Wonderfully Made

Breast Cancer

Three Angels Broadcasting Network

Program transcript

Participants: Amy Wellard, Cherie Lon Fernandez

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Series Code: WM

Program Code: WM000444


00:34 Welcome to "Wonderfully Made"
00:36 I'm Amy Wellard from the "Wildwood Lifestyle Center"
00:39 With me today is Dr. Cherie Lou Fernandez
00:41 and our subject is "postpartum care"
00:45 Welcome Dr. Cherie Lou
00:47 Today, we are going to talk about the baby is arriving
00:50 and there's all the excitement and anticipation
00:53 in the delivery room.
00:55 Mom is getting endorphins and getting high...
00:57 What's happening to daddy?
01:01 Oh, it's really nice for the husband to be there while
01:05 the woman is in labor because he can
01:09 see and empathize and know really how difficult
01:13 it is to go into labor and delivery.
01:15 It's really very important for the husband to be there,
01:18 and to be able to see and love
01:20 his wife more after she has given birth.
01:22 Funny thing is - sometimes men, they EMPATHIZE so much
01:27 Men can empathize if they love their wives really, really,
01:30 really, really and they empathize.
01:32 Sometimes the father FAINTS!
01:35 ...And you pick him up from the floor.
01:37 Everybody forgets about the mother and the baby!
01:39 They forget about the mom and the baby, and they go to the dad
01:42 So that's the reason why sometimes they would
01:43 rather not have the father there.
01:45 But when the baby comes out, many times, the mom is...
01:50 They all go rush to the baby and take care of the baby
01:53 especially when the baby has problems,
01:55 the one who is delivering the baby,
01:57 especially if they are doing 2 things at one time,
01:59 no nurse or whatever to take care of the baby,
02:02 there will be times when the mom will be left,
02:04 but that's not really a big problem.
02:08 So typically, the postpartum period is about
02:10 6 weeks from the birth of the baby? Yes
02:12 Right, so what kind of physical changes is the woman's body
02:16 going through that requires special attention?
02:19 Okay, yes - you said... you know when a woman
02:24 gets pregnant, there are so many physical changes
02:26 in the body of a woman...
02:28 And, I used to be a size 5, my feet were a size 5.
02:35 As I grew bigger with my pregnancy,
02:40 my feet became bigger and became a size 6
02:44 Well after I delivered, it became a 5-1/2,
02:47 and I've never gone back to 5
02:49 I don't know, maybe because of the weight, my foot spread,
02:53 and it's not as small as it used to be but there are changes
02:57 And you may not be able to come back to the same thing,
03:00 but the reproductive tract takes about 6 weeks.
03:05 You call that the "puerperium" ... the time when your
03:08 reproductive tract goes back to normal... it's 6 weeks.
03:16 I was going to ask you about afterpains...
03:18 Afterbirth pains - is this very common,
03:21 when the uterus is contracting going back to its regular size.
03:24 Sometimes the midwife or the birth attendant will
03:27 massage the abdomen.
03:28 For myself, that was quite a painful thing.
03:31 Is that really a necessary intervention?
03:33 Yes, especially for women just right after the delivery.
03:39 Okay, the baby comes out and then after that,
03:41 they wait for the placenta, they deliver the placenta,
03:45 and right after the delivery of the placenta,
03:47 many times if the woman has gone through
03:50 LONG protracted labor, the uterus is so tired...
03:55 too tired to contract.
03:57 So that's why many times the midwife has to massage
04:02 the hypogastric area to irritate the uterus and wake it up...
04:06 Hey, you still have work to do!
04:07 You have to contract!
04:09 If the uterus does not contract,
04:13 the mother can bleed to death. Really?
04:16 It HAS to contract!
04:17 However, when it comes to contract like this and strong,
04:21 it gives you a dysmenorrhea-like pain
04:24 that you call the after pain.
04:26 Okay so that's a bit like cramping or severe cramping?
04:29 Yes it is, but it's not something that is really
04:33 really bad - although it depends on your pain threshold.
04:36 Some women don't need to take medication;
04:38 some women need to take medication,
04:40 but this afterpain seems to be aggravated when
04:46 the mother puts the baby to the breast.
04:49 So when the baby sucks on the mom's breast,
04:54 there's an impulse that goes to the brain,
04:57 and tells the brain to tell the pituitary gland
05:01 to release oxytocin and oxytocin makes the uterus contract.
05:07 It is really helpful because then it makes the uterus
05:12 really more closed and that there will be no
05:16 bleeding afterwards...
05:18 So it helps cut the possibility of bleeding afterwards.
05:23 Gets things back to normal as quickly as possible.
05:25 Yes, as to the size of the uterus.
05:27 Now there is a certain amount of discharge that we can expect
05:31 after birth - a certain amount of blood and so on
05:33 for a number of days and so that leads to the question...
05:36 How safe after birth is it to having intercourse?
05:39 Yes, the lochia - which is the discharge,
05:43 will tell you whether your uterus has really
05:45 recovered or not... the discharge you call that.
05:49 It starts first as like red, as in fresh blood initially,
05:55 then it becomes brownish and then it becomes just tinged,
06:00 until it becomes clear and then it disappears.
06:03 When that happens, it's about 6 weeks.
06:06 So if you do not have this red, brown, lighter color,
06:11 and then it finally disappears, and it's protracted...
06:14 It's red, brown, red, brown, red-red, brown, you know...
06:17 And then it goes ahead more than 6 weeks,
06:20 that means your uterus is not well-contracted.
06:24 It's not really contracting good enough,
06:27 and probably even if it extends some more,
06:31 MAYBE you have some infection,
06:34 or MAYBE there is some placenta that is left behind.
06:39 Usually when you deliver the placenta,
06:42 you check for whether the placenta is complete,
06:46 and sometimes you don't know
06:48 some little parts of the placenta are left behind...
06:51 And if there are some placenta,
06:53 we called them "retained placenta" are left behind.
06:56 The uterus won't be able to close-down completely,
07:00 and so your lochia will tell you
07:03 whether you are really...
07:05 Your uterus... if it goes more than that,
07:07 you're either infected or you have retained placental segments
07:11 So would it be safe to have
07:13 intercourse after the lochia has stopped?
07:16 When it has stopped - yes, because then
07:17 that would be around 6 weeks... All right but not before.
07:20 I'd suggest not before because the uterus has not
07:23 yet completely recovered and you can induce,
07:28 or you can cause infection...
07:30 And it is hard too... It is a difficult thing.
07:33 Sometimes it can be really serious and life-threatening
07:36 to have uterine infection.
07:39 Now what about ladies that have had a C-section?
07:41 How soon after the delivery is it safe for them
07:45 in terms of infection, to have intercourse?
07:47 It is the same thing, it's the same thing you have to
07:50 have your uterus come back to normal first.
07:56 If you are talking about - with regards to being able to
07:59 have sexual intercourse after
08:01 delivery or after a normal delivery.
08:03 It's when your lochia is gone.
08:05 When the lochia is gone, that means your uterus
08:08 is already ready... it's physiologic.
08:13 Ready to start again. Yes
08:14 Usually the mom isn't quite ready.
08:16 You have to be sure though that you talk about contraception.
08:20 Because it depends on... there are many things
08:22 you will talk about later.
08:23 Now, something I notice from the Bible...
08:26 It talks about the recovery or the postpartum period,
08:30 when you've had a baby boy,
08:31 is shorter than when you've had a baby girl.
08:34 Now, can you comment on that from your practice?
08:37 Yes, I really have been baffled by this,
08:41 and why is it that the Bible says that after a
08:47 male baby is born, the puerperium is shorter
08:52 than that of a female baby...
08:55 And all that I can think of is aside from we being the one
09:00 who ate the fruit and laboring and the female issues,
09:05 and the hormones that are different in a female baby,
09:08 there is nothing that I can think of except
09:12 that's one question I would want to ask Jesus - why is it so
09:16 But you have a baby... it's the same!
09:20 It baffles me but there IS a reason!
09:22 But have you seen it to be true in your practice,
09:24 that ladies that give birth to boys seem to recover quicker?
09:28 No, I have not really seen; I didn't notice it.
09:31 Now, some people when they're giving birth,
09:34 they experience tears which is very unfortunate.
09:38 Hopefully if the baby's head is secured as it comes out,
09:41 we can minimize the risk of tearing,
09:43 but if that does happen, what can be
09:46 some of the best measures to take for a quick recovery?
09:49 Okay, many times you can also
09:52 have tears even if you deliver in the hospital, yes.
09:55 They do episiotomies in order for you not to have tears,
10:01 but sometimes even if you do episiotomies there ARE tears.
10:04 And an episiotomy is where they cut the perineum.
10:06 Yes when they cut the perineum so that you have a bigger space
10:09 for the head to come and you don't have to stretch your...
10:13 There are pros and cons there again, you know.
10:15 But anyway, you lacerate whether it's an episiotomy,
10:18 or whether it's a normal thing without the episiotomy,
10:21 you do lacerate...
10:23 And if it is severe enough, some midwives would repair.
10:29 Yes, they would repair it if it were severe...
10:32 Because sometimes, the laceration can go even up
10:35 to the rectum and that you would have one big hole.
10:38 Your vagina and your rectum together,
10:40 and so you need to have that repaired and that's going to
10:44 take a long time to recover.
10:47 So you can have initially, of course, as you have said earlier
10:55 ...we can put ice in the first 12 hours to make
11:00 the blood vessels constrict so that you don't bleed.
11:06 In severe tears, it's better for you not to put
11:10 any hot thing there until you are really sure
11:13 that all the blood vessels are constricted,
11:16 and all clots are already in place and fixed -
11:20 because if you have a big tear and there are small,
11:25 little oozing things and you put a hot pack
11:29 you're going to bleed, and it's an emergency,
11:32 and it's a real big thing to do.
11:34 It's hard to find the bleeder of an episiotomy when you
11:37 have already closed the episiotomy.
11:39 So you have to do ice first, then wait...
11:42 I'd rather just wait for 24 hours,
11:44 although you have to have 12 hours of cold,
11:48 and then the next day, you can do your hot and cold.
11:52 Keep it first just to be sure that you don't cause bleeding,
11:56 but the hot and cold sitz bath,
11:58 even if standing in the shower, you do this,
12:02 and let the water go there and go through it.
12:05 It's already helping increase the circulation in the area
12:09 to enhance the circulation.
12:11 I actually found a wonderful healing agent to
12:15 use the shower in that way and I was so thankful my tear,
12:19 which was very severe, was completely free from pain
12:23 and healed within 2 weeks, I think, that I can remember.
12:26 So it doesn't have to be a long time.
12:28 Yes, the vagina is very bloody, how do I say it...
12:34 It has a lot of blood vessels, so then it repairs itself fast.
12:38 That's a real blessing!
12:41 One of the things that many of us are afraid of after surgery
12:44 in that area is that we're not going to be able
12:46 to go to the bathroom without pain.
12:48 Yes, we have this a lot, especially when woman have
12:52 lacerated up to their rectum or 4th degree laceration.
12:57 Because when the bowel passes through the area
13:03 to your rectum and into your anal canal and out,
13:06 you stretch the area that was lacerated,
13:11 and they hold it back instead.
13:13 So it's very common that women who have had lacerations,
13:17 have constipation and/or don't want to go to the bathroom
13:20 to pee or urinate - they hold it because when they do,
13:24 it's painful - so then you get more chance of constipation
13:28 or you get more chance of urinary tract infections.
13:30 So you just have to soften the stools through your diet,
13:37 and/or prunes or have a laxative and yes, plenty of water,
13:41 the number one thing to do.
13:43 And pee and move your bowel regularly, not hold it back
13:47 because it's going to become worse. Okay
13:50 Because it will be harder to deliver another baby
13:53 in the form of your poop... I'm sorry.
13:56 Now, how about exercises to strengthen
13:59 the perineal floor afterwards?
14:01 Okay, you again call that Kegel exercises.
14:04 You have to make all the stretching and some micro-tears
14:09 in your muscles and the structures around it.
14:12 You have to be sure that it's already well first
14:15 and that usually comes around 4-6 weeks.
14:18 Then you can start doing your Kegel exercises
14:21 which is strengthening your pelvic floor so that
14:24 then you won't have incontinence meaning women just
14:30 cough and it comes out after a childbirth.
14:32 It's because the muscles that are closing your urethra
14:35 are relatively loose, so then you're not
14:39 able to hold your urine back efficient enough.
14:43 So just a cough or just a mere
14:46 pushing would cause urine to come out...
14:49 But when you strengthen through the Kegel exercises,
14:53 you would make your muscles stronger,
14:55 and diminish the possibility of incontinence.
14:59 Now obviously, if you've had a C-section,
15:02 you haven't got the same trauma on the perineal area
15:05 but is there some special care that people that have had
15:07 C- sections will really need that those with a
15:10 vaginal delivery wouldn't need so much.
15:12 Oh, the C-section needs more care... Oh, okay
15:19 It's because every time you have a bigger scar on your
15:24 abdominal wall and you have another...
15:27 I mean - not scar, incision on your abdominal wall,
15:30 and it depends on the kind of incision on your abdominal wall.
15:34 The midline incision on your abdominal wall heals faster
15:37 than the - You know they have this bikini-type,
15:39 the low one, the "Pfannenstiel," you call that...
15:43 That takes longer if there are more structures that you
15:48 would work on and cut and whatever.
15:51 So that one takes longer to heal than the midline incision.
15:55 Even the uterine cut, the midline or the transverse,
15:59 this one takes longer than this one does.
16:01 So that you have to take this into consideration
16:04 for how long your muscles would have to repair itself.
16:10 Repair themselves and also underneath, it's a take in,
16:16 it's a given and you should not be doing exercises
16:20 or really straining yourself within 2 months;
16:24 give enough time to heal...
16:27 BUT it is important after the operation, after the C-section,
16:31 that you stand up right away when you can.
16:34 Usually it's 8 hours... you have to be flat on bed first
16:38 because of the anesthesia, if it were a spinal anesthesia,
16:42 if it were a G.A., then you can get up right away...
16:45 BUT if it were a spinal anesthesia,
16:47 you have to be flat in bed for like 6-8 hours,
16:50 and your doctor will give that instruction -
16:52 "Flat on bed for so many hours"
16:56 so that you don't get spinal headaches,
16:58 so they say "flat in bed"
16:59 If you get up earlier than that,
17:01 you might develop severe headaches.
17:03 So they say "flat on bed" and as soon as you are
17:06 given the permission, if you can sit and get up,
17:09 the better it will be for you in your recovery...
17:12 because you don't want your organs to be sticking,
17:15 you know - adhering to each other;
17:16 adhesions being the #1, a very common occurrence
17:22 after abdominal operations.
17:24 Now you were mentioning earlier about wearing a binder
17:28 when you've had a C-section...
17:29 Is that something that is commonly offered to women
17:31 that have had C-sections to hold the abdomen in.
17:34 I think it is wise - usually I do it to my C-section patients
17:40 because I ask them to get up right away.
17:42 So even on the operating table, I already put my binder,
17:46 abdominal binder and put it really snug,
17:49 so that when she gets up, her abdominal wall
17:52 does not fall forward...
17:53 Because really the pain of C- section is not bad.
17:57 It's only when she gets up or when she sits down.
18:00 Because when she gets up, her abdominal wall falls like this;
18:03 when she sits down, it moves... you move your muscles.
18:06 But when it's taut with your abdominal binder there,
18:10 then the pain is not there.
18:12 Oh and they let you put a pillow here,
18:14 and hold it when you get up like this -
18:15 so that your abdominal wall won't just
18:18 fall forward and it's painful.
18:20 And does that binder actually help speed up the recovery?
18:23 It does not necessarily speed up the recovery,
18:26 but it helps you get around right which will help you
18:29 recover faster...
18:31 I see, so in an indirect connection.
18:33 Now what about weight loss?
18:35 Many ladies, after birth, find it SO hard
18:37 to lose those extra pounds.
18:39 Hopefully you've lost at least 15 with the birth of the baby;
18:42 you may have an extra 10 you are carrying around...
18:44 What can you recommend?
18:46 First and foremost, your most important thing to think about
18:53 after you deliver is not yourself.
18:55 Whether you're fat or whatever, whether you have extra pounds
18:58 because you're not supposed to be thinking of that
19:02 in the first 2 months because all the nourishment that
19:06 you are supposed to give to your baby, you're supposed to give.
19:09 And only after 2 months, will you be able,
19:13 I mean - physiologically, you can start thinking of
19:17 trying to do something to lose weight.
19:21 And obviously, a healthy lifestyle is going to be
19:23 the best way - right through the pregnancy
19:25 and in the postpartum, just keep it the same. Yes
19:28 What about calories?
19:29 Should she continue to keep up the calorie level as before?
19:33 Breastfeeding and lactating mothers still need more calories
19:37 because you're still feeding the baby,
19:39 especially when the baby is not yet eating.
19:43 So all that you need extra for your baby to grow
19:48 inside and outside, you have still to do that.
19:52 So that's why activity is really very important for you
19:55 to help keep you from...
19:59 Some women when they breast feed, they grow fatter
20:02 because they put on more weight because they're given permission
20:08 to eat because there are 2 of them...
20:09 The same way as in pregnancy but you still have to control.
20:12 Yes, you need more but that doesn't necessarily mean
20:16 that you're going to splurge! Okay
20:18 And then you have to exercise to lose the weight too.
20:21 Right, right... Now let's talk about the emotional signs,
20:25 or the emotional management of the "baby blues"
20:28 After the baby has been born, you've had the high,
20:31 and now there's a corresponding low afterwards.
20:34 Yes exactly! There are so many women who - it depends of course
20:40 because sometimes, for example, an unwed mom,
20:43 there is no dad and the parents didn't like the baby.
20:47 She's alone, she has to cope, and cope with this already
20:52 an emotional problem of being a single mom
20:55 taking care of her baby, and this change in the hormones
20:58 coming down again.
21:00 Hormones have a lot to do with this but it doesn't stay long.
21:03 It is a normal thing for you to
21:05 feel everybody is happy and you're sad.
21:09 It's because hormones are...
21:11 Although NOT everybody is like that!
21:14 Me, I didn't have a chance to feel the baby blues.
21:18 I was hoping to go through everything!
21:21 So you could empathize... So that I could empathize!
21:23 I prayed, "Lord, please help me go through these,
21:25 so that I could empathize. "
21:27 I wanted a normal delivery.
21:28 I didn't get a normal delivery.
21:29 I wanted to breastfeed -
21:31 at least I was able to do the pumping.
21:33 I wanted to have some blues, you know, postpartum blues.
21:38 I didn't get it - I had to get up FAST and be strong!
21:43 Because of my baby having so many problems.
21:46 So it's not always present, but it is present in many,
21:50 and it's hormones - it will pass when the hormones start to...
21:54 It's important though that the family should be there to help.
21:57 Now typically, it does pass within a few days
21:59 or a few weeks at the most, but if it's lingering,
22:02 or progressing and becoming worse...
22:03 Then maybe she does have clinical depression.
22:06 I mean, postpartum depression - you would say,
22:09 which is a more severe form, and this one you have to
22:13 ask somebody's help.
22:16 When you notice that it is lingering beyond 6 weeks,
22:19 she has already come back to normal, all hormones are normal,
22:22 and she's still doing it...
22:23 It must be depression and maybe you will need
22:27 more professional help.
22:29 Right, and at this time, it's so important to get the
22:31 support of the family and to be having people in
22:35 prayer for you makes such a difference.
22:37 That was my own experience,
22:39 and if I can just share with the viewers...
22:41 After my delivery, it was actually quite a
22:43 traumatic delivery and I had posttraumatic shock syndrome
22:46 for a number of weeks with anxiety and depression,
22:49 and as that waned, I became MORE depressed with
22:53 a postpartum psychosis to some extent...
22:58 But because of my dependence on the Lord,
23:01 dependence on His word, and staying much in prayer,
23:05 the Lord was able to - not through any credit to myself,
23:08 but the Lord was able to bring me through that.
23:10 It was a very LONG and trying protracted process,
23:14 and so if there is anybody watching today that is
23:16 going through that, I just want to encourage you
23:19 that the Lord is there...
23:20 He said, "I will never leave you or forsake you,
23:23 and when you pass through the waters, the waters of trouble
23:26 and suffering, I will be with thee"
23:29 And postpartum depression IS a serious condition;
23:31 it is a serious thing, and I do encourage you
23:34 to seek help from your health care provider as soon as you
23:36 feel that things are just getting too much,
23:39 and you feel either that you can't take care of yourself,
23:42 or you just don't want to take care of your baby,
23:44 or you feel in danger of harming yourself or your baby.
23:47 Please seek help and remember Jesus is there to help you.
23:50 Well, Dr. Cherie Lou, can you make any other comments
23:52 for ladies that are going through postpartum depression?
23:56 Especially if there is a history in the family of anybody
24:01 who has had postpartum blues and/or protracted depression.
24:07 It is VERY important that all the support is there.
24:13 In many Asian countries where everybody is just so ready
24:22 to pitch in - the grandma is there, the grand-aunts
24:27 and everybody...
24:28 First, they let the woman rest first.
24:31 The only thing she has to do is breastfeed her baby,
24:33 and everything is taken care of.
24:37 The love and the nurture of the people around her
24:41 is very important and the husband especially understanding
24:45 how difficult it is and you see all these things that the woman
24:49 went through.
24:50 Yes, there are actually some physiological components as well
24:55 It's not just necessarily a shock reaction to the birth
24:58 or just not being able to cope with this newborn,
25:01 if it's your first baby.
25:03 But you could actually be deficient because your body
25:05 has been so robbed, if you like, of nutrition,
25:07 especially essential fatty acids.
25:09 That could be a major contributor to depression.
25:14 That's why - just one thing, it's important really,
25:17 to seek consult when you're already seeing
25:20 that it's beyond your capacity
25:22 to just regularly take care of yourself.
25:26 Do you think it's important that ladies are aware
25:28 that whether they are at high risk of postpartum depression
25:31 BEFORE they give birth?
25:32 They have to talk about it with the doctor because the prognosis
25:36 really depends on how much your doctor knows of you,
25:40 how aggressive he will be in the management
25:46 of your postpartum blues and/or depression.
25:49 It is important that you are transparent with your doctor.
25:54 Now, there are some herbs that can help with depression
25:57 if it's not of a VERY, VERY severe psychotic nature,
26:01 and what would you recommend?
26:02 Oh, I have seen a lot of improvement with St. John's wort
26:07 St. John's wort is an herb that helps depression.
26:13 I've seen it really work, I could see it within 30 minutes
26:17 You could just look at the bottle and see the dose,
26:20 and that's what I did...
26:23 And it has been helping my patients who had
26:25 postpartum blues.
26:27 Now, how prevalent is it?
26:29 We don't want our viewers to feel that
26:30 it's going to happen to them.
26:33 It is there - it's a reality!
26:36 And it does happen often, so we just maybe think
26:42 she is tired or whatever.
26:43 It might just be mild but it can be severe,
26:46 and we cannot just leave these things... Right
26:50 Absolutely, they need to be treated,
26:51 and I think one study suggested that only 1 in 10 of women
26:56 actually have the very severe version
27:00 which I think I had some of... and so that's a wonderful thing.
27:03 So the other ladies can take a deep breath and be thankful
27:07 that it's not so likely it's going to happen to them.
27:09 Dr. Cherie Lou, thank you so much
27:11 for being with us today. It's my pleasure
27:12 Are there any more words of encouragement that you can
27:15 share with us today - for ladies that are perhaps first-time moms
27:19 in the postpartum period...
27:20 How they can get through that.
27:22 Oh, you are blessed with a new bundle of joy!
27:28 Again as when you were pregnant, you enjoyed your pregnancy,
27:31 now you have the fruit of your womb!
27:35 Don't ever think that you are sad, you are weak,
27:40 you are this or that.
27:42 Enjoy and look forward to having this bundle of joy grow with you
27:46 If you are a new mom, don't worry, you will learn!
27:49 And the Lord has put it in us
27:51 how to deal with problems from day-to-day.
27:54 It is exciting how the Lord can give you what you need.
27:58 Thank you so much, Dr. Cherie Lou
28:00 And thank you for joining us today.
28:02 I hope you have been blessed with the information,
28:04 and remember God is your healthcare provider.


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Revised 2014-12-17