When I was pregnant, I remember looking at my stomach and thinking, “Wow, that looks weird.” I didn’t have a typical baby bump. I would sit in the lobby of my OBGYN’s office or see pictures of pregnant people and think they had the cutest baby bumps - perfectly round like they had swallowed cantaloupe. My baby bump looked more like a couple of rolls. I thought maybe in the beginning I just wasn’t far enough along to really notice, but as the months passed my bump still looked the same. Rolls! At first I was afraid to ask my OBGYN about it because I felt embarrassed. As the months went by and my bump never rounded out, I couldn’t take it anymore and finally asked my doctor, “Why is my baby bump not a bump, but a roll?” Ha!
Because embarrassing questions pop up for all of us throughout pregnancy and even before getting pregnant, I asked my listeners for their embarrassing questions and sent those along to Lana Lange, MD
, an OBGYN from The Christ Hospital Health Network, for the answers.
Will my vagina always be different after delivery?Dr. Lange: Yes, it will be different. But, once you heal from delivery, you likely won’t notice a huge difference. Things pretty much work (and look) the same before and after having children!
Will I really have a bowel movement when I give birth?
Dr. Lange: Probably, but don’t worry, we won’t tell you about it! :)The sooner you let this issue go, the better off you and your OB will be in the delivery room. There isn’t a thing you can do about it, and if you try to prevent it, you aren’t going to be pushing effectively. To quote my daughter’s favorite princess…let it go, let it gooooo!
How long does it take for a woman’s body to fully recover from childbirth?
I’ve heard it can be compared to running a marathon. Is there a set amount of time a woman should give her body to recover before having another child?
Dr. Lange: This depends on the type of delivery you had and, if you had a vaginal delivery, what kind of tear you had. Normal physical activity is typically resumed in 4-6 weeks, but it can take up to a year for you to feel “yourself". During this time your skin regains its elasticity, your endurance and strength returns and the darkened areas of your skin slowly lighten. The healing from a C-section scar or vaginal laceration takes 6-8 weeks, but tenderness can continue for up to a year as well. We usually recommend at least 18 months between deliveries. However, the World Health Organization currently recommends two years between delivery and conception. We realize everyone is a little different, so you have to consider what is best for you.
My partner and I have been trying to conceive without any luck. How long should we continue to try before we seek fertility advice/assistance?
Dr. Lange: The conception rate between a healthy, sexually active couple is 20 percent (or 1 in 5 chance) per month. Infertility is defined as a year of trying without becoming pregnant. However, given that many woman have started planning pregnancy later in life (i.e. at age 38 or older), I will often start a general work-up for infertility at around 6-8 months in a woman of "advanced maternal age".
I have PCOS. How will this impact my ability to get pregnant? Will I have heightened symptoms during pregnancy or will this cause any pregnancy complications?
Dr. Lange: PCOS can sometimes make becoming pregnant difficult. In its purest form, PCOS prevents regular ovulation (release of an egg from the ovary). Without regular ovulation, your opportunities to become pregnant are decreased and it makes it harder to time intercourse appropriately. Luckily, ovulation can be induced with a fairly cheap and safe medication. Once pregnant, PCOS symptoms are not relevant. However, it can increase your risk of gestational diabetes.
I had a difficult pregnancy with my first child – morning sickness, hip and back pain, etc. What are the chances this will happen again with my future pregnancies?
Dr. Lange: Morning sickness is very common, and if you had it with your first pregnancy, it is likely it will happen again. However, every pregnancy is different, so it may not be as severe or last as long (or it could be worse). Many women believe it is related to the gender of the child being carried, but this isn’t true. Hip and back pain (and pelvic pain and pressure and pubic bone pain, etc.) tend to worsen with each subsequent pregnancy. There are some things you can do to help it, such as physical therapy and weight loss, but often you can do everything right and still have a difficult pregnancy.
I experienced postpartum depression with my first child. What are the chances that will happen again with my second?
Dr. Lange: Postpartum depression is a very serious problem. Luckily it is more recognized, less stigmatized, and better treated these days. The recurrence rates are quoted between 40-50%. This is quite significant, and therefore, we like to discuss prevention with patients during their subsequent pregnancy or at pre-conception visits. We will recommend continuing depression medications during pregnancy or restarting them soon after delivery. We see these patients earlier in follow-ups after the hospital and sometimes refer them to counseling or psychiatric services, as needed.
I would like more children, but I’m experiencing symptoms of a weakened pelvic floor. Is there anything I can do to solve this so I can have more children in the near future, or should I stop having children?
Dr. Lange: Tough question! We all experience some level of pelvic floor dysfunction after pregnancy and delivery. I believe it a personal decision as to whether or not you let it stop you from having more children, but I don’t think it should be your limiting factor. You can strengthen your pelvic floor between pregnancies and after concluding childbearing. Kegel exercises are the mainstay of pelvic floor rehab, but many of us are doing them wrong (or not often enough). You should discuss technique with your doctor. Many core strengthening exercises also target your pelvic muscles. Some home devices exist to help you retrain your pelvic floor, though they can be costly. We sometimes refer to physical therapy (yes, there are therapists trained specifically for this problem!) as well. If these methods fail, you often are left with surgical options.
What's the deal with eating fish during pregnancy?
Dr. Lange: Fish, in and of itself, is not harmful during pregnancy – even raw fish. It is a good source of omega-3-fatty acids (thought to be good for brain development). However, there are some fish that contain a large amount of mercury, and when eaten in large quantities, can cause fetal neurotoxicity. This impacts the brain and nerves and can cause developmental delays in your child. A few fish with the highest mercury content are mackerel king, shark, swordfish, and tilefish. You can find more information about different levels of mercury from a table published by the USFDA. Raw fish consumption is cautioned due to the risk of poor handling and the infections or food poisoning that can occur when consuming fish that wasn’t kept properly. In small amounts, and from a well-known and reliable source, sushi is not completely off the table (pun intended) in pregnancy.
When can I start having sex after giving birth?
Dr. Lange: The official party line answer is six weeks. This allows for healing of any tearing and prevents infection in the uterus that can occur from your cervix still being a little dilated. However, many women aren’t ready until closer to 8-10 weeks or more. They are sore, tired from being up at night, and a little afraid. That’s ok…if you ask, I’ll recommend whatever timeframe you prefer so you can say, "Sorry honey, not yet; doctor’s orders!" :)
HA! The doctor’s orders! Sounds good to me. These are just some of the questions that might be a little embarrassing to ask your doctor, but hopefully you know now that you don't need to be embarrassed! Dr. Lange and other OBGYNs have heard it all, and want to help you have peace of mind during your pregnancy, regardless of what you're wondering about!Looking for an OBGYN? Schedule an appointment with one of our women's health experts, at a location near you.