Sleepless Nights, Sleepless Days

There is probably nothing more exhausting than taking care of a baby (and this is from two girls who completed OB/GYN residency, working 80+ hour weeks!). A newborn trumps everything. There are no shifts, no sign out, and often no relief, which means there are many days with NO sleep. The fatigue you are feeling is like nothing else. And while we don’t have a degree in sleep therapy, or sleep training, or even come close to being baby whisperers, we do know what it feels like to be a new mom. Here, we offer a few tips on how to tackle your tiredness.

  1. Get Out of the House
    When all you want to do is lay down and close your eyes, it may seem somewhat odd that we are suggesting you do just the opposite. Take a shower, get dressed, get out and move. Getting some fresh air and boosting your heart rate a bit can make a big difference in your energy level and your mood. A short, brisk walk not only will help clear your mind but it also might help your baby go to sleep—now that’s efficiency!
  2. Remember to Eat AND Drink
    Food and drink are your friends. While you may not have time to whip up anything fancy, you do have time to chow down on a bowl of cereal or a PB&J sandwich. Additionally, invest in a water bottle, and every time you prepare to feed the baby, fill your bottle. This will help you keep your body in tip-top shape to deal with the fatigue, and for those of you who are breastfeeding, it will help keep the milk flowing.
  3. Cool it with the Caffeine
    When you can barely keep your eyes open, you might reach for liquid help. If you are a coffee, tea, or espresso girl, you go with something that is loaded with caffeine. While we certainly are cool with your ~ 2 cups of caffeine per day, anything more will most likely make you sick. Think jittery, anxious, and nauseous. Additionally, if you are breastfeeding, too much caffeine can dehydrate you, which is not good, especially when you are trying to make milk for your little one.
  4. Phone a Friend
    Ask for help from someone. Anyone. Your partner, a family member, a friend, or even a babysitter, they are there to help. Everyone needs some time off. Be it an hour, a night, or a day, we all need to walk away and take a breather for a bit. Extreme fatigue can seriously cloud your judgment, leading to accidents, injuries, or worse. Even Superwoman had buddies—ask yours for a break.
  5. Nothing is Forever
    Even the worst infant sleepers will one day catch some Z’s. While everyone talks about those babies that sleep through the night the moment they come home from the hospital, most take at least a few months to get into their slumber groove. That said, if several months have passed and you still are staying up all night, it’s probably a good idea to speak to your pediatrician. Something might be preventing your little one from lying down peacefully—your pediatrician should definitely be your go-to on this one.There are tons of books, blogs, and sleep experts out there who have made a living out of providing advice on sleep and sleep training. We certainly are not sleep experts, but we are women who have been there before and who, as doctors, know what you need to stay healthy. The words we offer come from a mixture of those two perspectives. Now, go find yourself a place to lay your head and get some rest!

When a Drizzle Becomes a Downpour: Post-Partum Hemorrhage

Bleeding after baby is nothing to say “boo” about. It happens to everyone, and it’s normal. First comes baby, then comes placenta, then comes bleeding. It’s a pretty standard course of events. For most women, the bleeding is moderate and slows down pretty quickly. Although pads become our good pals in the postpartum period, we are usually ready to break up with them after about four weeks. However, for some women, bleeding after baby (a.k.a. post-partum) can be heavy, heavier, and heaviest. When it starts and is difficult to stop, we call it a post-partum hemorrhage (a.k.a. PPH).

PPH can be the real deal. In fact, post-partum hemorrhage is the number-one cause of maternal mortality worldwide. It’s estimated that about every four minutes, a woman dies from PPH somewhere in the world. It’s a very serious problem. When the excessive bleeding occurs within 24 hours of Baby’s arrival, the PPH is classified as a primary PPH.

Almost all of the primary PPHs occur because the uterus is unable to contract or clamp down. Other likely causes include a retained placenta and blood clotting problems. Secondary PPH occurs between 24 hours and 6 to 12 weeks postpartum. When you see the red faucet turning on, off, and then on again, it is usually from retained placental tissue, abnormal placental attachment, infection, or clotting disorders.

As OBs we develop a pretty strong stomach and pretty thick skin. Very few things make us nervous or make us break a sweat. However, one exception to this rule is a bad PPH, the kind that seems to have no end in sight. If you should find yourself floating down this river, this is what your OB will do:

  1. She/he will start looking and start massaging. Uterine massage is the first move in this situation—most women are bleeding because the uterus has not yet contracted. Massage will move the uterus closer to contraction.
  2. When you still feel the pain or are still bleeding despite massage, medications come next. IV infusions, IM shots, and possibly even a trip to the operating room can be in your near future.
  3. Surgical interventions are reserved for really free-flowing situations, and we only go there when we have no place else to go. However, if we need to bring out the big guns to put an end to the bleeding, we can do it.
  4. If we need to call in our peers from other parts of the hospital—radiologists, interventional radiologists, surgeons, the blood products lab, etc.—we will. As the captain of the team, we need a good offensive line to defend the blitz. We may even need to transfuse blood products to keep you safe and keep things steady.

Secondary PPH is treated in more of a sly manner. It is not as dramatic, at least initially, as primary PPH. It can happen while you are still chilling in the hospital or hanging at home. As you can imagine, the latter can be very scary. While it is very rare (about 1%) of all pregnancies, it is usually due to retained placental tissue (darn thing just won’t go away!). It can also be an expression of an underlying blood clotting disorder that you never knew existed. In most of these cases, the first person on speed dial should be your OB/GYN. They will want to see you ASAP. They will often send you for one ultrasound and possibly more. While the operating room may be in your near future, we hope to avoid it. Too many trips to the OR, particularly in the post-partum period, can lead to scar tissue.

Although we can’t always predict who will bleed heavily in the post-partum period, it is not simply a game of eenie meenie miney mo; there are some red flags. Risk factors include long labors, fast labors, assisted labors, and labors that needed Pitocin (did we leave any labors out?). They also include a history of PPH in prior pregnancies, elevated blood pressure, a big uterus that held more than one baby, and infection. The best way to treat a PPH is to be prepared. Therefore, if you fall into one or more of these categories, we may full court press you, even if it’s just an easy jump shot. We would rather overreact than under prepare.

When the drizzle turns into a pour and you have forgotten your umbrella at home, you will kick yourself for not listening to the weather report. Drizzle, we can deal with. Nothing gets ruined, and it passes quickly. A downpour is a whole different situation. The same can be said for bleeding post-partum. Minimal or moderate bleeding is normal, doable, and “deal-able.” A little massage and medication and you are on your way. The more serious stuff can be dangerous. Downpours can turn into thunderstorms and hurricanes, if you don’t act quickly. Make sure you have shared your whole medical history with your OB/GYN, as this will serve as their trusty weather app. We don’t want to leave anyone out in the storm!

When Babies Are Not on the Brain: Post-Partum Contraception

Babies out. Bleeding is on. Boobs are big. Belly is still large. Sounds awesome. With all of these bothersome symptoms, “bonking” is completely out of the question. Let’s face it: when you look and feel like you have been through the wringer, intimacy is probably the last thing on your mind. But before you know it, all systems will be healed, and sex will be a go. And while those days seem further away than your first full night of sleep, it will happen. We promise! And when it does, even if you are breastfeeding, you can get pregnant without contraception. To avoid that major oops, here’s how best to prevent pregnancy postpartum.

Let’s do a quick Obstetrics 101 review. In most cases, it takes at least three weeks before ovulation resumes. Prior to this, elevations in your hormones (think hCG, progesterone, and estrogen) will keep ovulation in a holding pattern. After about one month, these levels will drop, and ovulation will resume. However, in women who are breastfeeding, prolactin (the hormone that helps you produce milk) will arrive and stay on the scene until you are ready to move on to formula or milk. In high levels, prolactin can function similar to hCG and prevent ovulation for some time.

No ovulation = no egg = no embryo = no pregnancy

The sticking point is that “some time” can be anytime; how long you can use breastfeeding as contraception depends on how frequently you are feeding/pumping, how many other “things” (a.k.a. formula or food) your baby is taking in, and your own body. Women with the exact same routines can start ovulating at very different times. Bottom line: breastfeeding is not a completely reliable source of contraception. You need a back-up mechanism.

So, what are your options? While there aren’t as many choices as for non-breastfeeding women, you do still have choices. Think about the contraceptive choices for breastfeeding women as a three-choice exam. Option A = oral contraceptive pills (a.k.a. OCPs), Option B = IUD, and Option C = barrier devices (condoms or a diaphragm).

You can go with any of the three and achieve pretty good results—if they are taken correctly! Which you select really depends on what is best for you, your medical history, and your personal needs. The first few months after bringing a baby home can be exhausting and hectic, to say the least. Remembering to take a pill daily at the same time may be harder than it sounds. The OCP prescribed to breastfeeding women, a.k.a. the “mini-pill,” only includes progesterone and must be taken at the same time daily to remain effective. While the toothbrush or shower trick may help, believe it or not, some days you might not make it into the shower (or even brush your teeth)! If you go with an Option B (IUD), you won’t have to think at all. Combined with its good contraceptive benefits, this may B the right choice for you!

If you have decided to go right to the bottle (aka formula)—and trust us, there is no judgment in that statement—you need post-partum contraception ASAP. This convo will usually commence at your six-week postpartum visit. Remember: sex before six weeks is off limits anyway! The options for women who are not breastfeeding are no different than for women who are breastfeeding. Where things diverge is in the type of oral contraceptive pills (a.k.a. hormones) that one can take.

Non-breastfeeding women can take good old-fashioned estrogen + progesterone pills as well as progesterone-only pills. Usually, the former is preferred due to slightly more flexibility in how perfect your timing when it’s taken needs to be. Because milk production is not an issue, the suppressive effect of estrogen on milk production is no big deal. If OCPs are not your speed (or medically a no go), you can also go with the patch, the ring, implantable devices, Depo-Provera, the IUD, condoms, or diaphragms.

Basically, barring any underlying medical issues, the sky is the limit. Pick what’s best for you and your busy lifestyle. Just remember: fatigue will be an issue, so the less you have to think, the better. Whatever you choose, be sure to commit; otherwise you may find yourself expecting way before you were expecting!

Let’s Get the Screening Started

If your little ones have finally started to sleep through the night, eat real food, and maybe even venture onto the potty, you are probably feeling pretty good. Major milestones for your kids mean a lot to you not only as a mom (#ProudMom) but also as an individual (#HiWorldIamBack). While your schedule still somewhat revolves around your little ones’ naptime (which, let’s face it, none of us really likes to give up), the bonds of babyhood are slowly being released. (See you later, diapers and bottles!) As things settle, you are ready to get not only your house back into order but also your health. This includes sleeping, eating, exercising, and screening. While screening may conjure up an image of TSA and airport security, what we are referring to may include an X-ray machine and takes a whole lot more than 3 seconds.

The screening we are talking about includes visiting your MD for a good, old-fashioned chat, a physical exam, and probably some tests. Although most of us can barely find time to get a haircut, a checkup is kind of essential. While this meeting may include nothing more than a quick conversation along with a height, weight, and blood pressure check and focused physical (think heart, lungs, breasts, abdomen, and pelvis), if something looks or sounds off, we recommend a more detailed follow-up exam with blood tests and imaging studies (X-ray, MRI, or CT scan).

Depending on where you are in life (a.k.a., your age) and what your family’s history is like, you are probably getting teed up for a mammogram and maybe a colonoscopy. Although you should already be doing breast self-exams and clinical breast exams (by a healthcare specialist), most of us welcome the big 4-0 with our first mammograms. While there is a lot of fear and anxiety over entering the world of mammograms, for most of us (no matter what your breast size is), it’s nothing more than a few minutes of discomfort. You have endured endless sleepless nights, changed innumerable dirty diapers, and sat with a breast pump on for hours—you can tolerate a mammogram!

Although admitting this is hard (it is for us too), as our kids age, so do we. With age comes not only maturity and perspective but also disease and illness. As a result, your body needs to be “looked at” more frequently than it was in your 20s. Prevention is the key to your body’s prosperity and longevity. So, while we don’t doubt that you are a woman with a loud roar, even the strongest among us can get sick. Having a good doctor who knows you and your body is crucial. Get checked up and checked out on a regular basis (not just when you are sick). Screening may not be as “sexy” as getting your hair colored or your skin cleansed, but it will likely help you keep looking and feeling sexy.

The bottom line is that you should get a mammogram, get a Pap smear (or at the least have your OB/GYN review your cervical cancer screening history), and share your past and your family’s past with your doctor. While your kids may no longer be babies, there will be several bumps in the road for which they will need you by their side. Screening will help you stay strong!