Blog

-By Kelley Sanford, BADP volunteer 

On July 23rd, BADP’s monthly Salon Series featured Mary L. Crouch, DPT, the clinical director of Pelvic Health and Rehabilitation Center in Berkeley, CA and Lauren Chickneas, Ph.D., a Licensed Clinical Psychologist specializing in working with pregnant and postpartum people. The evening focused on the process of healing both physically and psychologically after birth.

Lauren Chickneas’ portion of the event specifically focused on the warning signs that might indicate that a person should seek professional help postpartum and emphasized how doulas could play an integral role in the referral process given their close relationships with new mothers.

Lauren addressed some of the challenges facing many people during pregnancy and postpartum including the following:

• role changes
• marital changes
• lack of social support
• body changes
• feelings of loss
• loss of control
• loss of freedom

Lauren differentiated what distinguishes serious mental illness from a case of the baby blues. Lauren presented statistics that show that 60-90% of people experience baby blues from two days to up to three weeks postpartum. Lauren suggested that beyond three weeks people should seek professional advice for continuing mood disturbances. Lauren outlined the following specific symptoms that would warrant a referral postpartum:

• Persistent sleep disturbances including difficulty with sleep onset
• Sleep maintenance or quality
• Extreme anxiety
• Obsessive Compulsive Disorder tendencies including intrusive thoughts relating to harming the baby
• Appetite changes
• Profound guilt and shame
• Not bonding with the baby
• Excessive concerns about the baby’s health
• Shortness of breath, racing thoughts
• Postpartum psychosis-tends to happen with people who have undiagnosed manic depression

Because of the stigma around postpartum depression and anxiety many people do not communicate with their healthcare providers, family members, or friends regarding the symptoms they are experiencing. Lauren stressed that the earlier treatment is received, the more likely that the duration of the symptoms will be shortened and that the symptoms will not be as severe. Lauren also spoke about what types of treatment options exist for people postpartum. Ideally, Lauren emphasized that the most positive outcomes are created when support is created prenatally and follow through continues postpartum.

• talk therapy
• social support
• parent/child therapy
• psychiatrist referral if merited

Mary Crouch’s portion of the evening focused on the role that the pelvic floor muscles play in birth, what types of situations might be cause for treatment and how physical therapy can treat pain postpartum. During pregnancy the pelvic floor muscles are under increased stress due to additional weight load. Mary explained how during childbirth all of the pelvic floor muscles stretch to accommodate the passage of the birth. Directed pushing during labor may also increase the strain on the pelvic floor muscles. As a result labial pain, rectal pain and difficulty having bowel movements are common postpartum.

Mary spent a significant portion of her talk addressing episiotomies and C-sections and the long-term effects of the scar tissue that is created from these procedures. Scar tissue from tearing during birth can render it painful to sit, have intercourse, or use a tampon. She also stressed there may be more long-term effects from a mid-line versus a lateral episiotomy. People who have had C-sections during birth may experience fistulas, hematomas, anal incontinence and other operative injuries. Typically healing time postpartum ranges from 6-8 weeks depending upon the procedure and the individual’s experience.

Some of the preventative measures Mary recommended prenatally to diminish the likelihood of the need for procedures during delivery included:

• Daily perineal massage during pregnancy to avoid tearing during the birth (not beneficial after 32 weeks)
• EPI-NO, a childbirth and pelvic floor trainer that can be used to help reduce the risk of tearing and episiotomy during a natural birth. Studies have shown that use of the trainer can lead to a shorter second stage of labor as well.

• Visiting a physical therapist to be evaluated

Mary emphasized that every person is different and that pelvic floor exercises should not be blindly prescribed to anyone. While some people will benefit from Kegel exercises, others will benefit from stretching exercises that will relax the pelvic floor. She emphasized that every person should be evaluated to create a treatment plan that will have the most effective outcome for them.

Thank you to both Mary and Lauren for sharing your expertise at this informative event!