Tuesday Tidbits: Hemorrhage & Postpartum Care

March 2013 068“A bright red ribbon of blood weaves women together. We are blood sisters. We bleed and bleed, and we do not die. Usually.” –Susun Weed

These Tuesday Tidbits all come from the current issue of Midwifery Today. It is an excellent issue with tons of great information. As I referenced before, however, it is literally making my uterus ache and contract to read it since the theme is Hemorrhage. I’ve had to read it in small doses—5-10 pages at a time—and then come back to it later because the contractions/crampiness in my uterus and lower back get too intense for me to continue. I’ve always known that I have an intense response to blood, but this is the first time that I’ve really tuned in to the body memory my pelvic bowl still holds with regard to excessive postpartum blood loss. That blood loss is one of the things I don’t blog about, but today I’m writing about hemorrhage anyway (even though my back/uterus is starting up again as I type this). I guess you could call it “psychosomatic,” but I call it uterine memory.

Robin Lim’s article about postpartum hemorrhage in Bali includes a nice list of preventing and managing hemorrhage, one of the most significant being to minimize prenatal “scare” as much as possible. She writes about good prenatal nutrition and nurturing prenatal care and she also recommends this essential:

Build layers of support and trust for the mother in pregnancy and labor to help her cope with any social, psychological or spiritual challenges that she might be carrying…

Lim also says that laboring women use “qi” while laboring and birthing, which is our life force, our energy. She says that if women run out of “qi,” they have to dip into their “jin,” which is, “one’s God-given lifespan”:

“If a mother uses all of her qi to bring her baby out, then she has none left to bring her baby out and to close her uterus properly…As birth-keepers it is our job to maintain the qi of pregnant, laboring, birthing and breastfeeding mothers. The mother who maintains her qi and does not use up her jin can still be glowing and full of energy after having five children…the mother who has dipped too deeply into her jin, due to having depleted her qi, can be dangerously run down after having just one baby…”

While one might interpret this as being a little too esoteric for the practical mind and perhaps a tad too close to the victim-blaming “you create your own reality” thought processes that grate on my nerves, I really appreciated the idea of the responsibility of birth-keepers to guard mothers’ life-force energy and to act to preserve mother’s natural resources and reserves of strength.

On a midwifery education note, I love the writing of Sister MorningStar and I loved reading her thoughts on midwifery education, especially her observation that

…I’m dreaming of a way and time when women are as healthy as deer and mothers birth in the night before professionals arrive. Don’t misunderstand, I want and am willing to talk at any roundtable about midwifery education. We need everyone who cares about birth at such a table, including mothers. We need a global table with a global voice, passion and wisdom. I am not saying that birth and midwives are not made better with midwifery education, but I am saying that I have many questions about modern midwifery education and its effect on the experience of birth.

And, moving on to postpartum care, loved this quote from Darla Burns in an article by Allie Chee:

As Americans, we are under the impression that new moms are ‘Superwomen’ & can return to life as it was before baby. We must remember to celebrate this new mother and emulate the other cultures that honor new mothers by caring for them, supporting them, & placing value on the magnificent transformation she is going through. This is the greatest gift we can give to new mothers & newborns…

I appreciated that Chee included information about postpartum recovery from miscarriage and stillbirth as well, rather than assuming that postpartum care is a need only following a live birth. Consistent with my own experiences and observations she notes that, “in the case of miscarriage and stillbirth, a woman is usually sent home with no postpartum care instructions other than perhaps a list of negative signs to watch for that may indicate further complications with her health. In these instances, many friends and family members, often not knowing how to respond, leave the mother to grieve alone and to recover physically by herself.” Other interesting notes with regard to postpartum recovery after miscarriage or stillbirth include these two:

  • The depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child….
  • [with regard to postpartum recovery/”lying in” time in other cultures]…Amy Wong, an internationally acclaimed author and expert on postpartum writes, “Natural delivery requires at least 30 days of rest, while cesarean delivery, miscarriage and abortion require at least 40 days…”

Of course, this made me reflect on my own experiences. I feel fortunate that I was cared for with a lot of love and tenderness in my own miscarriage postpartum, with my mom bringing us food and providing child care and support, and my doula organizing and delivering meals from friends as well as offering a loving and supportive listening ear. That said, I was back in front of the classroom two weeks postpartum and felt like perhaps I was taking “too long” to get back to “normal.”

Definitely make sure to check out the complete issue! Midwifery Today is my favorite birth publication and is a treasure trove of information as well as personal experiences and reflection.

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