Depression

Five Things to Expect During Your Postpartum Recovery

As mothers and mothers to be, we typically spend a great deal of time planning and preparing for our child’s birth. We read books, take prenatal classes, write birth plans, pack bags, wash, fold and organize baby laundry and so much more in preparation for the big day. Very few of us however, give much thought to what the postpartum period will be like for OUR bodies. Consumed with the excitement of our baby to be, we may forget that once we bring home our bundle of joy we too will need care, rest and healing as we recover from the amazing feat of giving birth. Here are 5 things to expect from your postpartum recovery.

  1. Heavy bleeding: As your body sheds the uterine lining and also bleeds from where the placenta was attached, you will experience heavy bleeding known as lochia. You may see blood clots in this bleeding and it will likely appear bright red at first. The intensity of the bleeding should subside with time and gradually turn to spotting before it stops. Typically, this should last approximately 2-6 weeks after you give birth. To prepare, stock up on heavy duty overnight strength sanitary pads, mesh panties and even adult diapers can be a great option. This applies whether you had a vaginal delivery or a C-section.
  2. Some pain and discomfort: Take a moment to consider what an incredible thing it is that your body is going to birth a 6-10 pound baby. With this incredible miracle comes hard work and its fair share of aches and pains. Whether you have a natural birth or a C-section, you can expect to experience some cramping, soreness, muscle aches and joint pains. With a vaginal delivery you may also experience some burning and soreness of the perineum and with a C-section, pain at the incision site and abdominal pain as you recover from major surgery.
  3. Hormonal side effects: As your body seeks to adjust hormonally after giving birth, you will likely experience a few unpleasant side effects. These may include fluctuating emotions and weepiness, hot flashes, night sweats and chills, and continued feelings of clumsiness from the production of the hormone relaxin. Give yourself some grace during this period as you may not feel like yourself despite your excitement over your new baby. If you are concerned that the baby blues may be developing into something more serious like postpartum depression, contact your midwife, doctor or a counselor for support. There are many wonderful resources available for women suffering from postpartum depression. Don’t be afraid to ask for help. 
  4. Breast changes: As your milk comes in after baby is born, you may experience some engorgement and sore nipples and breasts as your supply adjusts to meet baby’s needs. You may also notice that your nipples appear darker. If you are recovering from a C-section, breastfeeding can initially be more challenging due to pain from your surgery and having to find a position that is comfortable for you and your newborn while you heal. Fear not though, it will get easier with time and your milk supply will adjust as you and your baby find your rhythm. Consider having nipple pads on hand for leaking breasts, cooling pads or ice packs for sore breasts and a nipple cream for aching and cracking nipples. Be sure to signup for our next Pumptalk 101 class if you have extra questions or would like some more suggestions.
  5. Constipation, incontinence, and frequent trips to the bathroom: Depending on how you delivered and your own personal recovery, you may experience a period of constipation following giving birth and/or urinary or fecal incontinence. A vaginal delivery can cause temporary nerve damage around the bladder making it more difficult to sense when you need to go to the bathroom. You may also have weakened bladder muscles, hemorrhoids and though less common, tears to the anal sphincter causing fecal leakage. Conversely, you may also experience constipation due to the slowing of your metabolism and digestive tract. Talk to your doctor or midwife for effective ways to manage these various side effects.

It’s not uncommon for the postpartum period to be filled with excitement, exhaustion, trepidation and feeling a bit overwhelmed. Make sure that amidst all the emotions and adjustments, you allow time for your own care and recovery. Your body has just undergone the incredible journey of childbirth and needs time to rest and heal so that you can focus on caring for your new, beautiful baby. 

Miscarriage: Common Concerns & Questions

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Pregnancy following a miscarriage can feel like a rollercoaster of emotions. While miscarriages are unfortunately quite common, occurring in approximately 10-20 percent of pregnancies, they can often make the miracle of pregnancy feel like it’s lost some of its innocence. An experience that was once only filled with excitement and joy is now riddled with anxiety, questions, lingering grief and doubts. Here are some common concerns and questions you may have if you are trying to get pregnant again following a miscarriage.

Why did it happen to me? 

One of the most difficult aspects of having a miscarriage can be the feeling of not understanding why it happened. Having answers or a reason why something has happened can sometimes make it easier to accept and move forward. With miscarriages, there is often no explanation, leaving the parents feeling bewildered and distraught. In most cases, miscarriages occur because the fetus is not developing properly or there is a chromosomal abnormality. The abnormalities occur by chance as the embryo develops and have nothing to do with anything you did or did not do during or before your pregnancy. It is rare that a miscarriage happens due to something inherently wrong with the mother’s health or habits. Typically, in these uncommon cases there is an existing health condition such as poorly controlled diabetes or an undiagnosed uterine problem. More often than not, the cause is unknown.

Will it happen again? 

Because most miscarriages are typically due to unexplained and random chromosomal abnormalities, your chances of having another miscarriage remain about the same as your previous pregnancy: between 10 and 20 percent. However, only approximately 2 percent of women have two miscarriages in a row, so you can take comfort in knowing that the chances of this occurring are rare. Most women fortunately go on to have healthy pregnancies and healthy babies. 

Is there anything I can do to prevent it? 

Unfortunately, because miscarriages are often due to random chromosomal abnormalities or the fetus not developing properly, there is usually nothing that can be done to prevent their occurrence. However, there are measures that you can take prior to and during pregnancy to help ensure a healthy, full-term pregnancy for you and baby. These include:

  • Starting a regular prenatal vitamin regimen several months prior to trying to conceive
  • Eliminating unhealthy habits like smoking, alcohol, recreational drug use and excessive caffeine consumption before trying to get pregnant
  • Maintaining a healthy weight and eating a nutritious and balanced diet
  • Avoiding risky activities, contact sports and other scenarios in which you might experience abdominal trauma.

Am I ready to be pregnant again? 

This is a question that only you (and your partner) can truly answer. Miscarriages can be physically and emotionally trying and allowing yourself time to grieve the loss of your baby is an important step towards healing. It is not uncommon to feel sadness, anger, confusion, and even guilt following the loss of a pregnancy. Take the time necessary to process your grief, whatever that time frame may be.

How long do I need to wait before trying to get pregnant again?

Following a miscarriage, it’s not uncommon to be wondering when you can try to get pregnant again. For many women, the urge to become pregnant again with a viable pregnancy becomes quite strong following a loss. If you are eager to conceive again after your miscarriage, talk to your doctor or midwife to determine when it is safe for you to try again. Typically, you will be advised not to have sex for two weeks following the miscarriage to prevent infection. If you do not experience any complications, your period should return within six weeks and your cycle should return to normal. Although many doctors and midwives will advise you to wait one or two menstrual cycles before trying to conceive, some research suggests that there is no medical need to wait. 

What will I do if it happens again?

If you do experience more than one miscarriage, it is a good idea to ask your doctor or midwife about having additional testing done to rule out any underlying medical issues that may be causing them to occur. This may include hormone imbalances, uterine fibroids, obstructions in the fallopian tubes, autoimmune disorders and other medical issues affecting fertility and pregnancy. Tests that your doctor or midwife might order include bloodwork, ultrasounds, chromosomal tests, and other exams and procedures to rule out problems with uterus, cervix and fallopian tubes.

How can I process the grief I’m experiencing?

It’s not uncommon to feel alone in your grief following a miscarriage as they are unfortunately often not a subject that is openly discussed. Particularly if the loss occurred before you had shared the news of your pregnancy with family and friends, you might feel as though you have no one to turn to as you process your grief. The grief that accompanies the loss of a pregnancy should not be experienced alone. Reach out to friends and family members who can support you during this time and who may have even experienced loss themselves. Seek out online support forums for women who have experienced a miscarriage to connect and hear stories of hope and future pregnancies. Let your partner know how they can best support you during this time whether it’s simply through listening or through creating some sort of small memorial honoring your baby in your home. Talk, write, cry, listen, hug and grieve as long as you need to in order to move past this difficult time in your life.

Trying to conceive and becoming pregnant following a miscarriage can be a scary and confusing journey. Take comfort in knowing that most women will go on to have healthy pregnancies and healthy babies following a miscarriage. For more information about coping with loss, pregnancy, natural birth, the postpartum period and infant care, contact Health Foundations for a free consultation with a midwife. We would love to support you in your journey.

Vitamin B-12 Injections: Use, Deficiency, Risks, & B-12 In Pregnancy

Vitamin b12 Injections

Vitamin B-12 injections are a great way to bridge any nutritional gaps in your diet and ensure that you are receiving what you need. Hydroxocobalamin is a natural form of Vitamin B-12 that can be administered via injection to improve energy levels, aid in red blood cell development and help maintain a healthy central nervous system. Here’s everything you need to know about Vitamin B-12 injections.

Recommended Dosage:

For adults over the age of 14, the recommended daily intake of Vitamin B-12 is 2.4 mcg. During pregnancy, the recommended amount increases to 2.6 mcg and when breastfeeding, to 2.8 mcg. Vitamin B-12 can be found in many foods, including meat, fish, eggs, poultry and milk and also in your prenatal multivitamin.

Vitamin B Deficiency:

While only 1-1.5 percent of Americans have a true deficiency, as many as 40 percent fall within the low-normal range for Vitamin B levels. Symptoms that may indicate low Vitamin B levels include fatigue, depression, low blood pressure, constipation, memory loss, weakness, sore tongue, tingling and numbness in fingers and toes, mood changes and difficulty walking. In more severe cases, a Vitamin-B deficiency can result in nerve damage, anemia and stomach complications.

Who’s At Risk?

Certain populations are at a higher risk for deficient and low levels of Vitamin B-12. These groups include vegetarians, vegans, and persons with pernicious anemia, gastrointestinal disorders and alcohol abuse problems. The increased risk for these populations is due to low levels of consumption and difficulty with vitamin absorption. 

Is it Possible to Have Too Much Vitamin B-12?

Fortunately, Vitamin B-12 is a water soluble vitamin that will be naturally eliminated by the body when the amount needed is exceeded. Because of this, taking more than the recommended dosage of Vitamin B-12 will neither help nor harm you unless you have an actual problem with deficiency. Toxicity is not a risk. 

The Shot:

The Vitamin B-12 shot has been shown to be effective at treating a deficiency, boosting energy and in some cases lessening symptoms of depression and improving cognitive function. The injection is given directly into the muscle, typically in the thigh or upper arm. The dose administered is dependent on the condition and can be tailored in frequency and amount based on the patient’s response. Common side effects associated with the B-12 shot include soreness at the injection site, diarrhea, swelling and itching. If you experience side effects from the shot, adjusting the dosage can be effective at reducing the occurrence. Serious and rarer side effects can include muscle cramping, irregular heartbeat, shortness of breath, slurred speech, vision changes, chest pain and weakness on one side of the body. Call your doctor or midwife immediately should you experience any of these more serious side effects. 

Vitamin B-12 in Pregnancy:

Vitamin B-12 is particularly important during pregnancy as it not only helps to regulate mom’s nervous system and red blood cell formation but also helps fight defects of baby’s spine and central nervous system. Also, because the Hydroxocobalamin version of the B-12 shot is a natural form of the vitamin, it is perfectly safe to receive during pregnancy and while breastfeeding. Moms who are strict vegetarians or vegans and are breastfeeding are at a higher risk for Vitamin B-12 deficiency. 

For more about essential vitamins and nutrients during pregnancy, check out this article. If you’re interested in learning more about the benefits of the Vitamin B-12 injection, contact Health Foundations to speak with one of our midwives. We offer the B-12 injections at the Birth Center in addition to many other health and wellness services for women. For questions about B-12 injections, pregnancy, natural birth and other women’s care matters, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center.

When Your Birth Doesn’t Go As Planned

Woman Contemplating Feelings

Whether you had hoped for a home or birth center delivery and needed to transfer to the hospital, or had prepared for a natural birth and ended up having a C-section, births that do not go according to plan can be disappointing. Many mothers spend their pregnancies preparing for and creating a detailed birth plan in the hopes of having the experience they’ve always envisioned for themselves and their baby. Despite the best laid plans, birthing classes, and providers, sometimes our bodies and our babies have other plans in mind. When your birth doesn’t go as planned, it’s not uncommon to experience some negative emotions along with the excitement you’re feeling about the new baby. Many women who have experienced some form  of birth trauma  or unexpected intervention report feeling disappointed, angry, guilty, frustrated, indifferent and sometimes even resentful towards their baby or their body. These feelings usually follow birth experiences that felt out of their control, traumatic or unexpected such as having an episiotomy or emergency C-section. If your birth experience has left you feeling as though your body failed to do what you had hoped it would do, here are some ways to cope with those negative emotions and acknowledge the strength and courage in your journey.

Writing Birth Story
  1. Acknowledge your feelings: This can be difficult to do when everyone is expecting you to be overjoyed by the arrival of your new baby. However, if you are experiencing disappointment, sadness, guilt or anger about the way your delivery unfolded, it’s important to take the time to allow yourself to experience those feelings without judgment. Giving birth may be the single most important event in your life thus far and it is okay to feel sadness about any part of the labor or delivery that was traumatic or upsetting to you. If you try to push away your negative feelings about the experience, they will likely resurface at a later date as unresolved issues. 
  2. Take steps to process your grief: It is perfectly normal to experience grief following a traumatic or upsetting birth experience. It is important to allow yourself to experience the grief so that you can move forward feeling as though you have processed your feelings. Talking to your midwife or doctor and asking questions so that you can better understand and process your experience is one way to work through what you may be feeling. Two cathartic ways to process grief following birth are: telling your birth story to a trusted friend or family member or writing down your birth story. Writing or telling a detailed account of your experience can help you process your feelings of disappointment or guilt and also help you identify  all of the moments (there are so many!) of great courage and strength.
  3. Surround yourself with loving and supportive people: Limit visitors in the early weeks following your delivery to people who can be sensitive to your feelings and your experience. While not intending to be unsupportive, people may make comments suggesting that the only thing that is important is that you have a healthy baby. You can gently remind them that the experience was important to you and you are not ready to discuss it further at this time. You can also ask your partner to help play gatekeeper in the early days staving off unnecessary visitors and unsavory comments.
  4. Acknowledge the strength and courage in your story: Even if your birth didn’t end the way you had hoped, do your best to remember the amazing work that your body did. Whether you labored for 18 hours before ultimately having a C-section, endured hours of natural labor before electing to have an epidural, or had to undergo any number of interventions that were frightening or upsetting to you, your body has done an amazing thing. There is also an incredible amount of strength and courage in having to let go of your birth plan and have a birth experience that feels completely out of your control. Whatever your story is, whatever the intervention or unplanned turn your birth took, your body has done a miraculous thing.
  5. Ask for help: Whether you would like extra support from your partner, your provider, a friend to listen or to seek out a new moms’ group in your area, make the effort to reach out for help and comfort. The postpartum period, despite the awe and excitement of a newborn, can be an isolating and overwhelming experience. Adding grief from your birth experience to this mix may be too much to handle on your own. If at any point your grief begins to impact your ability to function throughout the day or seems to overwhelm the joy you have for your new baby, see your doctor or a therapist for an assessment for Postpartum Depression. Although the baby blues are a normal experience in the weeks following delivery, moms who have experienced a traumatic birth experience are more likely to develop Postpartum Depression. Ask for help right away if you feel like you might be experiencing Postpartum Depression. Click here to learn more about Postpartum Depression

If you’ve experienced a traumatic or disappointing birth experience, don’t suffer in silence. There are many women out there whose birth plans have not gone according to plan and who are left feeling guilty, angry and even depressed. There is no shame in a birth that does not go as planned and no shame in grieving the experience you did not have. Remember that you gave it your all and that is enough; that you are just as strong, powerful and amazing as all of the other mamas before you. At Health Foundations, we are here to support you throughout your pregnancy, delivery and postpartum period, regardless of whether or not your delivery took place with us, in the hospital or in the operating room. We are here for you. Contact Health Foundations to schedule a free consultation with a midwife or to find support.

 

Your Six-Week Postpartum Visit - What to Expect

Midwife Postpartum Visit

Whether you give birth at a birth center with midwives or at the hospital with your OBGYN, you will likely have a postpartum follow up appointment about six weeks after you deliver. The purpose of the visit is to check on your physical and emotional well-being as you recover and adjust to your new life post childbirth. Here’s what you can expect to happen at your six-week postpartum check-up. 

NOTE: Health Foundations also provides a postpartum visit at 2 weeks for our families

A thorough assessment of how your body is recovering from childbirth: 

Your midwife or doctor will likely check the size of your uterus to see if it has returned to its pre-pregnancy size. She or he will also want to ensure that any vaginal tearing or C-section incisions are healing well, and assess for any post-birth physical problems like hemorrhoids, incontinence or constipation. Now’s the time to mention any other aches and pains you are experiencing. Your care provider will likely also clear you for sex and exercise at this visit should everything check out okay.

A check-in on your mental health: 

Your care provider may give you a written assessment for postpartum depression or she may just evaluate how you are feeling in discussion. Postpartum mood disorders affect approximately 10-15 percent of all new moms though many feel ashamed or afraid to seek the necessary help. If you are experiencing symptoms of depression such as hopelessness, sadness, anger or thoughts of harming yourself or your baby, please tell your care provider right away so they can support you in finding the appropriate help. There are many options for moms experiencing postpartum depression or anxiety including counseling, support groups and even medication. Your postpartum visit is a great opportunity to share any concerns about your mental well-being with your care provider.

A discussion about birth control:

Since you’ll most likely be cleared to resume having sexual intercourse with your partner at this visit, your care provider will probably want to discuss options for birth control. While exclusive breastfeeding can provide effective protection for the first six months postpartum and sometimes beyond, you may want to consider a back-up plan such as the mini-pill or an IUD if you don’t want to risk your kids being too close in age. Your midwife or OBGYN can discuss the various options for birth control with you and help you come up with a plan that works for you.

Your annual gynecological exam:

Many practitioners will go ahead and perform your annual exam at your six-week postpartum visit. She may conduct a pelvic exam, Pap smear and breast exam in addition to the usual physical exam measures such as weight and blood pressure. It’s a good time to discuss any other health concerns you have so be sure to bring a list of questions with you to the appointment. 

A breastfeeding consultation:

Your midwife or OBGYN will check in with you to see how breastfeeding is going with your new babe. They can help you troubleshoot any difficulties, address issues with engorgement or clogged ducts and refer you to a lactation consultant if you need additional guidance or support. 

Your postpartum visit is a great time to address any questions or concerns that you are having about your recovery, physical or mental health or adjustment to caring for a newborn. Be sure to come prepared with your questions written down so that you can make the most of the time with your care provider. At Health Foundations, our care doesn’t end in the birthing room. We are here for you during your postpartum period and beyond to support you and your new family as you adjust to motherhood. For questions about natural birth or postpartum care, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center.

Prenatal Depression: Warning Signs and When to Seek Help

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You’ve likely heard a good deal about postpartum depression from your care providers and possibly friends or family members with children. But prenatal depression, also known as antepartum depression, is a topic that is rarely discussed. Statistics suggests that some 14-23 percent of women will experience some depression during the course of their pregnancy varying in degree from mild to severe. 

Unfortunately, not all of these women will seek help however. One reason prenatal depression is often overlooked is because we can be quick to blame hormonal imbalances for the way we are feeling when pregnant. While it is true that fluctuations in the body’s hormones can affect the way we are feeling, if depressed mood or other concerning symptoms become severe or persistent, it is important to seek help.

Signs of Antepartum Depression:

Seek support from your health care provider if any of the following symptoms persist for more than two weeks or begin to affect your daily functioning:

  • Pervasive sadness or depressed mood
  • Noticeable changes in appetite (this can also be common during a normal pregnancy)
  • Loss of interest in activities you typically enjoy
  • Anxiety
  • Persistent feelings of guilt, worthlessness or hopelessness
  • Thoughts of self-harm, death or suicide
  • Excessive sleep or insomnia
  • Difficulty focusing
  • Feeling withdrawn or irritable around others
  • Feelings of restlessness and agitation
  • Loss of self-confidence

Triggers and Risk Factor:

You may be more likely to struggle with depression during pregnancy if you have experienced any of the following life events:

  • Complications during pregnancy
  • Episodes of abuse or trauma
  • A family or personal history with depression
  • Infertility struggles
  • Previous pregnancy losses
  • Relationship problems
  • Death of a close friend or family member
  • Financial stressors
  • Unplanned pregnancy
  • Chronic illness

Support and Treatment:

If you are struggling with prenatal depression, the good news is that there are plenty of options for treatment and ways to get the support that you need. Start by contacting your care provider as soon as you have any concerns about the way you are feeling. Your OB or midwife may suggest that you see a mental health care provider that can be a part of your prenatal team in order to best support you during your pregnancy. Treatment for depression during pregnancy may involve a number of therapeutic and natural options such as:

  • Support groups
  • Personal psychotherapy
  • Medication: Although many medications are not compatible with pregnancy as they do cross the placental barrier, there are some antidepressants that are considered to be safe when the benefit to the mother and baby outweighs the risk. If your depression is moderate to severe and is not responsive to other forms of treatment and approaches, your healthcare provider may suggest trying a low dose of an antidepressant medication. Be sure to educate yourself about all the risks and benefits associated with the medication before starting it and share any concerns you have with your care provider. Your doctor should be able to help you choose a medication that offers the most benefit to you and the smallest risk to your baby.
  • Light therapy
  • Acupuncture
  • Omega 3 fatty acids: A daily fish oil supplement may decrease symptoms of depression. Be sure to choose a supplement that is free of mercury which is not safe during pregnancy.
  • A healthy diet: Taking measures such as limiting the intake of sugar, processed carbohydrates, caffeine and artificial additives has been show to positively impact mental and physical health.
  • Vitamins, herbs and flower remedies: Discuss this option with your doctor, midwife or nutritionist to ensure that you choose safe options for pregnancy. Some vitamins, herbs and flowers have been shown to be beneficial for mood and serotonin levels.
  • Exercise: A regular exercise routine helps naturally increase your serotonin levels and reduce your cortisol levels which will improve the way you feel.
  • Rest: Not getting adequate sleep, particularly when you are pregnant, can negatively impact your mood. Try to establish a regular sleep routine to ensure you are getting the rest you need. If prenatal depression is left untreated, there are a number of serious risks to both mother and baby. 

Depression can lead to problems such as drinking, smoking, poor nutrition and self-harm. In addition to the danger these factors pose to the mother, substance use and poor nutrition during pregnancy can lead to prematurity, low birth weight and serious developmental problems for your baby. Furthermore, babies who are born to mothers suffering from depression may be more likely to be less attentive, less active and more agitated than babies born to non-depressed mothers. 

Reaching out for help is the most important step to take if you are concerned that you may be experiencing prenatal depression. Often women report feeling guilty or distraught that they are having these feelings during a time when they are expected to be happy and joyful. Do not let this deter you from asking for the help you need. If you are not comfortable reaching out to your care provider, speak to your partner or a trusted friend that can help you seek the support you need. At Health Foundations, we want to ensure that you are physically and mentally supported throughout your pregnancy. Contact us with any questions about prenatal depression or for a free consultation with a midwife and tour of our Birth Center. The wellbeing of you and your baby are our first priority.