Travel during pregnancy frequently comes up as a topic of conversation in my office. I once had a patient that was 24 weeks pregnant ask me if she could travel to Vegas for a few days, followed by Paris for a week and then spend a week in NYC prior to returning home to Florida, I said of course, but only if you take me with you! Other patients want to get in a Babymoon prior to delivery. Traveling during pregnancy, in general, is considered safe. However, there are some precautions to consider that you may not otherwise think about. If you are traveling while pregnant here are some suggestions to consider before leaving on your trip and while traveling:
- Avoid travel after 36 weeks (9 months). As your due-date nears, you want to stay close to your doctor and hospital because the onset of labor can be unpredictable.
- Get a copy of your prenatal records from your doctor before you leave. This will ensure that if an emergency arises and you need to be seen by another physician, he/she will be able to review your records and make better decisions about your care.
- Avoid sitting for long periods of time. This includes the plane, the car, the train, or the bus. If you are sitting for over 2 hours, then you need to get up and walk around for 5-10 minutes. Both pregnancy and sitting for long periods of time can increase your risk for developing clots in your legs (deep vein thrombosis or “DVT”). Walking around every 2 hours while traveling gets the blood in your legs moving and helps to prevent clots from forming.
- Drink plenty of water. It is very easy to get dehydrated during long trips, especially on a plane. Dehydration can cause uterine irritability and contractions. Keep a water bottle with you at all times and drink frequently.
- Consult with your doctor before leaving, if you plan on traveling out of the country. There may be additional recommendations to consider depending on the location you plan on traveling to.
- Women with complicated or “high risk” pregnancies should ALWAYS consult with their physician before making any travel plans.
Vaginal lacerations are extremely common during delivery. Not to be graphic, but you did just fit a cantaloupe through a hole the size of a tennis ball. Fortunately, the vaginal tissue is forgiving and stretches significantly during the vaginal birthing process. However, the vagina still does tear. There are four main categories of tears that occur during delivery based on the depth of the tear: first-degree laceration, second-degree laceration, third-degree laceration, and fourth-degree laceration. First and second-degree vaginal lacerations are the most common tears that occur during a vaginal delivery. Third-degree vaginal lacerations are less common, and fourth-degree vaginal lacerations are the least common of the types of tears; only occurring in about 1-2% of non-instrumented (forceps or vacuum) vaginal births. Unfortunately there is no fail proof way to prevent vaginal tearing. Most of it is dependent on your anatomy, the size of the baby, length of labor and use of instruments to aid in delivery (forceps or a vacuum).
First-degree lacerations are the most shallow of the four types of tears involving the outer most surface layer of vaginal tissue. First-degree tears usually heal quickly without complication. In general, first-degree tears will require some stitches to repair the tissue so that it heals correctly. Your physician or midwife places those stitches immediately after delivery. The stitches will dissolve in 6-8 weeks.
Second-degree lacerations involve slightly more tissue than the first degree, but only involve vaginal tissue and do not extend any deeper. Just like first-degree tears, second-degree tears heal quickly without any major complications. Stitches are required to bring the vaginal tissue back together to allow for healing. The stitches will dissolve in 6-8 weeks.
Third-degree vaginal lacerations involve the vaginal tissue and the anal sphincter, which is the ring of muscle that prevents you from leaking stool. These tears require stitches to repair the muscle as well as the vaginal tissue. The stitches will dissolve in 6-8 weeks. These tears have a higher risk of poor healing. Women with third degree vaginal tears can experience incontinence of stool and flatus (uncontrolled passing of stool and gas) even after repair. Many women will require pelvic floor physical therapy and a few women will require additional surgery in the future.
Fourth-degree vaginal lacerations involve the vaginal tissue, the anal sphincter and the rectum. These tears require a great deal of stitches to repair all of the torn tissue. These tears often do not heal well. Women who have fourth-degree tears are at high risk of developing a fistula (connection) between the vagina and the rectum. It is common after a fourth degree laceration to have incontinence of stool and flatus. Frequently these tears require multiple surgeries after delivery to correct the injury. Women with fourth degree tears will need pelvic floor physical therapy.
Preeclampsia is generally thought of as a complication diagnosed during pregnancy. However, preeclampsia can occur after pregnancy too. Preeclampsia during the fourth trimester can be devastating because it is often overlooked and under diagnosed. Preeclampsia (whether it is diagnosed during pregnancy or postpartum) puts women at risk for seizures, strokes, liver damage, kidney damage and even death. It is imperative for all women to be aware of the signs and symptoms of preeclampsia so that they can seek help immediately.
Here are signs and symptoms you need to look for after delivery:
- Unrelenting headache that is not relieved with Tylenol or ibuprofen.
- High blood pressures. Your blood pressure is considered high when the top number is 140 or higher and/or the bottom number is 90 or higher. If you don’t have a blood pressure cuff at home, you can check your blood pressure at a drug store, grocery store, or local fire station.
- Right upper quadrant abdominal pain. Pain whether it is sharp, gnawing or burning pain in the right upper abdomen, just under the right rib cage.
- Intractable nausea/vomiting.
- Visual disturbances such as difficulty seeing in all visual fields, or experiencing “squiggly lines” in your visual field.
- Chest pain and/or shortness of breath.
If you experience any one of these signs/symptoms listed above, you need to be evaluated by your physician. Contact your physician immediately, these symptoms cannot wait until tomorrow. If your physician is unable to see you, then you should go to the hospital for evaluation.
Gestational diabetes is a change in how your body manages sugar during pregnancy. It is diagnosed by a blood test drawn after drinking a sugar loaded drink at around 26-28 weeks pregnant. Gestational diabetes can either be diet controlled or require medications to control blood sugar levels during pregnancy. Women who are diagnosed with gestational diabetes, particularly gestational diabetes requiring medications to control blood sugar levels during pregnancy are at a higher risk for developing diabetes later in life.
If you were diagnosed with gestational diabetes while you were pregnant here are a few things you need to consider after delivery:
- You should have a diabetes-screening test performed after your six week postpartum visit with your obstetrician.
- Start exercising. Thirty to forty minutes of aerobic activity at least 5 days a week has been shown to reduce the risk of obesity and diabetes. Brisk walking is a fantastic choice for the postpartum momma. Walking is low impact, free, and easy to do in the company of your baby.
- Practice mindful eating to avoid over eating. Pay attention to your food when you are eating. Avoid eating while chatting with friends, watching TV or reading.
- Drink water. Avoid excessive sugar in sodas, sports drinks and fruit juices. Try flavoring your water with cucumbers, lemon, lime, or other fruits using a diffuser or just cut them up and put them directly in your water.
- Reach for fruit when you need a quick snack. Apples and bananas are easy to eat one handed and are not super messy.
- Eat your veggies. Fill most of your dinner plate with veggies instead of bread and pastas.
- Avoid eating foods that come out of a bag or box. These foods are usually high in sugar.
Small changes now could make a huge impact on your health in the future. In addition, you are teaching your children how to eat properly. They learn many of their habits by mimicking you. So improving your eating and exercise habits now will not only benefit you but also your children. Postpartum is the perfect time to take control of your health!
Cesarean sections are the most commonly performed abdominal surgery in the United States. Approximately 30% of all deliveries are cesarean sections. A majority of cesarean sections are performed due to complications of the labor process. Only about 1% of cesarean sections are elective. In my experience with my patients as well as being a patient recovering from a cesarean section, it is commonly forgotten that a cesarean section is major abdominal surgery. Here are five important things to keep in mind when recovering from a cesarean section:
- Time. I thought I would be able to hop right up and start back into my normal routine within two weeks of surgery. Ummm…that was a big fat NO. I have seen some patients be able to do this and I credit these ladies for their strength, incredible pain tolerance and faster than normal healing process. However, this is very rare and you should not compare your experience to anyone else’s because it can vary so widely. Most of us will need good old fashion time. Remember to give yourself time to recover. Six weeks is the minimum amount of time to allow for healing prior to returning to full activity. Now, of course, light activity is encouraged immediately after surgery, as tolerated. My rule of thumb is: if it hurts don’t do it. The first 6-8 weeks after a cesarean section is not the time to push your body. Do not push past the warning signs. At the least be sure to give yourself a full 6 weeks to recover after your cesarean section.
- Patience. I found this one difficult too. If you are normally a very active person, recovery from a cesarean section can be frustrating at times. Pain and fatigue will limit your activity for the first 4-6 weeks and even longer. I found that I wasn’t able to run normally without pain for about 12 weeks. Have patience to give your-self the time to recover. I think I was afraid that the first 4-6 weeks after delivery were the new norm, so I tried to push myself, which always ended in frustration resulting in impatience with everyone around me to include myself. If you are patient, nine times out of ten your body will return to its pre-pregnancy state. The pain will resolve, the swelling will resolve, the fatigue will resolve.
- Help. You need help. You can’t recover from a cesarean section and take care of your new baby all by yourself. The more help you can enlist, the better. You will need help with routine chores (ie washing clothes, vacuuming, mopping floors, cooking dinner, etc) for at least the first two weeks after delivery, but potentially longer depending on how you feel. Do not feel guilty asking for help. Help does not mean you are an incapable momma.
- Sleep. Hahaha, yah, I know sleep and newborn are an oxymoron, but this is where help comes in. The adage of sleeping when baby sleeps cannot be overstated for women who have had a cesarean section. During the first 4-6 weeks postpartum the household chores can be completed by helpers (family, friends, or paid professionals). The most important activities for you during the first 4-6 weeks after your cesarean section are feeding baby, bonding with baby and sleeping. When you are breast-feeding, sleep is definitely a commodity because unless you are pumping, no one else can help you feed the baby in the middle of the night so that you can sleep. You will have to remind yourself that every time baby naps, you should be napping as well, day or night. Do not underestimate the importance of sleep. During the time you are sleeping, your body is healing itself. Sleep deprived individuals do not heal as well and are at risk for both physical and mental illness. Even though it may feel like ground hog’s day for a month or so, getting good sleep in the first 4-6 weeks after your surgery will set you up for a healthier postpartum period.
- Pain relievers. I have not encountered a patient (myself included) who was able to tolerate the postoperative pain of a cesarean section without some kind of pain medication. Some women are able to tolerate the pain with ibuprofen and Tylenol, and that is fantastic as long as the pain is managed well enough that you are able to get out of bed and perform activities of daily living (i.e. get dressed, move around the house, fix a meal, sit on the toilet, etc) without agonizing pain. A majority of women will require some sort of narcotic containing pain medication for the first 3 to 5 days after their cesarean section. It is ideal to take the lowest effective dose of narcotics to control pain and to wean off narcotics within 5-7 days after surgery. You should be able to control postoperative pain with ibuprofen and Tylenol by 5-7 days after surgery.
Looking back on my postpartum experience, I have to say one of the most painful experiences I had was breast engorgement the day my breast milk came in. As I recall, my milk came in about 4 days after delivery. I had already been discharged from the hospital and had no idea what had hit me! I know, I know, but you are an Ob/Gyn what do you mean you had no idea what hit you. Well, you don’t truly get it until you experience it yourself. No one tells you how painful it is! Even my patients! I have never had a patient describe to me the pain of breast engorgement. Over night, my breasts tripled in size and were rock-hard. I literally thought they were going to explode. Ugh, it was awful. I of course panicked. But before YOU panic, here are three simple measures you take at home to relieve breast engorgement:
- Take a warm shower and gently massage your breast to hand express milk. The key word is GENTLY. I wanted to wring my breast out to get the milk out as fast as possible and relieve the pressure. Not only did that attempt leave me in tears in the shower, it was also wildly unsuccessful. It just doesn’t work that way! Use both hands and start GENTLY massaging close to the chest wall and work your hands toward the nipple.
- Pump or feed every two hours. You can place a warm compress on your breast prior to breast feeding or pumping or take a warm shower just prior to feeding or pumping. If you are pumping, try to avoid pumping for more than 20-30 minutes. Place your pump on the highest setting that is comfortable for you. Check your pump parts to make sure your flanges are fitting correctly on your breast and that your membranes are correctly placed within the pump. Don’t forget to attach the bottles to the flanges! Yes, in a late night stupor I forgot to do that. Talk about crying over spilled milk! If you are breastfeeding, be sure that your little one is latching well, if you are experiencing trouble with latching contact a lactation consultant for hands on help.
- Ibuprofen 600mg – 800mg every 6-8 hours will decrease inflammation, as well as help manage some of the pain. Remember to avoid taking ibuprofen on an empty stomach.