How You Feel Matters:
How to care for your mental health during conception, pregnancy, and postpartum
Bridget Cross, LCSW, PMH-C

Becoming pregnant and having a baby can be one of the most exciting and joy-filled times in any parent’s life. However, it is so normal to also feel stress, sadness, fear, overwhelm, anger, or anxiety during this immense transition. 

Though these emotional responses are common, they can also sometimes put you at risk for a mental health issue called a perinatal mood or anxiety disorder (PMAD). One in 5 moms will experience a PMAD during pregnancy or postpartum (as well as 1 in 10 partners). Among BIPOC moms, that number increases to 1 in 3. PMADs such as pregnancy and postpartum depression, anxiety, OCD, and PTSD are considered a major public health issue. In the US, postpartum depression is the #1 complication of childbirth. 

But here’s the good news: PMADs are completely treatable. With the help of your medical provider, and a maternal mental health specialist, as well as an effective support network, you can recover and thrive. If you’re struggling or worried about how you’re feeling, please know you are not alone. There is help out there and how you feel matters. 

One of the best things you can do to prevent PMADs is to create a plan to support your mental health before you conceive. However, if you’re already pregnant or if you’ve already had your baby, don’t worry! You’ve come to the right place. It is never too late to learn about your mental health and take definitive steps to find support, connection, and nurturing as you navigate new motherhood. 

In this new weekly blog series, I’ll be highlighting some simple ideas for tuning into and supporting your mental health during this season of life. Please feel free to share and check back next week for more!

1.  Find a support group, even if you don’t feel you need it yet.  

Connecting with others who are in it with you is one of the best ways to take care of yourself as you journey through conception, pregnancy, and postpartum. Due to the COVID-19 pandemic, options are limited, but a growing number of wonderful support groups are now available online: 

• Nurture Community Support is a local support group for new moms during baby’s first year. We explore topics such as health and wellness, relationships, mood changes, bonding with your baby, body image, sexuality, and more, all within a safe, non-judgmental space. Typically we meet at the Birth Center but for now we will be meeting on Zoom. Meetings resume on August 8 – register here!
• Local doula Ann Carroll of Doula Deliveries offers pregnancy yoga, parent/baby yoga classes, childbirth education, and more for families who are trying to conceive, pregnant, or in the postpartum period.
• Postpartum Support International (PSI) offers free online support groups almost every day of the week for pregnant and postpartum moms, for miscarriage and loss, for military families, for dads and partners, for NICU families, and for Black mamas.
• The Bloom Foundation offers a free support group for pregnant and new moms 2 days a week.
• Honey Space for Moms in Michigan offers many virtual groups for moms and parents of babies and kids of all ages.
• The Motherhood Center of NY offers several groups and classes for pregnant and new moms – all of which provide an opportunity for connection with other parents.
• PostpartumDads.org offers a support group for dads and partners during the perinatal period.

Stay tuned for a new suggestion next week, and please feel free to contact me if you have any questions, concerns, or feedback! You can reach me any time by email or on Facebook.  

Bridget Cross, LCSW, PMH-C

 

 

October’s blog was contributed by Dr. Kaleb Scroggin. Dr. Scroggin is a Savannah native, graduating from St. Andrew’s School before receiving his bachelor’s degree in exercise science and his Doctor of Chiropractic degree. He has done thousands of hours of post-doctorate pediatric and prenatal training, teaches students and doctors clinical pediatric chiropractic, and runs Restoration Chiropractic, a pediatric and prenatal chiropractic office in Savannah, Georgia.

Did I get hit by a truck? Nope, just pregnant…

When I meet with a new pregnant patient, one of the first questions I am asked is “Why do I feel like I got hit by a truck?” Many of these patients are only around 10 weeks gestation. At 10 weeks, your baby is only about the size of a kumquat, so what gives? This baby is not pressing on your sciatic nerve at that size, nor is it pushing on your ribs or low back. Why are you in so much physical pain when there is not any physical mechanism? The answer has three parts: alignment, stability, and hormones.

When you were a child, you most likely took a few tumbles, whether it was riding a bicycle, gymnastics, soccer, or just tripping over your dog. Most of the time these little falls did not mean very much to you, stinging for a while, but eventually the pain went away. What you may not have realized, though, is that your spine and hips can be bumped out of alignment during these thousands of falls.

Now there is good news and bad news…

The good news is that your body is amazing at adapting and can lock down, or splint, these misaligned joints so that the pain is minimized and you can go about your life. The bad news is that you may not feel the effects from these misalignments sometimes until decades later when something comes along and destabilizes them… like pregnancy.

When most people think of the effects of hormones, they may think of hot flashes, acne, or mood swings, but when you are pregnant, there is another hormone that affects you in a different way, called relaxin.

Relaxin is a hormone that is released during pregnancy, that “relaxes” your ligaments. This is a great thing for a pregnant mom whom is about to give birth. It helps her pelvis open more easily to aid baby in making their exit. The not-so-great part about relaxin is that it also destabilizes those joints that have been locked down for sometimes years and causes them to flair up. Relaxin spikes the highest during the first trimester, and then again towards the end of pregnancy. This means that if you are one of those women who have taken a spill that caused a misalignment, relaxin is about to destabilize all of the work that your body has done to protect your joints, which means that truck might be coming for you. Being in pain while pregnant is no fun, but knowing the cause of these issues means that there are ways for you to prevent your own suffering.
There are 3 THINGS you should do BEFORE you feel the pain (and once you feel it too).

The FIRST thing you should do is see a Prenatal Chiropractor. Their entire job is to gently correct misalignments and restore function to your body. It makes sense that maintaining proper function is something that you always do seeing how improper function is usually causing the pain in the first place. This is even more true during pregnancy with all of the changes your body is going through. We see many moms that wait until the pain is unbearable in their third trimester, and we consistently hear that they wished they had started sooner and not needlessly suffered.

When looking for a prenatal Chiropractor, go to ICPA4KIDS.com to look up a “Webster Certified” Chiropractor. The International Chiropractic Pediatric Association (ICPA) is the ONLY organization that certifies Chiropractors in this technique and it means that they have been evaluated to be excellent at caring for pregnant women.

The SECOND thing you should do that helps a ton of our patients, is get yourself a wedge pillow. You place the pillow in any chair that you sit in to help roll your hips forward. This allows a better lumbar curve, keeps your hips from pinching, and keeps you from “hunching”. These things help keep your head from having to stretch so far forward, which takes an enormous stress off of your back. We especially recommend these to our patients who sit in a car for a long duration of the day.

The THIRD thing that you should do? TUMMY TIME

No, I do not mean lay on your stomach while pregnant – but a huge contributor to these pains, on top of the misalignments, is your forward head posture. I cannot see you, but I know that you have it. Every inch forward your head is in front of your shoulders adds an extra 10 pounds of stress to your spine and this greatly influences how you feel. Chiropractic helps bring your head back over your shoulders, sitting on a wedge pillow keeps your head from being pulled forward, and tummy time helps strengthen and improve tone in your neck and back so that you can better fight gravity. Things like the bird-dog exercise, or crawling on your hands and knees will keep your belly from being squished while also training your back muscles. There are a variety of exercises that help. We prescribe specific ones that will help that individual the most after we analyze exactly what they need.

Seeing a chiropractor, reducing stress on your neck, and strengthening your back and neck muscles will greatly improve your stability, mobility, and bring your body back into balance so that you can survive that third trimester without feeling like you have been hit by a truck.

More questions?

Contact the author:
Kaleb Scroggin, DC
(912) 376-9191
MyHeadsOnStraight.com
RestorationChiroSavannah@gmail.com

May’s blog was contributed by our CNM, Shelia Love.  Shelia’s focus in this blog is on Women’s Health Care.  One of our goals at The Midwife Group Women’s Health and Birth Center is to provide care to women throughout their lifetimes, and Shelia is one of our midwives helping us achieve that part of our mission.  

Gyn-Ecology

        Vaginal irritation, infections, discomfort, odor and leaking of urine are the most common reasons women seek out gynecological care. Thousands of dollars are spent annually on feminine hygiene products. Many of these items cause more harm than good. Most women self diagnose and treat for prolonged periods of time before contacting a health care provider.  

        Many of these disorders and discomforts are self-induced. Social media, magazines and television bombards us with products for various disorders or just to make us feel “fresh”. So we purchase and use these items, not knowing that they may actually cause more problems.

        So let’s sort out the facts. Nature has physiologically provided the vagina with a self-cleaning balanced environment. Vaginal discharge and personal odor are normal and fluctuate with hormonal changes, menstrual cycle, pregnancy, sexual activity, breastfeeding, menopause, diet and many types of medication. Odor should not be offensive or fishy. Normal discharge may change from a slippery egg white consistency to creamy or thick white. Normal vaginal balance supports lubrication, pleasurable sexual experience, urinary functions prevents infections, and assists in facilitating conception and birth.

        Vaginal balance is measured by the secretion’s pH. pH is the measurement of a solution’s acid or base status on a scale from 0-14. 0 being the most acid and 14 the most base. The vagina’s ph ranges from 3.5 to 6-7 associated with hormonal changes. This range can leave the vagina/genitals more susceptible to common infections.

        Common feminine products, laundry detergents, aggressive cleaning, or personal hygiene practices can interrupt this fluctuating environment. Your sexual partner’s cologne, lotions or soaps can also disrupt the vaginal eco system. Plant based oil lubricants (coconut, olive oil) are very popular, but are not compatible with safer sex barriers made from latex or polyisoprene.

        So here are the  do’s and don’ts of maintaining proper vaginal balance:

DO’S 

• Use mild soap for washing your body including anything that enters the vagina hands, objects, penis (i.e. plain bar Dove or Pure and Natural)
• Remove underwear as often as possible for better air flow
• If necessary, use lubricants compatible with vaginal pH (ex. Luvena)
• If you notice an odor, itch or discharge fill bath tub with 4-5 inches warm water add ½ cup table salt, sit in tub, depress vaginal opening and swish water in vagina for 2-3 minutes 3 times a week.
• If you are prone to vaginal infections consider daily probiotic specifically for vaginal and urinary health (ex. Fem Dophilus, RepHresh Pills)

DON’TS 

• Douche
• Routinely use panty liners
• Use feminine wipes
• Deodorant pads or tampons
• Bleach underwear (peroxide will remove stains especially blood)
• Use dryer sheets for underwear (air dry is ideal)
• Use antibacterial or perfume soaps, lotions or sprays (including sexual partner) on anything that enters the vagina
• Wash sex toys with antibacterial soap or alcohol (use warm soapy water with Dove or Pure and Natural, rinse and air dry)
• Share toys

REMEMBER – if you experience pain, fever or abdominal tenderness or signs and symptoms increase, contact your healthcare provider for evaluation.

        Protecting and maintaining vaginal health is a part of your long-term health and wellness. Like many health issues our choices may make the difference between wellness or disease and impact quality of life

       There are many over the counter homeopathic products that maintain vaginal health or treat imbalances or infections but only your health care provider can recommend the proper one for your specific situation.

        If you have concerns about any ongoing vaginal or urinary issues, contact me and together we can make a plan to improve your intimate feminine wellness and quality of life.

Shelia Love
Certified Nurse Midwife

 

Our blog today is written by one of our Certified Nurse Midwives, Stephanie Curtis, CNM, DNP  

“If I don’t know my options, I don’t have any.” – Diana Korte

Every woman deserves the right to choose where and how she will birth her children. She may wish to introduce her child to the world in the comfort of her own home. She may desire the benefits of epidural anesthesia. She may opt for a midwife or a physician as her prenatal care provider.

But at the end of the day, with the appropriate education, I believe every woman would choose the safest option for herself and her baby.

The safety concern usually has to do with her medical history and development of her pregnancy. There are important questions which should be asked at the onset and throughout prenatal care to help determine the best “where” and “how” for every woman. Most of us have heard the phrase “high-risk pregnancy” too often. While there are many mothers out there who have endured those difficult circumstances, there are at least twice as many whose experiences have been relatively uncomplicated. The University of California San Francisco (an internationally recognized leader in women’s health care) reports, “High-risk complications occur in only 6 percent to 8 percent of all pregnancies.”

That means, many women are good candidates for out-of-hospital birth. Here, at The Midwife Group and Birth Center, we complete an initial screening via phone to confirm this is the case. Our role in the health care system is to exclusively support physiologic birth. We recognize there are conditions which are more likely to cause the process of pregnancy to depart from its normal course. Let’s explore some of those pre-pregnancy factors further.

 One of the first questions we ask is about previous uterine surgeries, primarily, cesarean sections. When it comes to vaginal birth after cesarean (VBAC), uterine rupture is the complication which is most often mentioned. Research shows the absolute risk of uterine rupture to be less than 1% in both women who choose an elective repeat c-section and in those who choose a trial of labor after c-section (TOLAC). We are huge proponents of VBACs, but the state of Georgia’s regulations will not allow us to attend those deliveries at the birth center.

Next, we’ll ask about your health history. Chronic issues such as hypertension and diabetes often affect pregnancy and labor in such a way that a hospital birth is needed. If you are taking medications which are not recommended while pregnant, in many cases, we can help you find an appropriate alternative. We will use your height and pre-pregnancy weight to calculate a body-mass-index (BMI). If your BMI is 40 or above, an out-of-hospital birth could be potentially unsafe. You can calculate your BMI here https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. The great news about BMI is that it can change! If you are planning to become pregnant and hoping to be a birth center client, we would be happy to see you for an annual exam or preconception visit where we could help you identify goals and plan to optimize yours and your future newborn’s well-being.

Lastly, there are a few misconceptions about what makes someone “high-risk”. For example, having had first trimester pregnancy losses or being 35 years of age or older when you become pregnant DOES NOT make you a “high-risk” patient. The same goes for couples who have had assistance with conception via medications or procedures such as in vitro fertilization (IVF) or intrauterine insemination (IUI). We would much rather have a conversation with you about these subjects than to have you rule yourself out. Here are some examples of truly high-risk conditions: carrying twins, a baby who remains breech after unsuccessful attempts to turn, bleeding disorders, pre-eclampsia or high blood pressure in pregnancy, and having too much or too little amniotic fluid.

A birth center, while a wonderful option, is not the safest option for every woman. You may be unable to choose a birth center but may still be able to choose a midwife depending on where you live. Many hospitals and physician practices work closely with midwives who provide prenatal care and who attend births on your local facility’s labor and delivery floor. You can search for a midwife here http://www.midwife.org/find-a-midwife.