Didn't I Just Do This? - Postpartum Depression

Everyone knows that the Baby Blues are common. After birth, mothers are sleep deprived, the are nursing all hours of the day and night, they are exhausted from the work of labor and delivery, the body is starting to produce milk. There are a lot of things that happen in the first few weeks after birth that can leave a mother feeling tired and overwhelmed. This is pretty “normal”, or well, common enough that we can just call it normal. Some women have a smooth, graceful transition with effortless breastfeeding, labors that hardly seem like work at all, get sleep when their baby sleeps, and the baby seems to be on a fantastic schedule from day one, and…well, the majority of us are jealous!

For others, the transition into motherhood is a rocky one. These moms usually have higher maintenance babies that have no discernible pattern, they are left exhausted, frustrated and overwhelmed. They don’t wake up in the morning and think “Oh jeez, I have to take a shower again today”, their thoughts are focused more on the minutiae, where the task of taking a shower becomes “Oh no, I have to get up out of bed, use the bathroom, take my jammies off, heat up the water in the shower, get in, get ALL of me wet, find the shampoo bottle, struggle with the cap, pour enough in my hand, scrub my hair, then sit there forever rinsing it out, THEN I have to find the conditioner….”  What, to most of us, is a simple “one-step” activity – taking a shower – becomes a monumental list of activities that all must be performed.

For women with depression, the minutiae of the day wear them down and they think “Didn’t I just do this??? Didn’t I just take a shower yesterday? Didn’t I go to the bathroom already? I have to wake up again?” It’s more than just being too busy or tired with a new baby that keeps them from taking a shower. It’s that a shower has become too great of a task. Even the thought of a shower has too many components and the mother’s mind wants to shut down at the thought of so much work.

This is a sign of postpartum depression and and a sign that she needs help. Professional  help. There’s no shame in that. Our hormones can wreak havoc on our bodies and through off the neurotransmitters in our mind.

Most of us are familiar with the signs and symptoms of depression, but sometimes these take on a more unique presentation. There can be a perseveration of an idea. One that she just cannot escape from. For me, I experienced this with my second child; however I did not recognize it for what it was. I was paranoid. I thought that if I brought my baby to the doctor he would inject her with something that would kill her. As I was driving down the highway, I experienced tremendous fear and anxiety that someone driving by would take out a gun and shoot her as they passed by. People in public were suspect as well. They may stab her as they walk by. I was fiercely protective of her and preoccupied with concerns, regardless of how irrational, that anyone could harm my baby. We did not put a birth announcement in the paper – a common practice 20 years ago – because I was convinced that it would alert baby snatchers who would then break into my house and steal her from me.

Depression can be more than just exaggerated baby blues. It can manifest in ways you do not expect. If you, or your partner, have any concerns about your thoughts and feelings, talk to your health care provider as soon as possible. Do not try to treat postpartum depression on your own. Respect your body by allowing a neutral third party to give a fair, unbiased assessment of what is going on.

Read more about Postpartum Depression by visiting

http://www.emedicinehealth.com/postpartum_depression/article_em.htm#postpartum_depression_overview

Even if your symptoms do not fit into the typical depression symptoms, talk to your provider. Here at our birthing center, women with mild PPD can be treated holistically with homeopathics, herbs, supplements, and a variety of other modalities; however they are monitored much more closely to ensure that the treatments are working and that they are not a risk to themselves or others. Not all depression needs to be treated with medications that can affect breastfeeding. Medications are essential in some cases, but not all. Remember, you can call your provider 24 hours a day 7 days a week. Offices have on-call staff for their off hours, and you should NEVER hesitate to call if you feel that you may harm yourself or your baby.

Try these resources to learn more about PPD or to find a counselor/group. You can also call your insurance company to ask for referrals.

http://www.pphatx.org/

http://www.postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators/PSI-Locations-United-States/PSI-Texas.aspx

http://www.anybabycan.org/programs-services/postpartum-services

http://www.maternalfetalcare.com/forms/pregnancy_parenting_adn_depression_resource_list.pdf

http://www.helppro.com/HP/therapist-finder/therapy-specialty/TX/Austin/67/Postpartum_Depression.aspx

http://www.medicinenet.com/postpartum_depression/austin-tx_city.htm

To learn more about giving your baby a beautiful beginning, visit www.beautifulbeginningbirth.com

To Circumcise or Not

http://www.dailymotion.com/video/xjkd30_infant-circumcision-injection-and-procedure_news

There are not many topics related to parenting as controversial as the decision to circumcise or not. Circumcision is the surgical removal of the clitoris and part of the labia in a female, or the foreskin in a male. I think most of us in this country would agree that female circumcision is a form of genital mutilation, however it a very common and accepted procedure in other cultures. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497147/

What we do not see here in the United States is the same outcry toward the same type of genital mutilation performed on our sons. There are many reasons why parents may choose to have their son undergo this surgery – religion, culture, a desire for him “to look like his father” (perhaps we should consider cosmetic surgery for other parts of his body as well). Currently 54.7% of males are circumcised. Some of the benefits linked to circumcision include a lower risk for contracting HIV and Herpes. http://www.medpagetoday.com/MeetingCoverage/CROI/31507, however the surgical procedure does not come risk free http://www.medpagetoday.com/MeetingCoverage/AAP/29075.

If you are considering circumcision for your son, we encourage you to do your research – watch the video, read about the pros and cons, and research the surgeon performing the surgery. There are many reasons why parents chose to circumcise and there are just as many that parents chose not to. It is our position that each couple should make informed choices regarding their baby's health care and the their medical team should respect their decisions.

 

On a personal note, I believe that nature should not be challenged. Foreskin serves a purpose and nature put it there for a reason. Let's respect the beauty of a natural, intact penis. http://www.nocirc.org/publish/pamphlet4.html

Written by Emma Morrison MS, LM, CPM

Developing your Baby's Brain with Toys

It's never too soon to begin providing your precious bundle with the proper stimulation to enhance his or her brain development. A great way to do this is to be interactive - sing songs, read books and talk to your baby about the things that are going on around you. Another great resource is Discovery Toys. These are excellent products that will keep both you and your baby entertained. Visit www. discoverytoys.com/BeautifulBeginning to see the latest products. To learn more and to get hands-on experience with the toys, call Emma to set up an appointment. 512-636-3661.

Beyond 40 Weeks

The long anticipated day has arrived….but the baby hasn’t. What happens when a pregnancy continues after the due date?

Practitioners use pregnancy dating to help track milestones during a pregnancy. It’s important to have as accurate a “due date” as possible, however this is sometimes easier said than done. Pregnancy due dates are calculated in several different ways. A normal, healthy pregnancy is expected to last 266 days from the day of fertilization. Most women are not certain of their day of ovulation, but most women can remember the first day of their last normal menstrual period, so this date is the most commonly used date to determine a due date¹. The Estimated Date of Delivery, or “due date” is just an estimate. Only 3% of babies are actually born on this date. A normal, healthy pregnancy is considered full term at 37 – 42 completed weeks.

Another way of determining the due date is through an ultrasound. Early (first trimester) ultrasounds are very accurate – to within 2-3 days. Later ultrasounds (second and third trimester) are only accurate within two weeks – not very helpful when determining a due date.

So, you have an estimated due date that has been confirmed by early ultrasound and now you hit 40 weeks and there are no signs of labor, what happens? Your midwife will probably ask your permission to perform a pelvic exam to check to see what progress your cervix has made toward labor preparation. The changes in the cervix give us information on the readiness of the cervix. The more ready the cervix, the higher the Bishop’s Score. While not usually a suggested source for accurate medical information, there is a good entry on Bishop’s Score at this site  http://en.wikipedia.org/wiki/Bishop_score.

At 40 weeks in a first time mother, we are not overly concerned if there are not many changes in the cervix yet however, I like to perform a Biophysical Profile² to ensure that the baby is doing well, the amniotic fluid volume is adequate and to have a good baseline in case further evaluation is needed later on.

By 41 weeks, in my practice, I like to see something going on. The cervix should be a little softer and a little more flexible. I would really like to see some dilation as well. At this point I like to start a natural encouragement of labor. I prefer to start off with gentle, natural methods that can help nudge the body into going into labor on its own. Our practice does not use any methods that will force a body into labor. We use gentle methods only.

Somewhere between 41 and 42 weeks I like to see the body going into labor. A pregnancy that does not have any complications such as preeclampsia, hypertension, gestations diabetes, etc can be allowed to wait this long for labor to begin with natural methods. It would be nice to allow a pregnancy to continue on for as long as it would like to, however we have to be realistic. Not all women can go into labor without intervention. Once we get close to the 42 week mark, there are some increased risks to both mother and baby.

After 42 weeks, a pregnancy is considered post-term.

 “Post-term pregnancy is associated with risks to the fetus, including increased perinatal mortality rate, low umbilical artery pH levels at delivery, low 5-minute Apgar scores, dysmaturity syndrome, and increased risk of death within the first year of life³…”

“A number of key morbidities are greater in infants born to post-term pregnancies as well as pregnancies that progress to and beyond 41 0/7 weeks gestation including meconium and meconium aspiration, neonatal acidemia, low Apgar scores, macrosomia, and, in turn, birth injury...Post-term pregnancy is also an independent risk factor for neonatal encephalopathy and for death in the first year of life. ⁴”

The potential complications are not limited to the baby. A birthing woman is at

”… an increase in labor dystocia, an increase in severe perineal injury related to macrosomia, and a doubling in the rate of cesarean delivery. Also, post-term pregnancy can cause anxiety for the pregnant woman³.”

The risks to the mother can be high, but are very manageable. The risks to the baby are not. It is important to note that “…evidence shows that antenatal fetal surveillance for post-term pregnancies does not decrease perinatal mortality…³”  Statistically, the incident of these risk factors is low, this is your baby’s life we are “gambling” on. Each practitioner has his/her own set of practice protocols that must be followed. For some, that means inducing at 40 weeks. Others are more comfortable waiting until the 43^rd week before intervention. When discussing post-term pregnancy with your provider, remember that your birth plan is important, but the MOST important part of your birth plan is a safe, healthy baby. Sometimes that means that more intervention than you planned for is needed.

Trust the practitioner you chose to assist you in bringing your little bundle into the world. It has been my experience that once that 40 week mark passes women tend to have high levels of anxiety as they begin to fear losing that birth plan they worked so hard to formulate. The more time that goes on, the higher the anxiety and the more difficult decisions become for a woman. Relax (the best you can) and trust. Your provider is working hard to protect your health AND the health of your baby. Trust in his/her wisdom and experience and be flexible in your expectations.

 

1.       http://americanpregnancy.org/duringpregnancy/calculatingdates.html    Source sited July 17, 2014

2.       http://www.acog.org/~/media/For%20Patients/faq098.pdf?dmc=1   Source sited July 17, 2014

3.       http://www.aafp.org/afp/2004/1201/p2221.html    Source sited July 17, 2014

4.       http://emedicine.medscape.com/article/261369-overview   Source sited July 17, 2014