Whether you are still in the newborn trenches or past the three-month mark, your body goes through huge changes after having a baby. It's always nice having some reassurance to keep you as a new mother healthy and happy. Today we are chatting about those changes your body goes through, what's normal, not normal, and everything in between.

Thanks for joining us. This is Newbies. Welcome to Newbies. My name is Kaile Garcia and I'll be your host today. If you haven't already, be sure to visit our website at newmommymedia.com and subscribe to our weekly newsletter, which keeps you updated on all the episodes we release each week. Another great way to stay updated is to hit that subscribe button in your podcast app.

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 Our expert today is Dr.

Ricki Pollicove. Dr. Ricki Pollicove has a national reputation for offering highly individualized and sensitive healthcare to women for more than 35 years, from treating PMS to menopause and optimal hormone balance at every age, including contraception, pregnancy, and preconception counseling. Thank you so much for being here.

Please tell us more about your family and where you're located. And I will tease, I was born in the Bay Area, so I love having a Bay Area-an Oh ... on our show. But please tell us more about your family and where you guys are located. Sure. Well, I actually was born in Boston because my father-

was in training there briefly, but I've basically been a Bay Area girl since age four. I love it. And went to all public schools in the East Bay, and then have been basically between Berkeley and San Francisco for college master's degree, and medical school. And had my own baby my third year of practice in- Oh, wow

as an OBGYN. So I always felt like every OBGYN needs to have a baby as her completion of her residency. You're too funny. I would agree with that. I love the OBs that I have that are new mothers within the, like, I don't know, the first like six to seven years, right? Mm-hmm. Like I just, I feel like they get it.

Yeah. Especially going through pregnancy. You know, I after being pregnant and the whole nausea thing and the breast tenderness thing, you know, I, I mean- And then, oh, okay, you can't even go on a swing now because it's gonna make you barf. So I was like, "Oh, so many things to learn that I didn't know I needed to learn."

And then there's the, you know, final performance, which is getting the baby out safely. Yeah. And I've always said to patients, and of course, I, I had a leg up, let us say, because I'd done hundreds of deliveries before my own. So I, I kind of had a, a realistic expectation of how good or bad it could be. But what was really amazing to me was the the way your pain increased.

And I just had this image of, like, the needle going up and up and up, and then I thought, "Oh, wow, no wonder women freak out," because it feels dangerous. Mm-hmm. And, you know, like, maybe this is the sort of pain you have if you'd been in a car accident and you had your spine transected and you'll never walk again.

I mean, your mind can go through some pretty dark places with labor. But- Absolutely. Yeah ... if, if you know you're gonna come out of this not only alive, but you're gonna have this little tender buddy next to you shortly, you can hang in there. If, if things are well positioned and the baby's not gigantic and, you know, the other things, like your blood pressure's normal-

blah, blah, blah. I love that. Oh gosh, I could talk about birth all day. I, I have two babies. One's three, and the other one is eight months old. Full disclaimer, listeners, she is a good sleeper, but she's sleeping on me, so she might wake up for the episode. And I've had, yeah, just beautiful, beautiful births.

But what you described definitely with the pain level increasing and increasing and increasing, it's like, "Okay, guys, is she, is she coming? Like, what's happening?" Well, that first baby, with the first baby in labor, you built a highway. The second labor, pretty much get to just drive down that road. So they're very different for most of us.

Oh, that's so true. So true. Anyway, we will talk more about this and more topics coming up, but first, let's take a quick break. Welcome back. We're discussing caring for mothers after birth. So we were talking before the break a little bit about birth itself. I think that's so important. I'll go first. I always love talking about my birth stories because I had precipitous labor with both of them.

Oh, wow. My first was barely four hours. I barely made it to the hospital. And my second, which you teased before the break, is kind of like the highway you said. My second was barely two hours. It was insane. So when I got to the hospital, I barely had time to do anything. They thought I was gonna give birth both times in triage.

They both came- ... within 20 minutes of me walking through the door. I had to sign all the paperwork afterwards, which is hilarious. Anyway, and so with both I, I just, I say, I will say I struggled a lot in pregnancy. I had HG for both pregnancies, so being pregnant was not my favorite. Birth was my jam because I got the babies out, and I did not tear.

And so it was very easy. Wow. Yeah, they're- That's amazing ... for being such a fast labor for both of them. Precipitous labor, one of the biggest risks is that you sort of blow this little bowling ball through your pelvis and perineum and rip it to shreds. How interesting. I did have small babies. My first was only 5-11.

Okay. Full term though, and then my second was seven pounds and two ounces. Uh-huh. So they were on the s- well, seven pounds is pretty average for a girl. Yeah. But they were on the, the smaller side. They weren't huge babies. But I didn't have any tearing. They just kind of just slipped out, honestly. And so with healing, for me, for a vaginal birth, I didn't have any major complications, but geez, I feel like no one talks about the healing process.

It's still, with me having no complications for both of my births, right, I still was, you know, taking it easy for four, four solid weeks. Yeah. I would notice I would go on a walk like around two to three weeks and then my bleeding would go up, you know? Yeah. And I was like, "Ooh, I need to really take it slow."

What is normal? Getting to the question finally. Right. What is normal for a, you know, a normal, no major complication vaginal birth for a solid healing time? Is it the six weeks? Is it sometimes longer? What have you seen? Well, first of all, for all the listeners who are green with envy with your birth stories.

I know. Because for most women it's kind of a knock-down, drag-out experience. Yeah. And what happens with these prolonged labors, which is typical for the first baby, is you get progressively swollen. You get edematous, so the tissue around the vagina, you know, your exit area thickens, and that's bad because- Mm-hmm

that, and especially if we're crying or, you know, we're just feeling really sorry for ourselves and kind of choked up, which is, again, is we've never done this before. Like, this is totally testing our mettle. So I always counseled patients before they went into labor, like their last few exams in my office once they were term, I'd do this little, you know, partner stretch thing where I would imitate a contraction with my two little fingers trying to, you know, nudge the cervix, massage it a little bit, but intentionally so it's uncomfortable and feels like a cramp, like a, a labor pain, and have women breathe.

And of course when you're examining them, you can feel them relax. It's that same pelvic floor awareness that helps us not clench against pain. So I had fortunately great coaching after my own birth to offer my patients, more like a doula. Mm-hmm. And, and in answer to your question, so much about how uncomfortable you are really depends upon the birth experience.

And my expression for all women after my own birth, which really was Totally normal, you know, healthy, no drugs, no anesthesia. I mean, it, it was natural. And my baby was small, six and a half pounds. So you know, that helps. But to, to tell women to melt like a candle wax so that you're not pulling up or getting more swollen than happens naturally.

And the next thing is postpartum, if you can elevate your hips higher than your heart, your heart's behind your left breast, so that little postural drainage gets the swelling out of all these tissues that basically, you know, had a, a bowling ball roll through them and bruise them. So like any injured limb, how you get it higher than your heart so your finger doesn't bleed or whatever.

If you want to get the swelling out, which makes a huge difference in terms of, A, pain, and B, very importantly, the rapidity with which you can heal. So that's my hottest tip for everybody listening, that unfortunately even wonderful doulas forget to tell women, "Yeah, get your bottom up." I used to say, "Bottom up, shoulders down."

The easy way to do that is take the middle cushion out of a three-cushion couch, put your rump on the first cushion, and of course, you're gonna have lots of towels and maybe a little plastic under there or the pad you're gonna have in your baby's crib in case they overflow their diapers. But- ... one of these things to protect your sofa.

But get your chest down in that well, and your head is gonna be on the first pillow of the couch or cushion so that you have a, an easy, stable way that you can get up and down from the sofa. Your pillows don't roll around and move. And you'll be amazed at how much better birth can be and postpartum if we're not puffy in the perineum and the vulva and all those tissues that just got so bruised.

Absolutely. I don't know why that wasn't explained to me. Your, your description was brilliant. I can actually envision myself. Like, that would've felt so lovely after giving birth. Absolutely. Like, you're right, you are. You're swollen and you're puffy. I've never had anyone describe it like that, but that is exactly how you feel.

Like, you just- And- Yes. ... if you can do that, guess what? Your anus stops throbbing. Mm-hmm. And if you unfortunately generated a few hemorrhoids, A, during the pregnancy, 'cause, you know, the head and all the, the aspects of the pregnancy itself put pressure on your veins. And I love to educate my patients about how their body works, and if you have pressure inhibiting venous return, well, it also inhibits lymphatic.

So all these things are sort of geared when you're pregnant to making you puffy. A lot of women start wearing support stockings 'cause they notice their ankles are turning into cankles. So all this sort of stuff, same thing is happening to everything basically below your belly button. So the more we can hasten the resolution or reabsorption of all that extra e- we call extracellular fluid, normal people just call it puffiness- Mm-hmm

um, it's amazing how much less pain you have between the anus and hemorrhoids and the vagina itself. How amazing. So switching gears, let's talk about a C-section, right? With no major- Mm-hmm ... complications. However, that is still a very major surgery. Yeah. . I say whether you get a f- Easier birth because you get top release, meaning you get a C-section, or you have vaginal birth one way or the other, either assisted with a vacuum or rarely, but sometimes forceps.

Mm-hmm. But both of them are, are pretty darn uncomfortable afterward. And the big thing, the big difference, and I like to help women not feel terrified of a C-section, 'cause number one, women have much less pain with urination and defecation, you know, passing- Mm ... a bowel movement. When you had a, a vaginal birth, I mean, that, that's really an accomplishment without crying for many women.

Yeah. Truly. So the C-section mom doesn't have that damage. On the other hand, some C-sections, there has really been a lot of effort, and they've been instrumented, and the baby still didn't come down, or maybe there's a crash section. Well, those women have, you know, soreness on both ends. They've got the C-section.

But think about it, your, your belly has been stretched out by this pregnancy, the baby, and so you're healing a wound that really doesn't have tension on it. And with very few exceptions, that incision is always a low transverse. We call it a Pfannenstiel or bikini cut. And, and when you think about it, the, the tension on it is not pulling it apart.

So I like to gear women towards the expectation that the pain of a cesarean is when you cough, sneeze, laugh, or, and sometimes when you empty your bladder, 'cause the lining on the other side of the bladder tugs in the peritoneal cavity, which, hey, that cavity's been entered with a scalpel. And so it sort of tweaks all the nerves and wakes them up.

That is so interesting. Yeah, I, I applaud C-section moms, I think. Yeah. Oof. And it's- And now the healing time, I know from speaking to C-section moms, it's a little bit longer sometimes, depending on how the incision happened. What's a typical healing look like for those who have had a C-section? Well, a big part of this depends upon how much there is to heal.

So women who had- Mm ... a really big baby and gained a ton of weight, they're more likely, because of course, if we gain a lot of weight, our, under the skin, we call it subcutaneous, but the deposition of fat under the skin, sometimes it becomes so thick. Well, those wounds are more predisposed to getting infected and, you know, it, a lot of this really has to do with the mom's baseline before the cesarean.

Mm. So, you know, all these things, if we don't gain too much excess weight, we will fare much better. And, you know, personally, I used to feel my backbones, you know, my vertebrae, just to see, make sure I could still feel them. In case I needed an epidural, I wanted the anesthesiologist to have an easy time finding the landmarks.

So postpartum A huge part of getting well and getting your energy back is it, to continue a low carbohydrate diet and ample hydration.

You will heal much faster if you have a high protein diet. Your mood will be supported and you're much more likely to have an even mood despite your incredible exhaustion if your blood sugar's not rising up and down. And for those moms who had gestational diabetes, this is even more important. I had many women tell me, "You know what?

That gestational diabetes diet really helped my mood be more even, and I'm gonna keep that up even though I'm no longer pregnant 'cause, you know, my partner could really tell I was less volatile." That's a huge insight. And anyway, these are all things that when I answer the question about how long it takes to heal, all these things are related.

And a, and a huge part is just simple hydration because we get rid of all the little crushed tissue byproducts that circulate that also make us more sore. Everywhere we tie a stitch, we actually, you know, crush a little tissue. So those intracellular products actually are very irritating, so the more water you drink, the faster you'll rinse all that stuff out.

And it makes a huge difference, especially for cesarean moms, to have less pain with good hydration That is so important, and I would, I would agree with that. I'm a big... In our household, like I mentioned earlier, we have a toddler we're big egg people. I have- Mm-hmm ... I, we go through eggs like crazy, honestly.

Yes. And they're kind of pricey now, but we eat at least, like, four to- Right ... five eggs a day. I just pr- So easy. It's my favorite protein source, honestly. Yeah. But I love that you mentioned, 'cause it is easy to make toast or have a bagel, you know, but I really do aim for breakfast as our big meal. I'm a big breakfast person, and I do remember- Yeah

for both of my postpartums, having just higher protein definitely helped in the long run. And this is where if you hard boil eggs, okay, they may not be as much fun as a nice fluffy omelet or whatever, but- ... they're quick. You can peel them one-handed. You know, that's the other thing. When you're nursing or baby care, so often you still have that infant in one arm, and so you're doing everything one-handed.

Well, it's even nice to have eggs peeled for you and have them in the fridge so that these are intentional ways that those who are part of your team, and I call it a village, that we've assembled and we've really made conscious, and this is another thing I think a good OB whether you're an MD or nurse practitioner, doula, reminds women to, in addition to your birth plan, which of course that may or may not happen the way you'd like it, but the plan that really could happen is assembling your sort of SOS, but not just when you're in an emergency, but just your supportive people.

Like, to have someone who comes in for two hours every day, whether it's a friend or if you're lucky, it could be a relative. You know, if you've got a good relationship with your mom or your mother-in-law, great. They do it lovingly and free. But- ... the important thing is somebody needs to make, make an assessment of the refrigerator.

Do you have milk? Do you have, you know, do you have your eggs? You, you should always be up two dozen in your family, but- ... these are good things. And also fresh fruit and veggies. Big on fresh, because all the nutrients we need to make good milk are in food. Just think, we evolved from cave women eating food.

We didn't eat supplements all the time. So, you know, dairy products, if you like cottage cheese and yogurt, those are wonderful. Especially Greek yogurt has a lot of protein. You can look at the label and see, okay, if I'm gonna try and get at least, you know, 50 to 70 grams of protein a day, how am I gonna accomplish that?

I so agree. Gosh, you're speaking my language. I'm such a foodie, and we definitely went through all of those. The cottage cheese, the Greek yogurt, the breakfast burritos. Again, we're big egg people, so we would have, yeah, the sausage. I'd put a bunch of veggies in it, and then like a breakfast sausage, eggs, bacon even.

I don't know. I just, yeah, I definitely... I think that's one of my favorite parts when I do hear that a friend or a neighbor is about to have a baby, I always bring over food, whether it's breakfast burritos or quiche. I'm a big egg person, so like a breakfast quiche with veggies. Ah, so lovely. Yeah. Anyway, we have more questions coming up, but first we're gonna take a quick break.

Welcome back. We are continuing our discussion of caring for mothers after birth. So we spoke a lot about food before the break, which is my favorite topic. However, switching gears, let's talk a little bit about the six to eight week checkup. How important is it to go, and what are some questions you typically hear when you come full circle from helping a mom become a mom, right?

You know, give birth, and then they're seeing you right after labor, you know, in six to eight weeks. Some questions that come to mind is bleeding. Is it still normal to bleed? Is it not normal to bleed, you know, at six-ish weeks? Or maybe they are feeling baby blues, you know? So what are some- Sure ... normal conversations you have at that six to eight week checkup?

Well, let us not forget About the nipples. Oh, absolutely. If you're breastfeeding. I am a breastfeeding mom, yes. And very often at that visit, I show women the wedge technique that we can do on ourselves, and I say it truly does help to guzzle, again, if you're not battling with alcoholism, but to guzzle some beer before-

trying to initiate nursing because that whole letdown reflex depends upon you being relaxed. And, you know, we're so goal-oriented and we want to be a champion nurser, and even though we can rough up our nipples with a washcloth or squeeze them, and I even encourage women who are in a heterosexual relationship to get a little beard or stubble attention.

To help nipples get less sensitive before a little baby is... I say they're not sucking for fun, they're sucking for life, and so we are-- it's impossible to be prepared for that. And most women come in with very painful nipples, whether they're cracked and bleeding. Happily today, we have much better nipple shields.

But the most important thing I, I really think is my question, how is your balance of your relationship with your partner and whoever else is helping you? You know, do you feel cared for too, or is all attention on the baby? Because mothers need to feel entitled to extra care from others. And if you're trying to go it alone and be the Rock of Gibraltar tough, tough mom, you are gonna crash because it is impossible.

In the olden days, and I'm an evolutionary medicine doc at heart, in the olden days, we had a village, literally. We had all these seasoned women helping out. We didn't have to call anybody. So when you think about the isolation, and in, in anticipating today's podcast, I was thinking the most important thing at six weeks for me is to say, "Do you feel isolated?"

Because- Mm ... everything bad trickles down from that. There's a lot more depression, a lot more feelings of hopelessness, a lot more feelings quietly, your internal dialogue, "I'm a failure. My breastfeeding's not going well. My baby's not thriving. It cries all the time." You know, this overwhelming fatigue. That question How's your village?

Do you feel supported? How can we, meaning not just me, but the nurse practitioners, if, if you had a fourth trimester doula, we have so many resources in our community. But when you're really down on yourself, and believe me, the hormonal milieu postpartum is basically cocking the trigger on depression because your estrogen's very low.

When you're nursing, your prolactin rises. Basically, it shuts down your ovaries like menopause. Well, we all, all know that women who become depressed when they're menopausal, they're often the same women that had a really rough go postpartum. Same thing. Our brains mostly need a healthy minimum of estrogen.

So a nice development in obstetrics today is most women, at least in the Bay Area, are discharged home after birth if, is, whether they had a C-section or vaginal birth, with estrogen cream. And that little bit of cream twice a day can make a huge difference because it helps your estrogen level not bottom out, which helps support your mood.

How incredible. I've never heard of that. I, I love that, honestly. Super important ... and you've s- obviously you've seen your patients and they've loved it, I'm assuming. Yes. Yes. And, and this is why a lot of my patients call me their gyneciatrist because you know, to me, it's such an honor to have this intimate, trustful relationship with women.

It, and plus, let us not overlook, y- you are so blessed to be the first human to welcome this new life to the earth. You know, that is awesome. And to regard this new being, this little spiritual, soulful entity that has all of the ingredients for life ahead, but just a physical body that's not rehearsed yet.

So it's an incredible moment for both the OB and the parents to welcome this life and have a sense of reverence for the whole process. So I have reverence for all the horrible mood stuff that we go through because so much of this really probably ultimately protects us from isolation and from all the things that if you think about predators and tigers entering the cave or whatever, you know, the fact that all hands are on deck helps preserve life and allow humans to evolve out of the cave.

So I look at us as this giant continuity to the ancient bodies with modern lives. I remember in the early, like, tr- fourth trimester days when I was having a rough night sleeping or breastfeeding. Breastfeeding with my second, I will say to our listeners, breastfeeding gets better. It really does.

With my first, I struggled so long. Mm-hmm. But with the second, it... Your body just kind of remembers for the most part. Obviously, if tongue ties are an issue, that's something else, or, you know, baby's just not latching properly. But if all things considered, breastfeeding the second time gets so much easier.

But going back to my first, when you're not sleeping, and breastfeeding was difficult, I always thought about hunter and gatherers. I was like, "We have been birthing babies since the dawn of time," you know? Mm-hmm. Right. Right. So I love thinking about that, and I love that you mentioned that, honestly. One of my last questions really is for the moms, and we kind of talked about, you know, having a village.

For the mothers in the fourth trimester who are not sleeping well, still fatigued, they have a village, they're not even eating, what would be your suggestion for maybe to look into something further, maybe even get hormones tested?

Well, that's a great question. Super important. One of the tragedies is when the care providers, OB, NP, whatever, they didn't think about hypothyroidism. Ooh. Because a delay in checking thyroid sufficiency, you know, a lot of women have their thyroid balance go wacky while they're pregnant. So again, we have a standard of care in OBGYN to, to check thyroid at various times in pregnancy.

Along with your blood count, and that of course is very important postpartum because if women didn't have any iron stores going into the pregnancy, they're even more anemic after, you know, the baby steals a lot, and then of course you all have the gush after your placenta comes out. So there, there, there's a lot of blood involved in this and so we have to be mindful of restoration, and particularly for vegetarians.

I always check iron stores before women are trying to get pregnant. To me, that's part of checking for rubella or measles immunity. So checking thyroid, checking for anemia, checking for other metabolic derangements, but the two biggies are your blood count and your thyroid function. Most women have still very low estrogen, particularly if they're breastfeeding.

But it is crucial if women are really failing to thrive that we check everything. And so those women, you know, all of us have background testosterone in addition to estradiol. And it's normal, especially if you're nursing, to have your estradiol very much suppressed. Well, now we know it is fine to support women with a little bit of estrogen.

It does not decrease your milk production. We can do that safely. Again, estrogen was demonized until November of last year. So, you know, heads up for everybody that's heading into the more senior direction of menopause. Estradiol, which is your most powerful hormone that supports basically healthy body, healthy mind, healthy sleep, by the way, is a big part of insomnia.

These are things to check in addition to just the physical. One other thing is to check the urine. You know how you get your urine dipped every time you go to the OB when you're pregnant? Well, urinary infections are not that rare postpartum. Why? Because a lot of women, you know, especially breastfeeding, they lose a lot of fluid.

They're not thinking about it. And their urine gets very concentrated. And so you're more prone to urinary tract infections. So that's another thing. And I educate women about clean catch. And yes, if you're still bleeding, let's put in a tampon before you try and get that urine sample so it's not contaminated with blood.

But all these things, if women are mindful of these risks and just keep pushing the fluid, and that's the job of whoever's helping out those two hours a day to make sure you've got the giant full water bottle right by wherever you sit and nurse and plenty of beverages. Of course, if you're educated about Ayurveda, Ayurvedic practitioners discourage you from using ice, but many women just love ice cold.

Well, you know what? Whatever you love, you're going to get because you deserve it. And I really think what's most important is hydration to prevent both urinary infections, but also it decreases all of your stiffness and soreness. And as much as it's uncomfortable to urinate and empty your bladder, it's good for you to do that many, many times a day.

Gosh, this has been such a great episode. Thank you so much for coming on. I always love speaking to doctors, OBs, even doulas. I know they don't do anything medical, but they do assist in births all the time. I just, I love it. I love talking about babies. I love talking about birth. Can you tell us one more time where you are located, and are you currently- Sure

accepting clients? Well, I'm in San Francisco, and full disclosure, I am now a grandmother. Oh. So I have- Congratulations. Yes. My daughter had two girls. They are now eight and a half and 10 and a half. And so I definitely got to sort of re-up my intimate birth experience- Aw ... when I was present for the vaginal birth for both of my daughter's children.

And- How special ... you know, so I feel like, oh my gosh, I have that seasoned, joyful wisdom that comes with being right there, close and personal, not just for my patients, but from my own daughter, who, you know, bless her heart, as I said, she gave me the privilege of a relatively easy vaginal birth, and with whom I have a great relationship.

So, you know, these are things to me to apply all my years of experience. And by the way, I'm in my 45th year of practice in San Francisco, and I do not do obstetrics anymore. I leave that for the younger doctors who can get by with less sleep. Mm-hmm. I get to sleep through the night, which I love. And I'm really all about healthy aging through the entire life cycle, which is why I pay so much attention to hormones and mood and all the elements when you're young that set the stage for a very healthy, vigorous, disease-free old age, if we can accomplish that.

Oh, gosh. Speak in my language, truly, and I think it's just because you reside in the Bay Area. I love it. Well, yay. Thank you so much again for coming on. This has been an absolutely amazing episode. Thank you so much. It's been a delight. Yay. Well, be sure to check out newmommymedia.com where we have all of our podcast episodes, plus videos and more.

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