POSTBIRTH - An Acronym that Can Reduce Maternal Mortality and Morbidity in the Postpartum Period

POSTBIRTH - An Acronym that Can Reduce Maternal Mortality and Morbidity in the Postpartum Period

by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE

Full text of the article can be found here.

Maternal mortality and morbidity in the United States are as high as they have ever been.  More people are dying from complications of pregnancy or childbirth than ever before.  61 percent of deaths related to childbirth occur in the postpartum period and most of those occur in the first 42 days after birth. The current estimated maternal mortality rate in the U.S. is 23.7/100,000 live births (MacDorman, Declercq, Cabral, & Morton, 2016).  

There is agreement that we must improve the way we care for people in the postpartum period if we want to be able to reduce the complications and deaths that occur after giving birth.  Part of this improvement lies in how warning signs information is provided to families after birth.  As it is not possible to identify who will have a postbirth complication, it is imperative that everyone receive information about concerns in the postpartum period that will need to be evaluated by a health care provider.  The postpartum nurse or mother-baby nurse is in a unique position to educate families on what to watch for postpartum.

Unfortunately, current research indicates that the information that postpartum nurses teach to new parents about warning signs is inconsistent and often inaccurate.  There is also evidence that many postpartum nurses are not aware of the major risks that face people after they give birth that can cause death or serious complications.  Families report being flooded with physical and emotional situations in the first days postpartum that make it difficult to take in important information accurately and clearly.   For these reasons, the postpartum discharge education RNs provide must be clear, concise, and accurate. When appropriately informed and educated, postpartum nurses are in an ideal position to improve postbirth outcomes, if they are given adequate time to share information with the new family.

A new study, Nursesʼ Knowledge and Teaching of Possible Postpartum Complications, published in MCN: The American Journal of Maternal/Child Nursing, examines postpartum nurses’ knowledge of maternal morbidity and mortality, and information they shared with women before discharge about identifying potential warning signs of postpartum complications. 

Almost half the postpartum nurses in the study were not aware that maternal mortality rates have increased.  Almost all (93%) of nurses knew that hemorrhage was one of the top three causes of death, but only 68% knew that hypertension was another, and barely 39% could identify infection as the third leading cause of death.

World Breastfeeding Awareness Month

It's world breastfeeding awareness month! In honor of this, my next several posts will be focusing on breastfeeding information, resources, research, best practices, stories, and photos. I of course understand and respect that not all families I work with are breastfeeding, whether by choice or not, and there is of course some that fall in between. As a birth doula, I am always happy to support my doula clients any way they choose, however I find that most often, my clients are worried about and are asking me about breastfeeding -- usually right after birth and the postpartum visit. I had the great pleasure this year of becoming a Certified Breastfeeding Counselor, and am loving that I am able to provide a greater depth of support to my clients around breastfeeding.

To kick off the week, I want to share an awesome blog post from Lamaze's Science and Sensibility blog, which has excellent resources for breastfeeding or soon-to-be breastfeeding families.

Read the blog post here.

Mothering The Mother: Postpartum Support for Women

During prenatal sessions with my doula clients, I always make a point to discuss postpartum plans. In the way in which every woman usually has some sort of birth preferences (hospital birth, home birth, birthing center birth, midwife, doctor or OB, natural birth, epidural birth, and so forth...) it is important to develop some ideas around what the plan is for postpartum care. 

Some of the questions I encourage my pregnant couples to ask themselves are: what is our sleeping arrangement and what are our beliefs in infant sleep? Where is our healthy food coming from? Who's around if we need support? Would we like a postpartum doula? How much time can we take off? Who is in charge of feeding? Who is in charge of feeding? Who will do the laundry and the chores?

Mothering the Mother: New Mothers Need a Focused Period of Rest and Recovery

An excerpt:

The postpartum period is considered to be the roughly six-week period when a woman recovers from the magnitude of pregnancy and birth. It is also the wild, messy, tender, achy, exhilarating time when a woman begins the process of shedding one way of being for an entirely new identity. It is a fleeting, essential moment, a powerful pause before the full initiation of the next chapter of her life. But in a society that encourages a new mother to "bounce back," right after birth, a woman is pushed to do the opposite of resting and recovering; she is encouraged to get back to a version of her body and her life that is gone forever. She has been forever transformed by the profound act of making another human being and requires care and attention before hurtling forward.

Let Babies Figure it Out On Their Own

This is a great piece on infant physical development. When my first son was 3 months old, I had the wonderful opportunity to take an infant developmental movement class at a nearby yoga studio. My teacher taught me so many wonderful things that I would never have otherwise learned about supporting my son's physical development. Even as someone who is quite physically attuned, with my background as a dancer and my current yoga practice, I just had no idea how many of the things that I was doing were not helpful, and potentially detrimental, to my kid's budding physicality. This article explains some of what I learned in my class.

"When an infant is propped or placed in sitting and standing before they have developed adequate upper body strength to move their own body into sitting and standing, their spinal curves will be develop out of sequence. The result, which I have seen over the years in my work with infants, children, athletes and adults, can become organ, glandular and/or spinal challenges such as scoliosis and lordosis because the cervical and lumbar curves have become dominant.

When a newborn or an infant is “propped” in a sitting position or placed into equipment by a caregiver, they will either stiffen or flop over. When a young infant is consistently sat and stood up, they will usually extend their limbs and stiffen throughout their entire body (a fear response) in an effort to support the weight of their head. This stiffening is easily felt when holding them and will not only disrupt the integration of their arms and legs with their torso but also delay their ability to roll over."

Postpartum & Breastfeeding Nutrition For the New Mother

Postpartum nutrition! Many women aren't aware that for breastfeeding a newborn (or older baby), that often women need to eat more than they did when when they were pregnant! Of course, quality is important as well, as it's not just about getting enough calories.  The amount a breastfeeding mother should eat also depends on level of exercise, overall caloric needs, and other variables, or course. The best rule of thumb is to eat to your hunger, being mindful of making healthy choices whenever possible. Through recent research, we know that a mother's varied diet will encourage her child to enjoy a wide palette of flavors - all the more encouraging to eat well while breastfeeding! Check out the links below for more info on postpartum eating and nourishing the new mother:

Recovery From Childbirth: Postpartum Foods

Do Breastfeeding Mothers Need Extra Food or Fluids?

Nourishing the New Mom

Maternal Nutrition During Breastfeeding

Celebrity Moms Who Ate Their Placenta...

I know you are curious!!! Find out which famous people have been public about consuming their placenta here. Satisfy your inner celebrity gossip curiosities!