Valerie Gommon Midwife’s Blog

Archive for the ‘Daily Mail’ Category

This is a guest blog by Helen Potter.

There are several reasons why a woman may have a caesarean section. A planned section may be scheduled because of the position or health of the baby, the mother’s medical history or at her request if she has had a previous, traumatic vaginal birth. An emergency section usually occurs because complications have arisen during natural labour. A ceasarean section is a major operation that requires incisions through the abdomen and uterus and so the significant recovery period is well accepted by medical professionals and society in general. However, the emotional after effects of this type of birth remain less acknowledged and far less discussed. The silence and stigma surrounding mental health after a c-section can be detrimental to new mothers who’ve not only just been through major surgery, but now have a newborn baby to care for too. Here are just a few of the emotional issues that may arise following a c-section.

Shock

It’s extremely common for the body to go into shock immediately after the surgery is carried out. Many women report shaking from head to toe as medication from the epidural and affect the muscles. But further on into the recovery process many women experience delayed shock, especially when the c-section was carried out in emergency circumstances. They spend so long preparing for their labour, writing birth plans and building up expectations so when things don’t go to plan it can be a huge surprise. Using a debriefing service following a c-section can be a good way to come to terms with the experience and understand why it had to happen.

Guilt

A study carried out by Channel Mum found that one in five mothers said that opting for a ceasarean would mean that they’d ‘failed’ and with that sense of failure undoubtedly follows feelings of guilt. Outdated social views can lead to women believing that a drug-free, natural labour is the most honourable way to give birth. Some women even report that having a caesarean has made them to feel like less of a woman and less of a mother. Of course this is untrue and all that really matters in labour is that mother and baby both come through the process safely.

Post natal depression

Although all women who go through childbirth are at risk from postnatal depression, studies show that women who have an emergency caesarean are up to six times more likely to suffer from the condition. The longer recovery period and feelings of guilt, failure and lack of control over their own body are all thought to contribute to this, alongside the hormonal changes that all new mums face. It’ is important to speak to a health visitor or GP if you think you could be suffering from postnatal depression. Self help advice, medication and therapy can all help to alleviate the symptoms.

Trouble bonding

Some women report that they have struggled to bond with their babies following a caesarean section. There are several theories for this. Biologically, research indicates that they miss out on the release of the hormone oxytocin (otherwise known as the love hormone). Immediately after natural childbirth the release of this hormone is higher than ever and missing out it can impair the initial bonding process. In addition to this, skin to skin contact (vital for developing early closeness and bonding) is rarely possible straight after a c-section and in many cases the baby is taken away and checked over while the mother recovers. On a more practical level, the long recovery process can sometimes render a new mum unable to carry out day to day care of the child which can make her feel disengaged from her new baby.

Fear of future pregnancy

Sometimes all of these factors combined, along with the physical pain of a c-section, can make women so fearful of a repeat performance that they choose not to become pregnant again. Of course this can be a devastating choice for a woman who really wants another baby. After a c-section, the probability of a natural birth next time is good – research indicates 60-80% of women can potentially go on to have a vaginal birth after a ceasarean (VBAC). But there are risks and these, alongside the fear of another c-section, can be enough to put some women off for life. If you feel like this but still long to expand your family it is important to talk to your GP or debriefing service to familiarise yourself with all of the facts so that you can make an informed choice.

Citation Section

NHS Choices, Ceasarean section, accessed 25.02.16

Metro, Thousands of women with postnatal depression suffering in silence, accessed 25.02.16

The Royal College of Midwives, What is the purpose of debriefing women in the postnatal period, accessed 25.02.16

The Daily Mail, The women made to feel guilty because they didn’t have a ‘perfect’ drug free birth, accessed 25.02.16

NCBI, Increased risk of postnatal depression after emergency ceasarean section, accessed 25.02.16

Psychguides, Living with postpartum depression, accessed 25.02.16

Mail Online, Women who have ceasarean section ‘less likely to bond,’ accessed 25.02.16

Mayoclinic, Vaginal birth after c-section (VBAC), accessed 25.02.16

 
Milton Keynes General Hospital is in the news this week with a story about a client who allegedly objected to non-white staff being in the delivery room. Apparently hospital staff have complained to the Equality and Human Rights Commission about the way the situation was handled earlier this month when an unnamed white woman had a Caesarean section at the hospital. The hospital said it had begun a full investigation and said it is thought to be the first time such a request has been made to them.

http://news.bbc.co.uk/1/hi/england/beds/bucks/herts/8330102.stm

http://www.dailymail.co.uk/news/article-1223598/Pregnant-woman-race-demand-Buckinghamshire-hospital-facing-prosecution.html

I was delighted to read Ulrika Jonnson’s article in today’s Daily Mail about Stress Incontinence.  How brave of this woman to admit something that most of us keep secret, Ulrika will have helped thousands of women with the public admission of her problem.  www.dailymail.co.uk/health/article-1160211/Ulrika-reveals-embarrassing-health-secret-TV-presenter-breaks-secret-taboo-incontinence-affects-millions-women.html

Stress incontinence is a large problem affecting 1:4 (or maybe even 1:3) women at some stage in their lives.

Urinary incontinence can be broken down into “frequency” (often associated with infection), “urgency” (usually caused by nerve pathway damage), “overflow” (when the bladder is atonic and has lost the ability to empty correctly) and “stress”.

Stress incontinence occurs when the intra-abdominal pressure rises abruptly when under stress, (e.g. coughing, laughing, sneezing).  Urine loss is likely to be small in volume, however it is not unknown for the stress to act as a “trigger” causing a complete void (perhaps when suffering from mixed “urge” and “stress” incontinence).

There are various theories and several predisposing factors to stress incontinence, these include the ageing process, denervation during childbirth, multiple pregnancy, multiparity, large babies, obesity, chronic cough, intra-abdominal mass (e.g. fibroids/tumour) and constipation.

Many women manage the problem day-to-day basis with the use of panty liners and by doing pelvic-floor exercises, but in many cases it can be treated, so speak to your GP about it or contact your local continence clinic – you can contact many of these clinics directly for a consultation www.bladderandbowelfoundation. org/continence-clinic-directory –  more than 70 per cent of cases can be helped, so it is very important to overcome your inhibitions and ask for help!  www.continence-foundation.org.uk is another really useful site.

Pelvic Floor Exercises

The first-line treatment for stress incontience is to do Pelvic Floor Exercises.  The muscles are in the bottom of the pelvis and form a sling that supports your pelvic organs (bladder, uterus and bowel) and are a vital part in preventing bladder and bowel incontinence. They also play a part in sexual function and are important during pregnancy and childbirth.

It is important to make sure that you are using the right group of muscles and contracting them in the right way. It helps to be lying down or sitting forward when you first try to do the exercises and you need to breathe normally.

Imagine that you are trying to stop yourself passing urine and at the same time trying to stop yourself passing wind. The muscles should feel as though they ‘lift and squeeze’ at the same time. The buttock and thigh muscles should remain relaxed but a gentle tightening in the lower part of your tummy muscles is quite normal.

You should try to do your pelvic-floor exercises at least three times a day. Most women aim for ten long squeezes followed by ten short squeezes. It can take three to five months before you notice an improvement.

Tighten pelvic-floor muscles and hold for several seconds and then relax for the same length of time. Repeat until muscles feel tired.

Tighten your pelvic-floor muscles for a second and then relax. Repeat until muscles feel tired.

One of the best booklets I have come across is “Fit for Motherhood” produced by the Association of Chartered Physiotherapists in Women’s Health www.acpwh.org.uk/docs/FitforMotherhood.pdf

There are also devices that can be bought to help you, for example www.tenscare.co.uk/index.php?action=products&product=75 or vaginal weights www.aquaflexvaginalweights.com however I really do encourage you to pluck up the courage and speak to your midwife or doctor first and ask for a referral to a physiotherapist.


Twitter