Postpartum haemorrhage : what you need to know

While delivering my daughter, I suffered a primary postpartum haemorrhage (PPH). I knew it was likely, because due to my EDS I’m prone to bleeding and have weak connective tissues. However, during my recovery in the postpartum period, I was surprised by how little others knew about PPH, but I understood every mother’s fear about suffering excessive bleeding.
Here’s what you need to know about postpartum haemorrhage.

What is it?

A postpartum haemorrhage is defined as losing more than 500ml of blood from the female genital tract after a natural delivery, or more than 1L after having a caesarean section.  There are two types of postpartum haemorrhage –
1) Primary – this occurs within the first 24h after giving birth, and affects 5 in 100 women. A severe primary haemorrhage is much more rare. This affects 6 in 1000 women, and involves losing more than 2L of blood.
2) Secondary – this occurs between 24h and 12 weeks after delivery, and affects 2 in 100 women.

What causes it?

A PPH happens most commonly because the womb doesn’t contract strongly enough after birth. It also happens because part of the placenta was left in the womb (retained placenta), or because of an infection in the lining of the womb (endometritis).

Who is more at risk?

How is it prevented?

During labour you will be offered an injection of Oxytocin as your baby is being born to stimulate contractions to help deliver the placenta.

How will having a PPH affect me?

It is important to treat a PPH quickly, as it can be life threatening. Once treated effectively, it is important to remember that having a postpartum haemorrhage can worsen the tiredness all women feel after delivering a baby.  If you had a previous PPH you have a 1 in 10 chance of experiencing it again,

How is it managed?

PPH is managed in different ways depending on the severity of the bleed. Treatment can involve massaging the uterus to stimulate contractions, inserting a catheter to empty the bladder to help the uterus contract, injections to make the uterus contract (which may cause nausea) and checking to make sure there is no retained placenta. If bleeding continues heavily, blood transfusions or surgery may be required. 
The NHS has a fabulous leaflet with more detailed information on more detailed management of PPH here.
While the concept of a PPH is scary, the reality is that doctors and midwives are trained in controlling heavy bleeding, and bleeding after childbirth is quite normal. Have you experienced a PPH or know someone who has? Let us know your story below.

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I didn’t fall in love with my baby right away

Everyone knows the scenario. A woman is in labour (and absolutely exhausted), the midwife is shouting ‘one more push’, and finally, a baby is born. The cord is cut and the baby is handed to mum, who feels this overwhelming rush of love they’ve never felt for anything in their life, right?

Well, that didn’t happen for me.

While I was only in active labour for four hours, I’d had what some may call a nightmare of a pregnancy. Due to my EDS I had spent a good portion of it in a wheelchair, I was having hydrotherapy for the SPD and PGP that I developed (if you’re not sure on those, click here for more info), and I’d broken my foot because my EDS couldn’t keep up with the constantly increasing weight that comes with being pregnant. In the early weeks of pregnancy I contracted a viral infection which increased my risk of miscarriage, and baby developing foetal hydrops. And those were just my issues. Add in having scans for little one three times a week because she refused to be active, growth scans because my doctor thought that at full term she would weigh less than 5lb, steroid injections as I’m high risk for preterm labour, and a short inpatient stay towards the end of my pregnancy because my hips wouldn’t stop dislocating, we were essentially living in our hospital 5-6 days a week.
So it’s safe to say I was relieved when she was born, and she started breathing around 30 seconds afterwards.
I was so excited to be passed my new baby, and to feel this huge rush that every woman I know had been telling me about since I announced that I was pregnant that I pushed through two second degree tears, a dislocated hip, failed pain relief, a small haemorrhage and an incompetent midwife just to hold her. The midwife handed her over to me, and I was so amazed that this tiny (yet huge?) person had been with me for the last nine months.
But I didn’t feel that huge rush of love that everyone was talking about.
To be honest, I panicked a little bit, and I thought something was wrong with me. She felt more like a really cute stranger that I had a really strong urge to protect (and cry all over). I tried to breastfeed her twice, but as I’d been given diamorphine too close to delivery, my new bundle of joy was a little dopey, and kept crawling past the breast to suckle on my neck. Cute.
I continued to feel this way for the next few days. I had panic attacks whenever I was left alone with her because I was terrified I was going to break her, I couldn’t sleep if I was alone with her because I was terrified something was going to happen to her, and in the end, including the time I was awake and in labour, I didn’t sleep for three days. I got so worked up about that initial meeting with my daughter that I couldn’t think about anything else. I was convinced I was broken, and that it meant I was going to be a bad mother and this was all a very bad idea. Don’t get me wrong, I thought she was adorable; I was so proud that I had made her, and I wanted to take care of her, but I was just so disappointed that I didn’t get that first meeting that people claim to be the best moment of their lives.
Looking back on it now, I realise it’s totally normal. The birth and pregnancy I had with my daughter was far from normal, my body had been through a whole ordeal, and I was exhausted. I was hormonal, sleep deprived, very drugged from labour, and did I mention they handed me my baby for the first time while stitching me up with no pain relief?
Ouch.
How did you feel when you first met your baby?

Taking control of my second pregnancy

There is another baby on the way in the Mummykind team! I’m pregnant with baby number two and this time round I know quite a bit more about what I am doing.

I have already had a couple of midwife appointments and in that time I have been able to exercise my right to decline routine testing which, if I’m honest, was totally empowering. They would like for me to have a fasting blood glucose test later on in pregnancy to test for Gestational Diabetes . They want me to have this test because I am slightly overweight for my height –  a BMI of 32 at the time (already 11 weeks pregnant and showing) and my Grandfather has Type 2 Diabetes.  I was tested in my first pregnancy and I was fine, as I knew I would be. The test was actually horrible for me, I was hungry, tired and felt so sick. They take two rounds of bloods which is about my limit before I pass out. I decided this time to not put myself through it. Saying “no” felt so good.

I plan to reject further carbon monoxide testing on the grounds that I will have to walk through fairly heavy traffic to get to each appointment and the results are skewed because of that. The first one was unpleasant and I don’t need to be using a giant plastic straw every single time I see a midwife for them to confirm to me that I don’t smoke and my boiler is fine.

Bye bye pregnancy vitamins. They make me feel ill and it turns out you only need to supplement with vitamin D after 12 weeks. There are tentative links being made between folic acid after 12 weeks and tongue ties in newborns which is something I would like to avoid if at all possible.

In my first pregnancy I was pushed from midwife to midwife to consultant and back to another different midwife – 9 midwives and 2 consultants in total by the time I was discharged (not including the ones who came and went through my labour and delivery). I never had a number for a specific person or an allocated individual looking after my care and needs. I have made it clear this time that this was detrimental to my previous care – I now have two ladies looking after me and I have both of their contact details. The feeling of security because of that alone puts my mind at rest.

I will be opting for Group B Strep testing this time. The midwife has already tried to downplay it but I’m not taking that risk again.

I trust my body. It’s becoming almost a mantra at this point. In my previous pregnancy I trusted healthcare providers over my own instinct. Now they do have their merits, they are highly trained and experienced after all. But they cant feel what you are feeling. There will be no telling me when I can and can’t push this time and if anyone indicates that they don’t think I’m trying hard enough or has the gall to tell me that I just need to push harder they will be told to leave.

I will be asking to see copies of the medical consent forms and disclaimers I will be asked to sign in the event of an emergency. It’s important to me that I know what I am signing and in the middle of labour I don’t want to be trying to get a grasp on this kind of thing. I will also be asking for a full run down of what pain relief I will be offered and the risks involved with them, as well as my own research into what will work best for me with my Fibromyalgia and previous traumatic birth.

I will be immediately disengaging from the health visiting service because I can’t bring myself to trust them after their stack of failures last time, if it will appease them I may attend weighing clinics on my own terms. I know that every health visitor is different and some are amazing but I’m not putting my mental health in the hands of a luck-of-the-draw system, the ones I met let me down last time so they aren’t welcome this time.

Knowing now that my children are genetically predisposed to tongue tie and CMPA I will not be hanging around if I spot a single symptom. 6 months of feeding hell with my first was too much for everyone and I refuse to go through it again.

Cloth nappies will be coming with me to the hospital and they will be used from day one. Anyone who wants to tell me it’s too much work or that the hospital “won’t allow” me  to use them will get a full lecture from me about the benefits of cloth, my rights as a parent and about belittling the choices of pregnant women.

To put it in a sentence:  I’m in charge.

8 things I wish I knew would happen postpartum

Before Olivia was born, I didn’t give very much thought to what would happen postpartum. The extent of my worrying into that period was limited to my mental health, as I was already suffering from antenatal depression. But, actually, there are a lot of things that I wish I had known about what I would experience in the days and weeks postpartum. Warning, some of them are gross, but childbirth is gross so I’m not apologising!

1. The first poo
Sorry to start off on possibly the most cringeworthy one, but holy mother of Christ… the first poo is a bitch. I tried to go for days. Days of needing it but not being able to get it out… it’s such a glorious and magical time… not.
A friend of mine who has just qualified as a midwife and was training at the time recommended that I try Lactulose (a liquid laxative). Hey, presto! It worked! But it takes a few days to kick in – so if you’re expecting, get some in the house ready for when you need it!
2. The first wee
I promise these aren’t all toilet related…
You may or may not know that you will be expected to produce a certain amount of wee in a bowl and present it to your midwives. However, if you’ve just been stitched up down there, and even if you haven’t, it bloody stings! So for your first wee, I recommend sitting on the toilet backwards and leaning forwards over the tank so as to angle the wee away from your very sore lady parts.
3.  You’ll be expected to leave the hospital ASAP
It’s no secret that the nhs are in crisis and need beds to be available, but sometimes it can seem like the midwives are simply trying to discharge you as quickly as possible. It didn’t make a huge difference to me either way as I wanted to go home the following day, but if you are struggling with any aspect of your postpartum physical or mental wellbeing, breastfeeding or your newborn’s health, then STAY IN THAT BED! Don’t move until you get help from someone. They cannot kick you out before you’re ready (unless you’re obviously taking the piss), so make sure you’re comfortable to leave those hospital walls because once you do, assistance is that little bit further away.
4. Don’t wash your hair
Thankfully after giving birth, my midwife could tell how much pain I was in and I was still pretty weak and shaky from throwing up throughout my labour. So she, being a wonderful kind soul, gave me personal wash down so that I didn’t have to go and brave a bath just yet. That being said, I did take a shower the next morning… and I washed my hair… with shampoo. Am I an idiot? I’d like to think I’m not, but it was pretty stupid to think that as I washed the shampoo out, I would form a magical protective bubble around my vagina that would prevent any shampoo going near my stitches… Think again!!!!!
5. Maxi dresses are your best friend
I wish I’d had more, because that first week, at least, postpartum, is so painful downstairs that you need to have absolutely no pressure on the area. A maxi dress will also conceal the hairy legs you’re 100% not going to shave and is just the most comfy thing that you can possibly wear after just giving birth.
6. Stock up on maternity pads/mats
For the car journey home from hospital I had to borrow maternity mats from the ward to put on the seat of the car. I say borrow… I didn’t give them back, don’t worry! I hadn’t even considered that. Even more shockingly – I hadn’t even considered that I might need them for when my waters broke on the way into hospital! They didn’t (they broke over a midwife’s hand instead), but it is still a possibility and you really don’t want to be cleaning that out of your car when you’ve got a newborn.
7. You will need separate bags
I don’t think I was quite realistic about the hospital stay. I assumed my birth plan would be totally accurate and so only packed one outfit for me, far too many for Olivia and absolutely nothing whatsoever for Jamie. Obviously, he then had to leave me with Olivia’s godmother in the hospital while he went home for provisions. Put whatever you want in your bags, but do pack separate ones for each of you!
8. Finally, it will go too quickly
All of the pain you feel and the sleep exhaustion will make the days and nights seem never-ending. But I promise you this, I wish I had known that it flies by in what feels like a blink. I don’t even remember my baby as a baby – she is a completely different child in both appearance and personality. I’d give anything to go back to having my tiny Olivia again and at the same time I love the way she is now (except the tantrums). For all of the stress, emotion and being so physically and mentally drained, it is worth it, and you’ll realise that all of those people who really pissed you off by saying that in your last weeks of pregnancy we’re absolutely right.

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Diastasis Recti 101

Aah, the mum tum. The pooch. The overhang. While the post-baby jelly belly is something most mums expect to encounter to some extent, fixing it isn’t always as straightforward as you might first imagine. It took nine months for your tummy to get that big, so it’ll take at least nine months to fix it, right?

But what if it doesn’t shrink? What if you still look 4 months pregnant months (or even years) after delivery, and nothing you do seems to be shifting the baby weight?

You might be amongst the 60% of mums who have a Diastasis Recti

From a medical perspective, (according to the Mayo Clinic):
“During pregnancy, the growing uterus stretches the muscles in the abdomen. This can cause the two large parallel bands of muscles that meet in the middle of the abdomen to separate — a condition called diastasis recti or diastasis recti abdominis.”

These muscles form part of a wall of muscle that holds the uterus, intestines and other organs in place and lends support to the pelvic floor. Typically, the gap will go back to normal around 8 weeks postpartum.  However, the gap sometimes does not close on it’s own, which can cause a number of health issues (not to mention leaving you perpetually frustrated at your stubborn tum).

Signs you may have a Diastasis Recti include: 

  • lower back pain
  • constipation
  • bloating
  • poor posture
  • incontinence that lasts for more than eight weeks postpartum (separated abs can cause issues with your pelvic floor)
  • a pooch or bulge in the middle of the stomach
  • dome like bulge in the stomach when coughing or getting up from lying down

Before you start to panic, it’s not all doom and gloom. Below is a list to help you check yourself for a diastasis, and what to do if you think you have one.

Checking for a diastasis

  1. Lie on your back with your feet flat on the floor, knees together and bent.
  2. Raise your head and shoulders off the floor so that you can see your tummy.
  3. Place your hand flat on your stomach, fingers pointing towards your toes.
  4. Try and feel for the gap between the muscles above and below your belly button. You might feel them squeezing your fingers tightly. You might not. That’s ok too.
  5. Note how many finger widths you can fit in the gap, and how high up your torso that measurement is. You may find your diastasis is larger at the bottom than the top, or vice versa.

Typically a diastasis recti is measured as 1 finger width = 1cm. Therefore, if your diastasis is 3 finger widths, it is 3cm wide. If you feel a gap wider than 2cm, you have a diastasis. A gap wider than 4-5cm wide is considered severe.

What to do if you think you have a diastasis recti

If you’ve found that you have a diastasis, it is more than possible to improve it. The best way to do this is to get guidance from a physiotherapist, who can advise you on the best exercises to do to close the gap. In the meantime, here’s a list of things to avoid:

  • traditional crunches, sit ups and planks, as these can increase intra-abdominal pressure and actually make the gap worse by putting too much strain on the muscles, effectively pulling the gap wider rather than closing it.
  • holding baby on one hip, if it is painful
  • coughing without supporting the ab muscles
  • lifting or carrying heavy loads

Alternatively, there are many diastasis recti repair exercises on youtube, which you may like to follow along to. Just be careful you don’t put too much pressure on your stomach, as this can delay your healing and even make the condition worse.

Last but not least, if exercises from your physical therapist fail to improve your condition, surgery is always an option, however this should be a last resort, and always discussed fully with your medical team.

Needless to say, if you’re experiencing any physical difficulties postpartum (be it months or years) you should always speak to a medical professional about your concerns. While having a Diastasis Recti can be a pain (both literally and figuratively), it can be improved over time.

You’ve got this, mama.

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Mental Health Monday: Speak Up

Although we may have all spent our teenage years trying desperately to get away from embarrassing parents, parents are a class of people that we will all come across in everyday life. Hopefully, many of you reading this post are parents – mothers or fathers. It’s so important to understand and raise awareness of not only maternal mental health but of parental mental health generally.

Particularly important is raising awareness in our workplaces, because of the progress that has been made towards diversity and equality across this sphere generally – though much still needs to be done. Gender equality is increasing and this progress cannot be undone by a lack of support or awareness of the issues faced by new mothers and fathers, who, of course, make up a significant proportion of our working population.

Work-related stress is something which has affected so many people, so it is increasingly crucial to make sure that parents have no further stress upon returning to work, either by making admissions that they are seeking help for mental health conditions, or by suffering in silence and perhaps struggling in the meantime. Postnatal depression is not normally a topic spoken about widely enough for others to recognise that it can affect both mothers and fathers equally, and potentially adoptive or other kinds of parents as well.

At the moment, postnatal depression is diagnosed in around 1 in 10 mothers (though the actual number affected may be much higher!) and, according to recent NCT research, it also affects 1 in 10 fathers, though it may sometimes be called paternal depression rather than postnatal.

But I truly believe that nobody should have to suffer in silence in fear of a backlash if they do make a public admission of his or her postnatal depression. Encouraging an open dialogue around parental mental health brings us one step closer to ending mental health stigma altogether.

In some respects, the stigma of postnatal depression is more difficult to overcome, as many people can’t even fathom how a happy event such as the birth of a baby can lead to depression, psychosis, PTSD or anxiety as a result. The truth is that there is no logic to mental health conditions, and the expectations we are given to feel a certain way can make us feel inadequate, or undeserving, which can be where it all begins.

So how do we overcome the stigma surrounding mental health concerns? It’s necessary for the proper functioning of society that we’re able to move forward, and we have to raise awareness in order to do just that.

Personally, I believe that we should endeavour to be accommodating in our lives and particularly in our professional careers for new parents, encouraging and helping people to speak up, as they may be fighting battles unknown to the rest of us.

This post was written as part of our Raising Healthy Minds campaign.

Baby Bonding Guilt

When you’re pregnant, people try to prepare you for the birth. They tell you about their birth stories, some of which may be more like horror stories to a first time pregnant mum! They ask you your birthing plan. They even tell you that you won’t sleep properly again, or at least for 18 years…

But no one prepares you for what I found a real struggle
…the bonding.

You spend your 9 months of pregnancy preparing. You buy all the bits you’re going to need, you stock up on what feels like, (but never is), more than enough nappies and baby wipes. You plan and sort out a welcoming nursery. You prepare the hospital bag and write your plan with the midwife. You get excited! This little baby is going to complete you!

But what if no matter how much you want this baby, no matter how much you have planned and no matter how much you want to love this baby.

What if when they’re born you don’t feel anything?

I hope that by talking about  it I can encourage mothers and fathers to be more open about their feelings and to not feel ashamed if they found the bonding process hard and not immediate. I truly believe that this affects more people than they’re willing to admit. After all, who wants to admit that they don’t love their baby? No one!  I want to show others that they shouldn’t feel guilt and shame, it will come in time even if it doesn’t feel like it right now.

Giving birth to a baby, as everyone says, very rarely goes to plan. But even if you are fairly relaxed on what you want during your birth, it doesn’t mean that you won’t be left thinking about it afterwards. Births can be traumatic and they can leave mums feeling as though they didn’t do things properly. Perhaps they had a C-section, rather than the vaginal birth they had hoped for. Perhaps they needed plenty of rest following the birth so weren’t able to be as active and do as much of the feeding in the early days. Perhaps they had trouble breast feeding their baby. Perhaps the baby had colic and wasn’t able to sleep comfortably very easily. These can really affect a mum’s and dad’s ability to bond, even though these are things completely out of their control!

What you’re not told is that the bonding process can take a few days, a few weeks or even months and if you’re one of those people who it takes time for, it can fill you with feelings of guilt; this is what I felt, I felt like an awful parent. It may seem that every other parent has this instant bond with their child but in all honesty I don’t think that is the case for a lot of people and I think that parents feel uncomfortable to admit to it because they worry that others will think they don’t care about their baby. This couldn’t be further from the truth!

The health visitors will suggest ways of helping… skin to skin, which is lovely, but if you’re unable to pick up your baby because you’re in pain or if you are having trouble because the desire to do so isn’t there, then that can be hard.

They will most likely suggest breastfeeding which is viewed by many as a good bonding method. However, I feel that if you’ve been unable to breastfeed for a number of reasons, (you can read our breastfeeding stories), then it can be unhelpful for the health visitors to push this suggestion because it may increase the mother’s feelings of guilt.

I think that in those early days that it’s made harder because of the broken sleep. The fact you are doing all these things for your baby and not getting much in return can make it difficult. It may sound daft but once you are recognised by your baby and you get reactions from them, which could be something as little as a smile, it makes the bonding so much easier. Even without these reactions, your baby knows you from your smell, your heartbeat and your voice, they’re just working out ways they can communicate with you.

These are some things I tried that you might like to try too:

  • Singing to your baby.
  • Talking to your baby.
  • Reading to your baby so they get to recognise your voice.
  • Lying next to your baby.
  • Wearing your baby in a sling.
  • Baby massage.
  • If possible, holding your baby against your chest.

Please remember that you are doing your best. It may seem like every other parent is finding parenting a walk in the park but I can assure you they’re most probably not! If you’re finding the bonding process hard it is not a reflection on you as a parent. Your body and mind have been through a huge change! The birth and early days may not have gone exactly as you’d planned as well and this is not your fault!

It is so important to forgive yourself for these feelings and to seek help if you feel you need it, there really is no shame in talking about this. You are an amazing parent and you will get through this difficult time, it might take a few months, but that’s not something you should feel ashamed about. Other parents you know got there earlier, that is their parenting journey. You will get the close bond with your baby that you have looked forward to throughout your pregnancy and it will be worth the wait. Some things you can plan for during the pregnancy, unfortunately this is one of those things you can’t and you don’t expect it to happen to you. I hope that by talking about this that other parents won’t feel alone like I did in those early months. When I look back on those times I don’t associate it with those bad feelings anymore, I only remember the good.

Writing this has made me feel quite emotional because I now have such an inseparable bond with my daughter and we are so happy. I hope my daughter knows how much she means to me everyday and I ho
pe she never doubts my love for her. I never saw myself getting here but once I did it made me feel like the richest woman alive. I have no doubt that you will get there too. 


Lucy At Home