MICA Month 2021: Standing Up for Those Who Can’t

May, the month we celebrate mothers, launches our fourth annual MICA Month. Standing Up for Those Who Can’t is our theme to advocate and to educate globally regarding maternal nerve injury from childbirth birth awareness.

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Mental Health After Femoral Nerve Damage

An incredibly strong mama shares with us today her mental journey with femoral nerve damage. Her powerful story truly shows that this injury reaches far beyond our lower extremities. It affects every aspect of life after having a baby. Thank you so much for being brave enough to share this story with us and helping so many others by doing so.


Once the physical healing is done, it seems that everyone else move’s on without a second thought. Sometimes it feels like friends and family do not care anymore, and that is understandable simply because they do not know the full struggle of this recovery.  Only those who have faced this challenge will ever understand the true impact this injury has on a mother, and coming to terms with what happened, to be okay with your experience, that can feel impossible.  

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Awareness and Education on “A Midwife Nation”

Jamie is a certified nurse midwife. Her goal is to help women through their pregnancy, birth, postpartum. She loves what she does and feels so blessed to walk alongside any woman’s joy or hardship, and truly believes that together we are stronger.

In February, Jamie posted a great blog post about lower extremity nerve injury that I’d love to share here. I so appreciate her helping spread the awareness and educating about nerve damage in the lower extremities from childbirth. To check out the original post (and her awesome website) go to https://amidwifenation.com/2021/02/03/women-ask-wednesday-what-is-lower-extremity-nerve-injury-and-can-it-happen-during-birth/. To contact Jamie, email her at amidwifenation@gmail.com.

Continue reading “Awareness and Education on “A Midwife Nation””

Awareness and Education on “A Midwife Nation”

Jamie is a certified nurse midwife. Her goal is to help women through their pregnancy, birth, postpartum. She loves what she does and feels so blessed to walk alongside any woman’s joy or hardship, and truly believes that together we are stronger.

In February, Jamie posted a great blog post about lower extremity nerve injury that I’d love to share here. I so appreciate her helping spread the awareness and educating about nerve damage in the lower extremities from childbirth. To check out the original post (and her awesome website) go to https://amidwifenation.com/2021/02/03/women-ask-wednesday-what-is-lower-extremity-nerve-injury-and-can-it-happen-during-birth/. To contact Jamie, email her at amidwifenation@gmail.com.


Women Ask Wednesday: What is lower extremity nerve injury? (And can it happen during birth?)

By Jamie Jamie Guertin

Hello! Today we’re chatting lower extremity nerve injury (LENI). I read an article in JOGNN (Journal of Obstetric, Gynecologic, & Neonatal Nursing) that was the impetus for today’s topic. After reading the article, I immediately reached out to my dear friend Chelsea – someone I knew personally that experienced LENI and asked if she would share her journey. She shared her story with us this past week (if you missed it, read it here and here!) and although she had a strong recovery, many women do not.

I asked her to share her story because I don’t think we talk enough about LENI as a risk factor of childbirth. I don’t remember having much education (if any) during my midwifery program on LENI. Nerve injury is on the birth consent in the facility I practice in, but it is often glossed over during counseling. Unfortunately, many women don’t actually read the consent and simply sign on the line where they are told. I’ve also seen women during postpartum visits that still struggle with some numbness in a foot or a leg and I wonder: How many women feel that their symptoms are “just normal” and they never say anything?

With that said, I think that there is an opportunity to educate women, nurses, providers (OB/GYNs, anesthesiologists/CRNAs), doulas, or any birth worker about LENI. More importantly, I think that we need to focus on prevention whenever possible as the standard and not the exception.

The content and references for today’s post are from the article published by Sleutel, True, Webb, et al. (2020) in the November issue of JOGNN and can be found here.

The authors did an outstanding job with the article. One of the reasons that LENI isn’t at the forefront of obstetric practice is because LENI is rarely mentioned in obstetric literature. Instead, LENI articles are most often published in anesthesia journals. I’m hoping the article by Sleutel, True, Webb, et al. (2020) paves the way for more articles on LENI in nursing and obstetric journals alike.

Let’s get into it! First, did you know nerve injuries from vaginal delivery are cited in literature back to the 1800s? The same nerve injury was also noted from farm workers in the 1900s – something called “strawberry pickers’ palsy” from all of the squatting involved in the occupation (Sleutel, True, Webb, et al., 2020). I had no idea! But I think it’s important to mention it’s not a new phenomenon and even more so to emphasize why talking about it is important.

The basics of nerve injury are simple: nerves are injured by stretching or compression. Symptoms of nerve damage vary among women but can manifest as numbness, paresthesia (tingling, pricking, chilling, burning), pain or loss of muscle function to the area affected (Sleutel, True, Webb, et al., 2020). In birth, a nerve injury can be devastating to the postpartum period – think of all the carrying, walking, diaper changing, etc. a new mama does for her babe.

The incidence of LENI is from five studies and ranges from 0.3%-2.3% depending on the study. Nerve injury can occur in vaginal births with and without anesthesia, operative births (birth assisted by use of vacuum or forceps) and cesarean sections with/without labor (Sleutel, True, Webb, et al., 2020). That’s every birth mode.

Most LENI cases are thought to be caused by positioning. Anesthesia, such as epidurals, are thought to mask early signs of nerve injury more than cause the injury (Sleutel, True, Webb, et al., 2020). This makes sense! If you wouldn’t lay with a peanut ball between your legs on your side for three hours on your couch at home, why would that be a good position in labor? Without anesthesia, your body would give you signs that you are uncomfortable in that position and that discomfort would prompt you to change positions.

Nerves are like any other tissue in the body – they need blood supply with oxygen. The femoral nerve and peroneal nerves are most commonly injured in LENI cases due to the nature of how the hips and knees are positioned in pushing (Sleutel, True, Webb, et al., 2020).

So, how do we work to prevent LENI in practice? Sleutel, True, Webb, et al. (2020) recommend these practices:

  • Educate birth workers in every discipline on the following equation:

STRETCH + COMPRESSION + TIME = INJURY

  • Laboring women should be encouraged to be mobile and change positions frequently
  • Hand position behind a woman’s knees should be placed to prevent deep tissue compression (especially near the lateral knee or posterior thigh)
  • Women should be educated on positions to avoid in labor to prevent LENI
  • Active pushing should be shortened to allow for passive descent
  • If LENI is diagnosed, a multidisciplinary team, including psychological support, should be employed “until full recovery is achieved” (p.520)
  • Lastly, if women voice concern or symptoms about the possibility of LENI, that the care team takes time to listen and address those concerns.

Going forward, Sleutel, True, Webb, et al. (2020) mention some really great points that I think are worth mentioning for any one working with birth (these are great long-term goals):

  • Electronic health systems should work to make documentation in labor, especially with positions, easy for care givers. The authors recommend offering pictures of birthing positions versus having to select or type out a position would as a great option.
  • Future publications should work to make consistent terminology to describe LENI
  • “Research is urgently needed on the effectiveness of preventative measures and optimal strategies to prevent recurrence with subsequent vaginal births” (p.521) – I love this recommendation, especially the use of the word urgent.
  • Qualitative research is recommended to evaluate women’s experiences of LENI

Wow. I just love everything about this article. It’s a great article to read if you have access to it – especially the review of the LENI articles previously published. If you work in birth settings, please take these recommendations to heart. Education about labor and birth starts in the clinic and LENI should be included in counseling and consent about birth as well as in the education women receive should they choose to receive anesthesia.

If you can’t access the article, you can read AWHONN’s practice brief for LENI for free. Either would be a wonderful journal club article to review with a team or unit!

Hope your Wednesday is lovely!

Hugs,

Jamie

References

Sleutel, M., True, B., Webb, J., Valdez, E., & Van Thi Tran, M. (2020). Integrative review of lower extremity nerve injury during vaginal birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 49(6), 507-524. https://doi.org/10.1016/j.jogn.2020.09.155

Nerve Damage Education and Advocacy Update

Today I would like to share huge news for the prevention of maternal nerve injuries! A big thank you to Jennifer Gibson Webb, RN, BSN, CCRN, and Martha Sleutel, PhD, RN, CNS, C-EFM for their tireless work and advocacy to the medical community on behalf of all women who have suffered nerve damage from childbirth in their lower extremities

In May, Jennifer and Martha presented virtually to the American College of Nurse Midwives conference about lower extremity nerve damage from childbirth. Then in November, they virtually presented protocols for the prevention of LENI ( Lower Extremity Nerve Injury) at the AWHONN ( Association of Women’s Health, Obstetrics and Neonatal Nursing) National Conference, which is a national conference for nurses. Jennifer was then was invited by AWHONN to record a podcast detailing her story, along with an anesthesiologist that helped rewrite some change in literature on the subject. This podcast was sent out to all members of AWHONN across the nation. They talk about nerve injuries from positioning and how to prevent them, what to look out for, and more. Check out the podcast here: https://open.spotify.com/episode/2gCHfucxuiTxnYc0e0xq31?si=29FwkFw8TSit-HxIjbFjXA

Additionally, the LENI protocols are being endorsed by AWHONN and were recently published in the Journal of Obstetric, Gynecologic and Neonatal Nursing. Please read more about the practice brief here: https://www.jognn.org/article/S0884-2175(20)30121-0/fulltext?fbclid=IwAR2vBVwM-g67tB5Z-4SByGk2EsCOgpg4n6v31lDIYxiQt5-GjEeXVDZ1Rwg

So grateful for all of this news! And thank you again to Jennifer and Martha!

A Miscarriage after Nerve Damage

October is Pregnancy and Infant Loss Awareness Month. It was started in 1988 to recognize the grief of bereaved parents and to show support to the families who have gone through such a tragic loss. As many as 1 in 4 known pregnancies end in miscarriage, but it can still be an incredibly lonely and isolating experience. So this October I decided to open up, share my experience with miscarriage, and hopefully help someone not feel as alone. I do want to warn that this story may be triggering for some. 


Deciding to have a second child ended up being a bigger decision than I had originally planned. I had always hoped for 3 kids and never questioned having at least 2. But after the labor and delivery of my first, I wasn’t so sure: 

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Foot Drop Awareness Day: 2 Years of Recovery

Today’s blog post is by Jodi M, who suffered from severe peroneal and tibial nerve damage in 2016 after the birth of her first child, resulting in foot drop. A huge thank you to her for all her advocacy work.


I cannot believe that this is my third year participating in National Foot Drop Awareness day!! As hard as 2020 has been, I am beyond blessed that my journey has lead me to be celebrating another year of foot drop recovery! I had never heard of foot drop until I sustained a nerve injury giving birth to my first child that resulted in severe damage to the peroneal and tibial nerves in both of my legs. I hope that my story can help others who are dealing with foot drop as well as bring about awareness of maternal nerve injuries.

My journey through foot drop began on July 29, 2016. I had been in labor 26 1/2 hours, I was exhausted from pushing for almost 3 hours, but my daughter was finally here and she was healthy (as well as almost 2 lbs larger than predicted)!! There was so much joy as I watched my daughter being held by my husband and then our parents. I have continued to hold onto this memory because the joy I was experiencing in that moment would soon turn into panic and confusion.

It had not even been a day since my daughter had been born that it became apparent something wasn’t right with my legs. The nurses couldn’t understand why my feet were still numb and couldn’t move even though it had been more than enough time for the epidural to wear off. I was sent to have an MRI of my spine. The results came back normal so a neurologist was ordered to come and examine me the next day.

“I’ve never seen anything like this before,” were the words that came from my neurologist’s mouth after she examined me. I remember hearing that and feeling any bit of hope I had drain from my body. If this neurologist who was clearly very educated had never seen an injury from childbirth like mine, what did my future look like? Would I ever walk again? After 4 MRIs, a spinal tap, steroids through an IV, and an EMG not one medical professional I met with while at the hospital could tell me. “I don’t think this is permanent,” was the most hopeful phrase I received from a doctor during my week long stay.

After I was discharged from the hospital I was sent home with no diagnosis, a walker, instructions not to use the shower (I did shower using a seat) or try to get in the bathtub, and to make sure that someone is with me at all times. It was so difficult to function doing every day tasks and completely impossible to take care of my newborn on my own. My mom had to live with my husband and I for almost a year to help me take care of my baby. My legs lost so much muscle in such a short amount of time that it took all I had to be able to get from one room to the other. It was also mentally exhausting because I had to concentrate on lifting my whole leg up and then placing (or slapping) my foot on the floor otherwise my toes would just drag behind. I began in home physical therapy at 2 weeks postpartum and graduated to outpatient physical therapy around 6 months postpartum. I was in physical therapy until 15 months postpartum.

My recovery came in stages from barely moving my big toe, to dealing with excruciating neuropathy, to wiggling all my toes and flexing my ankles. I would say that with the severity of my injury it took me about two years to be in a place where I felt my healing was complete. The sensation in my left foot has never completely returned to normal, but that doesn’t hinder me from being able to walk or function in my day to day life. I am very thankful to have recovered from such a severe injury and I am very blessed to say that I had my second child this July without a repeat injury!!

When I was 6 months postpartum I found a Facebook group called Moms with Femoral/Peroneal/Sciatic Nerve Damage From Labor/Delivery. I was immediately connected with other moms who had suffered nerve damage and I no longer felt alone. Since then I have become an admin of this group and have worked with the other admins to help grow the number of members from around 700 to 1700!! Through this group other resources have been created by the admins for maternal nerve injuries. Our website (www.nervedamagefromchildbirth.com) was created as an educational resource that didn’t really exist for newly injured moms. We also have two advocacy groups. Maternal Nerve Injury From Childbirth Awareness (MICA) was created by two of our admins who are mother and daughter and Unhindered Steps who was created by one of our admin’s sons. We all work very hard together to advocate and bring about awareness to these types of injuries that leave moms feeling completely alone.
I am very proud to work so closely with such a strong group of women!! I would not have been able to get through my recovery journey without them!

Happy National Foot Drop Awareness Day!!!

Keep pushing, keep exercising, keep hope: A story about foot drop

Today’s blog post features the tenacity of Farrah W, a mama who suffered from foot drop after the delivery of her child. Thank you, Farrah, for sharing your story. We wish you continued healing and success.


I joined this page (Moms with Femoral/Peroneal/Sciatic Nerve Damage from Labor and Delivery Facebook Group) years ago after having my first son in England on the Mildenhall Air Force base. I was a new and young mom; I was scared and had only the support of my son’s father. All of my family lived in the United States in Louisiana.

Toward the end of my pregnancy, I was experiencing nerve pain and a lot of health issues, so I was induced two weeks early. I didn’t really have a birth plan – I just had a good attitude/feeling about my birthing experience. I really thought it was going to be so magical and smooth. Everything started fine and I received an epidural with no problems.

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From labor to present, pain and neuropathy

Below is a Brooke’s story. She’s from regional Western Australia and suffered neuropathy in her foot and leg after giving birth. Brooke, thank you for sharing so much of your journey with all of us.


At 1:30pm, on my due date, my water broke.

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An Interview with “Someone You Should Meet”

Recently, nerve damage from childbirth was featured on Claire Renwick’s YouTube station “Someone You Should Meet.” Claire chatted with Paula Wroble, the founder of the facebook support group Moms with Femoral/Peroneal/Sciatic Nerve Damage from Labor/Delivery, and Martha Tutrani, the creator of MICA Month. So grab a cup of tea, maybe a box of tissues, and learn more about this injury and what we are trying to do about it:

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