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How can I look after myself post-birth? with Dr Kavya Chaganti
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The Baby Playbook Podcast discusses the importance of post-birth care for mothers. It emphasizes the need for mothers to prioritize their own health and well-being, in addition to caring for their babies. Dr. Kavya, a GP obstetrician, explains the role of GPs in postnatal care and the comprehensive support they can provide. The podcast highlights the importance of rest and self-care for mothers, as well as the various aspects of postpartum recovery that need attention. It also mentions the need for regular check-ups with a GP to address any medical concerns and provide continuity of care. The six-week postpartum appointment is discussed, covering topics such as birth trauma, recovery, mental health, breastfeeding, physical activity, contraception, and medication reviews. The podcast emphasizes the need for mothers to take care of themselves during this transformative period. Welcome to the Baby Playbook Podcast, really exciting to chat to our guest today because this is all about the care that you should be prioritizing or that you should be seeking out post-birth. So this one is for the mommas who, whatever birth story you have and whatever birth journey you've had, it's really important that we all prioritize our own health as well as the health of the baby. I think when you first have a child, especially if it's your first, you have so many appointments and worries during this time for the baby. It's all about the baby, it's all about the milestones, it's about when are their vaccinations, when should I be going for a checkup with the midwife? You tend to really forget about yourself and the fact that you've just seen through a birth, which is a major medical event in your life that needs attention and care and needs, I guess, the proper time to heal yourself after that. And you're so consumed by what the baby needs during this time. I really want to encourage everybody to find some time to focus on themselves even if it's not, I guess, the self-care that we hear about all the time because I know that can be quite a bit of pressure. Find some me time, have a coffee by yourself alone. I think that can fall to the side for a bit but what is really important to keep going is yourself and your medical care. So I want to share some resources and tools to help you. I want to introduce our guest today. Dr. Kavya is a GP obstetrician. She's based in Sydney and she has interest and experience in female health and children's health as well. So the perfect combo for this conversation. Dr. Kavya, you're also a mum to a baby and a toddler yourself outside of the clinic. You enjoy spending time with your family, listening to books on Audible, love that, never possible. Self-care finally has made it there and you've been recently binging This Is Us which I have been, that's been on my list for so long. I need to get my This Is Us account going so I can watch it. So thanks for the recommendation. Now a really fun fact is I met Dr. Kavya in a GP office. So I walked in. I don't actually remember what the appointment was about. It could have been about me. It could have been about one of my kids but I just felt a really warm, inviting feeling from you and it was a really pleasant GP experience. Not going to lie. I'm not one of those people that books an appointment with whoever's available. I don't tend to try and find a GP but you really encouraged me to form a bit more of a connection and a history with a GP to be able to have that care and that comfort and that understanding in this long journey of post-birth and motherhood. So thank you so much for joining me. Thank you so much for having me and that really nice introduction. You really nailed it at articulating why that postpartum recovery is so important for mums because I almost never have to tell a parent or a new mother that they're not looking after their child adequately or providing enough care for their child. So we almost never have to tell parents that but we almost always have to remind parents that they need to prioritize themselves a little bit more and as you said, they've just been through a major transformation of their body through nine months of pregnancy and recovering from surgery or birth, whatever type of birth they've had. It's really hard to make time for yourself so these reminders and tips that we'll talk about today hopefully will be helpful for lots of people. Amazing. Well let's kick off first with I think for many people, there's a lot of people involved in the birth process. So you might have a midwife, you might have an obstetrician, you might have a GP that you continue visiting during and up until the birth. There's quite a few people involved and everybody's context is different. So tell me, what's your role as a GP particularly during the postnatal stage and how does this fit in with all of the other care? Yes. So my role as a GP during the postnatal phase includes so many different things for both mum and baby and midwives and obstetricians can certainly provide a very thorough postpartum review and support but one thing GPs can offer that the others may not is the provision of vaccinations if needed, referrals to other doctors or services if required and as you'll see, as you'll hear as we discuss this, there's actually quite a lot to cover and often we need multiple appointments to get through everything. So a GP can be a great person to provide more continuity of care rather than that one-off appointment you might have with your obstetrician or midwife at that six-week check. The other thing is if you're a regular patient to your GP, they're also really well-versed with the remainder of your medical history. So if we made medication changes before you fell pregnant or at the start of your pregnancy or if you're due for checks for your other health conditions, we're like a great person to review all of that really comprehensively as well. Yeah, so important and I think something that I look back on that I perhaps could have done in the lead-up to birth was perhaps locking in these appointments before the baby came so then they were in the diary, they were ready to go because once the baby's there, it's really hard to start doing a bit of admin and thinking, I should go see my GP or I haven't called, I haven't gotten the appointment. So perhaps creating a bit of a plan in the lead-up would be a great way to kind of get it locked in and sorted. So what should mums be focusing on when it comes to their health following a birth? When it comes to their own health, I guess rest is a really important thing. Obviously, you've got a newborn to care for and I completely appreciate the varying realities of access and resources, supports, finances and other children if this is not your first baby but if you have the opportunity to delegate, outsource, whatever you possibly can so you can just focus on feeding your baby and resting whenever you can. And when I say rest, I really mean like putting your feet up, resting that pelvic floor and the perineum and trying to really allow everything to heal. Obviously, I still want you to take gentle walks and mobilize as tolerated but rest is actually really important and not many of us get a chance to do that enough postpartum. Your body's been through so much, whatever type of birth you've had so we need a lot more rest than we realize. And we want you to look after yourself physically, mentally, emotionally so you know that looking after a baby is more than a full-time job so often it comes at the expense of looking after yourself as best as possible so just rest is my number one tip and we can go through all the things that we would discuss in that first week one or week six appointment for mum as well when you're ready. What is one thing I want to ask that you found in your experience that mums tend to neglect the most during this time? It might be rest or it might be something else but what's one thing that seems to be a common occurrence? I don't know if I have one thing specifically but because there's so many different aspects to our recovery and we obviously have a new one to look after, I think one thing will always fall to the side or multiple things. I don't necessarily have a common theme but definitely out of the many, many things we need to be addressing, some of those will always fall to the side so having a regular GP that can look after you through all of that is useful. I can jump into the six-week appointment now if you like so we can go through that and see how easy it is for some of these things to just fall off to the side. In that first appointment, whether you come one week postpartum or six weeks postpartum, we'll talk about the birth and we've been hearing a lot more recently about birth trauma which is really good so we can provide some debriefing if that's needed. We'll be talking about your recovery so is your vaginal bleeding settling down, how much pain are you in, do you have adequate pain relief, are you able to move around comfortably and we need to look at your wound healing so whether that's the perineum or the surgical wound, your bowel and bladder functioning normally, are you having any issues with incontinence or leaking. We'll obviously talk about your mental health and how you're coping, we'll do a questionnaire called the Edinburgh Postnatal Depression Score, we'll talk about how you're bonding with baby, if there's any changes or issues with your relationship with your partner because often that can get quite strained postpartum because there's so much going on. Social support, so who's at home to give you a hand, are you feeling safe at home, breastfeeding if that's how you're feeding your baby so how is supply going, nipple damage, blocked ducts, mastitis, there's so many things that can affect breastfeeding issues and even if your formula feeding, is baby having any issues with the type of feeding that they're receiving. A lot of patients want to discuss returning to physical activity and that includes sex as well so physiotherapy, exercise physiologist, women's health or pelvic floor physio specifically can be really useful. Contraception, to answer your earlier question, this is probably one that gets missed quite commonly. So your fertility can go back to normal as early as three weeks postpartum, even if you're exclusively breastfeeding, even if you haven't returned to having periods. So if you're not planning another baby in the very near future, it's very important to prioritize that. Medication reviews I mentioned earlier, lots of people might need to stop or change certain medications at the start of their pregnancy or just before they plan a pregnancy. So we need to look at whether we need to go back to their previous medication. This is another common one actually, iodine for breastfeeding mothers. So lots of people stop their prenatal supplements after their pregnancy ends but actually breastfed babies rely on iodine for a month so it's really important to continue that prenatal supplement or get a breastfeeding supplement. Iodine supplements can be important for some patients if they've had a postpartum hemorrhage or just breastfeeding and not being able to eat as well as you normally would in that whole postpartum madness. Iodine deficiency is quite common so we might need to do a blood test and look at iodine deficiency if an iodine supplement is required. We can talk about future pregnancy planning if that's a priority for some patients. We need to talk about what's happened in that pregnancy, did they have hypertension or preeclampsia, do we need to be monitoring your blood pressure, did you have thyroid issues in pregnancy and we need to follow that up and see if that's normalized. If you have gestational diabetes during pregnancy, we need to repeat that glucose tolerance test postpartum. Sometimes we pick up at the start of pregnancy that you might not be immune to rubella or hepatitis B or certain things that we can't give you during pregnancy so those vaccines might be due. If you had a negative blood group, we want to make sure that anti-D injection was given postpartum if that was required and then we need to do an examination, so checking your tummy, your scalp, perineum, blood pressure, all of those things. It's quite easy amongst this mountain of a checklist for one or more of these things to get forgotten. Yeah, of course. I love that you've run through that because it also shows you how holistic this appointment can be. It's not just, I think people think, GP, they think, oh, if I'm feeling fine, I don't really need to go. That is all these questions that need to be asked and addressed by the end of the appointment and further on to be able to really keep you on track as a mom and I think the other thing to note here is that if you are performing at your best as mentally, emotionally, physically, making sure that all the levels are correct, then you will only become or be able to be a better mom to the baby. So it's really making sure that that foundation is right so that you are able to get through this newbornness of a period at your most excelled ability because you are looking after yourself, you're feeling good, your levels are great and your health is there, which is so important. So one thing I'm going to ask is, it is a lot, it feels like a lot. How can you possibly find the time to put yourself first? So you talked a little bit before about perhaps locking in this appointment pre-baby, so it's in there, it's in the schedule, you don't need to be making any phone calls. What are some other tips that you have on making it a little bit easier to keep up? Yes. Everyone's a little bit different but a few things that helped me were being organized ahead of the birth, so making appointments and things like that with your pelvic floor physio or lactation consultant or whatever supports you want to utilize postpartum. I did things like preparing meals that I could pop in the freezer before baby arrived or even asking friends and family to do one or two meals for you that you can put in the freezer. Organizing things like nappies and basics so you're not going to scramble once baby arrives. Utilize all the supports and resources that are available to you, so I delegated and outsourced whatever I could. Obviously, this is not doable for every person but if you can, things like cleaning, meals, dog walking, groceries, just outsource whatever you can so you can just focus on feeding your baby and resting. Be firm with your boundaries with family and visitors. So if there's just a lot going on and you're finding it a bit overwhelming to have guests, you can 100% put yourself first. If having visitors for a while is a bit too much, just tell them or say, hey, I'd love for you to come visit but I'm exhausted. Do you want to take the baby for a walk for half an hour so I can just put my feet up? So put them to work if they're coming over. And I think the most important thing is communication, so verbalize what you need, every basic need so you can keep looking after yourself. Hey, can you please hold the baby for 20 minutes so I can have a shower and have some food? Verbalize to your partner, parents, support person, whoever is with you that you need 30 minutes of kid-free time every day to do whatever you need to do, go for a walk or read or sleep or whatever it is you want to do to look after yourself. I love all of those things, especially the outsourcing and whether it be to friends or services, groceries, I think that's a really important part of surviving those first six months because you may, and as you said, not everybody has that help but I guess if you don't have mom to come over and look after the baby, you might have that friend that offers to come and visit and that could be an opportunity for you to sit up and pop the baby down and perhaps give your back a rest, give your arms a rest. Babies can get very heavy, especially when you're rocking them during that time, it can be quite straining. So I think, yeah, a really important message there of rest is key during that time and asking for help. I want to ask you, can you share some of the services that I guess you recommend to moms in the past that a lot of moms just don't even know exist? I know I've relied on a few services, now we are of course in Australia, this might be different elsewhere but I know a big service for me was, for example, the Australian Breastfeeding Hotline which I called 400 times in the middle of the night, it's a 24-hour service, I couldn't believe it was free. So I was on that 24-7, I also relied on Tandor for some postnatal blues that I was experiencing. I think there are quite a few resources but it can be really hard to find them. Whilst you're googling 400 questions, there's a lot coming through, so what are some of the key services that you found that you highly recommend to moms? Yeah. So lactation is one that you mentioned, so there's lots of lactation consultants available and there's an online website where you can find a list of lactation consultants and search by your area. So I'll try to find that link to pop in the show notes for you. There's confidence services, so people often think that leaking when you cough or sneeze or having issues with urgency or accidents postpartum is normal, but actually we've got lots of services to help manage that. So you can start with your GP, you can see a women's health or pelvic floor physiotherapist. There's lots of specific or specialized continence clinics and services as well. If you have an obstetrician, gynecologist, you can speak to them also. Mental health services, as you mentioned, so there's online, phone, in-person, public, private, inpatient services as well. So if you're having difficulty with baby blues or perinatal anxiety or depression or something else, definitely reach out early rather than later and be proactive about that. Sleep services is another big one. So if you're having issues with settling baby or baby sleep, you can reach out to a sleep consultant or a sleep support clinic. There's lots and lots of them out there. I've mentioned this a few times, but pelvic floor physiotherapy is the other one. So lots of people don't realize that strengthening your pelvic floor postpartum is really, really important, not just for continence, but lots of other reasons. So utilizing that, almost everyone should have at least one pelvic floor physiotherapy appointment sometime around the six to eight-week postpartum mark to have an assessment of how everything's going and some education on how to look after your pelvic floor long-term. Amazing. Thank you so much for sharing all of those. I think such a great conversation to have, really open and out there, making sure that we're prioritizing our health whilst we're looking after the baby, whilst we're trying to figure out how to prioritize their health as well, and hopefully making it a little bit easier for us to recover after this huge event in our life. Thank you so much, Dr. Kavya, for sharing. I am sure we will have you on the podcast again to talk about a completely different topic, especially the baby health side of things because that's a whole different side that of course, moms also need to wrap their head around. If you would like to keep up with Dr. Kavya, Two Aussie Doctors is her Instagram page. You and your husband have that medical background and I love the information that you share there. It's really helpful. I know as a mom, I was relying a lot on finding some key accounts where I trusted a bit of information and a few tips and tricks. So please do follow her there. And as you mentioned, a few of those resources, we will pop them in the show notes so everybody has access to be able to head on over, search in Google and get some care organized for this crazy time in their life. Thank you so much, Dr. Kavya. You're welcome. Thanks so much for having me.
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