Our providers are board-certified physicians, certified nurse-midwives and nurse practitioners. You may choose a physician, midwife, or nurse practitioner as your provider.
When it comes to pregnancy, our physicians and midwives are trained to provide pre-conception counseling, and both routine and high-risk obstetrical care. Working in partnership with Exeter Hospital, we can manage most obstetrical situations, including multiple gestation, hypertension, diabetes, and pre-term labor. In areas of special concern, we coordinate with fetal medicine specialists both locally and at major medical centers in New Hampshire and Massachusetts.
- Routine and high-risk obstetrical management
- Pre-conception counseling
- Breast-feeding support
Vaginal Births May Be Possible After Cesarean
Exeter Hospital, and Partners for Women’s Health, have been offering vaginal births after cesarean section (VBAC) for women who meet the qualifications since 2010. If you would like to learn more about VBAC, call Partners at (603) 778-0557; if you are already a Partners patient, talk with your healthcare provider.
You may choose to have a midwife manage your pregnancy and delivery. We are pleased to have several midwives on staff. Our midwives are highly skilled health professionals who are certified in midwifery. They provide excellent care for women through pregnancy and delivery, and also offer some alternative birthing options, such as hypnobirthing, in which the patient is taught self-hypnosis to help create a more comfortable birth.
Our midwives also offer well-woman care, such as annual exams and information on birth control. Their warm, relaxed style is often an attractive option for young women seeking their first gynecological health care provider. If you would like more information about our midwives and the services they provide, please ask.
We provide complete gynecological care for women through every stage of their lives.
Complete physical exams and age appropriate screenings
- General gynecological care
- Breast health
- Cancer screenings
- Menstrual problems
- Sexually transmitted diseases
- Gynecological surgery
- Comprehensive birth control counseling and prescriptions
- Adolescent health care
- Peri-menopause and menopause treatment
- Treatments for vaginal relaxation
- Osteoporosis screening
ABOUT NURSE PRACTITIONERS
Nurse practitioners are nationally-certified registered nurses with advanced education. Nurse practitioners can provide comprehensive care for women through every stage of their lives. This can include annual physicals, birth control counseling and prescription services, adolescent healthcare, peri-menopause and menopause treatment, and other standard gynecological services.
New Treatments for Incontinence: About Apex and InTone
Our new treatments for incontinence use products from In-Control Medical of Wisconsin, leaders in incontinence research. The products, called Apex and InTone, and are proven non-surgical solutions for bladder leakage.
One in three women suffers from some form of bladder leakage according to the National Association for Continence. Women may lose bladder control when they laugh, cough, or exercise due to stress incontinence. The loss of control may be only a few drops of leakage or it may be total loss of control, depending on the severity of the problem. This type of incontinence occurs when the muscles and tissue that help support the bladder become weak. These muscles can lose strength due to vaginal childbirth, hormonal changes, high-impact exercise, multiple pregnancies, being overweight, and chronic cough. Even having just one child can lead to some form of leakage, but even minor leakage may become worse over time.
The Apex and InTone products have proven very successful in helping women control their incontinence and get their lives back. Both products can be used for stress incontinence, and the Apex product is especially helpful for new moms affected by incontinence issues. The InTone device can also be used for urge incontinence (for people who need to go suddenly or frequently) and mixed incontinence, for women who have symptoms of both urge and stress incontinence.
The treatments use muscle stimulation via an inserted device, combined with exercises and biofeedback. Treatment usually takes 14 to 26 weeks and includes periodic provider visits to chart progress. Treatment continues until continence is achieved.
Commonly Asked Questions About Apex and InTone
What is InTone? What is Apex?
InTone is a medical device that treats your bladder leakage using the most effective, non-invasive strategies available. It combines proven technologies to treat stress, urge and mixed incontinence. An inflatable probe is inserted to aid in muscle stimulation for building strength so you can stop leakage when coughing, laughing, or exercising. Stimulation also calms spasms of the bladder muscle that cause the symptoms of urgency. InTone is connected to a computer which provides biofeedback advice and records your sessions.
Apex is similar to InTone in terms of type of device and how it works, but Apex is designed specifically for use with stress incontinence, while InTone can be used with all types of incontinence. Apex is also less technical in its approach; it inflates and is used for the same exercises but is not connected to a computer. If stress incontinence patients have trouble mastering the exercises with the Apex, they can switch to InTone with its computerized guidance.
What does InTone do?
InTone combines voice-guided pelvic floor exercises, visual biofeedback and muscle stimulation to strengthen your pelvic floor and stop spasms of the bladder muscle. If you have a strong pelvic floor muscle you can sneeze, cough, laugh and exercise without leaking.
How does InTone work?
Muscle stimulation is customized by your provider to ensure proper muscle activation when using InTone; this works in conjunction with voice-guided pelvic floor exercises using visual biofeedback to improve your performance. After your initial doctor’s visit, you will pursue the InTone course of treatment in the privacy of your home, returning for follow-up visits as indicated by your provider.
How do I use InTone?
InTone voice-guides your entire 12-minute home session, using the same directions that a provider would use during your visit. You will strengthen your pelvic floor muscles by contracting as indicated by the directions coming from the hand-held voice unit, as well as the deep muscle stimulation provided by the InTone device. Data from each session is stored in the voice-guided unit and will be discussed with your provider at your follow-up visits so your treatment can continue to be customized. These home-based sessions will be done just 12 minutes a day, six days per week.
How often are follow-up visits?
The first one will be two-weeks after your initial visit to assess your progress and make any adjustments. Additional visits are recommended to occur at 30-day intervals, depending on your specific diagnosis.
How long is treatment?
Fourteen weeks is usually required for stress incontinence and 26 weeks for urge or mixed incontinence. Most patients continue with follow-up visits every other month for the remainder of the year. Once maximum continence has been achieved, you will use InTone twice weekly to ensure no loss of functional gains.
Partners for Women’s Health Offers NovaSure
NovaSure is for women who have completed childbearing or who have chosen not to have children. One in five women live with periods that are so heavy they get in the way of day to day activities. NovaSure is a one-time, 5-minute procedure that can lighten or end a woman’s period. After this procedure, for over 90% of women, menstrual bleeding is dramatically reduced or stopped.
The NovaSure Endometrial Ablation is a quick, safe, and simple procedure to lighten or stop your periods. It does so without the side effects of hormones or the risks of hysterectomy. This one-time, five-minute procedure can be done in your doctor’s office, usually for the cost of a copay.
To learn more, click the link below to visit the NovaSure website:
- Ultrasound: We provide complete ultrasound services for both gynecological and obstetrical needs. Convenient access to service is our top priority.
- Basic infertility evaluation and treatment is available. Patients needing further assistance are referred to both local specialists and those at major medical centers in New Hampshire and Massachusetts.
- Laparoscopic surgeries
Dr. Evelyne Caron, one of our staff physicians, also specializes in pediatric and adolescent gynecology. Dr. Caron assists young and infant patients who have anatomical concerns or conditions, pelvic pain, pelvic disorders, problems in the development of female organs, or abnormal periods. To learn more about Dr. Caron, please visit our Staff page.
EMOTIONAL CHANGES DURING PREGNANCY AND POSTPARTUM
How common is it? NORMAL – 50-80% of women experience blues
Timeframe: Can occur anytime in the first week. Usually gone by 2-3 weeks after birth
Symptoms: Mood swings, weepiness, feeling overwhelmed. Resolves without medical assistance
DEPRESSION AND ANXIETY DURING PREGNANCY AND POSTPARTUM
How common is it? 15-23% of women, more often in teens. 10% of men
Timeframe: Can occur anytime in pregnancy or first year after birth. It can start gradually or suddenly. Unless treated, it may not go away.
- Frequent crying
- Sleep disturbances (insomnia / excessive sleeping)
- Appetite disturbances (eating too much or too little)
- Anxiety / panic attacks
- Feelings of anger / irritability
- Over-concern or lack of concern for baby
- Intrusive repetitive thoughts or mental pictures
- Reliving past trauma
- Feelings of guilt and worthlessness
- Feeling overwhelmed / unable to cope
- Loss of interest in things you previously enjoyed
- Fear of harming baby or yourself
What can I do?
It is not your fault and you are not to blame!
Talk with your healthcare provider about how you are feeling
Find a supportive person to talk with – reach out for support
Who can I call for support and information?
Mental Health Center of Greater Manchester Emergency Services 24/7: 603-668-4111
Postpartum Support International Warmline: 800-944-4PPD www.postpartum.net
Suicide Prevention Hotline: 800-273-TALK
How common is it? 1-2 per 1000 women. More often if someone has a history of mental illness
Timeframe: Usually occurs within the first 4 weeks after birth
Needs treatment immediately!
- Seeing or hearing things that others do not
- Agitation, restlessness, irritability
- Mania: feeling speeded up, distractible, excitable, having a decreased need to sleep, or exhibiting fast, pressured speech
- Paranoia (extreme fears)
- Extreme mood swings
- Inability to reason, delusions
- Thoughts or plan of hurting yourself or baby
What can I do? THIS IS AN EMERGENCY!
Needs to be treated by a doctor right away
Another family member or friend may notice something is wrong before you do
Who do I call for support and information?
Go to your local emergency room
EMOTIONAL SUPPORT SERVICES FOR PREGNANCY AND BIRTH
Mother-to-Mother Connections at Families First, The Seacoast Postpartum Support Group of New Hampshire
Families First Health Center in Portsmouth, NH
Finding Yourself in Motherhood
WentworthDouglass Hospital in Dover, NH
Thursdays 11:00am to 12:00 noon
The Mental Health Center of Greater Manchester
401 Cypress St, 2 Wall St, 1555 Elm St, Manchester, NH
Postpartum Support International: www.postpartum.net
- Links for support groups by state, information for dads / families, “Weekly Chat with an Expert”, telephone warmline support
Massachusetts General Women’s Mental Health Center: www.womensmentalhealth.org
- Reproductive psychiatry resource and information center
Online PPD Support: www.ppdsupportpage.com
- Online discussion forums for postpartum depression
Postpartum Dads: www.postpartumdads.com
- Excellent support resources for dads and families
Postpartum Progress Blog: www.postpartumprogress.com
- Most widely read blog on PPD, written by a survivor, advocate, and board member of Postpartum Support International
Postpartum Stress Center: www.postpartumstress.com
- Self-screening tools and patient support information
The following sites have research based information on risk/benefits of meds during pregnancy and lactation:
- Mother to Baby: https://mothertobaby.org/
- Infant Risk (Dr. Thomas Hale’s website): www.infantrisk.org
Robotic Surgery Available
Partners for Women’s Health offers robotic surgery to patients that qualify, thanks to Exeter Hospital’s da Vinci Xi surgical robot. Dr. Antonio Gargiulo, director of robotic surgery at Brigham &
Women’s Hospital in Boston, and medical director of the Center for Reproductive Care at Exeter Hospital, has been performing robotic surgery for 12 years and has trained key members
of the Exeter Hospital team. Among these is Dr. Evelyne Caron, one of Partners’ physicians; Dr. Caron has trained on the da Vinci robot and is now performing a range of gynecological surgeries using this technology. She will be regularly performing these surgeries going forward. The use of robotic surgery techniques has made complex surgeries faster and easier and has reduced the need for large incisions in many cases, allowing them to be done laporoscopically instead. Robotic surgery is especially helpful with fibroids, hysterectomies, and endometriosis issues. Physicians believe it will also be used for other modalities in the future.
Please view our video below for more details and information: