Category: Postnatal

A Birth Fear Explained; The Peri Tear – Latest Evidence

Info to help you head into labour not worried about tearing but armed with the tools to best help minimise tearing and understand how best to manage and heal post birth.

Anecdotally when speaking with women about childbirth, in a professional setting or with girlfriends one fear brought up commonly is “I’m worried about tearing”. Now this is a totally valid feeling and fear, however this information should help you to understand how incredibly common (and often not that big of a deal) peri tears are.

Current research have the odds of sustaining a peri tear at around 85% (with the majority being low grade tears (defined below) and 0.6%-11% being the more severe ones (defined below).

In my opinion, women should head into labour not wanting to not tear (although, that is the ideal) but armed with the tools to best help minimise tearing and understand how best to manage and heal post birth.

What is the perineum? Where is the perineum?

The perineum is the area shaped like a diamond, that involves your vagina and anus. It involves the superficial and deep structures of that region.

What are the stats around tears?

The more babies you have the incidence of peri tears decreases. Perineal tears reduce from 90.4% in women who are first time mamas to 68.8% in women who are having subsequent babies.

Are there risk factors to perineal tearing?

Yes. There are maternal, baby and intrapartum risk factors to consider. The factors greatest in your control (remember birth is unpredictable and birth plans sometimes should be seen more as birth wishes…have your ideal plan A but also be open to B and C) are the intrapartum risk factors. These are the things that you can do during labour and birth to help minimise tearing.

Some of these risk factors (but not limited to) include:

  • epidural use (as this greatly restricts your movement)
  • use of oxytocin (statistically intervention leads to more intervention)
  • instrumental birth (vacuum or forceps)
  • episiotomy
  • prolonged second stage (>60 mins)
    ** the research within this study didn’t indicate whether this 60 minutes was a blanketed time for both first time mothers and/or mums of multiple babies. Some studies give first time mothers a longer second stage before considering it “prolonged”.**

Questions to discuss with your health practitioner antenatally?

  • Discuss what your hospital or care providers vaginal examination policy is.
  • Discuss birthing positions, use of water (does the hospital offer warm compresses?)
  • Discuss perineal massage antenatally and have a discussion around whether this is something that could be beneficial for you (we have a free how-to download here).

Grades of tearing?

Perineal tears are graded from a labial graze and then one to four.

The most common are labial grazes, 1st degree tears (shallow tear to the skin) and 2nd degree tears (tear to the skin and muscle).

3rd (3A,3B,3C) degree and 4th degree tears are not as common (these all vary in definition, but to keep it simple they involve a tear to the skin, perineal muscle, and/or internal and external anal sphincter muscles — a 4th degree tear, involves a tear into the anal sphincter.

What’s the latest evidence saying?

  • Current evidence published in 2020 (Pubmed), retrospectively studied 22,387 pregnant women, and looked at the association between the number of vaginal examinations during labour and perineal trauma. The study concluded that performing five or more vaginal examinations (VEs) during active labour is associated with an increased risk of severe perineal trauma (defined as grade 3-4).  [DOI: 10.1007/s00404-020-05552-z]
  • Lying on your side, kneeling, standing or being on your hands and knees when you give birth will help. If you want more info on birth positions, head over here and have a read.
  • Avoiding long stretches of time squatting, sitting, or using a birth stool when you are pushing – if you’re getting good comfort from these positions, just switch it up, rotate your way through.
  • Ask your midwife to hold a warm, wet compress (a sterile hospital washcloth) on your perineum while you are pushing. Research concluded from a randomised control trial looking at the efficacy of warm peri compresses whilst pushing that women reported less pain whilst pushing when using a warm compress, working as a pain relief.

‘The use of a warm of a warm pack failed to decrease the likelihood of a laceration requiring sutures, which occurred in about 80% of women in both groups…however…women (who didn’t receive warm compresses) were more than twice as likely to have an anal tear (8.7% vs. 4.2%)’.  – Dahlen et al.

It also was linked to less perineal pain in the days after birth, as well as less reported urinary incontinence reported three months post birth.

 

Healing after birth

  • Make sure your sutures are looked at by a health professional
  • Keep clean and dry
  • Use ice and pain relief to minimise swelling
  • Begin pelvic floor exercises as soon as possible in the days post birth
  • If you sustain a more substantial tear, it’s important to follow up and be referred onto a physio that specialises in women’s health.
  • If in doubt, and you have questions, speak to your midwife, obstetrician, or GP.

Continue reading “A Birth Fear Explained; The Peri Tear – Latest Evidence”

The Newborn Bubble: a balancing act during Covid-19

The newborn bubble is a special time post birth…isolation is a contributing factor to feeling unsupported. Medicare have rolled out a bulk billed service allowing you to connect with health practitioners from the comfort of home.

With Covid-19 being at the forefront of most people’s minds, for many women their pregnancy, birth and postnatal period are at the forefront of theirs. With the world slowing down, and retreating to their homes, hopefully mothers and babies will be able to “bubble” that little bit longer…with less visitors, less pressures to tidy the house, less pressure to get out and about.

I love the newborn bubble. The special time post birth when you and your new baby are learning each other, bonding and finding your way through breastfeeding, sleep (or sleeplessness), snuggles and the general explosion of love. The days blur into the nights, blurring into weeks; and for how hard it can be, it repays itself ten-fold in the love you uncover for this newbie that’s now in your world. I’m lucky enough to have felt this way throughout the early days of motherhood.

Now on the flipside of this potential benefit (a prolonged bubble) of Covid-19 is that isolation is a massive factor in contributing to feeling unsupported.  20% (1 in 5) of women will be clinically diagnosed with postnatal depression in Australia (according to 2010 stats), with more than half of these women being diagnosed in the perinatal period. It could be suggested though, that with this period of self-isolation, clinicians being stretched, and people being more hesitant to step foot into health clinics etc., diagnosis could be missed, and therefore mothers could unnecessarily suffer through an illness that seeks attention and help. It is important to remember that this is an illness and not a reflection on a mother personally, and there are ways to seek help, especially during times like now. Now more than ever, it’s the responsibility of family and friends to call to check in, with new mums.

The Australian Government, has funded a 100 million dollar Medicare service for people in home isolation, quarantine, or unable to attend a doctors surgery for whatever reason, that allows health consultations via the phone or video link through mediums such as Facetime of Skype to consult with the general public (specifically people deemed to be vulnerable or immunocompromised). It’s a completely bulk billed service provided by GPs, specialists, nurses, mental health and allied health workers.

This will be an incredibly important service for new mums, not only for the protection of their babies (staying out of doctors clinics unnecessarily) but ensuring fast, efficient and easy access to help, if required.

Pharmacies and e-prescribing services will be eligible to participate in the home medicine services (great for mothers if they were to get mastitis, etc.).

For more info: https://www.pm.gov.au/media/24-billion-health-plan-fight-covid-19

Signs and Symptoms
According to PANDA, The Perinatal Anxiety & Depression Australia organisation, a combination of the following symptoms for someone suffering from PND is not uncommon:

  • Sleep disturbance unrelated to baby’s sleep needs
  • Appetite disturbance
  • Crying or not being able to cry
  • Inability to cope
  • Irritability
  • Anxiety
  • Negative, morbid or obsessive thoughts
  • Fear of being alone or fear of being with others
  • Memory difficulties and loss of concentration
  • Feeling guilty and inadequate
  • Loss of confidence and self-esteem
  • Thoughts of harm to self, baby or suicide

Need help?
– Beyond Blue and their support service: 1300 22 4636

– PANDA

– How is Dad going?

– Black Dog Institute and a self-test

– How to get help
– Contact your GP

Articles about PND:
– Men just as likely to suffer PND 

– Postnatal Depression treatment at home a huge success

– Postnatal Depression Beliefs Confused

– https://www.aihw.gov.au/reports/primary-health-care/perinatal-depression-data-from-the-2010-australia/contents/summary

 

 

 

The Benefits of a Snuggle

Skin-to-skin explained

No doubt if you’re having a bub, someone will have mentioned the importance of skin-to-skin with you. And if they haven’t, you’re going to read about it now.

Skin-to-skin is literally that. It’s the newbie nudie on your chest, your partners chest, the new baby’s sibling chest, having a snuggle.

Why is this encouraged? Well besides from it being squishy and delicious, research has found that there are life-altering changes that happen for Mums’, Dads’ and babies when they share a cuddle.

Your love hormone, Oxytocin, the hormone that comes out and says ‘hey’ when you’re feeling safe (think sex, contractions, breastfeeding, smooching), is released, helping with bonding and attachment.
Skin-to-skin is particularly great for Dads and partners to participate in. Whilst the Mums are having that post-birth heavenly shower or cup of tea, partners whip off their shirts, and love on their baby, getting all the loved up feels!
Tip: Ask for a warm blanket from the warmer, nothing better than a toasty snuggle.

If you’re planning on breastfeeding your baby, skin-to-skin is a wonderful way to start your breastfeeding journey. Breastfeeding is promoted by giving your baby easy access to its new food source and the time to root around and explore what they’ve got to do. They also are able to smoosh their smell all over your chest, making their mark on their new territory.

Skin-to-skin also helps reduce a baby’s stress hormone (cortisol). Your baby has been listening to your heartbeat from the inside for 9 months, so what could be better for your Bub to transition to the world than them snuggling up on your warm chest, listening to your heartbeat? Just writing this makes me think of a relaxed snuggle bunny all curled up on their mama’s chest, blissed out and loving life on the outside. Winning!!

Skin-to-skin helps to regulate a baby’s temperature, heart rate and their blood sugar levels. As midwives we want babies to be being pink, warm and sweet.  Skin-to-skin is a major contributing factor in helping babies to be pink (well perfused – good oxygen levels, good heart rate etc.) warm (normal temperature) and sweet (good blood sugar levels).

Skin-to-skin also does wonderful things to the mamas body, too, but we’ll delve into this in another post.

Keep in mind, if skin-to-skin doesn’t happen immediately at birth, for whatever reason, getting your baby to your chest, or your partners chest as soon as it is possible, still has benefits and is a worthwhile exercise. Plus it feels pretty great, too!

Skin-to-skin is happening more and more, and in some hospitals becoming part of their policies/ highly encouraged now for caesarean section births, so make sure if you want it, that you remind the theatre staff of your wishes.
For the emergency caesar mamas, or the mamas that don’t particularly want their baby immediately on their chest (you might be unwell, nauseous, vomiting etc, and not wanting to in that very moment), this can be a great opportunity for partners to have the first cuddle. I’ve seen many parents in the recovery of theatres taking off their tops and having that delish moment with their new bub. Swooooon!!!!

Remember skin-to-skin isn’t just important when Bub is minutes, hours or a few days old, it is encouraged as much and as often as you want, for as long as you want.

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Photo from Instagram – @melissajeanbabies
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Photos from Instagram – @melissajeanbabies

 

 

Feature image also by the talented @melissajeanbabies. Check out her piccies – she’s amazing!

Pelvic Floor Exercises; no activewear required!

You don’t need activewear or a gym membership to strengthen these bad boys, just a little discipline. Here’s the 411 on why as women; before, during and post babies we should be activating our pelvic floor.

Pelvic floor exercises are something that, as women, we’re told about over and over again, but are we doing these quick and uncomfortable exercises as often as we should be…i.e. everyday?
I know I don’t, and dare I speak on behalf of women, I’m sure the majority of us aren’t doing them as often as we should be. A study conducted in the UK has shown that 66% of women didn’t know where their pelvic floor was and only 40% doing their pelvic floor exercises on a regular basis – not great stats when I’m sure 100% of us do not want to be urinary and/or faecally incontinent in the long run!

So here’s a quick 411 on all things pelvic floor and why they are important for women pre-baby, during pregnancy and post baby.

What is the pelvic floor?

Think of your pelvic floor as a sling of muscles that support the uterus, bladder and bowel. Everything that comes out from down below passes through the pelvic floor. These sling-like muscles attach at the front to your pubic bone and at the back to your tail bone, from the base of your pelvis.

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How do I do a kegel correctly?

To understand the muscles involved in pelvic floor exercises imagine needing to do a wee but not being near the toilet…that initial squeeze is the activation of your pelvic floor. How to do your pelvic floor exercises, see link below:

Continence Foundation of Australia

The Royal Women’s Hospital

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via pilatespod.co.uk
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via mutusystem.com

What’s the point pre-baby?

  • Provides bladder and sphincter control
  • Facilitates a strong foundation for when you do have a baby (think bowling ball sitting on your bladder…), to help minimise urinary incontinence
  • Can improve orgasms and sexual pleasure

What’s the point during pregnancy?

During pregnancy, the hormone progesterone softens and relaxes the muscles and ligaments within your body, enabling it to help bub manoeuvre its way through the pelvis and birth canal.

This progesterone also slows other things down in your body and a common problem during pregnancy is constipation, so drink lots or water, stay active and embrace a fibre-rich diet.

During labour and birth the pressure of bearing down and pushing may stretch and weaken the pelvic floor, so having the foundation of a strong pelvic floor can benefit the efficacy of pushing. It’s also not a bad idea to look into birthing positions, as birthing in an upright position can increase pelvic diameter by 30% …working with gravity…making more room for bub (read our article on birthing positions here)

The benefits of doing your pelvic floor exercises (excerpt via huggies.com) :

  • The risk of uterine or bladder prolapse is reduced
  • Pregnancy, delivery and recovery time can be improved
  • Post-partum discomfort from perineal swelling and haemorrhoids is reduced
  • Perineal tearing and/or need for an episiotomy is reduced
  • Urinary incontinence/leakage during pregnancy and after delivery is reduced
  • A toned pelvic floor leads to more complete emptying of the bladder and bowel
  • Helps to avoid stress incontinence after delivery – small amounts of urine leakage when laughing, sneezing, coughing or lifting something heavy

 

How do I regain strength post baby, and when should I start doing my pelvic floor exercises?

Start doing those pelvic floor exercises ASAP. Some women may find in the days post birth that doing their exercises laying down is easier and they are able to engage the right muscles more easily. Give it a go!

Before baby and during pregnancy your pelvic floor strength will have been more toned and therefore your exercises will have been stronger and longer in duration. In the early days post birth it’s important to work up to it. Aim for a few seconds each day for the first week, and build up to it slowly.

Tools to help with pelvic floor instability and incontinence

If you’re one of those people that need a gadget to motivate you to do exercise, here are few to investigate:

http://www.epi-no.com.au/

http://www.kgoal.com.au/

 

 

 

 

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Birth Perceptions; the power of language

Language carries weight and power. We have a question for you…

It could be argued that the time in a woman’s life where she will seek, question and be influenced by information the most is during pregnancy. Pepper in hormones, lack of sleep and a tiny touch of anxiety about the impending birth and you have a woman that is susceptible to the weight and power of language.

We know that words have the ability to empower us, and also destroy our confidence. Statistically, we are more likely to say stuff we regret or that might be less thought out when we are under pressure, feel out of our depth, are in an unfamiliar environment or anxious (welcome to a birthing room).
As midwives throughout our training we focus on woman-centred language, and ways in which to support and empower women giving birth, including ways in which to make the birthing environment feel safe and reassuring. This is all well and good, but reassurance from a loved one, and/or support partner is invaluable, and may hold more weight physically and emotionally for some women.

So….we’re throwing this one out to you guys….what words of empowerment; from either your midwife, doula, obstetrician, loved one, or support partner, got you across the line? What do you remember most vividly?  Keeping in mind that language is not always verbal. Physical language is also telling.

Sharing is caring! We’d love for you to comment below (short and sweet, or long and lengthy, you pick) and share in the positivity and empowerment of birthing language.

 

 

Image source : @birthwithoutfear  @southcoastmidwifery @kassandranicole

 

Breastfeeding Myths Debunked

Do babies need water? Small boobs, no milk? We’re setting the record straight!

There are many myths out there surrounding breastfeeding. Some myths are passed down through generations, some specific to certain cultures, and of course, from mama-to-mama experience. Another factor is that with constant research being undertaken for greater evidence in pregnancy related areas, what we once did, may not be of best practice or recommended anymore. So here are some common questions/myths and their answers/debunking.

Q: It’s a hot day, so I’ll give my baby (<6months) a bottle of water?
A: No your little bubba does not need a bottle of water. Breastmilk has 2 parts (once the milk is in). Firstly when the baby latches it will suck more intensely and quickly…this is when the baby is getting foremilk, a thin, thirst quenching milk. When the baby switches rhythms and begins slower, more nutritive sucking, bub is receiving the hindmilk (a fattier, densely nutritious, calorie fuelled milk). So on a hot day, you might find your baby feeds more frequently and for short amounts of time…this is because baby is requiring the thirst quenching milk. Make sure you keep your own fluids up!

Q: I’ve got small boobs, so does that mean I don’t produce as much milk as someone with big boobs?
A: Breast size doesn’t affect milk production in the majority of women, this is because breast tissue is for the most part connective tissue and fatty tissue rather than milk producing glands. The amount of milk produced is connected to how often, how well and for how long bub feeds.

Q: My mother didn’t make much milk, so I won’t either:
A: Since your mum has had babies, a lot has changed. We now strongly encourage skin-to-skin immediately after birth (no washing of bub beforehand) and mother-infant bonding as well as rooming in with your baby. Complimentary feeds are not as frequent as they once were and many hospitals are striving for BFHI (Baby Friendly Hospital Initiative) accreditation which encourages breastfeeding and its benefits, and only utilising formula if there is a medical indication or maternal request.

Q: (Day 1) I don’t have enough milk:
A: When your baby is born and before your milk comes in around day 3-4, you have colostrum – a gold coloured, sticky fluid that your body has been making and storing since you were 16 weeks pregnant. Colostrum is not only gold in colour, it is liquid gold! It is densely rich in your antibodies, calories, protein and has a laxative effect (helping to push out the meconium, the black sticky poo, stimulating baby’s tummy) to make more room for breastmilk. You make the perfect amount of breastmilk for your baby. Colostrum is the initial breastmilk, and is of a lower volume than foremilk and hindmilk, however it is the perfect amount for your baby’s tiny tummy, at that point in time (see the image at the bottom of article).

Q: Formula fed babes are better sleepers than breastfed babes:
A: Formula and breastmilk have a difference composition and different protein molecules. Formula has larger protein molecules, meaning that it takes the baby longer to process and metabolise…sitting in their tummy longer…keeping them fuller for longer. Research has shown that though formula fed babies may sleep for longer periods than breastfed babies, their sleep quality is not of a better quality.
Breastfed babies begin to sleep for longer periods from around 4-6 weeks and it is at this time that their sleep duration seems to equate to that of a formula-fed bub.

FYI – Why babies don’t need a crazy amount of breastmilk on Day 1, and why they want to feed constantly in the days to come is explained perfectly in this picture below. Babies have tiny tummies, and breastmilk is metabolised very easily and quickly…hence their frequent feeding. Babies also feed frequently because they’re clever and know this brings the milk in quicker, especially at night time in the early days. You breastmilk producing hormone, Prolactin, is highest at night…and babies know it…hence why they sleep more soundly during the day and are crazily feeding throughout the night. Hang in there – they won’t be possessed, breastmilk crazy night monsters for too long!

via Pinterest
via Pinterest

Reference:

Saggy Boobs and Other Breastfeeding Myths 2008. Scotland. (This is an evidence based book that doesn’t take itself too seriously. An interesting read for mama’s wanting more info and more myths debunked!)

The Stages of Labour

Birth isn’t always like the movies. We’re breaking down the stages of labour from the first niggling pains to the birth of the placenta.

A lot of people think that as soon as labour pains begin, you dash erratically screaming and speeding to the hospital, like what you see on the movies. No, no – for the most part, it’s not like that…

We’re breaking down the stages of labour from the first niggles to having bub in your arms to the birth of the placenta. Let’s begin*!

*(Pregnant mamas – get your support person/people to look at this timeline – it’s a great reference tool so that they understand what you’re experiencing, what they can do to support you and what the midwife will be doing along the way. Also get them to check out this article on ways to support you during labour and birth).

P.S. As much as I’d love to be able to predict date of births, time of births, and mode of births (I’d be a bagillionaire) I can’t. Every one is different, and every labour is different, so this is just a rough anecdotal guide to each stage.

P.P.S. We haven’t spoken about pain relief options throughout the stages, but there’s stacks of evidence based info on pain relief here.

P.P.P.S. Lastly, membranes can rupture at any point in the birthing process, so we’ve left them off the timeline, as there’s no telling when this will happen.

EARLY LABOUR

Physical Signs women may experience:
– Irregular niggling pains (like period cramps)
– Contractions can be irregular, regular or not even felt.
– Loose bowels
– Bloody show (mucous plug that falls away from the opening of the cervix)
Emotions women may experience:
– Maybe this is it!
– Q: Should I go to the hospital now? (A: Call and speak to a birthing unit midwife, and they will help you with a bit of a plan for when to come in/ when to call back)
– I’m not sure if this is labour or not?!
Behaviour
Anxious – lots of walking…talking…smiling…restless…excitable…hungry…may not want to talk when having a contraction.

This period can last days, and be on and off. Some women won’t even notice this phase. This is the time where cervical changes begins.

FIRST STAGE

Physical Signs women may experience:
– Pains are stronger, more regular
– May feel a pattern starting to emerge
– Talking through contractions is becoming more of an effort
Emotions women may experience:
– It’s happening!
– Committed to the process
– Confident…. “I can do it”
Behaviour
– Lots of position changing…figuring out what is working best as pain relief (article on pain relief) and for comfort.
-lots of walking

*Late first stage – women can become more insular…they’re working hard and have a ‘Shh, I’m working” attitude towards birth. They begin to close their eyes more. This is the time where women become less modest, and loose inhibition. They are starting to feel more tired and start talking about sleep and how tired they are.

TRANSITION

Contractions can become more painful and frequent on that home stretch to being fully dilated (10cms). This is the point in time where a woman may begin to self doubt, may become confused, scream, tell you “she’s dying”… “giving up”…”going home”…
Women can become shaky, nauseous, vomit…have the urge to go to the toilet, as bub moves down the birth canal…it really depends.

As weird as it sounds this is a good sign! It means labour has progressed and baby is much closer to arriving!

SECOND STAGE – this is the pushing phase

Physical Signs women may experience:
– Mucousy show
– A second burst of energy
– Urge to go to the loo
– Spontaneously pushing
*  experience feelings of stretching, stinging, burning – all are common.
Emotions women may experience:
– More alert
– Chattier
– May be tired and sleep between contractions
Behaviour
– Calmer after transition
– Desire to focus so she can meet her baby

——————————-Baby Arrives!!!————————
via Buzzfeed
via Buzzfeed

THIRD STAGE

The birth of the placenta, can be either physiologically or actively managed (we will write a post on these modes of delivery soon!). Hopefully this will all be happening whilst you’re snuggling with your bub. Make sure you have a squiz at our article on delayed cord clamping – it’s a must read for mamas-to-be.

Because this isn’t the most evidence-based article we’ve written, here are some references so you can do some extra homework x

https://www.thewomens.org.au/health-information/pregnancy-and-birth/labour-birth/stages-of-labour/

http://www.pregnancybirthbaby.org.au/labour-the-signs-and-stages

Click to access having-a-baby.pdf

Postnatal depression – don’t look the other way

Did you know that over 1000 new parents each week in Australia are diagnosed with PND? Know the signs and symptoms!

Did you know that over 1000 new parents each week in Australia are diagnosed with postnatal depression (PND)? It’s a devastating statistic, and a debilitating illness. PND is not culturally, age or gender bias; and both men and women can suffer from it mildly, moderately or severely, immediately after birth or gradually in the weeks, months and year after birth. It can rear its ugly head after miscarriage, stillbirth, normal births, traumatic births and caesarean sections.

It is normal and common for women around day 3 post birth to feel teary, irritable, overly sensitive and moody. This is due to a woman’s hormone levels yo-yoing all over the place…around the same time as the milk is coming in…(convenient, right?!). It is okay to feel like this on and off for a few days, but if it persists, seek support and help is a must.

In light of September bringing awareness to depression and suicide through R U OK Day and it being Suicide Prevention Month, we thought this was apt timing to bring awareness to this commonly fought illness.

It is important to remember that this is an illness and not a reflection on you personally or as a mother or father. There are ways through postnatal depression, and we’ve provided a list of some of the support avenues out there at the bottom of this post. It is imperative that you seek professional help – speak to your GP.

Signs and Symptoms
According to PANDA, The Perinatal Anxiety & Depression Australia organisation, a combination of the following symptoms for someone suffering from PND is not uncommon:

  • Sleep disturbance unrelated to baby’s sleep needs
  • Appetite disturbance
  • Crying or not being able to cry
  • Inability to cope
  • Irritability
  • Anxiety
  • Negative, morbid or obsessive thoughts
  • Fear of being alone or fear of being with others
  • Memory difficulties and loss of concentration
  • Feeling guilty and inadequate
  • Loss of confidence and self-esteem
  • Thoughts of harm to self, baby or suicide
via Birth Without Fear
via Birth Without Fear

Need help?
– Beyond Blue and their support service: 1300 22 4636

– PANDA

– How is Dad going?

– Black Dog Institute and a self-test

– How to get help

– Contact your GP

Articles about PND:
– Men just as likely to suffer PND 

– Postnatal Depression treatment at home a huge success

– Postnatal Depression Beliefs Confused 

Postpartum Contraception

So you’ve had a baby! Contraception is probably the last thing on your mind, but it’s an important conversation to have with a healthcare provider…know your options!

So you’ve had a baby! Contraception is probably the last thing on your mind but, it’s an important conversation to have with a healthcare provider (Midwife, Obstetrician, GP, Family Planning Services) to discuss what will best suit you- and there’s quite the array!

If you are breastfeeding, postpartum contraception options include:

Lactational Amenorrhoea Method (LAM) – When you’re exclusively breastfeeding bub, the hormonal process can effect menstruation, halting ovulation (voila contraception!). The World Health Organisation accepts this as an effective method of contraception, and is considered 98% effective (the same efficacy as the pill) when used according to the guidelines. These guidelines should be discussed with a healthcare provider (this is very important…don’t want any surprises!)

Three criteria can be used to predict the return of your fertility.

  • Have you had a menstrual bleed? (for the purposes of LAM this is defined as any bleeding, on any two consecutive days, that occurs 2 months after the birth)
  • Are you giving regular supplementary foods or foods or fluids to your baby in addition to breastfeeding?
  • Is your infant older than 6 months of age?

If you answer no to all the above three questions, then you potentially meet the requirements for the LAM.

Progesterone only Pill (POP) – Progesterone only pills are considered safe whilst breastfeeding. POP works by thickening the cervical mucosa making it harder for sperm to penetrate. The important thing to note with the mini pill is that it needs to be taken at the same time each day (so set that alarm clock!)…because if you miss it (by 3 or more hours, that window is considered a missed pill, and extra contraceptive precaution will be needed).

Implanon® – is a progesterone implant, which may be suitable from 6 weeks. A conversation for your 6 week check up, perhaps?

Depo-Provera®/ Depo-Ralovera® – Progesterone intramuscular injection. Commence anytime from 6 weeks postpartum.

Mirena® – is an IUD. Dependent on hospital policy/doctor’s policy, the IUD may be able to be inserted within 48 hours postpartum. If this is not possible, it should be left until 4 weeks after childbirth. Its effective within 7 days, lasts 5 years and is a localised progesterone. If at any point you don’t want it anymore, it can be taken out…no 5 year lock in contract!

Note: women who have had a caesarean section should not have a IUD inserted prior to 6 weeks postpartum due to the increased risk of perforation.3

Side note: I have one of these bad boys, and they’re fab! 5 years contraception…tick…peace of mind.

Condoms – Can be used immediately.

Diaphragms – make sure size and fit is correct, and it is advised to wait 6 weeks.

Combined oral contraceptive Pill (COCP) – Not recommended to be used for the first 4-6 weeks. If breastfeeding is established, and no other methods are deemed suitable, this is an option to discuss with your GP etc.  The reason COCP is not recommended for the first 4-6 weeks, is because the combination of hormones can reek havoc with breastmilk supply establishing.

Non-breastfeeding mamas you really are spoilt for choice! All contraceptive methods are suitable. On average, for non-breastfeeding mamas, first ovulation cycle returns 45 days postpartum. 

References:

KEMH Policy and Guideline

POP info

LAM method

After you’ve had a baby

Vitamin K: Prophylaxis or Poppycock

The Vitamin K injection, does seem to sometimes, albeit unfairly, get lumped into the vaccination category by some people. It’s not a vaccine. More info here…

So I’m putting it out there, I’m pro-vaccination (insert horror and all things evil). I believe in herd immunity, and I believe that vaccinations against nasties such as whooping cough and chicken pox are a good thing! The Vitamin K injection, does seem to sometimes, albeit unfairly, get lumped into the vaccination category, and therefore is shoved into the evil corner by some with all the other vaccines – so this post will be about debunking the Vitamin K ‘vaccination’ and rather putting out there all things Vitamin K ‘injection’ related. It is an injection. Not a vaccination!

Vitamin K is a vitamin that naturally occurs in our bodies and is essential in helping our blood to clot and prevent serious bleeding. Babies cannot produce this for the first few months of life….so consenting to the Vitamin K injection helps bubs have enough Vitamin K to clot their blood (and prevent HDN – a rare bleeding into the brain).

There have been no reported reactions to the injection within Australia, since its implementation 25 years ago. There are two ways in which to give a baby Vitamin K:

1. Injection at birth

2. Oral doses (more complicated- a dose at birth, another 3-5 days old, and at 4 weeks).

There are some medical contraindications as to why you wouldn’t give a bubba Vitamin K… these are if they are sick, premie or if their mama took medication throughout pregnancy for certain reasons (talk to your midwife or doctor if you’re at all concerned).

If you’re seeking more info, it’s a great topic to bring up antenatally with your partner, midwife, obstetrician or GP. Of course at the end of the day, it’s your baby, your call!

For adults wanting to increase their Vitamin K stores within the body, as it is great for bone health (Vit. K helps calcium absorption) eating varied leafy green veggies should do the trick; think spinach, kale, celery as well as carrots, blackberries, raspberries, blueberries, sundried tomatoes….

For more information on Vitamin K please click resources and blog references below:

Vitamin K Royal Hospital For Women NSW

18 Foods high in Vitamin K for stronger bones

Vitamin K in neonates: facts and myths

Vitamin K for newborn babies Australian Government

image via theberry.com
image via theberry.com
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