Body After Baby – What to Expect After Child Birth with Dr. Roger Goldberghttp://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=80Your body undergoes significant changes throughout pregnancy, including after you’ve delivered your child. After childbirth, around 50% of women experience some loss of control over the bladder or bowels, and others have a change in their pelvic comfort or even sexual function. It’s essential for all of these women to understand that simple solutions exist to get the ‘body after baby’ back in order. Join Roger Goldberg, MD, Urogynecologist at NorthShore and author of Ever Since I Had My Baby, as he answers your questions about what child birth does to the pelvic floor, bladder and other parts of the body. Your participation and early questions are welcomed.Copyright 2014 NorthShore University HealthSystemPost at 8:48 AMAngela: Welcome! Today’s chat: Body After Baby – What to Expect After Giving Birth will begin shortly. Please start submitting your questions and Roger Goldberg, MD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the, <a href=" /healthresources/encyclopedia/encyclopedia.aspx?DocumentHwid=tn10043&ViewHwid=tn10043&lid=57195"> You and Your Body pages on our website. </a> We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=808:48 AMPost at 9:00 AMKimberly Parducci: I'm postpartum 5 days with zero bladder control. I had 4 hours of pushing an epidural, pitosin and my beautiful son was eventually vacuumed out. And the placenta was taken out manually as well. I've been told it's probably damage to the pudendal nerve. Are there exercises, positions, anything I can do to improve my condition. I was very active before the birth (yoga, surfing, running, etc) and would like to someday be able to return to this lifestyle if possible.<br/><br/>Dr. Roger Goldberg (NorthShore): Good morning and welcome, Believe it or not, even after an "uneventful" vaginal birth, many women notice a change in bladder control -- somewhere from 30 to 50% of childbearing women by age 40. In your case, the prolonged pushing (more than 2 hours), and vacuum, and manual extraction all do tend to take a greater toll on the pelvic supports. At this early stage, you need to give your body a chance to heal. Starting with gentle Kegel exercises is a great idea. But if you truly have 'zero' bladder control, I'd advise aligning yourself with a physical therapist who deals with female pelvic health / strengthening, and also seeing a urogynecologist if things don't improve after 6-12 weeks. We do see a good percentage of postpartum incontinence cases resolve within the first several months; but if your symptoms persist after 12 weeks, then the odds are you'll need some help. Realize that this condition WILL improve with the number of therapies we have these days.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:00 AMPost at 9:07 AMAnnemarie: Why am I no longer able to tell if I have to go to the bathroom? I gave birth about a week and half ago and thought I would have better control of this by now. When will this problem end?<br/><br/>Dr. Roger Goldberg (NorthShore): Although we don't discuss it much during pregnancy, in fact childbirth is a common reason for nerve injury. The good news, is that the vast majority of these injuries heal on their own -- there's lots of research on the pudendal nerve, in fact, showing that up to 80% of women after delivery have proven nerve dysfunction, but this resolves within the first year for the vast majority. You're at a very early stage of healing -- 1.5 weeks is just the beginning, and in general most women with your symptoms notice steady improvement over the next 6 weeks. General advise is to void on a 'scheduled' basis; not too often, not too little. With average fluid intake, around every 3 hours is a nice interval to strive for. If your sensations aren't improving in the months ahead, or are getting worse, or if you feel an inability to void, then I'd seek a basic evaluation from your gynecologist or a urogynecologist.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:07 AMPost at 9:14 AMJessica: How long can I expect it will take to return to my normal weight after giving birth? Will breast feeding help?<br/><br/>Dr. Roger Goldberg (NorthShore): Great question, unfortunately as you can imagine there's not just one answer and much of this boils down to 'common sense' advise. Breast feeding does, indeed, reportedly burn up to 500 calories per day (these estimates vary, but most breastfeeding moms attest to this 'boost'). It is generally OK to get right back to exercise if your obstetrician approves, but from a pelvic floor standpoint I generally advise to avoid very high-impact exercises for the first 6-12 weeks -- so that the pelvic supports have a full chance to heal. Perhaps the hardest adjustment is finding time to exercise, and also resuming (or starting) healthy eating patterns as your schedule will now revolve around the newborn. Try and stick to the basics - sensible meals, lots of water, avoid snacking, and chart out a fitness routine. Take a 'slow but sure' approach and remember that you need to be well nourished not only for nursing, but also to function well during the newborn period.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:14 AMPost at 9:21 AMDeedra: I am determined to get rid of my belly fat after my daughter was born. What exercises can help with this?<br/><br/>Dr. Roger Goldberg (NorthShore): Postpartum is a great time to focus on the core -- not only to reduce the 'belly fat', but also to strengthen the key muscles that lie deeper in the body. This is the 'pelvic floor' and if you rehabilitate this area now, it will have a big impact on your functioning in the decades ahead. My advise: 1. Obviously, general weight loss and fat-burning / aerobic exercise will be key. 2. Core specific: Aside from the usual abdominal exercises / crunches, I'd recommend pilates, combined with "kegel" type pelvic strengthening. This is a great combination. One local organization (Women's Health Foundation) has developed an exercise program that combines these elements ("total control") and they had experts from around the world help to develop the pelvic fitness routine. Their website is <a href="http://www.womenshealthfoundation.org">www.womenshealthfoundation.org</a>, and they have adapted material as well from my book ('ever since I had my baby').http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:21 AMPost at 9:28 AMLiz: When is it safe or recommended to have sexual relations again after giving birth?<br/><br/>: http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:28 AMPost at 9:33 AMDr. Roger Goldberg: Question just was asked -- When is it safe to begin sexual relations after childbirth? This answer varies, largely according to whether your delivery involved an episiotomy or vaginal tear (in which case you might need up to 6 weeks of healing). If there was no trauma to the vagina, then you might feel ready sooner, and this would rarely pose any risk. One often overlooked factor is breastfeeding; women who are nursing have much lower levels of estrogen, and this makes the vagina often feel dry and sore. A bit of local estrogen cream is sometimes recommended if this is the case. Finally, if you have had a c/section, then obviously the vagina will not require much healing at all, if any, after childbirth. When resuming intercourse, remember to use the 'opportunity' to practice your kegels -- now is the time to pay attention to your deeper pelvic floor muscles and get them back into shape!http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:33 AMPost at 9:34 AMKelly: I thought I’d have more energy and ability to get things done once my son was born. I am constantly overwhelmed, exhausted and moody. Could this be post-partum depression? What can I do?<br/><br/>Dr. Roger Goldberg (NorthShore): These days, we all "set the bar" very high for our own functioning, and sometimes overlook that childbirth is a HUGE physical, emotional, and life adjustment. Those of us who become parents do, in fact, sign up for a slightly more exhausted and chaotic and moody life than we had before ... but with great rewards! When you're in the thick of the postpartum, please realize that you are juggling an incredible number of tasks -- don't expect to be perfect, and don't be hard on yourself, just do your best and remember you must find little ways to take care of yourself, too. It does get easier! Most importantly, you raise such an important topic by mentioning postpartum depression. If you EVER feel that you're too overwhelmed, or question whether you're slipping into a depression, we live in a world where you have a tremendous number of resources to help. NorthShore has a dedicated confidential hotline for postpartum depression 24/7: the number is 1-866-364-MOMS or <a href=" /maternity-services/">NorthShore.orghttp://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:34 AMPost at 9:43 AMAmanda: Is there anything I can do to reduce my risk of having pelvic and bladder complications after delivery?<br/><br/>Dr. Roger Goldberg (NorthShore): Yes - there are MANY things you can do before, during and after delivery. This is a big question, in fact I wrote a whole book to try and answer it ('Ever Since I Had My Baby'); get a copy for free at the library, on amazon, or from a friend. But here are a few key recommendations: 1. Learn about your pelvic floor before delivery - i.e. the 'right' kegel exercise, so you can rehab these muscles afterwards 2. Be sure you're not "setup" for a difficult delivery (i.e. very small pelvis, huge baby, or both). Most women do great with vaginal childbirth, but there are some circumstances for which discussion of a cesarean is reasonable to consider. 3. Talk to your doc about laboring strategies (try to avoid very long pushing period), use of forceps and episiotomy ("only if needed" approach is best). I'm personally a believer in 'laboring down' which means relaxing with an epidural and delaying pushing until the baby's head is fairly low down. 4. Heal your pelvis afterwards!http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:43 AMPost at 9:50 AMFay: I have no sex drive after my baby was born 4 weeks ago. Is this normal? When can I expect my sex drive to “return to normal”?<br/><br/>Dr. Roger Goldberg (NorthShore): Up to 25% of women report some continued change in their sexual function, even 6 months after a 'normal' vaginal delivery. Clearly there are both physical and psychological / social reasons underlying this. In terms of the physical recovery: you still have plenty of healing to do. The nerves are calming down and regenerating (remember the pudendal nerve is commonly injured and heals over time), the muscles and tissues are healing, and if you're breastfeeding then also realize that a lack of estrogen takes a temporary toll on your lubrication / vaginal comfort and therefore also your desire. In terms of the "non-physical elements", no question that the exhaustion and distraction of parenting will naturally take a temporary toll on your sex drive. Give it time and plan a few date night as a couple -- it's going to take more effort at your early stage. All of these factors will improve over time ...http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:50 AMPost at 9:50 AMAngela: Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:50 AMPost at 9:57 AMMichelle: What is postpartum hemorrhaging and how can I reduce my chance of getting it?<br/><br/>Dr. Roger Goldberg (NorthShore): Deliveries routinely involve blood loss, but the odds of a significant hemorrhage are relatively low. Some women are known to be at higher risk (i.e. older age at the time of delivery, multiple deliveries, placental abnormalities or bleeding disorders), and in this case preparations would be made to anticipate a possible hemorrhage. You should ask this question of your obstetrician if you're concerned.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=809:57 AMPost at 10:00 AMAngela: Thank you for participating in our online chat today. An online transcript will be available shortly.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=8010:00 AM