Tag: Pregnancy

Being Weighed in Pregnancy

Posted by on in Birth Prep, Comfort, Plus-Size Pregnancy, Pregnancy, Trauma, Weight

Weight gain is one method to measure pregnancy health. It’s not the only way. Like everything else, being weighed is optional. You can set boundaries around being weighed or decline altogether.  

For many women, weigh-ins are a source of anxiety, regardless of their size. Society is filled with preconceived ideas about weight and a lot of people have past trauma or shame related to the number on the scale. That can stem from negative body image issues, being stigmatized due to weight, a history of disordered eating or body dysmorphia. For vulnerable people, the act of being weighed and hearing the number can significantly set back their recovery or treatment. 

I recommend speaking with your medical care provider about being weighed and employing shared decision making. Ask if it’s a routine part of care or if there’s a specific medical reason. If the “medical reason” is pregnancy, you could ask for more specific reasons. Use that information to decide if you agree to do weigh-ins at every appointment, do them differently than the usual, or skip them.  

Here are some tips for navigating weigh-ins:

  1. Share Concerns: Talk to your medical care provider about any anxieties or discomfort you may have regarding weighing. Ask questions and decide what’s best for you. 
  1. Say No Thank You: Remember, being weighed is always optional, including during pregnancy. It’s okay to decline if you’re not comfortable.
  1. Less Frequent Weigh-Ins: If frequent weigh-ins are causing stress, discuss a modified schedule of being weighed less frequently than at each appointment.
  1. Learn Total Weight Gained Only: For some people, it’s the total number that concerns them more than their pregnancy related change in weight. Request to learn the total amount of weight gained and not be told your current weight. 
  1. Do It at Home: If you prefer, you can weigh yourself at home and report the results at your prenatal appointments.
  1. Stand on Scale Backwards: If seeing the number causes stress, ask to face away from the display during the weigh-in. Be clear that you do not want to be told the number. (You may also ask for the weight to be blocked out on your copy of your prenatal records, if you are worried about accidentally or intentionally seeing it.)
  1. Tell Staff to Not Say It Out Loud: This prevents you and others from learning your weight, and maintains your privacy.
  1. Ask for Privacy: If the scale is in a public area, request to be weighed in a private space if that makes you more comfortable. You can also incorporate any of the above strategies. (Yes, one of my clients just told me her doctor’s office has the scale in the waiting room!)
  1. Change medical care providers: Hopefully you can come to an agreement that feels good to you. If you are not treated respectfully, then changing to another medical practice is usually an option. 

Your health journey is personal and deserves individualized support. This is one of many choices you can make through your pregnancy journey. Although such conversations can be difficult, it’s important to advocate for your comfort and well-being every step of the way. 

International Women’s Health Day

Posted by on in Pregnancy

Today is International Women’s Health Day.

Women’s health is terribly underfunded despite the fact we make up 50% of the population and in most cultures, women are the foundation of healthy families. A woman’s health affects her family and community. This is an issue that effects all people. We need to do better!

  • In Canada, less than 4 % of medical research dollars go toward women’s health.
  • Globally, half of all pregnancies are unplanned. While people may embrace these pregnancies, it’s a hardship for most. It can be a risk to their mental and/or physical health. For many, unplanned pregnancies are a fast-track to life-long poverty. Why so many unplanned pregnancies? This is a complex issue but most commonly they’re due to lack of availability of – and limited or no options in birth-control.
  • Globally, 800 women die daily (one every 2 minutes) from preventable pregnancy and birth complications. In many parts of the world this number is decreasing, however in North America maternal death is on the rise. Maternal deaths are most commonly due to postpartum hemorrhage, perinatal and postpartum infection, unsafe abortions, complications in birth (often due to mismanagement of labour), and preeclampsia. Generally, these are preventable and treatable issues. Women of colour are almost 3x as likely to die in childbirth compared to white women.
  • In almost all geographic areas, rates of postpartum mental illness far outweighs available treatment options. Women have no options or are told to wait 1-3 months for an appointment.
  • 1 in 10 women globally suffer from endometriosis, yet the first Canadian study into this condition began in 2019. Ten percent of women (190 million!) suffer from endometriosis. They are mostly dismissed and left without treatment options that exist, or they live in an area where there are no treatments options available.
  • In many places, women with fistulas after birth are shunned from their communities and left to fend for themselves. Many do not survive.
  • The stats on women’s heart health / cardiovascular illness is appalling. We’ve known for decades that heart-attacks in women present differently than men. However far too many are still misdiagnosed or not taken seriously. After a heart attack, women’s survival rates are considerably lower, especially if they are married and/or have children. (Married men who have heart-attacks often go home to be cared for during recovery. Married women who have heart attacks often go home and resume their role as primary caretaker of family and home.)
  • Women’s symptoms are more likely to be dismissed and their voices not taken as seriously during medical appointments and in the emergency room. They are less likely to be referred to specialists, and receive fewer diagnostic tests and prescription medications. This issue is amplified for BIPOC women and plus sized women.
  • Menopause negatively affects over 80% of women globally, yet there are very few medical treatment options. Research is vastly underfunded for an event that affects almost 50% of Earth’s population.

There are so many other examples of frightening outcomes, disparity and lack of resources for women’s health; too many to list here. We can do better.

Postpartum Sexuality

Posted by on in Birth Prep

Many individuals or couples have questions or concerns about postpartum sexuality. Resuming sexual relations takes time and patience. During the first 6-weeks postpartum, the birth parent’s body is in recovery mode – much more than simply a return to the non-pregnant state!  Almost every culture advocates 6 weeks of abstinence for medical or spiritual reasons. 

After giving birth, some people have no change in libido and a rare few experience an increased drive.  However the majority notice lessening or lack of sexual desire; it’s a normal result of the physical and hormonal changes that accompany birth and post-partum. Most researchers report a return to pre-pregnancy levels of sexual desire, enjoyment, and frequency within a year. The hormones of breastfeeding often lead to suppression of sexual desire. Other factors that play into the temporary decrease in sexual feelings include:

  • Lifestyle changes
  • Exhaustion or fatigue
  • Feeling “touched out” due to constant contact with infant
  • Time constrains with duration of sex due to infant needs
  • Loss of privacy as a couple
  • Individuals in a partnership dealing with new pressures such as how to be a devoted parent or deal with increased financial responsibility
  • Many birth-mothers find themselves feeling dependent on their partner partner in new ways – a major mental and emotional adjustment
  • Self-image – postpartum people may feel self-conscious of their body and it’s workings
  • Relationship satisfaction, which is a predictor of postpartum sexual desire and frequency of intercourse
  • Baby blues or postpartum depression

Did you Know?

  • It takes 6 weeks for the placenta attachment site to heal. During that time there’s actually an open wound in the uterus, at risk for infection or injury.
  • The perineum can take 4-8 weeks to heal after incisions or stitches.
  • Vaginal secretions are decreased due to postpartum hormone levels.
  • Either or both partners may feel shy.
  • Jealousy of baby, mother-baby relationship, or partner’s perceived freedom is normal.
  • Nipples may be sore or tender. Breasts may leak breast-milk with sexual stimulation.
  • Some people feel sexually aroused when their milk lets down.
  • It is not normal to have pain with intercourse or using the toilet after 8 weeks postpartum.

The top concerns by both genders at 4 months postpartum include when to resume sexual penetration, birth control, recovery from delivery, and postpartum body image. Have open discussions as a couple.

When to Begin Again…

  • To prevent infection or discomfort, wait until whichever is LATEST:
    • Postpartum bleeding has fully stopped
    • Perineal tears, injuries, sutures heal
    • 6 weeks
    • **Everyone involved is ready physically, mentally, emotionally**
  • Start slowly,  especially in cases of traumatic birth
  • Stop in case of pain or discomfort
  • Patience may be required during the time-period before resuming sexual relations. Try:
    • Mutual caring and love
    • Cuddling, hugging
    • Kissing
    • Other sensual, nonsexual contact such as massage

Challenges to Sexuality

  • Relationship as both parents transition to parenthood
  • Perceived or actual inadequate support and presence of partner
  • No time for intimacy, especially if in survival mode
  • Difficult or traumatic birth, including Caesarean, can have physical and emotional lingering effects
  • Trauma to perineum during birth process
  • Religious or cultural beliefs

Other Strategies

  • Postpartum support to ensure rest and recovery from pregnancy and birth
  • Daily connection and even romance
  • If partners find each other attractive or beautiful then tell them, or find something to compliment
  • Set aside time for sex when neither of you are tired or anxious e.g. weekly date (day or evening) when someone takes baby for a couple of hours, or a weekly rendezvous while baby sleeps
  • Use a lubricant, as it’s normal to be dry or drier than usual, especially if breastfeeding
    • Water-soluble are “healthiest” and help with irritation or sensitivity
    • Silicone-based last longer and are more slippery than water-soluble
    • Avoid petroleum products (Vaseline, baby oil, or mineral oil) as they’re toxic and can dissolve latex condoms or barriers
  • Don’t take it personally if if your partner isn’t interested in resuming sexual relations; this will improve with time as hormones and schedules normalize.

Contact Health Care Provider, such as Pelvic Floor Physiotherapist in Case of…

  • Pain with penetration or using the toilet beyond 8 weeks that isn’t lessening each week.
  • Any questions or concerns regarding sexuality postpartum.

Pelvic Floor Physiotherapy

  • Specialists in female pelvic floor care and recovery after birth; also help with prenatal pelvic floor health.

Other Practitioners who can Help

  • Painful penetration may be referred to a pelvic floor physiotherapy specialist or gynaecologist.
  • Sex therapist in case of non-physical or unidentified origin.
  • Couples counselling if relationship is strained.

References

Association of Reproductive Health Professionals. (2006, Sep). Postpartum Counseling – Sexuality and Contraception. Retrieved Sep 2011, from Association of Reproductive Health Professionals: http://www.arhp.org/publications-and-resources/quick-reference-guide-for-clinicians/postpartum-counseling/contraception

Calgary Health Region. (2007). From Here Through Maternity. Calgary: Alberta Health Services.

Davis, E. (1997). Heart & Hands (3rd ed.). Berkeley, CA: Celestial Arts.

Lim, R. (2001). After the Baby’s Birth – A Complete Guide for Postpartum Women (Revised ed.). Toronto: Celestial Arts.

McCabe, M. A. (2002). Psychological Factors and the Sexuality of Pregnant and Postpartum Women. The Journal of Sex Research , 39 (2), 94-103.

Pastore, L. P., Annette Owens MD, P., & Raymond, C. ,. (2007). Postpartum Sexuality Concerns Among First-Time Parents from One U.S. Academic Hospital. The Journal of Sexual Medicine , 4 (1), 115-123.