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Those post-birth weeks

Okay ladies, I'm coming towards the end of a long ass week. A law. Long ass week. Babies. Babies. I just left the hospital after doing rounds and delivering some babies, and it always reminds me when I do rounds of the things I wanna talk about. , I've talked about this before, but I really felt like it's important to discuss some of the things that you might experience physically postpartum in that couple of weeks, like that first one or two weeks, and my philosophy on help and what you need.

So first and foremost, let's say you've delivered. , you're going home. If it's vaginal, you might have stayed two nights. If it's C-section, you might have stayed three or four nights. Regardless. I say the same things to all my patients. Three things to expect when you go home. You might bleed more when you go home than you bleed in the hospital, because in the hospital, you're in your little space, you're in your little cocoon, as I call it, and then you go home and you're a little bit more active and you're walking around.

Sometimes when you're more active, your uterus all of a sudden tends to relax and gush out some blood. So it's not infrequent that we get phone calls saying, I just passed a big clot, a joke that people are like, my liver just came out, and if it's a clot and then you're not gushing blood afterwards. I know that sounds gross.

Then I'm not that worried usually, especially when the story is, yeah, I did feel good and I kind of, I did more, right? So again, if the story is I did more activity, all of a sudden I gushed a little bit, then it stopped. I'm not that worried. Call your doctor if I'm not your doctor. But if you are continuing to bleed, and our index of concern is typically if you are soaking through pads every 30 minutes.

That's too much bleeding. You should call your doctor again. It usually means you were a little bit overactive. It doesn't mean it's your fault. It's just that that's when we tend to see it. Now, of course, it can happen on its own. Out of the blue, you're lying in bed and you start bleeding. And again, if it's persistent, you should call the doctor.

The second thing is swelling. So when you are in labor or you've had a C-section, you've gotten a lot of IV fluids, and then you need to mobilize that fluid and pee it out. But your body doesn't do that quick enough. So the fluid essentially seeps out of your blood vessels into your tissue, which is like your hands, your feet into the tissue that surrounds all the blood vessels, and that's what the swelling is.

And that will often get worse over that first couple days after you go home. Sometimes for that week it will get. Like you thought you were gonna go home and have lost like 25 pounds between the baby and the fluid and the placenta, and all of a sudden the scale stays the same or even goes up because you're retaining fluid over the course of a week, two weeks.

For some of us more like my first baby, it took six weeks, but by my second and third it was quicker. And that does tend to happen. Your second and third, you swell less, but so over that course of that first couple of days, or. Your body needs to mobilize the fluid out of the tissue, get it into your blood vessels, where it filters through your kidneys and you pee it out.

How can you. By drinking a ton of water. Tons of water, because that just helps flush everything out. Okay? And then the third is that horrible headachey feeling that you often get, especially when your milk is coming in or when you're nursing. Because of that drop in the estrogen levels. Any of you who have had premenstrual migraines, you'll know that headache.

It's a throbbing, horrible headache. It can come along with some shaking chills that are almost like painful shaking. With a headache and sometimes hot flashes. It's like a very weird combination. It sometimes feels a little bit like menopausal hot flashes, because again, the mechanism is the drop in the estrogen.

If you have a fever, this is different than of course, Carl, your doctor. If you have that headache and you've had hypertension, then you should either check your blood pressure or call your doctor. But in the absence of those cases, you can certainly take oh ibuprofen, which we'll talk about in a second.

And then with the IBU. That really should come down. And as long as the headache decreases and you might wanna add some caffeine, then typically this is just the hormone. So those are the three things that are really common that happened that are a little bit confusing, that we often forget to tell patients.

So I try to preemptively tell everybody, ibuprofen and Tylenol. I wanna touch upon that. Ibuprofen is the generic for Motrin and Advil, Motrin, Advil, ibuprofen are all the same thing. And ibuprofen again is the generic. So at the hospital, again, regardless of C-section or vaginal, you are likely getting generic ibuprofen.

It's a big white pill. It'll be either 600 or 800 milligrams, which is equivalent to three or four of the over-the-counter pills. The over-the-counter pills are 200 milligrams each standardly, unless you're getting junior Advil or junior Motrin. But regular Motrin or ad. In America at least, it's 200 milligrams of ibuprofen.

So you can go home and either take 600 to 800 every six to eight hours. Your doctor will either give you a prescription or call on a prescription or electronically transmit a prescription. Or they might tell you to just buy over the counter Motrin or Advil, which you might have at home, and you would take six to 800 milligrams every six to eight hours.

And I find that that helps best for the pain in your breast. The pain. Vva, vagina, perineum, rectum, that whole area and your uterus. So if you take the ibuprofen every six to eight hours, Coupled with Tylenol every three to four if you need it, then you often don't need any narcotics, especially after a vaginal delivery, unless it's been a really challenging push, in which case you might have a lot of swelling and tearing that might hurt after a C-section.

You might actually go home after day night, three or four. And only have needed the Motrin and Tylenol and not the Percocet though. If you need the Percocet or Roxycodone. Roxy said these are different names of narcotics that we safely give patients for short periods of time. Um, it's okay. If you need that, you'll take that as well, and your doctor, again, will either give you a prescription or com or electronically transmit it.

Most of the time we're not allowed to call those prescriptions over the phone anymore because they're. Controlled substances. Substances. Um, so pain medicine wise, I think it's really important to stay ahead of your pain. So I tell my patients, you should ask your doctor by the way, that they should take the 600 or 800 of Motrin.

I prefer just going with 800 of Motrin every six to eight hours around the clock for a couple days after you've gone home. And what I usually say is, after a couple days, you're gonna find that you've forgotten a dose or two in there. And when you forgot the dose, were you either like, oh, I need it now.

I'm gonna set my alarm. Or, oh, I forgot a dose, and actually I'm okay. I can stretch out how often I'm taking it because this is not for your safety to take these medicines. This is for your comfort, and I want you to be comfortable because if you are in pain or in discomfort, it's harder to get up and take care of your baby and do all the things that you need to do to heal yourself.

Which leads me to my last point before I sign off today, which is if you have someone to help you, whether it. You've got a baby nurse. Whether or not you have a babysitter already that helps with maybe one of your other children, whether it's your mother or mother-in-law or a friend, anyone who is able-bodied and willing to come help you and take care of the baby with you.

I would take the help. This is outside of your birth partner because you and your birth partner are exhausted. And if you're new to the game, you don't know what you're doing necessarily. But if you have another baby or two, then you know what you're doing. But you have to like divide and conquer. So anyone who can help, it's really important and valuable.

And what I see time and time again today too, my patients express this was well, but I feel bad if I have someone else taking the baby in the middle of the night sometimes. Now hear me out on this one. We used to. When we had groups of women taking care of us. So in the olden days, which we're off often trying to mimic nowadays, right?

We're trying to get back to what we did in nature. In the olden days, we would have these gaggles of women in this village who would take care of us, and then our only role was nurse the baby. And then one of the women would take the baby and they would take care of the baby. While you got. And you slept so that you could heal.

So there was not this notion of like you were alone or you and your partner were alone in your home with nobody helping you, and you were like up all night feeling lousy. So first and foremost, like I've said, if you have someone who is willing and can come and help, if you know that you can get one chunk of sleep for four to five hours, like in two days, that's enough to kind of keep your brain from feeling like it's.

really going over the edge. So I suggest taking that help and getting earplugs and an eye patch so that when your mother or mother-in-law or friend or whoever has that baby for that four or five hours, you don't hear the baby cry. Cuz if you hear the baby cry, you're gonna be like, what's going on? Do I need to get up?

Why aren't they taking care of the baby? Okay, so suggestion is, use that help. Second suggestion is don't feel bad. It's not only that you shouldn't feel bad, because in the modern world, we do things that we didn't do in the past, but in fact, this is how we did it in the past. We did it with help. We did it with the village of people.

We didn't do this alone. Okay? Third is trusting your intuition. What I also say to my postpartum mama is when they're gonna go home about resting. And not being too physically active is this, women are systematically taught to not listen to their intuition, right? We're taught that you need a book, you need a person on Instagram, you need Facebook, you need your friends.

You need that support group. You need someone telling you how to do things right? Don't trust your intuition. That must be wrong. You need a group of people to tell you, and I'm here to say, don't listen to anyone except for me telling you not to listen to anyone about things like your, I. You're probably smart enough to know what to do in those first couple of weeks when knowing what to do is pretty simplistic.

It is nourishing yourself, taking care of yourself, getting rest when you can, and taking care of the baby when the baby needs. It doesn't have to be done in this systematically perfect way because no one knows what perfect is. Everyone's way is different. You guys might have heard me say this before, but when you ask a question, you get 10 different answers from pediatrician, a lactation in your ob gyn, and then five different.

That should not confuse you. That should be a sign that you actually don't necessarily have to get the right answer, cuz there is no right answer. And you can actually, again, trust your intuition to figure out what is best for you and for your baby. Now I'm not saying, not listening to us as doctors, cause I do think you should listen to us, to a degree of course, on safety issues.

But when it comes to should I breastfeed, should I bottle feeded? Should I use a binky? Should I not use a binky? Should I swaddle? Should I co-sleep? All these shoulds, there is no. In that scenario, you should really gather some data if you want, but use your intuition. If what people are suggesting is working for you, that's great.

And if it's not, then don't ask us the Motrin dose and stuff like that. But don't feel like everything we tell you as practitioners, and I include all of us nurses, lactation doctors, your friends, your in-laws. , the influencers you listen to. None of us is experts in you and your child. Okay? Now, the one time I say don't listen to what you think is your intuition is, let's say you've gone home vaginal or C-section.

You feel pretty good and you're like, oh, I feel great. My intuition is telling me I should go do 10 loads of laundry, or I should get on my Peloton, or I should just start doing some activity because that's what my intuition. Guess what your intuition is probably not telling you that you are being fooled by society's notion that we should be constantly on the move and achieving.

And so your intuition probably would say to you, hold on, you just went through something crazy like you grew a human being and that human being came out of your vagina or out of your abdomen. Therefore hang out and rest for a couple weeks. Right? That's what your intuition would actually probably say if you were listening to it.

But if you feel great and you think, Hey, I'm gonna go do something amazing, that's not your intuition. That is all of what we put on ourselves. I'm not suggesting not to go take a walk like I say to my patients, go take a stroll if it's nice out, but do not put on your running sneakers with the intention of exercise.

Okay? And that's also to just to protect your pelvic. You want things to heal so that when you're my age you're not like peeing on yourself and all that stuff that happens. Okay. Okay. That was just, you know, quick in my world quick cuz I did this under 15 minutes. Um, so anyway, I was kind of absent this week with you guys cuz I was like very present here on labor and delivery.

There was just a lot. Of stuff going on. Everybody was healthy. My patients were just phenomenal and tremendous this week. Okay, so I hope that helped. And to all you mamas who are birthing, please, please, please just accept help whenever you can get it because it's not a sign of weakness. It is a sign that you are nourishing yourself and taking care of yourself, and that's the best thing you can do.

Okay, bye.