What I Learned by Requesting My Labor and Delivery Notes…

Maura’s birth story has had a strong impact on my life. It has impacted my health, priorities, interests, and work. I’ve shared my story of Maura’s birth on the blog, and added to it as the story seemed to drag on long after I had Maura in my arms. I’m not even sure when that story ended and life got back to (new) normal. (I want to say around 15 months postpartum)

Throughout the last 2+ years, I’ve talked to numerous women about their birth experiences. Although I’ve heard stories similar to mine, and others very traumatic, the majority of stories I hear are relatively smooth sailing, even if they diverged slightly from the plan. Each time I shared my story,  I noticed my feelings surrounding it become more powerful. I was jealous of the smooth deliveries and the friends who returned to running or their old hobbies so quickly. I wanted to feel empowered by my birthing experience, but I felt defeated.

I tried to determine what went wrong, and who was to blame… because if there wasn’t something or someone to blame, how could I prevent the same story from happening again? If we couldn’t prevent it, how would I go forward and even consider having another child? If I were to have the same experience again, would I be able to handle it emotionally? I don’t know. I still don’t know.

What felt like as soon as Maura was born, people began asking when we would have another child. The first year or so, I always responded “Ha! Whenever I recover from having the first.” At first people would laugh, but then over time they looked confused, so I stopped making that joke. I got the point – people didn’t understand how I wasn’t recovered yet and not everyone was looking for a long conversation about pelvic floor health and birth trauma. This got me thinking, my daughter is two, I am 34, and I am physically healed. Maura is very busy, but overall a pretty easy kid. I have no reason to postpone having another child, other than the emotions that become stirred up thinking about my birthing experiences. I need to heal emotionally from the events surrounding Maura’s birth, and if it hasn’t naturally happened in two years – I have to do something about it myself. So I requested my medical records. (labor and delivery notes, progress notes, labs, etc.)

I read the notes over several times. Put them down. Read through them several more times. Had Greg read them. They didn’t tell a traumatic story. I’m not sure what I expected to read, but what I got was a step by step emotionless description of a pretty typical sounding birth. Had I made the experience more traumatic than it had actually been? Am I exaggerating the negatives in my story? No, I don’t think do.

I picked apart those notes and googled the heck out of every number and detail. It verified that several incidents that I remember very clearly did in fact happen (I pushed for a long time, I tore extensively, and lost a significant amount of blood) – It was not an easy delivery, but when described medically (without any emotion) it didn’t sound as traumatic as ‘it should‘ based on my feelings now. I even went back and read the Birth story that I wrote, it didn’t sound traumatic either. And oddly, thinking back to writing it – I didn’t feel like it was traumatic to me then. So where did this anxiety surrounding the story come from? Postpartum. I had an awful year postpartum. 

After Maura was born, I was in rough shape. I had “an uncountable” number of stitches according to my doctor. I hurt. I remember not thinking I could make it from the hospital room to the car without fainting. At Maura’s 2 day appointment, our lactation consultant assumed Maura was born via cesarean because I looked like I had major surgery, I barely could walk into the room. My nipples were also in awful shape. Maura had an awful latch that pretty much tore my boobs apart. I never reported it because it didn’t hurt as much as everything else. The LC had never seen someone nursing with such damage – and Maura ate every 1.5 hours as a newborn…. About a week postpartum my stitches became infected. Around 3 weeks my swelling went down enough to feel those stupid stitches, I hurt even more. At my 6 week check, I was NOT cleared for exercise and told to wait “maybe another month” to have sex. My tears still had not healed completely. I reported feeling a prolapse and started PT at 8 weeks for 2nd-3rd degree cystocele. I continued PT for almost 8 months. I really struggled emotionally with the slow pace of recovery and wondering if I’d ever heal. I saw specialists, tried every option and was pretty much convinced that I’d need surgery. During this same time I had a series of abnormal pap smears that led to a biopsy being taken – it was benign and confirmed as “changes due to chronic inflammation” – which oddly made sense, because around 3-4 months postpartum my joints had also become inflamed. I think I was at a doctors office every week all year. Add in the start of Maura’s hip journey and I can easily see the that the traumatic part of my story was not the birth, it was the entire year after. 

I did learn that I was anemic when I got to the hospital. Due to the blood loss (approx 1,000mL), I was critically anemic on discharge. This was why I felt so weak in the weeks to come, as well as contributed to my slow rate of healing. A blood transfusion was mentioned, but in my foggy state I refused (according to the notes, I don’t remember being offered). In the future, I can definitely monitor my iron more closely during pregnancy. And now I know the consequence of not having a transfusion – I might be more open if that were to come up again.

My goal was to use the notes to determine what went wrong, and what I can do to prevent a similar story in the future. Other than the anemia, they didn’t point out anything crazy that I didn’t know. No one is to blame, and nothing specific went wrong. They did however, give me the opportunity to review, think clearly, and begin to determine what I can do differently next time around. I’ve got a list, but I’ll save that for another post. Should you request your Labor and Delivery notes? Maybe, maybe not, but I’m glad I did. I learned that my focus was on the birth experience itself, and maybe I should be looking to my preparation for labor and creating a postpartum care plan next time rather than just a birth plan.

I also feel the need to say – I’m NOT pregnant. I need to know that I am completely healed physically and emotionally before wrapping my head around the idea.

 

 

 

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Posture, Breathing, and Postpartum Injury Prevention

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I like to think that I was in shape leading up to, and during pregnancy. I was running consistently before, and until 18 weeks pregnant (stopped due to pubic symphysis dysfunction), and lifted weights 2-3 times a week, I never stopped walking or moving my body. So why did I end up with an injured spasmy back on several occasions? Why did my prolapse persist long after my doctors predicted? I’m learning that it may have had more to do with my posture and alignment, than with my fitness or strength.

Let’s start with pregnancy posture’s effect on the back. During pregnancy, a woman is forced to carry a significant load of weight in the front of her body. The weight of the belly and breasts might round her shoulders and upper back forward. Her back arches in attempt to balance the weight in front of her. While this load increases, her abdominal muscles stretch and become less effective.  Her back muscles tighten in order to hold her upright and work overtime without the help of her abs for stability. She may shift her hips forward and clench her glutes to compensate (a permanently clenched muscle is a weak muscle.) Each woman is different, but the one thing that is the same is that there is a major muscle imbalance between front and the back after that baby load is gone. What does this imbalance mean? It means that every time a postpartum woman bends over, picks up her baby, lugs her baby in it’s carseat (the worst!), or reaches for something in front of her, her overworked back muscles are put at risk. It might take time to retrain and strengthen the abs after their extended rest, but there are changes that can be made to protect the back in the mean time.

Other common injuries postpartum women suffer from are diastasis recti (DR) and pelvic organ prolapse (POP). Both of these are in part caused by weak/stretched/damaged connective tissues and mismanaged intra-abdominal pressure.  DR is a separation of abdominal muscles due to weak connective tissue that then may bulge out under pressure, and POP being the decent of pelvic organs due to weak supporting ligaments and tissue that may bulge down under pressure. We can’t always fix the damage, but we can make postural and breathing changes to better regulate internal pressure that often increases the severity of both conditions and prevents healing.

OK. So how do we protect ourselves. Fix our posture and breath. Easy? Some changes are, some changes aren’t. Here are the easy ones:

  1. Make sure you’re practicing 360 breathing as often as possible. If we practice something only once or twice a day for a a few seconds, it’s easy to fall back into our normal shallow breathing patterns. You should feel your ribs expand in every direction (including your back), and you should feel your breath go all the way down to your pelvic floor. If your pelvic floor expands on your inhale – it will automatically contract on exhale – therefore strengthening it. A good 360 breath also evenly distributes pressure! If you pull your belly in on an inhale – the pressure that would have gone to your belly may redirect as excessive pressure down on your pelvic floor. Alternatively, breathing only into your belly (and not ribs) puts pressure against the abdominal wall every single breath preventing a DR from healing.
  2. Cue proper posture. Slouching, slumping, over arching backs, tucking bums, etc. don’t just cause aches and pains. Poor posture can limit 360 breathing and alter intra-abdominal pressure, it also can contribute to muscle imbalances and therefore puts people at risk for injury. Correcting posture can take a lot of work and specialized exercises, especially if poor posture has been present long term. Luckily, there are a few cues to help you get in better posture now.
  • ‘Imagine a string pulling up from your pubic bone through the crown of your head’
  • ‘Pretend you are ease dropping on a conversation taking place behind you’
  • ‘Stack your ribs over your pelvis’ (You want your ribs to aim for your hip bones, opposed to flaring out as seen when women thrust their chests forward)

3. Focus on both breathing and posture in ALL of your movements. Below are some of the most common movements that new moms do repeatedly – that we can focus on.

Lifting the baby. 

The tendency is to let the back round when we bend and not take breathing into consideration at all. The problem is that this posture puts strain on isolated back muscles and prevents a deep breath that would engage the pelvic floor and abdominal muscles. This lack of engagement puts both at risk of extra pressure.

What we should do is keep our backs nice and straight (squat or bend the knees if needed) take a deep inhale in preparation, and begin our exhale just before we exert ourselves. The exhale engages our pelvic floor and abs so that we don’t end up putting extra pressure on them.

Other controllable things to consider:

Raise the height of your changing table so that you’re not bending, or change where you change the baby so the the muscles worked are different each time.

Bring the baby close to your body before standing up. This alters the center of gravity and decreases the load on your back. (This was huge for me when Maura was placed in her cast. She could no longer be changed on our changing table and gained 5 pounds overnight, literally… This was also the second time I strained my back. If I knelt next to her on the floor, pulled her onto my lap, then stood up from a squat – my back was spared.)

Baby Carrying (with and without carriers)

The tendency here is to let posture go out the window.

With a newborn lacking head control women often lean back and let their hips go forward – this is a great angle for the baby but not for your abs/back/pelvic floor.

With a bigger baby and toddler it’s common to stick one hip out to support the weight, and even worse many women favor one side which leads the major muscle imbalances (and eventually rotational scoliosis in my case… oops!)

Often with a baby carrier, we feel like it’s easier on our bodies – but if the straps are too lose women can end up tensing the shoulders and back. If the waist/hip band is too low or loose she may end up with the same lean back, hips forward position to support the new baby. If the carrier is too tight, it may limit moms ability to breath deeply.

The best thing to do here is be aware of your posture and how carrying your child alters it. Do your best to remain up tall with the same cues as above. Change the position you have your child in frequently and rely on your arms (instead of your core) as often as possible. – Best to start that with your tiny newborn than attempt the change with your 30 lb toddler… holy arm burn!

Pushing a stroller

Keep yourself up tall, ribs over pelvis. Pushing the stroller with arms extended may shift posture by encouraging you to stick your bum out or bend at the waist. Keeping your elbows nice and close to your sides and again relying on your arms will protect you.

Lugging a baby in a car seat

I have no advice. I think I may try to avoid the click in baby seat if we have another round. I can’t think of any way to lift and lug this combo that is safe. If you must do it, remember the exhale on effort to protect yourself. Try to limit the distance the car seat is carried. Use a stroller even when it’s less convenient. I definitely am guilty of lugging the car seat only in and out of doctor appointments, and even through parking lots into stores etc. Thinking back, I easily could have cut down on that! Live and Learn.

The postpartum period is not easy on a women’s body. Hopefully some of this information can make your postpartum experience free of injury!

Coming soon will be a post on ‘Why I requested my Birth Records’ and I also noticed I have a half of a post written on the end of our Maple Syruping adventures that I never finished….. It’ll be long past season when I get around to it, but I’ll get there!

 

 

First Exercises Postpartum

Three weeks into my Postpartum Corrective Exercise Specialist course and I love it! It is incredibly informative and I wish I had this knowledge two years ago after I had Maura. It makes me even more excited to get working with moms (new and old) in person again.

Our first week we discussed the early postpartum period (the first 4 months). The biggest difference here, compared to what seems to be common practice, is that we’re not categorizing our fitness abilities into clear cut timelines, just because you gave birth 6 weeks ago doesn’t make you able to go for a run. Before even considering impact exercise you need to heal, strengthen, and correct your body. It takes about 4 months for your ligaments to tighten back up OR until you’re down to 3 or less nursing sessions a day! For me – that wouldn’t have been until about 18 months postpartum! Even with a prolapse my PT had told me running was safe…. that might not have been the case. Luckily, my body told me when it was uncomfortable and I think I did pretty well listening to it. I do think I would have felt better emotionally – had I known that waiting that long was more than ok.

Many women, especially those who were fit throughout pregnancy, or had relatively easy pregnancies and deliveries feel ready to jump right back into exercise. So if you feel good early on why wait? Consider the changes your body goes through during pregnancy – regardless if you struggled or not: Diaphram (breathing muscle) altered it’s positioning and changed your breathing patterns, your pelvic floor held the weight of your growing baby (even if you had a c-section, and took even more pressure if you ran through pregnancy), your abs stretched and essentially rested for several months, your back muscles increased their load to create stability (Hello muscle imbalances!), your posture changed, your ligaments are still loose and now that you’ve got a newborn you are sleep deprived and stressed as well.

So before you head out for a run, what should you do? Take a look at your breathing, your core strength, and posture. Shallow breathing, core weakness or imbalances, and wonky posture can wreck havoc on your body over time – increasing the risk of back injuries and prolapse, incontinence, and slowing down healing. Where to start?

Start Here.

Between 2 and 6 weeks postpartum you can start adding some gentle stretching and exercises to your walking (Of course always verify with your doctor!) The first weeks should focus on waking up the muscles that have been resting, and get your core (diaphram, abs, back, pelvic floor) muscles working together again.

360 degree breathing: Side lying is a great first position to practice breathing in. When you inhale, you should feel your back, sides, chest, belly expand AND your pelvic floor relax down. On your exhale, belly goes down, ribs go back in, and the pelvic floor tightens back up. (If you don’t feel your inhale reach your pelvic floor, your pelvic floor cannot heal. It needs to relax before it can strengthen.)

Another great position to practice your breath in is on your back with your knees up. Place your arms out to the sides bent at 90 degrees. This position also stretches our your chest – a great stretch if you’re nursing! On your exhale – slide your arms over head. Remember to follow the cues above for a good 360 degree breath! In this position you should feel your mid back press into the floor on inhale if you’re getting good rib expansion.

Cat/Cow yoga stretch: Positioned on your hands and knees – let your back/belly sink and arch while stretching your head and neck up tall. Then slowly raise your back/belly up into a rounded position. Practice your 360 breathing in both positions.

If your abs are weak, you may find yourself tightening your glutes (butt) or raising your shoulders towards your ears. Your goal is no NOT let the glutes or shoulders compensate.

Next post I’ll go over some injury prevention strategies and posture changes for postpartum! So excited to share some of what I’m learning with everyone.

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This was my first walk. Maura was almost a week old. I made it about 400 meters and remember feeling awwwwful. I know most women don’t have the same experiences that I did – but it would have been great to be armed with good information rather than the pressure to ‘get back at it’.

 

 

My Actual Weight Workout Today (20 minutes – full body)

Thought I’d share a  workout since it’s been a while – sorry about that! This is what I did during Maura’s nap today – it took maybe 20 minutes and I do my weight sessions rather leisurely so it probably could be done more efficiently. For weight, I used two 10 pound dumbbells. I held both for the squats, but only one for the Curtsy lunges. Everything else is as pictured – except I wore really frumpy sweat pants and watched Grey’s Anatomy while I worked out….  Any one else stilllll watch it? I took several years off, but got caught up while I was pregnant and Greg had a two week business trip, haha.

April 20 workout

April 20 workout 2

April 20 workout 3

Enjoy! Happy weekend!

Dear TWO Year Old Maura…

Dear Two Year Old Maura,

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I had every intention of writing an update every few months throughout your second year, but wow has this year been busy! I thought your milestones and discoveries would slow down after your first birthday, they definitely did not! This past year you went from being able to briefly hold yourself up with a walker, to walking, walking backwards, running, tip-toeing, marching, stomping, and now you’re soooo close to getting off the ground when you jump! You can walk up and down stairs with the help of a hand or railing, climb up ladders, into chairs, onto anything you set your mind to. The 6-9 month delay in gross motor milestones we were told to expect never happened, and you’re right on pace with all your 2 year old friends!

A year ago, you had a handful of words – mostly single syllables, or the first syllable of a word. Now, you’ve got hundreds of words, speak in full sentences, tell stories, and even have a good knock knock joke you tell pretty well! – (Knock knock, Who’s there? Cow-Go, Cow-Go Who? Noooo, Cow go MOO!) Dad and I joke that you can say any word you’ve ever heard spoken! You memorize lyrics to songs faster than I do, and I often find myself looking up the words to songs and nursery rhymes that you ask me about! This second year has been a whirlwind of vocabulary and I’ve loved hearing your little voice, and now love being let into your world of thoughts.

You still love being outside, and got to experience sledding, making snowmen, and building snow caves to your experiences this past winter. You’re excited for our garden this year and have already been helping get it ready by planting seeds inside, pulling out the muddy weeds, raking, and carrying soil in your new wheelbarrow! If you’re stuck inside, you enjoy building things, playing with your babies, or more recently pretend games like ‘restaurant’ where your Little People order meals, and you prep and serve the food from your kitchen, or ‘store’ where you bring me things from around the house and give me your ‘credit card’ to swipe while putting items back into shopping bags…

People warn first time moms about the Terrible Twos, but so far you get sweeter and sweeter. You melt my heart by saying things like “I have so much fun when I with you, Mama!” and spontaneously saying “I love you too” (without me saying it first). I often hear you telling your dolls you love them, rocking them, or reading to them. The only one you’re not feeling the love for is Ramsey – but maybe that relationship will grow with time?

Here’s to another year full of learning about you, adventures, and fun.

Love you baby girl,

Mom

From the mouth of a TWO year old…

Toddlers say some pretty hilarious things. Wishing I started writing these down sooner! Enjoy…

After leaving a particularly rough stop at Party City….

Maura: You fustated mama?

Me: Nope (I lied, I was about to lose my mind), are you?

Maura: Gettin there….

Me: You’re getting frustrated?

Maura: Ya, mama say no no no (starts waving her finger in the air)……. no no no no no no no

“Hold you (means herself) naked butt!”

“Bumpy road make head wobble like bobble head! Whoooaaa whoa!”

“When you (means herself) get big you have kong like Ramrams, and drink coffee! And … wine!!!”

“Dada, Mama Maura take tan car today? You get black car…. it real real cozy!” (She has a strong preference for Daddy’s new Acadia.)

“I miss dada. I real real miss tan car. I yuv tan car so much….” (And possibly an unhealthy attachment, haha.)

Do you write down or remember anything your kids have said that really made you laugh? Everyone calls this the ‘Terrible Twos’ but I’m kinda loving this age!

TWO year update coming asap!

How to Raise a (Body) Confident Daughter

Like a large number of women and girls, I lacked self esteem for many years. It’s easy to fall into the rut of not liking our bodies – we’re bombarded with messages that we are not enough as we are. Social media, magazines, and TV flash thin bodies, weight loss tips, body changing workouts, make up tips, ads for products to help us with all these changes we NEED to make to our bodies…  As a teenager and in my 20s, I obsessed with my weight and counting calories. This isn’t rare, and once I started working in eating disorder research I realized just how common this mentality is. I interviewed student after student who’s negative body image effected every aspect of their lives. A few ways my own body image impacted my life was avoiding social events with food, spending significant time pre-planning meals or food consumption, obsessively calculating and counting calories, punishing myself with exercise, missing school assignments because I was either distracted in class and didn’t know what was assigned, or getting distracted with weight loss antics and not saving time to do school work – weight loss was more important than school. I skipped presentations purposely so I wouldn’t have to stand in front of a class, experienced social anxieties, and quit the track team due to how I looked in our uniforms. I was depressed and anxious, and you know what? Student after student that I met through work confirmed that I was not the exception!

Now that I have a daughter, I think back on a lot of my experiences and wonder if I can protect her from experiencing the same. I don’t want her to waste one day of her life preoccupied by something as trivial as her appearance. We are SO MUCH MORE than our appearance! Someone I follow on Instagram recently asked a question about talking to our daughters about body image. She followed up the question by asking how we explain our aesthetic (losing inches, gaining muscle size, weight loss) workout goals without making our daughters think they should be doing the same…. I applaud this woman for being aware of the message she’s potentially sending her daughter BUT I don’t think we can out-do the message our actions send with a conversation.

I know that even within the next few years my innocent toddler will begin to hear the message that her body isn’t good enough. I can’t shelter her from the world – heck Disney characters have already begun their work on her. What I can do is hope that my constant example of self acceptance, and unconditional support of her exactly how she is, is stronger than the messages from the outside world. This is how I plan to raise a (body) confident daughter:

  • I will never criticize my body, or anyone else’s.
  • I will not set goals attached to aesthetics – I workout to be strong, capable, healthy, and feel good. I do NOT workout to alter my appearance.
  • I will never compare myself to others.
  • I will not use food as a reward or exercise as a punishment.
  • I will consistently tell my daughter she IS beautiful, but will also remind her that she is kind, funny, smart, fun to be around, helpful, capable, etc. (We receive so many comments on our looks elsewhere that it’s important to know we’re beautiful regardless of outward appearance. The negative messages need to be challenged).
  • I will let my daughter develop her own healthy relationship with food as nourishment by trusting that she knows when she is full or hungry.
  • I will lead by example in living my own healthy lifestyle (physically, mentally, and emotionally).
  • I will accept myself 100% as I am, so that she knows that despite what our culture says, it’s OK to be happy with who you are.

You know what else I’ve noticed? How much more comfortable in my own skin I am since practicing the above too. You can’t control everything, but you can be an example of confidence for your child to learn from.

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You be you, Beautiful girl.