Nurse Midwives can provide a large variety of women's health services. Below is a list of the services provided by your nurse midwife.

• Prenatal care
• Labor support and delivery
• Postpartum (after delivery) care
• Family planning/contraception- including birth control pills, IUD's, diaphragms, Depo Provera shots, birth control patches.
• Annual physicals, breast exams and pap smears
• Gynecologic care, including menstrual problems, vaginal and urinary tract infections, pelvic pain
• Adolescent annual exams/sports physicals
• First pap smears.
• Diagnosis and treatment of sexually transmitted diseases
• Menopause care, including hormone replacement
• Sexual health, decreased libido

Adolescent health
As teens begin to explore the newly accessible choices they have, they make decisions about lifestyles that may become habits of a lifetime.

As parents we try to guide them in making good choices. Most teens are healthy and transition into adulthood safely. However, we know that our adolescents face difficult situations that require tough choices. As their circle of influence becomes their friends and peers, their behaviors turn toward emphasis on their social lives, sexual development, intense emotional changes and their privacy.

Teens face many risks including substance abuse, pregnancy, sexually transmitted diseases, violence and accidental death.

• ¼ of all STD's occur in teens and 1 out of 8 girls between the ages of 15 and 19 become pregnant each year.
• ¾ of all adolescent deaths are the result of accidental injury or violence.

Many mothers ask when their daughters should have their first pap smear. Most young women do not need their first pap smear until they become sexually active. However, some young women have that first pelvic exam earlier because of menstrual difficulties or have other issues related to their reproductive health.

I often suggest that age 18 is a good age to consider a first pap smear if they haven't done so already. Many women are transitioning into young adulthood whether into college or the workforce and this is a good opportunity to examine their health practices. Young adults will also being to face more barriers to access to care that include our of pocket co-pays, transportation and coverage of their health needs by school based clinics.

The midwifery model of care emphasizes education and family centered care throughout life. This makes nurse midwives ideal care providers for adolescent women. Midwives promote healthy behaviors and facilitate the development of life long health choices.

Nurse-midwives are experts in the art of the "first pelvic" exam. Their high touch approach is especially welcome to the anxious teen. Midwives are wonderful teachers and spend a lot of time on patient education. Take the time to make an appointment for you and your daughter to talk with a nurse midwife about your adolescents unique health needs.

Childbirth options
The birth of a baby is a special time in your life. I want you to give birth joyfully, confidently and in the best of health. There are many choices you can make about how you give birth. Some of your options are listed below.

Activity in Labor
Standing, walking and sitting can shorten labor. It may also make labor less painful for you. If your labor progresses normally, I will suggest you walk around, use the Jacuzzi, rock in a rocking chair or labor in the shower.

Positions for birth
There are many positions you can chose for the time of birth including lying on your side, lying down, sitting, squatting, or on the hands and knees.

Pain medication
Emotional support, back rubs, time in the shower or Jacuzzi, breathing techniques and many more options to help you may be all you need in labor. If you desire medicine or an epidural, they can be used, as you need them.

Episiotomy
An episiotomy is a cut at the bottom of the vagina to make the vaginal opening bigger. I believe that all women do not need an episiotomy. I will work with you to allow the vaginal opening to stretch to its fullest to avoid an episiotomy. Sometimes it is necessary to cut an episiotomy to prevent a serious tear or to deliver the baby more quickly.

IV (intravenous fluids)
An IV can be started for a variety of reasons. Most commonly it is used to deliver medicine such as pitocin or a pain reliever or to give fluids to prevent dehydration. Sometimes it is needed if you have severe anemia or bleed easily. If you have none of these problems, you will not need an IV in labor.