Birth Trauma

Mamas on Bedrest: How pregnancy triggers physiologic and emotional responses in women

May 9th, 2014

Hey Mamas!

PregnantwomanonballI’m bringing you Part II of Kathy Morelli’s series on physical and hormonal influences on women’s mental health. In Part II she focuses on the changes that occur during pregnancy. Kathy breaks down the emotional responses to pregnancy this way:

Emotional. What if the pregnancy was unplanned? What if this pregnancy follows a stillbirth or miscarriage? What if her primary relationship with the baby’s father is not going well? There is also job stress, financial factors and a whole host of other life stressors that combined can make the news of a pregnancy hard to take and All of these emotional considerations require attention and adjustment. We clinicians and birth workers must be aware of these potential life stressors and be sure that we are as vigilant in addressing these emotional needs of the women that we serve as we are addressing their physical needs.

Physiologic/Hormonal. By the first six weeks of pregnancy, estrogen levels rise to three times more than during the menstrual cycle! Progesterone levels also rise quickly and Progesterone is also implicated in depressive moods. As the pregnancy progresses through the second and third trimester, along with elevated estrogen and progesterone levels, the hormones cortisol, prolactin and oxytocin rise. Cortisol is a strong player in the HPA feedback loop. High levels of cortisol are also associated with depression. And prolactin is also associated with anxiety, anger and irritability. Oxytocin is known as the bonding and happiness hormone. Natural oxytocin causes nutrition absorption, uterine contractions, pair-bonding, mother-infant bonding, pain amnesia, calmness and feelings of belonging and happiness. Now add in bed rest! Mamas on Bedrest are at increased risk of developing perinatal mood disorders because in addition to the normal hormonal fluctuations of pregnancy, the stress of being on bed rest and the unsurety of the pregnancy stimulate the “fight or flight” response, releasing additional cortisol and neurotransmitters that will affect Mamas’ mood.

During an uninterrupted birth, there is a surge of oxytocin, beta-endorphin, adrenaline, noradrenaline and prolactin. These hormones all combine to orchestrate the event of birth and positive emotional outcome. Oxytocin for uterine contractions, calmness, love.  Beta-endorphins for a protective emotional high during a peak physical activity.  Adrenaline rush for energy and the final push of the fetal ejection reflex.  And high prolactin levels to consolidate breast milk production and breastfeeding. However, if there is medical intervention of any sort during labor and delivery; an epidural, episiotiomy, forceps/vacuum extraction or cesarean section, this natural hormonal protection and mood enhancement is disrupted and often lost resulting in birth trauma, post tramautic stress disorder and post partum depression. The extent of the trauma is different for every woman and typically correlates to the level of intervention. Researchers are just beginning to understand the delicate interaction between hormones, labor and deliver and a women’s mental health, and as more research is done, we will have better understanding of this complex interaction and how best to care for women during pregnancy labor and delivery to protect their mental and as much as possible, minimize negative emotional effects.

In Part III, Kathy looks at hormones and post partum! 

 

Mamas on Bedrest: Don’t Lose Sight of What’s Truly Important!

April 30th, 2014

Happy Wednesday, Mamas!

In this video blog I want to encourage you to partner with your health care provider-not contradict or become adversarial-for best birth and health outcomes for you and your baby.

I was on one of my birthing professional sites and happened to read a disturbing account written by a woman who had hired a doula for her birth. The Doula essentially told this woman to do the opposite of whatever her OB advised, telling her that the OB was just trying to control her birth and give her a c-section. I was really moved by this account and got into a deep online discussion with some other workers on the site. Some wanted to blame the mama for listening to the doula, but I countered with “If you are unsure and has hired someone to help, it is natural to defer to their “expertise”.

That sparked this vlog. While I am a wholehearted proponent of doulas, THEY ARE NOT MEDICALLY TRAINED PROFESSIONALS! I really want to re-emphasizes the importance of having complete trust and confidence in your provider, being able to ask questions and have them answered fully to your satisfaction and being able to have the ancillary support that you need. Enjoy the post and please share your comments and experiences in the comments section below.

Mamas on Bedrest: Not all C-Sections are bad

January 24th, 2014

Mamas,

Vanessas-birth

My daughter at birth

Having a c-section is not the worst thing that can happen to you. I say this from the perspective of having had 2. While chatting with mamas in this community, one mama stated how she is terrified at the thought of having a c-section. I realized that c-sections have become demonized in the birth world and this is not a good thing.

On this blog, all over the web there and in numerous chats there are articles and points of view touting “normal”  and “natural” (meaning vaginal) delivery. I’ll admit that I am a proponent of minimal intervention. Having went through what I went through to have my children, I know the potential pitfalls of too much intervention. Intervention must be balanced with “watch and wait” and not overdone. Even though labor and delivery is a marathon process, there are many physiologic benefits for mamas and babies who endure the process and emerge victorious on the other side. So for women who can, I most certainly advocate for “natural, vaginal birth”  whenever possible.

Well, the sad truth is that this isnt always possible. Many years ago, many women (and babies) died as a result of being unable to deliver “naturally” and doctors and midwives of the day not having the skills or technique of cesarean section. Thankfully (for me and my daughter at least) clinicians have those skills and expertise and many mamas and babies are alive today. But what is a very viable and useful method of delivery and one that saves lives in critical situations has become an overused, overdone process. Cesarean sections are the second most performed surgery in the US second only to Hysterectoies. And while they are a critical tool in the obstetrical arsenal, their overuse has contributed to many mamas and babies are not faring so well during the childbirth process.

Currently cesarean sections account for a full one third of all births in the United States. According to the CDC, rates of C-section deliveries-especially first time c-section deliveries-have leveled off and are declining. This is good news because a first c-section is often an indication for subsequent c-sections. C-sections are often scheduled for the following reasons and these indications are responsible for 85% of all cesarean deliveries:

  • “large babies”
  • uterine/placental/vaginal issues,
  • fetal distress or shoulder dystocia
  • breech presentation
  • The leading indication for cesarean delivery is previous cesarean delivery

I doubt anyone would argue the necessity of a cesarean section for a mama and/or baby in distress; i.e. mama’s blood pressure skyrocketing and not responding to medication, a decrease in fetal heart rate, decreased fetal movement which may indicate a problem, or other complication. But in this country, c-section has (or had) become the norm for twins, mamas who have gone beyond 39 weeks (as late as 42 weeks is still considered full term!), induction (a whole other topic for a blog in and of itself!), “big baby” and several other “nebulous” reasons. C-sections became a way to “control” birth and to be able to dictate specifically when a baby would be born and who would be attending.

That is where we here in the US fell into problems. Birth is a wild and unpredictable process. Because we can never be exactly sure when conception and implantation occur (except in cases of assisted reproductive technology), clinicians really are guessing the age and developmental status of an infant in utero. Granted, we have some very sophisticated technology that we can use now and get a pretty accurate “guestimate”. But we are still guessing, and sometimes the guesses are off way more that expected. there also seems to be this need to control the process. Birth should not be controlled. It is as it is for a reason; so that mama’s and baby’s physiologies can interplay and together navigate the birth process. That process, that delicate physiologic communication is disrupted when clinicians intervene. Again, sometimes intervention is waranted. But historically in the US, the interventions are often more disruptive than beneficial.

So what should a mama do? How does she decide? Mamas, always have frank and open discussions about your care with your health care providers. Ask them what they hope to accomplish by performing a cesarean section and why they believe it is the best course of action in your particular case. Get as much information as you can; read, get second opinions if you feel uneasy. Make sure that in the end, whatever route of delivery you choose, you are comfortable with the decisions made and the procedures being performed.

Not all c-sections are bad. Many are lifesaving (as was the case with me and my daughter!). Just be sure that you are fully informed and fully at peace with your decision for the procedure before you signed the “informed consent”.  Remorse and regret following a birth that has not gone well can haunt a mama for years. It can have lifelong (negative) implications for the baby. And sadly, it cab alter the interaction between mama and child if not just initially, for many years to come.

What are your thoughts of C-section? Share your thoughts in the comments sections below.