POSTPARTUM #1 - Understanding Postpartum - statistics

This is the part of my paper which dives into postpartum as per the data/statistical analysis. It essentially says that women in Australia and internationally. Feel they are left to figure it out in terms of caring for their babies after being constantly checked on and assessed through out pregnancy —

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According to the World Health Organisation (WHO) (2010), the postpartum period poses the most substantial risk to both mother and baby, but receives less attention from healthcare providers than pregnancy and childbirth. It is also acknowledged by WHO that major changes occur during this sensitive period, and these changes determine the well-being and potential for a healthy future, for both mother and baby. 

Women in a Western setting, tend to understand the importance of the postpartum period in terms of how overwhelmed and underprepared they can be (Martin et al, 2013). A prospective observational study of postpartum women in Australia identified that, women experience significant morbidity in the early weeks postpartum that can continue well into postpartum life. The extent of which may have been underestimated in previous research (Cooklin et al, 2015).

On the contrary, postpartum period care is something traditional Chinese culture sees as imperative for the health of baby and most importantly for the future health of the mother (Yeh, St John & Venturato, 2016). From a Traditional Chinese medicine (TCM) perspective, the first six weeks after the birth of baby is seen to be a woman’s most vulnerable time mentally, physically and emotionally and therefore a network of support is deemed essential (Allison, 2016; Ou, Greeven, & Belger, 2016). 

Statistics:
Postpartum period statistics 
Australian postpartum period statistics 
Per Humphrey et al (2015), maternal death review is one of the oldest forms of clinical care quality assurance. From the latest published statistics on postpartum maternal deaths (those within the first 42 days after birth) in Australia there were, 7.1 deaths per 100,000 women and 13.8 deaths per 100,000 for indigenous women. The leading cause of maternal death was due to psychosocial causes including suicide. Followed by obstetric haemorrhage, thromboembolism and hypertensive disorders. The leading cause of indirect maternal deaths was cardiovascular disease. 

According to the Australian Bureau of statistics compilation from 1999 to 2008, complications during labour and the postpartum period account for the most deaths related to pregnancy and childbirth (Australian Bureau of Statistics, 2018). 

International postpartum period statistics 
As reported by Rudman and Waldenstrom (2007), hospital postpartum period care in Sweden has been evaluated as consistently more negative than assessments of other prenatal care. This study underlined the need to discuss and specify the aims of the postpartum period and the ability to provide high-quality follow-up care after childbirth. This becomes more difficult as the length of hospital stay is reduced in combination with an increased demand of information and personalised care from the public.
The most recent report on maternal deaths in the United Kingdom (UK), (2010-12) demonstrated that 10.1 deaths per 100,000 live births occurred. The National Maternity and 

Perinatal Audit data presented, that 2.7% of women giving birth to a singleton, term baby will haemorrhage 1500ml of blood or more. (National Maternity and Perinatal Audit, 2017). Additional epidemiological research in the UK demonstrated that, for 2016-17 80% of women who birthed at 37weeks gestation or later had skin-to-skin contact with their baby within one hour of birth and 74% of babies received maternal or donor breast milk as their first feed. However, breastfeeding prevalence at six to eight weeks postpartum averaged 44.4% (NHS, 2017). 

In United States of America (USA) from 2006-2010 the pregnancy related mortality ratio was 16.0 deaths per 100,000 live births. Large disparities existed between different ethnic groups and age, as noted maternal-mortality rate increased with age. During this period haemorrhage related deaths were on the decline however cardiovascular and infection related deaths increased (Creanga et al, 2015). 

Per the Centre for Disease Control and Prevention (CDC), 83% of babies born in 2015 were breastfed at some point. Which is a 7% increase from 2009. However, by three months 47% were exclusively breastfed and only 25% by six months (CDC, 2018). 

Postpartum period clinical ailments 
One of the most common severe ailments affecting women, which can have detrimental effects on the health of a new mother and her baby during the postpartum period, includes postnatal depression (PND) (Buist et al, 2008; Khajehei & Doherty, 2017).
However, the most common ailments affecting women during the postpartum period include fatigue, back pain, breast-feeding dysfunction, urinary incontinence, bowel incontinence, constipation, hemorrhoids, sexual dysfunction, anemia, and perineal trauma (Cooklin et al, 2015; Khajehei & Doherty, 2017; Rouhi et al, 2016; Priddis et al 2013). The importance of understanding these morbidities is their persistence to recur during the first 18months postpartum and their potential to have long-term consequences on maternal health (Woolhouse et al, 2012) if not supported in a way that the mother feels nourished and held. 

For example PND, the most well-known ailment regarding the postpartum period that accounts for a large percentage of maternal deaths (Humphrey et al, 2015) may result in depressive symptoms recurring throughout the first year, of motherhood (Buist et al, 2008, Khajehei & Doherty, 2017). 

Postpartum period from a Western cultural perspective 
According to Martin et al (2013) Western mothers feel underprepared for the changes that occur in the postpartum period and see prenatal education as necessary, yet lacking.
The professional practical advices, emotional care and information regarding maternal health offered postpartum from midwives, is perceived as postive (Fenwick, 2010). However, with the average length of hospital stay postpartum in Australia, at 2.8 days in 2002, and on a consistent decline, the information that is needed regarding baby and self-care may be reduced. This inturn according to Weigers (2006) causes a reduction in new parent’s confidence, leaving new parents anxious and unsatisfied (Zadoroznyj et al, 2015). 

Furthermore, according to Martin et al (2013) postpartum period support to aid in recovery is deficient, and there is a perpetuating sense amongst mothers that once baby is born, you are left for six weeks to deal with everything on your own. 

Quality care affects Western women who birth in public and private hospitals, as stated by Zadoroznyj et al (2015), public birthing women in Queensland, Australia had issues with the quality of care and length of stay in the hospital. Whereas, private birthing women were concerned with the lack of discharge information. Additionally, both public and private birthing women were unhappy regarding their breastfeeding support. However, according to Bodribb et al (2015) public birthing mothers, have higher satisfaction rates regarding postpartum period support. 

What has shown promise is the importance of a trained health visitor within the first six to eight weeks postpartum, who identifies and delivers a psychologically informed session, with the emphasis on mother rather than baby (Dennis & Dowswell, 2013). However, the level of this care is highly variable.

The two week wait.

THROUGH HER LENS, IS A COLLECTION OF LIFE EXPERIENCES FROM THE PERSPECTIVE OF A TRADITIONAL CHINESE MEDICINE MASTERS PRACTITIONER, TRAINED YOGI AND TRUSTER OF NATURE

During the time that a couple is actively trying to conceive, there is roughly a two week wait between ovulation and a pregnancy test. This time is known to be anxiety filled, stressful and frustrating. In TCM we know how important it is to be calm, soft and relaxed.

To be in a relaxed state ensures that the egg and sperm, now an embryo, can gently be moved back down the fallopian tube by hair like cells, known as cilia. Cilia is hair like in its size and appearance but muscular in its action. These cilia, are essential in pushing the embryo into the uterus in order to have the chance to implant and begin the journey of growing into a baby.

Consider for a moment how your body responds to stress or anxiety. Instantly when you start to feel the initial discomfort your body starts to tighten, your breath becomes short and shallow, and your senses are heightened and wary. This sort of impact is not only going to slow the movements of the cilia but possibly constrict the fallopian tubes and the uterus itself.

Our bodies are marvellous things, they are capable of enduring incredible feats and making crucial decisions without any help from us. Consider breathing for example. During these 2 weeks the body is deciding whether there will be life or not. This is no task that should be taken lightly. A future generation lies on this decision. If there is great stresses in the environment the body would do well not to allow the opportunity for life to form.

In a TCM treatment during this period, we work to maintain a gentle flow of energy (qi) that keeps the whole mental, emotional and physical body in balance. It is, as always important to focus on trusting the work that you have done to prepare yourself for conception. As well as releasing expectations of anything that increases stress. An obvious dilemma, however one that will continue to serve you as a whole.

What can you do to help yourself soften during this period?

Other than ensuring adequate sleep, food and connected time. Connected time being time spent feeling loved and connected to loved ones; including your partner, your friends or even your pet. Other options include;

• Acupuncture: This treatment can offer space to feel calm and rested, as the qi is aligned to support relaxation and balance.

• Breath work: When thoughts and ideas create stress within your being, catch yourself and offer a ‘breather’. Take a deep breath in for the count of 4, hold the breath at the top for a moment or two, then release the breath until every last drop of air has been removed from your lungs. Repeat. Then repeat again, over and over, even incorporate a mantra of words during the hold like, ‘Trust the process’, ‘I accept the result’, ‘I am open’.

• Yoga: Movement with breath. Incorporating some yoga poses in the morning or evening with the mantra you created above can have profound impacts on the overall homeostasis of the body. An example of this would be to create a flow moving from child’s pose to cow pose on the inhale; to downward dog on the exhale; to cow pose on the inhale; through cat pose to child’s pose on the exhale. Repeat 5-10 times. Repeat whenever needed and available.

• Meditation: The next step from breath work. Meditation is the idea of creating a meditative state, one that comes more easily the more often you practice. I recommend starting with a guided meditation a wonderful option is Sarah Blondin, she has many great short and wonderful options that may serve you more directly or utilise the Headspace app, or potentially even starting on the 21 days of abundance journey with Deepak Chopra.

• Magnesium: Adding topical magnesium to the soles of your feet, lower back and belly before bed at night also helps to increase the re-uptake of magnesium lost during these heightened days. Magnesium is leached from the cells during times of heightened stress, and we should already be well aware that living in modern society pays dividends on our overall stress levels. There are some wonderful topical magnesium products available.

Although this time seems stressful and is full of uncertainty, it is amazing how simple techniques such as those above have exponential potential to make you feel supported and relaxed.

Actively trying

Through her lens, is a collection of life experiences from the perspective of a Traditional Chinese medicine masters practitioner, trained yogi and truster of nature

“I mentioned previously that if you arrive in the clinic hoping for a pregnancy next cycle, whilst currently living in the same suboptimal ebb and flow you have lived over the past 6-12 ‘not yet pregnant’ months you are mistaken. However, one thing I see to be true, once you and your partner commit to the right small changes, great results are quite quickly attained.”

I never noticed it before, but now I do see it. I am a bit of a try-hard or hard-tryer as I like to put it. Just ask anyone who has born witness to my singing. You see, I know I’m not the best sounding singer (contrary to what my mum used to have me believe) but I will gladly belt out a song usually with my own lyrics added for extra delight. I am not afraid of how it sounds, I am livened by how it feels. This is generally how I live and practice, unafraid by the sound livened by the feels, and I’m not mad about it.

So here is a real life lived story -

Here I was midway through my masters just about to move back to Australia after living overseas for 7 years. My partner and I were ready for the baby that we had been gently preparing for over the past 4-ish years. In my head we’d fall pregnant, I’d restart my business in Australia and he’d finish off his sporting career in Switzerland. 9 months later he’d come back, out would pop our baby and I’d finish off my thesis whilst on maternity leave.

If reading that didn’t make you wince, you may be where I was. This amount of pressure is what I now like to call insanity.

This luckily was not achieved.

Just the thought of writing a thesis whilst on maternity leave actually leaves me feeling physically ill, let alone a whole pregnancy without a partner. I do know a few women who have done this and kudos to her, she is powerful and deserves much more reverence.

So I had been trying hard, following my daily practices like my religion. Knowing everything about my cycle, seeing, feeling and sensing exactly when to have sex to make the baby and being very impatient as one cycle had now passed and my plan was not going to plan. I pondered why is it not happening right now? I had done all the preparation, we were ready (or so I thought).

Now, this is where everyone has different beliefs, for me, I trust in divine timing and what my partner believes because everything and I mean everything he wholeheartedly believes in, comes to fruition. So when he told me, “you are too stressed, there is too much going on for you with work, study, and moving, when you let go it will happen”.
I know that doesn’t sound like too much of a miracle statement, I mean I know it’s not, because I tell it to nearly every one of my baby-making patients. But, it holds a potent message many of us in the baby making mix find so hard to do, because when your baby clock rings it is ridiculously hard to stop the sound. No matter how many Gayatri mantra’s, downward dogs, beach walks, fresh lemon teas, acupuncture sessions or burnt incense. The baby clocks ring tone is loud. Even for a practitioner who lives and breathes the knowledge of the destructive power of stress, anxiety, worry, trauma, etc. I am not immune.

I needed to do my work.

For me, that was and often is to land, let go and trust.

By this stage my partner had left to finish his career and I was in Australia creating mine. I had re-created a business I had run in Sweden, again in Sydney, and although it gave me great joy and fulfilled me quite substantially the constant rummaging noise in my head was overwhelming. So I adjusted by reducing my own work to work out of Peakhurst Chinese medicine. This calmed things a lot, but I needed further adjustment, I managed to take another step back and began working at another clinic. Both of these jobs gave me much needed space to let go of the ins and outs of running a business and focus on being a practitioner.

I was also trying hard to start and finish my final Master’s thesis. This for me was a journey into the abyss and back. I only state this from my own personal experience but working and studying at the same time is hard. Work is difficult as it is busy, as a practitioner we work hard to fully engage whilst in the treatment room with each individual, to remember where you were last session, identify any changes and scope out how to proceed. It is a constant juggle as we float from room to room, however one that has become ingrained and feels sturdy and familiar. Studying however, keeps your mind in constant fluctuation. Learning, adapting, and changing minute by minute.

SIDE NOTE - For anyone considering doing their masters I highly recommend the challenge. There are generally two different types of masters one is based upon course work, similar to an undergraduate degree but with more rigour and the other is based upon course work plus a final dissertation or small research project. I would recommend anyone to do the former over the latter. I chose the latter and whilst it enriched my thinking and gave me new tools of understanding such as; how to set up and run a research project; how to read research papers and decipher what they actually found not just what they are telling you; the basic aspects of ensuring you are researching something ethical, where by the benefits out way the risks; to understand statistics and run qi square tests to statistically evaluate answers; to write tens of thousands of words and then form meaning from it all in a few sentences. It was tough.

Writing a thesis in eight months start to finish is difficult and exhausting, nonetheless incredible to do. To immerse yourself in a topic you feel incredibly passionate about, and at the end of it, to identify aspects that could potentially support women in their postpartum journey, was enriching for me.

And we’re back -

So as my partner returned to Australia and we worked on restarting our life as we had done in numerous cities many times before. I made more changes, I had already adjusted the way I worked, I increased the way I practiced my meditation after I saw its potency in more practice, I committed to physical exercise and ate well, never skipping meals because I was busy. I also needed to let go of aspects of my surroundings that weren’t serving me. For example changing certain relationships with people, places and old patterned thoughts. However, it was not until I landed and let go that it would all fall in to place.

Here is the kicker. In order to calm everything down to land and let go and allow space for a baby. I was trying to enforce a regime of rigorous focus, stick to strict deadlines, whilst also floating around in thousands of thoughts that was writing a thesis. The paradox of it all is comical at best and insanity at worst. This sort of paradox is common among women and their partners who arrive in the treatment room. As I have mentioned I was not immune nor was I accepting of the contradictory conundrum during this period of time. I had created small changes that would exponentially support me when I did finally master the last piece to my puzzle. This piece is different for everyone in every aspect of whatever it is you aim to achieve. I earnestly believe that the continual changes and adjustments built strong supports and the final puzzle piece, “to really land and let go” the key. Without the supports the key wouldn’t work, and without the key the supports would continue to support but may not give the desired outcome.

After numerous cycles to no avail “It will happen when you let go” his words started to ring louder than the baby clock alarm. Interestingly just as my partner had promised once the work was done. Baby did come.

Why Through Her Lens?

This blog is an expression of my masters study integrated with lived experience. It is the amalgamated form of pen to paper from three years of postgraduate study and my progression into motherhood.

I submitted my masters in late December 2018 and I took solace in knowing it was finished. I could breathe a little deeper and sleep a little longer once more, and that I did. After the exhaustion of thinking was doused with sleep, a new sort of exhaustion grew as I pondered the question where to from here? There was so much I had discovered and felt needed to be shared.

I considered writing a research paper presenting my findings (this I may still do, if relevant); I considered ridding myself of the hard drive with all my hours of effort on it and the word ‘however’ never to be seen again; I considered how I would take with me all the golden knowledge of these women and their experiences and what I would need to feel accomplished by it. It was at this point, when the exhaustion wouldn’t let up and I had started to feel warmer and a little queasy, that I realised I was pregnant.

Masters - ‘The reality and potential of Traditional Chinese medicine in postpartum period care in Sydney: A mixed method study'

This study investigated postpartum period through the lens of both TCM practitioners and postpartum women. In order to realise the reality and potential of Traditional Chinese medicine’s use within this time.

Masters Study: Historically the Chinese culture of close familial support and rest is advised by Traditional Chinese medicine (TCM) during the postpartum period (PPP). It is unknown to what extent TCM practitioners are offering PPP care nor what postpartum women are experiencing. The aim of the study was to identify what TCM practitioners offer and what women experience in PPP care in Sydney, Australia. A Mixed methods study design was used. Online surveys of TCM practitioners and postpartum women and semistructured interviews of postpartum women who identified themselves in the survey were conducted. The Survey data was collected and analysed using descriptive statistics. Semistructured interviews were audio recorded and transcribed. Thematic analysis was used to generate codes and themes.
37 TCM practitioners responded to a survey. 90.2% offered PPP care and of these 8.6% treated more than five postpartum women per month. The most common presenting ailments were sadness/depression and low milk supply. 74 women responded to the postpartum survey, 46% were unaware of TCM as a means of support. Furthermore, women over 35 reported increased physical ailments (p<0.05;p=0.03) and first time mothers expected their PPP to be easier than subsequent mothers (p<0.05;p=0.04). The overarching theme from the interviews included ‘Postpartum is intense’. Sub-themes were identified as ‘it only takes one person’, ‘it’s a bit of a blur’, ‘luck plays a role’, and ‘hard to express how hard it is’. These interviews indicated that postpartum women were underprepared and their positive experiences were based on `luck’ rather than proactivity. It also presented that women were interested in being supported through this time.
The conclusions drawn here contribute to providing TCM practitioners information about physical and emotional issues women experienced during their PPP. It highlighted that practitioners only treat a small number of PPP women and that few women are aware of TCM PPP care. Further research is needed.

A Practitioners journey into motherhood

I don’t know why I was so lucky to enter motherhood the way I did, but it seems I became more lucky as I focused more on doing what was necessary, the work. The work is tedious and as a practitioner trained to catch, find and knead out the pieces that have been missed; to trail through the stuff of people’s day to day lives to find the perils of their current situation and what is the best way forward. This work on myself became increasingly heavy. Peeling back the layers of knowledge became an essential past time. Every day can be challenging in its own way, but nothing is more challenging then not believing that you already have what you really need in this moment. This journey has taught me continuously to let go and trust. Trust yourself and it’s innate knowledge that has been built within you in perfect synchronicity and balance. Trust what you need to let go of or change perspective towards. Trust the process, as all is coming.