations for vitamin D and calcium intake?

It is recommended that young women ages 9-18 consume 1300 mg/day of calcium and 600 IU/day of vitamin D. Healthy women ages 19-51 including those who are pregnant or lactating should consume 1000 mg/day of calcium and 600 IU/day of vitamin D. Women ages 51-70 should consume 1200 mg/
day of calcium and 600 IU/day of vitamin D. Women older than 70 years should increase their vitamin D consumption to 800 IU/day in addition to 1200 mg/day of calcium.

Should I take a calcium and/or vitamin D supplement?

Most individuals can achieve the recommended amounts through proper diet and nutrition, and it only takes 10-15 minutes of sun exposure to generate your daily vitamin D requirements. Research shows that most people get 600-900 mg of calcium daily from diet alone. There is also a recommended upper safe limit of 2000 mg/day of calcium and 4000 IU/day of vitamin D. Excess calcium and vitamin D has been associated with calcifications in blood vessels, kidney stones, cardiovascular risk and surprisingly falls and fractures. Some natural food sources of vitamin D include cod liver oil, salmon, mackerel, and fortified milk. If you are going to supplement your diet, check for USP verification on the label.

Should I have my vitamin D level checked?

Only those persons at risk for vitamin D deficiency need to have their levels screened. At risk persons include pregnant and nursing women, obese individuals, darker skinned individuals, persons who have undergone prior bariatric surgery, persons with Crohn’s disease, and persons with osteoporosis.
There are several other serious medical conditions in which vitamin D testing is also recommended so speak with your doctor first.

Don’t have one? Come see OB JEN at Capital Ob/Gyn Associates of Texas.
www.capobgyn.com

Pap and a Piece of Chocolate

I am going to let you in on a little secret. I have been practicing obstetrics and gynecology for over ten years now, I have cared for thousands of women through all manner of women’s medical issues, I have been pregnant and delivered two wonderful daughters, and I still dread going to the ob/gyn for my exam.

Will my ob/gyn use the plastic or the metal speculum? Did I shave too much or too little? Oh, fiddlesticks! I just realized I totally forgot to shave my legs, and I will have to leave my socks on because I am way overdue nail polish on my toes. Oh please Lord let my deodorant be working extra hard today because I can’t stop thinking about plastic or metal and now I am beginning to perspire and my
appointment isn’t until this afternoon. Yes, ob/gyn’s dread their own ob/gyn exams, too.

A few years ago my young girls became accomplished statisticians. They had concluded with reasonable probability that if we were going to visit the pediatrician, one or both of them would be statistically likely to receive a shot. Not wanting them to dread (read violently resist) going, I proposed that if they
received a shot, we would go for a treat of their choice afterwards. It worked!

Then I had a wonderful thought! What if my patients were to receive a small treat to ease the anxiety of coming to the ob/gyn? Something sweet and thoughtful that acknowledges that you might not have really wanted to, but you came in to take care of yourself? Sitting in a jar on the table you will ALWAYS find an assortment of small chocolates. Please help yourself, and we won’t tell anyone if you take two pieces.
We know, we understand; you were very brave.

To schedule an appointment with Capital Ob/Gyn Associates of Texas - Home of Pap and a Piece of Chocolate – please visit www.capobgyn.com or call 512-83-OB-JEN.

OB JEN “On Air” with Kathryn Bonner!

OB JEN is honored to be featured as a monthly radio guest on KLGO The Word 98.5/99.3 - Spirit Walking with Kathryn Bonner.  Each month, Dr. Jen Mushtaler covers topics with Kathryn Bonner that are essential to healthy and complete living. 

Featured in July, OB JEN engaged with Kathryn in a two-way dialogue about Postpartum Depression.  Listen to a replay here

In August’s show, OB Jen and Kathryn Bonner discussed hot flashes and the body temple.   Replay is coming soon!

Next Show: September 21st, 2:30-3pm
KLGO The Word 98.5/99.3
You can catch OB JEN on air with Kathryn Bonner again on September 21st from 2:30-3pm on KLGO The Word 98.5/99.3.  Tune in!

About the Show:
Spirit Walking with Kathryn Bonner is a refreshing approach that is truly needed because of the stressed out busyness that seems to be a part of today’s hectic culture. Kathryn has a show that will blow fresh winds of renewal into the hearts of those listening. Her show is all about women, for women! For you guys out there, come check it out too, as you will surely learn something of interest about us, if not; you will certainly get a great laugh!

Kathryn covers all sorts of things such as women’s health, wellness, marriage, movies, ministries, your body temple, Biblical teachings, struggles, raising children, dating, miracles, passion, purpose, how God speaks, creativity, dreams, mission work, finances, freedom in Christ and so much more! Kathryn will also interview experts, authors, speakers, Christian life coaches, doctors, and ordinary women making an extraordinary difference in the world!

Kathryn is an author, a speaker and a Life Purpose Coach. She knows the power of breaking through the fears and stepping fully into your faith by the gift of coaching.

OB JEN in NSIDE Magazine!

We are thrilled to announce that Dr. Jen Mushtaler was featured in NSIDE Magazine’s July/August issue.  Read the article to find out how OB JEN got started in her medical career and what the future holds for Capital Ob/Gyn Associates of Texas!

Dr. Jennifer Mushtaler grew up fascinated by science. Her father was a NASA engineer who worked on projects like the Mars Land Rover, Hubble telescope and Mission Control.

In school, classes would always stop to watch the space shuttles launch into space.

With a mathematics teacher for a mother and surrounded by engineers, astronauts and PhDs, Mushtaler thought she would become an engineer.

In fact, she did, earning a degree in electrical engineering at UT. However, she soon became drawn to medicine and continued on to medical school at UT Southwestern Parkland Memorial Hospital.

“It brings together science, innovation and healing people,” Mushtaler says of her chosen field. “The surgical specialty of ob/gyn was truly my calling. For me, there is very little that rivals the miracle of birth.”

The incredibly important journey of pregnancy and childbirth, along with general women’s reproductive health, is clearly something Mushtaler deeply loves and respects.

After 10 years of private practice experience, in October 2010, she founded Capital Ob/Gyn Associates of Texas, which operates on a collaborative philosophy of partnering with women in their health care needs, rather than the more traditional medical atmosphere of doctor and patient. The office setting is warm, intimate, compassionate and private.

“Each woman presents with her own unique health concerns and philosophies, so care plans are developed to address that uniqueness while adhering to the highest professional standards,” Mushtaler says. “My patients are so pleased with the atmosphere and the high level of care we offer. I sincerely hope there continues to be a future for this style of practice in the new age of medicine before us.”

Mushtaler is excited about today’s advances in minimally invasive surgery, which allows her to routinely perform major gynecological surgeries in an outpatient setting. Complete cancer resections and lymph node samplings are being done robotically.

“Patients avoid lengthy hospital stays and recoveries,” she says, “and the cosmesis is beautiful.”

She chuckles when answering a question about a “typical day.”

“There is nothing typical about ob/gyn, managing my own practice, balancing marriage, two wonderful young daughters and time for athletic endeavors,” she says. “I often find myself thinking, ‘Well, that was an exciting day. I wonder what will happen tomorrow!’”

Indeed, Mushtaler is incredibly active, counseling by example for her patients, as well as her daughters. She encourages women’s fitness and athletics, and is highly involved with causes such as LIVESTRONG, breast and cervical cancer awareness, triathlon training and much more.

Affectionately known as “OB Jen,” she constantly updates her blog at www.whosyourobjen.com with news and resources on these topics.

“I swim, I bike, I run because I believe there is a strong relationship between the physical and nutritional lifestyles we choose and our complete health,” she says.

In fact, her expertise with women’s fitness issues has led to her invitation to speak in forums such as the GOTRIbal podcast, which focuses on female endurance athletes.

“You don’t have to completely stop training when you get pregnant,” Mushtaler told GOTRIbal CEO Tanya Malasch. “You shouldn’t be going hard, but get out there for the love of it, and continue your base.”

Mushtaler recommends training at about 80 percent of your maximum heart rate while pregnant to stay safely in your aerobic zone; and for pregnant women who decide to begin a fitness routine, she recommends beginning very moderately and building up.

“I try to get them started by walking,” she says. “My recommendation is 30 minutes a day, five days a week. I do not recommend training in the anaerobic zone, as that has been shown to compromise blood flow to the baby.

“My patients come in all shapes, sizes, lifestyles, and no matter where they are in their health needs, I want them to feel empowered and encouraged.”

“Dr. Mushtaler is amazing,” says Tessa Spencer, who has been a patient for three years. At 35 years old, Spencer discovered she was pregnant, which came as a big surprise.

“Dr. Mushtaler and I worked out a plan of treatment for me and the baby, and she monitored me weekly,” Spencer says. “I had a very high-risk pregnancy, and she spent a lot of time talking to me and helping me make the right choices for my baby.”

Spencer had a Caesarean delivery at 34 weeks, but she and her baby were able to go home in two days.

“I always feel a sense of being at home with a good friend when I am with Dr. Mushtaler,” Spencer says. “She treated me and my baby with respect and love. I really felt she cared about us as individuals, not just patients.”

Such experiences and outcomes are very rewarding to Mushtaler.

“I find it particularly rewarding that my patients know that my interests are synonymous with theirs and trust that if medical intervention is needed, I will use it judiciously,” she says. “I love the long-term relationships I have developed with my patients and the opportunities to heal by simply listening, by medicine and by surgery when it is needed. The relief to a patient following a successful surgery and delivering healthy babies to happy, healthy mommies are equally gratifying.”

For more information, contact Dr. Jennifer Mushtaler and Capital Ob/Gyn Associates of Texas at 512-83-OBJEN or visit www.capobgyn.com.

OBJEN Sponsoring Couples Triathlon!

OB JEN is excited to be back as a sponsor of the 2011 Couple’s Triathlon! Jen and her husband, Trent, will be out on the course again this year so keep your eyes peeled for this couple!

Don’t be afraid to ask OB JEN questions about training or health while you’re there!

Couples Triathlon 2011! – Sunday July 10th

The Event:
Using a format that is unique in the sport of triathlon, teams of two, whether they be friends, spouses, family members or complete strangers combine their ages and sign up in the appropriate category. Each person on the team completes the triathlon individually, and then their times are combined for an overall result. One may also participate as an individual.

The Couples Triathlon course is an 800 meter swim in Decker Lake, 11.2 mile bike ride, and 3.2 mile run park roads and smooth off road paths.
The transition area will open bright and early Sunday morning at 6:00am and the race will begin at 8:00 am. Don’t be late!

There is tons of space and we’ve secured parking nearby, so bring the family and friends. As usual with our events, we’ll finish off with a great outdoor party, awards, and prize giveaway.

The Couples Triathlon is brought to you by High Five Events and Jack & Adam’s Bicycles: http://www.jackandadams.com/

For more information on the race please visit: http://www.couplestri.com/

We Are Having Twins!


Twins are a source of delight to parents, family and friends. Yet behind the awe of a twin pregnancy are challenges that expecting parents should be aware of so that they may partner with their obstetrician to achieve optimum outcomes.

In our practice we currently have quite a number of patients excitedly expecting twins. The rate of twin pregnancy in the United States is approximately 32 per 1000 births. An important aspect of our initial evaluation of a twin pregnancy is determining the chorionicity. When we determine chorionicity, we want to know whether the babies are sharing one placenta or if each baby has its own placenta. When the babies share one placenta there are different concerns for the infants than when there are two distinct placentas and two amniotic sacks. Another initial aspect of twin pregnancies is determining if chromosome abnormalities are present. Interestingly, the likelihood of an abnormality is higher in twin pregnancies. Fortunately, nuchal translucency, a non-invasive early ultrasound, is very sensitive for detecting trisomy 18 and 21. However, while we offer screening to all of our expectant mothers, this is a very individual decision that ultimately rests with the parents.

 
Undeniably, twin pregnancies are more likely to deliver preterm, and it is this risk that is often underappreciated. Sometimes preterm delivery is necessary because of medical concerns for the mommy or one or both babies. Often, preterm birth ensues after spontaneous onset of preterm labor or after premature rupture of the membranes. In our practice, we discuss openly these statistics so that our mommy’s and their families can make modifications in their daily lives to help support and nourish these special pregnancies. We will evaluate the cervical length via ultrasound between 22 and 32 weeks of gestation to look for any risks of preterm delivery. The use of oral medications to reduce preterm birth is not proven to work nor is prophylactic cerclage. However, the use of steroids has been shown to dramatically improve infant outcomes.

 

While twin pregnancies can be twice the fun, they can also be twice the ouch! Beyond 16-20 weeks into the pregnancy, growth of the abdomen will quickly outpace growth experienced in singleton pregnancies. This means that it becomes more difficult for mommy to reach down to tie her shoes (hint: a great gift is a pedicure) and it becomes more difficult to reach the steering wheel. Mommy may find that she tires easily, feels pelvic pressure and has lower back discomfort (another hint: a great gift is a pregnancy massage). We recommend at least 8 to 10 hours of sleep nightly, regular gentle exercise and increased intake of vitamins, vegetables and fruits.

 
Many of our mothers who are expecting with twins want to know if they can still have a natural, vaginal birth. Yes! That being said, we want to ensure a safe delivery for all three of the lives in our hands. A patient is a good candidate for a vaginal birth if the first baby is facing head down, the babies have achieved a safe minimum weight and the babies weights are within 10% of each other. We recommend that our patients have regular, interval ultrasounds of the babies to monitor these and other parameters of well-being. We have a lot of experience with breech and transverse presentations and when circumstances permit, we are pleased to offer these patients the opportunity for a vaginal delivery, too.

To schedule an appointment or consultation with Dr. Jennifer Mushtaler, please visit www.capobgyn.com or call 512-83.OBJEN.  We look forward to seeing you at Capital Ob/Gyn Associates of Texas.