OB-GYN Dr. Meedlen Charles walks us through the common changes you can expect– physically and mentally– during the postpartum period. She and Adriana Lozada break down which symptoms are red flags to discuss with your care provider.
How have you cared for yourself in postpartum? We’re holding space for your healing process @birthfulpodcast on social media.
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Related Birthful episodes:
- Talking Pelvic Health with a PT, with Sara Reardon
- All About Your Pelvic Floor, with Lisa Gillispie
- Structural Body Changes, with Molly Deutschbein
- Let’s Tackle Postpartum Mood and Anxiety Disorders
- Postpartum care: What to expect, the Mayo Clinic
- Postpartum Preeclampsia, The Preeclampsia Foundation
- National Racial Disparity Task Force Tackles Preeclampsia, Preeclampsia Foundation
- Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation, by Katy Bowman
- Perineal tears recovery and care, NCT First 1,000 Days New Parent Support
- Perineal Tear: What to Expect at Home, MyHealth Alberta
- Incontinence After Childbirth, University of Colorado Urogynecology
- Pregnancy and Childbirth, National Association for Continence (NAFC)
- Pelvic Organ Prolapse, National Association for Continence (NAFC)
- Pelvic organ prolapse, U.S. Department of Health & Human Services Office on Women’s Health
- PT Locator, Academy of Pelvic Health Physical Therapy
- 6 Things No One Tells You About C-section Recovery, Self
- Recovery after cesarean: the first six weeks, raisingchildren.com.au
- Identifying Postpartum Depression: A Three Question Screening Tool, MGH Center for Women’s Mental Health
- Urgent Maternal Warning Signs: HEAR HER Concerns, the CDC (even though it’s gendered, it’s a good campaign)
One thing you can do for you is to find a pelvic floor specialist in your area and commit to reaching out for a consult. Do it regardless of how long it’s been since you’ve given birth and especially if you are currently pregnant, because the tone and balance of your pelvic floor and core play a crucial role in how your baby is positioned and during the pushing stage. Ask your friends for recommendations or use the PT locator on the Academy of Pelvic Health Physical Therapy’s website.
The one thing you can do for the rest of us is to follow and support the work of the Preeclampsia Foundation. Their work recognizes that racial disparities are a fact of maternal health and how they impact health outcomes for Black families. Their racial disparities task force is working to create recommendations that address these issues as they relate to hypertensive disorders of pregnancy.
What Actually Happens After Giving Birth, Physically and Emotionally
Dr. Meedlen Charles:
It can happen at eight weeks, it can happen at eight months, it can happen at a year, so don’t think like, “Oh, at six weeks, I’m good to go. Yeah, I’m fine.” And then all of a sudden, seven months later, you know, and you’re thinking, “Well, I shouldn’t be feeling like this now. I’m way past the postpartum period.” Which is… People don’t seem to get postpartum period lasts more than six weeks.
That is OB/GYN, Dr. Meedlen Charles, who prides herself on teaching her patients and giving them the tools to help them take care of themselves. Today, we’re gonna be talking about what to expect physically and mentally during immediate postpartum and some red flags you should definitely contact your care provider about. You’re listening to Birthful, here to inform your intuition.
Welcome, Dr. Charles. It is wonderful having you on the show.
Dr. Charles: Thank you so much for having me and I’m very happy to be here.
Lozada: Can you tell us a little bit about yourself and how you identify?
Dr. Charles: I am a board certified OB/GYN, and I’ve been in practice now since… private practice in 2005. So, oh lord, that makes me really old, but yes. I don’t look old, though.
Lozada: You don’t. You don’t. And I’ve been a doula for 14 years, so a little less, but close to that too, right? Feeling old.
Dr. Charles: Right.
Lozada: So, I thought today we would talk about what people can expect during those early days postpartum, and physically and emotionally, so from the moment that they give birth until that first week or two weeks or so, few weeks, what can people expect?
Dr. Charles: Happiness. You know, seriously, you’re very happy. You spent pretty much nine months waiting to have this baby, and all of a sudden you have a baby in your arms, and when everything happens well, without any complications, even makes my heart sing, and the parents are happy, the nurses are happy, and when you have a beautiful delivery, and sometimes I even cry because it’s so wonderful. Obviously, there are going to be emotional changes as well too, because sometimes you look at your baby and you have this overwhelming feeling of love. As well too, you start crying, and shaking, because you never thought that you would have this amount of love for somebody before, even though you thought you would, but that when the baby comes out it’s an amazing feeling.
Of course, there’s the tiredness and other things as well too, but usually that’s the most important thing that happens right after you deliver.
Lozada: And I want to normalize that not everybody feels that overwhelming joy upon meeting their baby, that sometimes it can take… Depending on the birth, depending on how tired you are, depending on what your hormones are doing at that moment, it can take a little bit. It can take even days or weeks to get to a point, or more, to get to a point where you’re like, “Oh, I love you so much.” It might be a, “Hm, okay, you’re now in my life and I gotta figure out who you are.”
Dr. Charles: Right. Exactly.
Lozada: And what can people expect during those first few days postpartum physically?
Dr. Charles: Physically, initially when you have the baby, sometimes moms are very surprised that their belly still feels big, even though technically you’ve had the baby, but your belly has been over distended for a long period of time, so it feels like you’re still, it looks like you’re still pregnant. And it takes a while for your body physiology to go back to normal, so that’s one of the things that you can expect. Sometimes patients will also feel like after pains or cramping when they’re breastfeeding, and usually that’s secondary to the fact that they’re releasing oxytocin. Their own body is releasing oxytocin whenever the baby is suckling, and that helps the uterus or the womb to go back down to normal size within the first couple of weeks after delivery as well, too.
So, they can cause them to have severe cramping and pain, and it usually tends to basically be worse with each subsequent pregnancies, so also, too, patients can have discomfort, or they can get very swollen, so if you were pushing for a while and you had a laceration, depending on the patient, their perineum or their vulva can be very, very swollen, and they tend to have to use an ice pack or cold compress for at least the first 24 hours or so to really help out, as well as a discomfort from any kind of laceration repair or anything like that. Or you can also use some sitz bath as well, too. Maybe up to within one or three inches of water for about three times a day to help out.
Lozada: And that would be warm water.
Dr. Charles: Warm water. Right.
Lozada: And I think that’s really great. Let’s point out, like some people I know love that ice pack right after birth. Love that ice pack. But I think it’s important to note that it’s better during that immediate 24 hours, and then to promote blood flow, you want to maybe switch to warmer things like these sitz baths that you’re talking about.
Dr. Charles: Right. Exactly.
Lozada: Dr. Charles, let’s talk a little bit, because I know this is a big fear and a big concern of a lot of people, of the vaginal tears.
Dr. Charles: Okay, so it’s not unusual for that to happen, especially for first-time moms. Nowadays, most OB/GYNs will tend to stay away from episiotomies, because sometimes you don’t really know necessarily which patient is going to tear, which patient is not going to tear, so my personal way of practicing is I don’t routinely do episiotomies and I think most physicians basically don’t tend to do that. We usually tend to do an episiotomy for example for patients who have certain criteria. For example, if we want to get the baby out sooner rather than later, if we have like a baby in distress. But other than that, once you actually have the repair, usually we use stitches that tend to dissolve, and they will tend to dissolve by themselves within about anywhere from three to six weeks. And sometimes what happens, depending on exactly where you might have had the first degree laceration, which is the one where it’s very superficial, and if it’s hemostatic and it’s not bleeding, depending on exactly where it is, the provider may decide not to actually put any stitches in, but it might still feel a little bit raw, so every time you urinate you might feel burning, because the urine is very acidic, so every time you pee it stings a little bit, so that’s where your peri bottle would actually be very helpful.
So, you use it every time you go to the bathroom to pee. It dilutes the urine, so it doesn’t sting and burn whenever you actually go to the bathroom to pee.
Lozada: Yeah, and I think that’s a great thing for people to use, no matter if they have superficial abrasions, or tears, if there’s something that needed to be repaired and you’re feeling stinging when you pee, then using this peri bottle to spray before you go, or after you go, to then slightly just tap to dry and make things easier. What about… We’re talking all the fun topics here today. What about hemorrhoids?
Dr. Charles: Oh, hemorrhoids. Yay. You know, that’s the unfortunate stuff. Hemorrhoids, it’s very common, unfortunately, so again, exactly the same thing. We will give you… The cold packs actually would work really well. The witch hazel pads, the TUCK pads that they give you also at the hospital will also work really well, as well. And then the most important thing is to not be constipated, okay? So, the first thing I tell my moms is to make sure that they change their diet. One of the best ways to do that is making sure that you’re drinking tons of water, you tend to eat green leafy vegetables, whole grains. You definitely need to be doing all of those things to prevent constipation. Either use fiber, prune juice, stool softener, any of those things to actually make sure that you can actually take care of the hemorrhoids, as well too, and that’s really helpful.
Lozada: And at the hospital, they really want to make sure you have a bowel movement before you’re released, or at the beginning, those first few days, and that can be such a scary proposition for new moms, depending on the tear they had or how swollen they are.
Dr. Charles: And sometimes they make themselves constipated because they hold it in, because they think like if they push too much, it’s going to actually break the stitches. And it doesn’t, because the stitches are pretty strong, pretty much.
Lozada: Dr. Charles, in terms of what that time in the maternity floor after being in labor and delivery, moving to the postpartum area, what will that look like? What checkups can people expect for themselves?
Dr. Charles: We monitor the mom normally in the labor and delivery room for the first two hours to make sure that they’re not having any bleeding. We check their blood pressure. We make sure that their fundus, which is the top of the uterus, is staying firm, and after that, they bring you into your room. And then the nurses continue to monitor and do checks, checking your blood pressure, checking your bleeding, to make sure that everything is normal, and the nurses will basically follow. We’ll have a lactation consultant that is in house and they come in, they help you. With the vaginal delivery, usually you’ll tend to stay in the hospital for at least two nights, but if you’re a mom who’s like this is your second or third, your fourth baby, if your baby is completely stable, without any issues, any problems, we require the baby to stay in house for at least 24 hours, and then if everything is okay, after 24 hours, everything’s stable, we’ve checked your blood count to make sure that you’re not anemic, you’re stable, your vitals are fine, usually patients will go home after a vaginal delivery after 24 hours. Which is great. And that’s for a vaginal delivery.
Lozada: And if people had a cesarean, how does this change, this immediate postpartum change? What can they expect?
Dr. Charles: With a C-section, usually our patients will stay in house for at least again three nights, and again, if it’s somebody who’s had surgery before, sometimes they may go home after two nights, because they’re used to it and they’re doing great without any issues. They’re having a bowel movement, they’re eating well, they have no complications, no issues or anything like that, and they’ll see us in a couple of weeks after.
Lozada: So, let’s say regardless of if it was two days that they stayed in the hospital, three days, that when they finally get home, what are some things that they can expect in terms of their recovery, and what are things to watch out for?
Dr. Charles: Okay. Usually, when I tell my patients to go home, these are the things that I tell them to think about. The bleeding usually is heaviest, or what we call lochia pretty much, is heaviest the first couple of days after delivery. And then it will be reddish, and then pinkish, and then whiteish, yellow, and then whitish-yellow, up to about six weeks or so. About 15% of patients or moms will continue on having discharge beyond six weeks, but most people will usually tend to stop by like six weeks or so.
However, about 10 to 14 days, about two weeks after they’ve delivered, the bleeding that was very light spotting on day nine, 10, might get a little bit heavier with blood clots for a couple of days or so, and invariably people will think, “Oh, there’s something wrong.” Their dog jumped on their belly or they went to the grocery store, a kid pushed a cart onto their belly or something like that. But it’s usually the scar of the placenta that’s shedding, okay? So, as long as a mom is not soaking like one pad completely soaked, greater than one pad per hour for over two hours, they should totally be okay. That’s the first thing.
Also, symptoms of breast infections. So, usually that will be associated with some redness and some areas that would be very hard and what we call indurated on the upper outer corners of their breasts, which is the areas that is most difficult to actually remove the milk from, and are also associated with chills as well, too, and they’ll have temperatures. Very high temperatures. So, those are the symptoms that they need to actually give us a call about, so that we can actually get that treated.
If for some reason you have foul-smelling vaginal discharge, if you have severe belly pain that’s unrelieved by over-the-counter pain medication, it could be symptoms of an infection in the uterus or the womb, so you definitely need to give us a call. If for some reason you are having swelling of your feet, it’s not unusual to have that as you leave the hospital, to have really swollen legs, but you shouldn’t have one more swollen than the other, and you shouldn’t have like pain behind your calves, et cetera, because then that could be symptoms of a blood clot, and that’s something that you need to be worried about.
So, those are the things that I tell patients. Also, postpartum blues. Because there are some moms who they’re crying all the time, they are tired, and they have what we call postpartum blues, and postpartum blues are completely common, okay? And it’s totally normal. And moms need to know that there’s nothing wrong if they feel like that, you know? And usually that doesn’t last no more than about two weeks. Usually, by two weeks it should start subsiding, but if after two weeks for example you’re still having issues, usually then that can start becoming symptoms of postpartum depression, and that’s when it’s important to basically make sure that you talk, you call your pediatrician, you call your midwife, you call your doctor to make sure that they understand that there is something going on.
And sometimes one of the things I tell patients, which is very important, is that postpartum depression is not necessarily after the six week mark. It can happen at eight weeks, it can happen at eight months, it can happen at a year, so don’t think like, “Oh, at six weeks, I’m good to go! Yeah, I’m fine.” And then all of a sudden, seven months later and you’re thinking, “Well, I shouldn’t be feeling like this now. I’m way past the postpartum period.” Which is… People don’t seem to get “postpartum” period lasts more than six weeks.
Lozada: Oh, no. It’s years. It’s years. And I think it’s important to know also that dads or other partners can also get postpartum depression.
Dr. Charles: Yes. They can. They can. And you know, people don’t talk about it. And also, if they had a traumatic delivery, they feel powerless, like there was like an emergency cesarean section. They were very scared for their baby’s life, for their partner’s life, you know? And what it is is that we have to try to erase the stigma. I had a patient recently, she’s still pregnant, and she had issues dealing with the pregnancy, but she couldn’t tell her husband because he didn’t believe in therapy. I’m worried about her for when she goes home, because if she has any issues, she doesn’t have anybody else to help her. And it’s important to talk about it and to not feel ashamed about exactly what is going on in your life, you know? So, that’s very, very important.
Lozada: Absolutely. What are some concerns, what are some of the symptoms of say postpartum preeclampsia? Because I know that that is also something that doesn’t get talked about much.
Dr. Charles: Right. So, postpartum preeclampsia, here’s what we tell patients. So, if for some reason the swelling… Again, it’s very non-specific, meaning like you can totally have swelling with a normal patient, but let’s say for example you had elevated blood pressures during the pregnancy, and then you also had elevated blood pressures during the prenatal care, these are the things that you also… If all of a sudden you are gaining weight, and your swelling is even worse, okay, after you deliver, and you’re noticing also that you’re having severe headache, and you’re taking Tylenol, and it’s not going away, if you’re noticing that you’re having spots or blurred vision, that is not normal. If for some reason you’re having seizures at home, those things are not normal. Hopefully, it will not get to the point of seizures, but a lot of times you’re tired, you’re thinking, “Oh, it’s because I’m tired. I have a newborn at home. I’m not sleeping. That’s the reason why I’m having a headache.”
A headache postpartum is not something that you kind of like poopoo. You know? You definitely need to call your provider because we want to make sure that we see you, that we check your blood pressure, because it could be symptoms of postpartum preeclampsia or toxemia. And that’s very, very important.
Lozada: And another thing that I think can be a red flag or something to be aware of during postpartum is having a retained placenta. Can you talk about that?
Dr. Charles: Yes. Okay, so retained placenta is actually one of the causes of postpartum hemorrhage or bleeding after delivery. So, usually after a patient delivers, we always check, I always check to make sure that the placenta is intact, okay? So, you can have like a retained placenta either right after delivery, because you have 30 minutes to deliver the placenta after the baby is delivered. If for some reason the placenta does not deliver, then we have to do maneuvers to actually remove it, and then you have to make sure also too, after you do that, that there are no pieces left inside. You inspect the placenta and sometimes you may end up having to do an ultrasound.
But sometimes, again, if you end up going home and you’re having bleeding that is very, very heavy, again, more than one pad per hour for over two hours, and it’s not subsiding, that could be… You may have what we call retained products of conception in there, or retained parts of the placenta, and you need to call your doctor. And that’s very easy to do. They’ll do an ultrasound, a sonogram, and they will be able to actually see something, and then be able to take care of it.
Lozada: Yeah, because that can be very confusing for the body, going like, “I have a baby out here and I’m breastfeeding,” if people are breastfeeding, but the placenta pieces are giving the body the signal that you’re still pregnant, and then it could create infections, and yeah.
Dr. Charles: Right. Exactly.
Lozada: What about incontinence, and organ prolapse, and like some bigger issues?
Dr. Charles: So, these are the issues that people don’t talk about. So, it’s not unusual to have what’s called stress incontinence, which is leakage where anytime you cough, or you sneeze, or you stand up, and you’re doing jumping jacks, okay, imagine you’re like a 25-year-old woman and this is happening. You’re not even 90 years old or something. It sucks and you don’t know necessarily how long it’s gonna last. And let me tell you, it is so common, and people don’t talk about it, so us OB/GYNs and providers have to do a better job of actually asking our patients about that type of information, because sometimes our patients and our moms are very embarrassed to talk about it, so I tell my patients to do Kegel exercises, okay? So, again, initially at the first six weeks, if for some reason it doesn’t get better, I might give them maybe like eight weeks or so, and then after that I send them to pelvic floor therapy. They take the time, they actually examine you and tell you exactly what to do, and I think we don’t use pelvic floor therapists enough, and they are fantastic.
Actually, one patient yesterday, I was sending her home actually, she asked me about this. She said with her last baby, how long would she have painful intercourse. And I said, “Okay, how long are we talking about? Okay, maybe at the six…” Because a lot of time, people talk about to you, and they say at six weeks, by the way, is it okay for me to have sex? I said, “Well, physically you might be normal, but emotionally you may not be ready.” You know, so that’s another thing. But also too, it may take a while, because everybody heals differently and sometimes you may end up having scar tissue. So, a lot of times, you may need to get that scar tissue to have some relaxation and the pelvic floor therapists, they’re wonderful at this.
So, at a year out, six, nine months out, you really… For something that you shouldn’t be having pain just from where you had the repair still, so again, come and talk to your doctor. Do not be embarrassed. Do not worry about saying, “I don’t want to talk to my OB/GYN about this.” If you don’t talk to your OB/GYN or your midwife about this, who the heck are you gonna talk to? Your dentist? And then we’ll send you to pelvic floor therapy to take care of it, seriously, and they’ll know what to do. This is very important.
Lozada: Absolutely, because penetrative sex should not hurt, period. Done. Yeah.
Dr. Charles: It should not. And also, there’s also some vaginal dryness as well too, that can occur when you’re breastfeeding, and postpartum as well too, which is not unusual. So, sometimes it could be dryness, but if it’s literally just at one specific area instead of the whole vagina, it may be from the scar itself. And then diastasis recti is pretty common. That can occur from the beginning of the 35th week of pregnancy up to afterwards. It’s not something that I used to do very early on in my career. I only started doing checks on my postpartum patients in the last few years and there’s a way to examine the patients and to tell them exactly what kind of exercises to do.
Lozada: And just because we didn’t explain what it was, diastasis recti is when the abdominal muscles, the vertical abdominal muscles separate, and that fascia is more exposed, and then it’s normal because of all the pressures of pregnancy, but if it doesn’t come back, then that can create other problems and need some interventions like have a pelvic PT assess it and help you in what to do. Yeah.
Dr. Charles: Yes. Exactly.
Lozada: Fantastic. And would you agree that if at any point, say they’re waiting for their six-week checkup, but if at any point before that they feel like something is up, I need to talk to my doctor, but I don’t want to worry them or I’m not sure, that they should call anyway?
Dr. Charles: Of course. Let’s not even talk about the fact that the six-week postpartum visit is not enough, okay? Plain and simple. I believe they need to be seen earlier, technically. We just have tons of other insurances who are not really paying for the visit; therefore, doctors are not doing it, but depending on the patient, I know with our practice certain patients come in earlier than other patients, but they still need to be seen. So, please do not go the Google route. Please don’t. Give us a call. This is what we are here for. A phone call with one question I’ll answer in literally a minute or two, or even longer, and then I will save you tons of worry and sleepless nights, and we want to hear from you, because a lot of times it’s nothing, but a lot of times it is something that we need to actually see you for. So, always, always, always call your doctor.
Lozada: Yeah, and you shouldn’t be suffering because of it.
Dr. Charles: No, you should not. No.
Lozada: Dr. Charles, thank you so very much for coming on the show today and answering all my questions. I really appreciate it.
Dr. Charles: Thank you. Thank you. Thank you so much for having me. It was great, actually. It was just like having a conversation.
Lozada: That was OB/GYN, Dr. Meedlen Charles, who is passionate about helping expecting and new parents navigate the changes associated with the postpartum period and beyond. You can find Dr. Charles on Instagram @MeedlenCharles.
I hope your main takeaway from our conversation is that even though there are many expected physical and mental changes during postpartum, that does not mean that you have to endure their discomfort or just trudge through them. Postpartum is a time to honor your recovery and replenish your body and mind. Make sure you take as much care of yourself as you do your baby, and if you or your family members feel that there’s something not right with your health, then don’t delay in reaching out to your care provider.
One thing you can do for you is to find a pelvic floor specialist in your area and commit to reaching out for a consult. Do it regardless of how long it’s been since you’ve given birth and especially if you are currently pregnant, because the tone and balance of your pelvic floor and core play a crucial role in how your baby is positioned and during the pushing stage. Ask your friends for recommendations or use the PT locator on the Academy of Pelvic Health Physical Therapy’s website at APTAPelvicHealth.org. The one thing you can do for the rest of us is to follow and support the work of the Preeclampsia Foundation. Their work recognizes that racial disparities are a fact of maternal health and how they impact health outcomes for Black families. Their racial disparities task force is working to create recommendations that address these issues as they relate to hypertensive disorders of pregnancy, and you can learn more at preeclampsia.org.
Lozada: Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Jen Chien is executive director. Cedric Wilson is our lead producer. Kojin Tashiro mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen, and come back next week for more ways to inform your intuition.
Lozada, Adriana, host. “What Actually Happens After Giving Birth, Physically and Emotionally.” Birthful, Lantigua Williams & Co., March 31, 2021. Birthful.com.
About Dr. Meedlen Charles
Dr. Charles graduated Magna Cum Laude with a BS in Chemistry from Saint Elizabeth University in Morristown, NJ. She later graduated from Drexel University School of Medicine in 2001. She went on to train at Beth Israel Medical Center in NYC where she acted as Chief Resident.
In July 2005 Dr. Charles joined the Army and served as active duty military physician at Ft Riley, KS. In 2007 she was deployed to Afghanistan in support of Operation Enduring Freedom. She also served as Chief of the OB/GYN Department at Irwin Army Community Hospital at Ft Riley, KS. She has now been employed at NYP/Hudson Valley Hospital for the last 10 years where she has been named Physician of the Quarter. This is the place where she has performed her first water birth. She also works in conjunction with doulas.
Dr. Charles is board certified in general Obstetrics and Gynecology. She manages normal as well as high-risk obstetrics complicated by hypertension, gestational diabetes and twin pregnancies. She prides herself on teaching her patients and the community and giving them the tools to help them take care of themselves. She is currently focused on helping and providing expecting and new mothers on how to navigate the changes associated with the postpartum period and beyond.
Find her on Instagram @meedlencharles.
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