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Maternal Health Awareness at UPMC in South Central Pa.

Maternal wellness doesn't end after the baby is born. While it's critical to keep a woman healthy during her pregnancy, it is just as critical to ensure a new mom's physical and mental health after the baby arrives. Too often, the focus of care shifts to the infant when the mother is healing, exhausted, or suffering from anxiety or depression This poses a risk for the mother and her child.

One in five women experience mild sadness, tearfulness, and heightened emotions immediately after childbirth as a result of hormonal and physical changes. These are sometimes called the baby blues, and often go away on their own. Still, despite the fact some women eventually fall into a rhythm as a new mom, many need additional postpartum support.

Furthermore, despite the advances in medicine and medical technologies, according to the Centers for Disease Control, Pennsylvania ranks 21st in the nation in maternal death rates. This startling statistic has prompted action by establishing Maternal Health Awareness Day.

On Jan. 23, 2020, UPMC along with other health systems throughout the state will focus their attention on highlighting the problems women face as a result of pregnancy complications in addition to raising awareness about overall maternal health. Known as the "fourth trimester," medical professionals now recognize that these 12 weeks post-partum are equally as challenging and may leave new moms vulnerable in a different way.

A day to observe maternal health.

UPMC will use Maternal Health Awareness Day as a way to communicate to providers, staff, and the community the importance of the fourth trimester in order to reduce maternal morbidity (disease) and mortality (death), while highlighting UPMC Pinnacle services and programs already addressing post-partum depression, hypertension, and diabetes management. In doing so, we expect to improve successful outcomes for those mothers delivering at our hospitals from the beginning of their pregnancy and beyond.

It’s no secret that pregnancy can bring its share of changes and challenges to a woman's body and emotional well-being during those three trimesters; however, the challenges do not end upon welcoming a newborn. Changes in sleep patterns, an influx of hormones, and recovering from childbirth can put new moms' health at risk.

The fourth trimester is the period when the risk of postpartum mood and anxiety disorders is highest, which coincides with moms going back to work, while caring for a newborn and perhaps older children and even aging parents. In all the excitement about the birth and focus on the new baby, the new mom often puts her own needs aside to care for her infant, which can have a negative impact on her mental health.

After a baby is born, many new moms may not realize that that they still need to focus on their own health in order to provide for their baby. We recommend the following tips for new moms:

  • See your health care provider for scheduled postpartum appointments, even if you feel well.
  • Ask your provider about any medical or emotional conditions that are expected to change during the postpartum period.
  • Talk with your provider about any current medications you are taking that may need to be adjusted. Never stop prescribed medication or begin a new one without consulting with your provider.

It’s not all in your head.

According to the American Psychological Association, roughly 14 percent of new mothers develop postpartum depression (PPD). Postpartum depression is characterized by persistent and often disabling symptoms of depression or anxiety in the first weeks or months after childbirth. Postpartum post-traumatic stress disorder (PTSD) is caused by a real or perceived trauma during delivery or after the baby is born. It has the same symptoms as PPD plus others, including flashbacks, avoidance, hyperstimulation, and functional impairment.

Symptoms of being overwhelmed, or not feeling like yourself, should never be ignored. Otherwise, they could intensify and cause more distress over a longer period of time. These issues can range from the baby blues to postpartum mood and anxiety disorders, such as PPD and postpartum PSTD.

It's important that new moms and family members are aware of the signs so immediate help is provided. The good news is that PPD is treatable and with the proper care, women can return to a healthier state of mind. Although obstetricians and pediatricians routinely screen for signs of PPD at the baby's first wellness visit and mother's postpartum checkup (usually about four to six weeks after delivery), women and their partners are strongly encouraged to keep an eye open for any sudden changes in a woman's physical or mental health. Skipping appointments or dismissing feelings of discomfort can lead to serious complications such as infections, incomplete healing, or a mental breakdown.

The common signs of PPD include persistent feelings of:

  • Hopelessness
  • Sadness
  • Anxiety
  • Not being engaged with the baby
  • Not taking care of herself, dressing, showering, etc.
  • Something that seems "off"

The physical changes continue beyond pregnancy.

Tremendous hormonal and physical changes occur during the fourth trimester just as it did during the first three trimesters. A woman's body is trying to get back to its pre-pregnancy state and healing from the delivery. Almost all moms have some degree of pain after giving birth, but remaining in pain is not normal. Mothers who deliver vaginally may have to deal with perineal issues, which can include an episiotomy, vaginal tearing, and/or hemorrhoids. Mothers who give birth by C-section will need to monitor the incision and follow lifting/moving limitations. Women should talk with their provider to find relief and ensure they are not pushing themselves too soon.

Additional physical issues associated with the fourth trimester include breast changes — nipple pain from adjusting to breastfeeding, and breast engorgement (if not nursing) — as well as postpartum blood loss, which can cause low blood pressure and exhaustion. Almost all new mothers report fatigue due to sleep deprivation and shortened sleep cycles as the result of night-time feedings. This is where a new mom’s partner or extended family members can support her to help relieve the exhaustion associated with breastfeeding and caring for a newborn.

If you experience any of the following, call your health care provider immediately:

  • Bleeding, soaking through one pad per hour, or blood clots the size of an egg or bigger
  • Incision not healing
  • Red or swollen leg that is painful or warm to touch
  • Temperature of 100.4 F or higher
  • Headache that does not get better, even after taking medicine, or a bad headache with vision changes

Women are advised to call 9-1-1 if they experience the following:

  • Pain in chest
  • Obstructed breathing or shortness of breath
  • Seizures
  • Thoughts of hurting yourself or your baby
  • Woman In Doctors Office

If you are having difficulties during your fourth trimester or want to simply be reassured about your healing process and feelings, talk to your doctor. Just as you would err on the side of caution when it comes to your newborn, the same philosophy applies to new moms. Maintaining ongoing communication with your provider enables you to get in front of issues sooner so that you can enjoy your baby and feel good.

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