Fw: [wildbeachdoulas] Postpartum puzzler - edema + more after pre-eclamsia

[Guest guest]

Hi,

This came from another doula list I am on. I would love to hear some feedback.

I feel this lady is suffering from profound malnutrition, lack of minerals, good

fats, proteins, etc. combined with possible liver involvement. And major

lifestyle issues...

Thanks and Blessings,

Adrienne Leeds

Certified Clinical Herbalist

Holistic Doula

Apprentice Midwife

www.charlestondoulas.com

 

-

 

wildbeachdoulas

Tuesday, January 31, 2006 11:50 PM

[wildbeachdoulas] Postpartum puzzler - edema + more after pre-eclamsia

 

 

I need some expert advice. I've been working all kinds of hours with a mom of

twins, who has started having some very odd and unreassuring postpartum

symptoms. She's been to see both her OB/GYN and her primary care doc, had a

liver profile done ( " some of the numbers were a little off " ) and CBC (no results

on that yet), etc. She's also scheduled for an echo-cardiogram next week, and

they are testing her thyroid levels. However, the docs seem to be doing a lot

of this " just in case, " and really believe that she's fine.

 

My intuition says that's not quite accurate.

 

Here's the background:

 

* Mama is a lovely 40-year-old African American woman. This was her first

pregnancy. She has a very Type A, driven personality, and is an executive at a

home improvement store's corporate headquarters. She intends to return to work

at 6 weeks postpartum.

 

* The twins were conceived while she was on fertility medication. Four sacs

originally appeared on the u/s, but one embryo apparently never developed. One

fetus was miscarried at 12 weeks, leaving the twins-- a fraternal pair, boy and

girl.

 

* Mama was put on bedrest at 25 weeks after going into preterm labor twice, the

second time dilating to 2 cm and effacing to 100%.

 

* Preterm labor was stopped both times by mag sulf.

 

* Due to the bedrest, her appetite was low and it was always a struggle to eat

well. By 35-36 weeks gestation, she had some moderate edema that was constant

no matter what she did, and her BP began to go up. I interviewed with her for

postpartum doula work during this period, and encouraged her to eat (esp. more

protein), drink plenty of fluids and salt her food to perk her appetite. She

was too miserable to hear me well, and the Christmas holidays (she was allowed

to go off bedrest and got pretty busy-- too busy to eat, sometimes) didn't help

matters.

 

* By 37 wks+ 5, the doc was talking induction because her BP continued to rise,

swelling was increasing, and they felt she was showing signs of pre-eclamsia. I

repeated the encouragement to eat more protein, which she finally began to do--

by this time she was so uncomfortable with the swelling that she was willing to

try anything. A day and a half later, the swelling had begun to improve some

but her BP was still up. The doc sent her to the hospital for immediate action.

 

* She birthed at exactly 38 weeks, Dec 31, cesarean with an epidural. Baby A,

Chloe, was breech at this point so there was no offer of induction and vaginal

birth.

 

* Everything seemed fine immediately postpartum. Caleb was just under 5 lbs and

Chloe just under 4 lbs. Both nursed well and had no problems related to their

birthweight or gestational age. Both went home with mama when she was

discharged, though they were re-admitted a day or two afterward due to an

inability to regulate their body temps.

 

* Mama was not readmitted w/ babies, so she spent 4 days on a couch in the

waiting room. Breastfeeding assistance from staff wasn't adequate. Her milk

came in but staff didn't want the babies out of the incubators very long... with

predictable results. By the time the twins came home, she was down to nursing

each baby once per day.

 

* Lochia and involution seemed to be WNL, but healing of her incision was slow

and difficult. The wound drained profusely and had to be packed until the

latter part of last week. As of now, 4 weeks+2 pp, it's still not completely

healed.

 

* Her edema (primarily lower body) initially seemed to be resolving pretty well,

but then hit a plateau and just stopped improving. Her OB gave her a

prescription for a moderately strong diuretic on Monday of last week, when she

went in to have her incision checked.

 

* She began taking the diuretic that day, and either coincidentally or not

coincidentally, that is when things seemed to take a turn for the worse.

 

* As of Wednesday of last week, just two days after starting the diuretic, she

had /gained/ weight. In fact, she gained a total of 9 lbs last week. This,

despite eating very little-- her appetite is still low. In addition, while her

abdomen had gone down a good deal by Monday, I noticed on Weds that it was

swollen and distended to the point that she looked 8 months pregnant again. She

said it felt uncomfortably hard and tight, especially up high (just below her

breasts).

 

* As of today, her edema is definitely worse than it was last week. Her abdomen

is slightly less distended, but not by much. Still larger than it was a week

ago. She's had headaches, been very queasy and has vomited, and sometimes

experiences a great deal of dizziness that is periodic but doesn't seem related

to what she's doing. She wants to crunch on ice, and says everything tastes

like it has soap in it. The thought of food repulses her, and she's currently

subsisting on oranges and protein shakes. She says she has increased her fluid

intake but her urine output has /not/ increased. She's also troubled by

shortness of breath, moreso now than right after giving birth. Finally, the

whites of her eyes are slightly yellow.

 

Her docs told her to exercise (they feel her breathlessness is due to the extra

weight she's put on!), to eat bland foods (they think she has a GI virus that's

been going around), and to " get some rest. " Yeah, right.

 

Like I said, based on my intuition and observances, exercise and bland food and

rest (while it would certainly be good for her) are not going to address the

root cause here. She /is/ stressed-- with twins, low endurance from prolonged

bedrest, and a poorly healing cesarean wound to complicate her recovery, that's

pretty understandable. Although her Type A personality is softening some and

she's learning to relax a bit, she's also sometimes very hard on herself.

Unfortunately, extended family members are being hard on her too, apparently

feeling that she should be " feeling better " by now. This isn't the type of

woman who can easily allow herself to be lie around, so her prolonged recovery

and worsening physical symptoms say to me that something is wrong.

 

Fortunately, she is no longer taking the diuretic. Her only meds now are an

iron supplement (although her hematocrit was WNL today-- in fact, higher than it

had been just before she gave birth) and prenatal vitamins.

 

So, dear wise women... that brings us to the present. What do you think? Any

and all suggestions, advice and information are VERY welcome. The sooner, the

better. I'm concerned.

 

Much love,

 

 

 

 

 

" The most powerful thing you can do to change the world is to change your own

beliefs about the nature of life, people, and reality to something more positive

.. and begin to act accordingly. "

--Shakti Gawain

 

Sullivan, CBE, CMHD, EFT-CC

Childbirth Education, Holistic Doula Services, Reiki, EFT

Shekinah Birthing Co. - http://www.shekinahbirthing.com