Delivering caring, personalized, quality healthcare to women in an environment that is supportive, education-focused and compassionate.

Reproductive Health and Infertility

Togetherness for Mom & Baby Health – Why we promote rooming-in

Rooming in brings benefits for Mom & BabyIn a scene in the PBS series “Call the Midwife” , Nurse Jenny Lee (the main character) risks getting into trouble to sneak a newborn baby into an open ward so that a desperate mom can hold her child for the first time. It seems shocking today, but not so long ago, babies were kept in the nursery under observation while mom recovered in an open ward with other moms. Family and visitors would clamor for prime viewing spots outside the nursery window to see baby who lay swaddled and isolated beyond reach and comforting touch.

In recent years, as hospitals moved from open wards to private rooms, the practice of ‘rooming in’ has become common place, allowing moms and babies to stay together. Still, the practice of taking baby to the nursery to ‘give mom a break’ or a good night’s sleep continues. And indeed it would seem to make some sense, but research studies have shown that sleep patterns and breastfeeding are often better established when baby stays with mom and mom with support learns her child’s cues. For this reason we promote 24 hour rooming-in for new moms.

Mom to near 2 year old Felix, Cindy shares her experience rooming-in at TMC for Women,

I was going to the El Rio Birth Center and wanted to have a natural birth experience, but that wasn’t in the cards for me. At 41 weeks, it was time to go to the hospital. I was at TMC for two days before Felix was born via C-section. He was 10.5 lbs and a bit of a celebrity for the short time I was there. There hadn’t been such a big baby born in quite awhile. After the C-section, our midwife gave Felix to me right away…

Placed on Cindy’s chest immediately, Felix stayed with mom except for testing and a short time when Cindy cleaned up following the C-section.

The nurses at TMC were very kind and supportive and respectful of my need to have Felix with me at all times. I was there after the surgery for 3 days…It was amazing to have that little guy close to me, I wouldn’t have traded that experience for anything in the world.

What is the Newborn Nursery for?

Our Newborn Nursery is reserved for only those babies who need intensive observation or are having problems that prevent them from staying in their mother’s room.

Moms are encouraged to always keep their baby with them, and at the hospital their partner or a support person is welcome to stay overnight to help them with the baby, as they bond and get to know one another.

Why rooming-in is important

• Rooming-in promotes successful breastfeeding
• Keeping your baby with you at all times helps both of you sleep better
• The safest place for the baby is with the parent
• Being together strengthens your bond – the more time you spend together, the better you will know each other
• You will learn your baby’s cues, and the baby will be calmer hearing your familiar voice and your heartbeat
• You will feel more confident in your ability to care for the baby when you go home from the hospital

Resources
Keefe, MR.  Comparison of neonatal nighttime sleep-wake patterns in nursery versus rooming-in environments. Nurs Res. 1987 May-Jun;36(3):140-4. [Accessed 6-6-2014]

Doctor Takes Passion for Public Health to Ghana

“Here at TMC, I connect with countless women who not only love their birth experience, but feel secure within an environment with resources to address potential problems or complications. It’s a shared collective desire and a basic right that all women everywhere should have access to a safe and memorable pregnancy and birth.”

Eager to get back into global women’s health and struck by the wealth of resources largely available in the United States and the preventable maternal and child deaths happening elsewhere across the globe.  Dr. Tomekia Strickland, who practices at TMC for Women, is heading off to Ghana later this month to practice medicine for 10 days. Read more about Dr. Strickland’s journey here on TMC Medical Center’s News blog.

Celebrating 25 years of high-tech, yet gentle care for women

  • Celebrating 25 years of high-tech, yet gentle care for women

Photographs courtesy of Cindy Creed

Tracy is a surgical RN. She has a healthy respect for the operating room and doesn’t take lightly the idea of surgery. That sentiment was evident last Saturday when she spoke with a group of 50 women and surgical staff about how she felt when faced with her own surgery. Tracy talked of the fears she had when told of her need for surgery. She worried about the recovery, taking care of her family and the impact of a ‘woman’s surgery’ on her sense of womanhood. She also shared the relief when those fears were not realized – the swift recovery from surgery allowing her to get back to her regular routine, being able to maintain her sense of self, the importance of being in an environment dedicated to women’s surgery, and the relief of her symptoms thanks to the use of a robotic surgical system.

Tracy, other former patients, doctors and staff past and present, came together to celebrate 25 years of a dedicated women’s surgical space at TMC and to educate the public about a tool that is revolutionizing the recovery and pain management of major surgery ‑- the da Vinci Robotic Surgical System. Participants had an opportunity to operate the robotic system and to gain a doctor’s perspective. Drs. Gayle Dean, Jeffery Palen, Alton Hallum and Maryam Betheshti shared their experiences and insights, and responded enthusiastically to a barrage of questions from the audience that ranged from the specific to the larger potential of the da Vinci Surgical System.

As patients talked of their experiences, the conversation was often light and sometimes comedic. But the impact of having a dedicated space within the hospital with its own nurses and staff, each of whom can truly empathize with the emotional and physiological implications of their surgeries, was paramount. The importance of privacy, confidentiality and gentle care at this vulnerable juncture in a patient’s life is a focus for the Women’s Surgical Center staff as it has been for the past 25 years. Congratulations to the Joel M. Childers, M.D., Surgical Center staff on 25 years! Here’s to another 25 years, and more, of gentle care and education!

Don’t ignore the pain of infertility in your friends and family members

We’re participating in RESOLVE’s, the National Infertility Association,  Don’t Ignore Infertility week. We join RESOLVE in their efforts to “help raise awareness of infertility as a medical condition with social and emotional implications and to tear the wall of ignorance and silence that surrounds this devastating disease.” 

Some people are very open about their struggles to conceive. Others don’t let anyone know where they are in the process of building a family. Respect others’ decisions about what they are comfortable sharing. Don’t, for example, ask a couple if they plan to have a baby. For all you know, they might have been trying for years. If a friend tells you that she has been trying to conceive and it’s not been working, don’t tell her “stop worrying about it, and then you’ll get pregnant.” And never, ever complain about being a “fertile Myrtle” to anyone. Really.

It’s not easy to be friends to someone struggling with fertility, perhaps unless you have had your own tough row to hoe. Here is a great reference for providing support to loved ones experiencing infertility.

I had a very hard time conceiving and maintaining a pregnancy. Most of the time I wanted to hide in a cave, or at least live in a world free of pregnant people. I was scared of Announcements (“guess what? I’m PREGNANT!”) and scared of, well, lots of things.

But there were a few great friends who really “got it.” An office mate of mine, a man in his mid-30s, married, with a daughter, was a new member of our unit, and he started his job on the heels of my last, most complicated miscarriage. I told him what was going on since I was always in and out of the office for lab work and doctors’ appointments, and also because I was really into telling people about my miscarriages at that point. I was tired of ignoring my own pain, or of hiding it. He told me that he and his wife had a very hard time conceiving as well and shared with me their experience with assisted reproductive technology. I was relieved to hear of another person with fertility issues, and it made me feel much more comfortable.

A few months later, we were all at a meeting and a colleague made an Announcement. Luckily, I knew about it beforehand, but no one else did. I was seated next to my compassionate office mate, and he immediately turned to me and whispered, “Are you OK?” I wanted to hug him. I wanted to cry. I felt so much less alone than I would have, and it was such a lovely, thoughtful thing to do. I think this also shows that going through infertility or miscarriage firsthand is a sure route to genuine sympathy and ability to empathize.

Another example: The weekend of my good friend R’s wedding there was a rehearsal dinner/Halloween party at her house. She was always very sensitive to my situation and good about warning me about the presence of babies and pregnant people. She told me that there would be babies on Saturday night, but probably not many on Sunday, at the wedding. Saturday night was going alright, only one baby. Then a couple arrived with a cute little mermaid doll that turned out to be a cute little mermaid real live baby. It was unsettlingly adorable, and tiny, and I walked past them ‑ and smack into another baby. Then another. It was truly like a horror movie, the gauntlet of cute little babies dressed in costumes. I could hear the music from Psycho as I switched directions, taking an alternate path toward the front of the house, where I ran into another cute baby. I was trapped.

My husband took my hand and said “Let’s go for a walk.” Good husband. I sobbed and sobbed as we walked around the block, and realized I couldn’t go back in the house. I couldn’t hold it together. I knew I had to hold it together around any babies at the wedding the next day, and would be able to do so, but I felt so limited in my ability to cope just then. My husband said he’d go back in the house and let my friend R know we were leaving. Before he even explained, she mentioned The Babies. She understood.

She spent the night at our house that night to get some pre-wedding rest. By the time she came over I was asleep, but early in the morning we were up and raring to go with nuptial preparation energy. Before I even could apologize for leaving early, R said “Oh my god, there was one baby after the other! It must have been terrible for you!”

So, thank you, R and my husband, for supporting me and being so understanding, and thank you dear office mate for providing support where and when I least expected (and most needed) it.

Hello, It’s Nice to Meet You – Denise Murphy RN

This year we celebrate the 25 anniversary of our dedicated women’s surgery unit, The Joel M. Childers Women’s Surgical Center, the first of its kind in Southern Arizona. Denise Murphy is part of the surgical staff dedicated to providing a safe, private and caring environment for women undergoing surgery.
Where are you from? Tucson native or not? How long have you been in Tucson?
I was born and raised here in Tucson.  I attended Flowing Wells HS and attended nursing school at PCC.
What do you love about Tucson?
I love the desert weather and landscape.  My favorite time of year is monsoon season.  I always love the way the desert smells after a good rain.
What do you do for fun?
Most of my family lives here in Tucson.  I enjoy getting together with family and friends regularly. (family dinners, playing bunko etc.)  I also have three children and most of our weekend activities are centered around what they have going on.
What do you love about your job?
I started working in the Women’s Surgical Center back in 2000.  What I love most is that our staff is like a family.  We enjoy coming to work each day and we care about each other.  This translates into the care we deliver to our patients.  I also love the fact that what we do makes a difference to someone each day.  We operate on people everyday and for us it is second nature, but for someone who has never had surgery before this may be the scariest day of their life.  I take pride in the fact that I can help them through that.
What would you like women to know about the center?
Because of the nature of the surgeries performed in our department, our staff focuses on maintaining privacy for our women and delivering a more intimate level of care.

In regards to women’s health, it is important for us as women to educate ourselves about our bodies. Also, as a mother, we need to educate our children about their bodies and encourage them to ask questions. As we get older, it is important to go to your doctor for regular gynecological  exams and continue getting preventative care.  We know our bodies better than anyone, if you notice a change, do not hesitate to follow-up with your doctor.

What would you tell your 18-year-old self, 25-year-old self, 35-year-old self?
18-year-old self – I was starting college at this time.  I would tell myself to keep going to school, but to slow down and enjoy your youth a little more.

25-year-old self – I was married and was about to have my first child at this age.  I would tell myself to have a little more confidence in who I was.  Not to be so concerned with what I thought others were thinking.

35-year-old self – By this age, I had three children and had been an RN for 11 years.  I have actually enjoyed my 30s.  It is about finding peace with who you are and how you choose to live your life.  Using that confidence you wish you had in your 20s.  I would say – good for you!

Check out some of our other staff spotlights here

Don’t Ignore the Pain of Infertility in Yourself

We’re participating in RESOLVE’s, the National Infertility Association,  Don’t Ignore Infertility week. We join RESOLVE in their efforts to “help raise awareness of infertility as a medical condition with social and emotional implications and to tear the wall of ignorance and silence that surrounds this devastating disease.” 

Don’t ignore the pain of infertility in yourself
Tips and Resources

  • Take care of yourself and of your partner.
  • Take care of your couple-ness.
  • Here is a wonderful guide to surviving infertility, an online handbook on how to handle, as best you can, a situation over which you have little control.
  • Give yourself something to look forward to each month. Example: My husband and I had a tradition of scheduling a “Consolation Picnic” a few days after my period was due. If my period didn’t come, then the picnic was canceled, and we could be hopeful that I was pregnant. If my period did come, we were sad, but we could enjoy a lovely picnic in the desert, complete with a perfectly balanced sauvignon blanc and soft cheeses.
  • Create your own rituals and traditions that provide comfort.
  • Try getting acupuncture or massage as regularly as you can afford (there are some lower-cost “community clinics” for both acupuncture and massage in Tucson). Taking care of your body when you might feel at times betrayed by it is a loving and helpful thing.
  • Some fertility-challenged folks find help in discussion groups, books, or spirituality. One book that helped me a lot was When Things Fall Apart: Heart Advice for Difficult Times, by Pema Chodron.
  • Consider talking with a therapist or counselor. If you are seeing a fertility doctor, ask about specialists recommended by the clinic, or clinic support groups moderated by a counselor.
  • If you prefer connecting online, checking out the infertility forums at www.altdotlife.com or use the resources found here.
  • Share your pain with others if you want to, or feel free to keep it entirely to yourself.
  • I found it liberating to answer some questions honestly, without explanation. If someone asked me if we wanted to have kids, I’d say “Yes, we do.” And leave it at that.
  • Sometimes it helped to tell someone we were trying, and that if I had any news to share I would do so when I was ready. You get to decide how and what to share.

Infertility – Being Part of the Ten Percent

Infertility. Unless a person is born with a known physiological abnormality that is certain to lead to an inability to reproduce, we don’t normally come face to face with infertility until we’re trying to, well, make a baby.

Some people make babies with the greatest of ease (hello, Duggar family!), and others struggle to conceive a child for years on end, sometimes to no avail.

Why is this? There are various reasons couples can have difficulty conceiving. Infertility is defined by the American Congress of Obstetricians and Gynecologists as failure to conceive after 6-12 months of unprotected sex, depending on the age of the couple. (Many OB/GYNs recommend getting an infertility workup sooner if a woman is over 35, since she is likely to have a shorter window for conceiving successfully.) About 10 percent of couples are considered infertile, and the reasons can relate to the woman (more than half the time), the man (about 20 percent of the time), with the remainder of cases being of no known cause. (Same-sex couples obviously have unique challenges with pregnancy, with male couples having far fewer options when it comes to having children.)

Having a known cause of infertility is in some ways helpful, even if at first it is disheartening, because there are treatments for most of the causes of infertility. For women, the factors can be anatomical ‑ uterine, tubal or cervical abnormalities ‑ or hormonal ‑ imbalances that prevent regular ovulation or interfere with embryonic implantation. Lab tests done at different times throughout the menstrual cycle can help determine if there are hormonal issues, and in many cases these imbalances can be corrected or treated with medication. There are also tests such as a hysterosalpingogram that can identify or rule out anatomical problems.

Male-factor infertility is assessed by laboratory examination of a semen sample. If the number of sperm is low, or the sperm are abnormally shaped or don’t show typical mobility, then the male partner would have follow-up work to determine if there is a treatable cause for this.

Sometimes the issue is as simple as not identifying the best time to have sex. Women will usually be instructed on how to determine when they ovulate, using calculators, thermometers or ovulation prediction kits, so that intercourse can be appropriately timed. It’s often surprising for women to find out how early or late in their cycle they ovulate.

INCIID, the International Council on Infertility Information Dissemination, has a comprehensive guide to seeking help with conception ‑ what kinds of testing are recommended for each partner at each stage of the journey. INCIID also provides exhaustive information on experimental treatments, resources on using donors for sperm or egg or both, surrogacy and adoption. There are also discussion forums where people in the process of trying to conceive can share their stories, and provide and receive support.

The Arizona Medical Center for Reproductive Endocrinology and Infertility and the Reproductive Health Center are two local fertility clinics, providing comprehensive fertility assessment and reproductive assistance. Couples who have been trying to conceive unsuccessfully may wish to visit a reproductive endocrinologist ‑ a physician trained in obstetrics and gynecology, as well as reproductive medicine. The physician will do an extensive assessment of both partners, and as a team you will come up with a plan that will help you discover any underlying factors, treat them if possible, and consider assisted reproductive technology, or ART, if desired. There are numerous forms of ART, some more expensive and invasive than others. Your reproductive endocrinologist will help you decide on a treatment plan.

It’s important to take care of your whole self, and your relationship, if you are experiencing infertility. It can be challenging for both partners, though each person may handle it quite differently. Seek help from a therapist, an online community, or other support group. It can be very painful to have a challenging time doing what comes so easily to many others ‑ building a family.

Celebrate and Educate – Joel M. Childers M.D. Women’s Surgical Center

Women’s health needs and responses are beginning to garner more mainstream attention. Recognition that we are not simply small men with added mammary tissue and different plumbing is garnering more attention from medical researchers and the media. The differences between women’s physiology and men’s, our health needs and responses to care, are significant. At TMC recognition of these needs has a long history. This year we celebrate the 25th anniversary of the dedicated women-only surgery unit, The Joel M. Childers M.D. Women’s Surgical Center.

The center is focused on providing women with a gentle, responsive environment for a whole host of surgical procedures including tubal ligations, breast biopsies, mastectomies, hysterectomies, diagnostic as well as operative laparoscopies, and simple, general and plastic surgeries. These procedures, often only discussed in whispers, address aspects that many of us consider central to our womanhood: our fertility and our sexuality. The center provides an intimate, private and safe environment where you are surrounded by female staff who can sympathize with the complex feelings associated with these surgeries. Positioned in close proximity to Labor and Delivery, the center also provides support to the obstetrics staff when a broader team approach is desired for complex deliveries.

As we celebrate 25 years of a dedicated women’s surgical center at Tucson Medical Center we invite you to join us at Celebrate and EducateCelebrate and Educate will provide insights into the latest technology used in several of our common procedures, the da Vinci robotic surgical system. This technique allows doctors to perform precise, complex surgeries using only a small incision into the body. This technique reduces recovery time, blood loss and scarring meaning a faster return back to life for patients. Get up close and view the robot from the doctor’s perspective. Hear from and talk with patients and doctors about an approach that is revolutionizing how we think about recovery time from surgery. Join us to celebrate 25 years of listening to, involving and encouraging women patients’ voices in their own health care.

Celebrate and Educate
April 21
9am-1pm
Marshall Conference Room
Tucson Medical Center

Hello, It’s Nice to Meet You – Chris Beier RN

A warm smile, gentle care, and sincere compassion is what Chris Beier R.N. is dedicated to providing each of her patients at the Joel M.Childers MD Women’s Surgical Center. Chris is part of the all female nursing staff that provides the sense of privacy, gentle care and confidentiality that are the crucial underpinnings of a center created specifically to serve women’s needs. This year is the 25th Anniversary of the Joel M.Childers M.D. Women’s Surgical Center, the first dedicated space for women’s surgery in Tucson.

Meet Chris.

Where are you from? Tucson native or not? How long have you been in Tucson?
I am a Tucson Native and have lived here for 26 years

What do you love about Tucson?
I love the Mountains that surround us and the beautiful sunny weather. I personally like the fact that we do not have an elaborate freeway system like Phoenix. That’s what gives Tucson a small town feel to me. I am also a proud University of Arizona College of Nursing graduate. The U of A gives Tucson an identity and attracts many people from all over the world to come to our beautiful sunny campus and town.

What do you do for fun?
I enjoy exercising outdoors, country music concerts, and going to any U of A sporting events!

What do you love about your job?
I truly love working with women of all ages. Women’s surgery at TMC is such a unique unit and each staff member here can truly relate to our patient’s sentiments about their gynecological issues and surgical interventions that they may receive. The team here at Women’s Surgery strives to provide each surgical patient with a warm smile, gentle care, and sincere compassion.

What would you like women to know about the center?
At TMC Women’s Surgery you are not just another surgical patient. You are a strong courageous woman with an identity to us. We realize that female surgery is never something any woman wants to do, but when certain female conditions affect our day to day operation we often find ourselves vulnerable and fearful of how our bodies will react to surgery.  The best thing about TMC Women’s surgery is that we can all relate to your sentiments, and give you peace of mind about what to expect before, during, and after surgery. We make it a point to call every patient the next day to make sure they are doing well and answer any questions or concerns they might have. As a patient in women’s surgery you will never feel alone. Our all female nursing staff will protect your privacy and provide you with one on one nursing care until you are awake and physically stable. We will walk you through the surgical experience step by step and never leave your side.

What area of women’s surgical procedures are you most excited about?
I am particularly interested in diagnostic laparoscopy for infertility. I want women to know that it is minimally invasive and can provide you and your physician with valuable information to help figure out why you may be struggling with infertility. The recovery time can vary from 4-7 days depending on your body.

 What would you tell your 18 year old self, 25 year old self, 35 year old self?
I would tell my 18 year old self that routine gynecological exams are very important as I head into young adult hood and college.  If something does come up that is abnormal with my routine screening, women’s surgery can provide a safe effective out- patient surgical procedure to address the issue.

I would tell my 25 year old self to not fear laparoscopy or miscarriages because they are often common at this age and you will be surrounded by female nurses that can relate to what you are feeling and going through.

I’m not 35 yet but if I were I would tell myself that heavy painful periods can be safely resolved by getting an endometrial ablation but only if you are finished having children.

Debilitating Cramps, not Normal, not OK – Fighting Endometriosis

endometriosisPervasive, debilitating, but invisible, endometriosis affects 6.3 million women* in the US alone.

Like many diseases associated with the reproductive system endometriosis tends not to be discussed openly, and yet has significant impact on the health of millions of women.

“It started when I was 16. Bleeding in the middle of my cycle and crushing pelvic and abdominal pain before and during my period. Sometimes it seemed as if I was spending half the month in a fetal position on the bathroom floor. It incapacitated me. This couldn’t be normal. Could it? My menstrual cramps hadn’t been like that in the first four years. My digestive system was affected too, going to the bathroom could be excruciating.

It was over a decade and countless doctor’s visits later that a doctor put a name to what had crushed me every month – Endometriosis.”

What is Endometriosis?

Every month the endometrial tissue that lines your uterus builds up, breaks down and sheds resulting in your menstrual cycle. This is normal. Endometriosis occurs when endometrial tissue is found outside your uterus, building up, breaking down and shedding. This is definitely not normal. Not normal, but not unheard of.

The endometrial growths can be found on the ovaries, the Fallopian tubes, the outer wall of the uterus, the intestines, and throughout the abdomen and pelvic region, sometimes beyond. They shed, like the lining in the uterus, but there is nowhere for the blood and tissue to go and so it irritates the surrounding tissue.

“My menstrual cramps were always bad, but they started to get really bad in my late twenties. Sometimes I would collapse from the pain. The doctors thought it was a vasovagal response to the pain. When I was 28-years-old a medical resident suggested that I should start thinking about having children soon. If being pregnant didn’t help clear up the endometriosis then I should think about a hysterectomy. I told him I needed a dinner date first. Later, the irony of the suggestion became clear as endometriosis probably affected my fertility.”

What are the symptoms of endometriosis?

– Pain wherever the implants are growing, before, during and/or after their period; pain during sex, ovulation  or bowel movements

– Abnormal bleeding, heavy bleeding, bleeding mid cycle, after sex or with bowel movements or passing urine

– Difficulty getting pregnant

While the pain from endometriosis can be debilitating, there doesn’t always appear to be a direct relationship between severity of the disease and pain. Some women may only find out that they have endometriosis when they’re unable to become pregnant. There is no cure for endometriosis, but there are some effective treatments dependent upon the extent and stage of the disease along .

Your doctor may be able to feel endometrial adhesions with a pelvic exam or see a cyst with an ultra-sound, but the only definitive way to know whether you have endometriosis is to undergo laparoscopic surgery. (Laparoscopy is used at  The Joel M. Childers, MD Women’s Center  to diagnose and remove mild to moderate endometrial implants or scar tissue that is causing pain or compromising infertility.)

“I was lucky, the endometriosis responded to the hormone treatment. I was pain free for 10 years before I came off the medication when I was trying to conceive.”

How can endometriosis be treated?

– Pain management with over the counter anti-inflammatory drugs such as ibuprofen

Hormonal birth control pills and other hormone treatments can control and even shrink the implants and reduce the associated pain.

– Laparoscopic surgery to remove endometrial implants and scar tissue

Hysterectomy or Oophorectomy for severe endometriosis

Being aware of the symptoms of endometriosis and its impact is a first step in addressing this disease. You can find out more information about endometriosis including resources from the Endometriosis Association.

*From http://www.endometriosisassn.org/endo.html on March 30, 2012