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"Breastfeeding will prevent pregnancy."
We hear this all the time.
"Your vagina will become loose after giving birth."
I really do think this is a myth,
and one that we hear quite a bit.
[sighs] My favorite.
"Once you have one C-section,
you'll need to keep having them."
One C-section doesn't mean always a C-section.
I'm Dr. Laura Riley,
and I'm the chair of OB-GYN at Weill Cornell Medicine
and NewYork-Presbyterian Hospital.
I'm a high-risk obstetrician,
otherwise known as maternal fetal medicine specialist.
And I'm Dr. Dena Goffman.
I'm the chief of obstetrics at Columbia University
and NewYork-Presbyterian Hospital.
I'm also a maternal fetal medicine physician,
and today we will be debunking postpartum myths.
"Your baby bump disappears after you give birth."
We wish.
Your baby bump is probably going to last
several weeks after birth,
so don't bring anything too tight
to the hospital to go home with.
You still have the baby bump because your uterus
does not completely contract down to its normal size
after having a baby.
There is normal weight gain in pregnancy,
which isn't lost immediately.
Decrease in bowel function.
Everything needs to sort of take time
to move back towards normal.
So don't be discouraged if it takes time
for your baby bump to disappear.
"Your vagina will become loose after giving birth."
There may be changes in the short term.
And they'll say, "Oh, it just doesn't feel right."
You know, my answer to that
is just give it a little bit of time.
The blood flow to the vagina is great,
and so it's going to heal really quickly.
Those lacerations will heal,
but it may take a little bit more time
for some of the swelling to go away,
but that's going to all get better within weeks.
The other thing I would add
is that there are muscles in the vagina,
and those muscles may not have been used as much
during a nine-month pregnancy
or the immediate postpartum period,
but they can also be strengthened and improve over time.
"You can have sex right after childbirth."
So, this is a myth.
I can assure you that you won't want to have sex
right after childbirth,
no matter what your birth experience is.
For most patients,
this isn't something that they're thinking about doing
in the immediate postpartum period.
Yeah. I think that there's kind of two parts to this.
One is comfort.
It's unlikely that you'll be comfortable.
But the other reason is sort of a safety thing.
If your cervix is open, which we know it will be,
our concern is that the organisms in the vagina
will get into your uterus and increase the likelihood
that you get an infection.
And so that's part of the reason that we tell people
don't have intercourse
until the bleeding is completely stopped.
Oh, boy. OK.
How bad is it?
"Breastfeeding will come naturally." Oh.
Many patients after having gone through
pregnancy education, childbirth education,
and lactation education
still feel like they're supposed to know how to do this
as soon as they have their newborn in their arms.
And I would just really want to debunk that myth,
that somehow we're born to know how to breastfeed.
I remember my own frustration.
I thought, "I've been a physician for six years.
I've done all the education,
and I've educated other people."
And I get this baby, and the breastfeeding,
it felt like a disaster.
Breastfeeding is a process.
You got to be patient with yourself,
you got to be patient with your baby,
and sometimes it's working and you just don't believe it.
The way you know that the breastfeeding is working
and your baby's getting enough is weighing your baby.
You'd go to the pediatrician, and the pediatrician says,
"Your baby looks beautiful."
Maybe he's gained a little bit of weight,
or your baby's not continuing to lose weight,
and your baby's not jaundiced.
All those things point to the fact
that the breastfeeding is working.
And I think sometimes our patients feel like
because it's breastfeeding
that they're single-handedly responsible
for this piece of the newborn's life.
I like to make it a team sport
where everyone's participating,
to have someone else do some of the other stuff,
the burping, the changing, putting down to rest,
while you actually get some rest
so that your body can do this important work.
"Breastfeeding will help you
lose all the baby weight quickly."
You do need to increase your calories,
but most people will burn somewhere
around 800 extra calories a day in breastfeeding.
That is going to help you lose the weight.
I just wouldn't say
it's going to help you lose all the weight.
Breastfeeding is wonderful, but it's not magic.
Patients will come back at the six-week visit,
"Why am I still holding on to this?"
It took you nine months to put this weight on.
It's going to take some time to take it off.
Four months, six months for most people.
Is it normal for nursing to hurt?
It's not normal for nursing to hurt.
It shouldn't be excruciating or painful.
I think there are discomforts in the initial period.
Getting your newborn to latch appropriately
is a new sensation,
and then the first time the milk lets down,
that's another new sensation.
I hear what you're saying,
but the very first time that baby latches properly
and puts a huge amount of suction
on an area that is incredibly sensitive,
that is not nice.
I think that that's pain,
but the issue is it initially is uncomfortable,
and then it starts to get better.
It shouldn't continue to hurt for weeks.
So if it is seriously painful,
that's when you want the consultant to come in and say,
is this baby properly placed?
Because if the baby isn't properly placed on the nipple,
it really will hurt.
You can get little cuts.
You don't want to go down that road.
I tell people to get frozen peas.
That cold will help reduce
some of that discomfort and engorgement
and will actually conform to your breast,
and you can just plop them right into your bra.
"Your milk supply can't be improved."
Your milk supply can be improved.
Your body makes milk
when it perceives the need for milk.
So the more you put the baby to the breast
or a high-quality pump
that can do almost as well as a newborn
to drain what's currently in the breast
is the signal for your body to make the next batch of milk.
You just have to keep feeding, stimulating,
telling your body that there's a baby here who needs milk,
and your body will make it.
Your body learns that habit,
which is just fascinating to see and to have experienced.
It really is about breastfeeding regularly, pumping,
and then paying attention to the fact
that hopefully you're not dehydrated,
you're not overly stressed,
you're not running around doing all these other things
that can make it hard for your body to continue to keep up.
"Breastfeeding makes your baby clingy and dependent." Myth.
This is definitely not true.
Breastfed babies end up needing you for those feeds,
but the feeding doesn't mean that they need you more.
If you're exclusively breastfeeding
for the first eight or 12 weeks of a newborn's life,
they will be with you during those feeding sessions.
They're very frequent when they're little.
I don't think that necessarily means
that the babies are needy or clingy,
it's just a function of the fact
that that's where the breast milk is.
Once breastfeeding is well established,
there is definitely a role to pump
and have someone else feed breast milk in a bottle,
offload some of that breastfeeding
with other support people and family members.
The next myth is, "You shouldn't nurse if you're sick."
Not true.
There's very few instances where we will say
you should not nurse.
If you're sick, the good news
is that you are developing antibodies
to whatever it is that made you sick.
Those antibodies then get into the breast milk
and are transferred to your baby
and will actually protect your baby
from getting that same infection.
I think we've learned a lot in the last year and a half
about hand hygiene. If you're sick,
you should use those hygiene strategies
and continue to nurse your baby
so they get the antibodies that you're producing.
And we would suggest that you breastfeed
unless you're told otherwise.
"Breastfeeding will prevent pregnancy."
So, this is another myth
that we've certainly seen people get in trouble with.
So, breastfeeding is not a form of contraception.
It is not a reliable form of birth control.
When you're exclusively breastfeeding
in the early postpartum period,
you are less likely to resume menstruation and ovulation.
But when that resumes for different patients is different,
and it's very hard to predict.
And so if you are having unprotected intercourse,
even if you're breastfeeding,
there is a chance that you will conceive.
We've unfortunately seen people
who have conceived and not realized it
because they were under the impression
that this myth was true and that they were protected.
Breastfeeding is not a form of contraception.
We have a whole list of other opportunities for you.
"Everyone gets postpartum depression."
Postpartum depression is quite common,
more common than we previously recognized or acknowledged,
but definitely everyone does not get postpartum depression.
Riley: People who have anxiety
or depression prior to pregnancy
are at particularly high risk.
Postpartum depression
is really something to keep on your radar
for those first six to eight weeks
and not something that you should dismiss
if it doesn't happen right away.
Although a few people will get postpartum depression,
more people will actually experience baby blues.
Baby blues we think of as feeling down in the dumps
or very emotional or very anxious
for about 10 days, max two weeks, after the delivery.
So if you're still feeling super anxious,
really depressed, not normal in your own skin,
I think that it's really important to speak up
if it's three weeks after the delivery,
four weeks after the delivery.
And while we think postpartum depression
does have a hormonal component,
it doesn't mean that the support person
is free of that risk.
So I think that's a more recent recognition on our part,
and we want to be mindful of that risk
for support persons and partners as well.
"You will immediately fall in love with your baby."
We know scientifically that there are hormones
and peptides in your brain
that stimulate that bonding experience
and that natural love.
But I think there is also the competing life,
like fatigue,
feeling like you're not in control,
that can sometimes make that love
seem a little less lovely.
I think how you emotionally respond
to having this new person in your life
is different for everyone,
and so how you will feel about your baby
week three versus month three,
it's a process, and it evolves.
You will love your baby,
but it may not be sort of
like the commercials that you see
in those initial few weeks.
"Once you have one C-section,
you'll need to keep having them."
This is a myth.
One C-section doesn't mean always a C-section.
This has to be really individualized counseling
on what happened the first time
and what's safest for you and your future babies.
The vast majority of patients
who end up having a C-section for their first birth
will have the type of C-section
where you do have the option to have a vaginal birth
with the next pregnancy.
These are things that you will need to
talk to your provider,
understand why you needed a C-section the first time,
which can actually help you predict
the likelihood of success with a future vaginal birth.
And I think the other thing
that goes into the decision-making
is sort of, what do you plan reproductively?
One more child? Five more children?
The right birth for you really depends
on you and your baby and what's happening,
and I think we have to recognize that the best birth
for each patient isn't the same.
"You won't have vaginal bleeding after a C-section."
You will have some vaginal bleeding.
You are going to have less, generally, after a C-section.
Part of the reason is because when we do your surgery,
we try and wipe out the clots and things
that are in the uterine cavity.
So, the other thing to know is that
the blood flow to the uterus
is dramatically increased during pregnancy,
supporting growth of the baby,
supporting the placenta,
and that after the birth,
that blood flow to the uterus
decreases gradually over time.
So this is why you have extra blood flow
that continues and then gradually tapers off
as the uterus is shrinking back down towards normal size.
"Severe headaches are normal
when you're postpartum and overtired."
That's actually a myth.
Mild headaches or a headache after delivery
is something that you might anticipate,
just because you're tired, you're hungry, you're stressed.
I think severe headache
is what should be actually a red flag.
If you've got a headache
that's so horrible that you're saying,
"Oh, my gosh, I can't stand this,"
your vision's a little off,
or you're a little nauseous
'cause you have such a bad headache,
or you've taken some Tylenol
and this thing is still throbbing,
call somebody so that we can check you out.
In addition to a severe headache,
if you have severe nausea and vomiting,
upper-abdominal pain,
severe pain or swelling in your legs,
severe shortness of breath, chest pain, or fatigue,
increase in that bleeding that we talked about
more than has been going on in the last few days,
for us, these are warning signs
that actually could be representative
of a serious postpartum complication.
If you're not seen by your obstetrician,
we want you to let an urgent care
or an emergency department know
that you've been recently pregnant
and that you're postpartum,
so that they can help think through
some of the pregnancy-related concerns.
I love this one.
"It's better to have kids one right after the next."
Yeah. So, this is a myth.
We talk about, what's the right timing?
And I think the answer is not going to be the same
for every family, every situation,
but I think what we know medically
is that having those kids one right after the other
doesn't give your body the chance to recover.
And so what we typically think about
is about a year and a half between pregnancies
in order to allow that healing, that weight loss,
that healthy weight, exercise regimen,
so that you can go into a future pregnancy
really having healed and recovered from the first.
There are studies which show
your risk for complications in the next pregnancy
are actually higher if your children are closer
than that year-and-a-half time,
so there's a higher risk of having a preterm delivery,
higher risk of some bleeding complications.
So there's real good reasons why
you kind of want to space that apart.
The first 10 days are going to be tough.
You just got to be patient with yourself.
It is going to get better.
You really need to ask for help.
Don't hesitate.
And really take care of yourself and your baby.
You've got this.