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.

Protecting Teen Girls from Violence

Approximately one out of every 10 high school teenage girls in the US reported experiencing physical violence from their dating partners in the previous year. This is not abstract—this could be happening to someone you know. A girl in your family or community may have recently been slapped, punched, kicked, pushed or grabbed, sexually coerced or raped, called names online, threatened, or screamed at in public—all by the person she is in an intimate relationship with.

Throughout February, ACOG and other organizations have been raising awareness as part of Teen Dating Violence Awareness Month. It’s important that we educate young girls—and women—that unsafe relationships are not only about physical violence. Those who monitor cell phone use, stalk or humiliate online, or control their partner’s wardrobe, choice of friends, or contraceptive use are abusive.

As a father and grandfather, I want to do everything in my power to make sure my children and grandchildren are safe. This feeling extends into my practice as well. As an ob-gyn, I am in a unique position to reach out to my patients, letting them know my office is a safe environment in which they can seek help. ACOG recommends that physicians screen all women for intimate partner violence at periodic intervals. Recognizing violence in a teenage girl’s relationship can be especially critical because adolescent violence can lead to intimate partner violence when she grows up.

To get help for yourself or someone you love, call the National Domestic Violence Hotline at 800-799-SAFE. Teens can also learn about healthy relationships at loveisrespect.org or get teen-specific help through the Dating Abuse Helpline at 866-331-9474.

Heart Month Pop Quiz: Which is Better, HDL or LDL?

Quick—which type of cholesterol do you want more of, HDL or LDL?

Answer: HDL, or the “Happy” or “Healthy” type.

A lot of people can’t remember which type of cholesterol is the “good” one and which is the “bad” one, but it’s an important distinction. High cholesterol is one of the main culprits in heart disease, the leading killer of women in the US.

LDL (low-density lipoprotein) is the “bad” cholesterol that causes buildup and blockages in the arteries, which leads to heart attacks and strokes. The healthiest LDL level is less than 130 mg/dL.

HDL (high-density lipoprotein) is the “good” cholesterol that helps keep the “bad” LDL cholesterol from sticking to your arteries. You want a high HDL number (60 mg/dL or higher) to help lower your heart disease risk. Your ideal goal is a total cholesterol level (HDL+LDL combined) of less than 200 mg/dL.

As women move past menopause, their overall cholesterol level tends to rise. Estrogen levels prior to menopause raise HDL cholesterol; this benefit is lost after menopause. But there are things you can do to raise your HDL level and lower your bad LDL cholesterol: Lose weight, reduce foods with saturated fats in your diet, stop smoking, and exercise regularly. Medication may also be needed to lower your cholesterol levels.

Know your cholesterol levels and get tested every five years. Do it for your heart.

Heart Disease in Women

For many years, heart disease was thought of as a man’s disease. Most heart disease awareness efforts and research dollars focused on recognizing heart problems in men. But today we know different. Heart disease kills more women annually than all cancers combined, and more women than men have died from it every year since 1984.

While awareness efforts among women are improving, it’s time for heart disease research in women to catch up. We need more people like Barbra Streisand—who recently discussed her personal efforts to raise money for Cedars Sinai Women’s Heart Center in pause® magazine—to invest in heart disease prevention and treatment for women.

More clinical study is key in the fight against heart disease, but it’s also important to remember that you are your own first line of defense. Family history, high blood pressure, high cholesterol, diabetes, being overweight, and smoking increase your heart disease risk. To that end, the tried-and-true health trilogy of eating right, exercising, and avoiding smoking still applies. In addition, you can protect your heart health by lowering salt intake, controlling diabetes, keeping blood pressure and cholesterol levels low, managing stress in a healthy way, and visiting your doctor regularly.

Your heart supports you and everything you do every minute of every day. Repay the favor by committing to treating it right.

Why I Wear Red

I’ll be wearing red tomorrow, and it’s not because it’s my favorite color or because I was born on Valentine’s Day. February 3 is National Go Red for Women Day, raising awareness of heart disease in women. As an ob-gyn, my career has centered on keeping women well, especially when they are pregnant. Heart disease is a formidable enemy for my patients and me, and its impact is hard to deny. Speaking of pregnancy, did you know that heart disease has become one of the major causes of maternal mortality in this country?

An estimated 42 million women in the US are living with heart disease, the no. 1 killer of American women. But despite its prevalence, heart disease in women can be hard to spot. Feeling tired (even after a full night’s rest) or anxious, having an irregular heartbeat, or having trouble breathing or sleeping can all signal heart disease, but are often overlooked or attributed to other problems.

Many times, the first symptom of a heart problem is a major cardiac event like a heart attack. Chest pain or discomfort is the main symptom of heart attack in both women and men. However, other more subtle cues—such as nausea; lightheadedness; shortness of breath; pain in the back, jaw, neck, or arms; and breaking out in a cold sweat—are more common in women. These symptoms may not seem to warrant special attention, but if you are experiencing them, consider it an emergency and seek medical attention right away. Brushing off these signs delays timely care and hampers recovery.

By donning red tomorrow, I’ll show my support for my patients and the fight against heart disease. So, go ahead and ask about my outfit. It’s an easy way to spark a conversation that could save a life.

The Real Recipe for Good Health

Last week’s announcement that Paula Deen, the reigning queen of rich and decadent Southern cooking, has type-2 diabetes caused some controversy in the public and in the health community. The fact that Ms. Deen signed on as a spokesperson for a diabetes drug further fueled the debate. But in arguing about the rightness of Ms. Deen’s cooking style in light of her health issues, we may be missing the most important point: it is far easier to prevent diabetes than to make it go away once you’ve got it.

To avoid diabetes—a chronic and potentially life-threatening disease—diligence is key. You should know if your blood sugar level is within a normal range, so be sure to ask your doctor for a fasting blood glucose test at your next check-up. If your results come back high, or if you have a strong family history of diabetes, take steps to lower blood glucose levels through healthy diet and regular exercise. This is a far smarter plan than letting diabetes happen and trying to medicate it away. Additionally, making a preemptive investment in healthy habits now (eg, fresh fruits and vegetables, lean meats, and the occasional new pair of sneakers) is much cheaper in the long run than a lifetime of diabetes medication.

Though heredity and age play a role, for most people, diabetes is not a given. Don’t let it happen to you. Do something now to prevent the disease later.

A Plan to Defeat HPV

In a recent blog post titled “HPV and a Vaccine: Why We Can Beat Cervical Cancer,” William Smith, executive director of the National Coalition of STD Directors, looks in depth at the conundrum of cervical cancer in the US today. On one hand, we can now classify cervical cancer as a largely preventable disease. On the other, more than 4,000 women in the US still die from cervical cancer each year. If we are to drive these numbers down, HPV vaccination must play an essential role.

The human papillomavirus (HPV) is a known cause of cervical, vulvar, vaginal, and anal cancers in women; penile and anal cancers in men; and throat, esophageal, and other head and neck cancers in both sexes. The HPV vaccine has the potential to protect young women—and men—from many, if not all, of these cancers. Recommended for girls and women ages 9–26 and boys and men ages 11–26, HPV vaccination works best if given before any exposure to HPV or the onset of sexual activity. But despite the recommendations of ACOG and other health organizations and women’s advocates, vaccination rates have remained low.

Many parents are sensitive to discussions regarding their young daughters (and sons) and sexually transmitted infections (STI). However difficult the concept, parents would be remiss in avoiding a potentially life-saving vaccine for these reasons. HPV vaccination is just another tool in a parent’s arsenal to shield their children and family from cancer. It’s no different than routinely vaccinating infants against hepatitis B—another STI that can increase the risk of liver cancer—which has been commonplace for roughly 30 years.

As a parent, some things just make good sense. And with the benefits that it provides, HPV vaccination is clearly one of those things. Protect your children; get them vaccinated.

Double Take: Where’d All These Twins Come From?

If you’ve been noticing more twins around lately, it’s not just double vision. New data from the Centers for Disease Control and Prevention confirm that more twins are being born today than ever before. In fact, one in every 30 babies born in the US in 2009 was a twin.

Contrary to what some have said, oral contraceptive use is not a factor in the twin boom. The two main reasons for the increase: age of mother and fertility drugs. Women in their 30s—particularly those from 35 to 39—are more likely to ovulate more than one egg at a time, leading to historically higher rates of naturally conceived twins. With more than one-third of all US births occurring among women age 30 and older, the math adds up to more twins. Additionally, more couples of all ages are pursuing assisted reproductive technologies such as fertility drugs or in vitro fertilization, which increase the odds of a twin pregnancy.

While having twins can be twice as nice, there are some very real health concerns that come with carrying two or more embryos. Preterm labor is more common among twin pregnancies and frequently results in preterm birth. Roughly half of twins are delivered early, sometimes before they have fully developed. When compared to singleton babies, twins are more likely to be born small and require more hospitalization. Women carrying twins also have a higher likelihood of developing high blood pressure, preeclampsia, anemia, and other conditions. Efforts are ongoing to improve infertility treatments to avoid multiple gestation pregnancies.

With proper prenatal care and monitoring, it is possible to deliver a healthy pair of babies. However, women should be aware of the risks of carrying twins and work closely with their doctors to ensure a healthy pregnancy and delivery of two bundles of joy.

Put Your Cell Phone Down and Operate

Advances in technology have enabled us all to be connected in ways unimaginable just a few years ago. From practically anywhere, we can send and receive texts and emails, pull up websites, and use apps to access a wealth of information with a push of a button. A recent New York Times article highlighted how computer and smartphone technology has also made its way into the hospital setting and surgery room.

Admittedly, these technologies can be wonderful tools for improving the health and well-being of our patients. But we can quickly lose sight of the very real downside these gadgets can pose to our patients. It would seem to be common sense that personal calls, texts, and online surfing have no place in the operating room, in our clinics, or in hospital areas where patient care is ongoing.

As these devices become even more ubiquitous and the pressure to immediately respond and constantly check in can be great, we must recognize that we cannot focus on our patients if we are simultaneously glued to our smartphone or tablet. Just as there has been a great deal of awareness about the dangers of texting or talking on a cell phone while driving (or even walking!), we must focus awareness on the patient safety risks with the same technology-related problems. 

As physicians, our priority is always the patient. To this end, we need to eliminate unnecessary distractions when we are taking care of our patients. Hospitals and medical practices should develop and institute firm policies about how and when these technologies can be used…and when they cannot.

A Little More, a Little Less…

This time every year many of us set goals for the following year that are ambitious, to say the least. Like quitting smoking cold turkey or losing 20 pounds in a month. Often these New Year’s Resolutions are daunting and are more apt to overwhelm us rather than inspire us to make meaningful changes.

Let’s try something different—how about setting small, specific goals such as eating more fresh fruits and vegetables (5–9 servings/day) and fewer processed foods, cutting down on salt (less than a teaspoon/day), going for a walk on most days of the week, or drinking more water? Give yourself a month or two to work on each one and by year’s end, you’ll have several concrete accomplishments. You might even get some added benefits, such as losing weight or lowering your disease risk.

For me, I’m going to try to exercise more, but stress less about not getting to the gym every day. I’m also going to make more time for visiting our children and grandchildren, be a better listener, and cultivate an attitude of gratitude.

This is an excellent time to take stock of what you’ve accomplished in the last 12 months and set goals for the next 365. Remember to give yourself a pat on the back for making an effort to focus on your well-being…and don’t give up!    

On behalf of ACOG, I’d like to wish you a happy holiday season and a new year marked by fresh approaches, tenacity, and good health.

Wrong-Headed Decision on Plan B One-Step

For a decade, ACOG has supported making emergency contraception (EC) available over the counter (OTC) without an age restriction. So it was deeply troubling and disappointing to see HHS Secretary Kathleen Sebelius overrule the US Food and Drug Administration’s decision to remove the age restriction and make Plan B® One-Step accessible to all females capable of becoming pregnant.

The argument that 11- and 12-year-olds are not capable of understanding how to use EC isn’t true, based on the data, and it misses the point. The majority of girls this young are not sexually active and do not represent the bulk of adolescents who are at risk of an unwanted pregnancy. According to the Guttmacher Institute, nearly half of all high school students in the US have had sex at least once, and 85% of adolescent pregnancies are unintended. These high school students are the adolescents who would most benefit from OTC access to EC.

The overwhelming scientific evidence shows that EC is safe for teens and women and is highly effective in preventing unintended pregnancy. Ideally, all sexually active teens and women would use effective contraception each and every time they engaged in sexual intercourse to avoid an unplanned pregnancy. But, we don’t live in a perfect world—a condom tears or you miss a pill, for instance. Rapid access to EC is especially important for women that have been raped.

EC products contain the same hormones as oral contraceptives, only in a higher dose. EC works primarily by preventing ovulation, but it can also prevent fertilization or implantation. However, timing is critical: EC is most effective when taken within 72 hours after unprotected intercourse. This is why OTC access is so important. There’s no need to wait for a doctors’ appointment to get a prescription, or to have the prescription filled.

While EC does not replace the consistent use of reliable birth control, making it available without a prescription to all provides an important safety net. For this reason, ACOG will continue to advocate for removing this unnecessary age restriction to OTC EC.