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Postpartum Pain & Incontinence Part 3: Seeking professional assistance

Sept. 27, 2016

The postpartum period is often defined as the first 6-8 weeks after giving birth. Sadly in our culture, postpartum hip and low back pain, incontinence issues, and other physical complications often last well longer than the initial months after childbirth, sometimes continuing for years. MotherTend explores the common potential causes of postpartum pain and what moms can do to fully recover from pregnancy and giving birth. Part 3 covers postpartum professionals who can help you recover from more significant or longer last issues, including chiropractors, physical therapists, nutritionists, accupuncturists, and MotherTend's new postpartum posture and functional fitness program.

NEED MORE HELP? WHEN, WHERE, HOW, AND WHY.

For more on postpartum posture as it relates to pain and incontinence, see Part 1: Posture. For more on exercises to reinforce proper posture and restrengthen over-stretched postpartum muscles, see Part 2: Exercises.

It can be so hard to know when to seek additional professional help for postpartum issues for many reasons. Nobody talks about these problems, so most women don't know what a "normal recovery" is supposed to look like and even if you know you could use help, you might be held up by insurance coverage gaps, lack of time/childcare, or just not know where to go. Many physicians and even obstetricians don't know where to send women who are dealing with chronic postpartum pain or incontinence. Luckily for you (less so for me), I have the wisdom of experience working with people who really know what they're doing... and people who really do not. Allow me to direct you to the former!

  • Chiropractic: The reason I put this one first is because often times if the postural checks and exercises are not doing the trick, it may be due to an anatomical issue. Between carrying a heavy load on your front for almost a year, pushing a small human out of your pelvis, and then trying to carry that small human around, your pelvis, hips, ribs, etc. can get into all kinds of funny positions. If they're in those positions long enough, the surrounding muscles and ligaments may tighten/stretch to accommodate that position and before you know it, you're "stuck." Chiropractic can be a great way to get your joints back into proper alignment so that your muscles can function more optimally, and then you can do the postural work and exercises to get them to stay that way over time. I will say that not all chiropractors are alike! Many postpartum women respond better to a chiropractic approach that is more gentle, rather than using drop tables and other traditional techniques. I recommend the following chiropractors on the North Shore:

  • Physical Therapy: If you are dealing with a specific postpartum issue, such as prolapse, incontinence, or a broken tailbone, physical therapy can be really helpful with encouraging full recovery. I will caution you that even more so than chiropractic, it is imperative that you find a physical therapist who specializes in working with postpartum women! A PT who lacks knowledge regarding anatomical concerns in the postpartum period can do more harm than good. I found Pamela McIntosh, PT, DPT, WCS of the Center for Rehabilitation and Sports Medicine at Addison Gilbert Hospital to be extremely knowledgeable and helpful for my own postpartum issues. She was also nice enough to pass along an extensive list of all physical therapists in MA who specialize in pelvic floor issues, which is about as close as you can get to a list of postpartum specialists. Pelvic floor PTs located North of Boston are listed below:

  • Nutrition: I'll admit, I was initially very skeptical that nutrition could have any effect on my postpartum pain. However, between my gastrointestinal issues that I had been battling for years and my desire to bring my general inflammation levels down to a lower baseline, I decided to look into it further. My chiropractor, Dr. Courtney Brooks Neill (see above), does a form of food intolerance testing called applied kinesiology, which is a non-invasive approach to determine what foods might be aggravating the body. There is a substantial body of research suggesting that applied kinesiology is an effective technique for determining musculoskeletal and neural issues in the body, but it has not been well studied in its application to dietary concerns. However, a recent pilot study (small, exploratory study) 19 of 21 (90.5%) suspected food allergies found during applied kinesiology testing were later confirmed by serum blood tests; hopefully more research will emerge on this topic. In the meantime, I can say that cutting out gluten, corn, and coconut-- the three foods picked up during my applied kinesiology testing-- has virtually eliminated my IBS (irritable bowel syndrome... gosh I wish they would pick a cuter name for that!) symptoms and seems to have also helped with my pain flair ups, especially the flair ups that seem to be associated with menses. Specialists in dietary concerns for chronic pain are listed below:

  • Acupuncture: I did not seek acupuncture for my own personal postpartum issues. However, there is some research that suggests that acupuncture can reduce chronic pain. Sometimes when your body has been in pain for so long, it comes to expect it in a sort of self-fulfilling prophecy "pain feedback loop." If you have chronic postpartum pain that is not related to a specific anatomical issue, was not ameliorated by postural correction and exercises, and did not respond to chiropractic, acupuncture may get you to the next level of pain relief. Unfortunately I cannot recommend a specific local acupuncturist, but I recommend calling a few in the area and asking about their services and experience with postpartum women.

  • MotherTend's Postpartum Functional Fitness Service! Now that you know a little more about my background in fitness and my journey to functional postpartum wellness, I'd like to introduce a service that is new to MotherTend: Postpartum Function Fitness. This service is part of the general postpartum doula package, but can also be utilized separately. During these visits, I will go through all the exercises with you to ensure that they are being done correctly, help you progress to more advanced exercises, and retest your function as we go. Let me help you achieve a full postpartum recovery!

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Baby Carrier Reviews

April 8, 2016

Baby Carrier Reviews

Overwhelmed by all the babywearing options out there? MotherTend is here to help you decide on the best carrier for your family.

I can always count on my expectant parent friends for great blog topics. A mom-to-be from my home town recently asked me to recommend a carrier that is "easy" and "breathable." I don't think she was quite anticipating the length of my response, but it's difficult to be concise when there are so many carriers out there! Finding the right carrier can be a real challenge; unlike most baby items, one cannot simply pop on Amazon.com and look at reviews, not only because it's so person-specific, but also because many of them aren't sold at larger retailers. While of course the best way to find the right carrier is to try a bunch of different ones, the reality is that they can be really expensive and Babywearing groups with large lending libraries don't exist everywhere. If you can find a babywearing group close by, definitely try it out, even if your little one is still cooking. They often have weighted dolls you can use, or another mom might be willing to lend you a real baby! YouTube is also a fantastic resource for tutorials and trouble shooting on basically any carrier out there.

To find a babywearing group near you, try Babywearing International's (BWI) website. BWI has a Boston chapter that meets in JP, Somerville, and Arlington once a month each. There is also a Merrimack Valley group serving Northern MA and Southern NH. Of course, Facebook can be a great resource for all kinds of mom groups, including babywearing groups such as North Shore Babywearing and Hike It Baby North Shore MA.

All of that said, I am also more than happy to share my opinions on some of the baby carrier options. Please remember that carrier comfort and ease of use can depend on numerous factors, including age of the baby (weight, head control), physical limitations of mom and/or baby, season of the year, practice and skill, and sometimes just plain luck! So I do apologize in advance to anyone offended by my disdain for ring slings and Baby Bjorns.

Speak of the Devil, Baby Bjorn (and other narrow crotch/low hanging/forward facing carriers): Ouch! I'm not here to tell you that wearing a baby in a "crotch dangler" carrier will cause hip dysplasia, although it can exacerbate it in babies prone to that issue, so best to check with your pediatrician. For more info on that contentious topic, click here. My issue with these carriers is more the fact that the straps are not very supportive and the carriers tend to hold baby further away from your body than some of the more snugly carriers. These two factors combine to take quite a toll on the care giver's back. Additionally, younger babies tend to become overstimulated easily when forward facing, causing them to fall asleep in a very unsupported position. Think limbs flopping every which way, which isn't comfortable for either of you! If you are looking for a more supportive, but still easy to use, carrier, look no further than the...

Ergo: Probably the most common carrier in the US. It's a soft structured buckle carrier, which are very easy to use. Relatively breathable, but for an infant, you have to use the infant insert. It pretty much looks like a sleeping bag, so if you plan on wearing your baby from the get-go, this might not be the best choice. Be on the look out for "too good to be true" deals on Ergos, as I have heard rumors of a large number of fakes hitting the market. I'm not the type to care about knock-off brands with most things, but when it comes to carriers, you do not want to take chances. Some of these look-a-likes have had issues with buckles breaking and torn fabric, which is certainly not something you want to have happen while your baby is in it.

Ergo

Tula: Similar to the Ergo, a tiny bit more expensive, but for good reason... they have way more fun prints and best of all, the infant insert is way less intense and stifling.

Note that with both the Ergo and the Tula, an alternative to the infant inserts would be rolling up a blanket carefully under baby's bum from knee to knee, as well as to prop baby's neck and head (and anywhere else baby needs more support-- she should be propped so that her chin is not resting on her chest, in order to ensure a clear airway). This option would save you some $$ and also be more breathable for summer


Infantino Mei Tai: This was one of the first carriers I used and I loved it. Biggest pro is it's $25-30 at Target! It's also super versatile and far more adjustable than a buckled carrier. You can roll it over once at the waist and/or cinch it width-wise with a hair tie to fit a newborn. You can do front, back, or hip carries (I found hip carriers a little awkward, but it can be done). They are great for nursing in-- just untie the top straps and shimmy baby down and a little to the side. The down side is that it takes a little more practice to figure out than the buckle carriers because there's a specific way to wrap the straps. There are also other brands of mei tai's that are more cushioned and comfy, but definitely with a heftier price tag. I have a TopaTop Mei Tai that I am 100% in love with and they can be comparable to or slightly cheaper than the Ergo/Tula depending on the type of wrap they're converted from.

Ring slings: Very adjustable, requires no insert for newborn, super breathable, and some people say "easy" to put on, adjust, and nurse in. I actually had a VERY hard time figuring out how to get baby R in there without feeling like she was going to fall out the bottom and an even harder time figuring out how to get anything done with one arm essentially strapped to my side. Some people love them, but after trying a couple different ones, I came to terms with the fact that I had better things to do than readjust a carrier 45 times while taking the dog out or doing a load of laundry (which is impossible with stacked washer/dryer because your arm is STUCK TO YOUR SIDE!

lella

Woven wraps: There are a MILLION different types-- different prints, weaves, fabric types, thicknesses, lengths... they are definitely the Pandora's box of carriers. They require a lot more skill and work to use, but they're also incredibly comfortable once you find a carry you like (carry just refers to how you wrap it). You can do front, back, and hip carries, and there are probably hundreds of different ways to do them. They can range anywhere from $100-$1,500 (I'm not kidding... people pay that much for a piece of fabric) and people get really into buying and selling them in various Facebook groups (caution: it's extremely addicting!). I do have one wrap that I love and it is definitely the snuggest fitting and coziest carrier I've tried, just because you can cinch it in super close. They have serious sleepy dust, but require a lot of practice. I suggest only trying this if you have a babywearing group close by to help you learn and trouble shoot.

wrap

Baby K'Tan: They seem like a good idea and at first you'll think "oh this is nice," but 2 minutes later the fabric will stretch out and your baby will be flopping everywhere and you'll be like whyyyy?! Also they're surprisingly hot for two pieces of fabric. *Note that some people do love these and if you insist on going there, please buy a size smaller than you think you need!*

Last one... Moby wrap: Everyone gets these. Pros are they are very soft and snuggly, and you can wrap it before you put the baby in, which is definitely easier than woven wraps, which you generally have to wrap around the baby, requiring some octopus arm action. Cons are that they are stretchy and thus can really only accommodate babies until about 3 or 4 months. Their website says 35 pounds, which is about the weight of a 3 year old. That's a bunch of bologna. Could you put a 3 year old in one without it ripping? Probably. Would it be comfortable? Probably not. Also, they are stupidly hot. I think I got to use mine twice before the June temps were too high; it's like wrapping 4 vests around you.

Welcome to the overwhelming world of parenting choices! In conclusion, my personal suggestion would be to go with a Tula (if you prefer ease over comfort) or TopaTop mei tai (if you prefer comfort over ease). For more budget minded mamas (and papas), go for the Infantino mei tai. Even if you are not on a tight budget, get one anyway since you can roll it up and shove it in your diaper bag or glove box for emergencies! Ergo would be a close second choice to the Tula and you are likely to be able to find one used locally. 

A couple other seasonal tips...
Summer: no matter what you use for a carrier, newborns are floppy and hot as heck. It's like strapping a heat pack to you. I found that higher cut cotton shirts helped because then at least baby's face isn't directly lying on your skin-- cuts back on heat transfer and also heat rash on baby's cheeks.
Winter: If you plan on wearing through the winter, I cannot recommend Suse's Kinder Coats highly enough. You can get the basic kinder coat "like new" for $100. It accommodates front and back carries (the deluxe version also does hip carries), is incredibly warm and comfortable, and the liner unzips from the shell, so it's basically three coats in one-- winter, spring fleece, and rain coat. The front panel that zips in for front carries could also be used as a maternity option. I will say that they are not the most stylish apparel, but when you have a cute baby head poking out of your jacket, no one will notice!

Finally, for tips on baby wearing safely, check out Baby Gear Lab's Best Practice Tips for Baby Wearing.

Update: If you want to wear your baby comfortably, no matter what carrier you have, it is imperative to have proper posture and a well functioning core/pelvic floor! For more on how to achieve comfortable postpartum posture, see Postpartum Pain & Incontinence Part 1.

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Boogie Sucking: A Tutorial

Feb. 11, 2016

Boogie Sucking Tutorial

Afraid to use saline drops and the NoseFrida for the first time? MotherTend has you covered with this step-by-step. "My advice: Be quick and don't hold back. My friend who met a NoseFrida distributor at a parenting conference was assured that you cannot, in fact, suck a child's brain out through her nose with this thing."

A friend recently asked me if there is a "wrong way" to use saline drops and a snot sucker. As a veteran mom, I can tell you it's actually pretty straight forward and learning the technique is a necessity if your baby gets a cold in the early months. Newborn infants actually physically cannot breathe out of their mouths until about age 3 or 4 months and even after that, it may still be necessary to clear their nostrils in order to breastfeed or bottle feed, or to help them sleep. Or if your kid looks disgusting (albeit adorably disgusting) and you just can't take it anymore, like this:

Booger face

The NoseFrida is a fantastic invention with a hilariously inaccurate photo on the cover of a baby happily having a tiny vacuum shoved up his nose. You can, of course, read the instructions for use on the NoseFrida website (http://fridababy.com/product/nosefrida/). While their instructions explain how to put it together and theoretically how to use it, they fail to make mention of how you're supposed "place large tube against child's nostril (not inside) to create a seal" while said child is wildly flailing in a fit of hysteria. That's why I created this step-by-step process-- for those of us with fewer than four arms. I do include instructions for using saline drops first, since in my experience, it drastically increases the effectiveness of the NoseFrida (or any model of boogie sucker).

NoseFrida

Step 1: Straddle your child with her arms straight down by her sides and use your knees to pin her arms there. That way you have two hands free: one to hold her head still, the other to hold the drops, whilst feeling like the most loving, gentle parent ever.

Step 2: Guaranteed to make you worry that your neighbors will call CPS. Put the saline nozzle in the entrance to her nostril and squeeze a few times to get some in there whilst listening to her blood-curdling scream. 

Step 3: Try to get her to stay lying on her back like that for at least 15 seconds while she screams some more. This is not a time for your typical calming distractions; it's time to bring out the big guns. I'm talking yelling and clapping enthusiastically, and generally trying to look like a lunatic, in order to distract the baby as long as possible.

Step 4: Now that you have the human straight-jacket technique down, you can go ahead and follow FridaBaby's instructions to set up the NoseFrida. My advice: Be quick and don't hold back. My friend who met a NoseFrida distributor at a parenting conference was assured that you cannot, in fact, suck a child's brain out through her nose with this thing. 

Step 5: Apologize profusely to your child while simultaneously marveling at just how much snot was inside that tiny head. As soon as you're done taking photos of it to text to your friends and family, nurse the infant as a reward for surviving a horrible part of childhood. When she's done nursing, pour yourself a glass of wine for surviving a horrible part of parenting [I originally wrote "pour yourself a bottle of wine," which may have been a Freudian slip]. The good news is that this process almost always results in a fantastically long nap due to exhaustion from the physical and mental struggle... possibly for both parties involved.


Sleeping

There's tea in that mug, I swear.

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An unexpected twist: A postpartum professional with postpartum depression

Jan. 19, 2016

Postpartum Depression: My experience

As someone with a Master's degree in maternal and child health, a lactation counseling certification, and experience with serving new mothers, I thought I had maternal care figured out. Then I underwent a training in recognizing the symptoms of postpartum mood disorders and it all started to sound eerily familiar....

As someone with a Master's degree in maternal and child health, a lactation counseling certification, and experience with serving new mothers, I thought I had maternal care figured out. Then I underwent a training in recognizing the symptoms of postpartum mood disorders and it all started to sound eerily familiar.... 

I had experienced depression before. It came and went while I studied Exercise Science at Ithaca College, always becoming acutely more evident during the cold, windy, gray winter months in upstate NY. The worst was the year I lived in The Netherlands with my partner while he did his postdoc. I was socially isolated, employed very part-time at a job that made me feel undervalued, and I think we experienced about eight days of sun during that entire year. It felt exactly like you might have heard it described: a downward spiral. I would start to feel a little down, a little restless, and that feeling would intensify. As it worsened, I found myself withdrawing and refusing to leave the house. The isolation and lack of fresh air or sunlight would make it even worse, and I would curl up into a ball and sob. Sometimes crying helped relieve the feeling enough that I could get outside and snap out of it for a time.

Over time, I learned how to cope with the seasonal aspect of my depression. I made sure I got outside in as much daylight as possible during the winter. Meeting my partner helped, too; the calm of a solid, consistent, loving relationship grounded me. We enjoy similar outdoor activities, so my exercise became more consistent, as did healthy eating. I still experienced bad days here and there, as we all do, but they were infrequent and not as intense as they had been in the past.

Fast forward to the summer of 2013, between semesters of grad school. I had just had a baby and I was unbelievably overjoyed. I couldn't stop looking at her. My neck ached from hours of breastfeeding because I always had my neck craned to study that beautiful, chubby little face, those dimpled fingers, those amazingly minuscule toes. My partner was impressively helpful, cooking, bringing me food, and helping around the house. I knew logically that he was doing his best to care for us, but somehow I found myself becoming increasingly irritated with him. Don't even get me started on our poor dog, who I used to call my "baby"; one of the first two-word sentences my daughter learned was "MOO dog!" ("move dog!"). I had read from blogs and books that the first year with a new baby is a real test on relationships, so I assumed that it would improve soon.

newmama_resize.jpg

Some days I felt paralyzed by exhaustion and anxiety. Usually I "hit the wall," as I referred to it to my husband, around 3 or 4pm. Other days it was more like noon. Those were the days when I would only leave the house as necessary to walk the dog and then I would find myself racing back home, hoping I wouldn't run into neighbors and have to chitchat while my heart raced and my skin crawled. I had many moment so joy as I watched my daughter learn new skills and snuggled her as she fell asleep at the breast. Those moments helped to balance out the exhaustion and remind me how much I love to be a mom. It really wasn't all bad-- I was so grateful to have my wonderful child-- but it was just so darn HARD. I never once thought that I had posptartum depression because I wasn't sad. It felt nothing like my experience of depression in the past. Eventually these feelings just became the new normal and on the really bad days, I chalked it up to sleep deprivation.

A few months after my daughter turned two, we moved out of the city (Boston) and into a smaller town on the North Shore (Ipswich). The calmer pace of a more rural neighborhood helped a lot. I didn't have to worry as much about my daughter getting hit by a car or listen to angry people laying on their car horns. I was able to get outside more and exercise more consistently. Slowly, I started to feel as though a fog was lifting. As the "skies" cleared, that was when I knew that my postpartum experience was not what it should have been. I really did not need to suffer the way I did and I wished I had sought help sooner.

Women need to know that postpartum mood disorders can look very different to different people. Postpartum depression can also look different than general depression. If your life feels unbearably difficult on a regular basis, don't suffer through it. Don't be afraid to seek help. And please, please, please, don't feel like less of a person, less of a mother, for feeling the way you do. I was silent for a long time because I worried that admitting to having a postpartum mood disorder somehow compromised my credibility as a postpartum professional. But what better person to help support new mothers' emotional health than someone who has gone through it? Who better to challenge the stigma of perinatal mental health issues than a perinatal professional? This is why I refuse to be silent about my experience.

It is estimated that as many as 1 in 5 new mothers experience a postpartum mood disorder. It is the most common complication in new mothers. It's time to break the silence. It's time to challenge the stigma. 

For more information on postpartum mood disorders, please visit the following resources:

  • Massachusetts Postpartum Support International WARMLINE: (866) 472-1897

If you are experiencing a mental health emergency, please call the MA Emergency Services Program: (877) 382-1609

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