Today is Labor Day. So, I decided to write about labor and postpartum. Most of the times women ask me or think that all the complications or changes in the bladder, bowel, or pain are normal. As we have been told for generations, by Moms, grandmas, friends that incontinence, pain with intercourse, prolapse, back pain is normal after pregnancy and delivery because most of them have experienced or is experiencing one or the other. So, what do you think? Is it normal to live that way? Is it okay to link all of the above to the most rewarding labor in your life.? Do we decide to live with it?
The answer is NO!!! All of the above is not NORMAL but is very common.
Stages of labor during Vaginal Birth:
First: Begins with the onset of regular contractions and ends with complete dilation of the cervix. Usually lasts between 12-19 hours.
Second: Begins with complete dilation and ends with the delivery of the baby. Lasts 20 mins to 2 hours. The baby descends to the pelvic floor, crowning occurs.
Third: Placental stage: Delivery of baby to expulsion of the placenta. Lasts 5 to 30 mins to avoid cervical closure and increased risk of hemorrhage and placental retention
Fourth: Mother’s Physiological adjustment to the pregnancy and birth. Lasts 1-4 hour after delivery. The mother experiences intermittent uterine contractions for up to 48 hours, oxytocin is released during breastfeeding, and may increase contractions. Pain relief is important so milk ejection reflex can take place
The surgical procedure is used to deliver the baby through an incision in the abdomen and uterus.
Two types of incisions :
- Vertical: Only done in a dire emergency. Quicker to perform, better visualization of the uterus.easily visible when healed, It has a greater risk of hernia formation.
2. Pfannenstiel: Commonly used. Less visible when healed, less chance of hernia.
Recovery stage: Anesthesia has to wear down. The mother needs to perform slow transfers. Pain management is important to help recovery. The abdominal muscles are lengthened as the abdominal wall has an incision. Physical Therapy plays an important role after C-section.
A cut is given in the perineum that extends through skin and muscle. Injury to tissue may have long-standing implications. Healing occurs by scar tissue formation.
During labor, the mother can experience injuries like joint compression, lengthening of ligaments, scar tissue, muscle injury, fracture, nerve compression, back pain, sacroiliac dysfunction, etc.
It is very important to take into consideration the psychosocial factor. The mother as one through a lot of changes physically and physiologically. Most common are PTSD and postpartum depression or anxiety. She needs a lot of support and help. Letting the physician know is very important.
Birth to three months: It is important to screen for anxiety depression as she is making adjustments to the new life postpartum pain, breastfeeding challenges hormonal changes.
Common Complications after labor and delivery:
- Breast Mastitis: It is inflammation with or without infection. Common in 2nd and 3rd-week postpartum Treatment includes antibiotics, continue breastfeeding, and pumping. Heat, ice, support, analgesics help.
- Blocked milk duct: Edema, tenderness, hard lump, painful lump, and redness. Physical therapy can help.
- Diastasis recti: It is partial or complete separation of the rectus abdomen(the sic pack muscle) which meets at the midline of the stomach It is very common. 66% have it during pregnancy, 53% postpartum, 36% persist at 7 weeks. Physical therapy plays a very important role.
- Abdomen trigger points: Can cause pain, dysfunction
- Abdomen scar: C-section sutures heal by scar tissue formation which can be painful. Complications include irritable bowel syndrome, constipation, and digestive problems, painful intercourse & bowel movements, infertility. Pelvic Physical therapists can help by releasing scar trissue.
Pelvic Girdle Pain and Dysfunction: 1 in 4 women develop chronic postpartum pain and dysfunction. The mother can have coccydynia, fracture, sacroiliac dysfunction, sciatica. It is important to get expert consultation sooner than later. The study showed an 80% success rate in pain management after Physical therapy.
Pelvic floor: The pelvic floor consists of superficial muscles: help maintain clitoral erection, closes vagina, urethra. Deep muscles: Support pelvis, organs, fix the trunk with UE movement
- Urinary incontinence: This can be due to urgency, weakness. She can experience urinary retention.
- Bowel incontinence: Fecal incontinence or involuntary flatulence
- Supportive: Women can have prolapse postpartum secondary to weak pelvic floor muscles or decreased muscle coordination. It is characterized by a feeling of heaviness.
- Sexual pain: Many women experience pain with intercourse. This can be due to scar tissue formation or increase activity /tone of the pelvic floor muscles.
Pelvic floor Physical therapy plays an important role in the treatment of pelvic floor dysfunction. A study has shown pelvic physical therapy as the first-line of treatment for most pelvic floor disorders.