Post Partum Care

“I was on the Treadmill 2 days after I delivered” And in Surgery 2 months later!

April 27th, 2017

Pushing too hard to regain your pre-pregnancy physique and activity level can actually have the opposite effect and lead to injury.

In the last post, I shared how many of my clients compare themselves and their post partum progress to celebrities, who more often than not, have a full staff of people helping them with their babies, enabling them to rest, prepare them specialized diets and personally train them to get back to their pre-pregnancy physiques. I have spoken on this topic many times before in an earnest effort to put mamas’ worries to rest that they are not “slackers” if they don’t “bounce back” to their pre-pregnancy weights immediately post partum. For Mamas on Bedrest especially, most people don’t expect you to immediately dash through your homes putting everything into neat and tidy order post bed rest. You won’t have the energy. Some of you will need physical therapy to be able to regain your strength and mobility.  So I continue to encourage you to put the comparisons aside.

I also wanted to draw readers attention to a post on our Facebook Page by the Association for Prenatal and Perinatal Psychology and Health  “Women need a whole year to recover from childbirth despite the ‘fantasy’ image of celebrity mothers, study claims” 

A whole year??! Most American women balk at this statement and as one of my readers clearly stated,

“A year… wow. I wish. That’s literally impossible for most moms in the U.S.”

What a tragic statement about the US’s concern for women’s health, maternal health and the health and well being of mamas and their babies. I could write (and have written!!) an entire post about how the US doesn’t value childbearing as evidenced by our maternity policies and birth outcomes. I’ll refrain from reiterating my utter disdain at this time. But I  do want to address some very important issues that result when women resume their pre-pregnancy activities too soon, and how it can be detrimental to their own health and the health of their newborns.

Bonding – New mamas and their babies need time to bond. While there is already a very strong connection between mama and baby from the pregnancy, new mamas need to learn “this” baby’s cues; the cry of hunger, the cry from being wet, uncomfortable, tired….seasoned mamas know that every child is different, and it takes time to learn the needs and habits of their new little one. Likewise, a newborn is being bombarded with a whole world full of new cues and stimuli. The one thing that this little one needs to know is that when he/she cries, Mama (or some other caregiver) will be there to take care of them. This is the crux of the “fourth trimester” those 8-12 weeks in the early post partum when mamas and babies get to know one another, know each others cues and form their own “communication.”

Breastfeeding – I have said it before but it bears repeating; Breastfeeding is natural but it isn’t always easy. Some baby and mama duos have a hard time establishing a rhythm for breastfeeding. Getting into comfortable positions, establishing a good latch, baby being able to suck and swallow, mom not experiencing nipple pain,…this can all take time. Asian cultures have “The Golden Month” which is the first 40 days after a mama delivers. The women of her clan come and care for her, her family, her home and the baby so that she can rest and breastfeed. Mama does no housework, in fact, mama not only doesn’t leave the house, she stays mostly in bed! The elder women prepare nourishing foods and perform time honored rituals that help mama regain her strength-and establish good milk supply.

Out of necessity, here in the US many mamas must be back at work by 6 weeks. They may or may not have established their milk supply. Many will try to pump at work, but many work places don’t have adequate facilities nor provide adequate breaks in which a woman may pump and store her milk, and clean her supplies. Sadly, this situation results in many American women not breastfeeding beyond 6 months.

According to one of my favorite websites, Post Partum Progressapproximately 15% of Post Partum American women will have post partum depressive symptoms annually. That equates to approximately 600,000 American women! Many women won’t begin to exhibit symptoms for 60 days, well after the standard 6 week post partum visit. So many American women are undiagnosed, untreated and bogged down with the inability to focus, care for their babies, themselves or their families. Post partum depression is a serious medical condition as it can progress into a major depression (sometimes requiring hospitalization) or progress to post partum psychosis which can be deadly. Women with post partum depression need immediate medical attention so that they don’t hurt themselves or their babies. More important, post partum women need careful, longer term surveillance post partum, with many experts recommending that post partum health surveillance last throughout the first year!

Bodily Injury – Due to the pressure of the pregnancy on the pelvic floor and the subsequent pushing and stretching that occurred with labor and delivery, many women lose muscular tone in their perineums and experience prolapse-when a woman’s inner organs (mostly the uterus, bladder and rectum) present outside of her body. I see this primarily in women who begin too rigorous of an exercise program too soon. While not only being uncomfortable, organ prolapse can cause serious medical complications. Currently, with the exception of (mild) bladder prolapse for which a pessary can be placed to tuck the organ back up into the pelvis, the treatment for organ prolapse is surgery. Do you see the irony? While trying too aggressively to get back into shape (after bedrest?) you can land yourself back in bed! Ladies, a gentle walk with your baby in the stroller, yoga or prenatal/post partum fitness classes are the best way to get back into shape while being gentle with your body. Always remember,

“Nine months on, Nine Months off!”

I hope that these tips have helped you to remember the wonderfully fabulous beings that you are! Mamas, you’ve created and given life and that is far more important and worth celebrating than the latest celebrity siting!

 

What are your tips for getting back into the groove post partum? Share them in our comments section below and help another mama!

“Sarah Jessica Parker looked fantastic 2 weeks post partum and I look like a blob!”

April 20th, 2017

About a week ago I (re) posted an article on the Facebook Page about a study out of England which states that ‘women need a full year to recover from pregnancy and childbirth’. There was also a response by a reader,

“That’s literally impossible for most moms in the U.S.”

Sadly, she’s right. America is probably the worst industrialized nation for new mamas, not providing any sort of paid maternity leave, routine in home support for new moms or adequate resources for self care. While I have always been a fierce proponent of the “Year to grow ’em, a year to recover” philosophy, I completely understand that in America, many women MUST get back to work as soon as possible to help support their families.

Unfortunately, Far too many times I’ve had mamas “up and at ’em” just days after giving birth, trying to tackle the responsibilities of running their homes, caring for their older children, back to work full time and starting right in on an exercise regimen in order to “get back to their pre-pregnancy” physique as soon as possible. Not long after, they call me; exhausted, achey, homes and families in chaos, they’re crying at work and with faltering milk supplies. They can’t understand what’s wrong? Some women have actually sustained injuries from trying to do exercise programs that are just too rigorous for the early post partum, and I can think of two clients that actually developed organ prolapses (internal organs coming out of bodily openings) from putting too much stress on their already weakened pelvic floors.

“But Sarah Jessica Parker looked fantastic 2 weeks post partum and I look like a blob!”

What mamas fail to realize is that Sarah Jessica Parker-and other celebrity moms-usually have nannies, housekeepers, personal trainers, chefs and a hoard of other helpers that help them not only manage their homes and their babies, but also are instrumental in helping them regain that “Hollywood glow”. Most of us are lucky if our mothers can come for even a week after we deliver! Sarah Jessica Parker said as much on “The View” after the birth of her son. She shared that she was required to be back on set and able to fit into her wardrobe, so she had private pilates sessions daily, a personal chef preparing special meals and a personal assistant just to handle her affairs! She had a nanny to care for the baby which allowed her to sleep, a housekeeper and a whole host of other staff at her disposal to handle everything else. So yes, she looked fabulous just weeks post partum.

But that isn’t reality.

Mamas, pregnancy and childbirth fundamentally change a woman’s body. Even women who look utterly fabulous after their childbearing years will still have “badges of honor” indicating that they have successfully been pregnant, labored and delivered children. For some women, there will be the very slightest of slack to her abdominal muscles (until she has a tummy tuck!). Others will have faint-or not so faint-stretch marks on the belly, breasts, hips and thighs. Some women will have c-section incision scars. And still others will have invisible badges; that little trickle of urine that escapes when she laughs, coughs or sneezes, hemorrhoids, and other “inconveniences.”But all of them had to allow their bodies to recover. I can’t think of one woman who has given birth of any sort and not said,

“I never had ______ until after I was pregnant and gave birth.”

It just goes with the territory. Most of the so called “badges” are minor, simply little reminders of our journey. However, if women engage in activity that is too vigorous too soon after delivery, even returning to work before their bodies have had a chance to recuperate from the marathon that was pregnancy, labor and delivery, what may have started out as a minor inconvenience can develop into a major problem requiring more time, therapy and sometimes surgical intervention to resolve. Truly it would have been far less traumatic to simply ease back into daily routines.

American culture does not make it easy for women to recuperate from childbearing. However, women themselves can take these 7 steps to ease back into their pre-pregnancy routines.

  1. No vigorous activity until at least 8 weeks post partum, but if post c-section, consider waiting until 12 weeks post partum to fully heal.
  2. Learn and do pelvic floor strengthening exercises.
  3. Rest as much as possible, and whenever you can, take a nap.
  4. Let major housekeeping go and even get help with the small stuff if possible.
  5. Say no to outside activities. You don’t need to chaperone, bake cookies or make calls for any event. Focus on you!
  6. Spend time at home with family. This is precious bonding time for you all.
  7. Reduce work hours as much as possible.

I realize that some of these suggestions will be easier to implement than others. This list is also not exhaustive, but just a starting point. It’s just imperative mamas that you take care of yourselves so that you can get back to your daily routines with full strength and joy. It’s also important to fully heal from this pregnancy, especially if are planning to have other pregnancies in the future. If you start back too soon, you may set yourself back several weeks or injure yourself making subsequent pregnancies more difficult.

I know that it’s been a long haul, especially if you’ve spent weeks to months on bed rest. But please, please, please take a little more time to heal. Don’t compare yourselves to other women, especially not celebrities. Your journey is your journey and its best to honor your inner time table as much as possible, allowing your body to heal and prepare for subsequent pregnancies or to simply chart new territory as a mom! Whatever you decide to do, do it with a healthy, strong body!

Do you have a tip for recovering after pregnancy you’d like to share? Do you have a question? Share your thoughts in the comments section below. Your words could be just the thing a mama needs to read today!

Mamas on Bedrest: Pregnancy Can “Break” a Mama’s Heart!

April 13th, 2017

Pregnancy, while one of the most joyous times in a woman’s life, is also one of the most physically and physiologically stressful times. There is no doubt in anyone’s mind that pregnancy fundamentally changes a woman’s body; some women will gain as much as half of their pre-pregnancy weight during their pregnancies. Others will develop gestational diabetes, pregnancy induced hypertension or, in more severe cases peripartum cardiomyopathy (enlargement of the heart) or kidney failure. During pregnancy, the body increases its blood volume by 50 to better be able to nourish the growing fetus and maintain mama. Most women will “sail” through their pregnancies, labors and deliveries, have healthy children and will “live happily ever after”. Others won’t be so lucky and they or their children will perish from primarily preventable forms of heart disease.

 

Cardiovascular (heart) disease is a leading cause of death in the United States. A recent article published in Obstetrics and Gynecology reports that researchers in Illinois found that from 2000-2011, nearly 20% of all maternal deaths were heart related,  Here is what they found:

  • Most of the deaths occurred in the third trimester or within 6 weeks of the post partum period.
  • Most of the heart related problems happened in women ages 30-39, while the most severe cases occurred in women over 40.
  • Cardiomyopathy (enlarged heart)in pregnancy is a rare cardiac occurrence, is almost exclusively caused by pregnancy and occurs more often in young women, 20-29 years.
  • Death from cardiomyopathy is more likely to happen in very young women, less than 20 years old.
  • Black women have significantly higher rates of pregnancy related heart disease compared to White or Hispanic women.
  • 28% of all of the deaths were potentially preventable.

Yes, you read that last bullet point correctly. Twenty eight percent of the cardiovascular deaths that occurred during or just after pregnancy in the Illinois report were potentially preventable deaths! So what should you, as a Mama on Bedrest do to protect her heart?

  • Schedule and maintain your regular prenatal visits. Early detection and early action are the hallmarks of treatment success for any disease, but especially cardiovascular disease during pregnancy.
  • Notify your health care provider immediately if you notice any heart palpitations, difficulty breathing, unusual swelling in the hands, feet, face, changes in urine output. Now this may be difficult as you are likely experiencing all of these symptoms as a result of your pregnancy. Suffice it to say that if you have an increase in any of the symptoms or if they suddenly occur where they didn’t previously exist, then consult your health care provider.
  • INSIST ON FOLLOW UP AFTER YOU HAVE YOUR BABY!! One of the key points that came out of the points that came out of the Illinois study is that most of the heart disease related deaths occurred after 6 weeks post partum. Many women have their post partum follow up visits with their obstetricians and then don’t return for a year or unless there are other issues. If you had a problem, even a minor problem during your pregnancy, FOLLOW UP FOR UP TO A YEAR POST PARTUM. Many conditions will “flare” with the fluctuation of hormones during the post partum, i.e. get worse, so you want to be closely monitoring for symptoms.

It is imperative that mamas receive comprehensive care of cardiac problems and are fully treated to avoid-or at least mitigate-heart problems in the future. Thankfully not all mamas who have heart problems will die, but many will have life long problems as a result of incomplete care. Be sure to have ongoing follow up and let all subsequent providers know that you experienced heart problems while you were pregnant. 

The authors also note that providers must do a better job of

  • educating their patients about the signs and symptoms of cardiovascular disease
  • referring patients immediately to specialists when problems occur
  • continuing to monitor their patients’ conditions well into the post partum period, as long as a year post partum.

As this article clearly states, death from cardiovascular complications is very often preventable. Patients and physicians alike must be aware of the signs and symptoms of cardiovascular disease and both must have a low threshold for seeking evaluation; patients from their obstetricians, physicians from their specialists colleagues. Finally, it is imperative that women who developed cardiovascular symptoms during or just after pregnancy be evaluated for an extended time in the post partum, often up to one year post partum.

What is it like to have a pregnancy related heart problem? Hear a mamas story.

Have you experienced a heart problem during your pregnancy?  Please share your story.

If you have more questions, email info@mamasonbedrest.com

References

Medscape

Maternal Cardiovascular Mortality in Illinois, 2002-2011

Briller, Joan MD; Koch, Abigail R. MA; Geller, Stacie E. PhD
doi: 10.1097/AOG.0000000000001981
Original Research: PDF Only