Well, hello, we have Dr. Chris, who's here, who's here to talk to us about all the common changes that happen in around about that week to phase. So, but we'll first start by getting to know, Chris, who I have had the pleasure of working with for many years now, which we don't want to admit to have on that. Wow. And who you know, as a private midwife was fabulous in giving my first leg up into into private practice, which I'm always thankful for. But Chris is an obstetrician, a gynecologist, a father, a grandfather, and a collector of barbecues. So, Chris, tell me, why did you become an obstetrician?
There were many specialties around that. time that we're looking for people like me. It was actually the first special era we give are actually positive reinforcement from the people I was working with. So that was part of it. But it is an intriguing area of medicine that encompasses the surgical, the medical and a lot of attention to the psychological aspects of human experience. Yes, very true.
And lots of feel good hormones, helping these little moms with their babies, some feel good lands and a little bit of stress that we need to deal with. Oh, I see a lot of stress. Oh, very good. So I also wanted to ask you, what would be your best piece of advice for new parents? Look, it's a long time ago since I was a first period I went through and that experience will perhaps our will, but observing other people. Look, I think the best piece of advice is don't think that the first six weeks one is going to be for the first week.
First six weeks had to be survived. Not necessarily to, to be enjoyed or to be thrived upon. If you get through the first six weeks that looking for quality of life experience, that's very true. It is a challenging first six weeks. So thank you, Chris. Well, let's get on to the interesting stuff now.
And as you know, lots of moms are going home at different stages. Now, though, some people are going home at four hours post birth, six days post birth. So some of the information that we're going to talk about now hasn't been covered in hospital or it was covered in a big way. And they didn't retain that information. There. Lots of mums are surprised when they've been bleeding for weeks postnatal, and that is very normal.
But how would you explain the first few weeks of bleeding? bleeding after childbirth is because the placenta has been attached to the wall of the worm the wall of the uterus, a bit like an orange is joined to its appeal once that is removed, there's a rich blood supply through the uterus to a row area and in the bleeding is a combination of the immediate blood that's lost at the time when we read the placenta, and then it's part of a healing roid area and that can take that can take several weeks. It's not uncommon for the for the blood flow after the start at the beginning of the expected blood loss from normal birth is often in the order of up to 500 mils half a liter of blood, and that can happen in a matter of minutes. It's it was continued to commit extremely dangerous and that's one of the reasons that some doctors have a lot of anxiety about people giving birth outsider a healthcare environment.
But normally once that placenta is expelled the uterus contract stem and compresses the blood vessels feeding that that rule bed and that compression slows the blood flow very quickly. Sometimes clots within the uterine cavity before it's expelled. And that clot can be retained by the body for up to a couple of days sometimes. So it's not at all uncommon for two or three days after birth, for a woman to suddenly drop a clot, that, on occasion can be as big if not bigger than than a feast. And that's simply all blood. It's not fresh bleeding, it's not ongoing bleeding, it's just blood from that moment of birth.
It's hung around for a couple of days before the squeezes are there. Yeah. And often, you can feel that coming out, which is the nice feeling. And we did discuss this before we started filming. And I think the general consensus was that you should pop that clock in the loop. If that's where it happens to fall, I wouldn't fish it out.
Don't fish it out. The wife doesn't want to see it. We always say better out the name. So as long as it's out and you feeling better and the blood loss season continues You like a like a dripping tap, then that's true all within that normal range for sure. After that, you've got a healing area that is simply going to ease it's a bit like a a graze on your knee. And a little graze on your knee can take two or three weeks to heal.
Imagine if it's significantly bigger than that. And particularly in a moist area where it's not gonna dry out and scab, it's just gonna lose and dripping, dripping, drip. And so that does go on not uncommonly for three or four weeks, sometimes a little bit longer than that, if the bleeding is really prolonged, and certainly more than the sort of six or seven week mark, sometimes that indicates that perhaps a little bit of a syndrome and brain has been caught up in the uterus and hasn't actually been expelled at the time of birth and that might well need further medical attention. Excellent. So they would then go back to see their GP or if they had a private obstetrician. If your bleeding is becoming more heavy after the first week or so then I think getting some sort of medical attention is important.
And my my reflect simplest thing to remember and my representing fiction, in the various faced instance try and contact a medical health professional in order to determine the best way forward. Sometimes it needs ultrasounds, if it if it's actual procedure and so forth people down again, might need to cure it, you know, six or eight weeks after birth, just to make sure that the uterine cavity is entirely clear. Excellent. And, you know, trust trust your instinct. If you feel like something's really not right, then you know, you know, go and see healthcare professional and get it checked out. Yes.
So we all know you need more than two packs of pads now, because that's not going to get you through a few weeks. And they had as this area and, you know, in the hospital, no one really told you what to do. They said, Oh, you, you know, don't dry for a few weeks to feel safe. How long would you normally expect that it's a esperen Wind would take to heal. full strength from a healing Scott can take several months. And I think it's important not to restrict your activity until healing is complete.
But to resume normal activity as soon as your body allows. the limitations of course will be the strength of the words so you don't want to go performing extreme exertion, particularly that might strain the muscles and ligaments on the skin of the area of the incision, because you could potentially burst them but truth is most daily activities you can undertake without that level of exertion in terms of boosting the weight. Yeah. It wouldn't be uncommon though to the level exertion might cause increased pain that's not going to cause long term damage. It's not going to cause you know, ultimate failure of the wound or long term health of things but it is going to be short term discomfort. I think most of us will try and avoid that.
In fact, that's the purpose of pain is to help us avoid things that might go on to cause further damage. So my advice to women is to do as much as they reasonably can without causing excessive discomfort. It's common for the discomfort, this thing straining, even even perhaps just lifting the baby but lifting the baby doesn't put enough strain on it to cause damage. And I'd be very comfortable for a newborn man who's had a severe and to be lifting the baby to be bad enough to be doing this sort of thing. activities of daily living, I think are important things like you know, getting from the bedroom, to the bathroom, to the kitchen for to get yourself a snack to the lamps to lay down for the rest of the day and take the reverse journey, the end of the day, and I'd have everyone that could be doing that by the time they leave hospital.
Fabulous. And so then, obviously, they're given some discharge medications, which, you know, hopefully, they would have a good understanding about what they Taking with the wind dressing itself. You know, there's varying information about how long to leave it on. For some women I find in my practice, I'm prying it off at six weeks because they've become very attached to it. And then other people are taking it off, you know, day seven, have you got advice on most doctors who perform such as well have their own personal experience and give their own piece of advice. In general terms the skin ages have an incision have have fused have formed within the first two or three days of surgery.
And I'm likely to burst and miss this complication of potentially infection or potentially excessive exertion. But it depends a little bit on what sort of closure the surgeon is used with the idea of using an absorbable suture or whether it needs to be removed, sometimes staples, etc, etc. So that that can also have a significant effect on by sorts of matters and generally If the skinny chest has fused in the first two or three days, any dressing from that point on is not about helping healing but it's about reducing the impact or consequence of infection. There is sometimes some of the some of the dressing materials we use OCR in sections claim to reduce the long term incidence of thick scaffold motion of key word scar formation. So those women that you might be prying the the dressing off at six weeks, may we'll be taking, taking that a little bit to extremes but I'm thinking that the direction I have is gonna give them the ethics.
Absolutely. And the position of this is their infection. incision these days is so low that unless you're a Brazilian on the beach, it's visible anyway. But yes, it's always important to listen to your body and and to know you know, what you feel comfortable with. It is quite common to have another area above it for quite some time that many women are quite surprised by, because they think that everything will be right on the center line, but it's often just above the nerves that supply the area just above their regular incision versus area. those nerves actually come up from below.
So they travel across the area where the Syrian decision has been made. So that little area just above the incision, has no sensory nerves supplying it. Having those nerves haven't been capturing the operation. Nerves coming in from the side will eventually restore sensation to that area, although some people report that it's never quite as sensitive as it was before this is okay. Which, you know, is just, unfortunately, one of the things that happens. So, variants we've covered normal birth and fiction material.
So lots of, again, lots of different advice on Repairs from tears and enforcer. nephal sip sorry FTP FEC automates with the search of material when the skin edges coming together, be that three days again. Absolutely. The schema of the parent name and the vagina is actually quite active in repairing itself after after delivery, and skin ages will often fuse in the first two or three days after delivery. The top secret material that doctors will use to repair that will vary and their techniques will vary, but the degree of damage will vary as well and sometimes it's just a little taste within the vagina so much more extensive. Some can involve some of the deeper tissues, even on occasionally, the sphincter, the ring muscle around the anus, and inside different suture materials can be involved in those sorts of repairs as well.
My general advice for for a routine type of personal damage is I would regularly use a search of this candle dissolve in some The first two or three weeks, and sometimes women will notice a little knot or a little piece of cotton or stringy type material come away as that dissolves. But the immediate care involves keeping the area clean and dry. I particularly recommend after the first Baumeister effect the first few bowel motions, rather than just to walk as usual, I normally recommend but recommend the spandrel a share or proper wash and make sure that it's properly dry. Excellent. And back out. physios also kind of go through some really good tips and tricks on pelvic floor recovery and getting everything nice and tight as well.
So make sure you tune in to that one. So that's a lot of information, isn't it? And typically not things that people really want to talk about. They're not the nicest. I can't believe I'm doing this. In fact, I know we're talking about ladies bottoms.
I know we could talk about barbecues and the new barbecue on the market for you to talk about with us. So after we've gone through all that difficult information, that's, you know, not everybody's favorite topic. I guess there's lots of women that have had a different experience than what they thought with their birth, they might have had, you know, dreams or they swaying, aroma therapy field hypno birth, and unfortunately, you know, things didn't work out as they thought and they had us varying. And I don't understand why or how or, you know, in some cases, they haven't had the luxury of knowing an obstetrician or knowing who was there at the birth. And so they're not quite sure who to speak to. What would you know, obviously, you work in the public system as well as the private sector.
You know, have you got any advice for these people about where to get good information to review their story? Look my advice, much as yours that's before them, preparing them that the outcome Not simply the prices and that one's projected image, the romantic vision, the fantasy birth is okay to have but the reality is that it's not always going to happen. I think you do an excellent job yourself during your education, preparing people for those for those scenarios, and that's certainly what I think we have in mind that if it's during the painting, idle period, women have been very, very much better prepared. I do tend to focus on the outcome and try and simplify that being the well being of the mother and the baby and I think breath as much as we'd like it to be warm and fuzzy. All that sort of thing.
It is a wondrous thing but it's it's it's the pair of nature that gets us there and that can be brutal. And I'm not sure that falling away but it can be, it can be damaging to to mother and to baby, physically. And and that can leave some of the emotional issues that again, you do take them so very well in your in your practice. And, look, I think when people have had that type of experience, perhaps a little disappointed, apart from encouraging them to dwell on the positives of the outcome. I do recommend often that they verbalize some of their anxieties and clear them close to the time and that does set the scene for a more positive experience the next time it can guide the care as as to what the real desires are that that capital that warrant there that that person will be that my left for the for the next time.
In general, if you if you sort of restrict the discussion to things a lot people have had some hearings on this occasion, and what happens next time. A lot of that decision depends on the reason for this is there in this time, and they'll be in simple terms. As medics, we we summarize, it is A recurring indication or non recurring indication, it might be the same reason as the next time, in which case, guess what, you're going to have the same experience. And the sooner you get your head around that, the better. There are ones that are clearly non recurring, you know, this was a massive baby, and the next one is not going to be. So perhaps we should be allowed to think about a vaginal birth.
And I would be very happy to encourage people to do that. In general terms, however, they're gonna have the same unpredictable situations might arise during the next pregnancy. And that might be another reason that you end up having all that we would ideally think in the ideal world, you've got the opportunity to make that choice. Someone when women in fact will make the choice to their preferences, area clinics. Generally, healthcare systems, as we know them, will allow them to make that choice and support them in their choice. There might be times where it's really particularly desirable for women to choose a vaginal birth next time Possibly This is hearing but it's really I encourage people verbalize except the council extend the the encouragement of the healthy might have a healthy outcome is the primary concern.
And hopefully they'll find themselves in a caring situation where their feelings and so forth are dealt with unhealthier expectations to be hopefully more realistic, and very realistic in the next. And hopefully they understand I think that level of understanding the why, you know, to read to put in the Zerrin section, first time into Google, you know, you're going to get these real big general statements and they're going to lead to you feeling confused and overwhelmed by the information that's out there on the internet and it's not specific to what happened to you. You know, there's not a quarter that the 31st of the month we've only had seven forces. We need it. Who's gonna have it? That is not how a hospital works.
There's not a quarter that has to be met. Unfortunately each unfortunately or fortunately, each choice for your for you and your baby has been made with that in mind. It's not it often with them with a very significant amount of clinical experience by those carriers Do I need a guy I bring with them a wealth of experience and therefore a lot of experience in making judgments about our particular situation when we got here, care is still human, and still subject to some of those vagaries that we will have as humans, but generally, I'd be highly recommending they listen pretty carefully. It's not wrong for them to seek explanation and discussion, and I would hope that a good healthcare professional will give you that explanation as to why a particular course of action being required at a particular time and, and part of the debriefing of that I think will cover that issue.
Where do we go next time? Absolutely. Yes. Well, that wasn't full of sunshine and rainbows, but they're all very important bits of information that are going to help to reassure you, but to help to explain the normal changes that you're going to have in your body over the next few weeks. And probably things that you didn't ask or you thought, oh, will explain to me why I just passed the court and what should I do with it? And should I be worried?
Or how long is it going to take for these suture material to heal? And should I keep this bandage on forever? So, thank you for listening and thank you very much for your time and helping to explain and demystify some of the common common questions you might have at this time.