Susan Wallmeyer
Forum Replies Created
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Hi Kari!
My understanding is that complete previa will not shift and your treatment goals then move to supportive care like preventing bleeding and c-section prep. I think Debra had a lecture on this in a previous year of MAMPS, but not sure if it’s in any of the materials for this year?
Would love to know how things turn out for this patient and your approach!
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Just to add one more option, Kenna Bouvet is in Long Island City, Queens and is a fantastic MAMPS alum.
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Hi Maria,
I’ve been quiet in MAMPS this year because I actually just had a baby in late May, and unfortunately also had a 4th degree tear. So, I wanted to share my experience so far with what’s helped and resources. I think a lot of this information would apply to other types of tears too. It’s a tough situation because 4th degree tears are pretty rare (my OB said she’d only ever seen one before mine in her 18 years of practice) so OB’s don’t always know what to advise. Your patient needs a support team!
I feel lucky that my OB did a great job with the repair immediately following delivery, and compared with many I have had a pretty easy recovery (though it’s still been really hard). The main things to prioritize are keeping her bowel movements regular and soft, as any hard or difficult stools could damage the sutures and cause the tissue to tear again. In addition to daily Miralax and Senna, a diet high in fiber and with lots of fluid intake is key. If you’re able to get to her for home acupuncture, some distal points to help with regulating digestion would be great. She may have lost a good amount of blood from the delivery and there may be anemia, so asking questions along these lines and helping with tonifying qi & blood would also be helpful.
Pain management is huge here- and she would really benefit from some acupuncture treatments. Personally between the pain level and caring for a new baby there was no way for me to leave home, so again this is where home visits will be vital for her. I found that while trying to breastfeed and pump, simply sitting upright on the bed or couch was painful, so if she can work with someone on mastering side-lying breastfeeding that will be ideal.
As far as the sitz baths, I first tried them with epsom salts- this was helpful but also stung a bit. A specialist I saw later on said just to use warm (not hot) water as the warmth helps with circulation. Additionally some days I really found cooling packs (not ice) to be helpful. I know this is not really what we’d normally recommend in TCM but on days where it feels like there is a lot of heat present, I think it makes sense to use them sparingly.
There is a Facebook support group she can join called “4th degree tear support group” which has been helpful for me as well. It just shows you the variety of experiences people have even with the same degree tear.
If her OB hasn’t already connected her with a specialist, this needs to happen. Either a colorectal surgeon or urogynecologist should follow up with her on a regular basis to check on how things are healing. People can develop things like fistulas which need to be caught early.
I started pelvic floor PT around 7 weeks postpartum for scar mobilization and gaining my strength back, which felt really scary but has helped a LOT already.
Last, I think the emotional component is huge- it seems for most people there’s some amount of self-blame, and frustration with how long the healing takes while you just want to enjoy bonding with your baby (not to mention the sleep deprivation!). So, keeping an eye out for signs of anxiety or depression and gearing treatments to address this, in addition to just being someone to listen to her experience will be incredibly helpful.
Feel free to email me directly if you or your patient have any other questions!
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Hi Kenna,
I haven’t had the chance to work with a patient postpartum on this issue but years ago had a pregnant patient who experienced Reynaud’s in her nipples also, and that had become worse during pregnancy. She asked me for resources as she anticipated it could be a big issue with breastfeeding. I love your approach so far and also wonder if she might have any blood xu or stasis signs? It seems like both could potentially be involved with this.
Some advice I gathered about 3 years ago from LC’s and doulas on this topic is below:
-Being ready to apply heat after feeding (with a microwaved heat pad)
-Wool nursing pads for warmth such as these: https://danishwool.com/collections/health-and-wellness/products/nursing-pad-softline-style-pair
-Recommend asking her provider about B6 supplements
-Lots of fleece layers- line bra in fleece for anything under 50 degrees
-Medication to ask her doctor about: nifedipine
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Hi Kristen,
I don’t have much experience with DMER or the situation you are describing, but a few years ago had a patient who was still leaking breastmilk after she had already completely weaned her baby. I prescribed herbs- a base formula of Xiao Chai Hu Tang but importantly, including Mai Ya (barley). In low doses it increases milk production but as part of a formula with a high dose (45-60g) it decreases production. My patient did notice a difference taking this herb formula. Claudia had sent me some information she had learned from Sharon Weizenbaum on this topic, and I think it would potentially apply to a patient experiencing DMER, but since I did not learn directly from Sharon I am reluctant to pass on the information! Perhaps Claudia could weigh in here?
I’m not sure if you are an herbal practitioner but overall it seems that a formula to address her underlying diagnosis plus Mai Ya could be helpful here. I’m interested to hear others’ experiences.
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Hi Kristen,
I have treated a woman with placenta previa during her third pregnancy recently. With her second pregnancy she had previa as well and experienced a severe bleed around 28 weeks and then her doctors kept her in the hospital for weeks after which was quite traumatic. She wanted to do everything possible to try and minimize the previa or accreta from developing, prevent another bleed or premature contractions and address her overall health and anxiety. With her 1st pregnancy there was no previa but she delivered via c-section and she had a myomectomy at the same time (predisposing factors for previa).
I saw her throughout the pregnancy and though she did develop previa, it was not as severe as her second pregnancy and she never ended up having any bleeding. I performed direct moxa on Sp 1 weekly for her which I know is generally used to stop active bleeding but I wanted to experiment to see if it might also be useful with prevention. I also worked on clearing heat and coursing Lv Qi (a big part of her presentation) and boosting the Spleen. She did have some uterine tightening around 25-27 weeks that came and went, and at that time I focused on points to calm the uterus like Kd 9.
As per Debra’s guidance I made it clear to her that I couldn’t help significantly with placenta location as hers had almost completely covered the cervix from 2nd trimester onwards. At 27 weeks the placenta had moved off the cervix partially (the doctor called it “partial placenta previa) but by 30 weeks it was back to complete.
She ended up having a planned c-section at 37 weeks as is typical- she was THRILLED to make it that far without a bleed! The surgery went very well but she then experienced severe postpartum hemorrhage, thankfully while still in the hospital. She was discharged after a few more days and I was able to work with her a few times a week for about 2 weeks. We focused on reducing the initial swelling (Fluid was in lungs, swelling in thighs, feet, face and hands), reducing incision pain, nourishing blood and calming her shen as the sudden postpartum hemorrhage and subsequent blood transfusion had been so scary for her. She also had support of a perinatal therapist which was huge in that regard. Her recovery seemed remarkably quick during those 2 weeks.
Overall it was a really interesting case and very rewarding to see how much acupuncture and other therapies helped her. I think Debra’s lecture on previa (I think was last year’s MAMPS session?) is really important information to have as to assessing whether you will be able to help actually change the location of the placenta. Other than that, I think we can help a lot with the things I mentioned in this case… and this is just one case! Looking forward to hearing about others.
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Hi Kari,
I don’t have a doula certification so can’t speak to that part of things. I have been doing more postpartum home visits in the past few years- in my experience more people are asking about postpartum visits during pregnancy, and I think this might be due to increased conversations/greater awareness around the need for postpartum support and care (though we still have a long way to go!). I always make sure patients know I offer home visits postpartum, and for many I will do it at either a reduced rate or the same rate as an office visit for at least the first 6 weeks postpartum (can vary on a case-by-case basis, sometimes longer). I only see patients in my office 3 days/week and so I offer the home visits the other 2 days/week. I find that with travel time I normally max out at 3 home visits/day and limit it to a 30 minute commute of where I live.
Sometimes patients have a specific issue they want to address, other times they’re feeling pretty good so for general recovery we do motherwarming, acupuncture for underlying patterns and just talk about how things are going. So many of the new moms I see don’t have family support nearby. Some are working with me in addition to several other perinatal professionals (therapist, lactation consultant, PT and have a postpartum doula or chef coming in), others might just have their partner at home helping out. So there can be a real range of how heavily they will lean on your support. I agree we can do so much and this is a really underserved population! I have found the MAMPS lectures/discussions really great as well as recently found Penny Simpkin’s “Pregnancy, Childbirth and The Newborn” a great resource.
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Thanks Sarah and Kari! I haven’t yet tried bleeding/Gua Sha since she’s steadily been improving. I’ve seen her twice a week for the past few weeks and so far she reports she is no longer constipated, her back pain has decreased a lot (sleeping better) and the GERD and nausea is 10-15% better. She’s able to eat a wider variety of foods which she’s really happy about. I do think I’ll try bleeding/Gua Sha at some point soon- she’s happy to try anything and I think it could be helpful!
I love the idea of Lv 8/Lv 3 Sarah- I’ll definitely try that as well as press tacks at Ren 22. She loves the ear seeds and press tacks- she reports that they make her feel really empowered to feel like she’s doing something for her situation, and thinks they do help. Also, as far as having a supple liver and doing GB points- it’s interesting because she reports a lot of tension on the right GB 34 so I’ve been doing ashi points as well as cupping on that area- which now makes me wonder if that’s helping with the local pain as well as the digestive symptoms.
Thanks again for the feedback! I’ll keep everyone posted on this case.
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Hi Kristen,
Sabine Wilms just posted the article below which is a great read and reminder of the importance of rest, care and good nutrition as well as the SI and Ht meridians in treating lactation issues. Warm compresses on the breast prior to feeding can be helpful also.
Sabine’s article: https://www.happygoatproductions.com/blog/2022/8/13/virgin-milk-and-lactation-in-chinese-medicine
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Agreed with Kristen- thank you for sharing Sarah! Such a fantastic treatment you gave and I love the combination of gentle acupuncture and bodywork. This way of thinking through a safe treatment makes a lot of sense and really helped me as I didn’t know transverse babies have a higher risk of cord prolapse. Do you feel that you became so proficient in thinking about obstetric considerations such as this through your mentorship with midwives, reading OB/Midwifery textbooks, both? PS This would make an amazing case report 😉
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Thanks for the kind words, Cally! So glad you’ve found the info helpful.
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I can concur- Sarah was kind enough to send me an herbal blend for perineal wash and it was great. She also sent an herbal tea blend to drink- Sarah, not sure if you would like to share this one as well?
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Thank you so much Sarah!
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Great! I have added everyone to our email list. Stay tuned for details.