Your Questions, Answered: Q&A with Dr. Sonya Ye, OB/GYN Resident Physician
October 9, 2023
Even with the unimaginable amount of information you’ve received about pregnancy and postpartum from friends, family, and targeted Facebook ads, a question or two may still be lingering in the back of your mind. So, we had you ask us what you really wanted to know. No question should be left unanswered, which is why we’ve teamed up with Dr. Sonya Ye, our Chief Health Officer and resident physician OB/GYN, to answer your questions. Whether your inquiries are minor or major, general or particular, our goal is to help you feel prepared and ready to tackle anything that may come your way during the four trimesters. Here are the answers to your top inquiries:
Q: I am 37 weeks and would like to have a vaginal delivery without an epidural. How often do patients change their mind and end up getting an epidural? Is there a point at which you would suggest that the patient get an epidural?
A: It is so common for patients to change their mind about getting an epidural! You can request an epidural at any time during your labor course, but here are the things you should know:
Once you get one, you won’t be able to walk around. Some people value the ability to walk around the room or bounce on a birthing ball while others prefer earlier pain control. Your care team should support you in whatever you decide!
If you aren’t able to sit still for the administering of the epidural, it is likely that you wouldn’t be able to receive one. As you inch towards the end of the labor course, contractions can become more intense, and it will be hard to receive one as sitting still won’t be as easy.
Your doctor may suggest an epidural if you have been in labor for a very long time, but mostly, the right time to get an epidural is when you want one.
Labor is taxing, so in order for you to have some sort of rest, epidurals can be one way to help with relaxation. The second stage of labor, or the ‘pushing stage,’ is physically intense and can last about three hours for first-time moms. Epidurals can help you get a little nap in or to conserve energy so you can be ready for the pushing. Being calm, focused, and relaxed are very important to have a successful and stress-free delivery, and medication can help achieve that tranquil state.
It’s important to note that if you have an epidural, but would require an emergency c-section, you would most likely be able to stay awake for the procedure. However, if an emergency c-section is required and you haven’t received an epidural, you will have to be placed under general anesthesia for pain control.
Finally, I tell every mom who doesn’t want an epidural this: birthing without an epidural is a bad-ass, awesome thing to do. That being said, part of being a good mom is adjusting your plans to pick what is best for you and your family based on what you know at the moment. Sometimes moms come in and are set on laboring without an epidural, but as their contractions get worse, they wish to get one. Changing your mind doesn’t make you a failure – in fact, it makes you a great mom because you are already learning to adapt your plans, and go with the flow with whatever comes your way – which will happen a lot in motherhood.
Q: When can I start exercising again? Will my body ever look like it did before?
A: After giving birth, your stomach may still look "big" because it takes an average of 6-8 weeks for your uterus to return to its normal size. It’s also likely that your postpartum body will look and feel a little bit different from pre-pregnancy, and as a result, many mothers feel the pressure to start working out right away.
However, with the new responsibilities of motherhood, it’s important to understand that you don’t need to “bounce back.” Your “baby pooch” is a result of a tremendous and amazing feat, and you should have every right to appreciate and admire it. It’s also crucial that you give yourself the time to recover before diving back into vigorous exercise.
Regardless of whether it was vaginal or cesarean, giving birth is hard on your muscles, so avoiding high intensity exercise will help reduce additional strain. Rather, you might feel inclined to start by incorporating slow movements to get adjusted to your changed physique–which is totally OK! You shouldn’t expect to be running marathons immediately after birth, and the key is to aid your recovery and slowly regain your strength over time. For when you feel ready and have been cleared by your doctor, here are a few tips to help with your return to exercise:
Keep it simple and sweet. Don’t overexert yourself just yet–take it easy and always listen to your body.
Just do it. It doesn’t need to be complicated. Even slow and short periods of movements will be ultimately beneficial to your recovering body, to regain strength and increase blood flow that will aid in healing.
Have a plan. Strive for 150 minutes of movement per week (or about 20 minutes per day), dividing it up to fit within your schedule.
Utilize many types of movement. Walking, yoga, pilates, and postpartum-specific exercise classes are good exercises to start out with. Switching up the types of movement will allow your body to be reacquainted with a variety of strength and endurance-based workouts.
Q: What can I do to prepare for breastfeeding?
A: If you choose to breastfeed, it’ll require a lot of time and energy, so it’s recommended to prepare everything before your little one arrives! It's also important to note that your breast milk won't come in right away, so you can prepare accordingly. Here are the recommendations:
Get your breast pump. Chat with your OB/GYN about the variety of breast pumps available in the market. Luckily, insurance companies are legally required to cover the cost of breast pumps, but they do require a prescription, which often can be given as early as your second trimester. Having this device ready to go will save you time and stress.
Choose a lactation consultant, and schedule your first appointment. If you’re giving birth in a hospital, it is likely that there will be a lactation consultant present to guide you and give advice during your stay. However, whether you’re giving birth at home or in the hospital, I would recommend that all moms find a consultant they can see before and after birth; meeting with a IBCLC (or International Board Certified Lactation Consultant) before delivery will help you create a breastfeeding plan and even express colostrum (an extremely nutritious pre-milk), to save for your baby for the first few days as your milk comes in.
Prepare ahead to free up time. During the first few months, it is likely you’ll be breastfeeding or pumping a lot, meaning that you may not have as much time as you’d expect for day-to-day tasks. If you prepare frozen meals, clean and baby-proof your home, ask for assistance from friends and family in advance, and stock up on baby gear (especially diapers as well as formula samples for those first few days – newborns eat and poop a lot), it will open up more room (and time) to focus on breastfeeding and spending quality moments with your little one.
Breastfeeding is a challenge, and it’s ok to formula feed. When it comes to postnatal difficulties, breastfeeding can be right at the top of the list as one of the most frustrating and demanding endeavors, so it’s crucial to head into it with the understanding that it may be challenging. Your lactation consultant and OB/GYN can always help, but sometimes women find that breastfeeding is just not working for them. If you become unable or choose not to breastfeed, formula feeding is still a great option --and you should not feel guilty!
Q: How common is postpartum depression? What are some warning signs that I can watch out for?
A: Approximately one in seven women face the symptoms of postpartum depression after giving birth. If you are experiencing any of the symptoms listed below, you are not alone! But it will be vital for you to receive the care that you need. Look out for these signs, and also share them with your support system so that they can help monitor your wellbeing.
“Baby Blues” aren’t going away. Being teary-eyed or moody after giving birth is very common; but if these feelings persist for longer than 10 days and become more intense (i.e. you’re crying for long periods of time for no reason, easily irritated, or expressing anxiety, shame, or hopelessness), it could be likely that you have postpartum depression.
Increasing physical symptoms. Emotional and mental stresses from birth and postpartum can translate to physical complications. Watch out for physical symptoms of postpartum depression, such as headaches, chronic fatigue, lack of energy, change in appetite, and abnormal sleep patterns.
Lack of interest in daily activities. Sudden changes in behavior, such as avoiding tasks and responsibilities, retreating from friends and family, having lack of interest in caring for the baby or in hobbies are very telling signs that you may have postpartum depression.
Q: Are there ways to help prevent perineal (vaginal) tearing during birth?
A: Absolutely! Tearing might be the most nerve-wracking thing on your “things to watch out for during delivery” list–but there are ways to potentially prevent or mitigate.
Practice perineal massage to stretch and prepare the vaginal opening for delivery.
Kegel exercises will strengthen your pelvic floorand will ultimately help prevent tearing and reduce recovery time post-birth.
Research suggests that upright birthing positions, rather than horizontal, are likely to lead to less tears.Talk to your caregiver and practice birthing positions such as kneeling, squatting, or laying on your side to prepare you for actual birth.
Make a perineal tear prevention plan with your caregiver.Not only will your obstetrician or midwife have knowledge on how to prevent tears, informing them in advance will allow them to keep your concerns in mind when they are with you during delivery.
During birth, make sure to breathe with your contractions–having your whole body participate for each push can help prevent tearing.
Q: What are the best things to eat immediately after giving birth?
A: Exercise and giving birth are very similar because both require you to utilize your muscles and make you sweat, a lot. Just as you would eat certain foods to help refuel your body after taking a yoga class, running or cycling, you can eat certain foods to assist with your recovery after giving birth. This being said, the best things to eat immediately after giving birth are the following:
Foods with electrolytes. Electrolytes are important, because they can help speed up recovery and rebuild damaged tissue by supporting hydration, producing energy, and stimulating muscle contractions (read: helping your uterus shrink back) - and you can get it in foods, just as you would from drinks!Vegetables like spinach, kale, broccoli, and fruits such as watermelon, strawberries, oranges, bananas, and tomatoes are great choices. If you’re craving snacks, try reaching for things like olives, raisins, yogurt, peanuts, and almonds.
Protein-rich foods. Not only will foods with high amounts of protein help you recover (and heal wounds), but they also help keep your body strong. Consider lean meats, poultry, and fish as well as eggs, cheese and yogurt for great sources of protein. Try eating 5 servings a day, and 7 if you're breastfeeding - protein delivered through breastfeeding helps with baby's brain development and meaningful nourishment.
Q: I’m exhausted and sleep-deprived. How can I sleep better with a newborn?
A: Cluster feedings, late night cries, and balancing mom life with your daily schedule are all obstacles to getting the best possible sleep in the postpartum stage. Fret not, there are ways to optimize your sleep schedule:
Sleep when your baby sleeps! Ugh yeah, we hate this saying too, because it’s way easier said than done! But as a start, this is truly the best way to get some rest, especially in those first weeks. When the baby sleeps, don’t worry about taking care of chores or anything else; just try to get some sleep.
Don’t hesitate to ask for help. Many mothers choose to hire a nurse or a newborn care specialist, because caring for a newborn is no easy feat. If this is out of the budget for you, it’ll be especially important for your partner or family to help out, especially during the nighttime when you can take turns waking up with the baby. Leverage your support system to get some extra Zs, because you’re recovering too!
Practice good sleep hygiene. While the coffees and your daily dose of social media will help you get through this sleep-deprived time, try reducing caffeine and late night scrolls for a week or two. Practicing these sleep hygiene tips, along with attempting to stick to a sleep schedule, will greatly increase the quality of sleep you’ll receive–no matter how short. Of course, this can’t always happen, and when your baby calls, the iced mocha latte with an extra shot of espresso might also be calling, too.
Q: What can I do during pregnancy to make postpartum recovery smoother?
A: Post-birth, you’ll likely be focused on your baby more than anything else, so pregnancy would be the best time to prepare yourself for postpartum. Though there might be many things you could do, here are the 3 things I’d recommend for a smoother postpartum recovery.
Exercise. Unless your doctor advises you not to, it is so important and necessary for you to stay active during pregnancy. Whether it be your usual HIIT class, a walk around the park, or yoga in your living room, moving your body and staying strong will give you better stamina for delivery and will also allow you to start exercising sooner with much more ease after giving birth.
Stock up on the essentials. Now is the time to get some work done! Make sure to have witch hazel and perineal spray to numb the vaginal area as well as plenty of pads and underwear for postpartum bleeding; prepare nutritious meals that you can freeze and reheat in a pinch, and stock up on all of your favorite snacks –having these on hand will save you time and energy that you can instead utilize to focus on recovery and bonding with your baby.
Do your kegels. As you probably know, kegels are unique exercises that help strengthen the muscles around your pelvic floor (muscles supporting your uterus, bladder, small intestine and rectum). These will help prevent tearing during birth, and if you continue these through all trimesters, your weakened muscles that were strained during delivery will have a much easier time returning to their pre-birth form.
Maggie Nash is the Content Creator Intern for Hibiscus Motherhood who brings together creativity and education through her knowledge of all things women and gender. As a recent graduate from Creighton University receiving a BA in Cultural Anthropology, she utilizes her skills of research, adaptability, and analysis to create engaging content for the team. With a background in expanding reproductive health, Maggie is dedicated to Hibiscus Motherhood’s mission and vision of providing quality, comfortable care to mothers post birth, as well as educating interested individuals. If you have any questions regarding her work at Hibiscus Motherhood, you can contact her at email@example.com.