It is pouring rain outside as the car window fogs, I forgot the umbrella (of course), and now I have to run back into the grocery store because I forgot to grab diapers during my first grocery run. How did I forget to grab diapers? I had a living reminder staring at me from the shopping cart. As I plan my strategy to dodge the raindrops and run back into the grocery store for the second time with my little guy in tow (fun), I wonder what has happened to my brain. I am more forgetful, my brain feels foggy, and I have the emotional lability of a toddler. What is happening to me??
I think most new moms can relate to this (please say yes!). If you are a mom then you have probably heard of, or experienced “mom brain”. Most women complain of increased forgetfulness, lapses in judgment, and/or emotional instability after baby is born. So what is up? Is this normal? Are we all losing our minds?
Well, the answer is not so simple, but I can assure you that you are not losing your mind. The brain is a complex organ that we in the medical field have yet to completely understand. It truly is the final frontier. Pregnant and postpartum brains have been even more elusive because up until recently there has been very little research to evaluate the changes that may occur in the brain as a result of pregnancy. A new research paper published in 2016 describes visible changes in the brain in women during pregnancy and lasting up to two years after delivery. A group of researchers from Barcelona scanned the brains of women during pregnancy and again at intervals postpartum. These researchers demonstrated definite changes in the grey matter of the brain in the areas associated with social cognition. These changes are believed to help women understand the needs and emotions of their babies. While this change is extremely helpful for new moms to connect to their new babies, it also can explain why postpartum women have more intense emotional responses in general. This may explain why I now can no longer watch movies, TV shows, and commercials that have anything to do with children in distress.
As far as cognition and judgment… “Mom brain” really should be called “a preoccupied, hyperemotional, sleep deprived woman”. I know it feels like you are getting dumber by the second, but there is no research at this time to suggest that memory, cognition and overall judgment is affected by physical changes in the brain as a result of pregnancy or postpartum. Rather, the foggy feeling many women describe as “mom brain” is more likely a result of a combination of sleep deprivation, preoccupation with other tasks and thoughts, and distraction. A new mom goes from just thinking of herself, her partner and her job to suddenly thinking of a new mini person with all of the associated necessities that this little peanut comes with on little to no sleep and a hyperemotional brain. Sounds like fun! Let a man try to remember anything under those conditions!
Unfortunately, the causes of “mom brain” are difficult to avoid, but we can learn to manage symptoms. Here are some tips on how to function in the world with “mom brain”:
- Be patient with yourself. Remember there are physical changes your brain has undergone to make you the best mom you can be, but it does have other effects. So don’t cringe when you start crying at the Hallmark commercials. Give yourself room to be emotional and don’t judge. However, if your emotions are affecting your daily living or your ability to care for yourself or your family, then you should seek help from your physician or midwife.
- Make lists, lots and lots of lists. Find a good app on your phone for lists or do it the old fashion way with pen and paper. Just don’t leave home without it!
- Give yourself time to get tasks done. Rushing intensifies the feelings of fatigue and absentmindedness.
- Plan ahead. In my pre-baby life, I was accustomed to doing everything very last minute and in general flying by the seat of my pants. I have found out the hard way that the more I do it the old way, the more I forget. I have invested in a good calendar that I can share with my husband. I have made it a habit to prepare for the day the night before.
- Engage your partner with tasks to help you throughout the day.
- Get as much sleep as possible, even if it means frequent naps when baby naps.
- Make time for yourself daily, even if it is only thirty minutes. Make it a time to relax, decompress and allow your mind to wander.
You’ve Got this Momma!!!
I don’t know about you, but I require 8 to 9 hours of sleep daily to feel rested. Sleep requirements differ between individuals, but studies show that most people require 6 to 8 hours of sleep daily to feel rested and function at their highest capacity. Sleep is imperative for our bodies to heal, recover and rejuvenate.
Sleep in the fourth trimester can be quite elusive. I am pretty sure I didn’t sleep for the first two weeks my little guy came home, and I have very little memory of those days with him. I was so exhausted. I was trying to do it all…visit with friends when they wanted to stop in, cook, clean and take care of my little peanut. I felt guilty for wanting to sleep. It gives me the heebie-jeebies just thinking it about it now! If I could go back and tell my new mom self one thing, it would be sleep, make it a priority. Lack of sleep affects the body in such a profound way. You may not feel the results of fatigue immediately, but believe me it will hit you eventually.
Here are 5 ways sleep deprivation affects your body:
- Your body produces stress hormones causing you to be in a constant state of flight of fight.
- It increases your heart rate and blood pressure.
- It increases your risk for depression and anxiety.
- It depresses your immune system so your body has a harder time fighting off infections.
- It distorts your judgment depressing your ability to make sound decisions.
I encourage every momma out there living through the fourth trimester to take control of your health and well being by making sleep a priority every day. A well- rested momma is a more effective, loving, nurturing momma.
Here are some quick tips to help you prioritize and improve sleep:
- Sleep when baby sleeps. I know this seems obvious, but it is very tempting to spend baby’s nap times cooking, cleaning, doing laundry, visiting with guests, watching TV, interacting with social media, etc. All of these activities are fine as long as you are not sacrificing sleep to do them. Nap times are a precious commodity especially when baby is not yet sleeping through the night, so use this time to your advantage and get some rest.
- Ask for help and don’t turn down help. Let other people do chores for the first few weeks, until you and baby get the hang of each other. This frees up time for you to rest.
- Maximize your room for comfortable sleep. Make sure your room is quiet, dark and cool.
- Invest in a white noise machine or app.
- Avoid feeling guilty for sleeping.
- Avoid TV, computers, smart-phones within 30 minutes of sleeping. These devices will actually stimulate your brain making it more difficult to fall asleep.
Sleep will change your fourth trimester experience. It is vital to self-care during the fourth trimester. Prioritize sleep and you will be better prepared to care for your new baby, your family and yourself.
Vaginal lacerations are extremely common during delivery. Not to be graphic, but you did just fit a cantaloupe through a hole the size of a tennis ball. Fortunately, the vaginal tissue is forgiving and stretches significantly during the vaginal birthing process. However, the vagina still does tear. There are four main categories of tears that occur during delivery based on the depth of the tear: first-degree laceration, second-degree laceration, third-degree laceration, and fourth-degree laceration. First and second-degree vaginal lacerations are the most common tears that occur during a vaginal delivery. Third-degree vaginal lacerations are less common, and fourth-degree vaginal lacerations are the least common of the types of tears; only occurring in about 1-2% of non-instrumented (forceps or vacuum) vaginal births. Unfortunately there is no fail proof way to prevent vaginal tearing. Most of it is dependent on your anatomy, the size of the baby, length of labor and use of instruments to aid in delivery (forceps or a vacuum).
First-degree lacerations are the most shallow of the four types of tears involving the outer most surface layer of vaginal tissue. First-degree tears usually heal quickly without complication. In general, first-degree tears will require some stitches to repair the tissue so that it heals correctly. Your physician or midwife places those stitches immediately after delivery. The stitches will dissolve in 6-8 weeks.
Second-degree lacerations involve slightly more tissue than the first degree, but only involve vaginal tissue and do not extend any deeper. Just like first-degree tears, second-degree tears heal quickly without any major complications. Stitches are required to bring the vaginal tissue back together to allow for healing. The stitches will dissolve in 6-8 weeks.
Third-degree vaginal lacerations involve the vaginal tissue and the anal sphincter, which is the ring of muscle that prevents you from leaking stool. These tears require stitches to repair the muscle as well as the vaginal tissue. The stitches will dissolve in 6-8 weeks. These tears have a higher risk of poor healing. Women with third degree vaginal tears can experience incontinence of stool and flatus (uncontrolled passing of stool and gas) even after repair. Many women will require pelvic floor physical therapy and a few women will require additional surgery in the future.
Fourth-degree vaginal lacerations involve the vaginal tissue, the anal sphincter and the rectum. These tears require a great deal of stitches to repair all of the torn tissue. These tears often do not heal well. Women who have fourth-degree tears are at high risk of developing a fistula (connection) between the vagina and the rectum. It is common after a fourth degree laceration to have incontinence of stool and flatus. Frequently these tears require multiple surgeries after delivery to correct the injury. Women with fourth degree tears will need pelvic floor physical therapy.
Preeclampsia is generally thought of as a complication diagnosed during pregnancy. However, preeclampsia can occur after pregnancy too. Preeclampsia during the fourth trimester can be devastating because it is often overlooked and under diagnosed. Preeclampsia (whether it is diagnosed during pregnancy or postpartum) puts women at risk for seizures, strokes, liver damage, kidney damage and even death. It is imperative for all women to be aware of the signs and symptoms of preeclampsia so that they can seek help immediately.
Here are signs and symptoms you need to look for after delivery:
- Unrelenting headache that is not relieved with Tylenol or ibuprofen.
- High blood pressures. Your blood pressure is considered high when the top number is 140 or higher and/or the bottom number is 90 or higher. If you don’t have a blood pressure cuff at home, you can check your blood pressure at a drug store, grocery store, or local fire station.
- Right upper quadrant abdominal pain. Pain whether it is sharp, gnawing or burning pain in the right upper abdomen, just under the right rib cage.
- Intractable nausea/vomiting.
- Visual disturbances such as difficulty seeing in all visual fields, or experiencing “squiggly lines” in your visual field.
- Chest pain and/or shortness of breath.
If you experience any one of these signs/symptoms listed above, you need to be evaluated by your physician. Contact your physician immediately, these symptoms cannot wait until tomorrow. If your physician is unable to see you, then you should go to the hospital for evaluation.
Gestational diabetes is a change in how your body manages sugar during pregnancy. It is diagnosed by a blood test drawn after drinking a sugar loaded drink at around 26-28 weeks pregnant. Gestational diabetes can either be diet controlled or require medications to control blood sugar levels during pregnancy. Women who are diagnosed with gestational diabetes, particularly gestational diabetes requiring medications to control blood sugar levels during pregnancy are at a higher risk for developing diabetes later in life.
If you were diagnosed with gestational diabetes while you were pregnant here are a few things you need to consider after delivery:
- You should have a diabetes-screening test performed after your six week postpartum visit with your obstetrician.
- Start exercising. Thirty to forty minutes of aerobic activity at least 5 days a week has been shown to reduce the risk of obesity and diabetes. Brisk walking is a fantastic choice for the postpartum momma. Walking is low impact, free, and easy to do in the company of your baby.
- Practice mindful eating to avoid over eating. Pay attention to your food when you are eating. Avoid eating while chatting with friends, watching TV or reading.
- Drink water. Avoid excessive sugar in sodas, sports drinks and fruit juices. Try flavoring your water with cucumbers, lemon, lime, or other fruits using a diffuser or just cut them up and put them directly in your water.
- Reach for fruit when you need a quick snack. Apples and bananas are easy to eat one handed and are not super messy.
- Eat your veggies. Fill most of your dinner plate with veggies instead of bread and pastas.
- Avoid eating foods that come out of a bag or box. These foods are usually high in sugar.
Small changes now could make a huge impact on your health in the future. In addition, you are teaching your children how to eat properly. They learn many of their habits by mimicking you. So improving your eating and exercise habits now will not only benefit you but also your children. Postpartum is the perfect time to take control of your health!
Cesarean sections are the most commonly performed abdominal surgery in the United States. Approximately 30% of all deliveries are cesarean sections. A majority of cesarean sections are performed due to complications of the labor process. Only about 1% of cesarean sections are elective. In my experience with my patients as well as being a patient recovering from a cesarean section, it is commonly forgotten that a cesarean section is major abdominal surgery. Here are five important things to keep in mind when recovering from a cesarean section:
- Time. I thought I would be able to hop right up and start back into my normal routine within two weeks of surgery. Ummm…that was a big fat NO. I have seen some patients be able to do this and I credit these ladies for their strength, incredible pain tolerance and faster than normal healing process. However, this is very rare and you should not compare your experience to anyone else’s because it can vary so widely. Most of us will need good old fashion time. Remember to give yourself time to recover. Six weeks is the minimum amount of time to allow for healing prior to returning to full activity. Now, of course, light activity is encouraged immediately after surgery, as tolerated. My rule of thumb is: if it hurts don’t do it. The first 6-8 weeks after a cesarean section is not the time to push your body. Do not push past the warning signs. At the least be sure to give yourself a full 6 weeks to recover after your cesarean section.
- Patience. I found this one difficult too. If you are normally a very active person, recovery from a cesarean section can be frustrating at times. Pain and fatigue will limit your activity for the first 4-6 weeks and even longer. I found that I wasn’t able to run normally without pain for about 12 weeks. Have patience to give your-self the time to recover. I think I was afraid that the first 4-6 weeks after delivery were the new norm, so I tried to push myself, which always ended in frustration resulting in impatience with everyone around me to include myself. If you are patient, nine times out of ten your body will return to its pre-pregnancy state. The pain will resolve, the swelling will resolve, the fatigue will resolve.
- Help. You need help. You can’t recover from a cesarean section and take care of your new baby all by yourself. The more help you can enlist, the better. You will need help with routine chores (ie washing clothes, vacuuming, mopping floors, cooking dinner, etc) for at least the first two weeks after delivery, but potentially longer depending on how you feel. Do not feel guilty asking for help. Help does not mean you are an incapable momma.
- Sleep. Hahaha, yah, I know sleep and newborn are an oxymoron, but this is where help comes in. The adage of sleeping when baby sleeps cannot be overstated for women who have had a cesarean section. During the first 4-6 weeks postpartum the household chores can be completed by helpers (family, friends, or paid professionals). The most important activities for you during the first 4-6 weeks after your cesarean section are feeding baby, bonding with baby and sleeping. When you are breast-feeding, sleep is definitely a commodity because unless you are pumping, no one else can help you feed the baby in the middle of the night so that you can sleep. You will have to remind yourself that every time baby naps, you should be napping as well, day or night. Do not underestimate the importance of sleep. During the time you are sleeping, your body is healing itself. Sleep deprived individuals do not heal as well and are at risk for both physical and mental illness. Even though it may feel like ground hog’s day for a month or so, getting good sleep in the first 4-6 weeks after your surgery will set you up for a healthier postpartum period.
- Pain relievers. I have not encountered a patient (myself included) who was able to tolerate the postoperative pain of a cesarean section without some kind of pain medication. Some women are able to tolerate the pain with ibuprofen and Tylenol, and that is fantastic as long as the pain is managed well enough that you are able to get out of bed and perform activities of daily living (i.e. get dressed, move around the house, fix a meal, sit on the toilet, etc) without agonizing pain. A majority of women will require some sort of narcotic containing pain medication for the first 3 to 5 days after their cesarean section. It is ideal to take the lowest effective dose of narcotics to control pain and to wean off narcotics within 5-7 days after surgery. You should be able to control postoperative pain with ibuprofen and Tylenol by 5-7 days after surgery.
Looking back on my postpartum experience, I have to say one of the most painful experiences I had was breast engorgement the day my breast milk came in. As I recall, my milk came in about 4 days after delivery. I had already been discharged from the hospital and had no idea what had hit me! I know, I know, but you are an Ob/Gyn what do you mean you had no idea what hit you. Well, you don’t truly get it until you experience it yourself. No one tells you how painful it is! Even my patients! I have never had a patient describe to me the pain of breast engorgement. Over night, my breasts tripled in size and were rock-hard. I literally thought they were going to explode. Ugh, it was awful. I of course panicked. But before YOU panic, here are three simple measures you take at home to relieve breast engorgement:
- Take a warm shower and gently massage your breast to hand express milk. The key word is GENTLY. I wanted to wring my breast out to get the milk out as fast as possible and relieve the pressure. Not only did that attempt leave me in tears in the shower, it was also wildly unsuccessful. It just doesn’t work that way! Use both hands and start GENTLY massaging close to the chest wall and work your hands toward the nipple.
- Pump or feed every two hours. You can place a warm compress on your breast prior to breast feeding or pumping or take a warm shower just prior to feeding or pumping. If you are pumping, try to avoid pumping for more than 20-30 minutes. Place your pump on the highest setting that is comfortable for you. Check your pump parts to make sure your flanges are fitting correctly on your breast and that your membranes are correctly placed within the pump. Don’t forget to attach the bottles to the flanges! Yes, in a late night stupor I forgot to do that. Talk about crying over spilled milk! If you are breastfeeding, be sure that your little one is latching well, if you are experiencing trouble with latching contact a lactation consultant for hands on help.
- Ibuprofen 600mg – 800mg every 6-8 hours will decrease inflammation, as well as help manage some of the pain. Remember to avoid taking ibuprofen on an empty stomach.