Things You're Too Embarrassed to Ask a Doctor Season 1, Episode 9: Post-Pregnancy Woes with Dr. Maryam Siddiqui

[MUSIC PLAYING] You are listening to Things You Are Too Embarrassed to Ask a Doctor, a production of U Chicago Medicine. Each week will feature one physician, and ask them your most searched questions in their areas of expertise. For more information on our episodes, visit us at www.uchicagomedicine.org/podcast. Have something you're too afraid to ask your doctor? Tweet us at tytepodcast. I'm your host, Kat Carlton.

You think, oh, pregnancy-- it's going to be such a wonderful period. I had a really rough pregnancy. I had a hard time getting pregnant. Then pregnancy itself was just a nightmare. And I used to look at all these pregnant women and be like, how could they be so happy and be glowing? This totally sucks.

And then post-pregnancy, it didn't get much better. The result is I have a very healthy, active, precocious eight-year-old. But it was not an easy path.

Hey again, it's Kat. That was my co-worker, Shana. Like many of the moms in my life, she's endured not only a rough pregnancy, but she also had a heck of a time dealing with some of pregnancy's aftermath. Today on the show, we'll be talking post-pregnancy woes with general obstetrician and gynecologist Maryam Siddiqui. In her words, she treats--

Pregnancies and gyny issues-- all of the things in between.

When I was doing research for this episode, one question I kept seeing was, when will my body return to normal? And it made me wonder, what does normal mean, anyway?

Our bodies change with age. And our bodies change with exposure. And that's OK. But in terms of changes, like when do I stop carrying a lot of water weight around? Or when do I feel like my abdominal wall feels back to normal? Or when does my pelvic floor feel like back to normal?

Those are things that are actually-- physiologically, there is a predictable timeline. Of course, people fall close to that and outside of that. And then we have some support and exercises and follow-up for that, if people are falling outside their desired timeline to return.

So many people complain of their breasts sagging or, like you mentioned, their abdominal wall. So I'm guessing that is a term that means tummy. Having maybe stretch marks, or being a little looser. So are those things that will have a lasting effect?

Some of those things are not preventable, like your genetics, for example. So if genetics say that you are going to have stretch marks, you are going to have stretch marks. How do you minimize that?

Well, some of those things are in our control. Our genetics aren't in our control. But how much weight we gain during pregnancy, are we using any kind of moisturizers and creams? And those type of things can be sometimes helpful.

But some of those things are really underneath the surface of the skin and how the elastin stretches. And there are some things that you can do to prevent stretch marks. If you're a smoker, you should stop smoking. If you want to stay within the recommended weight gain, then that can be helpful.

But if you have stretch marks from puberty around your thigh area and breast area, which a lot of women do-- and that's a time for accelerated growth as well-- then chances are, you're going to get some stretch marks during pregnancy. They're brighter and more defined during the pregnancy. And then after you deliver, over a number of weeks, they'll become more pale and silvery.

I sat down with Shana, as well as my co-worker Venus, to discuss their post-pregnancy woes. Shana has who she calls, "a healthy, precocious eight-year-old daughter." And although she loves her daughter, Shana told me pregnancy and its aftermath for her were no cakewalk.

The first thing that I noticed was shortly after I gave birth that my hair fell out, and not in like a few strands here and there as you're brushing it, but in clumps in the shower. You know, you're not even awake in the morning. And you look down. And you see huge clumps of hair.

And it's very startling. And so I started to think something was really wrong. It disturbed me so much, that I decided to literally shave my head.

So why does this happen to women? Let's turn to Dr. Siddiqui for more.

What we see is that normally your hair growth is in two phases. There's a resting phase, and then there's a growth phase. So the hair will shed in concert. So there'll be times when the hair is shedding. And there'll be times when the hair is growing.

In pregnancy, that shedding phase is shut down. So you actually do have thicker, more luxurious hair during the pregnancy. And then what happens is after you deliver, then all of the hair that was supposed to be in the resting phase now starts to actually shed.

And so over the course of the next couple of months, you'll lose a lot of hair. And it does take up to a year for that hair growth to come fully back. Supplements can be helpful that are rich in biotin and the B vitamins, like the hair and nail formulas. And make sure that your ion reserve and your anemia is corrected is also important.

Sometimes people have excessive hair loss that is outside of what we would expect for postpartum. And those women probably need to get their thyroid function checked. Those are some of the things that we see. I think a lot of people worry about huge clumps of hair coming out. But it does eventually correct itself.

Another one has to do with feet. Many people report their feet changing size and shape during pregnancy. Is that permanent? Does that change after pregnancy?

Well, just anecdotally, from personal experience, I think my shoe size went up by half a size after pregnancy. And I don't think the shape of my foot changed. But I do think what was comfortable for me in a shoe definitely changed.

And I think during the pregnancy, because the feet are the lowest part of the body, they retain a lot of fluid. And so feet are typically puffier. And people notice that and may find certain shoes more comfortable. You're also carrying a lot more weight during the pregnancy. And so people with plantar fasciitis or arch issues might have issues during the pregnancy.

After you deliver, over the next 10 days immediately after you deliver is when most of the fluid retention really reverses itself. So you actually can start to see the bones in your feet and your ankles again. And that's all very reassuring for women.

But what you find comfortable might be different because during the pregnancy, too, just like all the other ligaments relax, we might have more relaxation in our feet and our ability to wear certain types of shoes-- the higher heels-- because ankle support and arch support might be changed during the pregnancy. But those changes should go back afterwards.

My co-worker Venus had a baby early in 2019 and started working with me at the hospital just a couple months after that. Like Shana, Venus said she went through some pretty unpleasant physical changes.

So during pregnancy, my nose grew like wide. I said that I looked like Mrs. Potato Head. I was just like the big pink nose because that's what it felt like. And it took about two months after delivery for my nose to get back to normal.

I lost a lot of hair. I remember the first time I washed my hair in the shower, just seeing the boatloads of hair at the bottom of the tub. And I took a picture and sent it to my hairdresser. And she was like, you need to get here ASAP.

In addition to her nose growing and her hair falling out, Venus said she experienced new emotional struggles after giving birth.

I think the biggest thing was the body dysmorphia. So I tried to breastfeed during the hospital stay. I had a little bit of trouble getting him to latch, which I expected because I had no idea what I was doing. But when I got home, I felt like my boobs were just gigantic and huge and kind of smothering him more than feeding him.

And so I remember one time it was like in the middle of the night. I was feeding him. And I looked down, and I could only see my boobs. I couldn't see his face. And so I just gave up breastfeeding from there because it was like, I'm going to kill him. Either he's not going to get enough milk, or I'm going to smother him.

So I went to formula from then on. And that was pretty much unexpected because I am a plus-sized girl, but I never really had body-image issues, I don't think, until then. And so since then, I've been very self-conscious about the weight that I gained and trying to lose the weight, and then just noticing that my boobs are still kind of huge.

Many of the women I talked to for this episode shared that they experienced a variety of mood disorder issues following pregnancy that they felt pretty unprepared for. So I asked Dr. Siddiqui what advice she has for people who are preparing to give birth, along with their families.

This is really important because postpartum mood disorder is actually the most common complication of pregnancy there is-- more than preeclampsia, more than gestational diabetes, all of the medical type of things we think of as complications. Really, the most common thing is postpartum depression.

Often, I see it more in women who have an underlying history of anxiety than in depression because the women who've had depression have usually taken medication, can recognize their symptoms. The women with anxiety sometimes find that sleep deprivation and the added responsibility to be an overwhelming trigger for more vigilance and just a really difficult time for them to snap out of the baby blues into a normal postpartum period, but to really avoid going into postpartum depression.

So there's been a couple of ways that I approach this with my patients. One is if you have a history of mood disorder, there is a higher chance that you're going to have depression postpartum. So even if it's been a number of years, what I ask people to do is get your ducks in a row.

Set up an appointment with your counselor. If you haven't seen a counselor in a while, make a new relationship before you deliver in the months preceding. And just let them know that I'm going to deliver around this time. And if I need someone, I may reach out. So that's step one.

Number two, talk to your partner, talk to your families, really about staggered support. So there's a lot of euphoria in initial visitors. Partner support and leave from work might be staggered more towards the first couple of weeks. But we find that women start to feel overwhelmed also when they're alone at home. So really staggering that support of visitors and people coming to help you to later into that six weeks and sometimes even beyond that time.

I think one of the other stressors for women is, how do I know that this is normal postpartum? Like, exhaustion and irritability from not getting enough rest, or is this really a medical condition? And trying to sort that out at home for six weeks before you see a provider is also not the right thing to do. So we try to set up a two-week postpartum visit for those women, who self-identify as being a risk for postpartum depression, or we think that they might need a check-in.

I think the take-home message would be, just like your life changes in so many ways, your body changes in so many ways. And to be accepting and kind to yourself is really the most important thing. The permission to allow yourself to relax to lose the weight for the year, the permission to bottle-feed, if breastfeeding is not working, the permission to view yourself as a strong person who nourished and sustained a life is really important in how our mindset is.

I think we see a lot of curated Instagram images. We see a lot of curated warrior stories from people who have succeeded at whatever-- breastfeeding for two years, or giving birth without any medication, or having any number of successes. And it's not a competition. It's not a competition for misery, and it's not a competition for success.

We each have our own journey. And to really spend a lot of time recognizing your strengths and your successes is important, and not to compare yourself, and not to get into those competitive mommy traps.

Great advice. Thanks so much for being on the show.

Thank you so much, Kat. Great topic.

Once again, I'm Kat Carlton. And you've been listening to Things You Are Too Embarrassed to Ask a Doctor. Music from today's episode is by Blue Dot Sessions. For more information on our show or to submit your own question, visit www.uchicagomedicine.org/podcast, or tweet us at tytepodcast.

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