Ask Dr Jessica Zucker, PhD about Psychological Needs of A Mom or Mom-to-Be

Dr. Jessica Zucker is a psychotherapist in Los Angeles specializing in women's health with a focus on fertility, prenatal and post-partum adjustments, and transitions to motherhood. Jessica works with adults, couples, mothers and daughters, infants and mothers, and developing families. She comes to the field of clinical psychology with a background in international women's reproductive health, mindfulness-based stress reduction, and psychoanalytically-oriented clinical training. Jessica is a writer with a keen interest in female identity development, mother-daughter relationships, and issues surrounding the body. Dr. Zucker trained at New York University, Harvard University, and the California Graduate Institute.
Ask Dr. Jessica is an interactive forum dedicated to exploring pertinent issues related to pregnancy, birthing, postpartum, and motherhood.

www.drjessicazucker.com

Tags: depression, partum, post, post-partum, prenatal, psychologist

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Here is a response from physical therapist Isa Herrera who specializes in pain after birth:

Although many women don't talk
about this topic, it is quite common to experience sexual pain after
childbirth. Many times, perineal
tears, no matter how small, are the culprit. Most women who have undergone an
episiotomy will experience some degree of vaginal pain in the immediate
post-partum period and often times, longer.
A Physical Therapist (PT), such as
myself, who specializes in pelvic floor muscle conditions can greatly help
women restore normal function to the muscles "down there". PT's can help by stretching the vaginal
muscles, mobilizing existing scar tissue and eliminating spasms and trigger
points commonly found in the pelvic floor muscles after childbirth, C-sections
included. Additionally, any woman
suffering from incontinence or prolapse can absolutely be helped by these
specialists. There is no need for
women to live with sexual pain, leaking, or pelvic pressure.

The following recommendation comes
from my current book, Ending Female Pain, to be released in August
2009. This book was designed with
women like you in mind, who are needlessly suffering from sexual pain. Many of
the chapters in Ending Female Pain describe external and internal
vaginal techniques for the relief of pelvic pain. I think the best technique
for you to try is the Pelvic Floor Muscle Clock Stretching. My approach with
all of my patients is one of empowerment, I want to teach you how to help
yourself and have the knowledge you need to get your body back. The following
is a short excerpt from my new book. This simple to perform method will help
put you on the road to pain free sex again. It can be done at home and all you
need is some alcohol free lubricant. I also
have more information and free downloads on my website at http://www.renew-PT.com as well, and you
can pre-order the book as well right off the bottom of the home page.

Excerpt from my soon to be released
book, Ending Female Pain:

Pelvic Floor Muscles "Clock
Stretches"

Getting
StartedThe
pelvic floor muscle clock stretching
techniques works great for women who are having pain with initial sexual penetration, painful scars, or
spasms in their pelvic floor muscles. For this method, imagine that your
vaginal opening is a clock.To
review, twelve o'clock is by the clitoris, six o'clock is by the rectum, three
o'clock is to the left and nine o'clock is to the right. Using a small medical dilator or
finger, start stretching your vagina using the clock as visualization. Remember
that the pelvic floor muscles (PFMs) are divided into three layers, each layer
corresponding to the knuckles of the finger and progressively situated deeper
inside the vagina. The first PFM layer is knuckle one, the second PFM layer is
knuckle two, and the third PFM layer is knuckle three.What to Do:

1. Focus your
stretching from 3 to 9 o'clock positions avoiding 12 o'clock position where the
bladder is located.

2. Focus on the
areas where it hurts the most with gently muscle stretching. Listen to your
body and listen to your pain.
Avoid pressing on an area where you feel a pulse and avoid pressing on
areas that produce tingling or numbness down the legs or gluteals muscles.

3. Start with
PFM Layer 1, then progress to Layer 2, and then to Layer 3, only when you feel
comfortable and confident.

4. Press around
the clock for 30 to 60 seconds or until you feel a release in the vaginal
muscles. You can go around the clock 2 to 3 times or you can stay on the same
spot for three repetitions of 30 to 60 seconds.

5. The main
thing is to decrease the pain as you press into the muscles. I always aim for
at least 50% reduction in pain when I do the clock stretches on my patients.
6. For women
who have just had babies or for those who have undergone surgeries, it is best
to wait at least six weeks and get cleared by your childbirth caregiver before
starting your clock-stretching program.
7. Oils that
can be used for stretching are vitamin E oil, Rose oil and any lubricant that
is organic and does not have alcohol in it.
8. Expect to
feel some muscle soreness for 24-72 hours after your stretching. This is a
normal response. If you are very sore after the stretching wait at least 24
hours before stretching the muscles again.
9. If you feel
have no pain with the intravaginal stretching you can repeat the stretching
again the next day. Stretching daily for 10- 15 minutes is Ok.
10. It is always a good idea to seek a pelvic floor rehabilitation
specialist to make sure you are on the right track.


Chelly said:
Hi Jessica,
Our baby is almost 5 months old. We had a wonderful at home birth with no complications. Not sure if this is your expertise but really need some help in this area... When my husband and I try to have intercourse it is very painful. It hurts about an inch in and on the 'side walls' if that makes sense, so it has nothing to do with any tears on outside. My husband's convinced that I just need to warm up with some foreplay but honestly I don't see how we would have the time to do foreplay and really I'm not ready for it to feel good but I don't want to be in so much pain either. I thought it may be vaginimus, however when I just use my fingers trying to find where it hurts, even then it hurts and I'm completely relaxed.
I've been told that OBGYN isn't that skilled in this area and need to meet with a pelvis specialist - do you know what these specialists are called?!

Thanks!
Dear Pam,

I am so sorry that I did not reply to your post sooner. Somehow I missed it. I will look into why I wasn't alerted to your question right away. I sincerely apologize.

Thank you so much for writing in to MyBestBirth and sharing your experiences around labor, deliver, and postpartum bonding. You are posing a question that I think a lot of women struggle with after birth - are my feelings valid? Am I the only person who feels this way? Why can't I "get over" these feelings?

Your thoughtfulness will do wonders for your one year old twins! I wonder what happened more specifically during labor and delivery and just afterward that has you feeling sad now and what may have occurred postpartum that left you worried that there was not enough time for bonding/attachment. It's very true that being present now is of central importance for you and for your babies. However, it does sound like you don't feel like you can be as present as you'd like to be and I wonder if you feel talking some more with a psychologist might be useful. You wrote that maybe it's "wishful thinking" that you can identify something that will help you heal. I don't think it's "wishful thinking" at all. I believe that exploring various aspects of pregnancy, labor, delivery, post-partum adjustments, and/or aspects of your own childhood which may be relevant to how you are feeling about bonding and attachment could be extremely useful in creating a sense of ease and grace in mothering. You and your twin babies can enjoy the benefits of attachment and bonding even more as you start to feel you have more understanding of what has created a chasm.

You are not alone in these feelings. Do know that it is not too late to develop a deeper understanding of yourself and your babies. Your curiosity and commitment to being available as a mommy will have a positive impact on your relationship with your growing children. Gaining more insight through reaching out for help will bring greater comfort for all of you.

Please let me know if I can be of more help.
Wishing you all the best,
Jessica

Pam said:
Dear Jessica,

I'm not even sure exactly what to ask. I guess I am wondering whether there tend to be certain characteristics or traits in some women that make it harder for them to "get over" their birth experience than others? I know my labour experience wasn't nearly as bad as those of some women I know, and yet they don't seem to obsess about their deliveries. Yet, I'm really struggling. I've talked to a psychologist a few times, and while that helped some, I feel like I'm overlooking some key aspect that is the essential problem, and that if I could just identify it, I could heal a little. (Maybe that's just wishful thinking though.)

My twins are nearly a year old, and I still often lie awake at night thinking about the hospital experience, sometimes crying. I watched _The Business of Being Born_ last week and cried throughout. I can't figure out exactly what it is that I am hung up on that I can't move past. One of the things I obsess about is that my babies and I missed out on bonding after birth. The ironic thing is that my worrying about this now is making me miss opportunities to bond with them in the present. Of course it's too late to go back and change the hospital experiece, so I want to find a way to stop that experience from affecting my current opportunities to bond with them.

I could tell you more about my labour story if that would help, but I do just wonder whether there tend to be certain things about some women that make it hard for them to recover--and if so, what some of them are--so I can get some ideas about how I might try to move past this event that seems to be exerting so much influence on me and my relationship with the babies. I'm tired of being sad, and I don't want my babies to have a sad mother.

Pam
Hi Jessica,

Thanks for your encouraging response. Sorry I didn't reply sooner--I didn't realize you'd responded. I'm not sure if you're still doing this, but I will say a little more in response to your note.

I realized there was a risk of lots of interventions & complication with twins but I was hoping for a fairly natural birth. The first part of my labour was fantastic. I got to 9cm within just a few hours, was managing the pain fine, and felt exhilirated that it was going so well. Then when I got into the labour room, the obs talked me into an epidural. I trusted them and took it. I am really angry with myself about this, because I feel that's when everything started to "go downhill." I was left to push for about an hour but I could tell it was totally ineffective. I couldn't feel a thing, my husband was having trouble reading the monitor and telling me when to push... I am also angry that I didn't get help with this. The obs came back and told me what I was doing wasn't working (so I felt like a big failure and then starting crying and pretty much didn't stop after that). After a last-ditch attempt with lots of "cheerleading", the heart rates were dropping, there was meconium, etc, and I ended up having a C-section before the anathesetic could take effect, so I could feel the pain of them cutting and pulling the babies out. (Surprisingly, though it was very traumatic at the time, this part is not what troubles me most.

When I have my "flashbacks" that make me cry, I think of my futile pushing, the doctors telling me I wasn't successful. And also I remember being alone afterwards. I sent my husband after the babies, who were in different nurseries--one in the regular one, one in ICU. (This was a mistake in retrospect). While he was running back and forth helplessly, I was alone and shaking violently, and not knowing why I thought I was going into shock. (there was a nurse, there, but...) I had always imagined that right after birth I'd be blissfully cradling my baby(ies), trying to breastfeed, happy, my husband beside me... But I didn't know where my babies were, and I never felt so alone. (Even right after the babies came out, by the time I saw them they were swaddled like mummies and I couldn't really touch them and then they were taken away.)

I had the babies at 6:30 a.m.. I got to see one fairly soon after I got put into a room, I think. The one in ICU (he was just there because he was small-nothing was wrong)--they kept telling me "later, maybe late afternoon" I could see him. I was beccoming increasingly frantic to see him, almost an animal-like panic. I begged and begged the nurses until they finally took me to see him. It wasn't much of a meeting, since I was vomitting and trying not to faint.

The thing that haunts me most--there's a scene in _the Business of Being Born_ where the baby is all alone and crying right after birth. I am so afraid that's what it was like for my two.

I feel like we missed our early bonding, and I can't get past my grief over that. Now it's overshadowing current opportunities to bond. Maybe there's no "normal" way to feel about your babies, but I can't help thinking my feelings aren't normal. Somehow I need to get past this experience and the memories and try to start from scratch with them. They are wonderful little kids and they deserve better.

Pam
Chelly said:
Hi Jessica,

Our baby is almost 5 months old. We had a wonderful at home birth with no complications. Not sure if this is your expertise but really need some help in this area... When my husband and I try to have intercourse it is very painful. It hurts about an inch in and on the 'side walls' if that makes sense, so it has nothing to do with any tears on outside. My husband's convinced that I just need to warm up with some foreplay but honestly I don't see how we would have the time to do foreplay and really I'm not ready for it to feel good but I don't want to be in so much pain either. I thought it may be vaginimus, however when I just use my fingers trying to find where it hurts, even then it hurts and I'm completely relaxed.

I've been told that OBGYN isn't that skilled in this area and need to meet with a pelvis specialist - do you know what these specialists are called?!

Thanks!
As a Lamaze Certified Childbirth Educator, PA and mother of three, I would also like to add that I believe women STRONGLY respond to the repeated encouragement that, in most cases, childbirth is a NORMAL process that occurs without complication. So many of the "complications" that do arise are directly related to the medical interventions we decide to utilize. For the woman who approaches her birth experience on the fence about pain meds, etc., having a few confident, positive people encouraging the capability of her and her body will help her to feel more calm, confident and empowered. These emotions tend to lead to a "better" birth-less complications, and less regret/frustration/confusion afterward.
Kimmelin Hull, PA-C, LCCE
www.pregnancytoparenthood.org

Dr. Jessica Zucker said:
Dear Rachel,
Thank you for your thoughtful question. It is refreshing and very insightful that you are considering how to make women's experiences of labor and delivery less traumatic. It would be a much safer system to navigate if more people were thinking about how women were feeling throughout the birthing process and how their memories of labor and delivery may impact post-partum adjustments. Here are some thoughts:

* Many women and couples that I work with report that their experience was nothing like they had "planned" or "pictured". Expectations of how the birthing process will unfold is tricky because birth is one of the first important moments in parenting- a moment when new parents may realize that their ideas of how the birth should take place may or may not be possible based on a myriad of issues. Women have expressed to me that their dreams were dashed (i.e. they hoped for a home birth and ended up with a c-section) and wished they had understood their expectations more clearly beforehand. Feelings of shame/regret/depression/anxiety may emerge as a consequence of not meeting a hope/goal that was established prior to laboring.
* Many new mothers have spoken about feeling alienated by hospital staff members who did not seem to take them seriously (i.e. they created a birth wish list stating they did not want an epidural and felt the nurses did not exhibit respect). Birthing mothers want to be informed and part of the decision making process during labor and delivery.
* Those who have experienced sexual abuse may have traumatic memories emerge during the birthing process and may benefit from support during and after delivery.
* Overall, creating an atmosphere of comfort, safety, and choice will allow for a less traumatic labor and delivery

Please feel free to ask me further questions.
Best of luck to you,
Dr. Zucker

Rachel Leavitt said:
Dr. Zucker-I am a labor and delivery nurse and I am really wanting to try and make the whole birth/labor less traumatic for mothers. I was just curious what sort of issues you see with women later down the road that relates to their birth/labor and how I could help alleviate that to begin with as their nurse. Thanks, Rachel

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