Tag: postpartum

Saving Women’s Lives

by Jennifer Doyle

As we close out Women’s History Month, and I want to take this moment to discuss an issue that is not only dear to my heart but also takes the lives of more than 700 women each year—maternal mortality.

A maternal death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy. The death is determined to be pregnancy-related if the cause of death is related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Of the 5,259 deaths within a year of pregnancy completion that occurred during 2011–2013 and were reported to the Centers for Disease Control and Prevention (CDC), 38.2% were found to be pregnancy-related. In the United States, more than half of all maternal deaths occur after birth—often after discharge from the hospital. This doesn’t have to happen. In fact, at least half of all pregnancy-related deaths are preventable when the warning signs of pregnancy or childbirth complications emerge and a mom can get the timely care she needs from her healthcare providers. The reality is that many women do not receive consistent messages or adequate guidance on identifying the warning signs of complications, or instructions about when, and where to obtain necessary medical attention.

AWHONN has created specific instructions for acting on these warning signs called “SAVE YOUR LIFE: Get Care for These POST-BIRTH Warning Signs.” Here are the specific signs you should watch for and act on during the first year after birth:

  • Pain in your chest
  • Obstructed breathing or shortness of breath
  • Seizures
  • Thoughts of hurting yourself or your baby
  • Bleeding that is soaking through one pad/hour, or blood clots the size of an egg or bigger
  • Incision that is not healing
  • Red or swollen leg that is painful or warm to touch
  • Temperature of 100.4 °F or higher
  • Headache that does not improve, even after taking medicine, or a bad headache with vision changes

For moms: If you are experiencing any of these post-birth warning signs, contact your health care provider or go to the nearest urgent care or hospital as soon as possible. For serious and potentially life threatening warning signs like pain in your chest, obstructed breathing, seizures, or if you have thoughts of hurting yourself or your baby, call 911. Let all responders know that you gave birth within the past year.

Recognizing and acting on these warning signs and complications that can lead to a mom’s death or injury is essential to reducing maternal deaths in the United States. Share this information with pregnant women you care for. AWHONN is committed to working together with nurses and moms to reduce maternal mortality rates. Let’s help women to be aware and to recognize the signs of post-birth complications in order to begin reversing this alarming trend.

Additional resources:

Jennifer Doyle is the 2018 AWHONN President and a women’s health nurse practitioner with nearly 25 years of experience in obstetrics. She is the APN of the Women’s Service Line at Summa Health in Akron, OH, as well as faculty and coordinator of the WHNP program at Kent State University in Kent, OH.

Disparities in Maternal Mortality

Black women are 243% more likely than white women to die from complications of pregnancy or childbirth, according to the latest data from the Centers for Disease Control and Prevention and Propublica, a collaborative of investigative journalists. One national study of 5 medical complications that commonly cause maternal death and injury determined black women were 2-3 times more likely to die than white women who had the same complications.

These truly alarming numbers are why during Black History Month and beyond the nurses of AWHONN want healthcare providers and moms alike to learn and share post-birth warning signs that have been shown to help new moms and their caregivers recognize potential problems and get the help they need—perhaps even saving their lives.

AWHONN has created specific instructions for acting on these warning signs called “SAVE YOUR LIFE: Get Care for these POST-BIRTH Warning Signs.” Here are the specific signs women should watch for and act on during the first year after birth:

  • Pain in your chest
  • Obstructed breathing or shortness of breath
  • Seizures
  • Thoughts of hurting yourself or your baby
  • Bleeding that is soaking through one pad/hour, or blood clots the size of an egg or bigger
  • Incision that is not healing
  • Red or swollen leg that is painful or warm to touch
  • Temperature of 100.4 °F or higher
  • Headache that does not improve, even after taking medicine, or bad headache with vision changes

If you are experiencing any of these post-birth warning signs, contact your healthcare provider or go to the nearest urgent care or hospital as soon as possible. For serious and potentially life-threatening warning signs like pain in your chest, obstructed breathing, or seizures, or if you have thoughts of hurting yourself or your baby, call 911. Let all responders know that you’ve just given birth within the past year.

Recognizing and acting on these warning signs and complications that can lead to a mom’s death or injury is essential to reducing maternal deaths in the United States. Currently, maternal mortality rates—the number of women dying during or within 1 year of childbirth—are increasing, climbing 27% to 24 maternal deaths per 100,000 births since 2000. In the United States, more than half of all maternal deaths occur after birth—often after discharge from the hospital. This doesn’t have to happen.

For black moms, it’s even bleaker. Black mothers in the United States die during or within 1 year of giving birth at 3-4 times the rate of white mothers. This difference in maternal deaths and injury among black women is a serious issue that needs our action. At least half of all pregnancy-related deaths are preventable when the warning signs of pregnancy or childbirth complications emerge and a mom can get the timely care she needs from her healthcare providers.

Share this information with other nurses and pregnant women you care for so that moms and nurses can work to reduce maternal mortality rates, especially the higher rates among black women. Together, we can help women recognize the signs of a post-birth problem to prevent unnecessary injury or death.

Mary Elizabeth Elkordy is the Communications and Public Relations Manager for the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN).

Alcohol and Pregnancy – An Approach Nurses Can Use to Prevent Fetal Alcohol Spectrum Disorders

By: Ann M. Mitchell, Holly Hagle, and Brayden Kameg

Prenatal exposure to alcohol can lead to a range of physical, mental, behavioral, learning, and developmental disabilities, with possible lifelong effects for the child exposed in utero. This range is commonly known as fetal alcohol spectrum disorder or FASD. FASDs are 100% preventable when a baby is not  exposed to alcohol during pregnancy.

Healthcare professionals may tell women that it’s OK to drink alcohol on occasion or even in moderation, when they are pregnant. However, evidence shows that there is no known safe type, safe amount, or safe time to consume alcohol while pregnant.

Additionally, it’s important for healthcare professionals to broach the subject of alcohol consumption, not only with their pregnant patients, but with all women of reproductive age. Women who are sexually active and not using effective contraception may be at an increased risk for alcohol exposed pregnancies, as nearly half of all pregnancies within the United States are unplanned.

It is critical that healthcare professionals educate all women of reproductive age about alcohol use and pregnancy. Alcohol screening and brief intervention (alcohol SBI) is one evidence-based approach to assessing patients for at-risk alcohol use. Screening includes use of a validated tool, such as the Alcohol Use Disorders Identification Test (AUDIT). The AUDIT is a clinically reliable and valid instrument (Bohn, Babor & Kranzler, 1995). The AUDIT has been consistently found to screen and detect alcohol use across a spectrum of low, moderate, and high risk consumption (Reinert & Allen, 2007).  The AUDIT has been found to be valid and reliable with diverse populations and in a variety of settings.

When a patient screens positive for at-risk use, a non-judgmental discussion, called a “brief intervention” occurs with the use of motivational interviewing techniques. For example, the patient is provided with the score on the AUDIT during the health care visit. If a patient scores between an 8 and 15, this score is discussed in relation to their current health condition and presented objectively to the patient as moderate alcohol consumption. If the AUDIT score is between 16 and 19, then brief counseling and continued monitoring are suggested. With a score of 20+ a referral for further assessment is indicated (Babor & Higgins-Biddle, 2001). The main goals of the brief intervention are to increase a patient’s awareness of their alcohol consumption patterns, understand the associated risks and options for reducing or eliminating those risks, and to increase their motivation to make healthy choices.

As nurses, it is our obligation to ensure that women are provided with the knowledge needed to make informed choices regarding their health. For example, giving the patient objective feedback about their score on the AUIDT and then asking them “What are your thoughts about this score?” is a way to elicit their thoughts and feelings about their alcohol consumption in relation to their health and wellness. Further, exploring the pros and cons of the patients current level of alcohol consumption is an excellent technique to elicit the patients thoughts and provides an opportunity for the health professional to provide feedback and health education.  Patients have high trust in confiding to their healthcare provider and in particular nurses.

Additional Resources

Dr. Ann M. Mitchell is professor of nursing and psychiatry at the University of Pittsburgh School of Nursing. She is principal investigator on a CDC-funded project for the implementation of alcohol screening and brief intervention with the ultimate goal of preventing FASDs.

Dr. Holly Hagle is Director of Education for the Institute for Research, Education and Training in Addiction (IRETA) and a partner in the CDC-funded FASD project.

Brayden Kameg is a graduate student in the psychiatric-mental health nurse practitioner DNP program at the University Of Pittsburgh School Of Nursing. She is actively participating in grant-related activities on Dr. Mitchell’s projects.

6 Tips For Postpartum Care for Mom “The Patient”

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by, Kristen Wesley “The Mom”

Kristen and IslaThere is a moment after labor when you realize that not only is your sweet little baby a patient, but that you are too. At least for me, that was something that hadn’t really registered. On the day that my little baby girl Isla was born I very quickly began to understand we would both need a ton of care in the hospital and at home.

You would think from all the books I read, articles I scoured, and the numerous second hand accounts from friends I received, it would have sunk in. But it just didn’t. It literally never occurred to me that I’d be a patient too during and after labor and birth. Continue reading →

Take A Walk In My Postpartum Shoes (Part 1)

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DaniFamily_1by, Danni Starr

An open letter to all the moms, soon to be moms or family supporting moms!

On December 31st, 2011 I gave birth to a beautiful baby girl! It was something I had dreamed about for so long. I remember the day after she was born crying on the phone with my midwife because I was so overwhelmed. She was so little and I didn’t really know what to do.

Being a little overwhelmed is common, medical specialists call it the baby blues. Post-birth, most moms (as many as 85%!) experience some form of the baby blues. This could be feeling irritable, exhausted, needing to cry for no reason or worrying that you won’t be a good mom.

I did not have that. I had something that damn near sucked the life out of me.

Once we returned home from the hospital, I rarely got off of the couch for 30 days. I got up to feed the baby and change her…I didn’t even eat. I remember just feeling so weird. Everything was robotic. Must feed baby, must change baby…I don’t even remember enjoying any of it.

I remember my husband picking me off of the couch giving me a hug and saying babe, you do not smell good…I am going to take you to the shower. He literally stripped me down and put me in the shower and helped wash me. Many times with post-partum depression (PPD) the mom is too tired to notice the symptoms, and it is a husband, partner, a family member or friend that shares that something just isn’t quite right.  I am thankful for my supportive system every day.

One night I was so tired that I actually Googled how many sleeping pills I could take without dying. I didn’t want to die, but I did want to be pretty close so that at least I would sleep for a few days. I literally had a bunch of pills laid out on the ottoman. I started to down them and then I thought. What if I am unconscious and she starts crying?! Nobody will hear her. I didn’t want her to cry and not have help. So I begged God to let me fall asleep and I threw the pills away. She saved my life.

Then the paranoia set in. I started to think that something very terrible was going to happen. So I started to place emergency items around the house. Things I would need to run away with. I made sure not to be too obvious because I didn’t want my husband to be on to me. One day he left to go to the store. I remember it so clearly, “babe I’m running to the store be back in a few.”

He stepped out of the house and I threw all of my emergency items in a bag, grabbed the baby and ran.

My grandpa was staying in a nursing home at the time and I knew nobody would look for me there so I went to his house and I hid out. I had NO contact with the outside world for days. Yes, I kidnapped my own child because at this point I was pretty unstable.

My husband and best friend were texting like crazy. Finally about ten days in I received a message from best friend which said, “I love you, but right now I have to love your baby more and I will call the police because I know you need help.” I finally told her where I was but begged her not to come. She sent a family friend who is a nurse to see me.

The nurse showed up and told me I had postpartum depression. I had no idea that 15% of new moms experience PPD which is way more intense than the blues, and encompassed so many of the things I was feeling and thinking. But at the time I didn’t know any of that, all I knew is that I just wanted to disappear. I hated everything, I couldn’t function and I was mad that I wasn’t connecting with such a precious little baby.

I never wanted to hurt my baby but I know many women who suffer from PPD do, and I would be lying if I said that I never wanted to hurt myself.

I don’t even remember when I started feeling better. There is so much about that time that scares me, so much more that I could share, but even writing about it makes me feel horrible. It’s a place I NEVER want to return to, and I would NEVER wish it upon anyone.

There were periods of time where I felt that I was bordering on insanity.

Follow the rest of my story in my Part 2 post publishing October 9th – National Depression Screening Day. Take care of yourself!
Danni Starr HeadshotDanni Starr
Danni Starr works daily as co-host of the nationally syndicated “The Kane Show.” Danni fell in love with radio at 19 and 11 years later, she still considers it her first true love. As a Mother and wife Danni is the “Den Mom” to the show & offers open, honest, opinions and advice.

 

The above story is adapted from Danni’s original post: https://www.facebook.com/notes/danni-starr/take-a-walk-in-my-postpartum-shoes/572481839449596

Get Support

Postpartum Support International: 1-800-994-4773 or postpartum.net
National Postpartum Depression Hotline: 1-800-PPD-MOMS

References and Learn More at

AWHONN’s Mood and Anxiety Disorders in Pregnant and Postpartum Women Position Statement

Postpartum Depression

Postpartum Recovery Tips for Moms from Our Nurses & Midwives

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In preparation for your new arrival it is likely you will take classes, read books and get advice from friends and family on how to take care of your new baby.

What you can easily forget in all the excitement is that you take care of yourself too!

To help you focus on YOU, we recently asked our nurses and midwives what postpartum recovery advice they give their patients.

We received advice for you from over 100 nurses!

Take note of the clear themes – limit visitors to take that time to bond with your new baby, accept help from others, do skin-to-skin and sleep when the baby sleeps!

Good luck in all your new parenting adventures!

Postpartum Care Tips from Nurses and MidwivesTop 20 tips from our nurses and midwives:

  1. Absolutely choose a hospital for the care you will receive and not the new beautiful building. You’re much more likely to receive a positive birth experience and the education you receive from your postpartum nurses will make all the difference in the world.
  2. As a former postpartum nurse, I noticed how often new mothers put their needs last. It seems often families look at postpartum time as party time. I have seen c-section moms sleeping in the same room as 15-20 family members talking loudly and passing baby around for hours. My best advice is for new mothers to have 1-2 designated family helpers to be there to help care for baby while she gets much needed naps throughout those exhausting first days. Baby’s hunger cues are often missed when there are too many visitors for long stretches of time. It is difficult for new mothers to set limits.
  3. Don’t be afraid to ask people to leave. I have seen so many new mothers that are worn out from feeling like they cannot turn people away. Turn off your phone too. I wish I did for the first couple of days.
  4. Breastfeeding is an acquired skill for you and baby, be prepared to be patient and try, try again. It is a wonderful thing for you both, but needs to be learned. Do not suffer in silence, please contact your OB/midwife for lactation nurse help/referral if you are having difficulty with latching and/or very sore nipples.
  5. Sleep when baby sleeps.

  6. If you had a cesarean, take a pillow for the car ride home to support your incision for the bumps in the road.
  7. Use the Dermoplast (benzocaine topical) spray before having a bowel movement…it’ll make the process a whole lot more comfortable and a lot less scary.
  8. If someone offers to come over so you can shower, take them up on it.  For c-section moms remember not only did you have a baby, but you had major surgery.
  9. Trust yourself and your instincts. Pick and choose the advice, tips, expert advice etc. that works for you. And know that if you’re worried about being a good mom, you already are.
  10. Padsicle! Pad, ice pack, tucks, then a spray of Dermoplast.
  11. Know your body. When you get home, use a hand held mirror to look at your perineum or you cesarean section incision. This way, if you experience problems, you will have a baseline to know if something is different, for example: increased swelling, redness, tenderness, or drainage from incision. It is helpful in knowing when to contact your physician with these issues.
  12. Limit your visitors. You will not get this time back. Use it to bond as a family, seek help with breastfeeding. Skin to skin is the best bonding tool! We want to help you succeed with breastfeeding. You can press your call light for every feeding if you need to. Your baby needs your love and protection. You are your baby’s primary advocate. Not all mothers’ choose to or are able to breastfeed. How you feed your baby is your decision and your nurse will support you. Ask visitors to wait until you’ve been home for at least a couple weeks. Settle in, recover. Don’t be afraid to ask for help. If someone wants to visit, ask them to leave their little ones at home.
  13. Sleep when the baby sleeps. Keep drinking water to flush out the excess fluids and keep hydrated. Accept help from anyone willing to cook a meal, run errands or do housework so you can rest and spend more time enjoying your new baby. Get outside for a walk. Fresh air and activity help to restore and rejuvenate sleep deprived minds and bodies as well as improve the blues!
  14. While planning your new routine, ask someone to watch the baby for an hour of each day for you to spend as you please.
  15. Good nutrition is key. Have a healthy snack each time you feed baby if you don’t have an appetite. Try to get a good four hour blocks of sleep several times a week. Ask support people to change, burp, comfort baby and only bring baby to you for breast feeding to extend your sleep when tired. Have a good support system and don’t be afraid to ask them for help. Soak up the sun when you can. Have an enjoyable activity to look forward to each week. Try to get out of the house, but if you can’t do something you enjoy at home or pamper yourself. Relax and enjoy your baby. Use what works for you and don’t try to follow everyone else’s advice.
  16. Accept offers of help and assistance with meals, cleaning etc. I tell father’s to give moms one uninterrupted hour to herself each day. She can bathe, sleep, read, or anything that she wants for that hour. Daddy needs time to get to know baby too!
  17. When you get home, set visiting hours and have each visitor bring groceries or food (they’ll be thrilled to get what you need). And stay in your pajamas. Most people will be less likely to overstay their welcome.
  18. Once “settled” in with the baby reach out to a Mother’s group ( stroller club, baby sitting co-op, Mommy and me Gym or Yoga class), to get out of the house and receive and provide support to other new Mom’s.
  19. Give yourself a break. Sit at the bottom of the shower and cry if you need to every now and then, parenting is hard work. Learning to breastfeed is hard work and so is incorporating another member into your family. Sleep deprivation and shifting hormones will, in fact, make you feel crazy at times but it will get better. You will find your new norm. It’s not all cute onesies and hair bows, it’s more like poopy onesies and newborn rashes, and that’s ok.
  20. You’re stronger than you think! Don’t worry about what others might think. Enjoy every moment.  Parenthood is a beautiful experience. Allow yourself grace & room to grow.

Do you have advice for new moms as well? If so let us know. We’ll keep rolling out the advice.

For additional resources for mom visit our Healthy Mom&Baby website!

Dangers After Delivery: Postpartum Preeclampsia

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by Tanya M. Shlosman

Pregnancy is a complicated journey full of a multitude of emotions. A pregnant woman has an abundant amount of advice and resources at her disposal, but it can be overwhelming to swim through the information and decide what to take to heart and what to take with a grain of salt.

I spent my first pregnancy worried about everything. With every blood test, every ache and pain, I quickly referenced my What to Expect When You’re Expecting book to calm my concerns. When I was diagnosed with preeclampsia and my son had to be delivered almost 4 weeks early due to dangerously high blood pressure, I remember feeling afraid and uninformed. Even after I was told I had preeclampsia, I never felt my doctors did a good job of explaining the condition.

If you don’t know, as I didn’t, preeclampsia is a serious disorder occurring when women develop high blood pressure, usually in the last months of pregnancy. Preeclampsia affects as many as 1 in 12 pregnancies and can progress rapidly, resulting in seizures in its most severe form, which is called eclampsia.

Some years later, when I was pregnant with my daughter, I felt prepared and confident that I knew what to expect and what to do to keep myself healthy. I had some challenging days but made it to 40 weeks with no signs of preeclampsia.

While I had a very difficult cesarean delivery, I was relieved that my 8 pound and 15 ounce baby girl was healthy! However, within a few hours of delivery, I began to feel very sick. No matter what I did, I could not catch my breath and a cough set in. Having to cough after surgery is not a pleasant experience but I thought I had just developed a cold and was not concerned.

I soon learned that it was more than a cold. I had developed postpartum preeclampsia and this caused extra fluid to build up in my lungs—a condition called pulmonary edema.

I was not only afraid but angry—angry that I was not told that preeclampsia could happen after giving birth. Postpartum preeclampsia is a rare condition, usually occurring within the first 48 hours after birth but it can occur as late as six weeks postpartum. I endured breathing treatments and was given blood pressure medication while in the hospital and after being sent home. While my trouble breathing was the most frightening symptom, I also had severe headaches, dizziness, and blurred vision. I stayed on blood pressure medicine for almost six months.

What makes preeclampsia so frightening is that there are no tests to determine who will be afflicted with the condition. And there is no known method for preventing preeclampsia, no matter when it occurs. But there are known  risk factors. For example, women are at an increased risk to develop preeclampsia if they are obese, over age 40 or under 18, have a multiple gestation (twins or more), chronic high blood pressure or any kind of diabetes. Research shows that about twenty percent of women who had preeclampsia in a prior pregnancy will have it again with the next pregnancy. Pregnant women should talk with their nurse, midwife or doctor about preeclampsia and what their risks may be.

All pregnant and postpartum women should be aware of the symptoms of preeclampsia but especially women who have an increased risk to develop the condition. Symptoms are headache, excessive swelling, changes in vision, and upper abdominal pain. Women who have these symptoms should call their midwife or doctor right away. However, some women who develop preeclampsia will have few, if any, symptoms.

Every woman should reach out with concerns, no matter how small they may seem.

We need to talk about our experiences, support preeclampsia research and outreach to other women. I found a great source of information and comfort in the Preeclampsia Foundation, with its informational website and community forum.

May is National Preeclampsia Awareness Month and there is no better time to understand this condition and how it could affect you and your baby.

Some places you can start are Health4Mom.org and the Preeclampsia Foundation.

You can also see the 7 Symptoms Every Pregnant Woman Should Know videos in English and Spanish:
[youtube=http://youtu.be/P9GxHQzwIzk]
[youtube=http://youtu.be/UVjZItybNBI]

TanyaTanya earned her Bachelor’s Degree and did her master’s course work at the University of Louisiana at Monroe and work as an assistant director at a historical museum. She is a writer of non-fiction and poetry and currently working on a book discussing World War II. She is most importantly a wife and proud mother of two and several fur-babies.