Post Partum Care
Mamas on Bedrest: How The US Can Overcome Barriers to Breastfeeding
April 11th, 2012
Human breastmilk is the best food for human babies.
Everyone from the American Academy of Pediatrics to Surgeon General Regina Benjamin, MD., have extolled its virtues and clearly stated, in no uncertain terms, that “Breastmilk is Best.” We know that infants who are breastfed are at decreased risk of lower respiratory tract infections in the first year, lower incidence of diarrhea and vomiting, have fewer ear infections, are less likely to develop asthma, childhood obesity and type 2 diabetes, Sudden Infant Death, eczema, acute lymphocytic and acute myelogenous leukemia. In preterm infants, lack of breastfeeding is linked to a 138% increase in necrotizing enterocolitis, a potentially life-threatening problem. Breastfeeding also benefits mamas. The risks for breast cancer and for ovarian cancer are increased in women who have never breastfed.
So it is a huge disappointment to see that in the United States according to the Centers for Disease Control and Prevention (CDC) only 74% of mothers start breastfeeding exclusively at birth. By six months, that number dips to approximately 43% exclusively breastfeeding and by one year that number is a sparse 23% who are still breastfeeding. What is even more disappointing is that amongst African American mothers, only 60% initiate breastfeeding and only 28% are still breastfeeding at six months.
These numbers are far from the targets set for Healthy People 2020.
Breastfeeding Goal Current Rate
Ever-breastfed infants 82% 74%
Exclusive breastfeeding at 3 mos 44% 33%
Breastfeeding at 6 mos 61% 43%
Exclusive breastfeeding at 6 mos 24% 14%
Breastfeeding at 12 mos 34% 23%
New Mothers Need Breastfeeding Support to Continue Breastfeeding long term
What the CDC and the data from the Infant Feeding Practices Study II (IFPS II) showed is that while many mothers started with the intention of breastfeeding, there is a large lack of support provided to new mothers in order to be successful. The surgeon general’s call to action cited the following five obstacles to breastfeeding,
- Lack of experience and/or lack of understanding amongst family members, consequently lack of support for the nursing family
- Limited support from other nursing mothers
- No support of provisions available for breastmilk pumping for moms at work.
- Lack of up-to-date instruction and information from health care professionals
- Hospital practices that impede successful breastfeeding and hinder getting professional help from a knowledgeable nurse or lactation consultant
Support from Qualified, Educated Hospital Personnel is Critical to Breastfeeding Success
These barriers are directly addressed and removed when hospitals are educated and willing to support new mothers who wish to breastfeed. The US Breastfeeding committee also recommends placing a newborn immediately on mama’s chest at birth, even before cutting the umbilical cord, because evidence shows that
“a baby who is placed skin-to-skin will likely find the breast and initiate breastfeeding within the first 60 minutes of life”
To better ensure that hospital staff are able to support and educate new mothers about the benefits of breastfeeding and to assist with any potential problems, The CDC developed Baby Friendly Hospital Practices as part of the IFPS II. These practices have also been promoted by the World Health Organization and the United Nations Children’s Fund (UNICEF) in the Baby-Friendly Hospital Initiative, which includes a breastfeeding-promotion component. The Baby-Friendly Hospital Initiative has identified “10 Steps to Successful Breastfeeding”
- Have a written breastfeeding policy that is routinely communicated to all health care staff
- Train all healthcare staff in skills necessary to implement this policy
- Inform all pregnant women about the benefits and management of breastfeeding
- Help mothers initiate breastfeeding within 1 hour of birth
- Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants
- Give newborn infants no food or drink other than breast milk unless medically indicated
- Practice rooming-in by allowing mothers and infants to remain together 24 h/d
- Encourage breastfeeding on demand
- Give no artificial teats, pacifiers, dummies, or soothers to breastfeeding infants
- Foster the establishment of breastfeeding support groups and refer mothers to them upon discharge from the hospital or clinic.
Sometimes a mama and her baby must be separated following delivery. In these cases, mamas should be taught to use breast pumps and to express breast milk that can be stored and given to their infants for feedings. When the infants are stable enough to breastfeed, mama and baby should be coached on best breastfeeding techniques by a trained lactation consultant to ensure the best chance of success.
Ensuring Success after Discharge Home
Prior to discharge, a trained lactation consultant should meet with mama again to ensure that principles of latching on, milk letdown, normal infant stooling patterns and weight gain are understood. Mama should be evaluated to ensure that she is not experiencing nipple pain, has adequate experience expressing milk and knows how to pump if needed, has all of her questions answered, has resources and numbers to call if she has subsequent questions and/or needs support.
For Resources on Breastfeeding Support, check out our resources page here.
For useful books on Breastfeeding, Check out our store and look in the breastfeeding section.
Mamas on Bedrest: Pregnancy, Labor & Delivery Complications Can Have Longstanding Effects
April 9th, 2012Every now and then I’ll read something and ask, “What were they thinking?”
Such was the case when I read an article/blog post on FitPregnancy.com. In what I am assuming was an attempt to mitigate fear and worry in pregnant women about to deliver, Marjorie Greenfield, M.D., a professor of OB-GYN at Case Western Reserve University School of Medicine was quoted as saying,
“Most ‘complications’ are irrelevant. They have no impact on the health of the mother or the baby.”
I found this statement appalling because many complications have longstanding effects-both physically and emotionally- on mothers and their children. As a woman who had significant intra partum bleeding (I use the word hemorrhage but that isn’t the official notation in my chart) my delivery “complication” had significant effects on me, my daughter (who spent 10 days in the NICU) and my husband who witnesses this traumatic birth.
Pregnancy complications have a significant impact on mamas and this is especially true for mamas on bed rest who have an increased risk of complications during labor and delivery (in addition to their bed rest complications) and who are at increased risk of post partum mood disorders. Mamas experience a wide range of feelings and emotions. Speaking from personal experience, I felt like my body failed me and my daughter because my delivery was so complicated and resulted in my daughter landing in the NICU. I experienced a profound sense of loss. My daughter never stayed in my room with me and I felt robbed of that experience. I hurt. I had delivered via c-section and on top of everything else, my body simply ached.
I felt “wrong” on many levels. I had a scheduled c-section. I had done a lot of research and saw that many “authorities” extolled the virtues of vaginal birth. Yet because of my reproductive history, I was told my body was unable to deliver vaginally without a significant risk of uterine rupture. My OB, husband and I discussed my options at length and decided on the c-section. After my delivery, I questioned my decision to have a scheduled c-section thinking perhaps if I had delivered vaginally my daughter and I would have fared better. I felt I had let may daughter down and that it was somehow my fault that she ended up in the NICU. I also felt that I had let my husband down. I had a tremendous amount of guilt that stayed with me for a long time.
Amazingly, I didn’t suffer from post partum depression. Amy Przeworski, PhD is an associate professor of psychology at Case Western Reserve University in Cleveland, Ohio who specializes in research of post partum depression and post traumatic stress symptom. She too read the article on FitPregnancy.com and penned a very well delineated response entitled The Relevant Woman, The Psychological Effects of Pregnancy Complications. Her blog post appears on Psychologytoday.com, Don’t Worry Mom, Coping with Anxiety in Families. She presents 3 important points in why pregnancy and delivery complications are “relevant”.
1. Labor and delivery complications are not irrelevant. Women who experience labor and delivery complications are at an increased risk for postpartum depression and often experience symptoms such as a sad mood that lasts for as long as two weeks, decreased interest in activities, difficulty sleeping, fatigue, worthlessness or excessive guilt, feeling slowed down or agitated, difficulty concentrating, and even thoughts of suicide. Women who have experienced labor and delivery complications often report feelings of failure and incompetence as a woman and a mother. Further, labor and delivery complications can have a real psychological impact on the mother, the mother’s relationship with her significant other, and her relationship with the baby.
2. Complications don’t just sound scary, they are scary. Labor and delivery complications are traumas and can cause post-traumatic stress disorder symptoms, such as emotional numbing, distress at reminders of the trauma, avoidance of thoughts and feeling associated with the trauma, inability to recall aspects of the trauma, decreased interest in activities, feeling detached from others, difficulty falling or staying asleep, irritability, and difficulty concentrating. Women can dissociate during these events, mentally checking out of them when the terror overwhelms them…The experience is also terrifying for significant others who helplessly watch their wives and girlfriends endure invasive and painful procedures or who fear for the life of their baby. (Which is exactly what happened to my husband!!
3. Isolation. Women often do not talk about their psychological reactions to the complications, experiencing shame that they have not “gotten over it” and continued feelings of failure as a mother because of their distress. Feelings of isolation and inferiority to other women who had “normal” deliveries are common. Few women who experienced complications are made aware of the high rates of postpartum depression and posttraumatic stress symptoms following labor and delivery complications. This contributes to women’s views that they are alone or that there is something wrong with them for continuing to experience distress after something as common as a C-section.
While I appreciate FitPregnancy.com’s attempt to give mothers reassurance that their labors and delivery are most likely going to progress just fine, this isn’t always the case. Pregnancy complications can have longstanding effects on a mother, her partner and her baby. Mamas need to have support, information about potential post partum depression signs and symptoms and resources quickly at hand to help.
If you had a complicated pregnancy, here are some resources that may be helpful to you.
Definitions of post partum mood disorders
Support for Birth Complications
Mamas on Bedrest: Post Partum Depression in Black Women
March 12th, 2012
Post Partum Depression, or depression of any type for that matter, is a taboo subject in black communities. It’s not to say that we don’t get depressed, it’s just that we seldom admit it openly. I had thought that this “don’t ask don’t tell” stance was limited to the African American Community. But in a blog post by Salha Kaitesi, I learned that the stigma of depression has deep seated roots that reach all the back to the motherland.
Salha describes post partum depression treatment (or the lack there of) in many countries worldwide,
“Thousands of new mothers worldwide suffer from it in silence and are left alone to cope with it because it is not recognised or diagnosed. Resources in many countries do not allow for the provision of appropriate care for PPD sufferers. PPD sometimes goes beyond the so called “normal” phase and it turns into an even more serious psychiatric illness known as Puerperal Psychosis.”
She goes on to describe how post partum depression is managed (or not managed) in Africa and poses questions that I myself have often asked.
“If we are all aware that this illness can affect any woman anywhere in the world, why aren’t we talking about it? Is Africa in denial? Being silent on the matter of PPD cannot make it disappear! Or is it because no one wants or wishes for their wife or daughter to labelled “crazy”? A generalised name that society gives to all with any form of mental health problem. “Gusara” is the word loosely translated in my mother tongue. Some communities go as far as blaming it on witch craft and black magic. What is worse is that in many parts of the sub-Saharan continent, public health systems are ill-equipped to deal with post partum depression, which means there is an absence of psychiatrists or clinical psychologists trained to help women cope with the condition.”
Salha suffered with post partum depression and shares from her own personal experience what it was like and how she came to terms with her condition. She also shares valuable tips on what she has learned with other African Women who may be suffering with Post Partum Depression.
1.Don’t suffer in silence. Tell anyone who is willing to listen and please seek medical help. I might not have opened up to my family and friends but I sure talked to my health visitors and doctors. It helped a lot.
2.You might think it’s taking forever to get back to being your old self again but it’s not. Take things one day at a time.
This is such important information and let me see how the roots of ignoring depression run deep. In my own upbringing, admitting depression is tantamount to admitting a lack of faith in God. Like many African Americans, I grew up with a strong southern black baptist background. We speak boldly about “how we got over”; enduring the ravages of slavery, Jim Crow and segregation. Yet we don’t openly discuss how emotionally and mentally traumatizing those experiences have been to our communities and to ourselves. It’s 2012 after all, things are so much better. Look, we’ve even got a black president!
But issues of race, class and gender still plague our communities and can take a serious emotional toll. While many of the issues plaguing the general community are not be the cause of post partum depression, how depression of any form is managed in the black community is still suboptimal.
I am so grateful to Salha for bringing the issue of Post Partum Depression in African women to light. Her wise words are much needed for women of color to see that PPD is widespread and can affect women of all cultures and backgrounds.
If you are a woman, Black, White, Latina, Asian or otherwise and have any of the symptoms described by Salha as hallmarks of post partum depression, please get help. If you are unsure of where to get help, please contact us at info@mamasonbedrest.com and we’ll help you get connected with help and resources. If anyone has any particular resources, please share them below. Mamas need this information.
It’s time to break the silence!
