1. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Medical Support of Women in Military Environments CAPT Mike Hughey, MC, USNR

2. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2 Pre-deployment Planning AMAL/Block Review Command Pregnancy Policy Screen personnel Brief deploying personnel

3. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 Supplies: GYN Specula Light Source Exam Table? Microscope?

4. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 Supplies: OB Wheel Tape Measure Doppler Nitrazine paper Bedpan

5. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 Supplies: Meds and More BCPs UTI Meds Anti-fungal Rx Metronizazole UCG Urine Dipsticks

6. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 Command Pregnancy Policy Ectopic 1/100 Miscarriage 1/5 Routine Care Environmental Hazards Cultural Issues Transfer Policy

7. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 Pre-deployment Screening Pap Acute/Chronic OB-GYN Issues Contraception Pregnancy

8. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8 Pre-deployment Briefing Urination Menstruation Bathing Quarters Clothing Liberty Risks Leadership Host Nation Pregnancy STDs/Safe Sex

9. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 Urination Issues Unpleasant Difficult Time-consuming Dangerous Consequently, many deployed women intentionally dehydrate, to avoid urination, but with the unintended consequences of: Decreased Physical Performance Decreased Mental Alertness Increased UTIs

10. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10 Urination Solutions Command Awareness Command Response Freshet Lady J Urinate in Tent: –Coffee Can –Ziplock Bag

11. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11 Menstruation Issues BCPs help: –Lighten flows –Shorten flows –Less cramps –Less PMS Pads or Tampons? –Weight –Volume –Convenience –Wicking –Personal Preference Wet Wipes: 5-6/day

12. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 12 Bathing Bring own soap Bring own shampoo Bring a black, nylon, one- piece bathing suit Shower facilities may be suboptimal and available only every few days or longer

13. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13 Quarters in the Field Mixed-gender –Unit cohesion –Protection Separate Gender –Privacy –Jealousy –Supervision

14. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14 Clothing Personal Preference Cotton underwear: –Absorbs, breathes –Good for relative inactivity –Bunches into an abrasive mass during exercise Nylon or other synthetic –Conducts moisture out to the BDUs –Remains relatively dry during vigorous workouts –Not comfortable in bivouac

15. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 15 Liberty Risks Risk of assault is significant Male Buddy –Appearance of inappropriate relationship –Alcohol tolerance issues Female Buddy –Few females –Fewer of the same or similar rank Command Decision

16. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 16 Host Nation Issues Conform to local standards of modest behavior & appearance Avoid being alone with host nation men, particularly in strongly male-dominated countries Unmarried pregnancy may be a special issue

17. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 17 STDs and Safe Sex Condoms are good protection against pregnancy, GC, chlamydia, HIV, Hep B, syphilis. Condoms are not very good protection against herpes or HPV. Any sexual activity that avoids contact with body fluids of either gender is safer than one that doesn’t. Sexual abstinence during deployment is the safest.

18. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 18