Postpartum Recovery & Complications

You can read about my recovery from Bella's birth here. 


General Postpartum Stuff
I only had a first degree tear this time which required a couple stitches. I say "only" because - hi, there was a 9+ lb baby that flew out my hoo-ha. Then again, a woman is apparently less likely to tear during subsequent births. And I shall now be done saying tear. [Shudder] Anyway, it all healed up a lot faster this time and things seemed normal-ish in the lady bits region by just a few days postpartum, which was so not the case last time. I remember being horribly afraid for the 6 week check-up because of the cervix check (or whatever it is they check at that appointment). I'm not worried this time. The pad-requiring bleeding tapered off within a week following the birth and since then it's been quite light if present at all. At this point I still have some days where I bleed a little (seems activity dependent), but most days it's at the point where I debate the need to wear a pantyliner. Lots more uterine cramping this time with breastfeeding during the first week, but that is normal. I took ibuprofen for it for several days and that did the trick. One thing that drove me crazy in those initial postpartum days was that the nausea & heartburn took about 3 days to go away. I felt so mad lying in my hospital bed and staring at the food menu and wanting exactly nothing on it. But my appetite has since returned and I haven't vomited in four whole weeks. WOO HOO!

For the rest of this post I'm going to issue a little disclaimer for those who are about to give birth and/or are currently in the middle of a hypnosis childbirth course. The complications that Oliver and I faced are not the norm and I don't want to be scaring anyone. So if you are sensitive to thinking "That could happen to me!" or if you are currently in the middle of HypnoBirthing or HypnoBabies - I'd say you can just skip this post all together. Keep it happy, yo!

The Hemorrhage & Subsequent Anemia
So I knew that a hemorrhage was a good possibility with Oliver's delivery since I had one (or a near-hemorrhage) with Bella. This was the number one reason why we went to the hospital early. Yes, delivering on the highway would be bad, but delivering on the highway and then hemorrhaging away from the hospital? Very, very bad. The bleeding began after I delivered the placenta, just like last time. This time the bleeding wasn't as emergent and there wasn't the sense of urgency to find the source of the bleed and stop it, but it was still quite concerning to the midwives and nurses.

The nurses thump hard on your stomach to contract your uterus and help it to stop bleeding after you give birth - they call it "uterine massage". Massage...HA!  Every time they "massaged me" (read: pummeled my stomach), I was passing huge clots and lots of blood.  Not such a big deal the first couple times, but when it kept happening again and again and again, well, then it was a problem. I was laying on one of those chucks absorbent pads and I had to lift my bum up using my legs bridge-style so they could change it. I remember feeling all strong and happy about how it was no problem-o the first couple times: I was totally strong enough to do that even right after birth! Hooray! I was going to be one of those mamas who can go run a mile the day after delivery! But by time 15? Yeah, weak city. I could barely lift myself. As the blood drained from me I could literally feel my energy and strength going with it. I was so bummed. I had hoped that it wouldn't happen again.

I got hooked up to IV pitocin (I guess I prefer my drugs after my drug-free birth?) and they put that cytotec stuff up my rectum again, but the latter was far less painful and bothersome this time than last time. Both of these drugs were used to encourage uterine cramping. The nurses continued to do a lot of super aggressive uterine massaging. My abs ended up quite bruised and it took three weeks to stop feeling sore.  I was also encouraged to empty my bladder like crazy as that also helps. Initially my body was feeling freaked out and I had trouble peeing, but eventually I was able to go. Thank god for that because it would have been catheter time, otherwise.

In the end, my hemoglobin dropped from my usual 13-something to 8-something. I was offered a transfusion, but decided to go with trying to get it up naturally through iron pills. I question this decision now, but whatever. Neither option was especially exciting.

There is no clear reason for why I hemorrhage with childbirth and apparently it's fairly unusual - I've seen stats around 5% of women. I googled to see if a c-section would prevent it should I get pregnant again, but nope - safest route is a med-free birth. And herein lies my biggest frustration with the hemorrhaging/anemia. I plan for and prepare myself for these med-free births and then I feel somewhat robbed of my post-birth high given how terrible lousy the hemorrhage makes me feel. Now, OF COURSE I am glad that in the end everything works out fine and it's great that I get the birth I wanted, but still. I wish I could have experienced that sweet and pleasant postpartum feeling for more than 2 minutes.

At four weeks postpartum, I'm feeling much better. I can walk a few blocks without thinking I'm going to faint and I can go up and down the stairs without huffing and puffing. I do feel like I'm behind where I should be in my recovery, not to mention that I feel like I've lost my normal muscle strength from not doing much activity, but it is what it is. Someday I'll get back to my normal level of activity and I hope this means I'll always appreciate being physically able to move without problems!

Should I get pregnant again, I fully expect I would hemorrhage again. Next time I would probably take the transfusion and ideally I would see if my mom and/or dad could donate blood for me ahead of time (both are O-type like me), so that I could use that. But the fact that I've hemorrhaged twice puts a big question mark in my mind about whether a third pregnancy would be a safe thing. Something to consider, for sure.

Oliver's Complications

Big Baby=Blood Sugar Issues
Did you know this? I had no idea that a bigger baby born to a mom without gestational diabetes would be at high risk for hypoglycemia (low blood sugar). It does makes sense when you think about it - the baby gets used to a steady amount of glucose via the placenta and then upon birth they get a lower amount via the colostrum. The first time they tested Oliver's blood sugar, he was just one point below normal. They protocol is to supplement with formula with any abnormal lab value. Since my colostrum was flowing and Oliver was already breastfeeding beautifully we asked to wait and let me feed him some more and just see what the next test was. The nurse (not the nice one who helped with the delivery) was all hem-haw, I don't know, I have to check with the pediatrician, but eventually they let us wait but with a lot of drama. The next test showed that Oliver  was slightly above the lowest acceptable level. Yay! However, then the next one after that he was down several points and that was after I had just fed him extra colostrum that I had expressed. Ugh. There simply wasn't enough glucose in my colostrum to support his big old baby body.

After talking it over with Husband (and my pediatrician Aunt and doctor Mom), we decided to proceed with supplementing formula to get his blood sugar up to normal, as it can be very dangerous to let it drop too low in newborns. My issue with supplementing was mostly messing up the gut flora (there are theories about breastfeeding's immune protection not being as great once you change gut flora with formula). Besides, it seemed really weird to supplement when my colostrum was abundant and he was breastfeeding just fine. However, I didn't see any other option since there wasn't a breastfeeding friend I could call to say - hey, can you bring some milk in? (Of course, upon looking it up on some breastfeeding websites, they were all  - there is no instance you would need to use formula in the case of low blood sugar. Oh boy. OF COURSE, things would have to be so polarized on this issue. Of course.) Once we supplemented we could see a clear difference in how Oliver was behaving - he was seemed more alert and was able to latch on and breastfeed even better. Supplementing with formula was the right decision.

This blood sugar checking went on through the day and night, before each feeding. This involved a heel stick. If the level was low they had to fill a small VIAL with blood by squeezing out drops from his foot in order to send it to the lab. This is absolute torture to witness and it sometimes took 15-20 minutes to get enough blood.  After his 7th or 8th heel stick and several vials of blood, they gave us the option to skip the tests if we agreed to supplement him after each feeding until my milk came in. After another debate of "What to do?" we opted to supplement each time and protect our poor boy's feet from getting poked again. We continued supplementing until Oliver was two days old and once my milk came in he didn't need it anymore. It has had zero effect on his ability to breastfeed.

Rh Incompatibility and Subsequent Jaundice in Oliver
Rh Incompatibility is a little complex, so if you want a detailed explanation go here. I'm going to give you the simplistic explanation. So I'm blood type O- and Husband is A+, which means that my body might recognize a baby with a positive Rh factor (Rh factor is the - or + part) as a foreign thing that needs to be attacked. This is not a problem with first babies, but can be very dangerous for the second baby. So I got Rhogam shots while pregnant with Bella and after delivering, and the same thing happened with Oliver (they are both A+). Now somehow something went wrong - either the Rhogam shots weren't strong enough or some other factor was at play, but my blood mixed with Oliver's either in utero or at birth and he developed something called hemolytic disease. Basically, my antibobodies got into his blood stream and saw his positive Rh factor as something to be attacked. This meant some of his red blood cells were destroyed, which leads to excess bilirubin and the jaundice. A secondary factor for his jaundice was all the bruising on his face from the fast birth.

In reading about hemolytic disease since his birth, I realize that we were lucky that Oliver simply developed jaundice and nothing horrible happened, like stillbirth. There was briefly talk of him needing a transfusion (what's with us and transfusions?!), but in the end that wasn't necessary. To treat the jaundice he needed to be exposed to a phototherapy light ("bili-bed") for as many hours a day as possible.

Oliver's bilibed set up in the co-sleeper

I was really glad we could do the bili-bed at home, but, man, it was not fun. The only thing you want to do is hold your newborn, but the treatment has you putting the baby on the bili-bed pretty much anytime you aren't changing or feeding him. It didn't really feel natural and made us feel disconnected. Plus, he didn't sleep so well on it. But it worked and 5 or 6 days later he was off the bed. One thing that helped was that my milk can in and he was drinking & pooping like crazy (the excess bilirubin is removed in stool).

I need to find out more information, but I believe this Rh incompatibility will get even more dangerous with subsequent pregnancies. And this is major reason #2 why I'm not sure that we should have any more babies. I don't know if the risk is worth it. Certainly I would have a lot of anxiety during that pregnancy knowing the potential for miscarriage and stillbirth.

Thrush
And now that brings us to our current problem: thrush.  Not exactly a postpartum issue, but the anemia and my compromised immune system likely played a role. You can kind of see why the thrush was the straw that broke the camel's back for me in terms of being able to manage and deal with things. I'm feeling quite a bit better, but I still have some pain and Oliver still has signs of thrush in his mouth. I need to make calls tomorrow to ask for another type of treatment. I could go on for 12 years about why this thrush is so hard and give you details on how time consuming it is and how conflicting all the information can be, but that's boring. I'm having a really hard time with dealing with it right now - I don't just feel like I'm in over my head, I feel like I'm 20 leagues under the sea. Not sure if it's just because it's legitimately overwhelming, especially with a toddler, or if I'm going through some baby blues stuff. Both probably? I do know I can't wait for the day when I can stop all these extra treatment steps & precautions.


In the end, nothing that bad happened. We have a healthy baby and a (close-to) healthy mama. There was no NICU time. We were still able to leave the hospital 28 hours after arriving. We were able to do many of our treatments at home and had the luxury of home health nurse visits. I have had a ton of family help. I'm really grateful for those things and I try to remind myself of them every time I find myself feeling like everything is so hard (which is approx every 30 minutes these days). So even though things weren't - and aren't - exactly smooth sailing in the postpartum period, we're OK. The important stuff is all OK. I just need to write that on my arm to help me keep perspective...