Moved over to main website blog:Begin your pelvic floor rehab

Hi to all the wonderful families connecting with Doulacare Ireland. My name is Louise Murphy and I’m a doula and a physiotherapist specialising in pelvic health. 

With the current Covid19 emergency, I’m really conscious that many women in Ireland at the moment won’t have access to pelvic health physiotherapy. This is obviously particularly difficult if you have an acute issue like a large tear after your baby's birth or urinary or bowel leakage or urgency.

So I wanted to reach out to share some tips on how to manage these problems and begin your pelvic floor rehab. 

1. Try not to panic. Not getting to your physiotherapist immediately doesn’t mean that things will necessarily get worse or never improve. If you have a lot of urgency or urge incontinence (leaking as you rush to the toilet), going to the toilet regularly (about every 2 hours) is advisable. This makes sure that the bladder isn’t over filling and overflowing.

2. Keep any stitches dry and clean. Don’t apply anything to them except water. Rinse the area or sit in a shallow bath after using the toilet and gently pat the area dry.

3. For the dreaded bowel movements:

   1. Take advantage of the gastrocolic reflex. This reflex means you’re most likely to have a bowel movement if you go to the toilet half an hour after breakfast, regardless whether you feel an urge or not. Try to make this part of your routine.

   2. Take your time. We all know how it is with a new baby – we run into the bathroom, sit down and push out the pee as fast as we can to get back to our (usually crying) as quickly as possible. So I want you to take your baby with you. Maybe in a bouncer or moses basket or even in a wrap if you have to. Aim to spend 5-7 minutes sitting on the toilet to allow things to happen.

   3. Use the correct position on the toilet. We are designed so that our bowels empty best in a squatting position so feet up on a stool, lean forwards, elbows on knees and entertain your baby, read a book or just enjoy some quiet time!

   4. Use your hand wrapped in tissue to support any stitches if it hurts to them to empty the bowel. 

   5. Take any laxative prescribes for you, hydrate well and eat healthily.

4. Start some pelvic floor rehab. I usually start this by making sure my patients can breathe well and have some awareness of their pelvic floor muscles and what they’re doing. This sounds simple but many, many people find this bit the most difficult part of their rehab. 

Breathing

So make sure that you can do:

• Upper chest breathing – hand on your upper chest and breathe in so that your chest rises towards your chin.

• Lateral (rib) breathing – hand on the ribs on each side and breathe in so that your hands move outwards on your ribs.

• Abdominal breathing – one hand on your chest and one on your tummy. Breathe in and concentrate on allowing your tummy to move outwards while minimising movement in your chest.

If you learn better from observing, just pop the different types of breathing into YouTube and lots of demo videos will come up. 

Practice these different types of breathing in different positions – lying, sitting, standing and practice being more mindful about how you normally breathe. 

Awareness

Once you’ve got the breathing mastered and can do it without having to concentrate too much, I normally move my patients on to working on their awareness. So while practicing your different types of breathing, pay attention to what’s happening with the pelvic floor. 

Just paying attention to begin with. At first you might not really notice anything but stick with it. 

Look out for:

• What the pelvic floor feels like when you breathe in.

• What it feels like when you breathe out.

• What are your tummy muscles doing?

• What’s your bum up to? Nothing? Tightening? Relaxed?

Ideally, we want you to be able to feel a subtle release of the pelvic floor as you breathe in and a gentle (not conscious) tighten or lift as you breathe out.

If you’re aware of this happening, you’re ready to move on to co-ordination.

This is pretty simple but takes practice. So: 

• Breathe in slowly

• Begin to breathe out

• Add a gentle pelvic floor squeeze as you continue to breathe out

• Release

You should be able to feel the squeeze and also the release. If you can’t feel the release, let you a little sooner as your muscle may not yet be strong enough to hold for the full breath out. 

Repeat this 5-10 times a few times a day. If you can, make your squeeze a little bit smaller with each repetition. This improves your control and sensation and reduces squeezing of the other muscles around the area which we want to keep to a minimum.

If you’ve got as far as this, you’re doing great! Keep working on these exercises in different positions and improving your control and sensation. 

If you’re struggling, please don’t feel alone. I’m available through Doulacare Ireland for a chat and will get back to you as soon as I possibly can. There are some online resources available to you that might also help and I’m linking to them below.

My online course: https://mindingmums.teachable.com/p/resetting-your-pelvic-floor (Coupon Code MARCH2020 for 30% off)

Free online Womens Health After Motherhood course:

https://www.futurelearn.com/courses/womens-health-after-motherhood

Videos from the Rotunda Physiotherapy Department:

https://rotunda.ie/knowledgebase/physiotherapy/

This link is about constipation and while you might not necessarily be constipated, a lot of the same information applies:

https://www.evidentlycochrane.net/feet-up-constipation/

Some information about dealing with bladder urgency:

https://www.ucsfhealth.org/education/bladder-training

Some physiotherapists are also doing virtual consultations for clients so chevk in with your local physio to see if they’re able to facilitate this for you. 

Good luck, 

Louise x

Many thanks to Louise for putting this blog together. You can read more about the support Louise offers here https://www.doulacare.ie/louise-murphy

Postnatal Depression, when love doesn’t come as a thunderbolt.

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Postnatal Depression, when love doesn’t come as a thunderbolt.

I was 21, and diagnosed with Poly Cystic Ovarian Syndrome (PCOS), on a hot June day, in the consultants room, in a Cork hospital. One minute I was worrying about my parent's car being clamped, and the next minute I was being told,  if I was ever going to have kids, do it now in my early 20s. He closed the folder and stood up, as I sank into the chair. Fast forward to 23, going out with my husband, and about four weeks into the relationship, the clock now ticking so loudly, I sit him down and tell him. In September 2011, my daughter was born. Five years after my PCOS diagnosis. A greyness descended, initial happiness replaced with fears, thoughts, overwhelming feelings. My brain telling me that I’m not good enough for her. My husband was beaming, but my heart was breaking, because, after five years of hoping, wishing, endless sticks to wee on, I didn’t get that thunderbolt. I was in shock. 

I stayed in the hospital for four days, because I didn’t want to go home until I felt ‘right’ . That thunderbolt didn’t come. Over the following days and weeks, I lied to friends and family who were enamoured by her. I was staying awake all night, afraid, and dreading the moment she would need me again. Would she be better with someone else as her mammy? I envied my husband's love for her. I envied how happy he was. I loved her, but felt that I wasn’t enough for her. What if she didn’t like me? Friends kept telling me how lucky we were to have a happy, healthy baby. I didn’t feel lucky, I felt guilty, ashamed that I wasn’t enjoying the baby I had longed for. I was lucky to find a breastfeeding support group,  that allowed me to cry, talk openly, and not be judged. It became my lifeline. I found Kathy Kendall-Tackett's book, The Hidden Feelings of Motherhood, and it was eye opening, and reassuring. Dr Andrew Mayers from Bournemouth University, has done some interesting research about partners developing postpartum depression too.

I had heard some myths about PND , and medication, and I had fears about asking for help. What if they take her off me? What if, what if, what if? I became numb, and comfortable in my numbness. I hit rock bottom in 2016, when my neighbour passed away suddenly. A few days later, at my doctor's for something else, I broke down. He gave me some options, and I chose a referral for counselling. It was amazing. A weight lifted. The shame and guilt could be put down. I could breathe. 

I now work as a postpartum Doula, with Doula Care Ireland. One client described me as “a wonderful calm presence amidst the chaos" .I am not a health care professional. I am not there to tell you what to do. I give you the information,  and allow you to make an informed choice that works for you and your family. There is no one magic cure for PND, but , with calm, clear, informative support you can begin your journey out of the greyness. I am continuously working on being the best version of myself, and it is a continuous process. Sometimes I see glimpses of how I felt, in my clients, and it reminds me that the process of being mentally well, is something we need to keep working on.

Written by one of our doulas Dee Burke. You can fins out more about Dee and the support she offers here https://www.doulacare.ie/dee-burke-1/

If you or someone you know is suffering with a postpartum mood disorder these resources may help

https://www.nurturecharity.org

http://www.pnd.ie

https://www.cuidiu.ie/httpwwwcuidiucomsupports_parenthood_postnatal

https://www.hse.ie/eng/services/list/4/mentalhealth/mother-and-infant-health/#Finally,%20support%20services%20for%20those%20with%20Poatnatal%20Depression

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What is the Fourth Trimester?

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What is The Fourth Trimester?

Imagine what the third trimester of pregnancy would be like for a baby: tightly cocooned in a warm, dark, comforting place. There are no hunger pains or thirst, no need to pass painful wind, no strange smells, no feeling the hot or cold — just a perfect environment tailor made for a baby.

I’m sure you can also imagine suddenly being born into a world with of all these things can be quite a rude shock!

A new baby isn’t born being able to fend for themselves and still has much developing to do – they can’t escape if they sense danger or fear, go and find mum or dad for security or a cuddle, nor can a baby chase mum for a feed whenever hunger or thirst calls… they completely rely on us for every single need.

A gentle adjustment into their new world in the form of a fourth trimester (which is named that way in order to be perceived as an extension of the third trimester) can make a huge difference to how baby feels and how mum and dad cope with parenthood.

Babies cry because it is their only means to alert their parents that they have a need to be met (and they will not stop crying until it is met), which can in turn make parent’s self esteem and confidence plummet if nothing seems to work. This is because they start wondering what they are doing wrong and if they are useless parents (they’re not).

Giving your baby a fourth trimester can make for such a more enjoyable, soothing time for all involved – so how can you give your baby a fourth trimester? Here are some simple ways to recreate womb life.

• Use a sling/wrap

Baby wearing can be a life saver in the early days. Using a sling can recreate several conditions from when baby was in the womb. Feeling tightly supported all over, close to mum’s heartbeat, warm and cosy. Both parents can use a sling to offer comfort to baby and strengthen your bond.

Make sure you choose a safe and suitable baby carrier – www.babywearingireland.ieis a great source of information. You can even get a sling consultant out to your house!

• Skin to skin!

Whether you are breast or formula feeding, skin to skin is a great way to increase bonding with your baby. Skin to skin contact offers the following benefits for your baby at birth (and beyond):

• Regulates his body temperature better even than in an incubator

• Maintains his heart rate, respiratory rate and blood pressure normal

• Has stable blood sugar

• Feels safe and calm so is less likely to cry

• Receives good bacteria from your body to promote good gut bacteria in baby and boost immune system.

• Is more likely to breastfeed exclusively and breastfeed longer

• Baby is more likely to latch on

• Baby is more likely to latch on well

• Will indicate to his mother when he is ready to feed

• Bath time!

Many babies absolutely love being in a nice warm bath. Some babies may not like a bath at first, as they don’t enjoy the air or cold on their skin as their clothes come off, but they soon grow to love them! If you’re not confident on how to hold a baby in a bath, you can ask your midwife, doula or PHN for a demonstration – or you can just jump in the bath with your baby for added skin to skin benefits. The soothing water surrounding your baby creates an environment similar to what he or she would have been used to in the womb.

Dim any bright lights and jump into that nice warm bath together – even dad can do this one so he can enjoy bonding time with his baby too.

• Bed Sharing or Co-Sleeping

Just like with cot sleeping, there are also safe co-sleeping guidelines. Both sleeping methods have risks if not practiced sensibly. Le Leche League have a 7 step guideline to safe co-sleeping. You can find the information here http://www.llli.org/sweetsleepbook/thesafesleepseven 

By bed sharing or co-sleeping (which includes specially designed cots which attach to the side of your bed, to give baby their own safe space), your baby can sleep in safety knowing that mum is close by. He can smell you and even touch you, without insecurity. Its also a great way to make sure mum gets her much needed rest. 

We’ve all heard the saying ‘sleep when baby sleeps’.

Especially in the fourth trimester, focus only on what you and your baby need – and it’ll make such a difference to how you feel when you’ve had more sleep. Sleep deprivation is one of the leading contributors to anxiety and depression in new mothers, so take care of yourself and enjoy those sleepy cuddles.

• Feed on demand for breast and bottle fed babies.

Offer The Breast If Baby Wants It : Breastfeeding is something your baby will become familiar with very quickly, from the moment she is born. It provides her with a great sense of comfort. She will feed often, especially in the early weeks, as she tries to establish your supply. It is important to follow your baby’s lead to allow her to create a milk supply to meet her individual needs. 

There are lots of places to get support with breastfeeding. (Cuidiu, La Leche League, Friends of Breastfeeding, Postpartum doulas) or the most qualified experts in breastfeeding – IBCLC’s (International Board Certified Lactation Consultants). 

You can find breastfeeding support in the following places:

• Cuidiu www.cuidiu-ict.ie

• Le Leche League www.lalecheleagueireland.com

• Friends of Breastfeeding www.friendsofbreastfeeding.ie

• Association of Lactation Consultants in Ireland www.alcireland.ie

• Irish Premature Babies www.irishprematurebabies.com

• Irish Multiple Birth Association www.imba.ie

• Doula Association of Ireland www.doula.ie

• KellyMom www.kellymom.com

If you choose to bottle feed remember your baby has been fed constantly throughout pregnancy. A three or four hour routine can be difficult for a new baby to adjust to. Also it is helpful to remember that a new born tummy is the size of a small marble/malteser and so they thrive on little and often. Paced bottle feeding can ensure your baby takes as much food as they need, without being forced to drink more to ‘finish the bottle’ Trust your baby to take what they need and this will help to avoid lots of spit up and tummy pain.

You can find more information here: http://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/ 

• Getting Out and About

Once you have recovered from birth it is important to try to get out and about. Every baby is different so trial and error will find the best way for you. Lots of babies love the motion of the car but some do not like the car seat so this can cause you stress. Some babies love the buggy for the ride, others would rather be worn or in a parent’s safe arms. Make a date with a friend to meet for a cupa somewhere or just take a gentle stroll around the block. The fresh air will help to lift your mood and may help baby to sleep.

• Coping With An Attached Baby

You may be reading this thinking it all sounds great, but it seems a little exhausting. Yes, it can be sometimes. But always remember: nothing is permanent, everything is temporary. Even when it feels like it’s going to last forever — it’s not.

Remember ‘This too shall pass’.

Sleep deprivation and discomfort is part of the job of being a parent, but it can be made much easier by:

• Sharing the load where possible – accept and ask for all the help you can

• Make sure your partner spends time settling baby too (he/she needs to learn – and baby will learn how daddy/mammy does it!)

• Seek out a postpartum doula if you can afford it

• Making sure you get a break/time out. Even a trip to the supermarket, coffee shop or 5 minutes in the garden

• Check your expectations. Are you expecting too much from yourself and/or your baby?

Your baby does not behave in these way to manipulate or annoy you, but to teach you what he likes and needs – and what makes him feel most safe and loved. By being open to the lesson and remembering that ‘this too will pass’ (a great mantra when things get a little tough) you’ll be an expert on your baby in no time.

Hang in there – it WILL get easier. Savour the good times & breathe through the tough ones. Take lots of photos ☺

Doula Jen   x

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