Metamucil, carpal tunnel and AROM
Welcome to the weekly ZIP - your Zenith Informed Pregnancy!
Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research.
This week's top pregnancy questions:
1️⃣ Is carpal tunnel a normal pregnancy symptom? Why does it happen?
2️⃣ What’s AROM and what are the pros/cons?
3️⃣ Can I use metamucil during pregnancy?
Is carpal tunnel a normal pregnancy symptom? Why does it happen?
A tingling or prickly feeling in your hands is one of those symptoms leaving moms saying Huh?? How could this possibly be pregnancy related? Alas, there is a reason it happens more than you’d think (up to ~1 in 3 moms experiences it!) during pregnancy specifically - so here’s what the science says about why.
📚The tl;dr from the evidence: Unfortunately, yes - carpal tunnel syndrome is a common and “normal” pregnancy symptom, that on its own isn’t usually cause for concern. It can feel like a numbness, “pins and needles” sensation, or tingling in your thumb/first few fingers, hand pain, or weakness in your grip. It’s a result of the median nerve (which passes through the yes, carpal tunnel - a narrow, rigid passage in the wrist) getting squeezed – as the median nerve is what provides feeling to your thumb, index, middle and ring fingers. It’s mainly uncomfortable, not harmful - wearing a wrist splint at night is often the primary approach used to manage the discomfort.
It can happen more easily and frequently during pregnancy, even for people who’ve never experienced it before, because of both hormonal changes (of course!) leading to increased relaxin and changes in the ligament that runs over the carpal tunnel, and increased swelling/fluid retention. Swelling in or around the wrist can increase pressure inside the carpal tunnel, and compress the nerve. It’s most common to begin experiencing this symptom later on in pregnancy, especially after ~32 weeks (when fluid shifts are getting bigger).
Pregnancy-related carpal tunnel syndrome is often temporary and resolves after birth, as your body’s hormone levels and fluid retention shift back to their pre-pregnancy levels, although some studies have shown that a smaller percentage of women do have symptoms that can persist postpartum. If you have severe symptoms (incessant numbness, or serious weakness/dropping things due to inability to hold a grip) or your symptoms don’t go away in the first few weeks postpartum, you should work with your doctor and/or a physical therapist on a plan to manage treatment approaches for your comfort and function.
👀 Read Penny’s full summary of the evidence for more on carpal tunnel syndrome
What’s AROM and what are the pros/cons?
Moms tend to have strong opinions and have learned a bunch about about labor induction, but AROM is a term (and procedure) that often comes as more of a surprise – sometimes not until a provider is asking for consent mid-labor. Here's what it is, why it's sometimes used, and what the tradeoffs actually look like so if it comes up during your labor and birth, you’re not caught off guard.
📚The tl;dr from the evidence: AROM stands for artificial rupture of membranes, which means “breaking your water” – it’s when a doctor makes a small opening in the amniotic sac to release the fluid (it’s also referred to as “amniotomy,” if you hear that term).
The idea is that releasing the amniotic fluid lets the baby's head put more direct pressure on the cervix, which can stimulate prostaglandin release and speed up or strengthen contractions. Evidence supports that AROM can shorten active labor, especially when it’s being used as part of an induction. It’s most often used to help move into active labor as part of an induction when the cervix has already been ripened (e.g. with a foley balloon, or with prostaglandin), or to help with slow progress when labor has already started (labor “augmentation”).
Some of the key risks/considerations: Once membranes are ruptured, a clock starts – many providers have time-based protocols for delivery (typically 18-24 hours) due to potential increased infection risk. Infection risk may rise the longer membranes are ruptured (e.g. total time from “water broken” to delivery), although the evidence is mixed on whether rates of chorioamnionitis (infection of the membranes/amniotic fluid) are actually increased with AROM. Before recommending AROM, your doctor will typically confirm that the baby's head is engaged and low in the pelvis (which lowers cord prolapse risk - an uncommon but serious complication where the umbilical cord slips down ahead of the baby) and rule out placenta previa, which is rare but relevant since rupturing membranes could cause bleeding.
As a result of these tradeoffs, guidelines support selective and individualized, not routine, use. If your provider suggests it, it's worth asking: what's the main reason you’re recommending it right now, and what happens/what are the alternatives if we wait?
👀 Read Penny’s full summary of the evidence for more on artificial rupture of membranes
Can I use metamucil during pregnancy?
Constipation doesn't get much airtime – it's not exactly the symptom anyone's rushing to post about or bring up with friends, but it affects roughly half of pregnant women at some point. Is metamucil safe? Here’s what the data says.
📚The tl;dr from the evidence: Metamucil is a fiber supplement designed to make bowel movements easier. Psyllium fiber is the active ingredient, and is considered a safe option during pregnancy as it’s not absorbed into the bloodstream in any meaningful amount.
Psyllium is a bulk-forming fiber – so unlike stimulant laxatives (like senna, or bisacodyl), it works mechanically rather than pharmacologically (it absorbs water and bulks up stool to help it move along). This means it does need water to work, and taking it without adequate hydration can actually make constipation worse. Pregnancy constipation is much more likely when low fiber intake is linked with low fluid intake, so increasing fiber (via diet and/or supplementation) and hydration is a "first line" choice to see if it improves your symptoms.
One caveat is that it can actually reduce absorption of some other medications, so it’s often advised to avoid taking it within 2 hours of other medications (e.g. your prenatal vitamin, supplemental iron, or any other medications you’re taking).
👀 Read Penny’s full summary of the evidence for more on metamucil
🤓 Zenith's top read of the week
Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!
Launching a National Effort to Improve Postpartum Hemorrhage Outcomes (Julia Resnick, American Hospital Association) - Postpartum hemorrhage (PPH) is a serious complication that can be life threatening to moms - and while there are several known risk factors, it’s estimated that ~20 up to ~40% of cases occur in women with no known risk factors at all. This means that there’s a huge need for proactive and accurate monitoring for new mothers in the hours and days following birth.
This new announcement comes out of a collaboration (the Safer Births Postpartum Hemorrhage Collaborative) between Epic, provider of electronic health record systems, and the American Hospital Association, aiming to achieve just that - better systematic preparation for and digital tools to support the monitoring for and early detection of PPH. Providers of all types and sizes are participating in this initiative, from rural critical access hospitals to multistate health systems. It’s great to see momentum for collaboration and better systems to catch PPH early and prevent the most serious outcomes!
Key excerpt:
“Occurring in 3% to 5% of all deliveries, PPH is responsible for 14.1% of maternal deaths in the United States. It also is the leading cause of severe maternal morbidity. Notably, 40% of such hemorrhages occur in patients without any risk factors.
Early detection and treatment of PPH are critical to ensure a full recovery. Fortunately, most cases are not life threatening if managed promptly. Incorporating tools into electronic health records and labor and delivery workflows can enhance providers’ ability to effectively diagnose and treat PPH.”