What to Expect After Giving Birth with Erica Newlin, MD

Podcast Transcript

Speaker 1: There's so much health advice out there, lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough, intimate health questions so you get the answers you need. This is the Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Annie Zaleski: Hello, and thank you for joining us for the Health Essentials Podcast. I'm your host, Annie Zaleski, and today we're talking about postpartum physical concerns with obstetrician and gynecologist, Dr. Erica Newlin.

Having a child can be one of the most joyous experiences of your life. At the same time, navigating the postpartum time or the time just after you've given birth can present challenges. Your body has transformed significantly in the past year, and even after you give birth, there are still physical changes to deal with — some unexpected or even challenging. Knowing what to expect from postpartum time can help prepare you to develop solutions to any concerns you might have that arise. Dr. Newlin is here to discuss physical postpartum concerns, what causes them and how you can navigate through them. Dr. Newlin, thank you so much for being here.

Dr. Erica Newlin: Yeah, thanks for having me.

Annie Zaleski: So, I'd like to start off our conversation by having you tell us a little bit about your work here at Cleveland Clinic. So, what kind of research and clinical work do you?

Dr. Erica Newlin: Sure. I'm a general OB-GYN. I'm out of the 850 Columbia Road office out in Westlake. I do a mix of everything, so delivering, surgery, seeing patients in the clinic — and it's been really great to have a variety of practice.

Annie Zaleski: So, one of the things I'm sure you're very familiar with is the postpartum period then. So, kind of define that and how long could people kind of expect to be postpartum. And is there kind of one agreed upon definition?

Dr. Erica Newlin: Yeah, that's a great question and one that's kind of come under debate a lot recently. So, traditionally, we've always talked about the postpartum period as being that first six to eight weeks after delivery. But recently, there's been more discussion, particularly among the American College of Obstetrics and Gynecology, as a reference to the fourth trimester, or the first 12 weeks or three months. Some conditions, even like postpartum depression or peripartum cardiomyopathy, we consider that whole year after delivery.

Annie Zaleski: Wow. So it sounds like the postpartum timeframe can kind of look different and be different for everybody.

Dr. Erica Newlin: It really can, and I tell many patients that the time that you take to recover can be very individualized. So, to not put pressure on yourself to bounce back super quickly because I think, particularly in the media, and pop culture and magazines, you're like, “I'm back to my pre-partum baby weight” right away and kind of that recovery can take a different time for each person.

Annie Zaleski: So, back up a little bit then, so after someone gives birth then kind of go through what's kind of going on in someone's body then. Obviously, there's things like hormones changing, physical changes, mental health changes, so what's going on?

Dr. Erica Newlin: For sure. So, when you think about it, immediately after delivery, the uterus is contracting back down to size. It's just basically held a watermelon, so it has to go back down to the size that it was before. There's a lot of fluid shifts. Your breasts are starting to become engorged since you're starting to produce milk. You can expect usually to lose around 20 pounds pretty quickly after delivery, just due to loss of the baby, placenta, fluid, but you may still look a little pregnant after delivery. There can be some big changes on hormones, too. There's a big shift in estrogen level and other hormonal changes, which may lead to mood changes and hot flashes. And your body has just gone through a major event, so you'll feel kind of sore and tired and need a little time to recover.

Annie Zaleski: Wow. So that's a lot then and it's pretty much almost systemic, I guess, in a sense.

Dr. Erica Newlin: Oh, for sure.

Annie Zaleski: What makes the postpartum time so challenging? I mean, obviously you just said that someone has gone through a major event, so why is it something that's so challenging?

Dr. Erica Newlin: So, the way I think about it is, you're going through major physical and emotional changes and all the while, you're trying to take care of this new, tiny human and adjust to your new role as a parent. And so really, it's just a lot of major body changes while a lot of life changes are going on at the same time.

Annie Zaleski: So, let's dive into some of the physical health changes postpartum then. So, in the postpartum time, what are some sort of first warning signs that things might be sort of amiss physically?

Dr. Erica Newlin: Yeah. The big things that I tell people to watch out for is one, monitoring your bleeding. So, at any time, if you're bleeding heavily more than a pad an hour or continuously passing very large clots, that's a reason to call. If at any time your pain is increasing, if say you were feeling better and then all of a sudden you're feeling worse, that would be something that would be a concern as well. We always tell people to monitor their discharge. So, some discharge is expected, but if it's ever super smelly or gross, that's not normal, fever, not normal, another reason to call. And really, kind of monitoring for other things, like if your mood suddenly changes or if you're having other issues, that's another reason the call.

Annie Zaleski: So, you mentioned bleeding then, and so after giving birth, your uterus will be shedding significantly, how long does that usually last then?

Dr. Erica Newlin: So, usually we're expecting that to last about four to five weeks with the majority of it being in the first couple weeks after delivery and then tapering off to be a light bleed. You may notice if you're breastfeeding that periods of breastfeeding cause those cramps and a heavier bleeding during breastfeeding, and that's just since the hormones with breastfeeding caused the uterus to contract down.

Annie Zaleski: That's good to know because I think a lot of people might not realize that and might be like, “What is going on?”

Dr. Erica Newlin: For sure. And that can be surprising the first time around when you're starting to breastfeed and you're like, “Why am I having all these cramps while I'm breastfeeding?” And that can be very normal.

Annie Zaleski: So, if you're bleeding extremely heavily, like you said, a pad an hour, then does that mean that you're hemorrhaging? Can it mean also something else, too?

Dr. Erica Newlin: Hemorrhage is our major concern and it can be very variable between people. When we talk about saturating pad an hour, usually we mean more than one pad an hour for a couple of hours because sometimes you may notice if you've been laying down taking a nap, you stand up, you suddenly have a gush or a clot. That's just gravity during its work. But if you're heavily bleeding consistently, then that's a reason to call because that could certainly be an indication of postpartum hemorrhage.

Annie Zaleski: So, how does this also differ from then basically having your regular period then? Are there major differences or ways people can tell, because how soon after you give birth do you resume menstruating?

Dr. Erica Newlin: Usually, if you're not breastfeeding, we expect that first period somewhere between six to eight weeks after delivery. Most women will have a break between that uterine shedding after delivery, a couple of weeks without any bleeding, and then suddenly their period comes back. If you’re breastfeeding, it could take a while. Sometimes, even with breastfeeding, you can expect six months or more. I expect the period usually to come back if you're starting to drop feeds or starting to sleep through the night, that may be the indicator to your body that you're ovulating again and you may have another period at that time. But don't fret if it takes a while after delivery, sometimes it's just your body adjusting.

Annie Zaleski: So that's, I mean, everything you just described there, it can just vary so wildly in people's experiences then.

Dr. Erica Newlin: Very much so. And that's tough sometimes because it's very tough to find information. You're talking with your friends, you're talking with your mom, and different people have different memories of that postpartum period. So, sometimes, what is normal can be very worrisome in that in those first couple weeks or months.

Annie Zaleski: So, another very serious thing that happens when some people give birth is perineum tearing, and so what is that?

Dr. Erica Newlin: So, when we talk about perineal tearing, we're talking about tearing in that area between the vagina and the anus, and tearing is super, super common. The statistic is usually around 70% of women have some tearing after delivery. So, people are very worried about tearing, but often after delivery it's not quite as bad as they thought that things would be.

Annie Zaleski: Yeah. I mean, you hear the word “tearing” and that just doesn't sound good and so it can be very frightening.

Dr. Erica Newlin: For sure.

Annie Zaleski: What are kind of the degrees of the tearing then and how do doctors kind of determine the severity?

Dr. Erica Newlin: Yeah. So immediately after you deliver, we'll do an exam and do a very good assessment of what tearing is there. And then we grade it usually on a scale of one to four, and one is tearing just in the vagina and a little bit of the tissue under, but not involving any of the muscle. Sometimes, a first-degree tear doesn't even need any stitches; sometimes it will; but sometimes, there may be just a stitch or two. When we talk about second-degree tearing, that's the most common type of tearing, that's involving not just the vagina, but also the muscles of the perineum underneath, but not involving any of the muscles around the anus. Third-degree tearing starts to involve that muscle around the anus. And then fourth-degree tearing is involving the anus itself. Thankfully, third and fourth degrees are much rarer than those first and second degree. With first time moms, the second-degree tear we see very, very commonly.

Annie Zaleski: I mean, how do doctors treat this? Because you mentioned stitches, but I would think that with muscle tears that can get very complicated then, especially because of the area of where the tearing is.

Dr. Erica Newlin: For sure. One thing that's nice about the vagina is it's very resilient and even with more extensive tears, recovers very, very well. So, usually, we can stitch and repair in the labor and delivery room. Occasionally, with the more severe tears, we go to the operating room to make sure that we get a really good look and make sure that we're doing a very good extensive repair. Some women with more severe tears, those third- and fourth-degree tears, will involve pelvic floor physical therapy or some of our sub-specialists just to make sure that you're healing well and that your recovery is on the right track.

Annie Zaleski: How can you tell when there's a problem then? Because I think people have probably heard about potentially having something get infected then, so what do you need to look out for?

Dr. Erica Newlin: Some swelling is certainly normal. I tell many patients don't look down there because it can be kind of a shock if you take a mirror and you look down there, you're swollen, there are stitches, it looks very different than it did the day before. But if your pain is suddenly increasing, if you find that you are feeling good one day and the next day suddenly you're having a lot of pain, if you're unable to sit down, if you're suddenly having heavy bleeding, if there's suddenly an increase in swelling there — that would be a reason to get checked out. Because sometimes, the stitches can open or there can be a large blood clot behind the repair that may need to be examined, or certainly there can be an infection as well.

Annie Zaleski: That seems like a common theme that if you notice something very serious and very different all of a sudden that's always a sign to kind of keep an eye on things.

Dr. Erica Newlin: Right. For sure.

Annie Zaleski: So, let's also talk about postpartum hair loss because I think this is something else that people have heard a lot about then, so what causes this?

Dr. Erica Newlin: So, it's thought to usually be due to the decrease in estrogen. So, during pregnancy, you aren't shedding as much hair as you were before. You may notice you get very luscious, nice hair during pregnancy because your hair just isn't shedding. And then after delivery, your body is all of a sudden catching up and so the shedding may be way more intense. I remember when I got a haircut probably about six weeks after I delivered my son and my hairdresser was commenting on how full my hair was and how much she loved my hair. But then halfway through, she whispered in my ear, "Do you know your hair is falling out?" And I was like, "Yeah, yeah, yeah, it's fine." So, it can be very intense in that beginning period. Sometimes, you can find that you're pulling out in the shower handfuls of hair. It can definitely, particularly for those of us with longer hair, it can be quite noticeable for us, but hopefully not noticeable for other people.

Annie Zaleski: That can be extremely jarring because you can be like, “What is going on? I had this great hair and it's all going away as well.”

Dr. Erica Newlin: For sure. It's not something that we often discuss, but it's something that people very commonly experience.

Annie Zaleski: So, how long does postpartum hair loss last then and is this permanent?

Dr. Erica Newlin: No, definitely not permanent. It can go over the first year after delivery. So, we'll peak at that month four and then taper off over that first year.

Annie Zaleski: So, is there any way for people to prevent hair loss from happening?

Dr. Erica Newlin: So, certainly not a way to prevent, but some things that you can do to help. Keep taking your prenatal vitamin. That folic acid can be helpful in helping with further hair and nail growth and things like that. Some other things that can help are thinking about how you're styling your hair, not putting a lot of heat on your hair, a lot of chemicals on your hair, kind of avoiding those tight ponytails or things that pull very hard on your hair can definitely help decrease the amount of hair loss.

Annie Zaleski: And that's good, that's at least something that is within people's reach to do, too. That's a pretty easy fix.

Dr. Erica Newlin: For sure. And I usually tell people to avoid a lot of the expensive herbal supplements because you can really spend a fortune and there hasn't been a lot of evidence that those things work. If you find something that works for you great, but I really don't want people spending a ton of money thinking that there's some sort of magic cure all out there.

Annie Zaleski: If people do potentially want to take supplements then, should they talk to their doctor before that because there's so much research out there that certain supplements can interact with different medicines in not great ways and things like that?

Dr. Erica Newlin: Definitely. And especially if you're breastfeeding, too, you definitely want to check before you're taking anything because there's a lot of variance in how well things are vetted as far as herbal supplements.

Annie Zaleski: So, another thing that a lot of people go through are bladder issues. I saw a stat that urinary incontinence affects up the one in four people after giving birth. So, why is that?

Dr. Erica Newlin: So, as we talked about, a lot of things are moving back into place. So, the uterus is contracting down, the ligaments that hold the bladder and the uterus are a little looser. Some women may even experience a little bit of, we call it prolapse, when it almost seems like the bladder is falling into the vagina a little bit. And plus, you may not have as good of muscular control over that sphincter that guards the bladder, so say you pushed for three hours or just pregnancy in general can tend to weaken those muscles. So, it takes a little time to get that control back and that can be normal and it is not an indicator that it will be something that is permanent.

Annie Zaleski: That's what I think probably a lot of people worry about, that my body is permanently changed after something like this.

Dr. Erica Newlin: For sure. It is super common to leak urine in those first couple weeks after delivery and it does get better.

Annie Zaleski: So, is it a couple weeks, though? How long do people typically have that leakage then? Does it vary from person to person?

Dr. Erica Newlin: It can vary from person to person. It's definitely at its height in that first couple weeks. Some women I see at their six week visit are still struggling with it a little bit and we give it a little more time usually. But if it's persistently a problem, then we talk about other treatment options.

Annie Zaleski: I was going to say, what do people kind of do to deal with that then? I think you could probably wear a pad, that's one option. When do you know that's something maybe you have to have other interventions?

Dr. Erica Newlin: So, certainly, you can wear a pad, but other things that I think help is you could try Kegel exercises, that can help get that strength back. So that, if people haven't heard of them, that would be those muscles that you use to stop urine when you're peeing and stop that stream, you tighten those muscles and you can do that even when you're not peeing. I often say when you're watching TV and the commercial comes on, do your Kegels and no one has to know what you're doing and that can help strengthen those muscles that are there.

Some other things that can help prevent leaking are timing when you go to the bathroom, so making sure that you're going every couple hours can help decrease that leaking. And also avoiding things that you might notice are triggers, like caffeine can be a trigger for sure and some other things people notice are triggers as well. But making sure that you stay really well hydrated, too, is important because you don't want to dehydrate yourself just because you're leaking urine. Constipation can be a factor, too, because if you're very full of poop it can press on your bladder.

Annie Zaleski: Well, you mentioned constipation and I think one of the other big concerns people have after giving birth is what they can expect then. So, when is it normal to have your first poop after giving birth?

Dr. Erica Newlin: So, it can really vary. Sometimes, it can vary depending on if you had a vaginal delivery versus a C-section. With a vaginal delivery, it may not be very delayed. It may be in that first day or two after delivery. With a C-section or if you're opioid pain medications, it can take three or four days for your first poop after delivery.

Annie Zaleski: Can you expect pain then afterward?

Dr. Erica Newlin: There can be some pain, particularly if your stools are hard. We often give you medication after delivery just to keep those stools soft. Again, if you are on opioid pain medications, it's really important to drink a lot of water and to have stool softeners since those can contribute as well. And like we talked about, if you have a higher grade perineal tear, like those third- and fourth-degree tears, it's very important to keep your poop soft, too, since it's putting pressure on those stitches.

Annie Zaleski: Do people typically expect changes to their pooping habits then in the postpartum period?

Dr. Erica Newlin: It can be. Similarly to how we talked about the stretching of those ligaments around the bladder, it can affect your pooping as well. So, it is much less common to leak poop than it is to leak urine. But I do hear that from some women, particularly ones that have had those more severe third and fourth degree tears. I would give it only a couple weeks and then if it's still happening at that six week period, that would be the time when I would involve pelvic floor physical therapy or one of our sub-specialists.

Annie Zaleski: So, you mentioned constipation then, how common is it that people then might have constipation?

Dr. Erica Newlin: It can be super common, not just from opioid pain medications, but sometimes, if you're taking iron after delivery that can be constipating, too. Sometimes, we'll give people iron if they've had a significant blood loss. Sometimes, after a C-section, then the bowels can take some time to wake up since you've just gone through a major surgery, sometimes, that can contribute as well. Sometimes, breastfeeding can be dehydrating, that can lead to constipation. So very common, we almost universally give people a stool softener when they leave as a just in case measure.

Annie Zaleski: Hemorrhoids, as well, I understand, are very common, so what are some solutions for that?

Dr. Erica Newlin: Oh, definitely. Hemorrhoids are very common in pregnancy to begin with. So, you add those third trimester hemorrhoids to having pushed out a baby that can irritate the hemorrhoids plus that constipation that we talked about postpartum can sometimes irritate the hemorrhoids as well. So, often we'll give people cooling pads, like witch hazel pads, or some sort of topical steroid can help just decrease that inflammation. And plus, it all comes down to trying to keep your stool soft, so sometimes it's as simple as a stool softener, sometimes something like MiraLax® can help, too.

Annie Zaleski: So, there are other serious issues that people might experience, such as postpartum cardiomyopathy, which can cause heart failure, and it's rare, but they do occur. So, what kind of causes this and what are some warning signs that people need to look out for?

Dr. Erica Newlin: We don't exactly know why some women get postpartum cardiomyopathy and why some do and some don't. We don't know the exact cause. We do know that pregnancy requires a lot of increased volume on the heart, a lot of increased work of the heart, so a lot maybe due to those fluid shifts. So, when I think about the symptoms of peripartum cardiomyopathy, it can be shortness of breath and leg swelling. And I know a lot of women out there are like, “Well, I feel short of breath and I have leg swelling when I'm pregnant” and postpartum, and that can be common. But it's all about kind of that degree of symptoms.

So, the way I break it down often for women is you felt short of breath because you were walking up a flight of stairs, normal; you felt short of breath because you walked from one end of the room to another, not normal and definitely a reason to call. And then leg swelling can be very common, too. So, if you find that you're suddenly having an increase in leg swelling and it's not going down or you find you're getting short of breath when you're laying flat postpartum, those can be things that are concerning. It would be a reason call.

Annie Zaleski: So, how soon would these symptoms kind of start to come up after giving birth then?

Dr. Erica Newlin: So, often, it can occur in the last month of pregnancy up to the first five months after pregnancy.

Annie Zaleski: So, that's a long range then, so that can be ... and I think that's good to know because I think some people might just dismiss, like you said, in the last kind of month of pregnancy like, “Oh, I'm fine,” but that can start even then.

Dr. Erica Newlin: Right. And we see it most commonly in that last month to kind of in that first month after. And so it can be very tough sometimes because as I was saying, women do experience kind of that shortness of breath, there's a big baby pressing on their lungs. And so I think that it can be tough to parse that out sometimes and it's never a silly reason to bring up your concern with your doctor.

Annie Zaleski: So, even though doctors aren't sure why some people develop this and some don't, are there any people that are potentially more inclined to potentially develop this, either because they have preexisting conditions or something else?

Dr. Erica Newlin: So, certainly, if you have any preexisting heart conditions, if you have high blood pressure, if you have preeclampsia, particularly with severe features, those are reasons to have a heightened suspicion.

Annie Zaleski: So, what are some other physical health challenges that someone might not expect they might have after giving birth that maybe we haven't discussed?

Dr. Erica Newlin: Yeah. So I think one thing we didn't touch on are hormonal changes. So, those hormonal changes can lead to hot flashes, night sweats. It honestly can feel almost like you hear people describe menopause. It feels very different. You can sweat a lot more, so some women find that they're stinkier than they were before. And that's temporary, just since your hormone changes can just lead you to be much sweatier.

And I do want to take a second, too, to talk about sex after delivery because I think that's something important that a lot of people worry about but may not feel comfortable bringing up. So we do recommend usually waiting at least six weeks after delivery just to give your body time to heal.

But I tell patients just even if you've waited that six weeks, if you don't yet feel ready, just make sure it's a time when you feel ready. And that the first couple times afterwards may feel weird or uncomfortable. Sometimes, particularly with breastfeeding, there may not be as much estrogen going to the vaginal tissue so it may be more irritated. You may need more lubrication than before. So, some minor discomforts are normal and temporary, but if you're having moderate to severe pain, that's not normal and that's not something that you should feel embarrassed to bring up with your doctor because it definitely warrants something to be looked at.

Annie Zaleski: And that's all good to know because you're right, I think people might be unclear, and the idea that go at your own pace, I think you mentioned that earlier, it's such a good rule of thumb for everything in the postpartum timeframe.

Dr. Erica Newlin: For sure because it can, as we talked about before, it can take different times for different people to feel ready for things and to recover.

Annie Zaleski: Along those same lines then, people I think might be wondering, when can they start exercising again after giving birth then? What does that sort of look like for people and what do people sort of recommend?

Dr. Erica Newlin: Yeah. So it's great to be active right away as far as going on walks, trying to do very light exercise. Certainly don't expect you to start training for your marathon week two after delivery. Definitely try to be active while giving yourself grace on being active. Usually, we give people the full clearance at that six weeks. If you've had a C-section, we do recommend lifting restrictions of not more than 10 to 15 pounds for that first six weeks. And that's so you're not putting a lot of stress on your incisions and a lot of stress on your body.

Usually a little light lifting is okay after a vaginal delivery, but not to the point where you feel like you're needing to do heavy exercise. Usually, we recommend waiting at least at six weeks. And then, I usually tell people you might feel a little deconditioned. You've gone through a major life event, you're not going to be at the same level of fitness that you were before you got pregnant. So, starting slow, allowing yourself a little time to rest, stop if something hurts, and let us know if you're having a lot of pain somewhere.

Annie Zaleski: And gosh, that can be so difficult because people are so eager to kind of get back into where they were and get back to different levels. And so I can imagine that can be the waiting game and being patient can be very difficult for some people.

Dr. Erica Newlin: Definitely, so that's why I say a little light exercise is OK because a lot of people are really itching to get out there and I think it can help with mood and things, especially when it's nice outside. Do some walks around the block or do some mall walks with the baby to get yourself out and about, but waiting a bit on that heavy exercise.

Annie Zaleski: Belly wrapping is something that I think a lot of people might have read about, too. Kind of what is this and what's that for?

Dr. Erica Newlin: Yeah. So belly wrapping refers to putting some sort of band around your abdomen after you deliver or some women even wear a band during pregnancy. And there are a lot of variations on the kinds of bands out there, what people use them for. They've been around for centuries. Some cultures advise wrapping afterwards traditionally. Some look more like girdles or more structured, some look like a big almost kind of headband that goes around your abdomen. People use them for a lot of different reasons. We give them very often after a C-section to provide some support on the incision and can help with discomfort. So, I think usually I tell people don't feel like you have to wear them, but sometimes they can just help you feel more supported, help you with your posture and can just make you feel better in that healing period.

Since some women describe that feeling of just feeling out of sorts afterwards because your ligaments are a little more stretched. As I mentioned, your uterus is still going back down a size so you may still look a little pregnant. So, the belly band may feel nice for you. I do want to say what the belly band won't do is make your waist smaller in the long run, or help you lose weight, or anything like that. So, definitely don't feel like you need to spend $100.00 on a belly band that promises that it will change your body forever.

Annie Zaleski: Wow. Are there any sort of safety concerns people need to kind of be on the lookout for when wearing belly bands?

Dr. Erica Newlin: Yeah, good question. So I think certainly if the belly band's causing you pain, then take it off. If you feel like it's cutting off any sort of circulation, that would be another reason to take it off. I usually recommend that people take it off with sleeping, too, and not keeping it on for prolonged periods at night.

Annie Zaleski: Is there a material of a belly band that's better than others that people should kind of focus on or look out for?

Dr. Erica Newlin: I think focusing on natural materials as much as you can, kind of cotton can be less irritating, and looking at ones where you're not having a lot of Velcro that's irritating the skin. So, trying to keep to those quote unquote hypoallergenic materials, so things like cotton are better and less irritating to you.

Annie Zaleski: So, we've gone over a lot of information here and I think what people might want to know is, and we've talked a little bit about this, but during the postpartum time, what's normal? I think a lot of people might ask this and it sounds like from what you're saying is that everybody is different.

Dr. Erica Newlin: Yeah, it can be very individual and I think the main takeaway is that this is a major period of adjustment for your body and for your overall mental health, and to just give yourself some allowances on things. You may not be able to get right back to where you were before and that's OK. Things happen with time. So, taking some time for yourself and allowing yourself time to heal is what's really important. And as I mentioned before, expect to feel a little better each day, but maybe just a little better. But if something is suddenly worse or if you have any concern at all, don't feel embarrassed about reaching out to your doctor.

Annie Zaleski: What are some good questions to ask your doctor if you are concerned about the postpartum time?

Dr. Erica Newlin: So, I think there are no silly questions, so really the best questions to ask your doctor are really whatever you feel like is concerning to you. I think bringing up what your planned exercise routine is or if you're still at six weeks having bleeding, that's something worth bringing up, too. If you're bleeding never stopped or if something is still causing you severe pain, that would be something to bring up, too.

Annie Zaleski: So, I like that, too, because I think no question is too small, no question is too big, no concern is too small either because you just don't know.

Dr. Erica Newlin: Right. And thankfully a lot more time is being paid in the medical community to this postpartum period because, it's kind of funny, in the last trimester of pregnancy, we're seeing you every week and then you'd have a baby, and traditionally we were like, “All right, see you in six weeks, goodbye.” And I think the American College of Obstetrics and Gynecology and OB-GYNs in general are trying to pay a little more attention to that postpartum time because it is a major period of adjustment for women.

Annie Zaleski: Well, is there anything else you want to add that we haven't covered then?

Dr. Erica Newlin: That really covers, I think, everything. Main take away, it's a major period of adjustment. Don't be embarrassed about anything you're experiencing. So, if your urine is leaking, if you're having trouble holding your poop, if you're having pain with sex — these are all things that we've heard before and are ready and willing to talk about. So, don't be afraid to bring these issues up with your gynecologist because I know it can be embarrassing and I know it can be tough to talk about, but that's really what we're here for.

Annie Zaleski: Well, thank you so much for being here. This has been a really great conversation. I really appreciate it.

Dr. Erica Newlin: Yeah, thank you.

Annie Zaleski: If you have postpartum concerns, your doctor can help you figure out the best next steps. Visit clevelandclinic.org/womenshealth or call the Women's Health Institute at 216.444.6601 for an appointment.

Speaker 1: Thank you for listening to Health Essentials brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. You can also follow us on Facebook, Twitter and Instagram for the latest health tips, news and information.