Postpartum Nightmares

In a 2007 study, doctors at the University of Montreal conducted a study involving postpartum, pregnant and never been pregnant women to study the prevalence of nightmares during pregnancy and postpartum. They concluded that postpartum women reported they had dreams which contained anxiety (75%) and the infant in peril (73%) compared to 50% of pregnant woman who had similar dreams.

These dreams often came with movements in sleep that suggested agitation and restlessness. The doctor conducting the study posited that new mom’s (and dad’s) experience these dream because they are settling into a phase of life that involves caring for a child that is still establishing a new reality in their lives. Combined with fragmented sleep is a hot bed for lucid dreams.

Despite being so common, it is still rarely discussed because of the often violent nature of the dreams. Many mom’s are concerned that they will be judged by others for having such explicit visions involving their baby. Emotional superstition also leaves women feeling that if they acknowledge or talk about the events in their dreams that they will somehow come true. Common themes involve car accidents, or losing a baby in blankets or sheets. But sleep specialists have argued that this is a part of the bonding processes that many parents go through, and dreams like this can help deepen the evolutionary protective nature of being an new parent, scary as they may be while having one. A lot of women saw these types of dreams reduced after a year or so, but would still occasionally have them for years after.

A more serious version of these postpartum nightmares are the ones associated with PTSD that has been known to occur in women who have experienced traumatic births. Nightmares in which they relive the traumatic events are a serious symptom of PTSD, and a doctor or professional should be contacted.

Additionally, though unrelated, if you feel like it’s possible that you might actually injure yourself or your baby immediate help needs to be sought, as this may be symptomatic of postpartum psychosis.

 

Vaginal Birth

The most common method of delivery is through vaginal birth. Two in three babies in the United States are birthed this way because for most women the pros of delivering vaginally outweigh the cons of delivering via surgery. This is not true for every woman, however, and knowing all the options available and discussing them with a doctor or midwife ahead of time can reduce complications for mom and baby.

A vaginal delivery without advance knowledge of any complications is often preferred because it is viewed as the most natural way of having a baby. This is true in part for several reasons that benefit the both mother and baby. First, physiologically speaking, while delivering vaginally hormones and mucus from the baby’s lungs are literally squeezed out. The release of mucus helps open a baby’s lungs, reducing breathing problems during their first few months. Additionally, hormones such as oxytocin and prolactin increase during labor, which assist in practical changes like the softening of a cervix for dilation, but are also regarded as the “love drug” that promotes bonding between mother and baby. The production of these hormones during labor also assists in the production of milk, and without having undergone surgery, a mother is typically able to breastfeed faster.

There are risks associated with vaginal delivery that vary from person to person. Unique situations such as pre-eclampsia, diabetes, a large fetus (particularly for women with a smaller pelvis), and infections like HIV or genital herpes that can be passed along during delivery are factors that many should take into account when devising their birth plan with a trusted medical provider. While these instances could effect the mother as well as the baby, the possibility of tearing of the perineum, genital prolapse, and weakened muscles of the pelvic floor are all things moms should be aware of prior to delivery.

All birth plans are as unique as the women creating them, and respect should be given to whichever makes the most sense for a mom and her baby.

 

Wisdom from a Midwife

 

How should women prepare for a vaginal delivery?

Education is key to letting the natural process of labor occur. I did not get prenatal education with my first pregnancy and I regret not being able to make more informed choices in my labor. There are so many forms of prenatal education available now – weekly emails, classes, videos, and social media outlets. When I teach childbirth classes I have women and their partners imagine labor will be like one (or all three) of the following: a marathon, a mountain climb, or the 24-hour stomach flu ; ) These are not neccesarily enjoyable when you are going through them, but people overcome them all the time. I affirm that even first time moms can acheive a natural birth if desired, but also let them know what resources/interventions are available if they cross the line into suffering. Suffering does not lead to a productive labor, so being prepared to handle the unpredictable nature of labor is important. – Anna Nieboer

More information on caesarean (c-section) delivery, and Vaginal Birth after Caesarean (VBAC)

Sources:

http://www.yourhormones.info/topical-issues/hormones-of-pregnancy-and-labour/

https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/basics/labor-and-delivery/hlv-20049465

VBAC Delivery

A conversation with a mother who gave birth 20 years ago would reveal that the wisdom of the day was if you have one c-section, every birth afterwards has to also be a c-section. The fear of uterine rupture and delivering in hospitals not equipped for emergency intervention was much greater in the past. Changes in how a caesarean surgery is performed have allowed for more women to attempt a vaginal birth after having a c-section. This is referred to as a Vaginal Birth After Caesarean, or VBAC.

About 70% of women who attempt a trial labor after caesarean (TLOC) are successful, but the success and reasoning behind having a VBAC, or not, vary depending on a battery of circumstances. First, many hospitals will not allow VBAC births because they are not set up to handle an emergency uterine rupture surgery. Though there is only a 1% chance of a rupture occurring, many clinics won’t take this risk. So women who want to attempt a VBAC should discuss this with their provider early in their pregnancy to make sure they are not only a viable candidate, but find out if their doctor’s office will allow it.

There are many reasons why women choose to have a VBAC even with the associated risk. Which includes avoiding major surgery, a shorter recovery time, and wanting to experience a vaginal birth, especially for those who want a larger family, as multiple caesarean scars can make surgeries harder and increase the likelihood of placental problems.

But there is an extensive assessment of each individual woman’s health and medical history that will let doctors know if she’s a viable candidate. The main thing that would disqualify a woman from trying a VBAC is the type of caesarean scar she has on her uterus. (Note, the abdominal scar doesn’t necessarily match the internal incision). Only women who received a low transverse c-section should attempt a VBAC. A high vertical incision used to be the standard, but has a higher rate of rupturing, which is why the old method was to not suggest a vaginal birth after c-section. Things that could prevent a VBAC are a prior uterine rupture, a fibroid removal, or some other uterine surgery. Additional factors that would decrease the likelihood of VBAC include:

  • Stalled labor
  • Advanced maternal age
  • Pregnancy that continues past 40 weeks
  • Body mass index greater than or equal to 40
  • Excessive weight gain during pregnancy
  • Preeclampsia
  • Previous delivery within 18 months
  • History of two or more prior C-sections and no vaginal deliveries
  • A need labor induction

Obviously the main risk associated with a VBAC is uterine rupture, which could lead to emergency surgery and possible uterine removal if the bleeding cannot be stopped. To prevent risk for mother and baby, a conversation about the woman’s medical history and factors should be discussed with her health care provider to create her individualized birth plan.

Wisdom from a Midwife

How should expectant mothers prepare for vbac?

Fear directly inhibits the process of labor. Oxytocin (the hormone that drives labor) is blocked by Adrenaline (hormone produced by fear/suffering). There is a lot of fear around VBAC in modern healthcare because many OB providers feel a repeat Cesarean Section has less liability. Unless a woman can feel supported prenatally & confident in attempting a VBAC, the fear will often inhibit natural labor and her “scheduled C/S” date that a provider often sets will arrive. Choosing a provider and birth team that decreases fear is a key factor in successful VBAC. – Anna Nieboer (CMN)

More information on vaginal birth and c-section birth

Sources:

https://www.mayoclinic.org/tests-procedures/vbac/in-depth/vbac/art-20044869

https://www.mayoclinic.org/tests-procedures/vbac/about/pac-20395249

Caesarean Section Birth

Commonly known as a C-Section, a caesarean section is the method of delivery through abdominal surgery. Though less common than a vaginal birth, 1 in 3 women will have their baby this way through pre-planned election because of health or personal reasons, or during an unplanned emergency. Knowing the facts and risks of a c-section is important whether having one is the plan or not because things can change quickly during a delivery if a risk to the mother or baby is discovered.

When creating a birth plan, it may be apparent to schedule a surgery in advance due to health concerns. Risks such as having a narrow pelvis, a heart condition, brain condition, or infection are main reasons why a c-section is considered. About 30% of women who have delivered a previous child through c-section  have following children also by surgery due to the risk of uterine rupture during labor. There are unfortunately many unforeseen circumstances during delivery that could precipitate a c-section to mitigate risk to the mother or baby. Some of these events include: a stalled labor; drastic change in a baby’s heart rate; a baby is in a breech or transverse position; a mother is carrying multiples; placenta previa has occurred and the cervix is being blocked; a prolapsed umbilical cord had come through the cervix ahead of the baby; or a mechanical obstruction of the cervix such as a fibroid, fractured pelvis, or hydrocephalus.

Any of the above situations can be scary, and to then by thrust into surgery unexpectedly only adds to the chaos. Some risks associated with having surgery include bleeding and hemorrhaging, and very rare cases of emergency hysterectomy, a longer hospital stay and recovery time, infection at the wound site and uterus, blood clots, and possible reactions to anesthesia.

Because trauma is subjective to each person’s experience, some women feel that an emergency c-section is a traumatic birth, and can lead to increased postpartum depression. An initial follow up appointment with a medical care provider for all postpartum women is recommend by the American College of OB-GYNs no later than 3 weeks after delivery to check on physical and metal wellbeing of the mother, child, and support network.

Like with any method of delivery, the reasons or method a woman choses is as unique as she is and should be respected. Having all information necessary to make an informed decision is an important first step.

Read more about vaginal delivery or VBAC delivery.

 

Sources:

https://medlineplus.gov/cesareansection.html

https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655

Postpartum Complications

Like any major health event, there can be risks and complications that threaten your life. If you or a loved one experience any of these symptoms after delivery of a baby, vaginal or c-section, call 911 or your healthcare provider immediately.

Be on the look out for the following:

  • Temperature of 100.4°F or higher
  • Calf or leg pain with redness, warmth or tenderness
  • Sudden and heavy blood loss, or increasing blood loss, including clots and dizziness.
  • Severe or persistent headache
  • Elevated blood pressure
  • Upper abdominal pain or tenderness
  • Have vomited or feel nauseous
  • Shortness of breath even when you rest
  • Chest pain
  • Thoughts of harming yourself or your baby

Click to download a printable form.

Urination & Bowel movements

Postpartum Urination & Bowel movements

Postpartum Urination & Bowel movements Urination & Bowel movements – Almost all women have some degree of incontinence postpartum—whether it is urine or fecal or both. Pregnancy and birth stretch the connective tissue (pelvic floor) at the base of the bladder and can cause nerve and muscle damage to the bladder or urethra. It is common to leak urine when you cough, strain or laugh in the immediate postpartum period. Also, the swelling or bruising of the tissues surrounding the bladder and urethra can also lead to difficulty urinating. Fearing the sting of urine on the tender perineal area can have the same effect. Difficulty urinating usually resolves on its own. In the meantime, streaming water from a peri-bottle on your vulva, from front to back, while you’re sitting on the toilet to urinate will help.

 

Contact your health care provider if you have any signs or symptoms of a urinary tract infection:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine

 

Postpartum pelvic physiotherapy is very helpful in reducing or eliminating incontinence and when used in combination with a pelvic floor support, pressure and strain from gravity and internal swelling on the perineum and pelvic floor soft tissues will be greatly reduced.

 

Postpartum Psychosis

Postpartum Psychosis, postpartum thoughts of hurting yourself or your baby

Postpartum Psychosis, postpartum thoughts of hurting yourself or your babyPostpartum Psychosis
A much more rare condition occurring in about one to two per 1,000 women. Onset is usually in the first several weeks following childbirth and symptoms are the same as PPMD, but far more severe and intense. Women with postpartum psychosis may exhibit frantic, excessive activity, are unable to eat, are incoherent or very confused, and make irrational statements. They may have hallucinations, believe people or others that do not exist are talking to them or directing their behavior. Loss of memory and thoughts of harming themselves, their baby, or others are immediate signs of postpartum psychosis and must be treated immediately by a physician specializing in treating this type of psychosis. Call your doctor or midwife or 911 for help.

Postpartum Hips

Postpartum hip pain, changes in hips after childbirth, lose hips, hip pain after childbirth

Postpartum hip pain, changes in hips after childbirth, lose hips, hip pain after childbirth Hips – A consequence of pregnancy, childbirth and the hormone Relaxin, that loosens your body to prepare for childbirth, is hip pain, which many women experience for  days or weeks postpartum. Pelvic/hip supports combined with ice or heat therapy and later physiotherapy will help relieve pain and regain normal function.

Postpartum Mood Disorders/Depression (PPMD)

Postpartum Mood Disorders/Depression (PPMD) PPMD is less common than the baby blues but not uncommon as it is estimated that 20 to 40 percent of women experience PPMD at some point during the first year after childbirth. Symptoms are similar to a mood disorder but more intense and longer lasting. Common Symptoms of PPMD: - feel inadequate, despondent - unable to cope with everyday life - hopeless - very anxious or have panic attacks - obsessed with getting things into order - fears about your health and your baby’s health - sleep difficulties - under or over eating - social withdrawal or not wanting to be alone - anger A difficult or unexpected childbirth experience, having a premature baby or special needs baby increases the likelihood of PPMD. You should contact your physician or midwife if these symptoms occur frequently and cause you to be unable to care for your baby and/or yourself.

Postpartum Mood Disorders/Depression (PPMD)  PPMD is less common than the baby blues but not uncommon as it is estimated that 20 to 40 percent of women experience PPMD at some point during the first year after childbirth. Symptoms are similar to a mood disorder but more intense and longer lasting. Common Symptoms of PPMD:                   - feel inadequate, despondent  - unable to cope with everyday life - hopeless - very anxious or have panic attacks - obsessed with getting things into order - fears about your health and your baby’s health - sleep difficulties - under or over eating - social withdrawal or not wanting to be alone   - anger  A difficult or unexpected childbirth experience, having a premature baby or special needs baby increases the likelihood of PPMD. You should contact your physician or midwife if these symptoms occur frequently and cause you to be unable to care for your baby and/or yourself.Postpartum Mood Disorders/Depression (PPMD)
PPMD is less common than the baby blues but not uncommon as it is estimated that 20 to 40 percent of women experience PPMD at some point during the first year after childbirth. Symptoms are similar to a mood disorder but more intense and longer lasting. Common Symptoms of PPMD:

– feel inadequate, despondent

– unable to cope with everyday life

– hopeless

– very anxious or have panic attacks

– obsessed with getting things into order

– fears about your health and your baby’s health

– sleep difficulties

– under or over eating

– social withdrawal or not wanting to be alone

– anger

A difficult or unexpected childbirth experience, having a premature baby or special needs baby increases the likelihood of PPMD. You should contact your physician or midwife if these symptoms occur frequently and cause you to be unable to care for your baby and/or yourself.

Pubic Symphysis Disorder

Pubic Symphysis Disorder, pubic pain

Pubic Symphysis Disorder, pubic pain Pubic Symphysis Disorder –

The left and right bones of your pelvic bones are joined at the front by a narrow section of cartilage and ligament. This is called the pubic symphysis. As the pelvic bones loosen during pregnancy, the pubic symphysis can temporarily separate. This is not a dangerous condition, but can be painful.

You can feel the pubic symphysis by pressing on your lower front pelvic bone, just above your genital area. Your health professional can tell when it is separated or misaligned simply by pressing on it. You can realign your pubic symphysis with exercise and pelvic support devices.

A separated pubic symphysis can take 3 to 8 months to heal on its own but sometimes never heals properly. For most women with this condition, pain or discomfort remains for months after childbirth.

Pubic Symphysis Disorder, pubic pain