The 4th Trimester: Healing After Childbirth


– Welcome to today’s web chat about the fourth trimester, also known as the first
six weeks after childbirth. My name is Alli Novara,
and I have the privilege of working with the Women’s Health Program at Von Voigtlander Women’s Hospital. I will be your host for today’s chat. Pregnant moms spend a lot of time learning what to expect from pregnancy and how to care for their newborns. While pregnancy anecdotes
and birth stories tend to dominate conversations at
baby showers and get-togethers, the challenging aspects
of the fourth trimester are often left unsaid. We are here today to help
moms gain the knowledge and confidence they need to take care of themselves physically and
mentally after giving birth. We’ll introduce our panelists in a moment, but first a few housekeeping items. You can submit questions at any time, even now, for our panelists to answer during the Q and A
portion of today’s chat. Questions can be submitted
by commenting on this video, but please note that your name or profile name will be visible
to others participating. If you prefer a more anonymous option, you can send a private message
to us via Facebook or email at [email protected] If you can’t stay for the whole chat, or wanna share the
recording with a friend, a video of the chat in its
entirety will be available on our Facebook page and posted to the Michigan Medicine
YouTube channel soon after. I’d like to introduce
you to our panelists now. Dr. Carolyn Swenson is a
urogynecologist whose staffs are at Michigan Healthy Healing
After Delivery Clinic, which was the first
specialty clinic of its kind in the U.S. to address
postpartum pelvic floor issues. Dr. Swenson specializes in
medical and surgical management of pelvic floor disorders
and sees patients in Ann Arbor at the Von
Voigtlander Women’s Clinic and the West Ann Arbor Health Center, and in Midland, Michigan at the Mid-Michigan Health
Center for Women’s Health. Dr. Katherine Rosenblum is a clinical and developmental psychologist with the U of M department of psychiatry. She is the co-director of the Women and Infant Mental Health
Program and sees patients at the Rachel Upjohn
Building in Ann Arbor. Dr. Rosenblum’s interests
include mental health in pregnancy, infancy,
and early childhood. Jen Shifferd is a board-certified
women’s health specialist who is co-lead of the Michigan
Medicine Pelvic Floor Program in the Department of Physical
Medicine and Rehabilitation. Jen helped to develop
the pelvic floor program at Michigan Medicine and
currently sees patients at the Brighton Center for Specialty Care. She treats patients across their lifespan for constipation, urinary
and fecal incontinence, pelvic floor pain, pelvic organ prolapse, scar occasions, and core muscle weakness. Thank you again for joining us. We’ll open up the floor now for questions, but I’d like to remind our audience that you can submit questions by commenting on this video directly, by direct messaging us on Facebook, or by emailing us at [email protected] We will not use your name when
we read off your question, but do know that if you comment directly on this video, your name or profile name will be
visible to other participants. Okay, so the first question. What are some of the
common concerns women have about their physical and mental
health after having a baby? – I can go ahead and comment
on the physical health after having a baby and
part of that depends on the route of delivery. So whether it was a vaginal
delivery or a C-section. Because each of those routes carries different physical changes, but the biggest question is
will my body ever be the same? Whether it’s vaginal
delivery or a C-section. And so part of the role of your OB/GYN and clinics like Michigan
Healthy Healing After Delivery is to help women get back
to regain the confidence that they had in their body. If they have any kind of symptoms that need addressing
like urinary incontinence or fecal incontinence or pelvic pain. That is, it’s our job
to help get women back to where they wanna be physically. – And I can speak to that
in terms of mental health because the sort of, birth of
a child is a very powerful, significant experience
emotionally and biologically. And with that come a
whole host of feelings that women very typically experience. So we hear often about
women experiencing something that people often refer
to as the baby blues, which actually is very
common in the first week or two following delivery. And is probably associated with many of the biological changes
and hormonal changes that occur through childbirth. I would say, this is in the research, approximately 85 percent of women who experience the baby blues, but for a significant number of women, 10 to 15 percent nationally,
but more for women at risk, these blues really can elevate into something more
significant and concerning that we refer to as postpartum depression. And I hope we’ll have a chance to talk a little bit more about that today because it’s a very common occurrence and one of the most sort of, commonly occurring
complications post-delivery. So something that we should
all know about and be aware of. – And I can comment in regards
to the physical aspect, being the physical therapist on the panel. In regards to that,
women following delivery, can have a variety of
complications as Carolyn mentioned and we really look at the whole picture. We look at the whole person. We not only check your pelvic floor, we’re also looking at your spine and your alignments and how
things come back together after delivery as well for any separation in your abdominal wall,
which is called a diastases. We’re looking, you know, when you see a pelvic
floor physical therapist, we’re checking everything,
and we’ll also look at what’s happening with your pelvic floor following a vaginal delivery regarding any perineal lacerations or weakness that may be occurring
or pain issues as well. And if you’ve had a Caesarian, we can address those adhesions and retrain your abdominal wall. – Great, thank you. How long does it take to
physically heal after giving birth? And let’s just, I’m gonna
add a second one in there. How is physical recovery different for a vaginal birth versus a C-section? – Should we tag team this one? – Yeah.
– Okay. So the first question
was how long does it take for your body to recover? And again, this is a question that I get commonly from patients, and I usually start by
saying the vast majority of the recovery is done within the first six weeks to six months. So we know by six months, over 90 percent of the tissue remodeling and changes in the pelvic floor and abdominal tissues has occurred. So this is kind of what we would consider the new normal baseline for a woman’s body at that point after delivery. But keeping that in mind, tissue remodeling can take
nine months to a year, so it almost takes as
long for a woman’s body to recover from a delivery as it takes to get her to be ready for a delivery, so I usually tell that to patients too to put it into perspective
that although it’s easy for us to want a quick fix, the baby’s out, now we want everything
to go back to normal. It’s really a process that takes months. Months and months. And not that you’re not gonna
feel better before one year, but it helps put things into
perspective for patients. – I agree with that. And in regards to the rehab aspect, when you see a physical therapist, you may be seeing a physical therapist for up to a few months,
sometimes a little less, sometimes a little more, depending on, even how things were
before having the baby. So if you had a weakness
in your muscles before and experiencing stress
incontinence where you cough, sneeze and have leakage, or even urgency where you’re having to hurry to the toilet or having issues with your bowels, may take a little bit longer, but we address all of those things. And also looking if you have
any pelvic organ prolapse to help in reducing that. So Kegels alone can help reduce things about a centimeter or so, but
we also have other techniques outside of doing Kegels to
help restore that muscle tone and help in reducing
pelvic organ prolapse. With rehab we’re also always
looking to reduce pain first and establish a normal muscle tone before we begin a strengthening program. So it’s really important that
those things are addressed before Kegels even begin. There’s a lot we do before Kegels. – And I will say, just to add to that. If you’ve had, if a woman
has had a more severe perineal laceration or a
prolonged second stage, which is the time when you’re pushing, there are various factors that could prolong the healing process, and so, just to keep that in mind as well. Typically if there is, especially pain that persists past six
weeks, that would be a reason that we would want a woman to come in and either talk to her OB/GYN or come see a urogynecologist to kind of see what’s going on. Because that would be an indication that the normal healing
process is not going as it should and usually
there are things we can do for that like pelvic
floor physical therapy, depending on what the issue is. – Great, thank you both. Was that, okay. We’ll move on to the next question. What is your recommendation
on herbal blend, ginger, Epsom salt, or plain
sitz baths after birth? – I can take that one as well. So I usually recommend
just warm water sitz baths with nothing added. And that is because anything that you put in there could
be a potential irritant, especially something like Epsom salt that I think would just
be really irritating and probably painful for a woman who has a perineal laceration. So my recommendation is
just warm water sitz baths, so just sitting in a couple
inches of warm water, either in the bathtub or
you can purchase a sitz bath that goes on the toilet, or you could just use a detachable shower head and just kind of irrigate the
area for about 10 minutes, two to three times a day. Once the skin has healed, you
can stop doing sitz baths, but that warm water
really promotes healing, it kind of cleans out the wound, helps prevent infection
and promote healing. And so, and it can really
feel really soothing. So just warm water is what I recommend. – Great. The next question is how long
will I bleed after birth? – That is for me as well. (panelists chuckle) So this varies, again depending on the type of your delivery. So, it can vary from anywhere from like two weeks to six
weeks or a little bit more. And what you wanna, so
I wouldn’t be concerned if you’re still having
bleeding at five or six weeks, as long as that amount of bleeding has been decreasing over time. It’s very common to have no bleeding and then when you’re nursing
have some increase in bleeding. That’s just because the
hormones that are released to help you let down your milk also cause uterine contractions, and so you have a little
more bleeding with that. So that varies, and again, it’s normal as long as the overall volume is decreasing over time. – Thank you. Can you talk about some
common pelvic floor problems? – I can too. Take it away Jen. – So, some things you might experience, if you’ve had a prolonged
pushing phase during labor and delivery, you are going to experience some different pelvic floor issues, possibly weakness
because you’re stretching that pudendal nerve that innervates the pelvic floor muscles. So there can be what’s
called some latency there. And that can contribute to weakness. Just carrying a baby
alone puts pressure down through the pelvic
floor and can put stress on those ligaments that
help to suspend your organs. So that feeling of pressure down in the pelvic area can
be pelvic organ prolapse and that is a common thing for women to experience after delivery as well. When you have a tear, we’ve
talked a little bit about tears. That happens at that perineal body, which is the tissue between
the vagina and the rectum, and depending on the grade of the tear, it’s up to four. Four is all the way to the anal region. That can determine as well your, what’s gonna happen
with your pelvic floor. If it tears all the way, you may have problems with
containing gas or stool. And those are things that can heal and can be repaired and
through proper rehabilitation, can be improved significantly. And other things that can happen, obviously if you have tearing, you can have pain as well. And scars do as they heal,
can adhere a little bit. So we teach women right
away how to start massaging that scar and that’s something you can do about four to six weeks after delivery once it’s fully healed
and you can even wait ’til your OB visit to
talk with your doctor about that to make sure it’s fully healed and you can start massaging that scar. And we usually recommend, you know, if this is the vaginal opening, and here’s my rectum, that perineal body’s gonna
be that skin in between. And we have women massage that back and forth, back and forth. You could use a little bit of
Vitamin E oil as you do it, not while it’s dry, but that’s something I
always would encourage people to start doing. Scar adhesion can happen as
well with a Caesarian incision. Any incision, you always
wanna massage perpendicular, not parallel to it, so you don’t open it. But with a Caesarian incision, usually those take about
four weeks to heal. You might have Steri-Strips on it. Those should have already fallen off and the incision should be fully closed before you ever attempt to massage that. But that is something that
we encourage women to do. So with a Caesarian you may
experience abdominal weakness. You will experience that with
a vaginal delivery as well, just for the fact that your
abdominals have been stretched with carrying a baby. And that’s another part of
the rehabilitation process. When that happens, when your abs are weak, you’re going to then rely primarily on those low back muscles as a primary stabilizer for your trunk. And it can cause some back
pain because of the imbalance, so it’s not uncommon
to also have back pain. There’s a lot of wonderful things that happen with pregnancy. Obviously we get to have
the joy of having our child, but these things that happen to your body, you do need to have rehab for that. And it is recommended. You can talk to your physician
six weeks following delivery about that to get a referral in. You, other things that you may experience are constipation or fecal leakage. That is another area that we can address and retrain those muscles and actually retrain you the proper way to position to have a bowel movement. And also if you’re
having pain in that area, we’ll of course be
addressing that as well. – Great, thank you. Looks like we had
another question come in. This is my third pregnancy
and historically, even though I’ve breastfed
and watched my diet, I get very bloated, swollen, and gain weight in the fourth trimester, which is discouraging. I suspect it is hormonal. Do you suggest any additional supplements in the fourth trimester to avoid this? – I don’t know that there
are any specific supplements that I would recommend. I would just say that overall, you know, there are a lot of fluid
shifts and hormonal shifts that happen after you deliver the baby and so in that early postpartum period. Part of the leg swelling can be related to those fluid shifts,
and usually you might also notice your urine output
significantly increases in the first couple of
weeks after you have a baby. And that’s your body’s way of getting rid of all of that extra fluid that you needed when you were pregnant. And that you’re trying to get rid of. The, if the leg swelling is persistent, I would say that that
sometimes can be a sign of something called pre-eclampsia, which commonly we think
of as a pregnancy problem, but this also can occur
in the postpartum period. So I would just to be
safe, go see your OB/GYN and get your blood pressure checked. They might get a urine test
too, to test it for protein, but yeah, otherwise, as
long as that is negative, I would say, I would just be reassured that it will get better. But I don’t recommend taking
any specific supplements. – Thank you. What is pelvic floor physical
therapy and or massage? – So pelvic floor therapy. First to be a pelvic floor therapist. Once you’ve graduated
as a physical therapist and you have a license,
you’re a generalist. You’re kind of, you have
a general understanding of all the different
areas of physical therapy. To go on to be trained for women’s health, you take additional courses, additional training beyond earning your physical therapy degree. And with pelvic floor physical therapy, we really are looking at the whole person, as I mentioned before. We’re looking at the pelvic floor muscles, their coordination, their strength. And any pain issues and how
this is affecting the symptoms that you’re coming in to see us for. Now, massage, when we’re
talking about massage. You know, physical therapy, we do a lot of different
hands-on techniques that I talked a little bit earlier about. We do scar tissue releases. We also do internal trigger
point muscle releases, just like you might have a trigger point in your neck or your back. We’re going to work on releasing those tight
areas internally as well. For women trying to get back to being able to have intercourse, we also teach you how to use vaginal dilators
to help you stretch at home. It’s really important in physical therapy that we teach you how to
also manage things at home. Because what we do alone in your weekly physical therapy
visits, it’s not enough. You also have to be your own advocate and be independent with the
things we give you at home. And we’re there to help you along the way and all of this is new for you, we know. And so those are things,
some things that we can do. So in relation to massage,
you’re really going to be experiencing more gentle stretching, whether it’s vaginal or rectal, internal trigger point releases, where it’s a little bit of a static hold, scar type work, and that kinda thing. – Thank you. Dr. Rosenblum, I’m gonna direct
this next question at you. My baby is now 10 months old, and I still worry about him
whenever I’m not with him. Other moms have told me this is a normal feeling I will experience for the rest of my life. Is this normal, or should I seek out mental health help or guidance? – Well, I’m really glad that
we’re asking a question also about anxiety in the postpartum, because I mentioned earlier that postpartum depression is very common. And that is true. But it’s also true that women
experience heightened levels of anxiety and worry. And oftentimes in the postpartum period, this is one of the sort
of most significant things that women will tell us
they’re experiencing. A couple of thoughts about that. First, after the birth of a baby, we actually have some really
wonderful amazing work that neuroimagers have done, looking at the brain of mothers, and actually fathers too,
following the birth of a child. And what they find is that
after the child is born, the part of the brain
that lights up is related to anxiety or OCD circuits
that are more active. And what that means is
that you’re more likely to be worried and sort of
preoccupied a little bit with how is my baby doing? Is my baby okay? Is my baby safe? And there’s probably some
evolutionary advantage to that. We want to be a little
bit worried about our kids so that we know that
we’re taking care of them and doing what we need
to to keep them safe. But sometimes this anxiety
can cause stress for parents that, and for new mothers. It’s maybe more than we would expect. And when it’s really interfering with a person’s ability to return to other important tasks
and things that they need to do in life, and they’re
experiencing a significant amount of worry, I would suggest
that that’s a time where it would be really important
to talk to your provider. Or to come to a clinic to talk with someone about those feelings and to do some screening and
to think about whether in fact, there might be some options for treatment that might help to alleviate
some of the unnecessary worry, so that there’s more pleasure and ability to enjoy this
period of parenthood. – Can I ask a follow-up
question about that? – You bet, sure.
– Because I get this, because I see patients around
two weeks postpartum often. I get a lot of comments
about that very thing. And I experienced the
same thing with my kids and you know, it’s like, I have to check on them every 20 minutes at night to make sure they’re still breathing. And patients tell me that same thing. And you know, it passed
after a couple of weeks and I was able to stop doing that. But is there kind of a normal time frame that we can give patients to expect like, if this doesn’t resolve
in a month or you know, that might be something
we need to readdress. – Yeah, I’m really glad you brought it up. And I’ll add something to that actually, because something that often
I will hear, because I ask. And people don’t always ask this. Is I’ll even ask people
about, are there things that you worry about, like
that you might hurt the baby? Or that something bad
might happen to the baby? And what know is when
we ask those questions, first of all, we’re not putting any ideas into anyone’s head,
so it’s really okay to ask. And actually, the opposite is true. People really often hold those feelings in and worry that even just
having these passing thoughts might mean that they’re a bad mother, that they might act on them, that there’s something
bigger to be worried about. Actually, those kinds
of worries and concerns that sort of come and go, are very, very common and are associated with what I talked about. The part of the brain
that sort of turns on to make us hypervigilant. That said, if those feelings
are really persisting. You know, that you’ve had
them for several weeks, you know, four weeks have gone by and you’re still finding yourself really anxiously preoccupied and worried, I think it’s really important to talk with somebody about that. To get a sense of, is this
sort of crossing a line into a something where I might want some extra help or support. I like to ask people
about what they’re feeling and what they’re experiencing because the other really important thing here is that mental health concerns in the postpartum are
often very undetected. And we know that if we
don’t ask the question, well how’re you feeling? How are you doing? And even beyond that. Sometimes people say, although this is really a wonderful thing,
that the baby’s come, they’re also struggling with feelings of being sad or anxious or
difficulties with sleep. And I wonder if any of
that’s happening for you? If we don’t ask those questions, oftentimes what happens
is women don’t tell us. There’s a lot of shame. There are a lot of myths about motherhood. That this should be sort
of the most joyful time and that there must be
something really wrong with you if you’re having these feelings. So when we ask the question,
we open the door to healing. Because there is help and there is hope for having those feelings
be addressed, supported, and not as debilitating. – Well, and along those
lines, I do wanna say, for my clinic, ’cause we do a
postpartum depression screen, so we often catch women at
risk for postpartum depression, kind of earlier than
they would have been seen if they just went to four or
six week postpartum visit. And any time there’s been a patient that I’m really concerned about, and I need to get them to see one of you in the perinatal mood clinic,
I can always get them in. Without a doubt you guys
are very accommodating, so thank you for that. – You bet. – ‘Cause that’s an
invaluable resource for us. – It’s a priority for us. Because this is a really important time and we know that time is of the essence. That when women are
suffering during this period, it really interferes with an
important time in their life and their baby’s life
and their family’s life. And so, at the Women and
Infant’s Mental Health Clinic, we make every effort to get
women in in a timely way. And I wanna say I’m also very glad that at the University of Michigan OBs and gynecologists are routinely
screening for depression. And that is so important. It really is a standard for the field, because if we don’t ask, then
oftentimes we don’t know. – Yep, absolutely. – In follow up to that question, can you explain the difference between postpartum depression
versus the baby blues? – So it’s really, I
think, a good question. Because as I mentioned earlier, during the postpartum period, the body has gone through
such a tremendous change. And this whole cascade of
hormones really does contribute to some really intense feelings. And I would say it’s hormonal and it’s also just the birth of a child. You know, your life has really, it’s really rocking your
world in these profound ways. And so having emotional swayings, having some periods of tearfulness and feeling overwhelmed, crying, that sort of thing is
really, really common during the first two weeks postpartum. There are a couple of things that we wanna pay attention to however. One is does this sort of remit? Does it end after two weeks? If it extends beyond those two weeks, we’re not talking about
baby blues anymore. We really need to be thinking about the potential for
a postpartum depression. The other thing that we
really wanna pay attention to is the severity of those mood swings. How significant are they? If these are really big shifts in mood and there’s really extreme lability, or the person is behaving in ways that are causing concern
in significant ways or worry to others,
that’s really important to pay attention to and could
be psychiatric emergency. And we refer to that as
postpartum psychosis sometimes. When people have really
significant mood swings, it interferes with their
sort of thinking reasonably about what’s happening for
the baby or for themselves. That’s also not depression. That’s a different sort of concern. But if that sort of really
significant lability is happening, we wanna make sure that you’re calling your provider and getting in to see someone quickly. If the sort of moodiness
lasts longer than two weeks, it would be really important,
you can talk to your OB and you can let them
know what you’re feeling. You can share concerns with others. I think the most
important thing is to talk and let people know that this is something that you’re struggling with
and to know that there’s help. That there are things that can be offered that can really address those symptoms. Postpartum depression is something that as I said affects
approximately 15 percent of women. So it’s common and it doesn’t
mean you’re a bad mother. It doesn’t mean that there’s
gonna necessarily be harm to your child. But what it does mean is
that you’re suffering. And that you really need the
help and support of treatment. – Thank you. Biologically, when are we truly ready to be separated from our babies? So, for example, to return to work? – I mean– (panelists laugh) – That’s a big question. So, the return to work
is such a big stress for so many women. And I think that it’s
undoubtedly one of the things that I hear most often from parents as a source of worry and concern. Like what is it gonna
be like when I return. So I think the first thing I wanna say is to go easy on yourself. And to know that this is
really, really a hard thing. In some countries, there’s
more protected time for families in the postpartum, and I frankly would
wish that for the women, fathers, and children in our country. I think it is very hard
to go back to work. I think you certainly should be talking with your provider about
your medical readiness to go back to work and if
you are really struggling, to really think about
whether there are options to delay or defer the return to work and not to add to that sort of burden. That said, I see it time and again that women do make the
transition back to work. And that can vary in terms
of when they do that. What’s generally true is that it’s hard. And so I just, I just sort
of wanna put out there, I think it’s less about just
the biological readiness, but also about the support
that you’re receiving, the opportunities for sleep, who’s helping with the kids, how are you addressing
issues around breastfeeding and what kind of support are you receiving for that if that’s
something that is important. I think really thinking about the context of support is critical. – Thank you. How long after pregnancy
should a couple wait before having intercourse? – I could take that one. So in general, we say nothing in the vagina for six weeks
after a vaginal delivery. And that’s even if you’ve
had no perineal tears or you had totally easy delivery,
which hopefully happens. But, and the reason for
that is because the uterus, which is big enough to accommodate a seven to eight pound baby has to involute back to the size of your fist or
about the side of a pear. And so that takes time to do that. Takes about six weeks. And during that process, the lining of the uterus has to shed and the inside of the uterus is more
exposed to the vagina during that process and so the real reason to, one real reason is to
prevent infection risk. So prevent endometritis which
is an infection in the uterus. A second reason is
because up to 80 percent of women will have some
sort of perineal laceration during a vaginal delivery. So, lacerations are very
common and they may be minor as Jen mentioned there are kind of four types of lacerations. First, second, third, and fourth degree. And a first degree is just a little cut on the vaginal skin and then
you have a fourth degree which is a complete tear
from the vagina all the way through the anus. And so a laceration, any laceration will take additional time to heal and you certainly don’t want anything producing friction on the repair or potentially compromising the repair that’s been done on that
perineal laceration. That’s not good for wound healing and that’s gonna be really painful. So in general, six weeks. Sometimes it’s a little bit longer, depending on the type of
laceration that a woman has had. – Can I actually go back to the question. ‘Cause I just have a thought
that I don’t know if you wanted to add anything to the
question that was just asked. – Regarding the laceration? Yeah, so in regards to
when to have intercourse, you know I think it’s,
we see a lot of patients that they’re definitely avoiding it because it’s painful just to sit and to honestly think of your partner entering there is like, forget it. So we really work with patients
in the pelvic floor rehab to help you gain that comfort back, going back again to we
work with teaching you how to massage your scar. We also use vaginal dilation to help with the stretching and work
up to the size of your partner. And once you’ve gained that comfort back and it’s less painful to
even insert a dilator, then we encourage patients to
try intercourse at that point. I think it’s important to
wait until you’re ready and to not feel pressured. I’m sure your partner realizes what your body’s just been through, so I think communication is key. And that’s an important part, but you can get back
there, it just takes time. I will often have patients
bring their partners in so they can kind of see what they’re doing and sometimes also help out with parts of the therapy as well. – Great, that’s very helpful information. – So I just wanted to go back if that’s okay.
– Absolutely. – To the question, ’cause I was thinking about the question that was
asked about the return to work. – Oh, return to work. Oh, okay I’m sorry I thought you were– – No, no that was good. I wanted you to be able to talk. That was the question, the prior question was
in both of your domain. So I was just thinking about
the return to work question. And how a lot of times I
think one of the things that people worry about is feeling guilty that it will harm their baby and worried about the
baby’s attachment to them. And I think, I just wanna
speak to that briefly to say that we actually
have quite a lot of research that tells us that children
whose parents work, whose mothers work, are perfectly capable of having wonderful, loving,
closely-bonded relationships with their parents. And so, I think that, I don’t
wanna minimize the challenge that families face in having
to make that transition, and including maybe
feelings of sadness or loss about not being able to
be home at that time, but I also wanna reassure families that the things that they are doing, the loving on their baby, the support for their baby during those early months and years still has the
effect of really creating a really wonderful bond and attachment for the baby with their parents and the outcomes can
be very, very positive for kids in that situation too. – Did you want me to comment
on the return to work? – Sure.
– Is that all right? – Yeah. – From the physical, not
just the mental aspect, but the physical aspect as well. That’s another reason why it’s important to go to physical therapy. We also look at what your
physical activities are at work and at home and teaching you the proper body mechanics with lifting. And now, it’s a little bit more
difficult getting the babies in and out of their
crib because they don’t drop down anymore, which
is so disappointing, because boy, that was so
much easier when my kids, we could do that. ‘Cause you can actually
bend more appropriately, but we do, we also work with proper way for holding your baby with breastfeeding and working on body mechanics and bringing baby to
breast not breast to baby. And we also have a
blocked milk duct program as well for women, I just wanted to, that’s a bad word to
say, plug that in there, but there you go. So, but it is, I think
you should also feel, not just mentally ready
but physically ready and from a full-time
working mom perspective, I have two boys. It’s good to get back to work. It does bring about even a
little adult conversations and you’ve worked hard for your degree. So it’s okay. – That’s right. And women experience that
in so many different ways, I might add, right? Like some women might really feel like, I really need to have
this sort of transition, and that’s wonderful. I think the important
thing is the support. And I’ll just jump on to add, the things that you’re talking
about are so important, not only for the body and physiology, but also for the mind
and for mental health. And so, we actually do know that women have experienced
complicated births, when they have many physical pains or sort of things happening in their body that are causing stress or discomfort, it actually increases risk
for depression and anxiety in the perinatal period
and so I think really, attending to your body and
making sure there’s space. That is so important.
– Because as moms, I mean, we put ourselves
last most of the time. – Yeah, that’s right.
– Absolutely. – I mean, seriously. We never have time for ourselves, right? – And we have data on that from our clinic and postpartum depression,
so we found that women who have urinary incontinence and pelvic pain had a higher rate of having a positive
postpartum depression screen. So you know, those are two kind of unique postpartum pelvic floor risk factors for a positive postpartum
depression screen that hadn’t really been
identified previously. So it’s really important if you have any of those kind of symptoms
to get care for those things, ’cause they can definitely
contribute to your mental health. – Absolutely.
– Well and I think, what’s also interesting to me about this. ‘Cause we’re talking a
whole broad range of things. But they’re all really very connected. And the other thing that I think can be really connected is some of the barriers that prevent women from getting the help that they need, right? That in fact, oftentimes
women will experience feelings of shame, embarrassment, isolation, guilt, some sense of worry and
also these aren’t the things that people always come and
talk to you about, right? They come with baby
gifts and baby showers, but no one is necessarily talking to you about pelvic floor issues and
concerns or mental health. – Even moms and daughters or girlfriends. I mean, it’s just not something
that is commonly discussed. – I will say, though, once our patients have gone
through pelvic floor rehab, it is the hot topic–
– Then they’re advocates. – Of conversation at any little luncheon or happy hour that’s happening that, the word gets spread around. But I do wanna mention, if I can, if people are looking for
a pelvic floor therapist, you can go to, there’s a national website. Either you can go to Pelvic Guru which is a great new connection for adding all the different kinds of
disciplines for physicians and resources for patients
and how to locate a PT. There’s also our American
Physical Therapy Association. The Women’s Health APTA.org,
you can go to PT locator. And locate a PT anywhere in the country that’s closest to you. – Well, and I think addressing
those kinds of things, you know, the people who
have been through this and then share it with
others, have so much power. And I often think that when we have, you know, celebrities or people who are sort of sharing their stories of recovery through depression
or anxiety postpartum, that that’s tremendously helpful to other women who maybe feel more alone. So I think we all have
such a responsibility for getting the word out there so that people know there’s
hope and there’s help. On the note of resources, certainly at the University of Michigan and the Department of Psychiatry, we have our Women and
Infant’s Mental Health Clinic, where we provide consultation and service around psychopharmacology but also psychotherapy and we have groups. All sorts of things that women and their families can
find tremendously helpful. And there are resources also online, so Postpartum Support
International, for example, is a really trustworthy
source of information to really understand
more that might help you if you’re sort of wondering,
where am I in this continuum or what sorts of options
are available to me. – And for physical therapy,
good to mention too, here in the Michigan Medicine
system we’re really expanding, so we have locations in Ann Arbor, at our Burlington building, Brighton, the Brighton Center for Specialty Care. We have Canton Health Center
and we have Northville. And we also have a
pediatric program as well. The PRC Clinic on Plymouth Road, so we really try to look at the lifespan of issues and address bedwetting
and constipation in kids. So if you’re a mom who’s also
experiencing those issues with your child, beyond a certain age, there’s help for that as well. – And our national
urogynecology association also has a great website
for patient resources that you can go to. It’s called voicesforpfd.org. PFD stands for pelvic floor disorders. So you can go there and learn more about urinary incontinence, prolapse, fecal incontinence, pelvic pain. They have some great handouts on the types of perineal lacerations, so you can get all kind of information to see if you’re wondering if you have a certain
pelvic floor disorder and what the treatment options are. It’s a great resource to go
and get that information. – That’s great, thank you. Okay, so I’m an aqua-cycling instructor and I can’t wait to get back to that and running again after the baby arrives. When can I return to my normal
exercise routine after birth? – I think, both of us. – Yeah, we can go together.
– Go ahead. – So, I get this question
a lot also in clinic. And it kinda depends on what your normal exercise routine is. It sounds like you are
a very active person, which is great, and we want you to get back to doing those
things as soon as possible. So, there’s no specific time. I encourage women to kind of
gradually increase their level of activity day by day,
as they feel up to it. So there are gonna be some
days where you’re tired and you just need to rest and sleep. And that is totally fine. But walking is certainly
one of those activities that you can get back to slowly. Start with short walks
and kind of increase. The nice thing about, I don’t
know what aqua-cycling is, that sounds really interesting. It sounds very low impact though, which is, if it is, you can kind of resume that whenever it’s comfortable for you. So if you’ve had a perineal laceration or perineal tear, sometimes
that can cause discomfort with the bicycle seat. But as long as it’s not
uncomfortable for you, I think low impact exerciseS
like the elliptical, the stationary bike, I
think those are great. Jen, what do you think? – So I think that you one,
need to listen to your body. And allow yourself to heal. One of the things we try to guide people as they’re going through
the rehab process with us and just helping you
to find your core first and get back to exercises that are low impact, definitely initially. Any time you’re getting
back into a workout regimen, I always tell people, go about
half of what you did before. So, if you’re a runner,
let’s start with walking and let’s work back into running. You need to allow the body
to heal like Carolyn said. You know, there’s a timeframe
for us to heal as well. You know, usually that first few months, you’re really healing. I know I’ve had two Caesarians myself. Might have pushed it a little too quick, but physical therapists, we’re kind of the worst
patients, I’ll just admit that. But you really do wanna
give yourself time to heal so you don’t injure
yourself and so I think that first three month
window is really important for the rehab and if you are concerned about how you’re feeling and if you feel like your core is weak and you’re having these pelvic floor issues, definitely see a physical therapist, because they’re going to guide you back in that right direction. And what Carolyn said is so true. If you had a perineal laceration or if you’re experiencing
pelvic floor pain, probably riding on a bike is not the best thing to start with. Things like even an
elliptical would be better or walking on a treadmill,
going out for a walk. Light jogging eventually is okay. For women now that have
pelvic organ prolapse, we definitely have more
advanced treatments in physical therapy and exercise protocols that we teach, so we can
actually get you back more to those exercises that you like to do with less of that sensation. And that does depend on the
grade of prolapse that you have. But know that there is
something that can help you. – Great, thank you. Many people know how
helpful a birth doula is. Would you recommend a
postpartum doula just as much, if not more, during the fourth trimester? – That’s a good question. (panelists laugh) – So I’ll speak to that. First of all, I have said already, and I think this is hopefully really clear that support during that postpartum period
is so, so important. And there are a variety of
different sources of support that people tell us that are
really important to them. And it might be a parenting partner, spouse, it might be a dear friend, it might be a mother or a mother-in-law. Someone who can really come
in and provide the help and support and maybe even some guidance that really most women
find very beneficial. I think through the ages, women during the postpartum
period have relied on other women to support them
during the postpartum period. I always think about
sort of the wise woman who really helps us. Unfortunately, maybe in many ways, our families now are
often much more isolated and spread out and we don’t have that kind of sense of community always, where people can come
in and really step in to offer support as it’s needed. So I think that postpartum doulas can be tremendously helpful as
knowledgeable sources of support in baby care. Also, really really important
to me is sort of thinking about who’s offering
mom support for sleep, because particularly when
women are struggling with mood, the number one thing we wanna attend to is what’s happening in mom’s sleep. And I think the first prescription pad that comes out usually
in our clinics is one that has to do with making sure that mom has the sleep that she needs. And obviously postpartum
sleep is not easy to come by. And so often what we
need to do is think about who are the folks who we can bring in who can offer mom several
nights of extended hours of uninterrupted sleep
when mood is disrupted. And that can really be a tremendous help in terms of a reset. So a postpartum doula can
sometimes help with that, a nighttime doula, for example. So I think having someone who’s coming in–
– [Jen] I should have done that (laughs). – I think we all should have done that. – That is sounding wonderful. – I think you’re gonna have a lot of women dialing in on that. – I think it can be tremendously helpful. And actually when someone’s struggling with mood and depression,
I think it’s more than just wonderful, it’s
actually medically necessary to really help them with getting
the sleep that they need. – Yeah, that’s very important. – Thank you, that’s great information. It looks like we have time
for about one more question. So, what can employers to do in order to make the transition
easier or more comfortable for a mom when she’s returning to work? – I think give her the time that she needs and work with your, sorry
didn’t mean to jump in Carolyn, work with your employer
and employee relationship. Work together and do what
you feel you’re ready for and comfortable for. – Yeah, I think the short
answer is listen to women. Ask them what they need. Because individual women may need slightly different things. I mean, if women are
nursing or breastfeeding, then obviously they need support. They need time to be able to breastfeed. They need a private space
in order to do that. They need a place to store
their milk during the day. And sometimes those things
can be really awkward and difficult conversations to have and women might not feel empowered to ask that from their
boss or their supervisor. But I think if that’s initiated by the supervisor who says,
I know this a difficult time for you, or can be a difficult time, what can I do to support you? I think that can go a long way. – Good. – I would absolutely concur with that. And I would say actually
listen also to dads and think about how it is
that we support whole families during this incredible transition and during this very
intensive parenting time. How can we provide support, is there flexibility in
shifts or sort of hours? Or in how things are happening? And being aware and really listening to what the needs are
I think can go a long, long way towards helping
families adapt, cope, and succeed in this sort of, you know, big challenging and wonderful
transition into parenthood. – I concur as well. – Thank you. Okay, well we are closing in on the end of our chat together today. So Dr. Swenson, Dr. Rosenblum, and Jen, I wanna thank you for sharing
your time and expertise today. It was great information. For more information on our Healthy Healing
After Delivery program, please call 877-462-6935. If you would like to see
one of our psychologists about postpartum depression, please call 734-764-0231 or you can visit the UM Department of Psychiatry website to learn more. We also have a wealth of online resources on a number of women’s health topics. You can check them out at www.uofm, sorry
dot
umwomenshealth.org/womens-health-resources. Thank you to our audience for spending part of
your afternoon with us. We hope today’s chat has been helpful. We have a brief survey we’ve prepared to help us learn how we can make chats like today’s more helpful to you, and to help us identify more topics you’d like to hear about. Please be sure to check
the comments to this video and we’ll have a link
there for you to follow. Once again, thank you for joining us and have a wonderful afternoon.

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