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My Postpartum Story: One Year Ago Today

Mama Strut Blog One Year Thumbnail

onyear-mainA year ago, I was discharged from the hospital with nearly 20 stitches and I was still bleeding from my wound. I had lost over 500ml of blood and continued to bleed for another four weeks. My condition caused me to have hot flashes and night sweats. I had trouble sleeping, I lost a lot of hair. As my swollen organs healed, they shrank back down about 2,000% to their original size.

I also lost weight. A lot of weight. More than 24 pounds in just 2 weeks. While weight loss sounds great in theory, I assure you it wasn’t in reality. My body was loose and weak – it just left me with a saggy, empty feeling.

I got dizzy when I stood up too fast. My back always hurt and my abdominal muscles were shot, so I had to use my arms to haul myself up from a lying or sitting position.

During the first 6 months of this postpartum recovery, I also caught a few colds. And every time I coughed, I peed myself because my pelvic floor muscles were shot, too.

My body itched, my face broke out, and some parts of my skin were raw and cracked. I was constantly thirsty as my body tried to keep up producing.

I was constantly in pain, which affected my mood and at times bordered on depression. I had a short temper and difficulty connecting with my loved ones. In the early days, I couldn’t see past the pain. Most days, I just didn’t see the light at the end of this long and arduous healing journey.

I sought the advice of my doctor, pleading, “This can’t be normal. I think there’s something wrong with me.” She tried to reassure me that everything I was experiencing was typical and would “resolve itself.” And I kept asking myself, “Why wasn’t I warned about this?”

When people complimented me on how great I looked and how much weight I had lost, and I would stare back at them with a strained smile, offer a polite thank you, and think to myself, “If you only knew.”

As months went by, it began to get better. I got stronger and my wounds healed. Some were still visible; some only I could sense. But my condition had forever changed my body. It felt different now – not bad, just different.

And today, one year later, I have actually gained a great appreciation for my body and its capabilities. Before these scars, I was a different person. There are scars, they are an emblem of what has shaped me into who I am today. Strong. Resilient. A mother.

This is postpartum.

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Q&A with Dr. Farzad Mahjoubi: What Every Expecting Mom Should Know About Epidurals

Anesthesiologist Dr. Farzad Mahjoubi

mama-blog-mahjoubi-mainQuestion & Answer with Anesthesiologist Dr. Farzad Mahjoubi.

What do you think is the most misunderstood concept about an epidural during labor?
The biggest misconception about epidurals is that the procedure often results in spinal cord injury. Epidurals for labor actually are done at the lumbar level, below where the spinal cord ends. So unless the anesthesiologist is completely off, it’s pretty much impossible to hit the spinal cord during an epidural. Another misconception is that epidurals can cause back pain following childbirth. This may occur if the anesthesiologist hits the spinal column or nerve roots during the procedure. But again, this is a rare occurrence in properly trained hands. Back pain following childbirth usually occurs from the baby’s head passing through the pelvic brim, or from the extra weight carried during pregnancy, weak abdominal muscles or body posture.

What do you wish your patients knew about preparing for an epidural?
The best way to prepare is to be educated on the patient’s role in the epidural. It’s important for the patient to remain calm and sit still during the few minutes the anesthesiologist is looking for the right space. An anxious patient may move at the slightest touch instead of remaining motionless. Also, proper positioning as shown by the obstetric nurse and anesthesiologist will help an epidural go smoothly.

Are there any medical conditions, predispositions, or other factors that would prevent moms-to-be from considering an epidural?
Any woman who has undergone back surgery should tell her doctor. Often, the anatomy is altered or hardware is placed during spinal surgery, and the anesthesiologist needs to take this into consideration during an epidural procedure. Moderate to severe Scoliosis should also be mentioned to the doctor for the same reason. There are multiple medical conditions that may affect epidural placement, such as bleeding disorders, systemic infection, altered brain anatomy, allergies to medications used during an epidural, heart problems such as valve disorders, and liver disorders that may impede in metabolism of medications used. However, the hospital staff and obstetrician are most likely aware of these conditions prior to the procedure, and such information is also noted in the medical chart.

What are the newest advances in anesthesia for new moms today?
Though not much has changed, there are new types of epidural syringes that aid anesthesiologists in finding the epidural space, but most of the physicians I know don’t rely on this syringe and rarely use it. Since the epidural works amazingly well, no major advances have been seen on the obstetric anesthesia stage in recent years.

Like any other medical treatment, epidurals come with risks. What suggestions do you have to reduce the risks?
As mentioned before, the more obese a patient is, the harder it is to do an epidural. Adhering to a healthy diet and lifestyle to avoid or reduce obesity helps greatly. And again, educating oneself about the epidural procedure will help decrease any related associated anxiety.

What are the warning signs for any adverse reactions to an epidural and how should the patient deal with those reactions? 
One uncommon, but debilitating, side effect of epidurals is a post-dural puncture headache. If the needle goes in a little too far, causing a small leakage in the cerebrospinal fluid, patients can get a severe headache that may last for months. If this happens, go the nearest emergency room and let them know you recently had an epidural. The ER physician should know that this is likely due to a PDPH (post-dural puncture headache). The anesthesiologist will be called and can immediately remedy the headache by performing a “Blood Patch,” a procedure where the patient’s own blood is used to patch up the small leak caused by the original epidural. It does involve the same procedure, except this time 15-20ml of blood is placed into the epidural space instead of a catheter. Another sign, though very rare following an epidural, is loss of bowel or bladder function, which can be symptomatic of a possible spinal cord injury. If this happens, immediately go the nearest ER.

What other pain management options do you recommend for a woman in labor? Please talk about the pluses and minuses of each one.
Instead of an epidural, IV pain medications can be used to decrease pain. The advantage of this option is that an epidural is not done. The disadvantage is that the baby will also get a dose of the IV medications used, so the types of medications are very limited because the baby has to be taken into account. Another disadvantage is that an epidural offers far more superior pain control than any IV medication can. IV medications also have systemic side effects, such as sedation and nausea. While nausea may still occur with an epidural, it is much less common if the same medication is placed in the epidural space vs. given in an IV. Other pain management options include breathing techniques and meditation. The advantage of these methods is that they don’t carry the same risks or side effects that profile IV medications or epidurals do, but the disadvantage is they provide significantly inferior pain control.

Anything else you think moms-to-be should know about pain management options before going to the hospital?
Epidurals are safe in the right hands, but the choice is ultimately a personal one. I would also advise not to wait until you are fully dilated, or close to being fully dilated, before asking for an epidural. Some moms do this thinking they can give birth via vaginal delivery without an epidural, but end up asking for one too close to the time of birth of her child. This is disadvantageous because it can create a situation where the anesthesiologist is not only rushed, but is also dealing with a patient in severe pain and who may not be able to hold still during the procedure.

Thank you Dr. Farzad Mahjoubi for taking the time to answer our questions about epidurals.

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How Painful Is Labor? More about Labor Pain.

Mama Strut Blog Labor Day - How to manage labor pain

labor painOn the one-year anniversary of my third and last labor, I look back on how I coped with the labor pain. This reflection brings up the question every first-time mama-to-be wants to know: how painful will labor be and what can I do to help myself cope with labor pain?

Maybe it’s the result of Hollywood depicting wild birth scenes or maybe it’s the abundance of unsubstantiated information on the Internet, but many mamas-to-be are developing a deep anxiety about birth – sometimes even months before delivery. This fear won’t only ruin your pregnancy, but can actually make birth more painful and more likely to end in an intervention. So, instead of focusing on the fear of pain, let’s explore how you can cope with labor instead.

You’ve Got This, Mama

To be clear – birth is a big deal and painful, Pain is a four-letter word, but not a negative one. It’s a way to express a physical sensation to others. Describing how your body feels during labor will help your caregivers provide the right support. No one should be negatively judged because they find birth painful (birth shaming and pain management are related topics that should also be addressed in light of dialogs that rank birth success depending on the amount of intervention or type of management dispensed).

Simply put, a successful birth is a healthy one for mama and baby. Do not listen to anyone that judges your birth choices.

There Are Many Options For Coping With Labor

Because labor is difficult and painful, there are numerous natural and pharmacological ways to help manage it. The degree of labor pain varies from mama to mama – contractions can range from “sensations” or menstrual cramp-like discomfort, to an intensely excruciating experience that, in the moment. you can’t imagine surviving. But don’t worry, you can’t die from labor pain.

Labor Pain Is Not Constant

The good news is that unlike any other types of pain you have felt throughout the course of your life, there are actually pain-free breaks between contractions. These breaks allow you to rest, breathe, and prepare yourself for the next contraction, as well as communicate with your support team.

Labor Pain Intensity Has Stages

Another important fact to keep in mind is that intense contractions warm up your body, starting slow and far apart and increasing in intensity.  This progression in intensity and frequency actually helps your body cope with them. Recognizing that you have managed through the last contraction will give you the confidence that you will be able to manage through the next despite the fact that it may be more intense.

It’s Not Pain, It’s Progress

Knowing what’s happening to your body during labor will help you see the pain as progress on your birthing journey, and not a sign of the body being in distress like other kinds of pain. The pain felt as the uterus contracts to help your baby exit is a positive thing – but because we have associated pain with something destructive happening to our body our entire lives, we are hardwired to interpret labor pain as a threat. Mentally recognizing that labor pain is different will help you view it as positive.

My personal birth mantra (which started off as a joke between me and my doctor) was “It’s not pain, it’s progress.” As I repeated this in my head throughout labor, it helped me focus on the task at-hand and even chuckle after a massive contraction that hurt like hell. Many mamas have report repetition and rhythm as coping mechanism to help keep them in the zone.

That being said, it is still pain and reducing that pain will increase your birth outcome and even your chances of postpartum depression. (citation)

Here are some things to consider when it comes to coping with labor pain:

Mama Musts

  • Be educated, informed, and prepared about birth and your pain management options.
  • Surround yourself with people (doctor/midwife/partner/doula) that support your wishes.
  • The positioning of your body and mobility can reduce pain – walking, squatting, and not lying on your back can reduce pressure and pain.
  • Create a calm labor and birthing environment (hospital/birth center/home birth), taking into consideration who is there, noise level, and familiarity for your personal comfort.
  • Do your best to have your baby in the optimal position for birth. See
  • Keep hydrated but not overly hydrated – not getting enough fluid during labor can be detrimental; having too much IV fluid can lead to swelling, making birth more difficult.

Natural Methods

  • Ice and heat therapy are tried and trusted ways to relieve pain, ease cramps, and relax muscle tension.
  • Some mamas-to-be prefer massage, while others in the heat of labor might not want to be touched, so talk to your support team about listening to your cues prior to the big day.
  • Water in the form of a tub or shower can help relax muscles, reduce gravity pressures, and ease tension.
  • Movement and changing positions in labor can provide relief from pressure.

Pharmacological Support

  • Nitrous Oxide provides anxiety and pain relief, and is self-administered, so you can decide how much is right for you. Studies have not shown any significant risks to the fetus or mother, but side effects can include dizziness, nausea, or vomiting.
  • Talk to your doctor beforehand about which intramuscular opiates – pain relieving drugs – are available to you, how they are administered, and the pros and cons of each.
  • An ambulatory (walking) epidural is a lower-dose epidural, which allows you to retain sensation in your legs so you can move around.
  • An epidural analgesia delivers pain medication through a tube inserted into the epidural space in the vertebral canal.
  • A spinal epidural delivers a local anesthetic in the lower back, just outside the spinal cord, to reduce sensations in pelvis or abdomen .
  • A local analgesia is injects pain-relieving medication directly to specific area of the body.

No matter which path you anticipate, keep in mind that when you are in the midst of labor, you might end up using a different coping mechanism or a combination of methods. The best way to prepare is to be educated – and open-minded – about all the ways you can cope with labor and remember, you got this mama!