#21 | Q&A: Supporting the Immune System in Pregnancy, Painful Postpartum Sex, Your Rights Regarding Separation of Baby After Childbirth, Why You Can Skip the Newborn Bath, What to Expect During the Postpartum Recovery Process

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast.
Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

All right, so let's jump into the first one. Are you ready? I'm ready. I keep stressing out about getting sick during pregnancy. What advice do you have for me? Well, certainly that is a concern. I think for women all the time in pregnancy, and it's especially concerning for for women right now. But let's just kind of focus on general wellness and pregnancy and keeping the immune system strong. I guess I want to say first that we should come from the place of trusting that we already have very strong immune systems and we sort of tend to think that when we're pregnant worse, we're much more so susceptible to getting sick or want to were much more afraid of getting sick. And while there is a slight immunosuppression during pregnancy, that is nature's way of protecting your body from rejecting your baby, basically. So that's that is necessary. But that does not mean that you are suddenly at really high risk of getting sick everywhere you go. And I feel like that is often the fear that women walk around with. So it's really about just starting with the basics. I know this is going to sound very elementary, but I can't say enough how important it is to just prioritize getting a good amount of sleep. Eating a well balanced and nutritionally dense diet, exercising or moving your body even if it's just walking or yoga. A little bit higher intensity cardio is excellent, but you absolutely need to move the body and staying hydrated.

And then if you are feeling like you're under a particularly high amount of stress, then incorporating activities that lower your stress like relaxing bounds, meditation. Again, walking can fall into that category yoga, any form of exercise, swimming, being in nature. And simply spending time outside is really helpful for destressing. So those are like basics. If you're not taking care of those things, you can supplement all day long, and it's not going to really do much for you. So once you're taking care of those things, and there are definitely a number of nutritional supplements that can also be helpful in giving your immune system. Just that little extra boost if you are feeling a little weaker. Vitamin C is one of my favorites and it's very safe. It's very effective and you can feed it to your kids to vitamin D is one that's really important and is particularly important if you live in the Northern Hemisphere. And it is important for pregnant women. Because we all we do tend to run a bit deficient in vitamin D. So again, 2000 IUs a day is a great place to start. If you if you've done your blood work and you know you're deficient, you can go up to 4000 to 6000 international units a day. And that that is definitely proven over and over to strengthen the immune system and help fight off infection. So there's something to take into consideration when it's winter versus summer if you're going outside for short. Yes, yes, absolutely. A little bit of sun exposure helps your body convert vitamin D that's the important part of of the sun exposure, but most of us just don't get enough. Other things that are helpful. If you are beginning to feel sick or somebody in your house a second you're trying to stave off a cold echinacea is great, ginger, garlic, edlerberry. Those are some of my favorites.  And I like to recommend a minimum of one whole lemon per day. And since you need to hydrate so well during pregnancy and even breastfeeding postpartum, just wake up in the morning, what I think is really nice and easy to do is fill a two liter pitcher of water and squeeze a whole lemon into it and just spend your morning drinking it before you start your day. Just cleanse your body in the morning and get all that lemon which has all those micronutrients, it's alkalizing, which counters any acidic food you've been eating, it's just such a it's such a powerful way to keep the immune system very strong. Totally. It's one of those simple steps like getting good sleep that can really change the balance of how healthy your body is on a daily basis. Plus, it makes drinking water a little bit more enjoyable.  And a healthy way to do it you can very important really put any, you can really put any fruit into water to make it healthy. It brings enzymes into it. It converts it from a neutral food into a living food so you can even put berries at the bottom of your water pitcher, cucumber mint. in water, there's so many things that make it really good but alright, so yeah, moving on to the Now one other thing I don't want to forget about is if you if you do have a cold or early flu symptoms or viral infection a netipot is a great way to reduce the viral load and and hopefully stave off getting sicker if you're getting a sinus infection or something like that.

They're really effective and helpful. And for body aches and stuff like that. And Epsom salt bath is a great way to ease the dis ease those discomforts and help the body heal. If and when you get sick during pregnancy. If you get a flu, a cold and any kind of sinus infection, all that's happening to your baby is the collection of antibodies. So you might be feeling crummy, you might have a fever, you might be feeling really worried about the baby, your baby is absolutely thriving and we'll definitely be born in a healthier state because of what you're enduring. So don't worry about the baby nature has this taken care of nature does not expect us to go nine months in pregnancy without ever getting anything and it's actually boosting your baby's immune system when you do so. It's unfortunate for you to be uncomfortable but picture just have very positive thoughts around your baby because it is definitely serving your baby. Yeah, that's absolutely true. I mean, a lot of the fear women have about germ exposure in pregnancy is really just that a fear and whatever you have ever been exposed to in the past and whatever you are exposed to while you're pregnant new, as you said, your your baby is going to get passive immunity and that is a good thing. All right.

Why don't you read the next one? This one. This next one actually came from a client of mine who emailed this to me. So let's talk about it because I'd love to get your take on it too.

Okay.

Hi, Cynthia. I'm hoping you can point me in the right direction. All has been great and I'm super in love with my four month old baby, but my vagina is still healing. My obgyn says pain upon sexual vaginal intercourse is normal still. But I refuse to believe there is nothing that can be done. Is this a question that you get often from women post childbirth, I think it is a problem due to scar tissue and tearing.

So this is a question I hear often. And Trisha, you do too, because we run the same postpartum support group together and there is invariably a session in every six week period where women talk about their bodies, and someone is courageous enough to bring about the whole Is this normal like this still hurts. I'm freaked out about this.

So a lot of this is very normal. And we certainly hear about it all the time. But normal doesn't mean we have to tolerate something. The word pain is always some kind of red flag. I personally have the mindset that pain is not normal. And since you do mention having torn and having scar tissue, whether it's from a Cesarean section for women or from tearing vaginally, scar tissue can cause complications. And it takes many months for scar tissue to finish forming, and it can attach to healthy tissue. So we know that if you get in on this early and do some work on it, you can actually really benefit yourself in the long term. So what I'm referring to is seeking the help of a pelvic floor specialist. This is a field that is growing very rapidly. And I have had I don't know how many clients see the pelvic floor specialists that I refer them to, but every one of them swears by them that everything changes.

After seeing them so whether it's clogged ducts, recovering from a C1section, preparing for vaginal birth or recovering from a vaginal birth, when in doubt, go see a pelvic floor specialist, especially if you are feeling pain with sex. Even if some of that is normal, I don't know the word pain, I think is a little bit of a red flag. Normally, I think it's a lot of emotional fear with sex. It's a lot of discomfort. But pain says something many months out Trisha, what do you think? I would agree that it can take many months and I've seen women even up to a year later still experiencing discomfort with intercourse. And that can happen with a deep tear a third or fourth degree tear even sometimes with a smaller tear that wasn't repaired. Well, sometimes you can pull the skin too tight and you can create this scar tissue as you were talking about that takes a very long time to go away. But that doesn't mean that it is like you said - it's not normal to have pain. And it doesn't mean that something can't be done about it, the sooner you are addressing it, the sooner you are seeing somebody about it, the sooner it can be resolved. I think a lot of us, a lot of women just feel that it's, you know, this is, this is what we deal with after having a baby and eventually it will go away. But it doesn't have to be that way. And, again, as you mentioned, there is a great amount of work being done in this field. And it's super exciting, because it's very needed.

And it pains me because, as you know, when one woman brings this up, it's a floodgate every time it's like one issue that comes up, where every woman has something to say, when it comes to recovering or sex, or body image, any kind of healing related to childbirth. There's just Everyone has their stuff they're holding in. And the truth is that even women who are willing to bring it up to their providers, the response they're getting, a lot of the time is oh that's just normal, and it will go away. And that's simply because it isn't something that midwives or obgyn are trained to deal with pelvic pain, pelvic discomfort, pelvic floor issues are not really part of. They're a very, very small part of our education.

And that, again, is why this whole field of pelvic floor therapy is so important and it's growing and so much is being done. And you may have to look far and wide. I would I would go outside your, your ob gyn or your midwife if you're not getting a response that feels sufficient. You know what I keep picturing when you're talking about this? Like I imagine, wouldn't it be so wonderful in some kind of fantasy world where any pregnant woman had just a team of people all the time, like her educator, her medical provider, her lactation expert, her chiropractor, her acupuncturist, her pelvic floor specialist, because everyone is so siloed and so many providers don't have any understanding, if not respect for what all the other providers are doing. So what a woman really has to do on her Oh, I didn't even mention mental health, of course. But it so many obgyn even say like, Oh, it's the baby blues, and no, in many cases it isn't. So it's up to us individually to create our team of people. And that's so much to how do you even begin, the one thing I say to my clients is always ask the right advice of the right person. Don't go to your pediatrician for breastfeeding advice. Don't go to your doctor for nutrition advice. You have to know who to go to for each respective bit of care that you need. But if only every provider knew about what the other providers were capable of doing, and offering, we could be offering such better care to women, prenatal and postpartum but we have to do it on our own. We have to be aware of those providers out there and create those teams to support us entirely on our own. Well, that's the dream model.

Have healthcare in general, if that were in some areas of healthcare are doing it better than others, but maternity care is one area where it is very poorly integrated. We don't have a maternity care system, we have maternity care providers, and it's not well integrated. And that is one of the main reasons that we have such poor outcomes in this country. And it's a lot of pressure on women to be their own care coordinator. And even if you do find that getting the providers to all work together and share patient or client information is also very hard. So we do have to take a lot of responsibility upon ourselves to integrate our own health care. And so what's a woman to do when she does ask her provider whom she really trusts? And she gets an answer that just doesn't resonate with her. That is the key. We've talked about this before. That's the key feeling if you get a result that does if you get an answer from your trusted provider who has cared for you and who you feel safe with, but that's particular thing that you ask them does not give you a good feeling. And that's sort of your sign to yourself to say, you know what, this is something that I need to seek another answer from another person. Yeah.

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So this one came in last week. And my sense is that this question is, in particular related to what's going on right now with COVID-19, and all the regulations and rules that are changing within hospitals. But it's also an important question in general, depending on where you give birth. So the question is, what are our rights in the hospital as far as having the baby with us? Can they take the baby away? If we say no.

When you have any demand in a hospital setting, you the law is always on your side. You know, you can always go through your birth and post birth, fighting, demanding and insisting on your rights. But this is something you need to discuss with your care provider. Now your prenatal visits. And my advice to you is start by asking them what's your typical protocol because that doctor may attend hundreds of births per year. And what they do by habit is going to be the driver here more than anything else. If a typically let's say, like, I've heard before, like, let you have your baby for half an hour, and then they take the baby away. That's what they will expect to do. So if you choose not to change providers, or if you don't have that as an option, and you're going to do things differently from their typical standard client, start preparing them beforehand. Like we're not going to want separation from the baby, we are going to want the baby to room in and be with us. Barring any immediate or urgent medical circumstance. The research fully supports your baby staying with you. There's no research in a normal birth to support your baby being taken away from you. I would even go so far as to say that if your birth isn't entirely normal, or if there is even a mild complication with the baby, not separating you and your baby is still even, it's actually more important. More important, yes, more important. But there are times up parent or parents have to let go and say take the baby, you can do better with this baby than I can. But absolutely, if a baby has like a fever or need some mild intervention, they're always safer and more likely to recover breathing difficulty and a big one.

Low blood sugar, but blood sugar that's not stabilizing or temperature that's not regulating properly. Keeping them on the Mom, what about meconium? in the lungs? What would you say about that one? Well, it turns on if they're having breathing difficulty or not, I mean, meconium in the lungs can create severe breathing difficulties or mild breathing difficulties. So if a baby needs to be intubated or something, they're obviously going to have to be taken away. I think it's kind of it would be impossible for us to go through every situation and say this is when it's okay.

And this is when it's not. But the important thing to know is that you should always advocate for having your baby with you and skin to skin as much as possible unless there is some absolute reason that they can't be. So it's an ongoing conversation with the nurses with the pediatrician. It's not really going to be a conversation with the OB or the midwife for very long because after the baby's born, other people are starting to the pediatrician Sam, you know, yeah, it becomes a different conversation.

So there's the immediate skin to skin postpartum and then there's the ongoing skin to skin and rooming in in the next 24 to 48 hours that you're with that you are in a hospital. You're reminding me of when a local hospital invited me to go tour their facility because they knew I was teaching you know I teach all these couples and every now and then I get invited to like a lunch and a tour and they walk me through very proudly Have a look. Our beds do this. But we have this and we have these wonderful showers. And really I'm going through with a very discerning eye, like what do you do about this? How do you handle that? What are you using that for that, you know, that really is rare, right? You're not using that routinely, right? You know, I go through with my own little. It's great because I get a lot of questions answered. But I remember getting a tour from a local hospital with a midwife I really liked and respected very much. And she was showing me all of their great features and impressing upon me how much they follow evidence based birthing practices. As we were walking down the corridor, we passed a nursery I guess you'd call it with one big wall of glass. And all these babies are lined up in these little bassinet and they were all swaddled, they were all totally bundled up like little burritos. Some of them were asleep and bonding to the sound of the other ones who were crying. And when we were walking by I just put my hand on and stopped her and I looked at that and I said, What is this? I mean, you You and I both know Yeah.

Evidence doesn't support this routine separation of baby from parents whatsoever. And she said, I know, I totally agree with you. But all I can tell you is, and you didn't hear this from me. She said, You've got to tell your couples to refuse to let the baby go. So I thought, oh man like it. But you know what, this is how all change happens. It comes from consumers changing. It really does. That's the only Unfortunately, that's the only way anything really improves any social movement, any improvement in health care, nutrition, the quality of our food, as so many human rights issues. It comes from us. It doesn't come from the top. And this is one. You could say minor thing, I guess. But people refusing. So now I've told this to the couples I work with, and I've had them report back to me that they refused. And what she shared with me was, it's happening because she said in her case, I can't speak obviously to all pediatricians and all hospitals. She said it's that the pediatricians don't want to deal with all the new parents. So they say put all babies into a room together, let us do our thing, go down the row, and get on with our day. Rather than congratulating them and answering the questions of all the new parents. I don't know if that's typically the case or not. But it still is showing, well, who's the priority here, the baby should be the priority and the parents after the baby like what's best for the baby? Where does the baby belong? Not with the pediatrician, the pediatrician can go to the parents. So many things that happen in large institutions like hospitals are simply a result of practicality and systems being put in place so they can effectively get through the volume of things that they need to do. And baby's being evaluated and bathed and monitored away from parents is a perfect example of that. And actually, the bathing of the baby is one of those things that is the that is typically the reason that mothers and babies get separated in the first place. And oftentimes it's the simply saying, we just need to take the baby for 20 minutes to bathe the baby and we'll bring your baby right back. But then something comes up and they get distracted and hours go by and then you potentially have missed a breastfeed session or you know, you are waiting to get your baby back and you can't. So now it's three hours later. Not that that happens every time but a simple solution to that is to say no to the baby bath. A baby bath is really not necessary at all. It's it seems rational like let's let's watch the baby Oh, sure. Like they, they came out of my body. Let's wash them and the vernix will can get washed off. Yes. So I think one of the reasons that people feel that they should be their baby is because they have they have come from a sterile environment, but they you know, they have sometimes blood on their head or on their body. And that isn't something we necessarily instinctually want to see on our babies. But that's they also come covered in this beautiful vernix that is so helpful to their skin and necessary to their skin and protective to them and we don't want to wipe that away. So I'm a huge proponent of skipping the baby bath. They don't need to be bathed for quite a while. It's one of the silliest things that that we do to intervene. It's just totally unnecessary. I did want to just mention, too, because this question did come about in response to one of our posts about COVID-19 on Instagram, that their women are very afraid right now that they will be forced to be separated from their babies simply as a result of the COVID-19 situation. And what if they are under investigation for COVID-19 or they're positive for COVID-19 or their partners positive for COVID-19. And I think it's important to reiterate that the World Health Organization fully supports keeping mothers and babies together regarding lists of status. If you're not at risk of it, you certainly shouldn't have separation. But even if you are showing symptoms or positive, the recommendation is still to keep mothers and babies together, but use use personal protective equipment when breastfeeding.

Alright, this question came in on Instagram and it's simply this Can you talk more about what to expect during the postpartum healing process? Big question again, ties a little bit to the earlier one. Well, I would say the first thing you can expect is to bleed for a long time. So this is just assuming a normal birth. I'm not going to comment right now on Zerrin section, or stitches. But best case scenario typically is to expect to bleed for quite a while up to six weeks and you know, postpartum going to the bathroom hurts because you can have all those micro abrasions, even if you didn't tear so that can really hurt.

It's really intimidating. So sometimes there's a lot of anxiety around just going to the bathroom. The thought of having intercourse again is absolutely inconceivable. Is that fair to say? And you shouldn't be thinking about having sex again?

Sure, yeah.

sensitive, vulnerable tender. And when women don't expect this, they sometimes think something is wrong even when nothing at all is wrong. This is one reason we love postpartum soothe, and Tricia, you recommended postpartum soothe to me, but the benefits of these herbs are like they're antimicrobial. They constrict blood vessels, which can lessen bleeding, they can I just feel really good is normal as it is to give birth vaginally the body still does have an injury like response and you have to treat it that way. So it is recommended that you keep ice packs or cooling on the vagina for the first 24 to 48 hours not longer than that. After that you actually want to use warmth. The ice pads that we recommend with the postpartum soothe tincture is great, very helpful for the first 24 to 48 hours. And then after that you're doing warm sitz baths or just washing yourself off with the warm water and the and the postpartum soothe tonic. And then after that you want you want the blood flow, you want blood to come because that's what is bringing the nutrients of healing.

Now this is this is we're talking not just a totally different type of blood than we're talking about what's coming out of the uterus, that blood is actually an excellent indicator of your level of activity. So the more you bleed, the more that's an indicator of how active you are. If you're bleeding increases, that is your body's way of telling you slow down. If your if your bleeding is slowing down, that's a positive sign that you are getting adequate rest and not doing not over exerting yourself most of the time postpartum doula. We'll see by the six week mark, some women will stop bleeding much earlier if you could stop bleeding as early as two weeks, three weeks again, if your bleeding slows down, and then your bleeding picks back up again. That is your body's way of telling you that you have overexerted yourself and you need to take it easy. I cannot emphasize enough how important it is in the postpartum healing process to take advantage of the first 10 to 14 days after you have a baby to truly rest. That means you're in bed with your baby and doing absolutely nothing other than feeding, sleeping, eating and going to the bathroom. It's like you feel better faster, but if you don't take care of yourself, the consequences of it can be worse. Right? Because your uterus is with every child your uterus is more lacks, it needs more rest to heal.

I mean, part of it for me was just that. I realized after I didn't give myself that kind of rest with my first baby that I didn't, you know, I did have a much longer postpartum recovery at six weeks, I was still uncomfortable at six weeks, I was still bleeding by my third, and I knew it was probably my last child. I also knew how much I loved and valued and cherished that time that that first two weeks postpartum is for me, the most blissful time of life, I could live in that state. And I did not want anything to disturb that. And I literally stayed in bed. I think I only did I think at 10 or 11 days, probably day 11 I was like, okay, maybe I'm, you know, maybe today I can get up and do something. But I really took that time and it was so special and I healed so much faster. For my third child, that is a time that you will never get back. That is the time that you will never feel more entitled to absolute rest, and you should take advantage of it. As a home birth midwife, we would put signs on the homes of where the babies were born. That said to visitors, you may come you may visit but please limit your visits to 45 minutes, you can visit the woman, the mother in bed, mother and baby in bed. And while you're there, you know, total load of laundry.

And you also need to be comfortable preparing your partner and all of your friends and community and family that you are in receiving mode and you have to get comfortable with that because most of us are not at all comfortable being in receiving mode. Most of us want to jump up and host and offer food and drink and make other people comfortable but it's really going to be unusually and ironically empowering to say you just give to me for this little while it's a blip in your life, you'll be back to yourself soon enough. Let people bring you food when they say what can I bring? Don't say nothing. I had the sweetest friend after I gave birth to Vanessa, who came over and brought me some gifts for her. And so sweet of her. And I remember when she was leaving, she was walking away, and she spun around. She was a mom of three. So she really had insight from experience. And she spun around as she was walking away and pointed her finger at me and said, and don't send me a thank you note. You get a pat And I remember thinking, well, that's not going to happen. I know how I was raised. Like, of course I'm sending one but she said she pointed against it. I mean it don't send me one. And
I could feel her sincerity so powerfully that she would have felt like damn it. Cynthia, did you still do not to do that for me? Like part part part? No. Because part of her gift for me was not to give her a thank you know, that was a major growth for me because that's where I like I

I don't feel comfortable not doing that. But now when I give a gift, I am just as compelling saying, part of this gift is please do not give me a thank you just thank me in person. Right? Please do not give me a thank you note. I think that was that was one of the most loving things anyone did for me. I think that's helpful to remind women too, that this is very much a thing of our culture, that we have such a short, postpartum period of time, but around the world, and in pretty much every other culture. Women are given 12 weeks, 16 weeks, even in some cultures, six months, I think, maybe even a year where they are really relieved of their duties other than tending to the baby. And women in this culture feel guilty after a few days of rest. I mean, it's so sad to me, we're the only country where there's absolutely no postpartum support. You have it in every African country in every South American, Asian European country of varying degrees, where everyone takes totally mender it's not about the baby, it's about the mother postpartum anxiety and depression varies greatly from country to country. And it's very much a function of how isolated a woman is, how supported she is. It hurts when we hear that rhetoric like this is the best health care in the world because when it comes to maternity ways there are like, not when it comes to prenatal amount when we're to postpartum you know, organ transplants. Yeah, we're way up there with things like that, but it boggles my mind how often we have to watch politicians arguing about our reproductive rights, and you just want to take a megaphone and be like, Hello, everyone. Hello, like we need better maternity care. We need postpartum support. Be this one little sliver of women's health care and completely ignoring the elephant in the room about maternal outcomes in the US. So what can we do we educate. Here's how we create change with women. That's right. What can we do we create change among ourselves, we change, we show up differently as clients. That's how things will improve in this country. Whether we like it or not, that's how things will improve and it will, but that's how it has to improve. It's the only only way it's going to happen. Thank you again to all our listeners for tuning in and for submitting your questions to our monthly q&a. Oh, Cynthia, one more thing before we jump off this episode is we did get a question about recommendations for natural birth books. And we have you and I have a plethora of recommendations for good books. So we decided that rather than just sort of run through a list of these on on the podcast on the episode that we're going to do a nice Instagram post for you with all the books, the top books that we recommend, so be on the lookout for that coming up very soon.

Actually, by the time you hear this episode, it will already be there on the page so you can go back and look for it. You can follow us at down to birth show on Instagram and if you tag us, we'll tag you back. You can also follow our monthly newsletter by texting down to birth one word to the number two to eight to eight. And remember you can also call in by dialing eight zero to get down. We look forward to our next episode with you next week.

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