On 07.01.2021 the "Being A Midwife" team received an invitation by Ashu Martha (Student Midwife, Cameroon) to be the speakers on the 2nd day of events of the"7 Days of Maternal & Child Health In-Depth Discovery" that she organized at her "Marthie's Midwifery DIARY". It was a great honor for us to take part and our title was:
Child Health and Its Effects on Maternal Health and Wellbeing.
Below, we have the speech we gave at your disposal at any time.
Disclaimer: Midwifery is a very inclusive and safe space for everyone, where your identity and your needs are valid and important to us. Thus, the terms used in this article aim towards making everyone feel comfortable and included.
Uterus owner (person with a uterus, uterus having person) <--> Woman
Parent <--> father (dad), mother (mom)
Birthing person <--> mother (mom)
Pregnant (pregnant person) <--> mother (mom)
Breastfeeding (Breast) <--> Chestfeeding (Chest)
[if you feel that you are not included at any point, please contact us and help us change that]
© Nikoleta Chatzipanagiotidou, Paraskevi Kamperi, The "Being a Midwife" blog, SOME RIGHTS RESERVED, 07/01/2021
So, we all know that a Midwife is a health professional who cares for birthing people and newborns around childbirth. But what is the midwife’s role? Is it just that? The answer to that would be “no”. Midwives play an important part in a woman’s life in, more than one, aspects. Their role is comprehensive and involves education, treatment, and collaboration with a more skilled medical team.
Midwives are the experts on childbirth and their responsibilities are likely to be diverse. They’ll:
1) provide full antenatal care, including parenting classes, clinical examinations and screening
2) identify high-risk pregnancies
3) monitor women and support them during labour and the birthing process
4) teach new and expectant parents how to feed, care for and bathe their babies
More specifically, a midwife is by the woman’s side from even before she has conceived, providing her with knowledge and support throughout her whole journey into motherhood.
However, a midwife is not only helpful in a hospital environment. Community work is a big part of their job and a very important one as well. Following the birth of the baby, community midwives will continue to support the parents at home. If you have given birth in a hospital, a community midwife will visit you on the day following discharge to make a plan of care for you and your baby. Similarly, if you have given birth at home, the midwife will return the following day.
These visits are made to make sure that the newborn’s health, besides the birthing person’s health, is in check. The usual postnatal baby checkups will be done by the midwife to ensure the newborn’s wellbeing and the midwife will also take note of how the baby is adapting to his/her new environment. These checks are of great importance because the mother’s health, both mentally and physically, is directly linked to her baby’s.
Newborns are not easy to handle. Newborn babies usually sleep 20 minutes to 4 hours at a time, up to 20 hours a day. Their stomachs are too small to keep them full for long, so they need to be fed every few hours. They might cry for several hours a day. These may be normal behaviors of a newborn, but the birthing person’s mental health and their powers are very fragile at that point of their life due to giving birth.
These behaviors of the baby, along with a variety of other reasons, are likely to contribute on the appearance of Postpartum Depression (PPD) to the mother. Postpartum depression affects up to 10-15% of mothers with onset in the 1st month after childbirth, without this being a strict rule. PPD is 50% more likely to appear in teenage parents, in comparison to adult parents (Driscoll,2006). Researches show that PPD is usually under-recognized and under-treated and this can lead to Postpartum Psychosis. PPD signs and symptoms may include Depressed mood or severe mood swings, Excessive crying, Difficulty bonding with the baby, Withdrawing from family and friends, Overwhelming fatigue or loss of energy, Fear that they're not a good parent, Thoughts of harming themselves or the baby.
Besides the behavioral problems of a newborn baby, another problem is breastfeeding and its difficulties. The main concern here is the reason behind the difficulty of chestfeeding. There are a few reasons for that but the 2 main ones are:
Wrong position of the baby on the breast (not latching correctly): To breastfeed successfully, a baby needs to latch on to both the breast tissue and nipple, and their tongue needs to cover the lower gum so the nipple is protected from damage.
2. The abnormal anatomy of the newborn’s mouth (Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual/ -Lip and palate clefts: Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. Cleft lip and cleft palate result when facial structures that are developing in an unborn baby don't close completely/ -High or arched palate: This is when the roof of the mouth is shaped in a way that is too high or narrow. )
These problems affect the mother in both a physical and a mental level. Non-successful chestfeeding can cause sore and cracked nipples, nipple pain, breast engorgement, clogged milk ducts, mastitis, thrush (a yeast infection) and oversupply. Also, it can make the parent feel inadequate and useless seeing her baby losing weight and it can lead to her not wanting to try to fix the problem and lose the bond between her and her baby, feeling frustrated with everything.
Another situation that has a big effect on the mother’s health and wellbeing is intrauterine fetal demise, or “stillbirth”, the death of a baby in the uterus. The term is usually applied to losses at or after the 20th week of gestation. The most common causes include: Congenital birth defects, Genetic abnormalities, Placental abruption and other placental disorders, Placental dysfunction leading to fetal growth restriction, Umbilical cord complications and Uterine rupture.
The physical changes that birthing people have after giving birth are similar to a stillbirth but are extremely hard to handle because of the fragile mental state, the pain and the shock. These include: breastmilk (and suppressing it), after-pains/ stomach cramps, bleeding (lochia), maybe stitches, piles (hemorrhoids), weak pelvic floor and the terrible feeling of getting the first period after a stillbirth.
Most people agree that the emotional trauma of shock and grief are far worse than the physical effects of stillbirth.
The grief reaction following a stillbirth has been demonstrated to be comparable to other types of bereavement, with the potential to cause serious short-term and long-term psychological problems. Some problems are personality disorders or mental illnesses, inadequate role performance and life transitions involving developmental changes, and crises as well as communication and relationship difficulties.
The death of a child (even at a bigger age) is a traumatic event that can have long-term effects on the lives of parents. Bereaved parents reported more depressive symptoms, poorer well-being, more health problems and were more likely to have experienced a depressive episode and marital disruption than were comparison parents.
Furthermore, because the death of a child defies the expected order of life events, many parents experience the event as a challenge to basic existential assumptions. Recovery from grief was associated with having a sense of life purpose and having additional children but was unrelated to the cause of death or the amount of time since the death, and it was never 100% successful.
Additionally, parents of children with severe or untreatable diseases and syndromes are, also, getting affected, both physically and psychologically. The physical struggle occurs, because of the care strain, the frequent hospital visits or even the hard work needed in order to provide all the necessary drugs and supplements. The mental burden (if I’m allowed to use this word) can be attributed to the everyday awareness of the situation or the moral encumbrance of a congenital disease that the mother transmitted to her baby.
On the other hand, a kid’s health can affect the mother’s by transmitting a communicable disease to her. This could be a simple flu or even highly contagious ones, like tuberculosis and, now, Covid-19. But the most worrying possibility is the one in which the parent is pregnant while getting the disease from an older child. Several perinatal infections can be extremely dangerous. I can mention only some of those, such as Rubella, infection from Cytomegalovirus (CMV), Varicella, Hepatitis B & C, erythema infectiosum, etc. These may lead to different complications of the pregnancy, affection of the fetal health and anatomy, higher perinatal fetal and maternal mortality risk, more serious outcome of the disease for the mother, severe widely spread internal inflammation after a possible intrauterine fetal death, and others. All those effects for both the fetus-infant and the parent depend on the disease and the point of time it will infect the mother.
Maternal health (physical and psychological) is fragile when dealing with children with disabilities too. Caregiving can be difficult and challenging, especially in cases of severe physical disabilities. Constant weight lifting (when lifting, moving and helping the child) can cause rotator cuff and meniscus tear, biceps tendinopathy, shoulder impingement, tendonitis and intervertebral disk herniation.
In addition to that, a working mother may have to deal with time management, due to tight working schedule, lack of off-days and short maternity leave period. Psychological effects are possible in cases that the person had faced the ethical dilemma of abortion during pregnancy. They may blame themselves for the decision of keeping the baby because they are now realizing how its condition affects its life.
Lastly, maternal wellbeing could get disturbed cause of physical damage. Children with several syndromes that can have violent episodes or movements, for example, Down Syndrome, Tourrette Syndrome and Sudden Onset Aggression can cause harm reflexively. Down Syndrome is known to have some violent episodes and children who suffer from it are known to have great muscle strength.
When it comes to Sudden Onset Aggression, which is more obvious during the teenage years, children appear incapable of restraining their anger and progress to aggressive behaviors. Tourrette Syndrome, on the other hand, can lead to harm because of involuntary spasmodic movements or a bit more violent behavior during tic flair-up episodes.
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