As an Obstetrician/ Gynecologist for over 25 years, I think I’ve pretty much seen and heard it all when it comes to the challenges of becoming a new parent. For new Moms, especially first-time new Moms, I find a few basic valid concerns crop up consistently. Each question could be answered in great detail, backed up by data and with lots of references but let’s save all that for later, shall we?
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What’s happens to my body now that I’m no longer pregnant? When should I worry there’s a problem?
Your body is amazing. Every organ system geared up for your pregnancy, and now that you’ve delivered, things begin to revert back to the way they were- some slowly and others rapidly. Common immediate concerns postpartum focus on a few things: bleeding too heavily, signs of infection or worsening pain or conditions linked to high blood pressure. Saturating a maxi pad hourly for two or more hours is never normal and neither is the continual passage of clots larger than a baseball (or lemon, depending on your point of reference). As a rule, an oral temperature greater than 100.4F suggests concern and >101F mandates a phone call to your Provider. Common infections sites include the uterus, breast, bladder, incision site or veins in the pelvis. The reappearance of pain at any location (usually the uterus, pelvis, vagina or breast) may indicate a problem requiring an examination.
Remember, the use of non-steroidal anti-inflammatory medications, like ibuprofen, seems to provide benefit to the majority of women postpartum. If it’s working for a while and then stops providing you benefit, I encourage patients to call. Lastly, some women may develop problems associated with hypertension (elevated blood pressure) postpartum, even when they didn’t have this issue while they were pregnant, or in labor. Concerning signs such as “the worst headache” of your life, blurred vision, agitation, sudden onset of nausea and vomiting or right upper quadrant abdominal pain warrant immediate attention.
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Will I ever lose this “baby weight”?
We, as women, place incredible pressure on ourselves to look as svelte and fit as possible. Pregnancy throws a monkey wrench into this goal and although we, for the most part, tolerate weight gain during pregnancy, we become absolutely driven postpartum to return to our pre-pregnancy selves asap. I tell patients it took them nine months to get to the end of pregnancy and our bodies don’t revert to our pre-pregnant state in 6 weeks. It’s going takes more time to do it in a healthy way: proper diet and consistent exercise and you’ll be back into your Size 4 jeans (if that’s where you started) after a few months.
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When is sex okay? (coupled with questions like will it hurt? And will it feel different to me/him?)
This is a super common question and often asked by the new Dad. I tell my patients to wait on average 4-6 weeks after delivery before becoming sexually active. This allows vaginal tears and laceration repairs time to heal and for the uterus to properly involute (shrink) and stop bleeding. Vaginal tissues may feel less lubricated and tender postpartum and require the use of water-based lubricants to lessen discomfort. Sleep deprivation as a new parent, and postpartum hormonal shifts physiologically result in a lack of sexual desire. Acknowledgement of this common issue as temporary is important to new parents as both worry if their sex life will ever be the same. I encourage women to begin strengthening the pelvic floor with Kegel exercise asap. After four weeks, other pelvic floor exercise like Pilates, yoga and barre classes can help restore muscle tone to the pelvic musculature and make sex as pleasurable as before pregnancy.
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How long should I breastfeed my baby?
My general response to this question is to set an initial goal of exclusive breastfeeding for your baby’s first six months. This is in keeping with not just the American College of Obstetrics and Gynecology (ACOG), the American Academy of Pediatrics (AAP) but is also consistent with the World Health Organization’s recommendation. All three organizations also recommend consideration of continued breastfeeding for the next 6-18 months with the addition of complementary solid foods. The WHO even recommends continued breastfeeding up to three years of age, if both mother and child elect. I find that sometimes patients are made to feel guilty or unworthy if they discontinue breastfeeding before the initial six-month goal. Often, there are legitimate physical or psychological reasons warranting a change to formula. It’s my role to inquire as to why, assist and provide resources and support if needed, but never to judge. I emphasize that any amount of breastfeeding provides benefit to your baby.
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How will I know if I’m just overwhelmed and sleep-deprived versus depressed postpartum? Do I need help?
Absolutely every new Mom experiences a transition in mood postpartum. The spectrum includes feeling mildly anxious and uncertain and crying “just because it feels better” to intense feelings that are prohibitive of you taking care of yourself and your baby. In other words, Postpartum Blues can be anticipated, to some extent, in all new Moms. After all, your hormones just took a cliff dive immediately post-delivery and that shift is strongly correlated to feeling moody. Resolution usually occurs within 1-2 weeks after delivery and without medication. Postpartum Depression (affecting one in seven women) is a much more profound and extended depression. Although usually beginning 1-3 weeks post-delivery, it can evolve any time up a year postpartum. Two consistent red flags I’ve noted for postpartum depression include insomnia and severe anxiety. Postpartum depression screening using the Edinburgh Postnatal Depression Scale (EPDS) https://pesnc.org/wp-content/uploads/EPDS.pdf serves as a good resource and takes less than 5 minutes to complete. Typically, your Provider asks you to perform some sort of a postpartum depression screening questionnaire around your routine postpartum visit at 4-6 weeks; earlier if you or family members are concerned. Treatment involves anti-depressants and sometimes adjunct talk therapy.
These questions and answers were put together by one of the Dr. Julie Schurr from Physicians for Women. has been an Obstetrician/Gynecologist for over 25 years and we are so honored to share some of her expert insight with our readers! For more information about Physicians for Women, visit http://www.mscwomenshealth.com/
