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Combining Convenience and Compassion

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LOUISVILLE With 11 board-certified female physicians at the helm, Women First of Louisville Obstetrics and Gynecology is no stranger to leading the way in women’s health care. Founded in 1988, the first all-female practice in the area prides itself on bringing a unique perspective and the latest technology to provide women of all ages with comprehensive care.

As stated by Lori Warren, MD, who has been with the practice since 1991, “The majority of doctors now going into OB-GYN are female, so we’ve seen a paradigm shift in women providers caring for women. And, we’re proud here at Women First, of course, because we have all female providers, and we feel it’s an honor to take care of our female patients.”

Warren, who is board certified in obstetrics and gynecology (OB-GYN) and female pelvic medicine and reconstructive surgery (FPMRS), received both her bachelor’s and medical degrees from the University of Kentucky. She then did a residency at Tufts University in Boston. Warren is also an assistant clinical professor with the University of Louisville’s Department of Obstetrics and Gynecology and co-director of the Minimally Invasive Gynecologic Surgery fellowship (MIGS).

Warren states, “Our vision is to provide comprehensive gynecologic and obstetrical care for women of all ages. Besides specializing in minimally invasive surgery and reconstructive pelvic surgery, I’m very interested in wellness and longevity for women. I enjoy teaching patients about nutrition, hormonal balance, and staying healthy as we age.

Women First’s goal is to ensure that each phase of comprehensive care, from evaluation with state-of-the art equipment to the diagnosis and surgical solution, can all be performed right in the office.

Comfort and Convenience

By offering many minimally invasive, in-office surgical procedures, Women First has found another to way to optimize the patient experience.

“We have continued to broaden our strategies so that we can better meet patient demand for convenience, as well as cost-effective, quality care,” says Executive Director Denise Kirkham, “We currently offer in-office services such as endometrial ablations for heavy periods, treatment of abnormal pap smears, and bladder Botox for urinary incontinence. By expanding into a larger surgery suite, we can offer a more comfortable and caring environment for our patients.”

Margarita Terrassa, MD, who serves as the medical director for the Women First in-office surgery and procedure suite, adds, “We are very proud to be the pioneers in offering surgical procedures in the comfort of our own office space. No one else here in Louisville is really doing that.”

After completing her undergraduate degree at Syracuse University in Syracuse, New York, Terrassa, who is board certified in obstetrics and gynecology, received her medical degree from Ponce School of Medicine in Ponce, Puerto Rico and completed a residency at Tulane University Hospital in New Orleans, Louisiana.

Both Terrassa and Warren are proponents of using cutting-edge technology and the most advanced techniques to ensure patients get the best results with the least discomfort. Currently, upwards of 95% of Women First’s surgical procedures are minimally invasive.

Warren states, “We’re making strides all the time in better techniques and better outcomes for women. We’ve been able to do very big surgeries through small incisions with less risk than ever before.” Warren’s passion for promoting minimally invasive surgery was so great that she founded Pass the Pearls, Inc., a non-profit organization whose mission is to educate women about minimally invasive surgery and help them gain access to quality surgical care.

And, Terrassa explains, “I perform all hysterectomies using daVinci® robotic technology, since it allows me to move my hands in ways that traditional laparoscopy does not. It also allows me to better visualize the anatomy and perform complicated laparoscopic procedures that require significant surgical dissection and suturing.”

Within the next few months, Warren and Women First plan to add transvaginal taping (TVT) to their in-office offerings as an option for the large number of women who suffer from stress urinary incontinence, which, according to, amounts to one in three over their lifetime.

“My goal is to be able to offer my patients an option to treat their stress urinary incontinence in our in-office setting,” says Warren. “To be able to offer this life-changing procedure in the comfort of our office is very exciting to me.”

Sympathy in Surgery

Terrassa states, “Pregnancy can be such an exciting time, but studies reveal that anywhere from ten to twenty-five percent of clinically recognized pregnancies will end in miscarriage.”

Women First plans to offer a more compassionate approach for patients who require medical procedures after a miscarriage. Terrassa says, “We are expanding to include surgical management for miscarriage in the comfort of our office. The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. We will offer a safe environment for our patients who undergo a D&C for pregnancy loss at less than ten weeks.”

By making the procedure available in-office, a woman can have her partner right there, holding her hand, throughout the process. Statistically, this vastly improves the experience.

By offering many minimally invasive, in-office surgical procedures, Women First has found another to way to optimize the patient experience.

“At Women First, we want to be able to offer a safe, comfortable, and caring space, where a couple is able to stay together during the procedure, and to support them with a compassionate team of nurses and physicians,” says Terrassa.

A Safer Sedative

Some find it surprising that it is the longtime best friend of dentists everywhere that is allowing more and more procedures to be done in-office. Warren explains, “We are now offering nitrous oxide and oxygen analgesia in our office, which is improving our patient experience by reducing pain and anxiety during office-based treatments.”

With nitrous oxide, which is short-acting and requires no IV or needle sticks, the patient is in complete control and can inhale as much or little of the sedative as she chooses.

Warren adds, “We always counsel our patients that they still have the option to go to the hospital, but more and more of them feel comfortable just having it done here. They have really taken to it. I’m surprised at how quickly patients adapted, and I have not offered it to one patient who didn’t want it.”

In addition to making strides in the in-office surgical arena, Women First is also changing the provider game by providing an all-inclusive flat rate for surgical procedures so the patient clearly knows the total cost for a procedure up front.

“Innovative cost options continue to be a very important focus for us,” says Kirkham. “Clearly communicating upfront an all-inclusive cost or fee for our surgeries helps our patients know exactly how much each procedure is before it’s scheduled…no surprises. This is definitely a more cost-effective option for our patients. And, who wouldn’t want to hold the hand of a caring family member or friend as well as your nurse during a procedure? I know that I would appreciate that level of caring and compassion.”