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Navigating Postpartum with Confidence · Meaningful Medicine with Novant Health

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  Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast, bringing
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  you access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm your host, Maggie McKay.
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  And today, our guest is certified nurse midwife Sharon Varner to discuss
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  being a certified nurse midwife.
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  Thank you so much for being here today.
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  Sharon Varner, CNM: Thank you for inviting me.
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  Host: Absolutely.
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  So to begin, what exactly is the fourth trimester?
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  I've heard of that, but I don't know what it is.
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  Sharon Varner, CNM: So, the fourth trimester is 12 weeks post-delivery.
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  It starts after you deliver the baby and then the 12 weeks after delivery.
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  Host: What do you wish every expectant mom knew before entering the fourth trimester?
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  Sharon Varner, CNM: To listen to their bodies and to rest and feed their babies.
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  Rest and feed.
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  Rest and feed.
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  Host: What should moms expect physically during the first six weeks after birth?
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  Because your body is going through some changes.
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  Sharon Varner, CNM: So for the first two weeks, there's a lot of exhaustion.
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  Two to six weeks, the body is going back to the normal functioning.
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  So in pregnancy, there's a 30% blood volume increase, and there's
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  an overworking of the heart, the kidneys, and that all goes
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  back to normal within six weeks.
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  Host: And how long does postpartum recovery really take?
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  Sharon Varner, CNM: A year.
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  We have 12 weeks for the fourth trimester.
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  But in reality, your body is still feeding a baby for six months to a year.
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  So, that's a lot of drain on a physical body.
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  Host: Sharon, what are some postpartum symptoms that should not be ignored?
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  Sharon Varner, CNM: Postpartum depression should not be ignored.
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  It's normal to have baby blues for one to two weeks where
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  you're happy, sad, happy, sad.
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  But if that lasts longer than two weeks, you need to contact your provider because
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  that could be postpartum depression.
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  If you're having fever, chills, red spots, hot spots on your
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  breast, that should not be ignored.
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  You need to contact your provider, because that could be mastitis.
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  And mastitis needs an antibiotic to help with that.
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  If you're running a temperature greater than 100.4,
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  you need to be seen because that's a sign of infection post-delivery.
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  If you're soaking more than a pad an hour times two pads, then we worry
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  something's going on with the involution of the uterus, so you need to be seen.
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  Host: What about if you're—I mean, we know your sleep's disrupted, of course,
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  but what if you're not sleeping at all?
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  Sharon Varner, CNM: So in the first week, you need to feed
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  the baby every one to two hours.
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  So, you want to sleep when the baby's sleeping, up when the baby's up.
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  If you're not sleeping at all, then you need to be seen.
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  That could be a sign of anxiety or depression, and
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  that needs to be addressed.
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  Host: How does midwifery care continue after birth?
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  Sharon Varner, CNM: So, midwife means with woman.
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  So, we listen to the woman's concerns.
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  We try and incorporate and do shared decision-making, where we help the
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  woman make healthful decisions for her life and her family and for the baby.
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  So, we focus on the full body—body, mind, spirit, and what she needs.
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  And every woman is different in what their needs are.
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  Some women don't have any struggles with breastfeeding, so they don't need the
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  assisted guidance with breastfeeding.
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  Some women don't struggle with depression, so they don't need information about that.
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  So, you throw out the information at the six-week appointment, and
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  you also just discuss it before they ever leave the hospital.
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  That way they know, is this normal?
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  Is this abnormal?
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  And I like the partner to be available when I'm giving them information
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  before discharge so that the partner knows what to expect post-delivery.
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  Host: Isn't that the truth?
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  When we were trying to get discharged after my son was born, my husband was
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  there and they gave a questionnaire to see about your mental health.
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  And I thought—
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  Sharon Varner, CNM: And we still do that.
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  Host: Do you?
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  That's a good idea.
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  Sharon Varner, CNM: Yes.
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  It's called Edinburgh.
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  Host: And it's
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  to guard against people who might have postpartum depression already before
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  they even leave the hospital, right?
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  Sharon Varner, CNM: Yes, it's a screening.
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  So if somebody's score is greater than eight, then we follow up at
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  two weeks postpartum and we don't wait till six weeks postpartum.
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  So dependent on that Edinburgh score, we will see them sooner or call them
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  and reach out to make sure she's doing okay with her emotions and her moods.
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  " Host: And don't fudge on your answers," as my husband said, because
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  he was watching me fill it out.
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  And he's like, "You need to be truthful."
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  And I said, "Then, they won't let me go home, and I want to go home."
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  But you need to be truthful, because obviously for your benefit and the baby's.
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  So, what can somebody expect during a postpartum visit with a midwife?
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  Sharon Varner, CNM: During a postpartum visit, we do a full body physical.
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  We discuss the birth what their perception of the birth was, what they're wanting
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  to do for contraception to prevent pregnancy for at least two years.
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  We'd like for the woman to give herself a two-year break just to allow
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  the body to heal and to allow that six to 12 months of breastfeeding.
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  We do a pelvic exam to make sure everything's healed from her
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  laceration to her uterus going back to pre-pregnancy size.
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  We do a weight to see where she's at with weight loss depending on what
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  she had gained during her pregnancy.
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  We do a breast examination, and we go over self-breast exam so
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  that she knows what to look for in case of a clogged duct, in case of
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  mastitis, in case of breast issues.
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  Women that are struggling in the postpartum period with breast issues
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  can come in and see us, and we'll do a lactation visit also with the patient.
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  Host: It sounds like you've got all the bases covered.
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  You've thought of everything.
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  That's awesome.
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  What concerns do moms most frequently bring up during postpartum appointments?
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  What do you hear from them?
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  Sharon Varner, CNM: They are worried about intimacy with their husbands,
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  especially if they've had a laceration.
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  Sometimes when they're breastfeeding, they don't understand the makeup
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  of the vagina, that it could be dry post-delivery and up to a year if they're
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  breastfeeding because of breastfeeding.
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  So, we discuss lubrication.
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  We discuss all the different types of birth control that fits into their lives.
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  So, they get concerned about body image issues.
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  They're concerned about bleeding and what's normal and what's not normal.
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  They're concerned about their going back to work and re-entering
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  the work force after having a baby and what that looks like.
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  And some of them, when they have other children, they're concerned
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  about how do we integrate a new child into the family, and how does
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  that function out in our lives?
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  Host: That going back to work one is a big one, because a lot
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  of people are still pumping, and you have to have a room for that.
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  And you're
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  already exhausted, and you're at work.
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  And with that in mind, how do midwives support emotional recovery,
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  not just physical recovery?
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  Sharon Varner, CNM: We give them resources.
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  We can't be everything, but we'll give them resources to counselors.
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  We'll give them resources to what to expect.
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  There's a lovely pump.
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  You discussed pumping.
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  Here at our office, we've had many of our colleagues that have delivered
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  babies, and they have these pumps that they put in their bra and they're
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  still working while they're pumping.
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  And it is amazing.
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  You don't even know what's going on unless you hear the pump going on.
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  But I mean, it's like a backpack.
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  They wear a backpack while they're pumping their breasts every four
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  hours while they're working.
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  So, it is amazing the things that technology has come up with to where we
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  can still support breastfeeding mothers.
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  And then, we also have a room if a colleague doesn't want to pump in front
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  of people, even though it's discreet, we have rooms and we put on the app
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  for the work restrictions or work, an adjunct, to allow the new mother
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  to nurse every two to four hours.
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  So, you need at least 20 to 30-minute break every two to four hours in
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  order to excrete the breast milk.
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  Host: My son's turning 23 tomorrow, and I wish they had that pump that you
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  talked about back then, because at work in the state I live in, it's the law.
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  You have to have a room for women to breastfeed.
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  And luckily, another coworker was in the same boat.
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  But do you know what—you're not going to believe it, Sharon.
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  Do you know what room they gave us?
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  It was sort of like a closet—the fire department room.
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  It all the switches and stuff for when the fire—it's a big high-rise.
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  And we're like, "Seriously?
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  This is where we'd have to pump?"
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  There was a chair, and that's it.
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  But I'm sure by now it's much nicer.
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  Sharon Varner, CNM: Yeah.
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  Host: But twenty-three years ago…
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  Sharon Varner, CNM: We have two comfortable rooms that our
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  colleagues use for pumping.
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  And it's private.
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  No windows, but a comfortable chair.
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  And some have their desk right there if they want to pump
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  and still continue to work.
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  Host: That's great.
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  Yeah, options, options.
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  I mean, I think new mothers—
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  Sharon Varner, CNM: There are lots of options.
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  Host: New mothers need all the help they can get.
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  In closing, is there anything else you'd like to add that you think that women
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  need to know that maybe they don't?
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  Sharon Varner, CNM: To give yourself grace and mercy.
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  We want to continue to run the household, clean, be able to do everything,
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  and you have to listen to your body.
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  You have to sleep, you have to eat.
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  You need at least 500 more calories a day if you're nursing another person, a baby.
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  You just have to give yourself grace, because there's a lot
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  of changes that your body goes through, and it's a lot to handle.
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  Host: Very good advice.
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  Thank you so much for sharing your expertise today.
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  This has been so educational.
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  We appreciate your time.
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  Sharon Varner, CNM: Thank you so much for inviting me.
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  Host: Of course.
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  Again, that's Sharon Varner.
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  To find a physician, advanced provider, or a certified nurse
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  midwife, visit novanthealth.org.
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  For more health and wellness information from our experts,
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  visit healthyheadlines.org.