Tag: Postpartum

Breast engorgement is one of the leading causes of postpartum pain. It is caused by high volumes of breast milk in the breast ducts or a clogged milk duct. Symptoms include skin redness, warmth to touch and pain. You may also notice flattening of the nipple and difficulty of latching for newborn. Many women find relief with increased frequency of breast feeding, pumping or hand expression of breast milk before and after breastfeeding. You can also try cold packs and breast massage to decrease swelling. Some women may also benefit from anti-inflammatory medications such as ibuprofen.

In some situations, women may develop a condition called mastitis (inflammation and/or infection in breast tissue). If you experience the above symptoms (skin redness, warmth to touch, pain) as well as fever and fatigue, you should contact your healthcare provider immediately. You may need an antibiotic to treat the infection. Mastitis can make you feel very sick, so do not delay getting help!

Need help learning how to hand express breast milk? Click here to see a video from Breastfeeding Medicine of Northeast Ohio: The Basics of Breast Massage and Hand Expression

https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/07/postpartum-pain-management

© WKU {2022} All rights reserved.

Your return to fertility (when you might get pregnant again) after having a baby is unpredictable. It is even possible to get pregnant before your first period after having your baby.  

For your health and the health of your baby, it is recommended to wait at least a year and a half before trying to get pregnant again. Leaving time between pregnancies allows your body and mind time to heal which can improve your health and your baby’s health.

It is also recommended that women wait 6 weeks postpartum before having sex. This recommendation, along with using contraception (also commonly called “birth control”), can help you heal and plan your family. There are a variety of contraceptive options. Ultimately, only you can decide which method is best for you and your family.  

Many women are not ready for sex at 6 weeks postpartum- that is very normal! Here are some reasons why:

1. Your body is still healing! Muscle takes 2-4 weeks, your skin and soft tissues can need 11-14 weeks, and in some cases, as long as 12 months to heal!
2. Unusual sleeping patterns may make it hard to find time for your significant other.
3. Psychological well-being: you simply may just not feel like it, and that is okay too!
4. Breastfeeding can lead to vaginal dryness making sex less enjoyable (can ask your doctor about a topical medication for this).

If you are ready to have sex and don’t already have a postpartum contraception plan, now is a great time to learn about your options. That way you can be ready to talk to your health care provider at your postpartum follow-up visit.

Here are some things to think about:

• Do you prefer hormonal or non-hormonal options?
• Do you plan on breast feeding?  Many options are safe in breast feeding, but it is important for you and your provider to discuss this. 
• Can you make your choice part of your daily routine? For example, is it easy for you to remember to take a pill every day?
• Do you want something permanent, meaning, you never want to get pregnant again? Or do you want to get pregnant in the future?
• Do you want something long acting, but not permanent? For example, something that you don’t have to remember each day.
• Are you interested in a method you place in your vagina? Or a method where a provider places a device in your uterus or arm?
• Do you have any medical conditions, lifestyle, or factors that may limit your options, such as high blood pressure, obesity or smoking?
• Do you want the method that prevents pregnancy the best in studies? 
• Do you mind if your periods change? Or if you have unscheduled bleeding during the month? 
• Have you talked with your husband or partner about your contraceptive plans?  Or their plans? Would they be interested in a vasectomy (a permanent option for men) or regularly using condoms? 

Here are some great resources to learn more about your options:

• Bedsider- https://www.bedsider.org/methods
• The Centers for Disease Control & Prevention- https://www.cdc.gov/reproductivehealth/contraception/
• Planned Parenthood- https://www.plannedparenthood.org/learn/birth-control
• Other articles mentioned: Wound Healing Phases – StatPearls – NCBI Bookshelf (nih.gov), Muscle injuries and strategies for improving their repair – PubMed (nih.gov)

Authors: Nikki B. Zite MD MPH, Megan Lacy MPH, Laurel Carbone MD, Samantha F. Ehrlich PhD, Jill M. Maples PhD, & Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

© WKU {2022} All rights reserved.

Congratulations, Mom! Now, some considerations for medications during postpartum. If you are breast feeding, remember that some medications you take can pass to your baby in breast milk. Medications to avoid if you’re breastfeeding include chemotherapy drugs, some mood stabilizers and antipsychotics, certain antibiotics (Metronidazole, Tetracyclines, Sulfa drugs, Ciprofloxacin, Levofloxacin), Atenolol, Retinoids, and Radiocontrast media. If you consume alcohol, delay consumption until after feeding and wait at least 2 hours after a single serving to feed again. High caffeine intake can cause infant irritability and poor sleep. Avoid illegal drugs, including marijuana, and smoking around your baby.  Remember drugs that make you sleepy or altered can have the same effect on your baby! Avoid estrogen containing birth control or medications immediately after delivery as this can increase your risk for a blood clot and decrease milk production. Let all medical providers know you are breast feeding before starting any new medication and refer to free LactMed website (https://www.ncbi.nlm.nih.gov/books/NBK501922/) or app for a full list of medications and recommendations.

Resources:

Breastfeeding and Maternal Medication, Recommendations for Drugs in the 11^th WHO Model List of Essential Drugs, Dept of Child and Adolescent Health and Development

https://apps.who.int/iris/bitstream/handle/10665/62435/55732.pdf;jsessionid=A0CC6334934CFEBDBD55209660AF58D5?sequence=1

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006.- LactMed App. [Updated 2019 Dec 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547435/

Author: Laurel Carbone, MD

© WKU {2022} All rights reserved.

After vaginal delivery, the most common pain is from breast swelling (also called engorgement), uterine contractions, and vaginal tears.  Cold packs and increasing the frequency of breast feeding can help with engorgement. Pain relievers like Tylenol and Motrin can decrease inflammation to relieve pain. Heating pads can help relieve pain associated with uterine cramps, which are most common during breastfeeding in the first few postpartum days. To help reduce pain associated with vaginal tears, ice packs can be applied to the perineum (the area between the vagina and anus).  Topical astringents, like witch hazel pads, or numbing creams can improve hemorrhoid symptoms.

• Padsicles can be very helpful (homemade: https://www.healthline.com/health/pregnancy/padsicles; or purchase: Frida Mom 2-in-1 Postpartum Absorbent Postpartum Perineal Ice Maxi Pads; Frida Mom Perineal Witch Hazel Cooling Pad Liners), especially when placed inside compression underwear.
• Compression underwear that extends above the belly can help with swelling and pain management in the vaginal and pelvic region. 
• Using a peri-bottle with room temperature to cool (not cold or warm) water to clean following urination instead of wiping. (i.e. Frida mom upside down peri-bottle)

Following cesarean delivery, it is important to take pain medication as recommended or prescribed by your health care provider. If NSAID dosing every 3 hours does not treat your pain, low dose opiates may be used. The goal is to use low dose opiates only as needed for break through pain. Codeine containing medications pass through the breast milk and adequate precaution must be taken if breast feeding. Choosing a breastfeeding position that puts less pressure on your incision and/or using a heating pad or compression belt may also provide incision pain relief. When you poop, sneeze/cough, or vomit in the first few weeks it can be helpful to use a small pillow (i.e. a throw pill from a couch) to brace/hold against your incision. This helps to absorb force to the incision. You can also hug the small pillow against your incision when rolling to get in and out of bed as well as when standing up from a chair.

Remember, constipation is common in the postpartum period (regardless of mode of delivery) and can make pain worse so stool softeners and certain laxatives can be helpful during this time.

Tips for managing constipation:

• Stay hydrated (with water) and eat fruits and veggies (fiber) can help to prevent or minimize constipation
• Position yourself on the toilet with a foot stool under your feet to bring your knees higher than your hips (https://www.squattypotty.com/) will help to ease the path of bowel elimination
• Try to blow out through your mouth when you poop by making a “SSSSHHHHH” or “HHAAAAA” sound instead of holding your breath
• Try to make your belly big and hard like a basketball when you are blowing out. 
• Daily movement and warm beverages, especially in the morning, can help to move stool through the system.  
• Belly massage can also help.

For vaginal or C-Section deliveries: slow deep breathing, focusing on the lower rib cage expanding in all directions, for a few minutes can help to decrease pain and promote reduction of swelling. This also sometimes helps mid to upper back pain.

For more information: https://www.acog.org/womens-health/faqs/postpartum-pain-management

Postpartum pain Management, ACOG Committee Opinion 742, July 2018

Author: Laurel Carbone, MD and Jill M. Maples, PhD, and Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

© WKU {2022} All rights reserved.

Your body has just been through a big transformation with pregnancy and delivery. Help to nourish your body by prioritizing recovery, especially during these next few weeks.

Sleep

While sleep may sound impossible right now, even short power naps can help add up to boost your body’s ability to recover. If you’re having trouble falling asleep, try these tips:

– Make the bedroom dark with blackout curtains or a sleep mask

– Reduce the temp. Studies have shown the ideal temperature for achieving deep sleep is 65-69 degrees. Check with your pediatrician for safe sleep tips for baby if room sharing.

– Limit screen time. Reduce your screen time before attempting to sleep and add in blue light blockers or reduce the blue light through your phone’s settings during dark hours

Ask for help

You don’t have to try to do everything on your own. If friends and family ask if there’s anything they can do, give them tasks to help you around the house. A postpartum doula may also be a great investment to help you during these first few weeks.

Nourish your body with food

Nutrition can play an integral part in postpartum recovery. Try to increase your intake of foods high in omega-3 fatty acids, iron, zinc, and fiber.

Activity

While early postpartum isn’t the time to start back to your regular exercise program, these are some activities you can prioritize during early postpartum.

Breathing

• Breathing is the foundation to your postpartum recovery and strength building process.

Kegels

• Not just a squeeze, a kegel is a contraction of the pelvic floor muscles that includes both a squeeze as if trying to stop the flow of urine and a lift, as if trying to lift something sitting at the vaginal opening up and inside the vagina like a vacuum cleaner. It is equally important that you can fully relax these muscles after you squeeze them. We recommend seeing a Pelvic Health Physical Therapist to perform a comprehensive assessment and assist you in proper performance, as we know that 50% of women perform kegels incorrectly when only given verbal directions. Pelvic Health Physical Therapist can also assist with any neck, back, abdominal, hip, or pelvic pain you may be having. Pelvic Health Physical Therapists are a critical part of the post-partum care team. (Optimizing Postpartum Care | ACOG). In some states you can see a Pelvic Health Physical Therapist without a referral from your physician. Other states require a prescription referral from your physician. 

Mobility Work

• It feels good to move your joints after spending so much time sitting to hold and feed baby, especially after 9 months of growing that baby. Focus on shoulder and hip mobility with movements such as wall angels, hip-hinging, rocking in quadruped, and shin box flows.

Walk

• Start out with short trips around the block and gradually build distance and time. Feeling symptomatic when walking? Sometimes changing to walking on a slight incline can help your body get into a better position.

Mental Health Monitoring

• Self-monitor for any signs of postpartum depression
• You can take this simple survey to screen yourself (edinburghscale.pdf (ucsf.edu) . If you score 13 or higher OR if you answered anything but NEVER on question 10, you really need to consult your doctor!

Casey Thomas-Hardesty, MS, NTP and Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

© WKU {2022} All rights reserved.

Vaccines, also known as immunizations, are important for your baby. Vaccines will help your baby avoid future infections and diseases by building immunity. As part of routine childhood healthcare, you will take your baby to a health care provider for vaccines at select time points in your baby’s lifetime.

You may have heard other parents express worries about the safety of vaccines. Fears about the safety of vaccines are completely understandable, however, the biggest fears about vaccines are not based on facts and evidence. 

Here are some facts about vaccines that should help you feel more confident in your decision to follow health care provider and national health guidelines about vaccines for your baby:

Fact #1 – Vaccination is the safest way to protect against certain diseases.

Vaccines produce an immune response similar to what is produced by the natural infection. It does not produce the risks of death or disability caused by certain diseases.

Fact #2 – Combined vaccines are safe and beneficial.

Giving vaccines at the same time adds no harmful effect on a child’s immune system. It lessens discomfort for the child. It also saves time and money. Children are exposed to more of an immune response from a common cold than they are from combined vaccines.

Fact #3 – It is always best to get vaccinated. This is true, even when you think the risk of infection is low, because if we stop vaccinations, deadly diseases will return.

Deadly diseases that seem to have been removed can come back when vaccination rates drop. By making sure each person gets vaccinated, we can decrease the presence of vaccine-preventable diseases. We all have a duty to do what we can to stop the spread of diseases. Even with better hygiene, clean living, and access to safe water, infections still spread. When people are not vaccinated, infectious diseases that have become rare can quickly rise again.

Fact #4 – There is no past or present link between vaccines and developmental disorders or disabilities.

There is no scientific proof to linking vaccination to developmental disorders or disabilities. The most common reaction to a vaccine is slight redness or a soreness that goes away in a few days without any complications. You may have heard that the measles, mumps, and rubella (MMR) vaccine or other vaccines cause developmental disorders, like autism. This rumor started with a single study in 1998 that was quickly found to have false data. The study was removed by the journal that published it and the researcher was stripped of his medical license.

Fact #5 – A vaccine causing disease would be extremely unlikely.

Most vaccines are made from inactivated parts of a virus or bacteria. It is not possible to get the disease from the vaccine. Some vaccines can cause mild symptoms like those of the disease they protect against. But, a common mistake is that these symptoms signal infection. If there are symptoms, it is the body’s appropriate immune response to the vaccine, not the disease.

Here is a link to the CDC’s website about vaccines for children: https://www.cdc.gov/vaccines/parents/index.html

References:

F Bustreo. Embrace the facts about vaccines, not the myths. World Health Organization. https://www.who.int/news-room/commentaries/detail/embrace-the-facts-about-vaccines-not-the-myths 

T Pongdee. Vaccines: The myths and the facts. American Academy of Allergy Asthma & Immunology. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/vaccine-myth-fact 

Public Health. Vaccine myths debunked. https://www.publichealth.org/public-awareness/understanding-vaccines/vaccine-myths-debunked/ 

Authors: Kimberly B. Fortner MD, Oluwafemifola Onaade MPH, Bandon Hays MD, Samantha F. Ehrlich PhD, Jill M. Maples PhD

© WKU {2022} All rights reserved.

Proper body mechanics refers to the application of body movement in a way that achieves maximum efficiency and reduces the risk of physical stress or injury.  Ergonomics is about creating a workspace that promotes efficiency and comfort. Together, proper body mechanics and ergonomics are the keys to preventing overuse and strain with baby care.

Think about how many times you lift your baby each day—lifting improperly puts a strain on your back and can cause injury. Using the followings techniques for lifting and incorporating ergonomic techniques for your changing table and other baby equipment will keep you pain and injury-free.

Start practicing these techniques before your baby is born. Learning how to lift your baby correctly from the start will help make proper lifting techniques a habit.

• Slow down and think about how you are going to lift properly.
• Put less stress on your back when lifting your baby and baby equipment by bending the knees, hinging at the hips, and keeping the back straight. Minimize bending from the waist or hips,
• When lifting from the floor squat or kneel in front of your baby to lift.
• Bring your baby as close to your body as possible before lifting. Avoid holding your baby out in front of your body, as that puts a strain on your back.
• Gently exhale through pursed lips or a relaxed mouth and contract the abdominal and pelvic floor muscles as you lift
• When carrying the baby and the carrier, focus on using good lifting mechanics.
• Avoid the one-arm “grab and lift”—always use both arms to lift and hold.
• When lifting your baby from the crib, position the baby as close as possible to your side of the crib by gently sliding your baby towards you.
• Before lifting your baby from the crib, take a big breath and as you exhale, tighten your abdominal muscles and pelvic floor as you slowly lift.
• Breast feeding position: bring baby to breast with pillows and supports instead of bringing breast to baby. Support your body with pillows, blankets, and or towels as needed as well to optimize your comfort and decrease neck and back strain.

Creating an Ergonomic Workstation

• Adjust baby changing table to a height that allows an upright position and prevents you from having to bend forward.
• Tables should be positioned so that their tops are just below the level of the elbow.
• Store your baby supplies such that you don’t have to reach overhead,  or bend and twist to get to them. If possible, set up the changing table against a wall and install shelving above the table within easy reach.
• Before you buy, make sure that baby cribs, carriers, and a changing table are easily adjustable to fit the person using them.

https://orthoinfo.aaos.org/en/staying-healthy/preventing-back-pain-tips-for-new-moms/

http://www.working-well.org/articles/pdf/parenting.pdf

Catherine Cram, MS & Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

© WKU {2022} All rights reserved.

Did you know the breastmilk you are making for your baby is 90% water? Did you know proper fluid intake will help you recover from your delivery?  For these reasons, and many more, it is so important you are taking in enough fluids! You should drink enough water to quench your thirst and then a little bit more. A quick and easy recommendation is to drink a glass of water with every meal and every time you breastfeed your baby! Many new moms find it helpful to have a water bottle or water jug near wherever you normally sit to nurse (or pump) as a reminder to drink.  

Keep in mind, if you are exercising, you need to drink!  

You want your urine to be pale yellow or almost clear. If it is darker than this, you need to drink more.  

Keep in mind carbonated beverages such as soft drinks can actually make you more dehydrated. Water is best!

Montgomery KS. Nutrition Column An Update on Water Needs during Pregnancy and Beyond. J Perinat Educ. 2002;11(3):40–42. doi:10.1624/105812402X88830 

Rigaud M, Sevalho Corçao C, Perrier ET, Boesen-Mariani S. Assessing a tool for self-monitoring hydration using urine color in pregnant and breastfeeding women: A cross-sectional, online survey. Ann Nutr Metab. 2017;70 Suppl 1:23-29. doi:10.1159/000463000 

García-Arroyo FE, Cristóbal M, Arellano-Buendía AS, et al. Rehydration with soft drink-like beverages exacerbates dehydration and worsens dehydration-associated renal injury. Am J Physiol Regul Integr Comp Physiol. 2016;311(1):R57-65. doi: 10.1152/ajpregu.00354.2015 

© WKU {2022} All rights reserved.

Did you know that nearly 1 in 4 new mothers experience clinical depression after having a baby? More than that, nearly all women experience emotional highs and lows in the challenging weeks after adding a new addition to your family. We know you love your squishy little baby more than anything in the world! And we know you are happy to have them! That said, it is okay to admit you are sad or overwhelmed. It’s okay to admit not every minute is butterflies and rainbows. These early days, weeks, and months are HARD. And you are not alone! If you are feeling sad, overwhelmed, overly teary, or any other extreme emotions, don’t hesitate to talk to your doctor. There are many great options out there to help you, including exercise!  Don’t let another moment go by where you are not at your best and your happiest! Your baby needs you to be your best version of yourself!

Here are some symptoms to look out for:

• Reduced quality of life
• Anxiety
• Lack of life interest
• Tearfulness
• Insecurity
• Inappropriate obsessional thoughts (i.e. that your baby will stop breathing if you do not monitor them constantly)
• Irritability
• Fatigue
• Guilt
• Fear of harming the baby
• Reluctance to breastfeed
• Difficulty processing birth or birth trauma

If you are not sure if your feelings warrant evaluation, click this link and take this simple quiz! https://psychology-tools.com/test/epds. It is only 10 questions and will provide you with a score. If you score anywhere from 10-30, we recommend you talk to your doctor! 

You may also want to talk with a spouse, partner, or close friend/family member and to ask if they have noticed a change in your mood. Sometimes, a loved one may recognize a change in mental health before you do.

https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

Cox  JLMurray  DChapman  G A controlled study of the onset, duration and prevalence of postnatal depression.  Br J Psychiatry 1993;16327- 31.

Gráinne M. Donnelly GM, PT, Brockwell E, Rankin A, Moore IA. Beyond the Musculoskeletal System: Considering Whole-Systems Readiness for Running Postpartum. J Wom Health PT. 2022;46(1):48-56.

© WKU {2022} All rights reserved.

You have taken care of yourself to deliver your baby.  Now, let’s talk about how to take care of you!  Your body has changed over the last 9 months and will continue to change over the next 6-18 months.  While many physical changes are very common after pregnancy and delivery (for example, leaking urine), they are not normal and you do not have to live with them!  Urinary incontinence (leaking urine for any reason) is considered normal for 2 weeks after delivery, as well as some pelvic heaviness and pressure (prolapse).These symptoms should progressively improve over the first 2-3 weeks postpartum.

 If these problems persist after 2 weeks, a physical therapist can help with exercises and lifestyle/behavioral modifications to reduce and potentially reverse your issues.  They can also help with the aches and pains associated with childcare activities including: neck and back pain, wrist and hand pain, impaired posture, and/or numbness and tingling in arms, legs, or pelvic area.  Other issues that can occur are diastasis recti (separation of abdominal muscle) and pelvic pain with vaginal penetration (sex, speculum exam by your doctor, tampon use when your menstrual cycle resumes).  It is important to address these symptoms early so you may return to your previous activity level and care for your baby without interference or pain. 

** A Women’s health physical therapist (WHPT) is a licensed clinician trained to evaluate and treat neuromuscular condition, including those related to pregnancy, postpartum, and pelvic pain. We commit ourselves to learning and caring for women in all phases of life.**

Written by Women’s Health Physical Therapist: Dr. Emily Davenport, PT, DPT, WCS, & Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

© WKU {2022} All rights reserved.