You Gotta Pee
Do you recall your doctor or midwife nagging you about drinking water during labour and possibly after you gave birth (assuming you were allowed to drink if you gave birth at a hospital)? Did they also nag you about peeing during labour and soon after giving birth? When I asked folks online what they wanted me to talk about in future posts, I had several people say that Postpartum Urinary Retention was a thing they experienced and no one prepared them for it.
What Is Postpartum Urinary Retention (PPUR)?
Depending on what you read, PPUR is something that can occur at up to 20% of births. It is usually defined as either not completely emptying the bladder when urinating after birth or the inability to urinate at all within approximately six hours after birth.
Changes in the pregnant body effect various organs in different ways. Because the bladder and uterus are so close to one another, often the pressure placed on the bladder by the uterus, baby, and pushing during birth can affect how the bladder performs. Sensations of a full bladder or the need to urinate can be muted somewhat because of excessive pressure or in births when an epidural is used. PPUR is more likely to happen after a cesarean birth, a primary vaginal birth*, and when an epidural is used. Just because these three factors are more likely to occur in hospital births, it does not mean that people giving birth at home are exempt from experiencing PPUR. Additional risk factors for PPUR can be episiotomy, vaginal tears, and giving birth to babies weighing over 4000g (8lb 13oz).
*While there are plenty of primary births that are planned homebirths, the vast majority of them still occur in hospital. Many primary vaginal births after a cesarean birth(s) occur as planned homebirths (VBACs/HBACs); PPUR is a likely complication at these births.
Why Is PPUR a Complication?
Aside from possibly causing a new parent pain or discomfort from a distended bladder, a distended bladder from PPUR can contribute to a risk of postpartum hemorrhage. PPUR induced hemorrhage happens because the distended bladder can keep a uterus from contracting effectively, keeping it from adequately constricting the blood vessels at the site where the placenta was attached. PPUR can also make birthing the placenta more difficult if the distended bladder is in the way. PPUR can require the use of repeated catheterisation for treatment, which can cause a UTI. Additionally, severe or mismanaged PPUR can lead to bladder dysfunction and urinary incontinence.
How Is PPUR Prevented And Treated?
Most "treatment" is proactive preventative measures such as:
encouraging frequent urination during labour,
encouraging upright positions during labour and immediate postpartum,
walking soon after giving birth,
client given plenty of privacy in the immediate postpartum period,
and warm baths or showers in the immediate postpartum period
If none of the above help a client empty their bladder on their own after birth in the six hours, using a catheter* to empty the bladder is the next option. Antibiotics may also be employed to avoid possible bladder or kidney infection if retention continues and repeated catheterisation is required.
*In PA most homebirth midwives do not carry or utilise catheters and carrying or administering antibiotics is not legal for non-nurse midwives. As a result, a non-emergency postpartum transfer to hospital would be necessary if PPUR is suspected.
And that is the basics of Postpartum Urinary Retention.
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