Participants: Amy Wellard, Cherie Lon Fernandez
Series Code: WM
Program Code: WM000444
00:34 Welcome to "Wonderfully Made"
00:36 I'm Amy Wellard from the "Wildwood Lifestyle Center" 00:39 With me today is Dr. Cherie Lou Fernandez 00:41 and our subject is "postpartum care" 00:45 Welcome Dr. Cherie Lou 00:47 Today, we are going to talk about the baby is arriving 00:50 and there's all the excitement and anticipation 00:53 in the delivery room. 00:55 Mom is getting endorphins and getting high... 00:57 What's happening to daddy? 01:01 Oh, it's really nice for the husband to be there while 01:05 the woman is in labor because he can 01:09 see and empathize and know really how difficult 01:13 it is to go into labor and delivery. 01:15 It's really very important for the husband to be there, 01:18 and to be able to see and love 01:20 his wife more after she has given birth. 01:22 Funny thing is - sometimes men, they EMPATHIZE so much 01:27 Men can empathize if they love their wives really, really, 01:30 really, really and they empathize. 01:32 Sometimes the father FAINTS! 01:35 ...And you pick him up from the floor. 01:37 Everybody forgets about the mother and the baby! 01:39 They forget about the mom and the baby, and they go to the dad 01:42 So that's the reason why sometimes they would 01:43 rather not have the father there. 01:45 But when the baby comes out, many times, the mom is... 01:50 They all go rush to the baby and take care of the baby 01:53 especially when the baby has problems, 01:55 the one who is delivering the baby, 01:57 especially if they are doing 2 things at one time, 01:59 no nurse or whatever to take care of the baby, 02:02 there will be times when the mom will be left, 02:04 but that's not really a big problem. 02:08 So typically, the postpartum period is about 02:10 6 weeks from the birth of the baby? Yes 02:12 Right, so what kind of physical changes is the woman's body 02:16 going through that requires special attention? 02:19 Okay, yes - you said... you know when a woman 02:24 gets pregnant, there are so many physical changes 02:26 in the body of a woman... 02:28 And, I used to be a size 5, my feet were a size 5. 02:35 As I grew bigger with my pregnancy, 02:40 my feet became bigger and became a size 6 02:44 Well after I delivered, it became a 5-1/2, 02:47 and I've never gone back to 5 02:49 I don't know, maybe because of the weight, my foot spread, 02:53 and it's not as small as it used to be but there are changes 02:57 And you may not be able to come back to the same thing, 03:00 but the reproductive tract takes about 6 weeks. 03:05 You call that the "puerperium" ... the time when your 03:08 reproductive tract goes back to normal... it's 6 weeks. 03:16 I was going to ask you about afterpains... 03:18 Afterbirth pains - is this very common, 03:21 when the uterus is contracting going back to its regular size. 03:24 Sometimes the midwife or the birth attendant will 03:27 massage the abdomen. 03:28 For myself, that was quite a painful thing. 03:31 Is that really a necessary intervention? 03:33 Yes, especially for women just right after the delivery. 03:39 Okay, the baby comes out and then after that, 03:41 they wait for the placenta, they deliver the placenta, 03:45 and right after the delivery of the placenta, 03:47 many times if the woman has gone through 03:50 LONG protracted labor, the uterus is so tired... 03:55 too tired to contract. 03:57 So that's why many times the midwife has to massage 04:02 the hypogastric area to irritate the uterus and wake it up... 04:06 Hey, you still have work to do! 04:07 You have to contract! 04:09 If the uterus does not contract, 04:13 the mother can bleed to death. Really? 04:16 It HAS to contract! 04:17 However, when it comes to contract like this and strong, 04:21 it gives you a dysmenorrhea-like pain 04:24 that you call the after pain. 04:26 Okay so that's a bit like cramping or severe cramping? 04:29 Yes it is, but it's not something that is really 04:33 really bad - although it depends on your pain threshold. 04:36 Some women don't need to take medication; 04:38 some women need to take medication, 04:40 but this afterpain seems to be aggravated when 04:46 the mother puts the baby to the breast. 04:49 So when the baby sucks on the mom's breast, 04:54 there's an impulse that goes to the brain, 04:57 and tells the brain to tell the pituitary gland 05:01 to release oxytocin and oxytocin makes the uterus contract. 05:07 It is really helpful because then it makes the uterus 05:12 really more closed and that there will be no 05:16 bleeding afterwards... 05:18 So it helps cut the possibility of bleeding afterwards. 05:23 Gets things back to normal as quickly as possible. 05:25 Yes, as to the size of the uterus. 05:27 Now there is a certain amount of discharge that we can expect 05:31 after birth - a certain amount of blood and so on 05:33 for a number of days and so that leads to the question... 05:36 How safe after birth is it to having intercourse? 05:39 Yes, the lochia - which is the discharge, 05:43 will tell you whether your uterus has really 05:45 recovered or not... the discharge you call that. 05:49 It starts first as like red, as in fresh blood initially, 05:55 then it becomes brownish and then it becomes just tinged, 06:00 until it becomes clear and then it disappears. 06:03 When that happens, it's about 6 weeks. 06:06 So if you do not have this red, brown, lighter color, 06:11 and then it finally disappears, and it's protracted... 06:14 It's red, brown, red, brown, red-red, brown, you know... 06:17 And then it goes ahead more than 6 weeks, 06:20 that means your uterus is not well-contracted. 06:24 It's not really contracting good enough, 06:27 and probably even if it extends some more, 06:31 MAYBE you have some infection, 06:34 or MAYBE there is some placenta that is left behind. 06:39 Usually when you deliver the placenta, 06:42 you check for whether the placenta is complete, 06:46 and sometimes you don't know 06:48 some little parts of the placenta are left behind... 06:51 And if there are some placenta, 06:53 we called them "retained placenta" are left behind. 06:56 The uterus won't be able to close-down completely, 07:00 and so your lochia will tell you 07:03 whether you are really... 07:05 Your uterus... if it goes more than that, 07:07 you're either infected or you have retained placental segments 07:11 So would it be safe to have 07:13 intercourse after the lochia has stopped? 07:16 When it has stopped - yes, because then 07:17 that would be around 6 weeks... All right but not before. 07:20 I'd suggest not before because the uterus has not 07:23 yet completely recovered and you can induce, 07:28 or you can cause infection... 07:30 And it is hard too... It is a difficult thing. 07:33 Sometimes it can be really serious and life-threatening 07:36 to have uterine infection. 07:39 Now what about ladies that have had a C-section? 07:41 How soon after the delivery is it safe for them 07:45 in terms of infection, to have intercourse? 07:47 It is the same thing, it's the same thing you have to 07:50 have your uterus come back to normal first. 07:56 If you are talking about - with regards to being able to 07:59 have sexual intercourse after 08:01 delivery or after a normal delivery. 08:03 It's when your lochia is gone. 08:05 When the lochia is gone, that means your uterus 08:08 is already ready... it's physiologic. 08:13 Ready to start again. Yes 08:14 Usually the mom isn't quite ready. 08:16 You have to be sure though that you talk about contraception. 08:20 Because it depends on... there are many things 08:22 you will talk about later. 08:23 Now, something I notice from the Bible... 08:26 It talks about the recovery or the postpartum period, 08:30 when you've had a baby boy, 08:31 is shorter than when you've had a baby girl. 08:34 Now, can you comment on that from your practice? 08:37 Yes, I really have been baffled by this, 08:41 and why is it that the Bible says that after a 08:47 male baby is born, the puerperium is shorter 08:52 than that of a female baby... 08:55 And all that I can think of is aside from we being the one 09:00 who ate the fruit and laboring and the female issues, 09:05 and the hormones that are different in a female baby, 09:08 there is nothing that I can think of except 09:12 that's one question I would want to ask Jesus - why is it so 09:16 But you have a baby... it's the same! 09:20 It baffles me but there IS a reason! 09:22 But have you seen it to be true in your practice, 09:24 that ladies that give birth to boys seem to recover quicker? 09:28 No, I have not really seen; I didn't notice it. 09:31 Now, some people when they're giving birth, 09:34 they experience tears which is very unfortunate. 09:38 Hopefully if the baby's head is secured as it comes out, 09:41 we can minimize the risk of tearing, 09:43 but if that does happen, what can be 09:46 some of the best measures to take for a quick recovery? 09:49 Okay, many times you can also 09:52 have tears even if you deliver in the hospital, yes. 09:55 They do episiotomies in order for you not to have tears, 10:01 but sometimes even if you do episiotomies there ARE tears. 10:04 And an episiotomy is where they cut the perineum. 10:06 Yes when they cut the perineum so that you have a bigger space 10:09 for the head to come and you don't have to stretch your... 10:13 There are pros and cons there again, you know. 10:15 But anyway, you lacerate whether it's an episiotomy, 10:18 or whether it's a normal thing without the episiotomy, 10:21 you do lacerate... 10:23 And if it is severe enough, some midwives would repair. 10:29 Yes, they would repair it if it were severe... 10:32 Because sometimes, the laceration can go even up 10:35 to the rectum and that you would have one big hole. 10:38 Your vagina and your rectum together, 10:40 and so you need to have that repaired and that's going to 10:44 take a long time to recover. 10:47 So you can have initially, of course, as you have said earlier 10:55 ...we can put ice in the first 12 hours to make 11:00 the blood vessels constrict so that you don't bleed. 11:06 In severe tears, it's better for you not to put 11:10 any hot thing there until you are really sure 11:13 that all the blood vessels are constricted, 11:16 and all clots are already in place and fixed - 11:20 because if you have a big tear and there are small, 11:25 little oozing things and you put a hot pack 11:29 you're going to bleed, and it's an emergency, 11:32 and it's a real big thing to do. 11:34 It's hard to find the bleeder of an episiotomy when you 11:37 have already closed the episiotomy. 11:39 So you have to do ice first, then wait... 11:42 I'd rather just wait for 24 hours, 11:44 although you have to have 12 hours of cold, 11:48 and then the next day, you can do your hot and cold. 11:52 Keep it first just to be sure that you don't cause bleeding, 11:56 but the hot and cold sitz bath, 11:58 even if standing in the shower, you do this, 12:02 and let the water go there and go through it. 12:05 It's already helping increase the circulation in the area 12:09 to enhance the circulation. 12:11 I actually found a wonderful healing agent to 12:15 use the shower in that way and I was so thankful my tear, 12:19 which was very severe, was completely free from pain 12:23 and healed within 2 weeks, I think, that I can remember. 12:26 So it doesn't have to be a long time. 12:28 Yes, the vagina is very bloody, how do I say it... 12:34 It has a lot of blood vessels, so then it repairs itself fast. 12:38 That's a real blessing! 12:41 One of the things that many of us are afraid of after surgery 12:44 in that area is that we're not going to be able 12:46 to go to the bathroom without pain. 12:48 Yes, we have this a lot, especially when woman have 12:52 lacerated up to their rectum or 4th degree laceration. 12:57 Because when the bowel passes through the area 13:03 to your rectum and into your anal canal and out, 13:06 you stretch the area that was lacerated, 13:11 and they hold it back instead. 13:13 So it's very common that women who have had lacerations, 13:17 have constipation and/or don't want to go to the bathroom 13:20 to pee or urinate - they hold it because when they do, 13:24 it's painful - so then you get more chance of constipation 13:28 or you get more chance of urinary tract infections. 13:30 So you just have to soften the stools through your diet, 13:37 and/or prunes or have a laxative and yes, plenty of water, 13:41 the number one thing to do. 13:43 And pee and move your bowel regularly, not hold it back 13:47 because it's going to become worse. Okay 13:50 Because it will be harder to deliver another baby 13:53 in the form of your poop... I'm sorry. 13:56 Now, how about exercises to strengthen 13:59 the perineal floor afterwards? 14:01 Okay, you again call that Kegel exercises. 14:04 You have to make all the stretching and some micro-tears 14:09 in your muscles and the structures around it. 14:12 You have to be sure that it's already well first 14:15 and that usually comes around 4-6 weeks. 14:18 Then you can start doing your Kegel exercises 14:21 which is strengthening your pelvic floor so that 14:24 then you won't have incontinence meaning women just 14:30 cough and it comes out after a childbirth. 14:32 It's because the muscles that are closing your urethra 14:35 are relatively loose, so then you're not 14:39 able to hold your urine back efficient enough. 14:43 So just a cough or just a mere 14:46 pushing would cause urine to come out... 14:49 But when you strengthen through the Kegel exercises, 14:53 you would make your muscles stronger, 14:55 and diminish the possibility of incontinence. 14:59 Now obviously, if you've had a C-section, 15:02 you haven't got the same trauma on the perineal area 15:05 but is there some special care that people that have had 15:07 C- sections will really need that those with a 15:10 vaginal delivery wouldn't need so much. 15:12 Oh, the C-section needs more care... Oh, okay 15:19 It's because every time you have a bigger scar on your 15:24 abdominal wall and you have another... 15:27 I mean - not scar, incision on your abdominal wall, 15:30 and it depends on the kind of incision on your abdominal wall. 15:34 The midline incision on your abdominal wall heals faster 15:37 than the - You know they have this bikini-type, 15:39 the low one, the "Pfannenstiel," you call that... 15:43 That takes longer if there are more structures that you 15:48 would work on and cut and whatever. 15:51 So that one takes longer to heal than the midline incision. 15:55 Even the uterine cut, the midline or the transverse, 15:59 this one takes longer than this one does. 16:01 So that you have to take this into consideration 16:04 for how long your muscles would have to repair itself. 16:10 Repair themselves and also underneath, it's a take in, 16:16 it's a given and you should not be doing exercises 16:20 or really straining yourself within 2 months; 16:24 give enough time to heal... 16:27 BUT it is important after the operation, after the C-section, 16:31 that you stand up right away when you can. 16:34 Usually it's 8 hours... you have to be flat on bed first 16:38 because of the anesthesia, if it were a spinal anesthesia, 16:42 if it were a G.A., then you can get up right away... 16:45 BUT if it were a spinal anesthesia, 16:47 you have to be flat in bed for like 6-8 hours, 16:50 and your doctor will give that instruction - 16:52 "Flat on bed for so many hours" 16:56 so that you don't get spinal headaches, 16:58 so they say "flat in bed" 16:59 If you get up earlier than that, 17:01 you might develop severe headaches. 17:03 So they say "flat on bed" and as soon as you are 17:06 given the permission, if you can sit and get up, 17:09 the better it will be for you in your recovery... 17:12 because you don't want your organs to be sticking, 17:15 you know - adhering to each other; 17:16 adhesions being the #1, a very common occurrence 17:22 after abdominal operations. 17:24 Now you were mentioning earlier about wearing a binder 17:28 when you've had a C-section... 17:29 Is that something that is commonly offered to women 17:31 that have had C-sections to hold the abdomen in. 17:34 I think it is wise - usually I do it to my C-section patients 17:40 because I ask them to get up right away. 17:42 So even on the operating table, I already put my binder, 17:46 abdominal binder and put it really snug, 17:49 so that when she gets up, her abdominal wall 17:52 does not fall forward... 17:53 Because really the pain of C- section is not bad. 17:57 It's only when she gets up or when she sits down. 18:00 Because when she gets up, her abdominal wall falls like this; 18:03 when she sits down, it moves... you move your muscles. 18:06 But when it's taut with your abdominal binder there, 18:10 then the pain is not there. 18:12 Oh and they let you put a pillow here, 18:14 and hold it when you get up like this - 18:15 so that your abdominal wall won't just 18:18 fall forward and it's painful. 18:20 And does that binder actually help speed up the recovery? 18:23 It does not necessarily speed up the recovery, 18:26 but it helps you get around right which will help you 18:29 recover faster... 18:31 I see, so in an indirect connection. 18:33 Now what about weight loss? 18:35 Many ladies, after birth, find it SO hard 18:37 to lose those extra pounds. 18:39 Hopefully you've lost at least 15 with the birth of the baby; 18:42 you may have an extra 10 you are carrying around... 18:44 What can you recommend? 18:46 First and foremost, your most important thing to think about 18:53 after you deliver is not yourself. 18:55 Whether you're fat or whatever, whether you have extra pounds 18:58 because you're not supposed to be thinking of that 19:02 in the first 2 months because all the nourishment that 19:06 you are supposed to give to your baby, you're supposed to give. 19:09 And only after 2 months, will you be able, 19:13 I mean - physiologically, you can start thinking of 19:17 trying to do something to lose weight. 19:21 And obviously, a healthy lifestyle is going to be 19:23 the best way - right through the pregnancy 19:25 and in the postpartum, just keep it the same. Yes 19:28 What about calories? 19:29 Should she continue to keep up the calorie level as before? 19:33 Breastfeeding and lactating mothers still need more calories 19:37 because you're still feeding the baby, 19:39 especially when the baby is not yet eating. 19:43 So all that you need extra for your baby to grow 19:48 inside and outside, you have still to do that. 19:52 So that's why activity is really very important for you 19:55 to help keep you from... 19:59 Some women when they breast feed, they grow fatter 20:02 because they put on more weight because they're given permission 20:08 to eat because there are 2 of them... 20:09 The same way as in pregnancy but you still have to control. 20:12 Yes, you need more but that doesn't necessarily mean 20:16 that you're going to splurge! Okay 20:18 And then you have to exercise to lose the weight too. 20:21 Right, right... Now let's talk about the emotional signs, 20:25 or the emotional management of the "baby blues" 20:28 After the baby has been born, you've had the high, 20:31 and now there's a corresponding low afterwards. 20:34 Yes exactly! There are so many women who - it depends of course 20:40 because sometimes, for example, an unwed mom, 20:43 there is no dad and the parents didn't like the baby. 20:47 She's alone, she has to cope, and cope with this already 20:52 an emotional problem of being a single mom 20:55 taking care of her baby, and this change in the hormones 20:58 coming down again. 21:00 Hormones have a lot to do with this but it doesn't stay long. 21:03 It is a normal thing for you to 21:05 feel everybody is happy and you're sad. 21:09 It's because hormones are... 21:11 Although NOT everybody is like that! 21:14 Me, I didn't have a chance to feel the baby blues. 21:18 I was hoping to go through everything! 21:21 So you could empathize... So that I could empathize! 21:23 I prayed, "Lord, please help me go through these, 21:25 so that I could empathize. " 21:27 I wanted a normal delivery. 21:28 I didn't get a normal delivery. 21:29 I wanted to breastfeed - 21:31 at least I was able to do the pumping. 21:33 I wanted to have some blues, you know, postpartum blues. 21:38 I didn't get it - I had to get up FAST and be strong! 21:43 Because of my baby having so many problems. 21:46 So it's not always present, but it is present in many, 21:50 and it's hormones - it will pass when the hormones start to... 21:54 It's important though that the family should be there to help. 21:57 Now typically, it does pass within a few days 21:59 or a few weeks at the most, but if it's lingering, 22:02 or progressing and becoming worse... 22:03 Then maybe she does have clinical depression. 22:06 I mean, postpartum depression - you would say, 22:09 which is a more severe form, and this one you have to 22:13 ask somebody's help. 22:16 When you notice that it is lingering beyond 6 weeks, 22:19 she has already come back to normal, all hormones are normal, 22:22 and she's still doing it... 22:23 It must be depression and maybe you will need 22:27 more professional help. 22:29 Right, and at this time, it's so important to get the 22:31 support of the family and to be having people in 22:35 prayer for you makes such a difference. 22:37 That was my own experience, 22:39 and if I can just share with the viewers... 22:41 After my delivery, it was actually quite a 22:43 traumatic delivery and I had posttraumatic shock syndrome 22:46 for a number of weeks with anxiety and depression, 22:49 and as that waned, I became MORE depressed with 22:53 a postpartum psychosis to some extent... 22:58 But because of my dependence on the Lord, 23:01 dependence on His word, and staying much in prayer, 23:05 the Lord was able to - not through any credit to myself, 23:08 but the Lord was able to bring me through that. 23:10 It was a very LONG and trying protracted process, 23:14 and so if there is anybody watching today that is 23:16 going through that, I just want to encourage you 23:19 that the Lord is there... 23:20 He said, "I will never leave you or forsake you, 23:23 and when you pass through the waters, the waters of trouble 23:26 and suffering, I will be with thee" 23:29 And postpartum depression IS a serious condition; 23:31 it is a serious thing, and I do encourage you 23:34 to seek help from your health care provider as soon as you 23:36 feel that things are just getting too much, 23:39 and you feel either that you can't take care of yourself, 23:42 or you just don't want to take care of your baby, 23:44 or you feel in danger of harming yourself or your baby. 23:47 Please seek help and remember Jesus is there to help you. 23:50 Well, Dr. Cherie Lou, can you make any other comments 23:52 for ladies that are going through postpartum depression? 23:56 Especially if there is a history in the family of anybody 24:01 who has had postpartum blues and/or protracted depression. 24:07 It is VERY important that all the support is there. 24:13 In many Asian countries where everybody is just so ready 24:22 to pitch in - the grandma is there, the grand-aunts 24:27 and everybody... 24:28 First, they let the woman rest first. 24:31 The only thing she has to do is breastfeed her baby, 24:33 and everything is taken care of. 24:37 The love and the nurture of the people around her 24:41 is very important and the husband especially understanding 24:45 how difficult it is and you see all these things that the woman 24:49 went through. 24:50 Yes, there are actually some physiological components as well 24:55 It's not just necessarily a shock reaction to the birth 24:58 or just not being able to cope with this newborn, 25:01 if it's your first baby. 25:03 But you could actually be deficient because your body 25:05 has been so robbed, if you like, of nutrition, 25:07 especially essential fatty acids. 25:09 That could be a major contributor to depression. 25:14 That's why - just one thing, it's important really, 25:17 to seek consult when you're already seeing 25:20 that it's beyond your capacity 25:22 to just regularly take care of yourself. 25:26 Do you think it's important that ladies are aware 25:28 that whether they are at high risk of postpartum depression 25:31 BEFORE they give birth? 25:32 They have to talk about it with the doctor because the prognosis 25:36 really depends on how much your doctor knows of you, 25:40 how aggressive he will be in the management 25:46 of your postpartum blues and/or depression. 25:49 It is important that you are transparent with your doctor. 25:54 Now, there are some herbs that can help with depression 25:57 if it's not of a VERY, VERY severe psychotic nature, 26:01 and what would you recommend? 26:02 Oh, I have seen a lot of improvement with St. John's wort 26:07 St. John's wort is an herb that helps depression. 26:13 I've seen it really work, I could see it within 30 minutes 26:17 You could just look at the bottle and see the dose, 26:20 and that's what I did... 26:23 And it has been helping my patients who had 26:25 postpartum blues. 26:27 Now, how prevalent is it? 26:29 We don't want our viewers to feel that 26:30 it's going to happen to them. 26:33 It is there - it's a reality! 26:36 And it does happen often, so we just maybe think 26:42 she is tired or whatever. 26:43 It might just be mild but it can be severe, 26:46 and we cannot just leave these things... Right 26:50 Absolutely, they need to be treated, 26:51 and I think one study suggested that only 1 in 10 of women 26:56 actually have the very severe version 27:00 which I think I had some of... and so that's a wonderful thing. 27:03 So the other ladies can take a deep breath and be thankful 27:07 that it's not so likely it's going to happen to them. 27:09 Dr. Cherie Lou, thank you so much 27:11 for being with us today. It's my pleasure 27:12 Are there any more words of encouragement that you can 27:15 share with us today - for ladies that are perhaps first-time moms 27:19 in the postpartum period... 27:20 How they can get through that. 27:22 Oh, you are blessed with a new bundle of joy! 27:28 Again as when you were pregnant, you enjoyed your pregnancy, 27:31 now you have the fruit of your womb! 27:35 Don't ever think that you are sad, you are weak, 27:40 you are this or that. 27:42 Enjoy and look forward to having this bundle of joy grow with you 27:46 If you are a new mom, don't worry, you will learn! 27:49 And the Lord has put it in us 27:51 how to deal with problems from day-to-day. 27:54 It is exciting how the Lord can give you what you need. 27:58 Thank you so much, Dr. Cherie Lou 28:00 And thank you for joining us today. 28:02 I hope you have been blessed with the information, 28:04 and remember God is your healthcare provider. |
Revised 2014-12-17