Dealing with Trauma and PTSD

This week I had a patient experience serious trauma- she had an emergent c-section on a 36 week old baby and then hemorrhaged a few hours later. I took care of her the next morning and the following three days and helped her deal with the traumatic situation the best I could, but it got me thinking about how often this happens and how many women must feel traumatized by it.

 

Once the woman has recovered medically from an emergency like a hemorrhage or an emergent c-section, healthcare workers tend to continue business as usual. When women don’t talk about what they go through, feelings of fear and pain can manifest and come out it ways like postpartum depression and, in severe cases, post traumatic stress disorder (PTSD).

Also important to remember- if you feel any symptoms of depression or PTSD (listed below) GET HELP and TALK to someone. Remember you are not alone!

Depression:

• Sadness
• Disinterest in baby
• Suicidal thoughts
• Thoughts of harming baby
• Thoughts of uselessness
• Lack of energy
• Insomnia

 

PTSD:

• Nightmares
• Flash backs
• Depression symptoms
• Inability to control emotions (especially anger)
• Insomnia
• Hallucinations

 

 

A new way that healthcare workers can help decrease the incidences of these devastating mental health effects is something called debriefing. 

• Debriefing involves you and your healthcare providers involved in the emergency talking through everything that had happened. As a healthcare worker myself, I know we are not the best at explaining what is going on, especially in an emergency situation.
• The best thing you can do during these situations is to ask questions!! And ask more when the situation has been resolved. Knowing what was happening has a surprising effect with your brain and preventing PTSD and depression.

 

These are both SERIOUS problems and you can get ahead of it while in the hospital! Ask questions, tell your doctors and nurses that you are concerned or scared so they can help you through it.

Pacifiers

One of the most controversial topics for newborn care and postpartum time is pacifier use. Recently, the understanding is no pacifier until 3-4 weeks old if breastfeeding. This is done so that baby doesn’t get “nipple confusion” before getting their breastfeeding skills more settled. However, there is really no evidence to show this. Recently we have been discussing this in my journal club so I wanted to give you all a list of pointers on pacifier use!

• If bottle feeding, go ahead and give a pacifier whenever needed. There is no risk of nipple confusion here.
• What is nipple confusion?
  • Some of you may be thinking that right now so here is a short summary: A baby learns how to latch onto their mom’s breast in the first few days of life. The idea behind nipple confusion is that the baby can no longer effectively latch onto mom’s breast because they have gotten used to how the pacifier feels instead.
• HOWEVER, there is very little evidence based practice on this topic. In our journal club, we did a literature review and the most compelling evidence found was that restricting pacifiers actually decreased the number of moms exclusively breastfeeding while increasing the number of moms supplementing with formula, or using formula exclusively.
  • This was thought to occur because when denied the pacifier, mom’s gave formula to quiet the baby.
  • This being said, mom’s who are motivated and able to put in the extra time to help their baby get past any nipple confusion that may occur, are usually able to continue exclusive breastfeeding.
• Avoid a pacifier if able to always! However, some babies go through a phase, especially during the first few days of life, where they eat or cry constantly and become somewhat inconsolable. You need sleep of course! In this situation I am always willing to give my patients a pacifier rather than formula.
• Sometimes you have an inconsolable baby who also has a hard time breastfeeding. I always try to avoid a pacifier in this situation with other soothing methods first. Here are some ways to avoid a pacifier:
  • Cuddle
  • Hold and walk around
  • Have baby suck on your finger
  • Skin to skin
  • Keep breastfeeding!
  • Rocking or swinging the baby
  • Swaddling up tight with warm blankets

The key with pacifier use is MOTIVATION. If you are motivated enough to continue breastfeeding and work a little harder the next day with your latch, then give that pacifier so you both can get some sleep! With babies who are quiet, sleep for long periods undisturbed, and have a hard time with their latch regularly, you should wait the 3-4 weeks to really settle in your feeding habits.

In the end, its your decision and your baby! You do what you think is best for you both. Hospitals stock pacifiers but may not routinely distribute them, so ask your nurse! But also, be prepared for this same information and possibly a lecture. Nurses are open to whatever you want to do, but they want to give you all the information and education you need. Just let them know you have done your research!

 

When To Call Your Doctor

Something that all moms what to know is what is normal and what isn’t. They often have a million questions about this and sometimes don’t think of them until after they leave the hospital. Then every mom becomes one of two people- the one who doesn’t ask when it could be important and the mom who calls their pediatrician too much and with every little question.

Below I’ve compiled a list of things to call your doctor about if you encounter it during your postpartum period! First is for mom, second is for baby.

Mom to call OB about: 

• Severe and sharp abdominal pain
• Persistent nausea and vomiting
• Heavy bleeding
  • This will be an obvious increase and back to bright red blood.
  • Heavy = More than 1 pad completely saturated within 1 hour
• Fever or signs of infection (foul discharge, pain, hot to touch, redness and swelling)
• If you are dizzy, lightheaded, or feeling faint
• You have tender breasts, lumps in your breasts, or any hard, tender areas in your breasts.
• You have symptoms of a UTI (urgency, frequency, burning)
• Severe pain or tenderness between your vagina and rectum (especially if you had a tear or episiotomy)
• Signs of a DVT or PE (see previous post on clots!)
  • Includes severe pain in your legs, chest, stomach, or back.
• Signs of postpartum depression
  • Despair, sadness, hopelessness, anxiety etc.

*Call 911 if you have severe chest pain, shortness of breath, heavy/continuous bleeding, loss of consciousness, or suicidal thoughts/feelings*

 

Mom to call Pediatrician for Baby about: 

• Fever (temp above 100.4) or low temperature (temp below 97.5)
• Lethargy, difficulty waking for multiple hours in a row (baby starts missing feedings because of sleepiness)
• Bloody, black, or purple stools
• Projectile vomiting, vomiting/diarrhea for more than a few hours
• Yellow skin
• Problems with umbilical cord or circumcision (see previous posts on these topics!)
• Difficulty breathing
  • When a baby has a hard time breathing, their nostrils flare, you can see their ribs, and they grunt.
  • If this is prolonged, you may also see their hands and feet start to turn blue or purple
• Inconsolable crying for a long period of time for seemingly no reason
• A rash
• Stuffiness or other symptoms of a cold that persist longer than a few days.

*Call 911 if baby is not breathing, blue, has a seizure, or any other emergency*

 

Always ask questions if you are unsure but hopefully this list helps you narrow down some things! As always, email me with questions!

Newborn Baths

In this brief post I will discuss newborn baths and basic care for the first few weeks of life.

For approximately the first week of life, newborns must be given sponge baths. This is because of the umbilical cord that is still present. Submerging it in water increases the risk for infection, so until it falls off, use wipes, washcloths with soap, etc. This kind of bath will also be done in the hospital if you’d like to observe and ask any questions.

Once the umbilical cord stump falls off, the baby can start tub baths. Multiple products are on the market to help hold your baby in the sink or bath tub (hammocks, pillows, etc.) while you bath them.

  

Water temperature should be warm but not hot. Check the water temperature with your elbow or the inside of your wrist. These areas are more sensitive to hot water than your fingers and hands are.

Body wash and soap should be mild and for sensitive skin. Baby soap is best, but mild soap of any kind is good too. In the hospital we use Johnson and Johnson baby wash.

Avoid putting soap on baby’s face- just use warm water. Soap can be too irritating for a baby’s face and eyes. However, shampooing a baby’s hair should be done.

Baths do not have to be done every day like some people think. They can be done every 3-4 days or even once a week. Wipes over the body can be used for everyday use.

 

Always feel free to ask questions at the hospital with your nurse or email me!

Shaken Baby Syndrome

In this post I’ll discuss a serious and far too widespread incident with many new moms and babies- Shaken Baby Syndrome.

This syndrome is used to describe the damage to the baby’s brain after it is shaken. This movement causes the brain to “rattle” inside the skull. Hitting the skull causes bleeding and bruising to the brain. This can cause brain damage that can affect the baby’s development, or even death. This usually occurs when a parent or caregiver is overwhelmed by stress, anxiety or depression, causing them to lose control, shaking baby.

 

 

 

 

 

 

Your nurses will warn you about this while in the hospital but it’s important to know what causes this to occur. Most often, women with a history of anxiety, depression, or postpartum depression are at risk for this to happen to them. As baby’s get older, they sometimes get fussier and fussier. This can be extremely frustrating, especially for mom’s who are alone for large parts of most days. This frustration, coupled with sleep deprivation and a history of anxiety or depression can lead a woman to do ANYTHING to make her baby sleep. Eventually, she (or he if dad), may lose control. This sometimes leads the parent to shake the baby out of frustration.

This can happen to ANYONE. Lack of sleep, frustration, anxiety, depression, etc. are things that all new parents are at risk for. Watch for warning signs in you and your partner for anxiety, lack of sleep, and depression.

If you feel at any time out of control and overwhelmed, put the baby down and walk away. Share the stress with your partner and your doctor and GET HELP as soon as you think you need it. Support groups and family are great resources during these stressful times and can help you from making a devastating choice.

As always, email me with questions!

Temperature Basics

Taking a newborn’s temperature frequently is extremely important. They sometimes have a difficult time regulating it in their first few weeks of life and can be indicative of other issues, such as low blood sugar, infection, or sepsis. Being able to accurately take and interpret a baby’s temperature is an important and often overlooked aspect of newborn care. Your nurse and other caregivers will monitor your newborn’s temperature throughout your stay in the hospital and your pediatrician will as well on follow up visits. Watch what they do and how they do it and ask questions if you have any!

The axillary temperature is the most commonly used for newborns- rectal temperature is no longer done as it has been shown to be as accurate but more invasive. This is best done by lifting the baby’s arm, placing the end of the thermometer probe in the armpit, and holding the newborn’s arm down until the thermometer finishes it’s measurement.

Knowing the normal temperature values is important as well. A baby’s temperature can mean a lot of things, low or high. You can measure in Celsius or Fahrenheit- in Celsius, a baby’s temperature should be 36.5-37.5. In Fahrenheit, it should be 97.7-99.5.

Take your baby’s temperature once a day at least for the first few weeks. Notify your pediatrician if low or high. They will ask if there are any other significant symptoms. These will include sleepiness, fussiness, inability to eat, constant crying, changes in diaper habits, etc.

As always, ask any questions that come up!

 

 

Postpartum Support

Something that a lot of moms worry about is what happens after they leave the hospital and no longer have a nurse helping and caring for her and her baby. What a lot of women and families don’t know is that there a multitude of options for support from the hospital and even from home.

 

Support Groups: Like I’ve said in previous posts, most hospitals offer support groups for their patients. Ask about this before you’re discharged from the hospital. They’ll have support groups for specifics like postpartum depression, breastfeeding, etc.

Midwives: Something to look into even before you get pregnant is midwives. Midwives are certified to give you prenatal care, deliver babies, and give postpartum care as well. Midwives are often more open to delivering at home, water births, the use of a doula, or lack of interventions like epidurals than most doctors are. Midwives will develop a postpartum plan with you base on how much help you need with newborn care and things like breastfeeding. They’ll often follow up within days of birth and multiple times, unlike others who just offer a 6 week postpartum follow up.

Postpartum Doulas: Especially if you used and liked having a doula present at your delivery, you will want to look into a postpartum doula. These are available through homecare agencies and will come visit you, help you with breastfeeding, cook/clean, allow you some personal time and can check your bleeding and baby’s weight gain. These are super useful and if anything, can help you around the house and help prevent you from getting overwhelmed during this period and really enjoy the time you have with your family and your new baby.

Lactation Consultant: As mentioned, most hospitals will have breastfeeding support groups lead by a lactation consultant. These can be great resources for you to utilize! Most antepartum and postpartum homecare agencies will have lactation consultants who will do home visits and personal appointments. They can really help you identify certain problems and offer support during breastfeeding issues.

 

Homecare during the antepartum and postpartum period is becoming more and more popular. Don’t be afraid to look into these options if you feel overwhelmed! The postpartum time period should be a time to enjoy with your baby, not worry about it.

 

Please email me if you have any questions about these options!

Bulb Syringe Basics!

In this post I’ll be discussing a basic but SUPER IMPORTANT piece of equipment for your new baby- the bulb syringe! If you don’t know what this is, you’ll recognize it’s picture:

This small syringe can be life saving for your baby! It is used to suck formula, milk, breast milk, saliva, etc. out of your baby’s mouth to prevent choking. Spitting up is very common with babies, especially in the first few days of life. Since babies can’t lift their heads or control their necks very well, choking when spitting up can be extremely dangerous. The bulb syringe helps you to suck anything out of their mouths and prevent choking from occurring.

To Use:

1. Sit the baby up
2. Pat on baby’s back to push anything out of their throat/lungs and into their mouth
3. Collapse the bulb with your thumb
4. Insert tip into baby’s mouth (side, not the center and not too far back into the baby’s throat)
5. Release the bulb while the tip remains in the baby’s mouth. This will suck anything in their mouth out, and into the bulb.
6. Empty the bulb between each suck to ensure not pushing anything back into the babies mouth.

Here’s a good video if these steps were confusing for you!

Hospitals have these on stock and usually keep at least one in every baby crib for your use. This is also yours to take home. Make sure you always have it on hand!

 

If you have any questions please ask your nurse during your hospital stay and feel free to email me!

Umbilical Cord Care

In this post I’ll discuss briefly umbilical cord care in your newborn. This is relatively simple but can frighten a lot of new parents.

At birth, the umbilical cord is clipped on both sides (mom and baby), and then cut between the two clamps. A new clamp is added close to the newborn’s body, leaving as little remaining cord as possible. For the first 24-48 hours, the cord remains soft and vascularized. The clamp will remain in place for this period of time.

Pictured below is a normal clamp and cord during the first day of life.

Once the cord is dry, your nurse will remove the clamp, leaving a dried piece of the umbilical cord behind. Pictured below is a normal dry/healing umbilical cord stump.

   

Your nurse will give you instructions when you and your baby are discharged home, however here are a few key points:

• While the dried umbilical cord piece remains attached, babies must have sponge baths only. There is a risk of infection when the cord is submerged into water.
• The piece of cord left will fall off within the first week of life (this can vary for every child, contact your pediatrician if you have any concerns)
• Once the piece of cord falls off, the baby may then be given tub baths.
• Dry is completely normal, however call your pediatrician if the cord has any of the following changes:
  • Returns to soft or pliable feeling
  • Begins to bleed
  • Begins to leak any fluid or pus
  • Feels warm or hot to the touch
  • Does not fall off after 1 week

 

Umbilical cord care is relatively simple comparatively to everything going on with a newborn, however it does tend to confuse a lot of parents. If you ever have any concerns, ask your nurse before you go home or call your pediatrician once you go home.

As always, email me if you have any further questions!

Reasons to Bottle Feed

In this post I’ll build on my previous by discussing reasons to bottle feed. Obviously, there are concrete reasons why a woman can’t breastfeed, even if she wants to. Here I’ll list them, but the most important reason to remember is that YOU WANT TO. It’s your body and your baby and if you wish to bottle feed, that is completely your decision.

Medical Reasons Not to Breastfeed: 

• You are HIV positive. We have anti-retrovirals now to keep your baby from contracting HIV in utero and immediately after birth, but it can be spread through breastmilk as well. These babies should be bottle fed.
• You have a severe illness, especially in the bloodstream. Insignificant illnesses like a cold or even the flu, do not qualify. These include cancers, anemia, heart disease, etc.
• You are infected with the herpes virus and have sores present on your breasts. This is an active form of the infection and can spread to your baby’s mouth if breastfeeding is initiated. Breastfeeding can be initiated when the sores heal.
• You are taking medications that pass through the breastmilk (see my medication safety post for details!)
• You have hepatitis B. Once your baby has received the hepatitis B vaccine, breastfeeding can be initiated.
• You have hepatitis C (especially if your nipples are cracked or bleeding) as this disease can pass through bodily fluids and has no known cure or vaccine for prevention.
• You have active tuberculosis. If you are being treated and cleared by your doctor however, you can.
• You are smoking marijuana, using illicit drugs, or drinking large amounts of alcohol. These can all pass through your breastmilk and to your baby.
  • While marijuana is legal in many states and you may use it for a medical reason, there is some evidence to suggest that it can impair a baby’s brain development.
• You are receiving chemo or chemotherapy drugs. These are toxic and can pass through breastmilk.
• You are receiving radiation, especially to the chest. This can affect your breast tissue and breast milk.
• If your baby is diagnosed with diseases like galactosemia or PKU. This makes them unable to digest the breastmilk.
• You have had breast enhancement or reduction surgery. These may change milk production and make you unable to make enough. You can attempt to breastfeed as much as possible but you may need to supplement with some formula as well. It’s more important that your baby get enough to eat.
• If you are a current smoker, you CAN breastfeed. However, do NOT light up for at least 95 minutes before breastfeeding. This will clear your milk. Also, do NOT smoke around your baby. Second hand smoke is dangerous for them as well.
• You have insufficient glandular tissue. A lactation consultant is able to diagnose this, but basically it means your body does not have enough breastmilk creating tissue and you may need to supplement.

 

These are all reasons you shouldn’t breastfeed for your safety and the safety of your baby. DO NOT be discouraged by this. Your baby will be just as healthy and happy 🙂

 

Please email me with any questions! 🙂