What’s Happening Down There – Vaginal Birth Postpartum Care

In my first year working as a doula and childbirth educator, I have found that what surprises women the most is not how tired they feel in the third trimester, not the intensity or duration of labor, and not the overwhelming joy they feel when they see their baby for the first time, but rather, what it feels like to recover from a vaginal birth. First, let me be very clear: every woman experiences birth and recovery differently. Some women may feel like doing cartwheels just hours after birth, some women may experience mild discomfort, and some women may experience a rough recovery. Much like other variables in birth, there is no way to predict what your experience will be.

The ease or difficulty with which you recover from a vaginal birth may (or may not) depend on many factors: your level of fitness prior to birth, how many vaginal births you’ve had before, how your care provider cares for your perineum during pushing, how you pushed during birth (directed vs. following your natural urges), positions used for pushing, and the length of time that you spend in labor and during pushing. The following information shares tips for soothing some of the more common discomforts women experience after a vaginal birth. As with anything, be sure to with consult your care provider about treatment options.

Swelling – Unless you have a very rapid birth, you will most likely experience swelling “down there.” Your vulva will look and feel swollen. Don’t worry, though — it will go away within a few days. For soothing, many hospitals have special pads that turn magically into ice packs. You can also wet and freeze a regular pad — it will feel wonderful, trust me.

Soreness – As with most things on your body that swell (see above), your vagina and surrounding parts will most likely feel sore for a few days to a couple of weeks after giving birth. Even if you do not tear (see below), you still may feel tender from stretched and swollen tissues. The best thing you can do to recover is to take it easy and rest your body.

Burning/stinging – If your perineum tears (or if you have an episiotomy) during birth, you will most likely experience additional discomfort in the days and first couple of weeks after birth. Your best source of soothing is the peri bottle that is given to you during your hospital stay (basically, a squeeze bottle to squirt warm water over your perineum as you urinate to prevent stinging and to cleanse your genitals). Home birth mamas can purchase these online or use any small, clean squirt bottle. Some women also find that witch hazel pads and an anesthetic spray (like Dermoplast) can also provide soothing relief.

Hemorrhoids – You may have developed hemorrhoids during your pregnancy, and if you didn’t, you may experience them after birth (as a result of pushing). Either way, these swollen, bulging vericose veins near your anus can cause irritation, itching, and can even be painful. There are many remedies to soothe your sore bum, including ice packs, witch hazel pads, a sitz bath, medicated hemorrhoid cream, and over-the-counter anti-inflammatory medication (ibuprofen, acetaminophin). Avoiding standing or sitting for long periods of time will also aid in reducing swelling.

Weak abdominal muscles – Your mid-section goes through an amazing transformation from pregnancy to postpartum. Immediately after you have your baby, your “tummy” will still look as though it’s about 6-8 months pregnant, as a result of your uterus, which takes time to shrink back down. Additionally, similar to late in pregnancy, you may find yourself having a hard time sitting up from lying down and getting up from a sitting position. This difficulty comes not from the weight of your baby, of course, but from weak core muscles. Some women experience the normal stretching of skin and muscle that occurs with pregnancy and some women experience what is known as “diastasis recti,” which is the separation of the right and left side of your abdominal muscles. To aid in postpartum abdominal strength, you might consider wearing a belly binding apparatus, which provides more stability as you move around. For diagnosis and healing of diastasis recti, you will want to consult with your doctor and/or a physical therapist.

Lingering contractions – Otherwise known as “after pains,” these post-birth contractions are necessary to shrink down your uterus to its pre-pregnancy state, but may also may cause you to tap back into your deep breathing coping methods used for labor! The good news is that many first-time moms may not even notice these contractions, and for second-time moms and beyond, they are brief and will disappear completely after a few days.

 

What was your postpartum vaginal birth experience like? Did you experience something not on our list? Share in the comments!

 

Why You May Want to “Labor Down” Before Pushing in Birth

Congratulations, you are completely effaced and dilated to 10 cm — you’re ready to push out a baby! Or are you?

Many of us have come to believe that pushing during birth begins when you have reached the magical 10 cm. But in fact, there is a beneficial practice that can come before pushing called “laboring down.” Instead of forcefully and actively pushing with each contraction immediately after reaching 10 cm, laboring down allows your body to naturally bring baby further down and rotate while you follow only natural, gentle urges to push (or not push at all). This process can last for up to 1 to 2 hours.

Pushing is hard work, and while many women find it satisfying to begin working with their contractions by pushing, it can be helpful to allow yourself a span of time to let your body do the work naturally before exerting the energy it takes to push out your baby. First-time moms may push for 1-3 hours, or it could be 10-20 minutes. And because it’s impossible to predict the amount of time you’ll spend pushing, laboring down is an effective way to help you conserve energy by reducing the amount of time spent actively pushing.

Similar to laboring down, some women may experience a “rest and be thankful” phase after reaching 10 cm. With this normally occurring phenomenon, labor seems to “stall” and you experience no natural urge to push for around an hour after completing dilation. Instead of pushing with each contraction during this time (which exerts a lot of energy), you may want to consider waiting until you have the natural urge to push. Like laboring down, rest-and-be-thankful allows your body to rotate and bring baby down without exerting a lot of energy on your part.

So whether you’re laboring down or resting and being thankful, when should you start pushing? When you begin to feel the overwhelming urge to forcefully bear down with your contractions, it’s a good sign to go ahead and push. If your urge to push isn’t overwhelming (or if you never feel the urge, as is common when you have an epidural), you can wait until your baby’s head is visible (your partner or care provider can let you know).

 

Did you “labor down” or have a “rest and be thankful” phase? Share your experience!

 

photo credit: HoboMama via photopin cc

60 Tips for Healthy Birth: Part 3 – Bring a Loved One, Friend or Doula for Continuous Support

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

 

10 Ways to Have the Best Continuous Support During Labor and Birth

1. Learn why bringing a loved one, friend, or doula for continuous support is important for you and your baby.

2. Encourage your designated labor support person(s) to read The Birth Partner by Penny Simkin.

3. Curious about professional labor support? Find out why a doula can be a wonderful asset to your support team.

4. Learn about the many ways you can find comfort in labor by taking a good childbirth class.

5. Choose a care provider and place of birth that encourages bringing a doula to your birth.

6. Create a birth plan/preferences sheet and share it with your birth support person to make sure that she knows your wishes.

7. Spend time connecting with your birth support person prior to going into labor — get to know each other (if you don’t already), share your feelings about the upcoming birth, and talk about what you envision as the best labor support.

8. Pack a hospital or birth center bag with items you imagine will be useful to the person who supports you during labor — nourishment, scents, favorite lotion, focal point, etc.

9. Be sure that your support team — all of the members present with you during labor and those actively supporting you — are people you actually want by your side. You only get to birth this baby once!

10. If your spouse, family member, or friend is the one who will be your labor support person, be sure they know it is not their job to “save” you from the hard work of labor, but rather to support and comfort throughout your labor, as best as they possibly can.

 

How Did You Know You Were Pregnant – Real Women Share

As a follow-up to last week’s post about the most common early pregnancy signs, this week we hear from real moms who share their early pregnancy signs and how they just knew they were pregnant.

It was most evident with my third, and I don’t remember it being so pleasant. I was tired, had to pee CONSTANTLY, couldn’t poop for the life of me, and my pants were suspiciously not fitting quit right as though my uterus knew something I didn’t. That and I just ‘didn’t feel right.’ No romantic glow here…vomiting started one week later.

-Chelsea W.

 

I had cravings — nothing too random (chocolate milkshake & fries were always on my mind) — but the intensity of the cravings was incredible! I really HAD to have whatever it was, and now! And heartburn, heartburn, heartburn! Smells also seemed to intensify. I had a linen-scented candle and I had to throw it out because it seemed to smell so horrible at the time! 

-Amanda R.

 

My boobs told me the first time. They were crazy tender. Also, my pee smelled different. The second time I had bronchitis and a double ear infection, so I missed my pregnancy symptoms. I was just miserable all over. At some point, I realized I didn’t start my period and took a test.

-Richee E.

 

When I became pregnant with our 3rd child, I knew before I missed my period. We lost our second child as a 40-week stillbirth the previous year, and I had become very aware of my body and cycles during my grief. It was definitely fun to show friends and family a positive test result, but my husband and I knew without a doubt before any tests.

-Sherri W.

 

As soon as implantation happens, I go from having no dreams (that I remember) to having very vivid, realistic dreams. Some stressful, some intense.

-Marisa H.

 

I knew by my boobs. Getting in the shower was quite painful on them. Then, I realized I was supposed to be on my period and I wasn’t. Soon after that, the nose swelling began — and it continued the whole pregnancy. I had nose swelling which followed with a sinus infection… nose swelled the whole pregnancy. 

Gina G.

 

I felt the overwhelming urge to go and take a nap in the middle of the day — and I never nap. In fact, one day, I actually went out to my car during my lunch break and fell asleep for 20 minutes!

-Shelly B.

 

Apparently, my husband knew before I did. He told me I became really moody with him and snapped at everything he said, lol! Since we were trying to get pregnant, he thought it was because I was pregnant. Thankfully, I wasn’t quite as hormonal the rest of my pregnancy as I was in the beginning.

-Avery F.

 

Before I was ever got a positive pregnancy test, I started having round ligament pains when I rolled over in bed. I thought it was impossible to feel those pains that early in a pregnancy, but this was my third, so maybe? As it turned out, I was actually pregnant!

-Cara T.

 

I remember cramping early on — just like I was going to get my period, but it never came. It was like a dull aching feeling in my pelvis and lower back. It lasted for quite a while in the early part of my pregnancy and I remember noticing it most in the middle of the night. 

-Karin L.

 

We want to know — how did you know you were pregnant? Chime in with your experience in the comments!

 

60 Tips for Healthy Birth: Part 2 – Walk, Move Around and Change Positions Throughout Labor

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Walk, Move Around and Change Positions Throughout Labor

1. Learn why walking, moving around, and changing positions throughout labor is important for you and your baby during labor.

2. Limit interventions, like epidural and routine IV fluids, both of which can restrict your ability to move during labor.

3. Bring a trusted friend, family member, your partner, or doula to serve as your birth support person who will be in charge of reminding you to change positions and offer suggestions for movement that keeps labor progressing, facilitates baby’s positioning, or allows you to rest in between contractions.

4. Find a care provider who supports evidence-based practices for a healthy birth, including remaining mobile during labor.

5. Make sure your place of birth is one that encourages women to move around and change positions during labor.

6. Request intermittent fetal monitoring (usually 20 minutes out of every hour) instead of continuous fetal monitoring, which is more restrictive for movement and has been shown to increase the risk of more interventions.

7. Labor as long as possible at home, where you are free to move around as much as you like.

8. If you need to have an epidural, ask your care provider and anesthesiologist about having a lower dose epidural to be able to move and change positions easily, and possibly get up and walk short distances (though many hospitals do not permit this).

9. If you must be monitored continuously or hooked up to an IV (like you would during an induction), you can still get out of the bed! Enlist the help of your support person(s) to help you move around with wires in tow.

10. Familiarize yourself with the many different labor positions you can use to help promote comfort and facilitate labor and birth.

Common Early Pregnancy Symptoms

Many women report knowing they were pregnant before they tested positive on a pregnancy test, and some recall early pregnancy symptoms only in hindsight after getting their long-awaited “BFP” (big fat positive). But most ALL women who are trying to conceive will hit the internet to Google possible pregnancy symptoms before they pee on a stick. It’s just so hard to wait! Of course, there’s no precise way to determine pregnancy by symptoms alone, but you can make an educated guess based on some of the most common early pregnancy symptoms.

Think you might be pregnant? Take a look at this list and see if any of your symptoms match up.

Implantation spotting (bleeding) – At about 6 to 12 days after fertilization, the egg will implant in the lining of your uterus which can cause light spotting.

Late period – Perhaps one of the most obvious sign, but only if you have regular cycles and/or are charting your basal body temperature to detect ovulation and pregnancy.

Tender breasts – Thanks to pregnancy hormones, tender breasts may be one of your first noticeable symptoms of pregnancy. But it could also be a sign of menstruation about to begin.

Nausea – Again, another symptom caused by hormones. While most women don’t report feeling nauseous until week 6 or 8 of their pregnancy, others report feeling queasy earlier.

Unusual tiredness – Hormones are also responsible for a feeling of intense tiredness that washes over you, making you feel like napping anytime, anywhere.

Cramping – As your uterus begins to change and grow — especially if this is your first pregnancy — you may experience cramping that feels similar to menstrual cramps.

Back ache – Often a result of the above symptom or due to a normal loosening of ligaments that occurs during pregnancy.

Frequent urination – Yes, this begins early on. Not due to baby’s growing size (as is the reason for late-in-pregnancy frequent urination), but an increase in fluids that your body produces.

Sensitivity to smells & food aversions – This is often part of the fun little early pregnancy “morning sickness” package.

Light-headedness or fainting – Fainting isn’t just for Hollywood, folks — it can be a real symptom early on in pregnancy, caused by the major changes in blood volume in your body. It can also be caused by low blood sugar.

Mood swings – If you’ve noticed unusual spells of weepiness or irritability, you might just be pregnant! This is caused by — you guessed it — an increase in hormones brought on by pregnancy.

 

Did you experience any of these common symptoms early on in your pregnancy? What would you add to the list?

 

 

National Birth Defects Prevention Awareness Month

National Birth Defects Prevention NetworkJanuary is National Birth Defects Prevention Awareness Month. As a woman who is pregnant, trying to get pregnant, or will one day get pregnant, it’s important to know what current research says about preventing birth defects. According to the National Birth Defects Prevention Network (NBDPN), birth defects are the leading cause of infant mortality. The good news, however, is that you can take steps before and during your pregnancy to prevent birth defects. NBDPN advises women who are pregnant or who are planning to become pregnant to take the following steps to prevent birth defects:

  • Consume 400 micrograms of folic acid daily
  • Manage chronic maternal illnesses such as diabetes, seizure disorders, or phenylketonuria (PKU)
  • Reach and maintain a healthy weight
  • Talk to a health care provider about taking any medications, both prescription and over-the-counter
  • Avoid alcohol, smoking, and illicit drugs
  • See a health care provider regularly
  • Avoid toxic substances at work or at home
  • Ensure protection against domestic violence
  • Know their family history and seek reproductive genetic counseling, if appropriate

Patricia Olney, MS, a certified genetic counselor and pregnancy risk specialist at MotherToBaby (the pregnancy and breastfeeding medications and toxins exposure specialist organization)  informs parents about the importance of taking folic acid:

Since one-half of U.S. pregnancies are unplanned and because birth defects occur very early in pregnancy (3-4 weeks after conception), the United States Centers for Disease Control recommends all women of childbearing age consume folic acid daily.  CDC estimates that most of these birth defects could be prevented if this recommendation were followed before and during early pregnancy.

Folic acid can be found naturally in dark leafy greens (spinach, kale, collard greens, romaine lettuce), asparagus, broccoli, brussels sprouts, cauliflower, celery, carrots, squash, beets, oranges, papayas, grapefruit, strawberries,  fruits (bananas, melons, and lemons), beans (with lentils yielding the highest amount), seeds and nuts, avocado, yeast, mushrooms, and beef. To ensure that you are receiving sufficient folic acid on a daily basis, CDC advises taking a synthetic supplement (vitamin) of folic acid that delivers at least 400 micrograms of folic acid.

To learn more about prevention or find a support group, NBDPN has created a comprehensive list of birth defect internet resources for parents and families.

60 Tips for Healthy Birth: Part 1 – Let Labor Begin on Its Own

In this six-part series, we will share 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

 

10 Ways to Let Labor Begin on Its Own

1. Learn why letting labor begin on its own is important for you and your baby.

2. Choose a doctor or midwife who has a low rate of induction and who is comfortable with a pregnancy that lasts 42 weeks.

3. Know that your “due” date is not an expiration date. Only about 5 percent of moms give birth on their due date. Instead of a day, think of it as your due “month.”

4.  Learn about induction — when it’s needed for medical reasons and when it’s used for reasons of convenience. A good childbirth class will cover this topic in detail, as well as give you the tools you need to ask the best questions and make an informed decision.

5. If your care provider suggests an induction, ask questions. Is it an emergency? What’s the risk in waiting? What are the alternatives?

6. Unsure of your care provider’s recommendations? Consider seeking a second opinion.

7. Want to avoid the barrage of calls, texts, and emails around your due date? Keep your due date a secret. Tell friends and family you’re due “sometime in April,” or whatever month your predicted due date is in.

8. Prepare yourself for the mental mind game that occurs with nearly every mom who reaches 39-40 weeks. Schedule mini celebrations for each passing day or days — lunch with a friend, pedicure, ice cream, movie, bliss out to your favorite tunes. Do whatever it takes to relax and take your mind off of having a baby!

9. Remind yourself that every day your baby is still on the inside is one more day she needs to grow and develop. Healthy babies are worth the wait.

10. If you end up needing an induction, learn how you can keep your labor as normal and healthy as possible. If you are induced through the use of Pitocin, consider asking if your care provider can turn down or turn off the Pitocin once your body has established a good contraction pattern.

Five Fun Ways to Document Your Pregnancy

Liz Abbene, one of our contributors, waiting for her belly cast to dry during her 4th pregnancy.

Newly pregnant? Documenting your pregnancy is a fun way to preserve the memory of your growing baby and changing body, and your child will one day love looking at the images, notes, or letters where she was in your “tummy.” Below are five fun ways to document your pregnancy.

1. Weekly belly photos. This can be done in SO many ways. It can be as simple as taking a profile photo of your belly in the same spot and same shirt every week of your pregnancy, or as elaborate as putting your images into a video, or creating a hard bound or digital book. You can keep your images simple, or add a note, message, or comparison item (“your baby is the size of a lemon…”) for fun. For some inspiration, check out this weekly belly shots board on Pinterest.

2. Keep a pregnancy journal. Your journal can include photos, mementos, notes about your pregnancy, doctors’ visits information, sonogram pictures, letters to your baby — anything you want to preserve and share about your pregnancy. You can create your own, or you can purchase one of the many available online or at a major bookstore.

3. Weekly letters to your baby. This is not only a wonderful way to preserve the memories from your pregnancy, but also an amazing gift that your child will always treasure. You can write hand-written letters, you can set up an email account and email your baby, or your can blog your letters.

4. Professional maternity photo shoot. If you can swing it, professional maternity photos are a wonderful way to capture a moment in time during your pregnancy. You can have them taken solo or with your partner. Be sure to research different poses and shots before going to your shoot so that you get just the look you were hoping for (Google “maternity photo poses”).

5. Belly cast. For a more three dimensional documentation of your pregnancy, you can have your belly cast so that you can preserve your shape forever. You can purchase a kit online or find someone locally who will come to your house and do it for you. Once your cast is dry, you can decorate or paint it as you like. Some moms also use their cast to pose their newborn for the first set of baby photos.

 

How did you document your pregnancy? If you have a link, please share it with us! 

Enjoy the Holidays, Safe, Sane & Sound During Pregnancy

By Dr. Kecia Gaither

Deck the halls and hark the herald! Well ladies, the holiday season is upon us again.  Time for family and friends, shopping and travel, New Year’s resolutions and my personal favorite—cooking and eating.  So let’s  discuss a few things, from a medical  perspective, that will keep you and your precious cargo well and whole for the holiday season.

Travel: Recommendations for travel will vary depending on your destination, mode of transportation and the length of time spent traveling. Basic rules: being pregnant increases your risk of blood clots in the legs; long hours of sedentary travel further increases that risk—it’s important during your excursions to wear comfortable clothes, support stockings and to get up and stretch at least every two hours to get that blood pumping.  If you are going to an exotic destination, try to avoid those locales where vaccinations are needed; if you must go, consult your physician to verify which vaccinations are safe during pregnancy.  Be extra cautious about consuming the water in foreign countries to avoid stomach upset/traveler’s diarrhea—err on the side of drinking bottled water in these circumstances.

Flying during pregnancy, pending your medical status, is considered safe in the first and second trimesters.  Prior to making your reservation, it would be prudent to contact your airline carrier for their travel policies concerning  pregnant women as restrictions may vary.  Due to a lack of oxygen, it may be wise to avoid flying in small, unpressurized planes while pregnant.

Food: Food is the mainstay of any holiday celebration — however, there are some foods pregnant women should avoid due to the bacteria, viruses or parasites which may be present.  These critters can cross the placenta and not only affect mom, but baby as well.  Listeria, a bacteria, is top on the list of germs that can cause severe food borne illness, miscarriage, and stillbirth.  Foods such as unpasteurized cheese/milk, and poorly cooked hot dogs may contain this bacteria, so be vigilant in their consumption.  Foods with raw eggs,  (like eggnog), or  uncooked vegetables (particularly sprouts), or under-cooked poultry may contain E.coli and Salmonella, both of which can cause sickness for mom. Undercooked pork products  may contain a parasite which can cause trichinosis — this one can also cross the placenta and affect the fetus, causing stillbirth, so be sure that all pork is thoroughly cooked. Proper refrigeration of cooked food also is important. The USDA recommends pregnant women avoid foods which have been left out for more than 2 hours.

New Years’ Resolutions

When you’re pregnant, there are a few resolutions that are certainly worth thinking about, and that are attainable and maintainable.

  1.  Cut the mama drama – decrease the stress in your life.  Stress for anyone, but particularly pregnant women, affects both mother and fetus—presents with an increased risk of preterm labor/delivery, low birth weight infants.  Stress also contributes to the development of hypertension.  Anecdotally, mothers who are under immense stress tend to have crankier babies.  Stress busters—meditation, yoga, aromatherapy, professional counseling and therapy—all are safe, natural ways to de-stress.
  2. Open wide and say AAH! – pay attention to your dental health.  Infection is thought to play a major role, among other things, in the genesis of preterm labor and heart disease. Periodontal disease, is, in effect, a lingering oral infection.  A trip to the dentist for cleaning of plaque/attention to any gum disease decreases your incidence of preterm labor and delivery.  Make sure to schedule routine visits for maintenance of your oral health throughout the year.
  3. An apple a day keeps the doctor away– the old adage is true; nutrition contributes to great health. Pay attention to your nutritional choices with the new year—focus on increasing your fruit, vegetable, beans, and whole grains intake—cut down on fatty high cholesterol containing foods/processed foods. Lean meats like chicken and turkey are great. Increase your water consumption and eliminate drinks containing high fructose corn syrup.  Good nutrition contributes to a healthy growing fetus, and post delivery, helps with good milk production and keeping mom in a positive nutritional balance.

With those thoughts in mind, enjoy your holiday season, ladies!

 

Dr. Kecia Gaither serves as the Vice Chairman and the Director of Maternal Fetal Medicine in the Department of Obstetrics &
Gynecology at Brookdale University Hospital and Medical Center located in Brooklyn, N.Y. – one of the region’s largest and busiest nonprofit teaching hospitals. In her current position, Dr. Gaither oversees the hospital’s OB/GYN’s Ultrasound Unit and the Maternal Fetal Medicine Division. With more than 20 years of professional experience, Gaither’s expertise is grounded in the
research and care for women with diabetes, HIV and obesity in pregnancy.

A New York City native, Gaither’s mission as a medical professional is to offer exemplary prenatal care to those often
underserved and overlooked. The women who enter Dr. Gaither’s office are typically without the financial means nor the emotional support needed to receive the proper care needed while carrying a high-risk pregnancy.

photo credit: richiebits via photopin cc