King County Journal Newspaper 

Pill can be used to halt periods
2004-03-28
by Jean Parietti
Journal Reporter

More women are considering the use of continuous birth-control pills to eliminate monthly periods, a local obstetrician-gynecologist says.

As long as the pills use a combination of estrogen and progesterone, there is no buildup in the lining of the uterus, explained Dr. Jim Rice, who practices at Valley Women's Clinic in Renton.

As women realize it's safe to use continuous pills, ``it's becoming a growing trend,'' he said.

For instance, a woman may decide to skip one or more periods if she's going on vacation or getting married, Rice said, noting that most female gynecologists he knows don't menstruate every month, as a convenience.

A recent Gallup survey of 301 women ob-gyns found that more than half had used continuous pills, also known as ``menstrual suppression.'' Of those surveyed, 69 percent said the practice is safe over the long term and 30 percent agreed it is safe if used occasionally, according to the poll, which was commissioned by the American College of Obstetricians and Gynecologists.

On Living: Elective Caesarean sections slowly gaining ground in U.S.
2004-03-25
by Jean Parietti
Journal Reporter

Elective Caesarean section deliveries are considered ``mainstream'' in some parts of the world, and they may become more common in the United States, a local obstetrician-gynecologist says.

``It's an area that's probably beginning to evolve'' in this country, said Dr. Jim Rice, past president of the Washington State Obstetrical Association.

In fact, a report issued last summer by Health Grades, a Colorado-based healthcare quality company, showed that ``patient choice'' C-sections -- those for which there may be no medical reason -- rose 20 percent in the United States from 1999 to 2001. Still, elective Caesareans represented slightly less than 2 percent of all C-sections done at the 1,920 hospitals included in the report.

Of the 18 states studied, Washington had one of the lowest rates -- about 1.2 percent -- while New York, Florida and Texas had the highest rates in 2001.

Rice, who practices at Valley Women's Clinic in Renton, said he isn't necessarily opposed to elective C-sections, but doesn't have a lot of patients asking for them yet.

``I think the most important thing is for patients to understand the risks and benefits'' of both C-sections and vaginal delivery, Rice said.

In the past, he said, C-sections have been considered riskier than vaginal delivery. For instance, when a C-section is done after a woman has been in labor for a long time, there is a higher risk of bleeding and infection, Rice said.

When the C-section is planned and labor hasn't started, the risks might be less. ``Still, a C-section is a major surgery, so you do have a slower recovery, you are going to have a scar on your tummy,'' and there's more risk of scarring in the uterus, Rice said.

On the plus side, ``people can schedule when they can have their baby,'' he said. ``That's an important thing in our culture.''

For instance, a woman may want her mother to be present for the baby's birth, but the grandma-to-be lives out of state and has to ask for time off from her job well in advance. So the pregnant woman may choose a C-section to make that possible.

Having a C-section may provide other benefits over vaginal delivery.

``If you read the publications in Argentina, patients (who choose C-sections) are reporting improved sexual function,'' Rice said.

And with C-sections, the risk of pelvic prolapse and stress incontinence is about 10 percent lower than with vaginal deliveries, Rice said.

Pelvic prolapse is a condition in which muscle weakness causes the uterus, bladder, rectum, or small bowel to protrude into the vaginal canal, according to the American College of Obstetricians and Gynecologists. Childbirth and aging are the main causes of pelvic support problems, which can cause discomfort and incontinence.

Stress incontinence, which develops when the pelvic floor muscles become weak, is the leakage of urine that can occur when a woman sneezes, laughs or coughs.