QUESTION FROM READER: This is great and totally echoed everything we learned from our childbirth class this past weekend!! One thing I would like to know more about is post-partum care and the best tips/tricks for making it through those first few weeks of uncomfort.

ANSWER, DR. GILMORE: The best way to approach postpartum is to do everything gradually. Let your body be your guide. Here are some random things that come to mind for common discomforts during pregnancy and postpartum. Please know that these are things people don’t like to acknowledge no less talk about. However, they are essentially for postpartum recovery:

Hemorrhoid care: The majority of women who decide to have babies deal with hemorrhoids at some point in time. This is my little magic solution- witch hazel. It is the major ingredient in the costly “tucks pads”. You can by a bottle of witch hazel solution for a couple of dollars in any pharmacy by the rubbing alcohol. Use the witch hazel to clean yourself after “#2”. You can also make cold compresses by soaking the little disposable make up pads in the witch hazel solution and keeping them in the refrigerator. Witch hazel is astringent. It is soothing and can actually help keep hemorrhoids from enlarging or getting inflamed. A simple but life-saving remedy. Remember hemorrhoids are basically varicose veins of the hiney. They can recede but they really don’t ever go away, sorry.

Stitches/ incision: Follow your providers instructions carefully in regards to incision care and have it checked when they ask. Prevention is key. If there is a problem they know what they are looking for and they can put up things quickly. For the perineum the squirt bottle or “peri- bottle” is your friend. Use it with nice warm water for cleaning and healing. 

Kegel exercises:
Whether you have a vaginal or a surgical birth your perineal muscles have been over taxed with pregnancy. They need a little exercise. Kegel exercise can be initiated right after birth. Kegel exercises are basically when you isolate and tighten your perineal muscles. The perineal muscles are the group of muscles that support your urethra, vagina and rectum. By strengthening the perineal muscles you improve muscle tone and blood flow to the perineal and vaginal area. When doing Kegels exercises start with an empty bladder and try to incorporate all of the perineal muscles including the vaginal and rectal muscles. If you are not sure what Kegel exercises are this website gives the best description from the resources I looked at:
https://www.babycenter.com/kegel-exercises.
You can do Kegels whenever you want because nobody knows you are doing them. If you get into a routine Kegels can improve perineal, bowel, and bladder function throughout the life span.

Pain management:
Unless you have an aspirin allergy non-steroidal anti-inflammatory (NSAIDs) like Motrin or Aleve are your best bet. They help with pain caused by uterine cramping, they help with perineal inflammation, and they help with incisional pain as well. Narcotic pain agents are not necessary if you have had a vaginal birth and they are only used in limited quantities after a surgical birth. They can cause sedation, constipation and GI upset with prolonged use. Work closely with your provider to determine what the best plan is for your situation.

 


COMMENT FROM A READER: As an experienced labor and delivery nurse, I wish more of my moms would read this and come in with realistic expectations- especially the “go with the flow” attitude!!! The only thing I want to piggy-back on is the birth plan. If you choose to have a birth plan, PLEASE PLEASE PLEASE go through it with your provider to see what they agree with and disagree with, etc., before you come to the hospital. It is soooo frustrating to be the nurse that gets this well thought out birth plan from a patient who has a provider who you know will not follow any of it, and have to let the patient down. It’s not usually our fault you can’t have intermittent monitoring, etc.- some providers just aren’t comfortable with it. By discussing it before going into labor, you can know that your birth plan will be able to be followed, or not. A lot of patients think it’s because of hospital restrictions that we cannot follow your birth plan, but 9 times out of 10, it’s because of your provider.
Thank you again for such a wonderful post!!!!!!!

 


PREGNANCY & BIRTH 


If you didn’t read the original spotlight post with Meg Hall & her Mother Brenda M Gilmore DNP, CNM, FNP, CNE, you can find it HERE. I would recommend reading that post first. Below you will find a compiled list of questions that readers had after reading the post above and the follow up answers from Dr. Gilmore. 

Q&A

QUESTION FROM READER: Great post, so informative! I have 10 weeks left. Thoughts on cord banking? I know it’s personal and expensive but haven’t seen a lot of studies or news on it. 

ANSWER, DR. GILMORE: Cord blood banking is kind of like an insurance policy using stem cells. Almost every day there is more and information on how stem cells are used to treat many types of immunologic disorders, blood disorders, and other medical conditions. The cord blood is a treasure trove of stem cells. There multiple companies throughout the country who will help you collect and store your babies cord blood (stem cells) for a fee of course. Usually there is a fairly large fee for the cord blood collection and processing (1-3 thousand dollars) based on the services you buy then you pay an annual fee for storage (1-3 hundred dollars). The premise is that if you don’t collect the cord blood/ stem cells they will be tossed and lost forever. The thing is you don’t know if your child may need these cells decades later. This process is a way to preserve that option. Actually, I am pretty neutral on this subject. I think if the parents or the parent’s family has a long history of medical problems then it definitely should be considered. But it really is a very personal decision. Some parents just want the peace of mind that the stems cells have been saved and they will be available in the future. Now, when choosing a company be sure you look at their reviews and check out their reputation. The biggest indicator of their effectiveness is if they have had successful stem cell transfers in the past and how many. Below are 2 companies that I worked with in the past. I am not advocating for either of them and there are other reputable companies not listed here. But this is a good place to start for comparison and information. Also know that some states give you the opportunity to donate your stem cells to a public bank as well. https://parentsguidecordblood.org/en/donate-cord-blood

https://www.cordblood.com/cord-blood-banking-cost/cord-blood-stem-cells

https://www.cryo-cell.com/cord-blood-banking-costs
 


QUESTION FROM READER: what are your thoughts on laughing gas as an option for pain relief during labor? I’ve read a bit about it and how they use it in other countries. Do you believe this is a safe option? If I were to ask for this option, am I likely to get a negative response from my physician? Thank you for your time!! 🙂

ANSWER, DR. GILMORE: What you are talking about is nitrous oxide. It is a gas that the mother can self-administer during labor for pain management. I have not personally used this mode of pain management but it is used here in the US. About 2 years ago at the American College of Nurse Midwives conference a group of Air Force midwives did an education session on this. They use the nitrous oxide quite a bit. It was quite interesting. It is a gas (nitrous oxide) that is mixed with oxygen and delivered through a mask. The gas makes the woman relax, feel sleepy, and reduces her perception of pain. Just like IV pain medication it is short acting and does not take all the pain away. The laboring woman can use the gas during contractions to manage the pain. The key to this therapy is that only the woman in labor manages the mask. If there is someone else applying the mask then there is risk of the woman receiving too much of the gas. I do think it’s great to have many tools in the pain management toolbox. However, there is limited availability for this so check your particular area to see what your options are. http://americanpregnancy.org/labor-and-birth/nitrous-oxide-labor/
 


QUESTION FROM READER: Super silly question….What are your views on the old wives tale about full moons and labor. I’ve heard nurses swear by it, but that there is absolutely no concrete evidence. I’m due in a week and a half and there’s a full moon on Wednesday, so just asking for fun!

ANSWER, DR. GILMORE: Yes, today is super, blue, blood moon etc. etc. Unfortunately, we won’t get see it on the east coast but I hope to see pictures because I’m sure it will be spectacular! I wish I could tell you
that there is some truth to the old wives’ tales. There are plenty of experienced nurses that feel there is a correlation. However, this has been studied quite a bit over the years and there really
isn’t evidence to support it. But you know what things happen. I think babies come when they are supposed to. They are the really the only ones who know the plan and they aren’t telling
anyone. Here’s to your little one and my granddaughter coming sooner than later! –

 


QUESTION FROM READER: This is probably a total noob question, but re: cord clamping…historically was the thought that the cord would have to be cut for babies to…live? (Not sure the best way to word that.) Your mom mentioned she’s seen a baby “pink up” while still attached, so I’m wondering if that in the past it was thought that wouldn’t happen, enter immediate cord cutting? 

ANSWER, DR. GILMORE: Delayed cord cutting allows continued flow of oxygen and nutrients through the umbilical cord for a short time after birth. In the case I described the baby received a little extra oxygen boost right after birth while remaining skin to skin with mom and it eased the transition to life outside of the uterus. If the baby’s umbilical cord had been cut early we would not have had this opportunity. The baby may been separated from mom to provide the needed support.


QUESTION FROM READER: Thank you for the great blog post! Could you also cover c-sections? I’ve had one so I don’t have questions but I’d still love to read your views – how to prepare (physically and mentally!), recovery etc. Also related to delayed cord clamping, feeding right away (particularly if the section is under anaesthesia) etc.

ANSWER, DR. GILMORE: We are very fortunate to have surgical options for birth when a vaginal birth is not feasible. I have assisted with c-section deliveries throughout my midwifery career. Birth is amazing in any shape or form. However, the transition to life outside the uterus is different after a c-section for a newborn. They tend to need a little more respiratory support and that has to take priority over delayed cord cutting. Honestly, if there are emergent issues after a vaginal birth that would have to take precedent over delayed cord cutting also. If possible spinal anesthesia is preferred over general to avoid neonatal sedation. Yes, there is potential for delay maternal newborn bonding after c-section but hospitals are really working on this. There is a definite movement to facilitate skin to skin contact and early breastfeeding after surgery. And remember skin to skin contact is not limited to just after birth. It should be done as much as possible with babies. It feels so good to both moms and babies. Moms after c-section may need some additional support initially but successful breastfeeding is definitely an attainable goal. Lastly, I continue to be amazed at how quickly mothers recover for surgical birth. At our hospital women after vaginal birth go home in 1-2 days. Women after c-section go home after 3 days (sometimes 4). That’s not a huge difference in the hospital stay for major abdominal surgery. It just shows hows strong a woman’s body is. The ultimate goal is healthy mom and healthy baby. We are so blessed to have so many options to reach that goal. 


COMMENT FROM READER: Thank you for this post! For someone who has recently had their first baby (3.5 weeks ago), I really relate to a lot of what your mom has said and can’t recommend her advice enough! Labor, delivery and post partum should be as relaxing and stress free as possible, and her advice really helps guide new moms in that direction. One thing I would reiterate is get breast feeding help if you want to breast feed! When it comes to breast feeding, the best advice I’ve gotten, and your mom touches on this as well, is to solicit the help of a Lactation consultant. Almost all hospitals have them and they can be a huge help if you really want to breast feed but have no clue what you’re doing. My son had jaundice and had to be on phototherapy for a few days after birth. He was having a really hard time latching to my breast (which I later found out is fairly common with jaundice as the newborns can have a weak suck) and he wasn’t getting enough colostrum and breast milk. I had to ask multiple times for a lactation consultant to come and assist, and it wasn’t until I started crying to my husband and nurse that I was concerned about the lack of nutrients my son was getting, that the consultant finally came. We talked through different options and ended up using donor milk through an SNS (supplemental nutrition system) until my milk came in and we were able to get my son to latch. We still have to use a nipple shield off and on to help with the latch, but if it weren’t for the help of the lactation consultant, we probably would have switched to formula, which was not an ideal option for us. 

Apologies for the long winded comment, but I’d just tell all new moms to be your own advocate. Don’t be afraid to ask for help, even if you have to ask multiple times. Be adamant about it, because once you’re home, you don’t want to feel helpless.

Thanks again for this post! It’s great advice!


FOLLOW UP Q&A AROUND BIRTH

July 14, 2020

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