Total Health Radio

After the Birth: What You Weren’t Expecting

Podcast published: July 9, 2014



Close up of mom with newborn

You’ve had a baby.  Now what?

Total Health Radio has had straight talk about pregnancy and truth telling about childbirth.  But what about those first days and weeks after giving birth?  In this episode, we focus less on the baby and more on the changes you are going through during that time – what’s normal, what’s not, and what may surprise you.  Packed with tips for making new moms more comfortable and advice on how spouses and partners can best provide support, this show is valuable listening for expectant parents – and the people who love them.

About the Guest
Amanda Calhoun, MD, is an obstetrics and gynecology doctor for Kaiser Permanente in Northern California.  You can follow Dr. Calhoun on Twitter: @kppregnancydoc

Episode Host
Farra Levin communicates for a living at Kaiser Permanente, and she loves talking about health topics and issues. Her passion comes through in her interviews – along with her humor and straight-talking attitude.  Read more about Farra.

Learn More
If you’re seeking more info on life immediately after childbirth and caring for yourself during that hectic time, these sites may help:


Transcript

FARRA: Hi everyone, this is Farra Levin, host for this episode of Total Health Radio. Regular listeners of Total Health Radio might notice that this show is a little bit different than our other shows. It’s a frank conversation about the first few months of motherhood, how crazy and hectic they might be, and some of the reality around the changes that your body goes through. Our Kaiser Permanente experts shared with us the questions that their patients ask the most — and even some of the questions that they’re too embarrassed to ask. What you might hear might make you blush or squirm in your chair a little bit, but we hope that this interview helps you, or the new mom in your life, prepare for what comes after the baby bump. Enjoy the show.

FARRA: Welcome to Total Health Radio, I’m your host, Farra Levin. In past shows, we’ve covered the not-so-pretty parts of pregnancy — and even childbirth. But ladies, brace yourselves, because today we’re here to talk about what it really means to become a new mom in those first few months. We are joined again by Amanda Calhoun, an OB-GYN with Kaiser Permanente in Northern California. Thanks so much for coming back!

DR. CALHOUN: Thanks so much for having me back!

FARRA: So we’ve done the, “I’m pregnant,” we’ve done the, “I’m pushing the kid out” childbirth show. Let’s look at the first 24 to 36 hours after birth. What should women expect?

DR. CALHOUN: So the first thing you’re going to worry about is your breastfeeding, usually. And to remember that the milk doesn’t really come in for a good few days. So, not to get frustrated, keep working on that latch, keep getting baby to breast at least every couple hours. They’re gonna need to do that, to be educated on how to breast feed and to get your milk supply in. Then there’s bleeding, there’s sore perineum…

FARRA: So let’s talk about that, because I think people plan for the breastfeeding – maybe, hopefully. But the actual pain afterwards, and the, “this is not my own body yet” feeling – what can women expect? What is normal and maybe what is not normal?

DR. CALHOUN: So there’s gonna be pain, especially with a tear and stitches in the perineum, which most first time moms will get. Make that ice pack out of a diaper for the first 24 hours, ‘cause your bottom will be really sore. Also use the squirt bottle, a little water squirt bottle when your urine’s coming out, because your urine will be concentrated, and when the urine hits the stitches, that can be very stingy. For our C-section moms, the key is to get ahead of your pain. It is having a baby, but it is also major abdominal surgery, so you’re going to need pain medication. You’re not gonna be an addict by taking narcotics for two weeks because you’re recovering from surgery. So get the pain medicine in on a regular basis, and then get up and moving around, because even though it’s sore, it really does help with healing.

FARRA: And, I know just from personal experience, when you’re in the hospital immediately following you sort of have that first stand up, when you’re actually gonna stand up and try and go to the bathroom—

DR. CALHOUN: And it’s like the Great Flood.

FARRA: Yes! You’re—you have this moment of panic. You get up to go to the bathroom for that first time, and wow, that’s not what you expect. It’s a little…

DR. CALHOUN: It’s dramatic!

FARRA: You feel like you’re bleeding out—you have this moment of like, “Is this normal?”

DR. CALHOUN: Right. And it is normal to have a huge gush of blood right after you deliver, and it will be sort of like the heaviest period of your life for that first day. But then it really does taper down. And if you have a C-section, it’s going to be less than if you have a vaginal delivery. And if you’ve had kids before, it’s going to be more than if you—if it’s your first kid.

FARRA: So now we’ve talked about this huge amount of blood gushing out, and probably the first thing you want to do is take a shower or a bath, yes? No?

DR. CALHOUN: Yes, definitely a shower. It’ll make you feel more like a human, and also, especially if you have an incision, after the first day or two it’s nice to flush out your incision with a little bit of water. Bath we don’t recommend until you’ve stopped bleeding, but little sitz bathes, little splash-arounds of the perineum, especially if you have stitches, can be quite soothing.

FARRA: And that’s again where that water bottle will help, too, right? Putting that water bottle down there.

DR. CALHOUN: Absolutely right.

FARRA: And is that just normal water, or should you mix that with something else?

DR. CALHOUN: No, just warm water is fine.

FARRA: So is it expected that you will be able to immediately urinate, and then even have a bowel movement? I think that that first one might be a little scary?

DR. CALHOUN: It is frightening to have your first bowel movement, especially if you have stitches. Because you’re so worried about it. Also, a lot of pain medications can cause constipation. And breastfeeding, in and of itself, can cause constipation. And God forbid, if you’re on iron from having lost blood, that can cause constipation, too. And that kind of straining can be really difficult, particularly if you have hemorrhoids on top of it. So staying really well hydrated—high fiber, stool softeners, all those things will help you for that first bowel movement. Now it might take some time; it might take a few days for that first bowel movement to come, particularly because you won’t be eating anything very heavy in labor and in that first day or so. But be gentle, take your time and make sure that you’re hydrating really well.

FARRA: Well, plus they probably pooped during delivery, right? So it’s not like it’s been that long!

DR. CALHOUN: Correct, correct. We always say, “If you’re pooping during delivery, that means that you’re pushing in the right space.” Because it’s exactly that same movement of your pelvic floor muscles that makes you defecate, that helps you push out a baby.

FARRA: So you have gone maybe more recently than you thought…

DR. CALHOUN: Potentially you have just pooped on your obstetrician, but we’re used to it. It’s fine. We just wipe it tidily up and keep going!

FARRA: Perfect. We’ve done the first 24 to 36 hours after birth, and that’s probably also when that support system in the hospital’s really helpful. And then, for some reason, people think it’s OK to send you home with the baby, and you have this moment of, “I don’t know what to do with this baby!” So you get home and it’s great, and everyone comes and says, “Hi,” and then they all kind of go away. And you’re here with this baby that you have no idea how to take care of. So you’re learning that. But I think the thing that we really want to talk about is, what is the mom going through? So the baby—they have their own set of issues in terms of what we need to do to take care of them, but what can a mom expect in that first week, being home?

DR. CALHOUN: So it’s a big transition, especially for first time moms. Your uterus is cramping, or you’re recovering from your C-section incision. You’re still bleeding like a heavy period. Your breast milk comes in, and that can be quite dramatic. The breasts get really swollen, really heavy, and very full. And it’s like a common time for engorgement, so breast massage and a hot shower, or pumping a little bit after you nurse, can really make a difference. That’s usually the biggest challenge in that first week. On top of it, of course, it’s getting your breastfeeding down and making sure that you’re finding a comfortable position at home, which might be different from what you were doing in the hospital. Other thing that’s huge is your sleep. For people who aren’t used to sleeplessness, that can be very challenging. Remember that in Vietnam, sleeplessness was used as a form of torture because it does really make you feel a little bit crazy. So you’ve got to try to sleep when the baby sleeps, and whether it’s your partner, your sister, your mom, your friend, whoever’s there around with you, let them, again, do the swaddling, do the diaper changing so that you can get some rest. You should pretty much be living in your bathrobe and flip-flops for the entire first couple weeks at home. And then try to sleep if you can, and at the very least, rest, try to close your eyes a little, read a little bit of a book till you fall asleep, but definitely avoid the screens, because they can mess up your sleep cycle even more than the baby.

FARRA: Do people find, like hot flashes or sweating after having babies and going home? That sort of—you feel like you’re going a little bit crazy in your body?

DR. CALHOUN: Absolutely…absolutely. And then there’s the baby blues on top of it, which is all linked into those huge hormonal changes. So as you said, there are the hot flashes, there’s the sleeplessness, there’s a little bit of tearfulness, which is usually hormone changes. Also, just the life is very different. All the attention was on you, and now all that attention is on baby. And there’s a little bit of that, “Hey, what about me? I’m recovering from this big event; I need some attention, too.” So there’s so many shifts, both in your body and in your psyche, that it’s really a time that you need support.

FARRA: So is this when we start to have the conversation about postpartum?

DR. CALHOUN: I think it’s good to have that conversation, but at this point, usually it’s baby blues, if you’re talking about the first week or two, which is the huge hormonal transition. True postpartum depression usually doesn’t kick in until four or six weeks, but of course, every woman is different.

FARRA: And is that just sort of an extension of the baby blues? Like you can’t shake it when your hormone levels…

DR. CALHOUN: How do they differentiate? So the main reason—the main way that you differentiate between regular baby blues and postpartum depression are that it doesn’t get better; that it’s going on a little bit later; and it’s really getting in the way of your functioning. So baby blues—you’re feeling dead and you’re feeling, you know, like you’re not doing it right or what not, but you’re consolable. And if you make small adjustments, it gets better. When it’s postpartum depression, it’s sort of no matter what you do, you don’t feel better. And then it extends on.

FARRA: So what should the partner be looking for, and then what do they do? Do they talk to the mom about it?

DR. CALHOUN: Well, I always tell my partners before delivery that I’m depending on them to let me know. Because oftentimes the mom is so much in her own head, trying to breastfeed, trying to sleep, trying not to bleed everywhere, that it’s hard to know what—if she’s on a normal path, or if this is really getting to the point that she needs more help. So the partners can see more because they’re are home with them all the time, not in their 15-20 minute office visit. Is she able to function? If I’m getting the baby and swaddling and taking the baby away, is she able to rest and feel better? That’s actually a really big sort of test for postpartum depression, is, if you can sleep, and if you have help, and still feel badly, then we’re much more concerned about postpartum depression.

FARRA: So it is really something people should be mindful of, look for, and then have the conversation about. People shouldn’t be scared to talk about it.

DR. CALHOUN: Absolutely.

FARRA: So the other thing that we’ve talked about throughout this show is sex. So we’re a month out.

DR. CALHOUN: Do nothing. Leave the poor gal alone. Also, you’re gonna feel at maybe your least sexy in your life. You’re bleeding, you have stitches, you’ve got breast milk out of control, flying everywhere. You aren’t eating properly, you’re not sleeping properly. There’ll be nothing about you, in general, that makes you feel like having sex. Now, six-eight weeks, that’s a different story. Your body is feeling a little more back to normal, you actually might be interested in your partner at that point. You might be sleeping in more of a pattern; you’re more confident in your breastfeeding. Your partner’s dying, cause they’re seeing you do this beautiful thing and want to be with you. So that’s more of at time where your libidos might be coming back, and you’re feeling better about your body. For women who stop bleeding earlier, especially women having their second or third baby, that don’t have any stitches, those are the ones you gotta keep your eye on, because they’re one ones most likely to jump back into it sooner.

FARRA: So the bleeding stopped, but is it gonna feel different? Having sex now, versus when you had sex before you even got pregnant? Let’s go back to pre-pregnancy. So we know it was different then, but now someone might think, oh, I pushed the kid out; I feel a little bit better. Is it gonna feel the same?

DR. CALHOUN: You know, every woman is different, but it’s definitely a change. The architecture may have changed, how you’re feeling about your body may have changed. If you’re breastfeeding, you’ve changed hormonally. And so it’s important to be gentle with yourself and particularly gentle when you’re first having sex. Use lots of lube—pre-buy your lube before you even try, because the prolactin hormone that’s released from the breastfeeding suppresses your estrogen hormone, which can lead you to having a drier vagina. Also you have, in many instances, recently healed stitches, which is another thing that you don’t want to create any kind of friction there. So definitely pre-purchase your lube, and just be conscious of the fact that things might be a little bit different, but that you’ll find your new groove.

FARRA: What are the risks for starting to have sexual intercourse before the six to eight weeks?

DR. CALHOUN: So the main things are around infection, and then breaking down any kind of sutures in the vagina. So, it takes a good four to six weeks for the uterus to squeeze back, all the way down to its normal size, and for the cervix to really be as closed as possible. So we don’t want to introduce infection. But the bigger thing is really, if you have stitches, you don’t want to break that down. So definitely take your time going back into having sex.

FARRA: So we talked about Kegels before. I’m wondering now, should women be doing Kegels immediately after?

DR. CALHOUN: Oh, my God, yes! Yes! Yes! Yes!

FARRA: Really! Even if they’ve had stitches?

DR. CALHOUN: Even if they’ve had stitches. Absolutely start your Kegels. You need your Kegels, especially cause you’ve sort of stretched out your pelvis, you’ve stressed your bladder. You want to make sure that you’re getting that pelvic floor back together. You gotta take your vagina to the gym and do little sets of 10 at every stoplight to get yourself back going again.

FARRA: The pelvic floor—it’s that group of muscles that really sort of holds everything up, right?

DR. CALHOUN: Correct. Holds up you vagina, your bladder, your cervix, uterus. And you want that sort of girdle of muscles to be as strong as possible.

FARRA: So now we’ve gotten through the pregnancy, the childbirth and the after you’re home. So stay tuned for our breastfeeding show, and as always, definitely follow Dr. Calhoun on @kppregnancydoc on Twitter. Lots of really great information, and more conversations about this.

DR. CALHOUN: Thanks so much for having me; always fun.

 

This show is for educational purposes only. If you have specific health concerns, you are encouraged to address those with your personal doctor. And as always, if you’re having a health emergency, please call 9-1-1 or go to the nearest emergency department.