Baby Clues
Information & advice on dealing with babies

RPOC stands for retained products of conception. This is where all or part of the placenta or membranes are left in the uterus during the final stage of labour. In most cases this is detected following the examination of the placenta after delivery.

Retained placenta can be caused by:

• failed separation due to failure of uterine contraction or morbid adherence e.g. to a fibroid or scar
• separated but retained due to e.g. a snapped cord contracted uterus, closed cervix

Reports suggest that retained placenta is one of the mosts common causes of postpartum haemorrhage.

There are a number of options for treating RPOC here is the most commonly used

Women with a retained placenta oxytocin injection into the umbilical vein with 20 IU of oxytocin in 20 ml of saline is recommended, followed by proximal clamping of the cord. If the placenta is still retained 30 minutes after oxytocin injection, or sooner if there is concern about the woman’s condition, women should be offered an assessment of the need to remove the placenta. Women should be informed that this assessment can be painful and they should be advised to have analgesia or even anaesthesia for this assessment

It is worth pointing out that this is very rare and that it very rarely causes any problems however in few cases a hysterectomy may be needed as a PPH occurs or a severe infection.

The pelvis consists of two halves which are connected at the front by a joint called the symphysis pubis, this joint is strengthened by ligaments which means that under normal circumstances, very little movement occurs, to make your baby’s passage through your pelvis as easy as possible, your body produces the hormone relaxin. This softens the ligaments which causes the joints to move more during and just after pregnancy. It is unclear what causes SPD but current thinking suggests that if one side of the pelvis moves more than the other when you move your legs, it can cause pain and inflammation of the symphysis pubis. Alot of women with SPD experience significant pain without any great separation of the joint which would suggest the amount of pain is not related to the degree of separation.

The most common symptoms of SPD are pain in the pubic area and groin. Other symptoms can include back pain, Pelvic Girdle Pain (PGP) or hip pain. It is common to feel a grinding or clicking in your pubic area and the pain may travel down the inside of the thighs or between your legs. The pain can be made worse by separating your legs, walking, going up or down stairs or moving around in bed, often it is worse at night and can stop you getting much sleep. Activities such as getting up to go to the toilet in the middle of the night can be especially painful.

If your doctor or midwife diagnoses you with SPD they should refer you to a physiotherapist. They will have experience in treating this complaint. SPD is diagnosed using your description of symptoms and a series of tests designed to look at the stability, movement and pain in your pelvic joints. SPD can’t be cured however the symptoms can be managed using:

• a pelvic support belt
• exercises for the tummy and pelvic floor muscles
• mobilisation (a gentler form of manipulation) of your hip, back or pelvis
• hydrotherapy

The physiotherapist will also give you advice on how to make daily activities less painful and on how to make the birth easier. In some cases a vaginal birth may not be possible so in these instances a Caesarean will be carried out.

There are a number of things you can do to help yourself

• Don’t push through any pain; if it hurts, where possible don’t do it. This can make your symptoms worse and will take longer to settle down
• Try to keep mobile, moving little and often.
• Rest regularly by sitting reasonably upright with your back well supported.
• Avoid heavy lifting or pushing

Research shows approximately 60% of women with SPD still experienced some symptoms after delivery. In the majority of cases women report their symptoms improve after the birth of their baby although a small percentage still have pain when their babies are a year old. You should continue with physiotherapy after the birth and get help with looking after your baby during the early weeks where possible. Some ex-sufferers find they experience pain every month just before their period is due, which is caused by hormones which have a similar effect to the pregnancy hormone relaxin.

The information on this page is the standard advice given for those of you where this isn’t your first child I know that the self help advice is easier said than done, just try to take it as easy as possible. It’s also worth pointing out that for some women as your baby gets bigger the SPD will deteriorate, in some cases you may be given crutches to help take some of the weight off your pelvis. You may find having warm baths and taking paracetamol may help your doctor may also be able to prescribe codeine to help ease the discomfort. Unfortunately in most cases it is simply a case of grit your teeth and bear it until the birth of your baby. For more information on various self help techniques and up to date information on this condition try visiting the Pelvic Partnership’s website

There is some queries with regards to the use of Tramadol to manage the pain, the simple answer in due to the fact that in it proved to be dangerous in the tests conducted on animals and the lack of human tests it is not advisable to use during pregnancy. It becomes less straightforward when looking at it as a treatment whilst breastfeeding the manufacturers advise against it because it passes into the breast milk. However it is believed that the amount is very low as so some argue that it is safe to use while breastfeeding.

Post-Partum Haemorrhage (PPH) is excessive bleeding following the birth of your baby. There are 2 types of PPH; primary and secondary.

Primary PPH is blood loss of over 500ml within 24 hours of delivery. It is the most common type of PPH, below are some of the most common causes:

• Uterine Atony – for those of you who don’t know this is simply the loss of muscle tone in the uterus; normally the uterus contracts which compresses the vessels and reduces the blood flow; if you have a uterine atony the lack of contraction can cause acute bleeds. It is estimated that 75-80% of PPH is a result of uterine atony.
• Retained Placenta – This can be all or part of the placenta.
• Lacerations of the Vagina or Vulva
• Hematoma – This is the collection of blood outside the blood vessels and can be caused by an internal bleed

Secondary PPH is defined as abnormal bleeding from 24 hours up to 6 weeks after giving birth.
The two most common causes of secondary PPH are:

• Infection- endometritis. Occurs in 1-3% after spontaneous vaginal delivery. It is the most common cause of postnatal morbidity between day 2 and day 10. At this point I should point out that if you have an infection following delivery it does not mean that you have Secondary PPH or will necessarily develop it as you can see from the percentage of cases it is quite rare.
• Retained products of conception (RPOC) – This is usually in cases where the placenta is incomplete or if the pregnancy has been terminated and there has been some foetal tissue left behind, again this is very rare and is usually detected before it causes any problems.

Both Primary and Secondary PPH are diagnosed following an examination of the genital tract, blood tests and in some cases a MSU (a urine sample). The good news is that both types of PPH are treatable having suffered from Primary PPH myself I know that if the facts are not explained to you it can seem very scary and this is perfectly normal if you experience either Primary or Secondary PPH and the medical professionals involved in your care don’t explain what is going just ask they will oblige and explain what is happening. I can verify this as when midwife realised I had a primary PPH it seemed like doctors and other medical staff seemed to appear from nowhere and it seemed like everyone had adopted panic stations and were talking amongst themselves, without telling me what was going on, I simply said “stop. Now, tell me what is happening.” The midwife apologised and explained what was going on and what they were going to about it.

It is important to point out that if you don’t understand you shouldn’t be afraid to ask because further down the line it may be relevant and it can save alot of time if you are able to supply them with the information rather them having to trawl through your entire medical file to gain the information. As I discovered with my second pregnancy because I had asked what was going on when I had complications with the first pregnancy I was able to answer the questions asked to gain treatment for a complication with this pregnancy faster as they didn’t have to trawl through over 20 years worth of notes.

Post-Natal Depression also called Post Post-Partum Depression (PPD) is a relatively common condition that occurs following the birth of a baby it is estimated that it occurs in approximately 10-15% of women; the severity of the condition can vary from mild depressive episodes commonly termed the “baby blues” through the spectrum to a very rare condition called “postnatal psychosis”.

The symptoms of PPD are like those which occur in ‘ordinary’ depression. These include:

• Feeling ‘low’, ‘miserable’ and tearful with no apparent reason. The feelings are present for most of the time, though they may be worse at certain times of day, particularly the morning.
• The inability to enjoy yourself. It is particularly prominent in new mothers who feel they aren’t enjoying having a new baby in the way they expected to. Which can lead to feeling of guilt which can compound the problem
• You may become irritable this could be with other children, the new baby and particularly with the partner.
• Disturbed sleeping patterns are a part of looking after a new baby. Mothers with PPD may find the additional problems of finding it hard to go to sleep even though you are tired, or waking early in the morning. In addition the lack of energy may be worse if you have PPD
• A decreased appetite can be another symptom of PPD which can become a problem since new mothers need all the energy they can get to look after their babies.
• Anxiety is a frequently occurring symptom in PPD. It can take many forms from being tense and ‘on edge’ all the time. The normal concerns any mother feels for a new baby may become overwhelming. Also some mothers report that they experience ‘panic attacks’ which are episodes lasting several minutes when they feel as if something catastrophic is about to happen – such as collapsing, having a heart attack or stroke.
• Feelings of being ‘worthless’ and ‘hopeless’. These are common in PPD. All mothers are faced with new and sometimes difficult problems with a new baby. However, mothers with PND feel all the more ‘not able to cope’ and unable to see a way through their difficulties.

Nobody knows what causes PPD; although it is likely that there are several factors. Following childbirth the hormone levels change combined with the stress of looking after a new baby and disturbed sleep. Mothers who have previously had mental health problems most commonly depressive episodes or if there is a family history of depression. Studies have also shown that significant life events during pregnancy, unplanned pregnancies and babies who are born with some kind of defect can also mean that the mother is more likely to develop PPD.

PPD is very treatable and is treated using the same methods as “normal” depression (antidepressants, therapy).Getting extra support and help with looking after the baby is also important. In instances where antidepressants are necessary it can cause problems with breastfeeding, since some drugs get into breast milk, however there are drugs that are safe. You should remember that the most important thing both from the baby’s and your point of view is to get better as quickly as possible. There are a few things that you are able to do to help. Depression is an illness and you are not suffering from it because you are weak or hopeless. Also remember that it is very common and that it will get better. Don’t worry that you will lose your baby. When mothers have PPD they often think that they are poor mothers and that if they speak to somebody like their GP, they will have their baby taken from them. This will NOT happen. What will happen is that you will get the help that you need to get rid of the PPD. Having a baby is tiring and stressful for any mother, you will not be able to manage all the things that you did before the birth. Reduce your commitments and accept help when it is offered. It is important that if you have a partner that you involve your partner. Having a young baby will be difficult for him too and he will be concerned about your illness. Encourage him to speak to your health visitor or GP so they can understand the illness you have, it is also important that you make time for yourself and with your partner. I can’t stress enough that if you have PPD it is NOT your fault and that with support it will help end the episode of illness as quickly as possible.

Mothers with PPD often worry about harming their babies, or not looking after them properly; generally they look after their children at least as well as other mothers. Unfortunately mothers and other family members do sometimes harm babies (battered babies). Very rarely a mother with postnatal psychosis may harm her child, this may be because she is suffering from false beliefs (delusions) such as that the child is terminally ill. Another option is that mothers may kill their babies before committing suicide themselves thinking that it is better for both of them to be dead. It is important to stress that cases are very rare and that PPD and postnatal psychosis are treatable illnesses and the sooner they are treated the better. If you have any worries that you may harm your baby, or you have worries that a mum you know may harm their child, speak to a health visitor or doctor as soon as possible. Due to the current system health professionals monitor the situation very closely however they are not mind readers if you feel that you may be experiencing PPD it is important to express these concerns to your health visitor.

Having suffered from PPD myself I can’t stress the importance of getting help as early as possible and it is NOT your fault and there is nothing you can do to prevent PPD and it is possible to have a normal life after the illness is treated and cured. My daughter is now 2 and we have a happy and healthy relationship