Mamas on Bedrest: Facial Drooping Post Partum

August 30th, 2013

Hi Mamas,

As you all now know, I am a very proud great auntie! My darling grand niece will be a whole week old tomorrow!

So imagine my surprise and concern when my nephew called because my niece-in-law is now experiencing some right sided facial drooping. It started a couple of days ago and he noticed that when his wife smiles, one side of her mouth doesn’t raise up and the eyebrow on that side doesn’t raise up either. This concerned husband and new dad wanted to know what to do.

There are a few reasons that a mama may have facial drooping post partum, but two in particular come to mind. The first and most benign is Bells Palsy. Bell’s Palsy occurs when the facial nerve on one side of the face becomes inflamed and/or the nerve root is compressed such that nerve signals are not able to be carried back and forth from the brain to the facial muscles.  Hence the unilateral facial droop. Sometimes people with Bell’s Palsy will also experience eye dryness or excessive tearing on the affected side, dry mouth, decreased taste, decreased saliva production and hearing and/or balance.

While no one knows the exact reasons that Bell’s Palsy occurs, some common cases of Bell’s Palsy are viruses; the herpes viruses, Epstein Barr virus, Measles virus, mononucleosis, respiratory infections and influenza. I have also heard people develop Bell’s palsy after being in extreme cold for a long period of time. Finally and far less talked about is that Bell’s Palsy can occur in the post partum period. Because mamas in the early post partum, especially those who  are breastfeeding, have a lot of Relaxin on board, all their ligaments and tendons are very soft and lax. There is also muscle laxity and sometimes, if a mama has a nerve opening that is naturally small, the laxity in her muscles may press on the nerve and result in Bell’s palsy.

Evaluation of any sort of facial droop and proper diagnosis is very important. While Bell’s Palsy is a relatively benign condition, it mimics many of the signs and symptoms of a stroke. So if you or someone you know/love begins exhibiting signs of one-sided facial drooping  they should be evaluated by a health care professional as soon as possible. The evaluation is quite simple. The health care provider will take a detailed history and then do an examination focusing on the neurological examination. The neurological examination will look at the symmetry of the face, symmetry of movement of the face (i.e. do both eyebrows raise, do both corners of the mouth raise when patient smiles, etc…), and sensation. Depending on the history and the findings on the examination, the health care provider will either order more tests or make the diagnosis of Bell’s Palsy and suggestions for treatment.

Treatment for Bell’s palsy is relatively simple. Most times there is no treatment and the symptoms simply resolve on their own in a few weeks to a couple of months. If the patient has a history of a virus, they may be prescribed corticosteroids to reduce the inflammation. Most times things that make the patient feel better are all that is needed.

One reason it is very important for new mamas to be evaluated when they develop one-sided facial weakness is because women in the early post partum are at increased risk for having strokes. Because a pregnant woman’s blood volume increases by 50% during pregnancy, that combined with the increased estrogen are a perfect set up for blood clots to develop, for one to become lodged in a blood vessel and for a stroke to occur. This is a much more serious condition than Bell’s Palsy and may require medical intervention in order to avoid lifelong nerve damage and sensory loss.

I am still waiting to hear back from my nephew to see how my niece-in-law is doing. He was taking her to the doctor today. I am hoping and praying that all is well and given that she is young and quite healthy, the likelihood is that this is a benign process. However, since we can’t be sure it’s best to take no chances.

When in doubt, Get checked out!! I’ll keep you posted!

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