Category:Women's Health

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Overview

Each clinic does Women’s Health Care as able, including PAP smears, breast exams, IUD Implanon placements/removal, and endometrial biopsies. There are several case managers who help with women’s health (see attached list). YKHC has a CDC Breast and Cervical Health Grant that helps YK bring in patients for PAP smears, annual exams and cancer diagnosis of breast or cervical or uterine cancer. The grant will pay for travel, meals and lodging if necessary for any women between the ages of 21-64.

The current YKHC PAP guideline suggests no PAP under 21 and then Q 3 years after that until 30. At 30 years – 65 years of age they need paps Q 5 years—as long as there is no hx of abnormalities.

We now use liquid PAPs (see LAB section). If abnormal PAPs, they are followed on a database by the CDC Breast and Cervical Care Manager: Nina Jones RN. We follow the ASCCP guidelines for dealing with abnormal PAPs. There is a great app for it on your smart phone.

Any abnormal looking cervixes, endometrial biopsies and skin lesion removals in the perineum that you feel need further work up, can be referred to Women’s Health in Bethel. Feel free to contact the Gynecology Case Manager for that @ 543-6557. Mammograms can begin at age 40 but, our current YKHC guideline is to start at age 45 and do them every 2 years.

For annual exams, you can use Well Woman’s encounter pathway note. Please make sure to document Family History, Procedure History and give Birth Control.

If you have a patient with an abnormal breast exam she will need a mammogram and a breast ultrasound, both must be done prior to the surgeon seeing them. You need to clearly document where the mass is. If she is under 40 they will only do a sono. If she is over 40 they will do both a sono/mammo.

All referrals to ANMC surgery, whether to see the general surgeon in Bethel, in Specialty Clinic and/or a surgeon in Anchorage, need to have a phone consult with an ANMC surgeon and be documented on the specialty referral form. The WH Grant Case Manager (543-6296) will make sure that copies of the mammogram and sono go to ANMC for review prior to the patient’s visit.

Women’s Health Grant Info

PAPs & Mammograms

The Women's Health Grant is funded by the CDC and is not associated with YKHC. They only fund for certain appointments or follow-ups. These appointments are for Annual PAPs, Mammograms and any abnormal follow-ups. But this differs as to exactly what age the patient is.

Ages

  • 21-29 WH Grant will pay for PAP every three years since last exam (subject to change)
  • 30-64 WH Grant will pay for PAP & Mammo every three – five years since last exam
  • 50-64 WH Grant will pay for PAP & Mammo every year since last exam
  • Over 64 no coverage from the grant

The Women's Health Grant does not pay for any trips to Anchorage for OB/GYN related issues, surgeries unless it's a breast biopsy or LEEP procedure.

Any abnormal Mammos or PAP follow-ups will also be paid for by the Grant.

Any questions please feel free to call Grant Supervisor Roxanne Andersen Ext: 6696

Case Manager Christina Jones RN Ext 6296

WH Grant Admin Assistant: Ext 6990

Women’s Health Contact Information

Prenatal Case Manager

Ann Glasheen WHNP Phone 543-6305 Fax 543-6689 for questions regarding HROB patients, Labs, medications.

Prenatal Case Manager’s Secretary

Rebecca Martins Phone 543-6189 Fax 543-6689 for prenatal questions/Be-In-Bethel questions/appointments, info on prenatal appointments and Anchorage appointments.

OB/GYN Case Manager

Brenda A. Lamont, RN Phone 543-6557 Fax 543-6689 for OB/GYN referrals, 17 hydroxy-progesterone medication questions.

Women’s Health Grant Care Manager

Christina Jones, RN Phone 543-6296 Fax 543-6689 for Women’s Health Grant questions, Colpo questions/scheduling, PAP, breast, mammogram follow-up questions

Women’s Health Grant Secretary

Phone 543-6990 Fax 543-6689 for Women’s Health Grant appointments, Women’s Health Grant application/questions, OB/GYN appointments (ONLY after a referral has been made)

Midwifery In Rural Alaska: A 1994 article by former YKHC midwife Joan Koval. Still relevant today. PDF will open in your browser. Click your browser's back button to return to the wiki. Link the Joan Koval article here it is in the women’s health folder…

Prenatal Information

Ann Glasheen is the primary resource for the prenatal paperwork. We have a large number of pregnant patients, many who are high risk due to chronic HTN or preeclampsia. At the top of each HPI for a pregnant woman, put a summary sentence like this example.

Pt is a 32 yr old G5P3 AB1 with a EDC of 12/25/15 at 22 weeks gestation with a history of Cholestasis of Pregnancy and Kell Antibodys.

Refer to the OB review attached to the end of this document. Use the RAVEN documents and the Ad Hoc Prenatal Flow Sheet and First Prenatal Visit to complete your documentation for each visit.

Prenatal Appointment Schedule if Uncomplicated

Q4 week: Appts until 32 weeks
Q2 week: Until be-in-Bethel Date
Q1 week: Appts in Bethel and/or Anchorage

Prenatal Labs/Sono Needed

1st prenatal
(If in SRC do labs): CBC, HepBxAg, RPR, CCUA and urine culture, GC/CT, Rubella. Make Bethel appt. for 1st trimester sono. We want a sono as early as possible on everyone.
11-13 weeks: If Advanced Maternal Age, 35 or older, first trimester screening for Down’s. Contact Ann Glasheen for particulars.
15-21 weeks: Do Quad screen
18-24 weeks: Make a 2nd Sono appt. in Bethel for Anatomy screen
24-28 weeks: Prenatal with CBC/GST. If the GST is over 140, will need a GTT ASAP.
36 weeks: Into Bethel and/or Anchorage, CBC, GC/CT, and GBS culture

STDs

We have a very large amount of STDs in the Delta region as well. When someone asks for a STD check, please do Urine or Cervical GC/CT, RPR, and HIV tests. When doing the urine STD test, it needs to be done with dirty urine without having to wipe beforehand. Also ask if they are interested in Hep B, C and Herpes test as well. It’s good to ask whether if the patient is on birth control and what they are using. Educate them in Birth Control. Many women when asked, would like to start on some but, they are too shy to ask for it. We use EPT if pats are positive and using charge nurses to follow up results – fill out the required Partner Information forms .

HROB Stickers--Problems/Plans

Pregnancy Termination

See the attached form to fill out. You can hand them this information packet (get from Dr Roll), but they need to make their own appointment into Anchorage for a termination. If they are over 13 weeks and 6 days the termination cannot be done in Anchorage and the patient will have to fly down to Seattle to go to the Cedar Valley Clinic in Renton WA. Medicaid will still pay for it but you need to apply for the emergency Medicaid so it can be done before too late in the pregnancy.

FAQ

What is an abortion?

It is the termination of a pregnancy. It can be done medically (abortion pills) or surgically in a clinic setting. All pregnancies are confirmed by doing a dating sonogram prior to either procedure.

Is abortion legal?

Yes. Abortion was made legal in Alaska in 1971. In 1973 the Supreme Court decision known as Roe vs. Wade legalized abortion throughout the United States. The Supreme Court has mandated some restrictions on abortion practices, which vary state to state. In the state of Alaska, a termination can be performed prior to 13 weeks and 6 days from the FIRST day of your last menstrual period. Some clinics in Alaska will only perform an abortion up to 12 weeks. Over 13 weeks patients will need to travel to Seattle, Washington.

Are there risk factors?

Yes. As with any medical procedure, there are always some risks involved. Your provider at the clinic you choose will explain these risks to you in detail at your appointment.

What is the difference between a medical and surgical abortion? What is the cost?

A medical abortion can be done from 4-8 weeks from the first day of your last period. Whether you are considered a candidate for this type of abortion is totally left to the discretion of the clinic you choose. If you are traveling from rural Alaska, you will need to stay in Anchorage or Seattle for at least 2-3 days because follow up in the clinic is necessary.

The cost varies in each clinic and if you choose to have additional sedation or pain medication, it may require an additional fee. The average cost is $650-$1500 for either type of abortion. It is always YOUR responsibility to ask about the fees

What should I do for my appointment?

Wear comfortable clothing, a two piece outfit that will allow easy access to your arm while blood pressures are being monitored. DO NOT CONSUME ALCOHOL, ASPIRIN PRODUCTS, OR USE ANY RECREATIONAL DRUGS 24 HOURS BEFORE YOUR APPOINTMENT. If possible, decrease or eliminate all tobacco products including cigarettes and chew. Ask the clinic what you may eat/drink before this procedure and if you may continue to take your regular daily medications or vitamins.

Are there any websites to explore more information concerning abortion?

Yes. An Alaskan organization which offers reproductive choices is The Alaska Pro-Choice Alliance. Their website is: http://www.alaskaprochoice.org. Further information is through the state of AK. http://www.hss.state.ak.us/dph/wcfh/informedconsent/default.htm. Another non-local organization is the Feminist Women’s Health Center which provides reproductive health information. Their website is: http://www.fwhc.org/abortion/index.htm.

What if I have difficulty with my decision AFTER the abortion is over?

Each clinic is different, but post abortion counseling may be included as part of the original fee. Please clarify this BEFORE your appointment. Some websites you may want to explore include: http://www.4exhale.org and www.peaceafterabortion.com

Do I have other options besides abortion?

Yes. You could also consider adoption as an alternative option to abortion. See these websites for more information or contact your provider or the Social Worker at your local hospital. http://www.americanadoptions.com/Alaska or https://www.cssalaska.org/our-programs/adoption-services/

How do I make an appointment for an abortion?

If you have private insurance or you will self pay, you may call and schedule your appointment. If you have no means to pay, you should see if you are eligible for Alaskan Medicaid by applying for Emergency Medicaid. You will need to have your Alaskan Medicaid number BEFORE you can call and make an appointment. The clinics that are available for this procedure are below.

In the State of Alaska (must be less than 13 weeks pregnant):

Colleen Murphy, MD
4231 Lake Otis Parkway
Anchorage, AK 99508
907-563-7228 Fax: 907-563-6278

Susan Lemagie, MD
425 E. Dahlia, Suite J
Palmer, AK 99645
907-745-8379 Fax: 907-745-0153
(Does not accept Medicaid)
(up to 12 weeks gest. Est: $1440.00)

Planned Parenthood of Alaska-Anchorage
4001 Lake Otis Parkway
Anchorage, AK 99508
907-563-2229 Fax: 907-563-7419
1-800-769-0045

Michael Merrick, MD
416 Frontage Road, Suite 400
Kenai, AK 99611
907-283-5487 Fax: 907-283-6062
(Patient must stay in area)
(up to 12 weeks gest. Est: $700-800)

Alaska Women’s Health Services
4100 Lake Otis Parkway
Anchorage, AK 99508
907-563-7228

If you are more than 13 weeks pregnant:

Cedar River Clinic
263 Rainier Ave. South, Suite 200
Renton, Washington 98057
1-800-572-4223 or 425-255-0471
Fax: 425-255-0262

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