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Reproductive Health Matters

Pregnancy and Back Pain – Tips from an Expert

The waddling gait, the hands pressed into the small of her back, mama-to-be is uncomfortable.

An aching back is such a common part of pregnancy that the waddling and back clutching is a stereotype of late-term pregnancy. But backaches can start much earlier in pregnancy. The vast majority of pregnant women will experience backaches during pregnancy. For many, it persists after the birth of the baby.

Tim Evens PT of Agility Spine & Sports Physical Therapy gave us the lowdown on why back pain is an issue during pregnancy and what to do to prevent and to treat back pain.

Why do so many pregnant women experience backaches?

As the baby grows and mama’s belly grows, the increased weight, shift in center of balance, and the increased mobility of some of the joints of the pelvis (hypermobility of the sacroiliac joint) all contribute to extra strain on the lower back. This added strain and resulting distorted movements with joints locked at the end range of motion can make daily life painful.

What can you do to prevent backaches during pregnancy?

A strong core and upright posture before and during pregnancy can help prevent backaches.

  • Squats help strengthen legs, abs and pelvic floor, and require balance and can be performed during pregnancy.
  • Balancing exercises, such as through yoga, can provide core strengthening
  • Avoid over stretching
  • Limit how much sitting you do each day
  • Exercise 30 minutes every day

When to contact a physical therapist?

Evens suggests that if back or pelvic pain is limiting daily function do not wait to seek help. Often it is an issue that can be easily addressed. The first port of call is your primary care physician who can rule out other issues. If this is a second or third pregnancy and this is a familiar pain you may wish to check in with your physical therapist’s office.

How can a physical therapist help you if you experience backaches?

A physical therapist can help you return to fully functional movement, and address tissue healing and trauma of back and pelvis pain. As many of these issues can be addressed simply, Evens encourages women to seek help if the pain is limiting their daily function. Don’t let it linger for months when it is easy to fix and can help reduce stress during a time that can be fraught with stress anyway.

At your appointment the physical therapist will evaluate your flexibility, strength, balance and posture. The therapist may manipulate or move your body to address immediate tissue issues, and almost always will provide you with at-home daily exercises to increase strength, mobility and flexibility.

How to perform a squat

Tips on how to perform a squat from Tim Evens Physical Therapist. Particularly important for pregnant women to maintain/develop core/pelvic strengthEvens provided these tips for performing an effective squat:

Hold your lower lumbar spine in a neutral position. As you squat the low spine should not flex (tail should not tuck under)

Make sure your knees do not move in front of your toes. This ensures that the majority of motion is coming from the hips

Remember good squats require good hip strength and flexibility.


This post was first shared on May 1, 2014 on TMC for Women

TMC babies providing life-saving stem cells via cord blood

Not so very long ago, two families welcomed babies into the world at Tucson Medical Center – and made an important decision. They chose to make a public donation of umbilical cord blood to give the gift of life and provide hope for others in need.

The donations of cord blood, which are rich in stem cells and used to rebuild immune systems, were matches for a child in Australia who was struggling with acute myelogenous leukemia – a cancer of the blood and bone marrow. The most recent match helped a child being treated at the University of Minnesota facing acute lymphoblastic leukemia, the most common type of childhood cancer.

Tucson Medical Center wants to thank everyone who makes the choice to provide life-saving cells so that others may have treatment options. The matches are made possible because of the Arizona Public Cord Blood Program, which TMC joined in October 2014. Those who do not intend to privately bank their baby’s umbilical cord blood have the opportunity to donate it to others. Donated cord blood is listed on the Be The Match national registry.

Since the program’s inception in 2011, 43 life-saving matches have been made including these donations– the second and third match for TMC.

“As we celebrate the ways we can make a difference in the world, we want to thank everyone whose generosity allows other children the opportunity to grow and thrive,” said Kristen Wilt, TMC cord blood coordinator. “That includes the families who provide the cord blood, as well as the providers whose expertise and commitment has such a tremendous impact on patients and families they will never meet.”

The procedure is painless, the program is free for patients, and everything is kept confidential.

The latest match was collected from baby born at TMC in May, 2016 by Dr. Jennifer Reinhart and Annie Reiners, RN.

For more information on cord blood donation, please visit the Tucson Medical Center website and these blog posts.

Arizona Public Cord Blood Program

Outpatient lactation services receiving support from TMC Mega Raffle

Little Kailey Nowak decided to enter the world five weeks ahead of her due date. Her mom, Kelly, experienced difficulties with breastfeeding almost immediately. “She wouldn’t latch on, or if she did, it would only be for a few seconds,” she said. “It was awful. I cried every single day for six weeks as I pumped and fed my baby through a bottle. My plan was to breastfeed, and when I couldn’t, it truly felt like I was failing as a mother. People were

The family lives in Sierra Vista and with few lactation support services available there, Nowak’s pediatrician suggested she seek expert advice from the lactation specialists at TMC, where she had previously rented her hospital-grade breast pump. “I didn’t know what to expect, but the lactation specialists solved my problems and had Kailey successfully breastfeeding just two minutes into my session. It was the most magical moment of being a mom. I finally felt like I was doing a good job for her, and I wish I would have pursued this help sooner.”

The Mega Raffle provides funding for new moms to visit the outpatient breastfeeding clinic even if the service is not covered by their insurance or if they cannot otherwise afford it.




This is the fifth of our six-part series of blogs that show how the TMC Mega Raffle is making a difference for patients and the community.


TMC receives $25,000 grant from Avon Breast Health Outreach Program

Avon Breast Health Outreach Program in Tucson

The Avon Breast Health Outreach Program has again awarded a $25,000 one-year grant to Tucson Medical Center to increase awareness of the life-saving benefits of early detection of breast cancer.

Breast cancer is the most common form of cancer in women in the United States and early detection still provides the best opportunity for successful treatment .

Tucson Medical Center created the TMC Breast Health and Education Program to educate Tucson-area women and refer them to low-cost or free mammograms and clinical breast exams in their own communities. The vital program provides services to women who would not otherwise seek a screening mammogram.

Avon Breast Health Outreach Program

Denise Navarrete, TMC breast health and education program coordinator


The fund’s national advisory board selected The TMC Breast Health and Education Program as one of 56 new grant recipients nationwide in the 2017 cycle of Avon Breast Health Outreach Program grants. Programs were selected based on their ability to effectively reach underserved women in the communities they serve.

It is the nineteenth year that TMC has received funding from the Avon Breast Cancer Crusade to support its work on this important health issue, and in recognition of the program’s excellence.

Since May of 1998, the TMC Breast Health and Education Program has reached more than 50,000 women with information about the importance of early detection and has referred almost 7,000 women for mammograms and clinical breast exams.

The TMC Breast Health and Education Program helps ensure that all women have access to early detection information and options.

“We are proud that the Avon Breast Cancer Crusade shares our mission and has chosen to support our program. With these funds we will be able to reach women with breast cancer information and resources to Early detection saves lives at TMC Breast Center Avon Breast Cancer Crusade help overcome factors that keep them from practicing good breast health,” said Denise Navarrete, TMC breast health and education program coordinator.

For more information on the TMC Breast Health and Education Program at Tucson Medical Center please call (520) 324-1286. To learn more about the Avon Breast Health Outreach Program, visit

Call the Midwife – Shelley McGrew, CNM

For more than 34 years, even before the opening of Tucson Birth Center in 1982, midwives have been helping women deliver their babies at Tucson Medical Center. Today, we continue to partner with the midwives of the Tucson Birth Center and El Rio Congress to provide the only option in Tucson for women to give birth with the support of a midwife with admitting privileges in the hospital setting.  

We celebrate National Midwifery Week with a focus on midwives and the powerful role and impact they have in the evolution of our services for women and the community. Each day we will meet one of the El Rio amazing midwives serving our community.

shelley mcgrew midwife tucson

Meet Shelley McGrew, Certified Nurse Midwife

Shelley was born at TMC and grew up in Oracle, AZ. She lived and began her work with pregnant and birthing women in NYC from 1986-1999, returning back to AZ and have been here since.

“I have been a CNM for two years. I became a massage therapist specializing in perinatal massage in 1990, then became a labor doula and childbirth educator for many years. In 1997 I became an RN and worked for many years as a labor & delivery nurse before finally realizing my dream and becoming a midwife at age 50.”

Why did you choose midwifery?

“Midwifery is about being with women through their lifecycle – supporting normalcy with evidence-based care – providing education and resources so they can be empowered in their own health. What could be better?!”

What do you love about being a midwife?

“Empowering women – supporting them as they discover their own strengths. From contraception to childbearing to menopause.”

What impact do you see of having midwives involved in hospital birth?

“Midwives contribute to TMC being in the top 10 hospitals in the nation with the lowest cesarean rates. Being part of the amazing team of nurses and doctors at TMC allows us to provide midwifery care to women with diverse backgrounds and needs.”

What would you like to see in the future?

“I’d like to see even more physical and policy support for natural and low intervention hospital births.”

Is a midwife is the right choice for me?

“Do you have any health issues that need OB or perinatologist care? Are you planning a vaginal birth?  What type of birth experience are you hoping for?”

At both the Birth Center and in TMC for Women’s remodeled rooms there is a focus on environment, what and how do you feel this aids women in birthing?

“A peaceful environment helps women relax, feel safe and have privacy which facilitates the birth process. I appreciate TMC’s policy of allowing women to have who they choose with them at their birth without external constraints – this autonomy is important and is culturally sensitive.”

 What gives you the greatest joy in your work?

“The look of joy & accomplishment when a woman meets her baby. I also love it when the dads cry.”

Call the Midwife – Greta Gill, MSN, CNM

For more than 34 years, even before the opening of Tucson Birth Center in 1982, midwives have been helping women deliver their babies at Tucson Medical CenterToday, we continue to partner with the midwives of the Tucson Birth Center and El Rio Congress to provide the only option in Tucson for women to give birth with the support of a midwife with admitting privileges in the hospital setting.  

We celebrate National Midwifery Week with a focus on midwives and the powerful role and impact they have in the evolution of our services for women and the community. Each day we will meet one of the El Rio amazing midwives serving our community.

midwife greta gill

Meet Greta Gill, Master of Science in Nursing, Certified Nurse Midwife

Greta Gill, Director of Midwifery at the El Rio Birth and Women’s Health Center and the El Rio Congress Health Center moved to Tucson in 2008, but has been practicing midwifery for the past 16 years.

Why did you choose midwifery?

“I became a midwife because I wanted to join the profession which maintains the ancient tradition of women helping women.

As a midwife, I start from the belief that pregnancy is a normal part of a woman’s life. Most women are a well and need support, guidance and education instead of high tech medical interventions. The wellness model is a hallmark of midwifery care and we as a profession excel in prevention.”

Is a midwife right for me?

“In selecting any provider, a health care consumer should evaluate whether a partnership can be formed. It is also important that women feel they have adequate time with their provider to receive education and guidance.”

What impact do you see of having midwives involved in hospital birth?

“Midwives have worked alongside nurses and physicians to make maternity care more family-centered, personal and safe.”

What gives you the greatest joy in your work?

“I am continuously in awe of women’s strength and courage. It is my privilege to witness their love and dedication to creating new families.”

At both the Birth Center and in TMC for Women’s remodeled rooms there is a focus on environment, what and how do you feel this aids women in birthing?

“Choices for women are important. Birthing is an intensely physical process that can be impeded by stress and anxiety. Every woman has an idea about what she needs to feel safe and comfortable. TMC is working to provide a wonderful menu of options.”

Greta is originally from Richmond, Virginia, but moved to Tucson in 2008.  She states that “Midwifery is more than a job to me. It is my calling and my way of life. I am honored to carry on the tradition of women helping women and be in service to others. I value every woman who trusts me with her health care.” 

She has three children, all brought into the world by midwives (Her youngest was delivered by Sue Ann at TMC so she can tell you firsthand that you will be well cared for by the midwives!). 

Call the Midwife – Sandra Hodges CNM, WHNP

For more than 34 years, even before the opening of Tucson Birth Center in 1982, midwives have been helping women deliver their babies at Tucson Medical CenterToday, we continue to partner with the midwives of the Tucson Birth Center and El Rio Congress to provide the only option in Tucson for women to give birth with the support of a midwife with admitting privileges in the hospital setting.  

We celebrate National Midwifery Week with a focus on midwives and the powerful role and impact they have in the evolution of our services for women and the community. Each day we will meet one of the El Rio amazing midwives serving our community.

midwife sandra hodges cmn #midwivesmakeadifferenceMeet Sandra Hodges, Certified Nurse Midwife and Women’s Health Nurse Practitioner.

Sandra has been at the Birth Center for the past four years, but has been a practicing midwife since 1997.

Why did you choose midwifery?  

Midwifery appealed to me when I first did an OB rotation in nursing school. Later one of my head nurses was a midwife and I knew I wanted that path. I really like helping women to identify and achieve their goals, especially for pregnancy and birth! I do enjoy women’s health in general, and have expanded my training and education for gynecological care. I love having the time to talk to women and build relationships.

What impact do you see of having midwives involved in hospital birth and what would you like to see in the future?

I have been able to see how my midwifery practice has influenced change in different places I’ve worked. The doctors I worked with in the first job learned to decrease their episiotomy rates after I joined that practice. Delayed cord clamping has been another way midwives have led change in the hospital settings I’ve worked. I would like women to have the option of water birth at TMC!

What question should expectant mothers ask themselves when considering whether a midwife is the right choice for them?

What do you want out of your pregnancy and birth? Do you have risk factors that require physician management, like diabetes or chronic health problems? Where do you find yourself on the continuum of health promotion versus medical intervention? If you believe that pregnancy and birth are a healthy state for women, then you should consider midwifery.

What is the role of the physical birthing environment at TMC for Women and at The Birth Center aide women during labor and delivery?

Honestly, it’s less the environment and more the woman’s sense of power in her care and place. The nursing care is really a huge part of her experience, and we’re so glad that the women we serve are usually delighted with their nursing care.

 Sandra Hodges is a Tucson native. Born at TMC, Sandra graduated from Cholla High School, and graduated from the University of Arizona with a nursing degree. She and her husband Mark both joined the military and served as nurses in the Army. They came back to Tucson in 2012 after Mark retired from 31 years of military service! She has two adult sons who also live in Tucson. 


Tips from a Maternity Services Tour with Pam Penner

Pam Penner, stands in the foyer of TMC for Children gathering around her expectant mothers and their partners for a tour of the Labor and Delivery, and Mom Baby units. As a doula and as a PCT/Nurse’s aide at another local hospital, Pam has attended many births all over Tucson helping women bring their babies into the world. But it was assisting with her granddaughter’s entry into the world at TMC for Women that prompted her to be part of the Maternity Services tour at TMC.

Pam feels passionately about making sure that all women have the option to have a birth experience that matches what her own daughter had at TMC for Women. That passion is evident as she retells how her son-in-law, deployed in Afghanistan at the time, was able to watch the birth of their child via Skype. How every one provided support so that it might happen, and what that meant to her daughter’s family. There are tears on more than one face as she recounts the experience, and at the end of the tour one woman, accompanied by a friend, approaches Pam for more information as her partner is currently deployed overseas.

Every step of the tour Pam provides insights and tips, sometimes comical, but always practical, answering questions and calming jitters.

While there is no comparison to going on a maternity services tour with Pam or one of our other fine tour guides, we’ve assembled some of the tips we gained on Pam’s tour: 

  1. Pre-register in advance

    There is nothing like filling out registration paperwork when you feel like you’re about to burst with baby. So pre-register beforehand. 

  1. Who can visit with me in Labor & Delivery?

    At TMC for Women there is no limit on numbers in a regular labor and delivery as long as it doesn’t impede the midwives, doctors and nurses. And yes, your kids can be there too. However, you may not want a whole bunch of people in there. Ask yourself who you want by your side?  Or you may change your mind part way through which is why…

  2. You should get to know your nurse and share your birth plan

    In the midst of labor you may not be able to ask nicely for loved ones to leave and yet that might be exactly what you want and need – your nurse can make that happen. Make sure you talk with your nurse beforehand about what you want, and she can support you in making that happen. Share your birth plan too. (Don’t know what to include in your birth plan? We have some ideas.)

  1. Want the option of sitting in the tub during early labor? Ask while in Triage

    While all the rooms have large showers that you can use during labor, four of our rooms also have large tubs as well. If you want to spend the early part of labor in the tub, make sure you ask when you’re in triage to see if one of these rooms is available. Note: these rooms cannot be reserved.

  1. Make your labor and delivery room your own

    Whether it’s music, adjusting the thermostat, aromatic oils on cotton balls, make the room comfortable for you.

  1. Birthing balls, peanut balls, and squat bars

    Research how you might use the following beforehand, and ask for birthing balls, peanut ball, squat bars when you move from triage to your room. We have them at TMC. Pam is also a big advocate of rice bags. Rice bags can be made or bought, and then heated in the microwave to provide soothing heat.

For more information about tours, childbirth classes, breastfeeding support and postpartum support in Tucson check our main website.





For moms struggling with breastfeeding the TMC for Women Lactation Consultants are here to help

Breastfeeding at its best is inexpensive, easy and provides a whole host of health benefits for both mother and child. But you would not be alone if at first you struggle with breastfeeding. A trained lactation consultant, typically certified by the International Board of Lactation Consultant Examiners, can provide the insights needed to get over the stumbling blocks that prevent many women from continuing to breastfeed and reap the benefits.

Damiana Cohen and Noreen Carver with Jade Beall photographs

Noreen Carver IBCLC and Damiana Cohen Mother Baby Manager


Along with our weekly free breastfeeding support group, we also now offer private outpatient consultations. Supplemental funding from TMC Foundation ensures that all women can access this resource.

The TMC for Women Outpatient Breastfeeding Clinic was created to help women and babies with breastfeeding once they have left the hospital or birth center. Lactation consultants can help address latch problems, provide nipple shields and help with supplemental nursing systems (for those babies who are ineffective at nursing, preemies or special needs babies or for moms who have a low-milk supply or whose bodies need encouragement to lactate).

Lactation Consultation Room

The goal of the outpatient Breastfeeding Clinic to make sure all new mothers in our community can access trained lactation consultants and overcome hurdles to breastfeeding, no matter what their insurance or ability to pay. You can still access support via telephone on our breastfeeding warmline, 520 324 5730. (When clients call this phone number you can leave a message either on our Outpatient Line to schedule an appointment or the main line for questions. The lactation consultants return calls in between patient care and between hours of about 8 am to 6pm.) In person visits provide another level of support that is impossible to attain via a phone conversation. The appointments are typically an hour to an hour and a half long and take place in a distinctly non-clinical like setting, nestled in a quiet corner of our campus.

Call 520-324-5730 to make an appointment for an outpatient consultation.

What you should know about our breastfeeding consultations:

  1. Services are available to anyone in the community regardless of where you deliver your baby.
  2. You do not need a referral
  3. If you have insurance, they will be billed first, if they refuse to cover it or if you don’t have insurance, the cost will be covered under a grant from the TMC Foundation. Our TMC community recognizes the benefits of supporting breastfeeding for the health of mom, baby and the community at large.
  4. Don’t have easy transportation? Perhaps you’ve just had a C-section and can’t drive? No worries, we can help with transportation to and from your appointment. Just ask when you schedule your appointment.
  5. You will see a registered nurse who is a certified lactation consultant
  6. Need more than one consultation? No problem, multiple appointments are available.
  7. This is no cold hospital room appointment- appointments are held in a comfortable, private sitting area designed by the lactation consultants in line with what we know helps support women breastfeed.

Thanks to the support of the TMC Facilities Department who helped furnish the room and to Sandy Forbes, Donna Morton and an anonymous donor who donated the gorgeous photographs by Tucson photographer Jade Beall.


Breastfeeding – How to get off to a great start!

The TMC for Women Lactation Consultants have helped thousands of women successfully breastfeed their babies. Here are some of their suggestions to help you and your baby create a successful breastfeeding relationship:

Before baby arrives

1. Take a Breastfeeding Basics Class

Before baby arrives, take a breastfeeding class. This is a great time to connect with lactation consultants, other expectant parents and get pointers before baby arrives.

2. Ask potential pediatricians about their office’s approach to breastfeeding.

As an expectant parent, when interviewing pediatricians, include some questions about breastfeeding to make sure you and your child’s pediatrician are on the same page. Knowing you and your child’s pediatrician have similar goals can be important in ensuring your child’s breastfeeding success. The American Academy of Pediatrics provides a great list of topics to include, for example “Do you observe breastfeeding in the office to identify any problems?” “How can you support me in breastfeeding when I return to work.”

3. Identify resources BEFORE baby arrives

-Is there a breastfeeding support group at your local hospital? (If you’re in Tucson we have a weekly free breastfeeding support group at TMC open to all new moms, hosted by a lactation consultant.)

-What about a La Leche League group?

-Where would you access a breast pump if you need one? Did you know The Desert Cradle hospital-based shop offers electric breast pump rentals and sales, nursing and newborn products?

Susan Dennis IBCLC recommended these books as resources also:



Nursing Mother’s Companion by Huggins

Breastfeeding Made Simple Seven Natural Laws for Nursing Mothers by Mohrbacher and Kendall-Tackett



In the hospital and beyond

1. Enjoy the golden hour and more!

We know that the quiet ‘Golden Hour’ after baby arrives is a critical bonding time, but it isn’t just that hour following. Allow yourself, your baby and support person plenty of time after delivery to rest, and establish the nursing relationship without lots of spectators. Visitors are excited to meet the baby and to congratulate you, this is wonderful, but in the excitement and attention it can be difficult for new mothers to establish a comfortable nursing relationship with their child. Visitors can see you and the baby once you and baby are home and feeling a little more confident.

2. Skin to skin

You’ve probably seen the videos of newborn babies moving across their mother’s bodies to feed. Keep your baby skin/skin as much as possible and allow baby to feed at breast as much as he or she desires. Continue this at home.

3. Connect with the lactation consultants

While at the hospital or birth center. At TMC nursing assistance is available seven days a week.

4. Sleep when baby sleeps

It’s a familiar refrain – when baby sleeps you should sleep. The temptation is to try and get things done while baby naps, but try and get sleep during the day or when your baby is sleeping so you are ready when your baby is ready to feed more often (usually at night).

Remember if you’re having difficulty we offer one-on-one outpatient lactation consultations with our IBCLC Lactation Consultants.