About James N. Martin, Jr, MD

Dr. Martin is professor of ob-gyn and director of the division of maternal-fetal medicine at the Winfred L. Wiser Hospital for Women and Infants, University of Mississippi Medical Center, in Jackson. Dr. Martin was ACOG President from May 2011-May 2012.

Fighting Preeclampsia in May and Beyond

This is my last blog post as ACOG president (I continue as immediate past president for another year), so I’d like to finish where it all began, with my Issue of the Year: preeclampsia. It’s a condition that affects up to 7% of pregnant women, and in my opinion, it’s the most important medical complication of pregnancy. It’s potentially life-threatening to mother and baby during pregnancy and can signal health problems for the mother later in life. Unfortunately, this serious and common condition is understudied and largely misunderstood.

As part of my President’s Program on Monday, May 7, at The College’s Annual Clinical Meeting, I invited three of my esteemed colleagues at the forefront of preeclampsia research to share what we know, what’s new, and the advances that may be coming soon in preventing and treating preeclampsia. This session will help educate ob-gyns about the condition. It’s imperative that physicians appreciate a patient’s experience of preeclampsia. It’s also extremely important to raise awareness of the signs and symptoms of preeclampsia among women.

High blood pressure and protein in the urine can both signal preeclampsia. Because these changes are hard—if not impossible—for women to spot, blood pressure and urine tests are routinely checked at each prenatal visit. Other symptoms may arise, especially in the last three months of pregnancy, including sudden weight gain, headaches, swelling of the face or hands, blurred or altered vision, chest pain or shortness of breath, pain in the upper right abdomen area, and nausea and vomiting. These symptoms may seem normal, but because preeclampsia can worsen quickly, it’s important that pregnant women alert their doctor immediately if they occur.

Preeclampsia Awareness Month (PAM) in May is an excellent time to educate women and spread the word about this condition. The Preeclampsia Foundation’s website has a page devoted to the signs and symptoms of preeclampsia and what women can do to monitor themselves for preeclampsia-related changes. The foundation also has great news and information about risk factors, resources, and local PAM events. The more we know, the safer we can make pregnancy for women and their families.

Two Must-Sees in San Diego

I talked recently about the excitement leading up to ACOG’s upcoming Annual Clinical Meeting (ACM). As in every year, attendees can look forward to a thoughtful and comprehensive scientific program. I wanted to share two of the sessions that have particularly piqued my interest from this year’s line-up.

While I admit to being a stargazer, the special session on maternal and child mortality headlined by Christy Turlington Burns and Tonya Lewis Lee promises to offer much, much more than a celebrity sighting. Both are activists and documentary filmmakers who have used their star power to raise awareness about maternal and child health in the US and around the world. Maternal and infant mortality is an issue that ACOG continuously works to address and improve. With all the advances in medicine and obstetrics available to us, it is a travesty that mothers and babies around the world are still dying every day. In fact, the US has the highest rate of maternal mortality among industrialized nations. Ms. Turlington Burns and Ms. Lewis Lee will share the insights that they have gained from their time spent on the front lines with at-risk women and children.

Switching gears, the second session I won’t miss addresses cosmetic gynecology—a hot topic in ob-gyn. We are a society preoccupied with appearances, and procedures that promise to give our looks a boost generally receive a lot of attention. Some ob-gyns have stepped into the cosmetic surgery arena, performing cosmetic gynecologic procedures such as labioplasty, “revirgination,” and other forms of vaginal “rejuvenation” as well as aesthetic procedures such as injecting Botox. A four-expert panel will discuss the pros, cons, and ethics of ob-gyns performing these surgeries and the controversies that surround some of these procedures.

These are just two highlights in a scientific program studded with clinical pearls. Check back from May 5–9 to hear more about the happenings at the ACM.

Meetings Matter—The Importance of Our Annual Clinical Meeting

The ob-gyn community is abuzz in anticipation of our 60th Annual Clinical Meeting (ACM), just over two weeks away in San Diego. You read that right. We’re excited over an annual meeting. I’ve been an ob-gyn since the 1970s and I’ve had many reasons for attending the ACM over the years. In my opinion, each meeting gets better and more relevant to my daily practice.

The ACM is the best place to gather with other ob-gyns to learn about and discuss a wide array of new findings in research and in clinical practice. The phenomenal poster sessions—where more than 260 research abstracts will be presented—help physicians get a pulse on emerging areas in ob-gyn research and of the breakthroughs that may be coming soon. The ACM also provides an excellent opportunity to meet up with colleagues, collaborators, and friends from the US and abroad. It has been the birthplace of countless projects and initiatives that support our mission of providing the highest quality women’s health care and eliminating obstacles and health disparities our patients may face.

Of all the times I’ve attended, this particular ACM holds special significance. It marks the sunset of my tenure as president of ACOG. It has been an amazing and transformational year for our organization. One of the highlights of my presidency has been shining a national spotlight on preeclampsia, a leading cause of maternal and infant sickness and death in the US that is both understudied and misunderstood. Unfortunately it is also an area of reproductive research that is woefully underfunded especially with regard to clinical trial undertakings. The 2012 ACM will kick off with my President’s Program on preeclampsia. I’m very excited to have James M. Roberts, MD, giving the historical and current perspective on the condition; John Barton, MD, reporting on the findings of ACOG’s Preeclampsia Task Force and some of the implications for our clinical practice; and Eleni Z. Tsigas of the Preeclampsia Foundation discussing how it affects women and families.

So for the next few weeks, I’ll be looking forward to all that awaits me at the ACM. There’s still time to register for what promises to be an informative, fun, and comprehensive meeting. Hope to see you in San Diego!

The Original Organic Baby Food

Breastfeeding—it’s a woman’s built-in system for nourishing her baby. It provides complete nutrition, and it’s an inexpensive and convenient feeding option. ACOG recommends that infants be breastfed for the first six months. Unfortunately, people in the US have not whole-heartedly embraced breastfeeding, making it a constant source of debate, controversy, and awkward pauses. But I say enough already. It’s time to move beyond thinking that breastfeeding is odd, taboo, or indecent.

Breastfeeding helps babies build strong digestive and immune systems and may protect against respiratory infections, some childhood cancers, and obesity. Breastfed babies often have less gas, constipation, and diarrhea, fewer feeding problems, and less illness than do formula-fed babies. Women who breastfeed may lose weight faster, experience less stress during the postpartum period, build stronger bonds with their babies, and have a decreased risk of breast and ovarian cancer in the future. Exclusive breastfeeding can also temporarily stop ovulation, lowering the risk of pregnancy. However, it is not a foolproof method of contraception. Women who want to avoid pregnancy should discuss birth control options with their ob-gyn to be on the safe side.

Overall, the benefits of breastfeeding are great, and the vast majority of women are able to breastfeed. But even though breastfeeding is a natural process, it’s not always intuitive. That’s why it’s a good idea to let your doctor and health care team know your breastfeeding plans before you deliver. They will help you start and support your breastfeeding once the baby is born. For some, learning how to nurse takes time, patience, and practice.

Women may also face logistical or workplace-based obstacles to breastfeeding. ACOG continues to advocate for employers to provide designated spaces to facilitate breastfeeding moms. In the meantime, it’s a good idea to talk to your coworkers and other moms who have breastfed and share strategies for how you can make breastfeeding work at work.

If you’re pregnant, consider giving breastfeeding a try. If it’s not the best choice for you and your baby, that’s OK. But who knows? You may be surprised to find that it comes…naturally.

The Truth About Growing Up

The teenage years can be among the most challenging in the human experience. It’s a time of unparalleled physical and emotional growth when new, interesting, and sometimes frightening events happen in quick succession. Peer pressure to experiment with drugs and alcohol, have sex, be popular, figure out what to say and wear and do—the list goes on and on.

Today’s teens may have it harder than ever before. The new documentary “Bully” gives us a glimpse into what typical teens face at school every day—the content is so mature that it garnered an “R” rating, ironically prohibiting many of those who most need to see the movie from viewing it without an adult present.

In a perfect world, teens would consult their parents for advice on navigating the sometimes turbulent process of growing up. But we all know that’s not how it usually plays out. Many teens would rather avoid awkward conversations with their parents or other adults, instead turning to friends who are just as confused about the facts. The consequences of misinformation—such as teen pregnancy, substance abuse problems, or suffering in silence—are too steep.

As an ob-gyn, I remind my young patients that my door is always open if they need help working through difficult times. But, in case they’re not quite ready to have a conversation with me, their parents, or another trusted adult, there are some great online resources available:

  • www.girlsmarts.org: This website is devoted to helping teens work through tough scenarios such as meeting new friends in chat rooms; experimenting with smoking, alcohol, and drugs; and weight issues and eating disorders. Girlsmarts features polls, blog posts written by teens, and video content related to teen issues.
  • www.stopbullying.gov: The Centers for Disease Control and Prevention recently relaunched its anti-bullying website. The resources and information provided encourages teens, parents, schools, and communities to find solutions to prevent and respond to bullying and foster a safe environment for all members of the community.
  • Patient Fact Sheets: ACOG has developed a series of fact sheets for teens on a variety of topics such as body art and piercings, body image, stress and trauma, internet safety, plastic surgery, and pregnancy options. Corresponding fact sheets for parents are also available.

Share these resources with teens you know and see what happens. They just might spark a healthy conversation too important to miss.

Access to Contraception Is Every Woman’s Right

You’d have to be living under a rock to have missed the recent political and culture debates about contraceptive access and coverage. Having practiced ob-gyn since the early 1970s, I can tell you that contraception is a fundamental part of women’s health care, just as important as Pap screening, prenatal care, and breast exams. ACOG has long advocated for the right of women to obtain contraception, expanded access to and coverage of it, and a doctor’s ability to prescribe contraception to his or her patients.

More than 80% of reproductive-age women will use contraception for a wide variety of reasons, not just for birth control. Hormonal contraceptives can help with gynecologic problems such as endometriosis, menstrual cycle irregularities, fibroids, and premenstrual syndrome. They also treat acne, improve bone density, help with perimenopausal symptoms, and reduce the risk of certain cancers.

Of course, many women use contraception to avoid pregnancy. However, not enough do, because roughly half of the pregnancies in the US are unintended. Unplanned pregnancies often cause undue strain on women, their families, and society. Lack of access and affordability of contraception deprives a woman of her right to plan a pregnancy at a time that makes most sense for her. Clearly, any campaign to reduce unintended pregnancy must be coupled with a comprehensive program of sex education and easily accessible options for contraceptive health.

I take pride in the fact that my patients turn to me for advice and guidance about medical issues, healthy lifestyle, screenings, immunizations, and their contraceptive needs. I trust that women know what’s best for their lives and their bodies. I also know that contraception is a basic necessity used to protect and improve women’s health. And I am not alone. I stand with ACOG in putting women first. I fully support the right of all women to unimpeded contraceptive access.

What Is Endometriosis?

March is Endometriosis Awareness Month. Do you know what endometriosis is?

If your answer is no, you’re not alone. Although it is a common disease affecting up to 10% of reproductive-age women and is the culprit in many cases of chronic pelvic pain, painful periods, and infertility, most people are largely unfamiliar with what it is and how this condition impacts women.

Endometriosis occurs when the cells that line the uterus migrate to other parts of the pelvic region, attaching where they don’t belong, which leads to a recurring cycle of bleeding and healing and the eventual development of scar tissue. The scar tissue can cause mild to severe pelvic pain before and during menstruation; pain during sex, urination, or bowel movements; and menstrual bleeding more than once a month. In some women, endometriosis causes no symptoms at all and they may be first diagnosed when they have trouble getting pregnant. It’s most often seen in women in their 30s and 40s, but it can occur in women of any age. Women who have never had children and those who have a mother, sister, or daughter with endometriosis may be at increased risk.

Endometriosis can only be diagnosed through surgery, so if you have symptoms or risk factors, talk to your doctor. Laparascopy—a surgical procedure that uses a lighted scope to view the pelvic organs—is often used to detect endometriosis. If scar tissue is found, it can often be removed during the procedure. Your doctor may also recommend medication, such as ibuprofen or naproxen, for pain relief or prescribe birth control pills to control the menstrual cycle and shrink areas of endometriosis. In severe cases, there are other medications that may be potentially beneficial, or hysterectomy may be an option.

For more information, click here.

What’s Up, Doc?

Sometimes it seems you can’t go more than a few weeks without hearing about a medical organization changing recommendations about a particular health screening regimen or a tried-and-true treatment. From mammograms to prostate exams—not to mention the endless advice on which new or old medicines to take or avoid—it happens in every area of health and medicine. Just this week, two organizations released new advice on how often women should be screened for cervical cancer.

Each time a standard recommendation changes, I can expect a flurry of questions from my patients. The most common question is “Why should I switch from doing something that I know (eg, get a Pap test every year) to something that’s so different (eg, wait three to five years between cervical screenings)?” The answer will vary depending on the specific test or the recommendations involved, but it often comes down to the same concept: evidence-based medicine.

Evidence-based medicine combines research findings on how a disease works with real-life data and feedback on how that disease—and patients—respond to certain prevention and treatment strategies. This evidence provides a more complete picture of how a disease is best handled. Medical organizations like ACOG use it to develop practice recommendations and physicians rely on it as the foundation for how we treat patients.

Because new information is always being discovered, health recommendations need to be routinely updated. This is all part of the process of providing the patient with the best, most effective, and up-to-date care available.

If news of new recommendations leaves you feeling confused or frustrated, talk to your doctor.  He or she can explain the changes. And because every guideline does not apply to every patient, only you and your doctor can determine what impact, if any, it will have on you. It’s always ok to ask: “What’s up doc?”

Colonoscopy—It’s Not As Bad As You Think

If I were to ask you about the screening test that you dread the most, what would it be? For many people, the resounding answer would be a colonoscopy. The prep, the exam itself, the area being examined…it can all seem very strange and uncomfortable.  

While you may be skittish about the idea of the exam, colonoscopy is truly a procedure in which the end justifies the means. Colon cancer remains the third leading cause of cancer death among women, and an estimated 70,000 women will be diagnosed with the disease this year. Colonoscopy detects precancerous growths (polyps) and cancers early on, when they are most treatable—especially important because colon cancer often shows no symptoms. A recent study published in the New England Journal of Medicine reported that the procedure cuts the rate of death in half. And the preparation itself has gotten easier—the cleansing preparation can now be performed with pills and water instead of gallons of unpleasant liquid.

ACOG recommends that all women should be screened regularly for colon cancer beginning at age 50. Earlier screening is suggested for African American women and those at increased risk, including women who have a first-degree relative younger than age 60 or two or more first-degree relatives of any age with colorectal cancer or polyps; had colorectal cancer or polyps themselves; had bowel disease, such as chronic ulcerative colitis, inflammatory bowel disease, or Crohn’s disease; or a family history of certain types of colon problems or colon cancer.

During Colon Cancer Awareness Month in March, maybe it’s time to put your fears and anxiety aside. Once the procedure is done, you can ease your mind knowing you’ve done the right thing and that you have roughly 10 years before having to do it again. Considering that it could save your life, a colonoscopy is time minutes well spent.

Staying Healthy After Cancer Treatment

If you’re one of the 2 million breast cancer survivors in the US today, you know that battling cancer is no small feat. But after cancer goes into remission, you might think the hard part’s over, right? Not always.

Although the tools we use to fight cancer—from chemotherapy to surgery—can be life-saving, they also can affect fertility, sexual function, body image, and contraceptive needs. Some anti-cancer medications can also increase the risk of osteoporosis.

Symptoms such as vaginal dryness, decreased sex drive, and hot flashes are common, but compared with cancer, they may not seem worthy of a complaint. And even if you felt strong and didn’t lean heavily on others for emotional support during the initial cancer treatments, the long-term effects of “being an island” can erode relationships and lead to depressive symptoms. All of these treatable symptoms can have a very real effect on your quality of life. You’ve been through enough, and there’s no need to suffer in silence.

Talk to your doctor about your symptoms. He or she can recommend lubricating creams or gels to combat vaginal dryness, or suggest relaxation and dietary changes to help reduce hot flashes. You and your doctor should discuss your contraceptive options to prevent pregnancy or talk about fertility concerns if you’re considering getting pregnant in the future. Reduce your risk of bone loss or fractures through lifestyle changes such as weight-bearing and muscle-strengthening exercise, quitting smoking, and consuming less alcohol. If you are depressed, your doctor can refer you to counselors or support groups.

No matter the problem, your doctor should know about it and may be able to help. Keep an open line of communication after your treatment ends, and speak up. You’ll be glad you did.