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Expert Q&A

	By Rachel Wickersham Doula

I'm worried about my daughter, who has toxemia due to pregnancy. She delivered a 10-pound baby two weeks ago by Cesarean section. She was sent home with extreme swelling in her hands and feet, and she was told there was no medication to give her and that it would go away. The swelling is still there, and depression is setting in. What can I do?

Usually, toxemia of pregnancy occurs before the birth, and symptoms disappear after the birth. Swelling, however, can sometimes take a while to go down. If your daughter has checked it out with her caregiver and has been assured it is normal and will go away, then as a doula, my primary concern would be to help her stay comfortable until the swelling goes down and also to help her deal with the depression that is setting in.

For the swelling, I would recommend she elevate her feet as often as possible. Also, as soon as her caregiver approves, I'd suggest submerging herself in a bath, or better yet, a deep pool of water. Hydrostatic pressure of water can push fluid that is trapped in tissues back into the blood stream where it can be eliminated by the kidneys. Postpartum massage may also be helpful. It can also help her feel nurtured, which may lift her spirits.

As for the depression, it is not unusual for a woman who has had a medical complication in late pregnancy and a resultant surgical delivery to feel depressed. In addition to adjusting to new motherhood, this mother must recover from major surgery and get over the fear that she may have felt when diagnosed with toxemia, a potentially life-threatening condition.

A postpartum doula visiting on a regular basis could help your daughter with her physical recovery and her emotional healing. By physically assisting her with the care and feeding of her baby and by affirming her mothering skills and instincts, the doula promotes a healthy parent-child bond. By doing light housework, preparing a nutritious meal, tending to the baby so Mom can nap and perhaps drawing up a daily relaxation bath (after baths have been approved by her caregiver), she can nurture your daughter though her physical recovery. And by simply listening to her with a trained ear as she processes her feelings about the birth and about her slow healing, the doula can promote emotional recovery. Doulas are trained to recognize signs of normal adjustment and are also aware of warning signs of the "baby blues" or signs of serious depression. So if your daughter appears to need more than simply "to process," the doula can make an appropriate referral.

Overall, I'd highly recommend doula care for anyone in your daughter's situation. It can make the difference between a difficult adjustment and a smoother, more enjoyable one.

Congratulations on the birth of your grandbaby!

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