Speaker 1: The information in this podcast is provided for education and
Speaker 1: research information only.
Speaker 2: It is not a substitute for professional health advice. If
Speaker 2: you're trying to get pregnant, or you are pregnant and
Speaker 2: you feel a little bit overwhelmed by all you need
Speaker 2: to know, then this is the right podcast for you.
Speaker 2: Welcome to the show. I'm Bridget Maloney.
Speaker 1: And I'm obstetrician doctor Patrick Maloney, and this is the
Speaker 1: kick your expert led podcast that delivers the essentials of
Speaker 1: growing a baby. Make sure you head to our website
Speaker 1: grown mybaby dot com dot au to get some moreesome
Speaker 1: free tools like our pregnancy knowledge checker to help you
Speaker 1: feel like you got this.
Speaker 2: Welcome everyone. I'm Bridgid Maloney.
Speaker 1: And I'm obstetrician doctor Patrick Maloney.
Speaker 2: And but we're doing it like a three partter series,
Speaker 2: except we started part one like two years ago.
Speaker 1: Okay, good few.
Speaker 2: So this is we're going to do all the postpartum symptoms.
Speaker 1: Oh okay, Like we did all the early pregnancy symptoms.
Speaker 2: And then all the late pregnancy symptoms. And this is
Speaker 2: like closing that loop which all the postpartum symptoms.
Speaker 1: Well done us.
Speaker 2: Yeah, because there's a lot and you know, this. This
Speaker 2: is a time that I don't think is spoken about
Speaker 2: really enough. A lot of people spend a lot of
Speaker 2: time learning the information about pregnancy about birth, and then
Speaker 2: we get a lot of I wish somebody had told me.
Speaker 2: We cover all of this in our Grow My Baby program,
Speaker 2: so people, and in probably greater depth. But you know,
Speaker 2: all the people in that program should know these but
Speaker 2: we want, you know, it's really nice to have this
Speaker 2: in your back.
Speaker 1: Pocket somewhere during the excitement of the later stage that
Speaker 1: the pregnancy had been a really good idea for people
Speaker 1: to concentrate in on for just a moment, on the
Speaker 1: post partum first, say, six weeks, and what to expect
Speaker 1: in that time, because it really can be a surprise
Speaker 1: to poople on something they haven't really considered.
Speaker 2: And we're only going to cover issues for the birthing person.
Speaker 2: You know, there's maybe it's another episode we talk about
Speaker 2: the postpartum for dads. Yes, and this isn't about newborns.
Speaker 1: Don't know just about symptoms for month, symptoms for month A.
Speaker 2: Right, I'm going to start with the most obvious one.
Speaker 2: Vaginal bleeding.
Speaker 1: Yeah, proceed, proceed, Okay, So you know vaginal bleeding after
Speaker 1: baby is normal and it's said that it should probably go.
Speaker 1: It's normal for it to go for six weeks. I
Speaker 1: think within the you know that six weeks is kind
Speaker 1: of an arbitrary cutoff. But what we like to see
Speaker 1: is there's a bit less with every passing week that
Speaker 1: it's never at any point it's too heavy. And what's
Speaker 1: too heavy I think that means a lot of bright
Speaker 1: red blood. It means large cloths. Yeah, and it shouldn't
Speaker 1: be associated with other symptoms like if you've got a
Speaker 1: lot of vaginal bleeding and you've got a fever, then
Speaker 1: that can be an infection within the uterus. And then
Speaker 1: you know, other things we look at when we sort
Speaker 1: of work out how much is too much and are
Speaker 1: we concerned is you know, what was the woman's hemoglobin
Speaker 1: like in late pregnancy and how much blood was lost
Speaker 1: with the birth. So, for example, if someone came into
Speaker 1: the pregnancy the end of the pregnancy a bit leaned hemoglobin,
Speaker 1: a bit iron deficient, and then had a birth where
Speaker 1: they lost a lot of blood, I might be much
Speaker 1: more cold instead of how much bleeding that woman was
Speaker 1: having over the subsequent six weeks. Whereas someone came in
Speaker 1: with a eriton of three hundred and a hemoglobin of
Speaker 1: one hundred and forty one. They've got a bit to spare.
Speaker 2: Those levels that you just said, are they the normal, Yeah, that's.
Speaker 1: Someone who's really iron replete. Yeah, maybe someone that had
Speaker 1: had an infusion about two thirds away through the pregnancy.
Speaker 1: But I'm just making a point that it depends on
Speaker 1: how much to spare. So the trick here is that
Speaker 1: it's a normal process, normal bleed, but we need to
Speaker 1: keep an eye on us. If the patient's concerned, we
Speaker 1: can check emoglobin, we can check iron stores, and we
Speaker 1: can make sure that there's nothing funny going on that's
Speaker 1: making the bleeding worse. And the two big ones I
Speaker 1: guess are infection and retain products. A little bit of
Speaker 1: the placenta left behind that can that can cause the
Speaker 1: uterus to not be able to clamp down fully and
Speaker 1: continue to bleed.
Speaker 2: That's actually on my list, so we might as well
Speaker 2: cover that now. So retain products. We've done a podcast
Speaker 2: on Plus Center on the placenter, so we covered it there.
Speaker 2: But that's what people would notice the is it.
Speaker 1: Yeah, So it presents as heavy bleeding usually Yeah, and
Speaker 1: that can also be fever and you know, your local
Speaker 1: friendly obstetrici knows that that's a possibility, reviews the birth
Speaker 1: notes as a look and sees that the midwife has
Speaker 1: dutifully examined the placenta after it came out. But they
Speaker 1: were concerned that maybe when they tried to sort of
Speaker 1: arrange the placenta like a jig saw to make the
Speaker 1: big pie shape, that a bit was missing. And they asked,
Speaker 1: they asked around, and everyone said no, no, no, it all
Speaker 1: seemed to be there, but maybe it wasn't. And then
Speaker 1: we go and do an ultrasound. When you do an ultrasound,
Speaker 1: it's an important point. When you do an ultrasound in
Speaker 1: the early postpartum period. Everyone's uterus looks like there's suff
Speaker 1: still in it. Oh, really okay, because the uterus is
Speaker 1: swollen and the lining is indistinct, and there's blood in there,
Speaker 1: and it kind of looked. Everyone's uterus looks abnormal, and
Speaker 1: everyone's looks like there might be still something in it,
Speaker 1: and everyone's looks like nothing like that the uterress of
Speaker 1: a non pregnant woman. And so we need the skills
Speaker 1: of a good sonographer to say, no, that's a normal
Speaker 1: picture versus no, there's clearly something still in there. Every
Speaker 1: obstetrician in the world is can someone to theater or
Speaker 1: retain products only to find nothing in there? And that's
Speaker 1: a that's an you know that happens, but it's an
Speaker 1: imaging imaging quality issue. And and everyone has taken someone
Speaker 1: to theater out of desperation when someone won't stop bleeding
Speaker 1: or has a persistent fever, swearing that the uterus is
Speaker 1: empty on scan and has found something in it. So
Speaker 1: we have to have what we call a high index
Speaker 1: of suspicion just even if the scan looks fine, sometimes
Speaker 1: just need to have a look.
Speaker 2: And I remember hearing correct me if I'm wrong, But
Speaker 2: the blass center coming off the wall of the uterus
Speaker 2: is about the size of a plate. As the uterus
Speaker 2: is shrinking down, obviously the plate gets smaller, but like
Speaker 2: it's like a wound, isn't it.
Speaker 1: Yeah, So there's a there's a when the placenta is
Speaker 1: just disengaged, the internal wall of the uterus is is
Speaker 1: flashy and red, and the uterus has to be to
Speaker 1: clamp down to stop all that area bleeding.
Speaker 2: I also want to add my mom tip that when
Speaker 2: I was breastfeeding and i'd get the milk let down.
Speaker 2: I'd also have a bleed.
Speaker 1: Yes, that's normal too, Yeah, yeah, but it.
Speaker 2: Comes as a bit of a shock, and if you're
Speaker 2: not prepared and you don't have the proper sort of
Speaker 2: pad on like you know, you think, oh my god, damn,
Speaker 2: I've done it again.
Speaker 1: Yeah, so that's normal, and I guess that's one of
Speaker 1: nature's ways of making sure that everyone doesn't have a
Speaker 1: postpartum hemorrhage. Is there's a reflex between the breast and
Speaker 1: the uterus, and when the baby's on the breast, the
Speaker 1: uterus will contract.
Speaker 2: Yeah, which also is a postpartum symptom. I'm going to say.
Speaker 2: It does hurt, So it hurts, yeah, and it hurt
Speaker 2: more the more babies I had, right, yep, all right,
Speaker 2: vaginal bleeding crossing that off. Mood swings, yeah yeah. We've
Speaker 2: talked about baby blues with doctor Kylie McKenzie in the
Speaker 2: Mental Health Good podcast, but it's worth mentioning here, of course.
Speaker 1: I mean, obviously, mood changes after the birth are I
Speaker 1: guess near universal. Is it a hormonal effect from the
Speaker 1: placenta leave anybody? Yes? Is it a Is it our
Speaker 1: brain's reaction to a massive change in our life. Yes,
Speaker 1: is it the result of pain and sleep deprivation. Yes,
Speaker 1: you're going to get some You're going to get mood changes,
Speaker 1: You're going to get some sudden changes from one to
Speaker 1: the other. And I guess it's probably best looked at
Speaker 1: it as a normal phenomenon. So I think it's important
Speaker 1: that we also have a look at the so called
Speaker 1: red flags, and those are those are features of postpartum
Speaker 1: life that are kind of that are not normal or
Speaker 1: correlate highly with diagnosed post pund depression. And the things
Speaker 1: that we really look at there are people who have
Speaker 1: persistent lowered mood, persistent anxiety, persistent feelings that things will
Speaker 1: never improve, thoughts of self harm or suicide, or thoughts
Speaker 1: of harming the baby, and they are those things are
Speaker 1: sort of considered well beyond the boundaries of the normal
Speaker 1: ups and downs of the postpartum process, and we identify
Speaker 1: those people and helping them out.
Speaker 2: Yeah, And the more that we talk about it, the
Speaker 2: more that it normalizes that it's not anything that person
Speaker 2: has done, you know, it's just something that needs to
Speaker 2: be supported.
Speaker 1: Yeah, yeah, yeah, And the development of postal depression is
Speaker 1: our contemporary understanding of that is that it's you know,
Speaker 1: it's a hormonal event on top of a pre existing
Speaker 1: probably genetic predisposition towards that illness as well.
Speaker 2: Yep, I want to talk about night sweats, which is
Speaker 2: a postpartum symptom. I had more with my first than
Speaker 2: any other, and they are just like waking up in
Speaker 2: a pull of sweat. It was just so uncomfortable.
Speaker 1: Yeah, often experienced at the time of the onset of lactation,
Speaker 1: and really quite dramatic. It's a good idea for people
Speaker 1: to have a thermometer at home when you've got a baby,
Speaker 1: because you want to be able to check the baby's temperature.
Speaker 1: But there's an important difference between the sort of night
Speaker 1: sweats you might get if you've got really full breasts
Speaker 1: versus the versus a fever. Yeah, and if you've got
Speaker 1: an ordinary sticking in your ear thermometer, you'll be able
Speaker 1: to tell a difference.
Speaker 2: Another just it just reminded me when when you said
Speaker 2: breastfeeding that I would actually start sweating when I was
Speaker 2: breastfeeding with my first, not not subsequent, but with my first,
Speaker 2: and it was a very slippery affair. I'd be sweating,
Speaker 2: there'd be milk everywhere.
Speaker 1: Yeah, it's so uncomfortable, So that's I mean, it's normal,
Speaker 1: but but I guess uncomfortable, but important to distinguish it
Speaker 1: from from a fever pausing sweats.
Speaker 2: Another very common symptom after the first couple of days
Speaker 2: of birth is constipation, isn't it.
Speaker 1: Absolutely Lots of people are constipated when they're pregnant anyway,
Speaker 1: hormonal effect. Maybe they're on constipating medications like on denceitron
Speaker 1: for nausea. Iron iron absolutely, absolutely iron. And then and
Speaker 1: then they go and have the baby, and we give
Speaker 1: them pain relief, often consisting of paracetamol and codeine in
Speaker 1: various doses, constipating, they lose bloods, will give my mind, constipating,
Speaker 1: and and we wonder why they get constipated. Yeah, and
Speaker 1: then then the other thing that happens straight after birth
Speaker 1: is there is there's relative immobility for a few days,
Speaker 1: which a lot of us feel in our bolts. And
Speaker 1: then there's a issue for some of us that our
Speaker 1: bowels work much better if with a daily stimulus like caffeine,
Speaker 1: which might be less.
Speaker 2: Yeah, and we.
Speaker 1: Don't want anyone to smoke, but if smokers will often
Speaker 1: notice I can action between nicotine and their bowels. Yeah,
Speaker 1: and of course they're not smoking. So every common to
Speaker 1: have bow upset and in that postpartum period, that's super common.
Speaker 2: Can I say another potential cause, and that's fear, like
Speaker 2: you know, a fear of fear pushing, and especially if
Speaker 2: you've had a paraneal tear and needed stitches or whatever like.
Speaker 1: Yeah, and unquestionably if you've had a third degree to it,
Speaker 1: that actually involves the animal sphincter. Because even though we
Speaker 1: want people to have confidence in the repairs that we've done,
Speaker 1: going and doing a bowel motion is a big vote
Speaker 1: of confidence in the in the sphincter repair. Yeah, absolutely,
Speaker 1: all of that is is vital. So in that sort
Speaker 1: of scenario where there's a lot of stitches, in particular
Speaker 1: third degree tear stitches, we're not going to wait for
Speaker 1: the constipation happen. We're going to treat it in advance
Speaker 1: with still softeners and so forth. I think there's also
Speaker 1: a phenomenon too that that an advanced pregnancy, you know,
Speaker 1: a term pregnancy, puts all of the bowel under a
Speaker 1: fair bit of pressure compression, and then suddenly you take
Speaker 1: all that away, And I think the bow is a
Speaker 1: bit floppy for a while and doesn't get back all
Speaker 1: of its original tone, and that that can just take
Speaker 1: a little bit of time as well.
Speaker 2: I think too that once you've had the baby, you
Speaker 2: all of a sudden eating things perhaps you haven't been
Speaker 2: eating for a while, like cheesus, and like maybe meals
Speaker 2: are just too big also, like you just I found
Speaker 2: that was my little tip as I was becoming more
Speaker 2: experienced at the old post birth. Just eat eat small meals.
Speaker 2: And you know, I made sure that I had lots
Speaker 2: of fruit. And Yeah, the.
Speaker 1: People I concentrate on the most in a preventative way,
Speaker 1: people who have had a degree tear or even a
Speaker 1: large second degree tear, and people have had caesarian section,
Speaker 1: because like any operation, upset your boughs. Yeah, when we
Speaker 1: open the belly to do with Caesar, there's there's very
Speaker 1: rarely any bough, any small bough sitting between the car
Speaker 1: and the uterus. It's normally open the tummy and the
Speaker 1: first thing you see is the uterus. But as the operation,
Speaker 1: once you get the baby in the placenta out, the
Speaker 1: uterus shrinks right back down and bow that's above the
Speaker 1: uterus sneaks its way into the field of view, and
Speaker 1: the way we get that out of the road is
Speaker 1: to get some wet packs and sort of pack that
Speaker 1: bowl away so we can concentrate on safely closing up
Speaker 1: the uterus without hitting bow. And that touching of the
Speaker 1: bow causes the bow to go on strike for about
Speaker 1: a day, so no surprises that surgery causes temporary impairment
Speaker 1: a bow function as well.
Speaker 2: This is kind of a given. Unfortunately, swollen or painful breasts,
Speaker 2: even if you're not breastfeeding, you know, there's a time
Speaker 2: that they're swollen and painful.
Speaker 1: Absolutely yep. So if we're going to if someone really
Speaker 1: doesn't want to breastfeed for whatever reason, it's a good
Speaker 1: idea to give those medications that stops the breast, stops
Speaker 1: the breast milk before the breasts get really full and
Speaker 1: terribly painful. Otherwise fullness and painfulnes is going to be
Speaker 1: part of the initiation of lactation needs, needs support, pain
Speaker 1: relief support, and lactation advice to get the baby on
Speaker 1: get a good balance between baby's needs and breast production.
Speaker 2: Yeah, and something that we know through the clinic is
Speaker 2: that we've got it sort of like in tandem people
Speaker 2: see the lactation consultant and the physiotherapist that does ultrasound
Speaker 2: for mastitis and crack nipples and painful sort of breast
Speaker 2: So you know, there's definitely support there. You don't have
Speaker 2: to push through, like just reach out, like there's helplines
Speaker 2: as well.
Speaker 1: So yeah, initial, the initial establishment of healthy breastfeeding is
Speaker 1: less intuitive than you think. Yeah, and you know, if
Speaker 1: you think of this from a sort of a darwinianffective,
Speaker 1: it should be easy, it should work every time, yeah
Speaker 1: a bit, but it doesn't. And and it's very common
Speaker 1: to need to malp yep.
Speaker 2: I should have probably talked about this moment. We talked
Speaker 2: about constipation. But hemorrhoids, Yeah, yeah, that's a that's a
Speaker 2: really common and nobody really wants to talk about they've
Speaker 2: got hemorrhoids.
Speaker 1: But no, so hemorrhoids are very very common. And again
Speaker 1: kind of normal pregnancy hormones dilate veins and you'll you
Speaker 1: know that can present as a hemorrhoid. People bring hemorrhoids
Speaker 1: to my attention. I want to know whether it's bleeding,
Speaker 1: whether it's drip drip dripping into the toilet bowl, or
Speaker 1: whether it's only causing a little spot on the toilet paper,
Speaker 1: and that sort of gives me an idea of how
Speaker 1: severe the situation is. But almost all of the time
Speaker 1: the treatment is a cream that combines cortizone to shrink
Speaker 1: it up a bit and local anesthetics. It hurts less
Speaker 1: and time and time. Yeah, there are operations for hemorrhoids,
Speaker 1: but as I spent a lot of times explaining to
Speaker 1: my patients, it's really only something that you would, in
Speaker 1: any sensible approach, only consider when you'd had all your babies.
Speaker 2: Yeah, because you get it fixed and it might come back.
Speaker 1: Yeah, exactly. You don't want to go and see a
Speaker 1: general surgeon for a hemorrhoid actomy, which is a painful
Speaker 1: operation and an operation that is a little difficult to
Speaker 1: recover from, only to have another baby and all comes back. Yeah.
Speaker 1: I encourage people to be as as some patient as
Speaker 1: they possibly can, reassess the situation with their local doctor
Speaker 1: when their last baby has been born, and then lots
Speaker 1: of people, when they're not pregnant anymore, they'll go away,
Speaker 1: and a small number they'll persist, and those people should
Speaker 1: consider a surgical repair when they finished their family.
Speaker 2: Yeah, I'm going to couple these two together, fatigue and
Speaker 2: trouble sleeping.
Speaker 1: Yeah, they're probably the same thing, aren't they. Yeah, so
Speaker 1: I'm fatigued that looking after a newborn is it is.
Speaker 1: It's not a full time job. It's three full time jobs.
Speaker 1: So it's three eight hour shifts in twenty four hours.
Speaker 1: It's constantly on the job. You'll get some sleep, but
Speaker 1: they it won't be it won't be a long it
Speaker 1: won't be the long rejuvenating sleeps that we like of
Speaker 1: six seven, eight hours. It'll be pits and starts with
Speaker 1: the baby when the baby's brand new and we want
Speaker 1: to help, we want that does it get into a
Speaker 1: better routine over weeks, But it doesn't happen over days,
Speaker 1: So so it's tiring. You'll be tired and then trouble sleeping. Yeah,
Speaker 1: that's just the disturbance, not only of the moor monal disturbance,
Speaker 1: it's also the massive, big deal it is for you
Speaker 1: as a person to suddenly have a baby and our
Speaker 1: brain needs to process that. And also it's because what
Speaker 1: our brain wants to do is got a bit about
Speaker 1: ten o'clock at night, sleep for eight hours. Yeah, and
Speaker 1: that's just maybe that's just not going to happen.
Speaker 2: I remember, you know, after the last I used to
Speaker 2: do a dream feed and then then I would have
Speaker 2: I would know that I needed to get back into bed,
Speaker 2: you know, after that ten thirty feet or whatever, I'd
Speaker 2: needed to get back into bed. But I did have
Speaker 2: trouble sleeping because I think there was a lot of
Speaker 2: sort of nighttime anxiety about well, how is my night
Speaker 2: going to go? Yeah, And it was self fulfilling prophecy
Speaker 2: because sometimes it went really badly. But I didn't have
Speaker 2: the sleep in the first place because I was too
Speaker 2: worried and wired about know how the night was going
Speaker 2: to go.
Speaker 1: Yeah, So that pregnant or not. One of the main
Speaker 1: reasons why people get distressed with sleeplessness is they start
Speaker 1: thinking about how they manage tomorrow if they don't sleep. Yeah,
Speaker 1: And that creates its own anxiety and disturbance, and the
Speaker 1: thing acts as a bit of a vicious circle. Yeah.
Speaker 1: But you know, it's one of the reasons why we
Speaker 1: really really hope for people that are a reasonable routine
Speaker 1: can be established within weeks and not months. Yeah, but
Speaker 1: unfortunately not within days.
Speaker 2: Yeah. Yeah, And people will say to sleep when the
Speaker 2: baby sleeps, but just sleep whenever you can.
Speaker 1: Whenever you can.
Speaker 2: You might want to do the housework or whatever. You
Speaker 2: might want to sit on your phone while the baby sleeps.
Speaker 2: Wrapped up with that pat like and just thinking about
Speaker 2: my nighttime anxiety. It was a bit of I would
Speaker 2: say hyper vigilance. You know, I was listening for baby noises.
Speaker 1: That's right. And it can depend whether the baby's in
Speaker 1: a separate room or in the in a creep in
Speaker 1: the room with you. But yeah, new the worst fear
Speaker 1: in new parent is that something might happen to the
Speaker 1: baby in that while they're asleep. And it's that hyper
Speaker 1: vigilance is I think something that we just all need
Speaker 1: to develop through time.
Speaker 2: And you know, if you've got even with our third
Speaker 2: and fourth, the baby was right next door and the
Speaker 2: doors were opened, but I still had a baby monitor.
Speaker 1: Yeah, they're going to be too upset if we goodn't
Speaker 1: hear them from there exactly.
Speaker 2: Now, this is something that a lot of women talk about,
Speaker 2: you know, because I think it says a lot about
Speaker 2: the journey that they've been through.
Speaker 1: But it's hair loss, yep, Yeah, another presumably hormonal feature. Yeah,
Speaker 1: and the good news about that, the hair loss that
Speaker 1: happens there. It's not it's not like my hair loss.
Speaker 1: When when's talking about when mine's gone, it's gone. And
Speaker 1: but the normal hair loss that happens in the postpart
Speaker 1: and period for women, they'll come back. Yeah, if you
Speaker 1: didn't have some other reason dermatitis of the scale or whatever,
Speaker 1: or there are some genetic groups in the world where
Speaker 1: women get genetic hair loss. If you were like if
Speaker 1: you were like everybody else in a just shedding some
Speaker 1: hair befoend of hormonal reasons, it'll be back.
Speaker 2: There's I think pregnant women will. Postpartum women are targeted
Speaker 2: a little bit by all the shampoos that promise that
Speaker 2: it'll make your hair grow.
Speaker 1: Back, right, Yeah, are they? Well, well, I mean I
Speaker 1: think it's come back anyway, no matter what you do.
Speaker 2: Yeah. This is something that we've done a podcast on before,
Speaker 2: but let's touch on it again, and that is urinary
Speaker 2: and fecal incontinence.
Speaker 1: It's so important. So the urinary incontinence following childbirth, in
Speaker 1: particular vaginal childbirth. It's not I hesitate to say it's
Speaker 1: normal because it's not normal tilek urine, but it's often
Speaker 1: assumed by the patient to be something that is permanent
Speaker 1: or necessarily needing treatment, and in those early days it
Speaker 1: may just be because the tissue has been really stretched,
Speaker 1: there's some residual hormonal effect. You might be holding onto
Speaker 1: a lot of fluid like you might be on an
Speaker 1: intravenous trip in the hospital and so forth, and it
Speaker 1: might just all settle right down because not that at all,
Speaker 1: and some people will never get their for you're an
Speaker 1: area function back again, super important that we involve pervic
Speaker 1: floor physiotherapists in the management in the management of this,
Speaker 1: and I think the perfect way to do that is
Speaker 1: to see pervic floor physiotherapists before you have the baby.
Speaker 1: Yeah yeah, So the exercises, it turns out the effective
Speaker 1: exercises as as proven by the peervict floor physios, not
Speaker 1: not gynecologists, not doctors, but the pelvic floor physios have
Speaker 1: led the way over the years determining through research which
Speaker 1: what works and what doesn't. They are not intuitive, then
Speaker 1: you don't you can't work them out yourself, and you
Speaker 1: can't learn them off a pamphlet. If a pelvic floor
Speaker 1: physiotherapist teaches you how to do it, and it's off
Speaker 1: a bit of a hands on affair. Then you will
Speaker 1: do them more reliably and they'll work more reliably.
Speaker 2: Yeah.
Speaker 1: So whether you're stressing continents of ring, its temporarial perm
Speaker 1: or long term, who cares, just do the exercises anyway.
Speaker 1: They won't do any harm. Yeah, and that's the way
Speaker 1: through it.
Speaker 2: Yeah, Yeah, Yeah. I remember going to see Blinda, our
Speaker 2: physio at our clinic, and she did the abdominal ultrasound
Speaker 2: and I was doing what I thought was the pelvic
Speaker 2: floor exercise and I was actually bearing down rather than
Speaker 2: you know, where I needed to go. So that was
Speaker 2: so intuitive. So that bio feedback loop was fantastic.
Speaker 1: Absolutely, and what you thought was the right way to
Speaker 1: do it was not. And fecal incontinence, you shouldn't get
Speaker 1: fecal in continence, and persistent fecal incontinence after a baby
Speaker 1: suggest occult hidden damage to the to the anal sphincter.
Speaker 1: And we certainly see, we certainly see people who have
Speaker 1: had a third degree tear which was not identified as
Speaker 1: a third degree tear in the immediate postpartum examination. And
Speaker 1: some of those are from not noticing and some of
Speaker 1: those are from not looking. But so I encourage my
Speaker 1: junior Burghers. That's what I call my junior doctors who
Speaker 1: I'm in charge of teaching. You can have a proper
Speaker 1: look and and you know, if someone's got a you know,
Speaker 1: find someone who's got an epidural in ask them for
Speaker 1: permission to examine them and learn the technique of having
Speaker 1: a proper look and then apply that as gently as
Speaker 1: you can to every immediate postpartum woman you look after. Yeah,
Speaker 1: and if somebody has got a risk factor or a
Speaker 1: hidden third degree tear like a big baby, long labor
Speaker 1: vacuum or forces, even more important because the background risk
Speaker 1: is higher, and have a good look because we've got
Speaker 1: one shot at fixing that properly. Go to theater, proper
Speaker 1: block repair the sphincter works really well that that person
Speaker 1: will be continent and if we miss it, you don't
Speaker 1: get another shot at it. You can repair it later,
Speaker 1: but the results aren't as good.
Speaker 3: And is it with a colorectal surgeoncy, Yeah, So that
Speaker 3: person's going to be sent for public floor physiotherapy, which
Speaker 3: if the tear is bad enough, it won't work, and
Speaker 3: then they will have a trans transanal ultrasound and the
Speaker 3: trans anal ultrasound goes in the anus and takes an
Speaker 3: ultrasound in a big circle.
Speaker 1: And you can see the gap in the sphincter. You
Speaker 1: can see the whole that the tear. Yeah, that never healed.
Speaker 1: And then yeah, we use we use colorectal surgeons with
Speaker 1: an interesting perianal conditions to repair it well. But it's complicated,
Speaker 1: and it's long term, and it's irritating and invasive, and
Speaker 1: the results aren't as good as a primary repair done properly.
Speaker 2: I just want to pick up on a point. I
Speaker 2: read a story about this woman who had gone back
Speaker 2: to work and she was in the lift with her
Speaker 2: boss and just kept farting.
Speaker 1: Yeah, so that's a good test. You should be able
Speaker 1: to hold a fart in and so so you can
Speaker 1: imagine your anal sphincter tone has to be pretty bad
Speaker 1: to have eqal soiling. But even if it's moderately bad,
Speaker 1: you won't be able to hold in a fart. And
Speaker 1: that you should be able to hold in a fart
Speaker 1: for obvious reasons. Yeah, and that needs a tension from
Speaker 1: an expert pelvic foor physiotherapist. And if that's not working,
Speaker 1: a trans aantal ultrasound and a colorectal opinion.
Speaker 2: All right, I've got one more common issue, and then
Speaker 2: I've got a few more rare issues. So the last
Speaker 2: common one that I've got is painful sex.
Speaker 1: I think, Yeah, that's right. I think one of nature's
Speaker 1: contraceptives is that the is that sex can be painful
Speaker 1: during breastfeeding. And maybe that's one of the nature's ways
Speaker 1: of saying hold on a minute, that we'll just hold
Speaker 1: off for a bit, because you know, otherwise it doesn't
Speaker 1: make a lot of sense. But I think what happens
Speaker 1: is that the hormonal environment of lactation does make the
Speaker 1: vagina less lubricated and more tender, and sometimes people find
Speaker 1: that something they can get around with a lubricants. But
Speaker 1: I've certainly used vaginal estrogen supplementation in in people as well,
Speaker 1: if they're breastfiting long term and they're back to regular
Speaker 1: intercourse and they're finding it very uncomfortable, and that actually
Speaker 1: works really well. This is the same estrogen cream we
Speaker 1: use in the postmenopause or women who are still regularly
Speaker 1: sexually active but no vaginal estrogen.
Speaker 2: Yeah, right, and they would just talk to their gp
Speaker 2: about that. Yeah, I imagine I would imagine a lot
Speaker 2: of people put up with that, and you know, potentially
Speaker 2: leads to other things like closeness with your partner and
Speaker 2: all the other Yeah.
Speaker 1: That's right. If you're ready, if you're ready emotionally to
Speaker 1: return to w intercourse, then you want your body to follow.
Speaker 2: Yeah.
Speaker 1: Yeah, sexual problems don't get treated enough at all in
Speaker 1: the first place. It's frustrating with that one, though, because
Speaker 1: it's a relatively easy fix because those vaginal estrogens almost
Speaker 1: none of it is absorbed systemically, so it's super safe
Speaker 1: to put some estrogen the cream in the vagina and
Speaker 1: it really helps. I might have mentioned this on the
Speaker 1: podcast before, but there's an old medical story of a
Speaker 1: doctor who put a sign on his desk saying, I
Speaker 1: am comfortable dealing with problems of a sexual nature.
Speaker 2: Yeah, I've never heard you say that.
Speaker 1: And then a couple of weeks later we had to
Speaker 1: take the sign away because he wasn't getting any work
Speaker 1: done because everyone went up and started.
Speaker 2: Finally someone exactly.
Speaker 1: Yeah, so everyone's got problems of a sexual nature, but
Speaker 1: we don't.
Speaker 2: Talk about well you speaking of that. Hopefully we'll have
Speaker 2: a sex therapist on very soon.
Speaker 1: I'm excited by that. Yeah.
Speaker 2: Yeah, So we'll have to get everybody to get primed
Speaker 2: with the questions. Now I'm going to go onto the
Speaker 2: less common and postpartum thyroiditis. Now we've covered this in
Speaker 2: the thyroid episode. I'm going to put all the where
Speaker 2: we're the links to the particular episodes so people can
Speaker 2: go back and get a more in depth discussion. But
Speaker 2: just quickly, what is that?
Speaker 1: Yeah, postpartum thyroiditis is a is an autoimmune thyroid condition
Speaker 1: where you can get sudden and quite impressive hyper theroidism
Speaker 1: following pregnancy. Usually happens in someone with a pre existing
Speaker 1: thyroid diagnosis, but not always, and and it can be
Speaker 1: it can be severe, and we gotta we've gotta watch
Speaker 1: out for it in everyone on thyroid medication, and even
Speaker 1: someone who's not never had a day's thorid problem in
Speaker 1: their life but present presents with the typical features of
Speaker 1: hyper thyroidism, which are you know, tremor, excessive sweating and
Speaker 1: so forth.
Speaker 2: Interesting, All right, periinatal obsessive compulsive disorder.
Speaker 1: Yeah, this is an interesting one. I don't know anything
Speaker 1: about perry natal obsessive compulsive disorder, I'm happy to say,
Speaker 1: but I think it makes a broader point that if
Speaker 1: you are somewhat susceptible genetically or otherwise to the development
Speaker 1: of a mental illness, the postpartum period might be when
Speaker 1: that comes out. Yeah, it's a tough period for everybody.
Speaker 2: Yeah, lots of different stresses.
Speaker 1: All all at once. So the hormonal stress, the sleep deprivation,
Speaker 1: the adjustment disorder, all at the same time.
Speaker 4: All right, postpartum pre clampsia, Yes, postpartum preclams here is
Speaker 4: a thing, So so you can develop the the preclampsia
Speaker 4: doesn't mean pre the baby.
Speaker 1: It means preclamsy, means pre fitting. So we try and
Speaker 1: diagnose the the the symptoms of high blood pressure, urinary protein,
Speaker 1: poor fetal growth, abnormal blood tests, and symptoms all in
Speaker 1: the that that that are a cluster of of symptoms
Speaker 1: called preclampsia before the woman gets a clamsier, which is
Speaker 1: fitting and very dangerous in a very dangerous obstetric emergency.
Speaker 1: And so that can actually happen after babies out. Most
Speaker 1: of the risk goes away when the baby's out and
Speaker 1: the typical time for getting preclam series like pregnancy. But
Speaker 1: there are some outlies. Some people who get it really
Speaker 1: really early, seriously early, and that's a real.
Speaker 2: Problem their pregnancy.
Speaker 1: Yeah, if you get super bad preclams here at twenty
Speaker 1: three weeks and the only treatment is delivery, then we're
Speaker 1: in trouble, and you can get it postparter. And in fact,
Speaker 1: you know, when we're looking after people with preclams here,
Speaker 1: really they're only in the clear when the diarysis has happened.
Speaker 1: So not that the placenta is out, but that the
Speaker 1: hormonal environment for the woman has returned to normal and
Speaker 1: the excess fluid that she's been holding onto is urinated out.
Speaker 2: And so roughly, how when does diarysis happen?
Speaker 1: A couple of days? Couple of days, Yeah, so that's
Speaker 1: really that the risk of getting an eclamptic seizure drops
Speaker 1: at that point, but not necessarily right when the baby
Speaker 1: comes out.
Speaker 2: So when if someone was to get postpartum preclams here,
Speaker 2: when would they note when is that typically going to occur?
Speaker 1: Well, maybe say they've already got preclams yet, but that
Speaker 1: doesn't just go away magically when a baby's warm, or
Speaker 1: maybe they didn't already have preclams. Yeah, the baby's out,
Speaker 1: and then suddenly they developed the features of hyper reflecting
Speaker 1: their headache visual disturbance, urinary protein and you think, what's
Speaker 1: all this, she's ready to deliver it. Well, that's still
Speaker 1: preclamps here. It's just happened after the babies come.
Speaker 2: And if she's in the hospital, if you had a
Speaker 2: hospital birth, would that happen within that hospital.
Speaker 1: Yeah, that's one of the reasons you're still there. Yeah,
Speaker 1: so we would be observing for them.
Speaker 2: Yeah. The next one is changes in vision. But like,
Speaker 2: is pre postpartum preclamsy the only reason that you might
Speaker 2: get changes in vision.
Speaker 1: No, some people get changes in the elasticity of the
Speaker 1: lens in their eye that are hormonely mediated and occasionally
Speaker 1: permit right. Yeah, and there's a hearing version of that
Speaker 1: as well. Yeah, yeah, I.
Speaker 2: Forgot about the hearing. Does not even hear, but the
Speaker 2: hearing as well.
Speaker 1: We've got a family member who's hearing was never quite
Speaker 1: right after baby. So yeah, it's that those are thought
Speaker 1: to be hormonally mediated effects on the visual and hearing
Speaker 1: mechanisms that that occasionally don't don't go back to quite
Speaker 1: where he used to be.
Speaker 2: Now, another mental health issue, postpartum psychosis. We also covered
Speaker 2: this with doctor Carli Good. Yeah, but just maybe if
Speaker 2: someone's just listening to this. What what is that?
Speaker 1: Yeah? Post part of psychosis is a meant is an
Speaker 1: obstetric emergency. It's a mental health a condition that arises
Speaker 1: after the baby comes, probably triggered by hormonal changes with
Speaker 1: the placenta, living the body and so forth, but certainly
Speaker 1: also having a strong pre existing component to it, and it,
Speaker 1: you know, a tendency towards that diagnosis, perhaps a family history,
Speaker 1: and it presents like schizophrenia. Right, So a seriously abnormal
Speaker 1: mental state, potentially involving delusions are hallucinations, and the associated
Speaker 1: danger to mother and baby.
Speaker 2: We did mention in that podcast. It's very very rare,
Speaker 2: isn't it?
Speaker 1: Super rare but super serious?
Speaker 2: Yeah.
Speaker 1: Yeah, so needs immediate psychiatric intervention, medication, and the use
Speaker 1: of a mother baby unit so that the mother and
Speaker 1: baby can be kept together while a mental illness passes
Speaker 1: but looked up but observed in a safe environment.
Speaker 2: Seems to be something that a birth partner should know about,
Speaker 2: because I'm imagining that the woman herself, she may not
Speaker 2: know what state she's in, or you know, maybe she
Speaker 2: can say, but you know, get your partners to listen
Speaker 2: to this episode so they can understand what it is
Speaker 2: that you're dealing with on this postpartum.
Speaker 1: Yeah, there's a lot of stuff here. Number twenty three
Speaker 1: or something.
Speaker 2: Right, perineal nerve damage.
Speaker 1: Yeah, that's a that's a thing. It's a bit rare,
Speaker 1: typically related to force its and it's you know, there's
Speaker 1: a there's a nerve that can be damaged in childbirth
Speaker 1: that affects the sensations around the vaginal eatening. And it's
Speaker 1: a rare but but significant complication of instrumental child births.
Speaker 1: And I've never actually seen a case of this, but
Speaker 1: I yeah, so it's rare, but yeah, I understand. I
Speaker 1: understand that the management is in conjunction with neurologists and
Speaker 1: can can involve the use of some of those medications
Speaker 1: that can help with what's called neuropathic pain or from
Speaker 1: a damaged nerve. Yep.
Speaker 2: The last one on my list is one that our
Speaker 2: friend Katie Lowless, who we interviewed a few episodes ago,
Speaker 2: and that is perry partum cardiomyopathy.
Speaker 1: Yeah, fascinating condition.
Speaker 2: This is a very hard to diagnose.
Speaker 1: Yeah, it is, although although so perry partum cardiomyopathy is
Speaker 1: a condition where the heart muscle becomes seriously abnormal, floppy,
Speaker 1: not contracting efficiently, and the heart becomes enlarged, and without
Speaker 1: the proper support that you could get from an intensive
Speaker 1: care unit and so forth, it can be extremely serious
Speaker 1: or fatal. It's it is difficult to diagnose because if
Speaker 1: someone turns up with the typical features of shortness of
Speaker 1: breath and apparent cardiac failure, it's uncommon. It's unclear that
Speaker 1: would be happening to another wise healthy young person. On
Speaker 1: the other hand, you do tend to know if they're
Speaker 1: recently at a baby. Yeah. So yeah, a very very
Speaker 1: interesting but thankfully uncommon cardiac complication of bregnancy.
Speaker 2: Wow, God, anyone listening to this, pat, I think, I mean,
Speaker 2: hopefully they're already pregnant.
Speaker 1: Like, you won't get all twenty three. You're allowed to
Speaker 1: have three, let's say, yeah, yeah, and none of this,
Speaker 1: none of the last seven. No, No, you have to
Speaker 1: have Yeah, you have to have the ones from the start.
Speaker 1: So look, it's you know, these are things that can happen.
Speaker 1: Half the battle is knowing about it.
Speaker 2: Yeah. Yeah.
Speaker 1: Then then you can say, well, hang, I've heard of this,
Speaker 1: go to your trusted obstetric provider and and and get
Speaker 1: some help.
Speaker 2: Yeah, that's right. You know, of these things, I think
Speaker 2: I might have only had probably three. And it's just more.
Speaker 2: I think it's useful doing episodes like this because A
Speaker 2: we've talked about it before, like people say, I wish
Speaker 2: I had somebody had had told me. So here we go,
Speaker 2: we're telling you. But b if you get if you
Speaker 2: have your partner listening to this, I think it will
Speaker 2: give them a level of understanding of what it is
Speaker 2: that you're recovering from. Yes, and you know, whether that
Speaker 2: doesn't necessarily mean that they need to do anything to
Speaker 2: fix it, but just having that understanding and be able
Speaker 2: to go, Okay, well we know what this is, and
Speaker 2: we know that this passes, or we know that this
Speaker 2: is in the first couple of weeks or whatever. And
Speaker 2: also when it comes to sort of your mental health,
Speaker 2: well it looks like it's not passing. Now we need
Speaker 2: to get some support. Yeah, whatever.
Speaker 1: It is a general understanding of the enormity of what
Speaker 1: the woman's been through and that it doesn't all it's
Speaker 1: not all fixed the day that.
Speaker 2: Baby comes, sir, No, No, that's right. And on top
Speaker 2: of that, you've got to learn about your baby. Yeah,
Speaker 2: So that's another thing. All right, everyone will I. I
Speaker 2: think that has given a really good overview of potential
Speaker 2: postpartum symptoms. It doesn't mean you're going to get every
Speaker 2: single one. Remember, no, no, just take a listen and
Speaker 2: please be gentle on yourself.
Speaker 1: Thanks for listening, everybody.
Speaker 2: Thanks for listening. Bye for now, see you next week.