Emily post pregnancy post

What is the proper etiquette when inquiring if a woman is with child?
There is none.

I googled “when is it ok to ask a woman if she is pregnant” and came up with thousands of responses.
Here’s my favorite:

Screen shot 2013-01-25 at 11.07.26 AM

(I would add another woman after delivery because it takes about 6 weeks for your uterus to return to a non-protruding state.)
I saw a patient for her first OB appointment today. Her sister was with her, was not my patient, but looked to be pregnant too. My first thought was to comment about how cool it was for them to be pregnant at the same time … then I questioned myself. What if the sister wasn’t pregnant? What if she was (to put it nicely) apple shaped?
Women in their child bearing age often struggle with weight fluctuations. Fat or pregnant? Don’t ask. If a woman is in her pudgy phase, the last thing she wants to be asked is if she’s pregnant.
If you think someone is pregnant and you are extending a courtesy to her (giving up a subway seat, holding the elevator door), still extend that courtesy. If the woman is not pregnant, she will appreciate the gesture just as much, as long as it’s not accompanied by a “when are you due?” remark.

Being an obstetrician does not make it right for me to ask random women if they are pregnant. Being in line next to someone at the market doesn’t give you the right either.

I apologize for not having the link to the picture. I found it online couldn’t find the original source. Let me know if you know if so I can give credit!

Post partum care package

Intro / addendum:

I started giving postpartum care packages as baby shower and delivery gifts to my friends along with at least a little postpartum advice from their ‘call me anytime’ OBGYN.  This is the post that started it all. Those packages focused a bit more on the medical practicality side of things and a little less on pampering…but it was the pampering (terrible baby pun there, sorry) that my friends responded to most. After my son was born and I experienced the remarkable challenges of postpartum firsthand, the idea for the Après Push Pack coalesced into a collection of the very best of those products.

In those moments I had between feedings, pumping and trying to be nice to my husband, I used all my organic and natural beauty products as picker uppers – a small luxury, a treat, a gift to myself for trying to do the best I could. And I only wanted organic, safe products so I didn’t feel I had to wash off my hand cream or wipe off my lip balm before cuddling and kissing my baby again.

I’ve gladly spent hours pouring over natural and organic beauty creams, lotions, powders, you name it – – testing on myself and anyone within reach, and picking out my favorites to share: small, U.S. companies with similar goals at their core – to help make women feel better (and yes, John Kelly chocolates make you feel better!).

And there you have it … have a look if you want an amazing baby shower or hospital gift for a friend, or a self care gift all to yourself (well deserved, I might add): Après Push.


My original post:

A dear friend is about 30 weeks pregnant, and today is her baby shower. They say do what you know … and I know post partum women. Here’s the care package I compiled (with a custom pill box) and accompanying note:Melanie care packagemeds

My dear friend Melanie,
You will need, and hopefully get, many wonderful presents for the baby. You are probably anticipating those first few days / weeks home with him, making sure you have everything he will need.

The over looked part is what mama needs those first days / weeks. This care package covers some of that.  Here’s also some (not well publicized) info about your post delivery lady parts, straight from an ObGyn.

*** First … meds ***
If you have a normal delivery, you should be ok with higher dose Motrin and Tylenol (so your doctor probably won’t give you a prescription).

If you end up with a c-section, you will need prescription pain medicine (which your doctor will give you before you leave the hospital)

*** Second … some info***

* Your uterus:
It will be at the level of your belly button after delivery, and it goes back to normal size by 4 weeks.

It’s normal to have cramping pain – the uterus goes back to its original size by contracting, which causes cramps.

The same hormone that stimulates breast milk, oxytocin (the synthetic version is pitocin), also causes your uterus to contract. So, when you are breast feeding your uterus will be contracting. Some women say that pain is worse than anything else. Motrin is a good medicine to take for this kind of pain, and it’s the best pain medication for breast milk.

* Your breasts:
It’s normal to only get a little colostrom the first few days. Almost every mom thinks she’s not producing enough milk. You will. Just keep feeding. Don’t go more than 5 hours without feeding or pumping.
By about the 4th day you will start feeling engorged. Some women’s breasts literally feel like rocks. Just pump out the milk completely, by baby or machine (20-30 minutes), as often as you need (probably every few hours). It will get better.

Your nipples will be super sensitive and tender. It will probably hurt every time you initiate breast feeding, but it shouldn’t hurt once the baby is latched. If it does, it’s a sign that something isn’t quite right.  There are all kinds of nipple creams out there. Lanolin is tried and true. It has gotten a bad rep because of the possibility of the baby consuming some when it feeds. All you have to do is wash off with a little soap and water right before you breast feed to avoid baby’s exposure. It probably works better than any of those organic wanna-be products.

Use the breast packs for comfort:
– Cold if you need some symptom relief for engorged breasts.
– Warm if you want to stimulate more milk let down, or if you have clogged ducts. A clogged duct feels like a small, firm pebble or worm under your skin. If you have them, keep feeding / pumping and using the heat.

* Abajo:
It will be super swollen the first few days. Ice it. That’s the best way to reduce the swelling.

If you have a vaginal delivery, you will probably have stitches. Almost everyone with their first baby needs them. It’s hard to tear/break the suture material, even though it feels like you are when you move around.  They will dissolve. You won’t need to have them removed. It can take several weeks for them to dissolve, and sometimes little parts of the suture material will fall out – that is normal. It is a sign that the part of the stitch that was inside dissolved completely (which is the important part), and the outside part did not, but is not attached to anything. It might be cream or purple colored suture.

After the swelling goes down, women find perineal comfort a few ways:
– Keep icing to keep the area cool
– Water spray bottle with cold water
– Dermaplast spray (which we give everyone at our hospital because it has analgesic numbing qualities, which most women appreciate)
– Witch hazel – cools down the irritation
– Sitz baths

You will have hemorrhoids. The way you push: the same way you push when you are super constipated. If you push the baby out, you will have hemorrhoids from pushing so much. If you have a c-section, you will be constipated from the pain meds / anesthesia, and will have hemorrhoids from that. Use Preparation H – it seriously works. Use the witch hazel pads.

Your intestines slow down so much during pregnancy and labor, and even up to 6 weeks after the baby is born. Colace will help as a stool softener. Simethicone breaks up the gas bubbles to help them pass and move easier in your intestines. It’s a secret most people don’t know about, and it works great.

*** Other little things you may need and why ***
Tylenol is good for headaches and general pain – just straight forward acetaminophen. You can take Tylenol and Motrin at the same time if you need to because they work in different ways.

I use Tylenol for migraines for headaches because it works so well – it has a touch of caffeine and aspirin in it. Both are safe for breast milk, but you might want to avoid caffeine if you are going to nap. Don’t take Motrin and Tylenol for migraines at the same time.

Magnesium: we prescribe this to pregnant women to help with headaches. Try it. Other bonuses with magnesium: it can decrease constipation, some people think it helps with low abdominal pain, it’s a vitamin supplement.

Lavender mist: because it feels so good. It refreshes and calms. I love this stuff.

lavender mist

Mario Badescu lip balm: you deserve it. You need it.

lip wax

Mario Badescu Eye cream: every post partum mama needs help with those circles.

*** One last thing ***
Several women in my life have told me they felt alone and lonely right after delivery. Even when their partner was doing everything they possibly could to help, most women still felt the majority of the burden. This feeling is normal. It will pass.

Of course you are going to be so happy. But not every moment of every day is going to be happy. It is normal to feel overwhelmed and a little out of sorts. Up to 80% of women get the baby blues. Feeling guilty about having these feelings only adds to the problem. You are not a bad mother if you feel that way. No one likes to admit it, but I’m telling the truth. You’ll feel better in a week or two. As my sister says about having babies: “not every thing is great.”

*** I love you and am so happy for you and Jeff.
Please let me know if I can help with anything. I am here for you!

love Sara
(and Josh, of course, but don’t tell him what really happens to women after they give birth)

Following doctor’s orders

Getty Villa

(Yes, it’s as interesting in real life. See it at the Getty Villa)

I love when little statistics pop out at me when I am reading medical journals. My most recent experience: in one study, post partum women were instructed to abstain from sexual intercourse until 6 weeks post partum. Of these women, 45% had unprotected intercourse before that time. So, basically, 45% of women did not follow the instructions of their doctors.

I tell my patients the same thing as this study. My usual instructions (said in front of their partner, if at all possible): “no intercourse until you see me at your post partum visit in 4-6 weeks”.