Ep. 13: The transition from postpartum to parenting

Episode Transcript

Courtney Collen (Host): Hello and welcome to Her Kind of Healthy, a health podcast series brought to you by Sanford Women’s. I’m your host, Courtney Collen with Sanford Health News. We want to start new conversations about age-old topics from fertility and postpartum depression to managing stress, healthy living and so much more. Her Kind of Healthy is designed to bring you honest conversations about self-care, happiness and your overall wellbeing with our Sanford Health Experts.

In this episode, we are focusing on that special transition from postpartum to parenting. To help guide us along, I have two Sanford Health experts: Dr. Elizabeth Miller, who is a Sanford Women’s specialist in obstetrics and gynecology, as well as Dr. Jennifer Haggar, who specializes in pediatrics. Dr. Miller, Dr. Haggar. Welcome.

Dr. Miller and Dr. Haggar: Thanks for having us.

Courtney Collen (Host): Thanks for being here.

Before we dive into the main topic, I want to level set real quick. When we’re talking about that time period after baby, after delivery, we call that postpartum. What is postpartum?

Dr. Elizabeth Miller: I think that’s a good question because I think postpartum can refer to a few different periods. Postpartum can be immediately after delivery and the care that mom is getting at that time, but it can also be the care that mom needs and the transition her body goes through up to the first year after delivery.

Host: Yeah. Talk about what is happening in the body after you give birth.

Dr. Elizabeth Miller: It is one of the biggest transitions that the body ever goes through. There’s a huge change in hormones, right after delivery. Some of the biggest things that happen is that the uterus has to go from a much larger size, to a much smaller size by contracting down and controlling any extra bleeding after delivery, milk starts to come in. There’s just so much that the body goes through.

Host: And emotionally. This is an important time for mom and baby to really bond beyond just in utero. Talk about how important this time is and how special it is for parents and baby.

Dr. Elizabeth Miller: Yes, this bonding time is so important. I think it’s also important to recognize that some of these emotions can be even more heightened. And mood changes are really, really important to recognize and consider in this transition. It’s not uncommon with these hormonal changes and sleep deprivation, everything else that is going on, that there can be some postpartum blues, depression, anxiety, and we want to make sure that we’re supporting moms through that time. There’s also the really exciting bonding that happens during this time.

Here at Sanford, we really support skin-to-skin after delivery for mom and baby. If baby is doing well, comes out with good color, is crying, we want to get baby to mom as soon as possible, especially for that first golden hour of life. This is so important for temperature regulation for baby, for helping the milk come in. And that is one of the first things that we can do to support mom and baby.

Mom will then be seen by her delivering provider, the OB/GYN team, midwife, or family medicine team in the postpartum suites and make sure that she’s doing well from a bleeding perspective, feeding perspective, that all of her needs are being met. And then we traditionally see patients at a six-week postpartum visit. That being said, if mom has any extra needs, like needs a blood pressure check, needs an incision check, we can see them at one week or two weeks.

And then nationally, we’re really trying to advocate for postpartum care to be covered through the first year of life. And we recognize that it’s not just a six-week visit, you’re done and everything is fine. We can just move on from this whole pregnancy thing. Postpartum care really needs to extend further. The body is not done going through all the changes of pregnancy and postpartum at six weeks. This is especially true for our breastfeeding moms who are going to need continued support during this time but also to be checking on things like mood, making sure that pelvic floor health is being taken seriously. I just think that checking in once can be really hard. So we encourage our patients to come and see us more frequently as needed. So stay tuned as we’re working on that.

Host: Can you walk us through one of those postpartum checkups? What does that care look like for mom?

Dr. Elizabeth Miller: When mom comes in, the first thing that we ask about is how is she doing and how is baby doing. We do a mood assessment to screen for things like depression and anxiety. We ask about bleeding. We ask about feeding plans. And if there’s any difficulty with feeding, whether breastfeeding, pumping or working on bottle feeding, we talk about bleeding and see if that has started to normalize in those first six weeks.

We also review contraception plans. We want moms to feel very comfortable with their family planning and interpregnancy intervals. And so we talk extensively about options for that. And then we also update any routine wellness care that we need. Mom might be due for a Pap smear, for example. And then we set up the expectation for when we’re going to see mom next. We really want to see mom annually, but sooner if needed.

Host: Good to know. What other postpartum services are available for patients?

Dr. Elizabeth Miller: I think that we’re going to talk about lactation services in more detail, but just from a gynecologic perspective, there is a lot that happens to the body during the birth process. And pelvic floor health is really important. We have specially trained pelvic floor physical therapists who can help right after delivery. We usually start that about six weeks or after to help kind of build up and strengthen those muscles and start the repair process. And I think that most women could benefit from that. There is also a really cool service that is a return to running program for moms who have delivered and they use the alter G system to help moms be able to return to their training and running afterwards.

Host: Great to know, let’s switch gears here and talk about baby and bring in Dr. Haggar for this conversation. When baby is born, what happens next?

Dr. Jennifer Haggar: Well, I could hug Dr. Miller for delivering a healthy baby and putting them to mom’s chest because that’s the absolute best way for baby to begin their life. From bonding, from feeding and from connectedness here in the hospital, shortly after birth, baby’s going to be assessed by one of our very skilled nurses and then by their physician after that.

So, a pediatrician or family practice doctor will look baby over from head to toe and also just kind of dig and dive through pregnancy history through ultrasounds. Is there anything that came up during pregnancy that may impact baby’s health? Do we need to do additional screening or evaluation to just make sure baby’s starting out life on a really healthy path and track?

Baby is seen daily here in the hospital. And then we see babies really quickly after they leave the hospital. Typically, we’re seeing babies one, two or three days after hospital discharge, because so much changes in those first few days and it can be so completely overwhelming as a parent. And so we’re there to kind of help and support through all of that.

Host: What do some of those first appointments in the first week look like in the clinic?

Dr. Jennifer Haggar: I really encourage families to come in with a little bit of their own ideas and agenda because if they have anything they’re wondering about or worrying about, we’re going to address that first and foremost, because they usually come with the best questions and know what they need to know better than I do. After that, we’re going to go through how’s feeding, how is sleeping? How is pooping? How is peeing? How’s baby doing at all the things they have to do?

Baby will be looked over, head to toe. There’s a lot of physiologic changes for baby as they go from relying on the placenta to their own lungs and heart. And so we’re going to make sure that transition’s going well. And then we’re also there to assess mom’s mental health at each of those immediate visits. All the way up until six months of age, we’re going to assess moms, any postpartum depression, any postpartum anxiety. And a lot of times then I’m reaching out to her care provider to make sure that she’s getting the care she needs. Because we see them quite frequently in those first few months and can be a resource to help with that transition as well.

Host: So you talked about feeding being one of those things that you really care for new baby and mom of course. Talk about Sanford’s lactation and breastfeeding support for mom and baby.

Dr. Jennifer Haggar: From a lactation and breastfeeding support, one of the first things is just having families set their goals prior to delivery. What are they hoping for with feeding and making sure they have good information and resources on how to get set up for success. And then after delivery, we have fantastic support for them.

Our lactation specialists are here in the hospital and they’re going to meet with every family who hopes to breastfeed and just make sure that those first few days are going as well as possible. We’re going to assess things in the office and then we also have outpatient lactation support. So, they go in, they can have baby weight, they can feed and weigh baby again. And when you’re at awake for the fifth time and not sure if your baby’s getting anything and you can go in and see that they just drank two ounces, it just changes your whole perspective or if it’s not going as well and they’re fantastic at helping troubleshoot what might be the challenge and how we can overcome it.

Courtney Collen: Sure. Wonderful. Now we did talk about postpartum depression. How common is postpartum depression?

Dr. Elizabeth Miller: I think it’s really important to recognize that postpartum depression is much more common than I think people think. And that we talk about and it’s something that I bring up during our prenatal visits, especially to have the patient’s partner on board to also start looking for and screening for any of these changes at home. Some of the signs that we can see are that people are having trouble sleeping, they’re not finding as much joy in things that usually made them happy. They might not be concentrating as well, or they might feel guilty, worthless. You can have changes in your appetite and you can also just have depressed thoughts or thoughts about harming themselves or someone else like the baby.

Dr. Jennifer Haggar: That’s a fantastic description. And postpartum anxiety is probably just as common. And it’s hard not to worry. You get this precious human that you’re now in charge of taking care of and then, oh, don’t worry. But it’s really a question of, is it normal worries? And you, can you kind of think through and process through them or are those worries just running around and around in your head and it’s so hard to shut them off that you can’t sleep or that you can’t concentrate? Are they really the dominant thing that’s in your head? And even when you’re trying, you can’t shut those things off.

Host: Well, thank you for that information. It’s really good insight. And maybe talk about how important that collaboration is between the two of you. I mean, you’re not in the same clinic all the time, but you work together for mom and baby to make sure everyone’s healthy and cared for. Talk about that a little bit.

Dr. Jennifer Haggar: Healthy mom is going to help promote a healthy baby. And so one of the best things I can do, if I’m noticing any concerns, is make sure that I’m encouraging mom to take care of herself. Because you do put so much energy and effort into caring for a baby that you can kind of put yourself on the back burner. But that means sometimes in my clinic we’re taking mom’s blood pressure and sending it over or we’re reaching out and saying, Hey, this depression or anxiety screener looked abnormal. So I think it is important that your care team is a team because the health of mom affects baby and the health of baby affects mom.

Dr. Elizabeth Miller: I just love Dr. Haggar’s point that she’s seeing these patients more frequently, her patients more frequently in clinic. And so if there’s anything that’s picked up about mom and then she lets us know, that just makes our job much easier and we can connect with mom right away. And I just wanted to point out too: a lot of women are concerned about the stigma of mood changes after delivery, about postpartum depression or postpartum anxiety. And I just hope that we can really normalize that conversation and let them know that we have really good resources available. It’s not always about an antidepressant medication. It might be meeting with one of our integrative health therapists. Medication might be needed. It might just be checking in more frequently, but we want to make sure that everyone is getting the help that they need.

Host: Well, thank you for sharing that. When we talk about this transition from postpartum to parenting, do you have any tips for staying well, staying healthy? We, you know, what are some tips that you have?

Dr. Jennifer Haggar: Boundaries.

Just for the family, knowing that this is a time that they will be exhausted, that mom needs to heal. I can’t think of another time where you go through a medical change like delivery and you’re not told to rest. And so moms go through this big change, whether it’s a C-section or vaginal delivery and then they go home and we tell them, you have to wake up every two to three hours and feed baby. That’s exhausting. And so knowing that your primary goal is to care for yourself and care for your baby and eat and shower and maybe go for a walk. The other stuff can wait. And just not putting too much on your plate when really you have this fantastic and joyful, hopefully joyful time. So boundaries, that’s my one word.

Dr. Elizabeth Miller: I think that’s excellent advice.

Host: Dr. Haggar, Dr. Miller, Thank you so much for your insight and expertise in this area. I think it’s such a special transition and it’s so great to have both of your insights. Thanks to both of you.

Dr. Miller and Dr. Haggar: Thank you! Thanks for having us.

Host: I’m Courtney Collen. Thanks for being here.

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Behavioral Health, Children’s, Family Medicine, Parenting, Pregnancy, Sioux Falls, Women’s