Troubled Pregnancies Can Mean Years of Health Problems
Melody Lynch-Kimery had a fairly routine pregnancy. But when she got to the hospital for delivery, she says things quickly turned dangerous.
After an emergency cesarean section, Lynch-Kimery hemorrhaged, and lost about half of the blood in her body.
“I just kept thinking ‘I’m not going to die. I'm not going to die. I'm not going to let you let me die,’” she says.
After her traumatic delivery, Lynch-Kimery spent a week in the hospital. She went home with her newborn daughter, Sawyer, thinking her delivery complications were resolved.
About three months later, she started to feel pain in her lower abdomen.
“Just randomly one day I started to have a lot of burning, just a lot of cramping, a lot of pain around my scar area,” Lynch-Kimery says.
She spent months seeing doctors and researching her symptoms online. The pain, she eventually learned, was most likely caused by scar tissue surrounding her C-section scar.
About a third of all deliveries are by C-section according to the Centers for Disease Control and Prevention.
“Anywhere from 6 to 18 percent of those will end up with chronic pain in their scar,” says Jennifer Wasserman, a physical therapist who studies chronic pain after C-sections.
Chronic pain is one of many health concerns that women can struggle with after giving birth. Women like Lynch-Kimery who have complicated pregnancies or deliveries can see long-lasting effects to their physical and mental health.
Among developed countries, the United States has the highest rate of pregnant women and new mothers dying. And for every woman who dies, dozens more come close.
Rates of maternal mortality are particularly high for women of color like Lynch-Kimery, who is half black.
Many women who become pregnant already have chronic conditions like high blood pressure and obesity that can negatively impact their pregnancy and future health. Others develop health problems during pregnancy.
The two major pregnancy and delivery complications women face are preeclampsia, or high blood pressure, and gestational diabetes, or diabetes that develops during pregnancy.
“Both of these conditions are associated with basically a doubling in their lifelong risk for cardiovascular disease,” says Dr. Lisa Hollier, president of the American College of Obstetricians and Gynecologists. “What we’re seeing is that pregnancy can act as sort of a natural stress test.”
Hollier says most dangerous pregnancy complications clear up after delivery. But some women see a long-lasting impact.
A 2017 review of studies found that women with gestational diabetes, preeclampsia and preterm delivery had higher risks of heart disease, diabetes and stroke.
“The fact that [a woman] has these complications during pregnancy, it can be used as a warning sign to her and to her physician that she is at future risk for long-term problems,” Hollier says.
Mental health problems can also develop.
“Some situations, like having a pre-term birth of a baby that goes to the neonatal intensive care unit, are also associated with a mom developing postpartum depression,” Hollier says. “It’s really important to be sure that a woman is receiving integrated care so that her mental health is not seen as completely separate from her physical health.”
Lack of postpartum care
One problem is that many women don’t seek medical care after delivery. Women are told to see their doctor between six and 12 weeks after giving birth. But 20 to 40 percent of women don’t go to that appointment. Those rates are even worse for mothers on Medicaid; they account for more than half of all births.
And 15 percent of women don’t have a primary care doctor after delivery.
“Women who are young don’t go to the doctor every year unless they’ve got a problem, so they’re not being monitored,” says Susan Groth, a nurse and associate professor in the school of nursing at the University of Rochester in New York.
With a grant from the National Institutes of Health, Groth will study how pregnancy affects healthy women three years following delivery.
She says this study will fill gaps in research, which in the past has focused on a mother’s health only a few months following delivery.
“The studies have not looked at women long enough to see really what changes over time,” Groth says. “Does pregnancy make a difference in their health, or is that really just this incident that happens and then everybody goes back to normal?”
The "fourth trimester”
The College of Obstetricians and Gynecologists also now recommends that women see their doctor three weeks after delivery – or sooner, if there are complications.
“Women with high blood pressure, for example, are often seen within the first five to seven days after the delivery,” Hollier says. “We really believe that to best optimize the health of women, the postpartum care should really be process, not a visit.”
And experts say care should continue long after one postpartum visit. They call it the “fourth trimester.”
During this period, doctors transition women into routine care and connect them to follow up services, like physical therapy.
Lynch-Kimery travels an hour from her home in Bloomington to Indianapolis every few weeks to see physical therapist Camille Fenwick.
“So tell me how you been feeling since I’ve seen you last,” Fenwick asks to start the appointment.
Lynch-Kimery says her pain has been “on and off.” It’s better after stretching, which Fenwick has shown her how to do safely in previous sessions. The pain is worse when she exercises too long.
Fenwick then massages along the six-inch C-section scar on Lynch-Kimery's lower abdomen.
“I’m kind of going across that scar and getting those little muscles around it to help it to loosen up a little bit,” Fenwick explains. "I'm kind of feeling for any stuck kind of places or check and see as far as pain that she may have while I’m doing it.”
Then, Lynch-Kimery stretches on an exercise ball and with a Pilates reformer machine, working to strengthen her core and pelvic floor.
Lynch-Kimery isn’t sure how long she’ll need therapy for her scar tissue pain. She says the cost of the sessions adds up. Those bills keep her from seeking other needed postpartum care, like therapy to address the trauma of her near-deadly delivery.
“I’d love to be free of it,” she says. “I’d love to not have to worry about it.”
For now, she’s focused on her daughter, and making the best of a health problem she never anticipated.
This story was produced by Side Effects Public Media, a news collaborative covering public health.
Editor's note: A previous version of the story mischaracterized Susan Groth's position.