Birmingham Mom Collective has the answers to all your burning postpartum questions thanks to three of UAB’s top women’s health experts: Isuzu Meyer, MD (Urogynecology), Audra Williams, MD (Obstetrics and Gynecology), and Kristi Gulledge (Lactation).
We are grateful they took the time to share their wisdom with our readers. Let’s get started.
What are the most common health issues you see in postpartum patients?
Dr. Williams: Mood disorders like anxiety and depression. Changes in bladder or bowel function, particularly leaking urine.
What are the signs that you need to seek pelvic floor therapy after giving birth? What can you do to strengthen your pelvic floor postpartum?
Dr. Meyer: Many women (up to 60%) experience pelvic floor symptoms such as urinary leakage (incontinence) and/or pelvic organ prolapse (feeling a bulge in the vagina) during pregnancy. These symptoms often resolve during the postpartum period, although this may not happen immediately after childbirth. Most women typically have spontaneous improvement of their symptoms by 12 months postpartum; however, the length of recovery can vary among individuals. Women should discuss with a provider if they have persistent or worsening symptoms, such as urinary leakage or a bothersome vaginal bulge.
Most women benefit from pelvic floor therapy after childbirth. The timing of pelvic floor exercises depends on several factors including pelvic floor injuries during pregnancy/childbirth, pain, the mode of delivery, etc. Some women can start pelvic floor exercises soon after delivery. It is important to consult a provider who is familiar with pelvic floor disorders and discuss the timing of initiating pelvic floor therapy, treatment options, and expectations.
It is also important to know that every woman recovers at a different pace, and it may take longer to notice improvements for some women. Many do not perform pelvic floor exercises correctly, prolonging the issue. Learning the correct techniques to engage the muscles is the key to a successful recovery. Pelvic floor exercises and strengthening are only a part of pelvic floor therapy, though. Some may require strengthening while others may need to focus on relaxing and lengthening the muscles first. When appropriate, your provider can refer you to a pelvic floor therapist who is specialized in pelvic floor disorders.
For moms who are breastfeeding, what best practices do you recommend for staying healthy and avoiding lactation issues?
Ms. Gulledge: Many moms have concerns about making enough milk. It is normal to not feel changes in your breasts for three to five days after delivery. Mothers start the process of making milk when they are four to five months pregnant. After delivery of the infant, regardless of how far along in the pregnancy, the mother’s body has colostrum. Nursing or expressing the colostrum as soon as possible after delivery sends the message to grow the milk supply.
A newborn infant’s stomach is very small—just the size of a cherry or hazelnut. Moms have just the right amount of milk. The nursing baby is best at getting the colostrum. Colostrum is thick, can be a variety of colors, and contains all the nutrients the baby needs.
Breastfeeding has been shown to help moms recover quickly from pregnancy. The hormones of breastfeeding help moms to feel more relaxed and help shrink the uterus more quickly. Nursing the baby with signs of hunger, 8-12 times per day, tells the body how much milk to make. If a mom is using the pump to provide breast milk, she should pump 8-12 times per day, for 15-30 minutes. Early frequent stimulation soon after birth, and the weeks that follow, tell the body how much milk to make. Large gaps of time when a mom is not nursing or pumping can cause lower milk volume. Moms should eat when they are hungry, stay well hydrated, and rest when the baby sleeps.
Engorgement, or swelling of the breasts, happens three to five days after delivery. During this time it is best to continue to nurse with signs of hunger. Warm, wet compresses can be applied prior to nursing, and hand expression can also be used to soften the breast so the baby may latch more easily. Ice packs can be applied for ten minutes after nursing.
Nursing the baby with signs of hunger is very important to help manage the fullness. If the breast becomes very firm and hard, moms may need to reach out to a lactation consultant for assistance.
Explain the differences between a clogged duct, mastitis, and thrush. Are there any other lactation issues that could cause health complications for mom or baby?
Clogged Milk Duct
Ms. Gulledge: A clogged milk duct is not an infectious process. It does not require antibiotics for treatment. Clogged ducts, also known as plugged milk ducts, are usually small pea- to grape-sized lumps. They are painful. The treatment is to nurse or pump frequently. Warm compresses can be applied before nursing and pumping, and ice can be applied after nursing or pumping. This can help to reduce swelling and inflammation. Applying compression over or behind the lump while nursing or pumping may be helpful.
Avoid constricting clothing. Try changing breastfeeding positions, at times pointing the baby’s nose in the direction of the plug. If a mom develops a fever or the clog does not resolve within two to three days, she should contact her doctor.
Mastitis
Ms. Gulledge: Mastitis is an infectious process requiring medical attention and antibiotics for treatment. Continuing to breastfeed or pump is highly recommended. Typically a mom reports a painful red area of the breast and flu-like symptoms. Most moms with mastitis will have a fever. A 10-14 day course of antibiotics should be completed to fully treat the infection. Most moms report feeling better within three days, but it is very important to finish the treatment ordered by the physician. Warm compresses and occasional ice packs will help soothe the inflammation.
Thrush
Ms. Gulledge: Thrush is a fungal infection or yeast overgrowth occurring in the baby’s mouth or on mom’s nipple. It requires medical evaluation and treatment. Both mom and baby should be treated at the same time. The infant may seem to have white patches or bumps in the cheeks, lips, or on the tongue. Mom may have pink shiny nipples that itch and burn. Thrush can cause the baby to not eat well and cause mom to report painful nursing or pumping. Mom and baby should complete the treatment prescribed. Mom may also pay special attention to cleaning or sterilizing anything that touches her breast or the baby’s mouth.
What are the differences between the baby blues and postpartum depression?
Dr. Williams: Baby blues are very common (40% of new moms) and are typically self-limited. Women with baby blues may experience mild symptoms like sadness, crying, insomnia, and mood lability, but this usually resolves within two weeks of the baby’s birth.
Postpartum depression tends to have more severe and longer lasting symptoms that can include significant anxiety about the health of the baby, inability to get out of bed, or thoughts of self-harm. Postpartum depression can be diagnosed anytime within the first year of a baby’s life.
What treatment do you recommend for a woman who may be experiencing postpartum anxiety and/or depression?
Dr. Williams: For women with mild to moderate symptoms, I usually recommend starting with therapy. Prescription medications like antidepressants can also be very helpful in women that may not be able to access therapy or that have more severe symptoms. Many of these medications are safe for women that are breastfeeding. I think it’s also important for women to have a support system, whether that is from friends and family or a support group of moms that are going through similar things.
Birmingham Mom Collective is honored to be part of a support system for local moms, and we’re thankful for our UAB experts who help our readers better manage this postpartum period!
