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Post-partum: What to expect in the 6 weeks after delivery

©MFMER

Everything’s new. Everything’s exciting. And everything’s hard. The first six weeks after birth probably aren’t talked about enough. Myra J. Wick, M.D., Ph.D., Mayo Clinic obstetrician, gynecologist and medical geneticist, joins Co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D., for candid convo of what comes after birth, including:

*          Diapers, pads, witch hazel, laxatives and other essentials

*          Post-partum depression and anxiety

*          Getting baby to sleep — mom, too!

*          Building a village to help child and parents

*          Fatigue and exhaustion

*          Healing the birth canal

*          Keeping up with the parent treadmill — and regularly stepping off

Listen: Post-partum: What to expect in the 6 weeks after delivery

Read the transcript:

Dr. Angela Mattke:

Welcome to the Mayo Clinic Moms podcast. We’re having candid conversations and answering difficult questions about pregnancy, raising kids, and everything mom-related. I’m Dr. Angela Mattke, and I’m a mom of two and a pediatrician at Mayo Clinic Children’s Center in Rochester, Minnesota. My co-host is Dr. Nipunie Rajapakse, who’s a pediatric infectious disease doctor, also at Mayo Clinic, and is also pregnant.

On today’s episode, we’re talking about what to expect in the postpartum period, which is the first six weeks after delivery. You might be asking yourself if it’s normal to feel this way. This isn’t what Instagram told me that postpartum was going to be like. Why don’t I look great? Why am I so exhausted? Why isn’t my baby sleeping? We’re also going to talk about postpartum depression, the baby blues, and anxiety. We’ll also talk about surviving exhaustion and feeling alone with the baby. How do you deal with the changes that have happened in your body?

Nipunie, I know that you’ve had some things in your pregnancy — you talked about having morning sickness, and your prenatal vitamin makes you sick. And now you’re probably pretty uncomfortable. You’re not sleeping well, and you’re tired; but I’m telling you, you’re probably in a pretty good place right now as far as the pregnancy journey goes, and I don’t want to scare you, but what happens in the postpartum period, I feel I wasn’t really prepared for, and nobody really told me about it. And so, I think we really want to prepare you for this today, and all of our listeners as well.

Dr. Nipunie Rajapakse:

Yeah. I thought this was going to be a bundle of joy, but the more I learn, the more I hear about this postpartum period getting home, [I’m learning] what that entails with some of the struggles that come along with it. I’m really interested to learn from your experience and Dr. Wick’s experience as well.

Dr. Angela Mattke:

Yeah, absolutely. A baby is a bundle of joy, and it’s such a blessing, and it’s a wonderful experience, but we need to talk about what happens after you have pushed a baby through your vagina — and what happens to that vagina afterwards, and the carnage that it has experienced, especially after a vaginal delivery.

Dr. Nipunie Rajapakse:

Yeah. What would you say, Angie, surprised you most when you brought your kids home for the first time?

Dr. Angela Mattke:

It wasn’t the changes or the pain or the bleeding or things like that. I think it was the exhaustion. I thought I could handle exhaustion because we were used to not sleeping every fourth day, and working for 30 hours straight or more; but there’s no post-call day with a baby. You don’t get to go take a five-hour nap. It’s continuous, and especially if you’re trying to breastfeed, and you spend 40 minutes breastfeeding and then 20 minutes cleaning up and trying to get the baby to sleep. And then you’ve got one hour left to try and fall asleep, get a nap, and wake up again in order to get the baby up to breastfeed. It’s this never-ending treadmill that you’re on, where you feel like you just don’t catch up.

Dr. Nipunie Rajapakse:

Yeah. I have felt the same way. I thought I knew lack of sleep and exhaustion from going through medical training, but everyone tells me this is on a whole other level than what we experienced then for sure. When it comes to things that you needed at home, was there anything that you would recommend having ready to go at home in terms of helping with the recovery from delivery? Maybe things you didn’t think of, or that you missed?

Dr. Angela Mattke:

Dr. Wick, I want to hear your thoughts on this, but I think having appropriate pads at home and even bringing home some of the stuff from the hospital was really helpful. Some of the ice, the special little plastic or paper container that is waterproof is helpful for icing. Bringing home some of that mesh underwear that’s super sexy that you’re really excited to wear. But that can be helpful because you won’t ruin some of your own underwear. And then someone had told me to have some witch hazel on hand, and I found that helpful as well. Dr. Wick, what do you think?

Dr. Myra Wick:

Yeah, yeah. I think all those things are good tips. I think things that surprised me were how fast you went through diapers. Oh my gosh.

Dr. Angela Mattke:

That’s so true. You go through 15 a day in the first couple weeks.

Dr. Myra Wick:

Yeah. If you’re having a term delivery, don’t buy a ton of newborn diapers because the baby is going to grow out of them so fast. And you won’t be able to use ’em; the baby will be too big. And then just feeling like I was wet all the time. You know, my breasts were leaking, and I needed a pad and the engorgement with the first baby, it’s crazy, and now we’re dismissing patients from the hospital early. A lot of times that engorgement happens when you’re at home, and it’s uncomfortable. Sometimes you can even get a little low-grade fever. I think those are the things.

Dr. Angela Mattke:

Yeah, it’s pretty miserable.

Dr. Nipunie Rajapakse:

I love the tip about the newborn diapers because we have a friend who has generously donated their 800 extra newborn diapers that they bought to us.

Dr. Myra Wick:

Oh, no!

Dr. Angela Mattke:

800?! Oh my goodness.

Dr. Nipunie Rajapakse:

800 extras. I think we’re set there with our supply.

Dr. Angela Mattke:

Maybe your baby will be small and will fit in those for a while. Good luck with that.

Dr. Nipunie Rajapakse:

Yeah, for sure. In terms of other unexpected things I’ve heard — we talked a bit about pooping during the delivery itself, but I’ve heard first stool after delivery can sometimes be an adventure, and issues with constipation can certainly make that part of recovery more difficult. Any tips or tricks there that you have to offer?

Dr. Myra Wick:

I have a story there. After our last child, I was so constipated, and my in-laws were coming to visit, and it was a different time, of course. My mom came over, and I was sobbing in the shower, and she came in the bathroom and she’s like, “What can I do?”. She ran to the drugstore and got everything she could– Dulcolax, MiraLAX. And finally, I just decided I needed that cocktail, and then things were fine! But yeah, I was miserable. They’ll give you stool softeners with senna in the hospital. If you do have to use a little bit of laxative in your breastfeeding, that’s okay. It’s okay to do that.

Dr. Angela Mattke:

Yeah. Absolutely.

Dr. Myra Wick:

And make sure you’re drinking a lot of water. Breastfeeding takes a lot of liquid, and your bowels need water to function normally. Just really push the water.

Dr. Angela Mattke:

I like how you said they’ll give you that in the hospital. I would say don’t not take it because sometimes you can say, “Oh I don’t need it. I’m stooling fine.” You’re stooling fine now, but you don’t know what you’re going to be stooling like tomorrow or the next day. Keep it going so you’re not having to strain, because it’s pretty miserable. You’ll be in a lot of pain if that happens. It’s a great question, by the way, Nipunie; it’s a really good question.

Dr. Myra Wick:

And nobody wants to talk about it.

Dr. Angela Mattke:

Exactly.

Dr. Nipunie Rajapakse:

Yeah, exactly. There’s very little discussion about it. I thought it was a good one to bring up. I know we’ve spent a lot of time talking about some of the physical health effects, what your body goes through during the pregnancy, during the delivery. Obviously, pregnancy postpartum period, there are a lot of different types of mood disturbances that can happen as well. And so, in wanting to be proactive about that, what would be some of the factors that might put someone at higher risk for having postpartum depression or postpartum anxiety, for example, or other postpartum mood disorders?

Dr. Myra Wick:

Well, I think having a mood disorder before delivery or even before you’re pregnant puts patients at risk. Sometimes having a really difficult pregnancy or difficult labor experience might contribute as well. Those are some of the things that we look at. We do a lot of screening during pregnancy. We have a couple of different screening tools, and I know sometimes patients get tired of filling out those same questionnaires over and over, but it’s our way of assessing how people are doing and making sure that we’re catching things early. The other thing that we’ve started doing is offering a two-week postpartum mood check. We’re doing that virtually so that moms don’t have to come dragging in and find a parking spot and all that when they have a two-week-old baby.

We do that over the phone, but if moms want to come in or feel like they need to come in, we can certainly do that in person, too. We are also extremely fortunate to have some psychiatrists that are specially trained in prenatal and perinatal psychiatry. We actually have them in our outpatient unit one day a week or half a day a week. They are just an awesome resource for our whole practice. And I know we’re very blessed to have that, but we have all those tools that help us as providers take care of our patients.

Dr. Angela Mattke:

I would add in, Dr. Wick, that because you guys see them usually at six weeks or eight weeks, depending on what type of delivery, at least at Mayo Clinic, we screen all moms for postpartum depression at their well-child visits with their infants. I think that this has been an initiative across the United States because postpartum depression can happen anytime, up to about a year after birth. You might not be under the care of your obstetrician or midwife or family medicine provider at that time, but you’re coming into our office. So we are doing screening at 2, 4, 6, 9, and 12 months for postpartum depression symptoms. And I can say in my own personal experience, we have been able to help a lot of women identify that they were struggling with depression, because sometimes it’s hard to realize where you’re at by yourself, but looking from the outside, it’s a lot more obvious to other people, and we can get them the help they need. Because we know that babies do better when their mom’s mental health is in a better place. We can help address that for them when they’re struggling.

INTERMISSION

Dr. Angela Mattke:

Are you thinking about getting pregnant, or maybe you’re a current mom-to-be, or you’re like myself and you’re in the midst of raising kids, and you’re looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books, starting from Fertility and Conception to Guide to a Healthy Pregnancy, Guide to Your Baby’s First Years, and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child. You can find these amazing books from Mayo Clinic Press wherever books are sold, or on the Mayo Clinic Press website.

BACK TO THE SHOW

Dr. Nipunie Rajapakse:

I know that many of these things exist on a spectrum, from more severe to more moderate symptoms. What would be some of the things to keep an eye out for and to know to seek help if you’re experiencing them?

Dr. Myra Wick:

It’s really common to have postpartum baby blues the first two to three weeks where you feel up and down; you’re so excited and overwhelmed and sleep-deprived and you may just cry spontaneously for no reason. And those are all normal responses. I think things to watch out for, after that period of two to three weeks – very, very down, very anxious, not able to function; maybe you’re not able to take care of the baby or you’re not taking care of yourself. Care for yourself is a little different postpartum—but specifically when you’re really just not keeping up. Maybe you’re not getting out of bed. You’re not doing the things that would be normally done by a new mom. Those are things your partner can help watch for as well. Obviously, if things are very severe, if you’re feeling suicidal, then we’re going to refer you to an emergency department. But more often, it’s feeling really down and unable to function the way you’d like to.

Dr. Nipunie Rajapakse:

I think that’s a great point about the role that partners can play, Dr. Wick, and recognizing some of these things as well. I think we’re also starting to recognize postpartum mood disorders occurring in partners as well, more and more commonly. I think it’s important to make sure you’re looking out for each other during this phase as well.

Dr. Myra Wick:

Right. We’re seeing a lot of anxiety and I don’t know if it’s probably related to the pandemic. I feel like we are really seeing a lot of anxiety in the last couple of years. We can help with that too. And the psychiatrists we work with are very aware and happy to see those patients as well.

Dr. Nipunie Rajapakse:

By myself, I anticipate that I’ll be anxious about the baby — is the baby okay? Are they eating enough, are they gaining enough weight, and all that. How do you know when it is above and beyond the usual anxiety that a new mom would experience with a new baby?

Dr. Myra Wick:

I think if it’s interfering with how you’re functioning daily. I had a patient recently that said I can’t even go to the grocery store and leave the baby with my mother-in-law because I’m afraid that something’s going to happen, or she’s not going to do something right. That’s probably a little bit beyond what a normal reaction would be. It’s normal to go to Target and think, “Oh, I wonder what my baby’s doing. And I hope my husband’s okay with the baby.” And you know they are; in your heart, you know they are. But to not be able to leave because of that is probably beyond what would be considered typical.

Dr. Angela Mattke:

I noticed in the first couple weeks after — even in the first couple days, I just couldn’t sleep because every little sound the baby would make would wake me up. And now we have recommendations that all babies co-room, so meaning they sleep in their parents’ room for at least the first six months of life, if not the first 12 months of life. We know that that’s good for reducing sudden infant death syndrome, but it also has been shown to decrease sleep quality for everyone else in their room. I know I definitely experienced that, and I think it was just driving me crazy because I couldn’t sleep, and I’d worry I’d missed something. I think it just was the cycle. The less sleep you get, the more anxious you get, and then you get less sleep again because you’re worried you’re going to miss something. That was a hard thing for me. Getting some white noise in the room so I could sleep and I wouldn’t hear everything was really, really helpful. Then your anxiety gets better because you finally get some sleep. It’s this vicious cycle. Something to think about.

Dr. Nipunie Rajapakse:

For sure. Yeah. I think the sleep deprivation and tips on how and when to sleep are going to be really helpful for us for that period after the baby comes home, for sure. And hopefully, being able to trade off a bit and things like that will be helpful also.

Dr. Angela Mattke:

Yeah. Having a partner is helpful. But for those people that don’t have partners, try and get their community, get their village — friends and their parents and other people that can help out. Don’t be afraid to ask for help and ask them to come watch the baby for a little bit. Your baby’s going to be okay; you’ll be sleeping in the room down the hall. Everything will be fine. Nipunie, you mentioned that you’ve been getting a lot of hits on Instagram about baby stuff and pregnancy. Have you seen some of those snapback photos or the postpartum pictures?

Dr. Nipunie Rajapakse:

Yeah. It’s a lot of people posting and they’re looking back to their usual self within a couple weeks of having this child. And I think realistic expectations are what I want to know. Is that realistic or what can you actually expect to happen to your body afterwards? I’m sure it’s not as fast as what they show on social media.

Dr. Angela Mattke:

No. And they’ve got lighting and glam teams and everything like that too. Keep in mind that there’s a lot of editing that goes into those photos, but Dr. Wick, I think you can weigh in on this a little bit more, but I think that’s completely unrealistic. You just spent nine months being pregnant. I think, in my mind, it should take at least nine months, if not more, for your body to go back to a similar way it looked and felt at that time. Also keep in mind that your body’s never going to be the same. It’s going to be different. You just grew a child in your body and then gave birth to it. That’s a beautiful thing. Things shouldn’t probably be like they were before because you want to show that you did something pretty powerful. What do you think, Dr. Wick?

Dr. Myra Wick:

Yeah, I agree. Everything’s saggier.

Dr. Angela Mattke:

Yes.

Dr. Myra Wick:

Even though you might be exercising and working on things, it’s never really quite the same.

Dr. Angela Mattke:

Exactly. I feel like those ab muscles, they never really go back together as much as you want. So yeah, quit looking at Instagram. I think everyone needs to stop the snapback photos and just be more supportive. I really love this trend of people posting realistic photos of what your body actually looks like after birth. I’ve really enjoyed a lot of the celebrities who’ve shed some reality on what life is really like.

Dr. Nipunie Rajapakse:

Yeah, definitely nice to see what the reality is. When it comes to getting back into exercise, Dr. Wick, are there restrictions or guidance on when it’s safe to start exercising after you’ve had a baby?

Dr. Myra Wick:

Yeah. You know, for the first couple of weeks, especially if you’ve had a C-section, we want you to be careful, and we don’t want you lifting more than 25 pounds after C-section for the first six weeks. We want all those layers, the fascia, the tough layer that holds everything in, to be well-healed. But it’s okay to start walking a little bit, especially if it’s nice outside — get out and take the baby in a stroller and listen to your body. If you’re starting to feel tired or something’s pulling or tugging, then maybe it’s time to turn around and rest. But gradually work your way back. Don’t expect that you’re going to go out and run a 10-mile run after six weeks. Most people have to gradually work their way back into things. I think the most important thing is just listening to what your body’s telling you about fatigue.

Dr. Angela Mattke:

I want to thank you both for this great discussion today, and I want to thank our audience for listening. I hope you can join us on more episodes of our pregnancy podcast. The next episode will be all about feeding your baby — questions about breastmilk versus formula, or — how do I know if my baby’s getting enough? Can what I eat affect my breast milk? Can I have a glass of wine once in a while? And what about antibodies from vaccines? COVID vaccines, influenza vaccines — will those transfer to my baby? And more. Make sure you catch that episode. Thanks everyone for joining today. Make sure you don’t miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoyed this episode, and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We’ll see you next time.

Angela Mattke

Angela C. Mattke, M.D.

Dr. Mattke is the medical editor of Mayo Clinic Guide to Raising a Healthy Child and  a pediatrician in the Division of Community Pediatrics and Adolescent Medicine at Mayo Clinic Children’s Center in Rochester, Minnesota.

Nipunie Rajapakse, M.D.

Dr. Rajapakse is a pediatric infectious diseases physician at Mayo Clinic in Rochester, Minnesota. Her clinical focus includes management of pediatric infections. Her primary research interests include studying ways of optimizing antibiotic use in children (antimicrobial stewardship) to decrease antibiotic resistance and other harmful effects. She has worked for the World Health Organization and has an interest in global health and outbreaks of emerging infectious diseases.

Myra J. Wick, M.D., Ph.D.

Dr. Wick, medical editor of Mayo Clinic Guide to a Healthy Pregnancy,2nd Edition, is a specialist in the Department of Obstetrics and Gynecology and the Department of Clinical Genomics. She is also an associate professor at the Mayo Clinic College of Medicine and Science — and a mother of four children. Dr. Wick has particular medical expertise and interest in prenatal genetics and diagnosis.

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