All Things Postpartum

Everything you need to know about being postpartum with our very first guest! Pavi is an amazing momma of two, and also happens to be Supraja's sister and Sara's patient! 
Here is the realest account of the postpartum experience from postpartum bodies, sex after babies, postpartum depression and anxiety , breastfeeding,  and the horrors of a yeast infections with a recent vaginal laceration - yikes (spoiler: she survived friends).
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Transcript

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Hi, I am Sara, and I'm Supraja, and this is Gyn & Tonic. Welcome back to Intimate Convos with your besties. Hi girls. Hi. Did everybody recognize that voice? So we have our first guest star today. Hi. Hi Pavi. Hello. Me part two is here. I was actually explaining Pavi to somebody today.. I was like, she's kind of like Supraja but like more wild. I would not describe myself as more wild. You wouldn't, I feel like you're like me on steroids. I'm like more outgoing probably. I. Yeah. And just like talking fast. Oh my God. I, I know, I know, I know. I saw. It's like, what's happening? Wow. literally, they just wiggled their toes. It's like a, okay guys, we're sitting in my sister's nursery to record this episode, and someone's playing footsie with us across the way. Yeah. Literally we looked outside and there's someone just feet smooshed up against a window. I would literally, my first thought was like, is that a dead body? But now he's clearly not dead, moving around his feet. Okay. Maybe he is doing like feet up the wall. No, he's like literally trying to open the blinds fully with his feet. Wow. That is some skill. Okay. Got inspiration from everywhere today. Anyway. How are you ladies doing?,Pavi, I'm so excited that you're our first guest. Thank you for having me. I'm super psyched to be here. Woo. Talk about this topic very near and dear to my heart. I know we're gonna be talking all things postpartum today from a patient's perspective. I'm postpartum technically. You're still postpartum? Yeah. I'm still postpartum, Sara. Okay. But first, before we started recording, Sara teased that someone had just come back into her life. So we have to hear the Deets. Okay. Because listen, when I was in Italy last week, Uhhuh, I did this thing that I had heard on a podcast where you write a love letter to yourself. Oh, that's very sweet. Like from a lover. Okay. And so I wrote it. Oh, you were like, your skin is so sweet and soft to caress. It's like literally a love letter to, I wrote, I read it to Laura before I went to bed. And then you folded up and you put it under your pillow. What is this supposed to do? It's supposed to like, you know, bring love into your life. Okay. Did you leave the letter in Italy? I almost forgot it. I was like, damn, , the housekeeper's gonna think I'm a maniac. Was it senual letter or you don't have to answer. No. Yeah, it was Sara's erotic letter to herself. Or is it more just like, uh, you're vibrant and , just like words of affirmation Yeah, more words of affirmation. It wasn't erotic. I was like, love letters could go either way. Both. are appreciated. Both they're appreciated. So I did the love letter. Yeah. And then while I was in Italy, a couple days later, somebody messaged me, texted me. Does it start with an J? and end with an H? No, not that one. God does it. It was an Italian not living in Italy. Wait, he moved out of Italy? No, a different one. Different Italian. I know I have a lot of Italians in my life, but Wow, he, so he's someone who recently was in your life, correct? Oh, yeah. Wait, but you're so happy about it. No, I'm not. I just think it's funny. Oh, okay. I would probably not date this person again. What did he say? He's like, oh, I'm trying to sell my clothes at consignment store. Why that? I'm not even kidding. He's like, I was just wondering if this place in Brookline takes men's clothing. And I was like, What, ? Exactly. I don't know. It's been three months. I'm glad you're not dating him again. Wait, are you dating him again? No. Well, no, I wouldn't. A lack of awareness of what to talk to people about. Well, was it just his entry? I don't know. And I wrote, oh, well, blah.. Well, I said photos of myself. I was like, chow, I'm in Sorento. Oh, oh, cute. Oh.'cause he's Italian. Italian. So very timely Italian. Yeah. And so I sent beautiful photos of myself and then I was like, I'm actually in Italy right now, but blah, blah, blah. I responded to his question and then he responded back and he is like, well, if you would be open to it, would like to get coffee with you and catch up. Oh, are you going to, I'll think about it. Oh no, I'm probably, well, I know. I was like, did you already do it yesterday? No, not yet. Do I know you? And is the sky blue? No, I, I was gonna say, that sounds great. Why not? Yeah, I was just like, oh, I was scared to tell you You were? Yeah. Oh, why? Because I was like, oh, she's gonna be upset with me. Or like, Aw, no, never. Well, not that I think I would, I don't, I feel like once I close the door on somebody, I close the door. Obviously. I don't say never, never. But I, I, there's so many people I go on dates with where I'm like, I wish I could just be friends with this person.. I don't wanna date 'em. Yeah. But I don't wanna be friends with them. You can be friends with people you don't wanna marry. That makes sense. Yeah. I liked him. I did too. I liked him too. And then he just like, Hey, it's been two weeks. How are you? I'm, I've been busy. I'm sorry. I'm like, I'm busy too. Clearly you think the way to talk to people is to ask about consignment stores. So like maybe we just cut them some slack on social skills, had slack or think it's a warning. I don't know if this is why you're scared to tell me.. But No, I don't have any judgment of that. Sara.. I'll keep you posted on what happened. Okay. can't wait. And yeah, I'm sorry that I might be scary. And also know that I would never judge you. And if you wanted to be friends with him, that's great. If you wanna date him, that's great. I hope it works out hear about it on the next podcast and then call one of you really excited. Be like, wait, what happened? No, I, the actual details, I know you're never gonna judge me, but I also know you're like, you're, you're protective. Yeah. And you're encouraging me to stand up for the kind of love that I deserve. Yeah. And so I, I know I need to be doing that too, but I'm, I don't think I would be pursue this person. I think it would be more just like, well, we could be friends maybe. Yeah. Yeah. We'll see. T b d, is he open to becoming a better communicator? I hope so. He did apologize when I called him out on it. Remember? Oh, back in the day. Yeah, yeah, yeah. Willingness to change counts for a lot. I think so. But also we were just discussing him in Spain and now he's come out back around when you're in Italy. Mm-hmm. So maybe if we like go to France together, you guys will get pregnant or something. Ooh, we'll see about that. Okay. But okay. Exciting. And you got offer accepted. Yay. We didn't even cheers to what we're drinking. Cheers. Cheers. What are we drinking? Uh, we're drinking Aperol, spritzes. Well, tell us about your house. Okay. My house, multi gray, super owner. Cute. This is her second home that she owns. Fancy pants. This throw to brag about that. Oh, sorry. I think it's kind of gross. Okay. Well, but gross that I'm very grateful for my life and the opportunities presented to me and I do think like my parents didn't have it for a long time, so it's also good to like be proud of the, the opportunities they afforded you. Mm-hmm. But also I acknowledge like I could only do it because my mom could help me with the down payment there's a lot of privilege that went into me being able to do it. Yeah. But I always think like you're such good people that you just deserve the world. Oh's. So sweet. I really think that that's so nice. Remember when I messed up my real estate taxes? Oh my God. You tell this story so much. This is my favorite story.'cause this like literally epitomizes you guys. But I like messed up my real estate taxes. First time homeowner, I didn't know what I was doing and I , forgot to prove that I was a resident of my town that I live in. And then I got a new updated mortgage and they're like, by the way, you owe seven grand in back taxes. I literally sobbed. I had the money. I'm very also privileged and I'm safe. But I was very sad to have people. You also didn't grow up with quite as much Privilege yeah. Well and so that's why I, financial security is so important to me. But so then I told Supraja and she was like, do you need the money? I'll give you the money. I was like, I don't need you to lend me the money. I am okay. And you're like, I didn't say lend. I said, I'll give you the money. And then I see Pavi for a prenatal visit.'cause I was her doctor. She was my doctor. I'm telling Pavi this story'cause it was still in my mind. And she's like, oh my God, do you need me to give you the money? I'll give you the money. And I was like, no, no, no. I don't need you lending the money. And she also corrects me and goes, I didn't say lend you the money. I said, give you the money. I was like, oh my God, you guys are like broken from the same stick or whatever. That Sara didn't even need it. So we didn't actually do that. It's cute that you think just us offering is like that. Nice. But Oprah, that's what Oprah said. She said, don't ever lend your friends money. Always give them money. Yeah. It's easy for Oprah to say Oprah. Oprah's not gonna miss it. Oprah, we're waiting for our check. Yeah. Sara needs seven grand. Oprah. If you're handing it out, I'll take seven grand too. Yeah, why not? Me too. Well, so should we talk about Pavi and her journey? Let's do it. We have so many good topics that we wanted to touch base about today, let's jump into the first one because postpartum bodies. Postpartum bodies. Yeah. I feel like everything I know about this is 'cause just seeing you go through it, Pavi. Oh. What I was saying to someone earlier today is that society has this expectation that you have a baby and then two and a half weeks later, you're like back to your old self. And you have this like, beautiful, gorgeous baby that only cries at home and your breasts are just like oozing gallons of milk, but only when the baby requires it, when she's crying quietly at home. And that is like very, very, very different than reality. Yeah. And in reality, for me and many women that I know, we're nine, 10 months postpartum and our bodies just don't feel right. I've heard so many women say , I just don't feel right. I remember after Tarak, I actually went to my PCP Tarak's, my nephew, number one. Yes. After my son that I delivered, she delivered our baby. Yeah, I went to the doctor and I was like, something just doesn't feel right. Something just doesn't feel right. And I love my P C P I when I love a doctor. I like hang on to them for dear life. But, um, although I've banned my sister from seeing Sara. Yeah. I can't see Sara again. We've, we've cut off that side of our relationship. We have to protect Sara's heart too. Yeah. No, I love Pavi. I just put a lot of pressure on myself. I'm taking, it's too hard. My pregnancies are too hard. Like doctors can only see me one time. Not because of me, just 'cause my body doesn't, definitely not the patient. Yeah. My body does not like pregnancy. I think, and you guys can speak to it medically, but like our bodies are still very hormonal at this point, and there's a lot of biological processes still happening, not to mention, like, it's not like my daughter sleeps through the night ever. Yeah. Um, or you know, and I'm adjusting to being a mom of two and working full time, so, and my body is softer in places and my clothes don't fit. Right. And both times, one thing that I've done that's really helped is just buy new clothes. Like, I'm like, I'm just not going to, like, I work out, I eat right. But I just, I'm like, I'm just gonna buy new clothes while my body readjusts or doesn't. It's, yeah, I think that's so true that there's like a fictionalized version of what it feels like to be postpartum and maybe for a select few people that's true, but for most people it's not. And I know you talked about a lot of different transitions there, but especially with your body, I always think it's crazy that people not carrying, the child can never know, never what it is to sacrifice your body and just never have it back. Mm-hmm Adam and I talk about this all the time because he is very athletic, has been his whole life. That's like a big part of his identity. And I'm like , if you were just told , you will never have this type of body ever again. That would be a big cost to you in your identity, but people who have uterus are just told okay, well you're gonna do this. It's a gift . Yeah. But also society doesn't necessarily, appreciate the form that you take after you've had a baby . Yeah. Like we're praised for the tiny spelt like 16 year old bodies that we have and everybody's bodies changes postpartum. Yeah. And I actually think, when I think about my mom, I think about her softness and how comforting that is to me. Yeah. And, and my son actually talks about my softness now, which , He says it and he loves it. But I'm like, society doesn't reward that. But my body has changed to provide comfort for my children. Mm-hmm. Which in and of itself is a beautiful thing. And I remember you actually asked Tarak about it one day when I was feeling really low about my body. Yeah. And I still think about like the joy on his face and it's like such a moving thing I have not been socialized to think of this version of myself as the cutest version. Yeah. So I think you're a beautiful Pavi. Oh, thank you. But it, I think it's true. I feel like this is the thing that makes me the most scared about getting pregnant one day. It's not the actual pregnancy, it's after because you know, I myself have so many insecurities about my own body. Yeah. And it's like your body does change it. It permanently changes forever. Yeah. It just does. It does. I like joke with my husband all the time. I'm like, so I've had two of our children, my lower half is covered in stretch marks. It will never look the same. I have a child sucking my nipples raw, like I am not in the physical fitness that I wasn't even like right before I had the baby. Even though it's been nine months and I work out every day. Meanwhile, like my husband's running marathons and like the fitness he's ever been, I'm like, like nature did not set us up for success here. I am liking though, that there's this new trend on. Social media where people are starting to post about what their bodies look like after. And the women who are posting I still look pregnant a week or two weeks, or three weeks or four, like 10 months pregnant. I think I look like a month or two pregnant for sure. No, you don't. But I like appreciate the realness finally.'cause I think what was really upsetting to me is when people were posting. Two weeks later, and I'm at the beach and I'm already in a swimsuit. I was like, that's just not the reality for a lot of people. And it makes us all, everybody feel like that's what the norm is. Yeah. Yeah. And that's absolutely not the norm. I've actually heard so many women and myself included, talk about how like the pregnancy weight actually comes off at a certain point, but then you gain it back until you stop breastfeeding, which I don't know if you guys have any medical awareness or if that's medically documented anyway, but anecdotally it's happened to me and so many others that I know. I've just heard the full spectrum. Yeah. And I was gonna say, I think it, there's so many different factors. Breastfeeding definitely makes you lose weight, like that's true. But also your lifestyle changes what you're able to do and not do changes. So probably what you're eating changes. Like all, there's so many factors. Postpartum is such a transitory state too that Yeah, it's hard to pin it to one thing, but I hear what you're saying in that like that's a period where people's bodies fluctuate a lot. Yeah. And there's a lot of value judgements assigned to so much of that. There's so much judgment about postpartum everything. Yeah. Okay. So I feel like Pavi, the biggest fights we've gotten into is when that's not okay. We had a fight, which was not about this, so we just fight a lot. So, and I are very close and we also fight a lot. We saw therapists together. Sissy therapists. Mm-hmm. I didn't know this. You didn't? No, it was very helpful. Oh yeah. I was gonna say that some of our fights have been when you feel like I'm judging your parenting, which I'm really trying to work on this is a big thing lately because the thing that people are always talking about now is like gentle parenting and blogs and people hating on one another and everybody has an opinion. There's so much of that in mom land., first tell people that I don't judge you. I do not feel judged for my momming by Supri. Supraja is a very passionate person and sometimes expresses her opinions about right and wrong, very passionately. I don't judgmentally, I don't think she's ever judging me as a mom. In fact, she's very supportive. Oh, very sweet. I know I made you say all that, but there are some truth that came up. I just think like when you're parenting this child, you're responsible for everything about them and every decision you make feels giant, like. If you don't breastfeed this one time, like, is your child gonna get diabetes and eczema and have a miserable life? I think things feel that, oh my God, this is what's coming up., I think we feel that that level of intensity, like with Tarak, I did a lot of exclusive pumping and I would pump literally at work for like three hours a day because I felt the pressure I was like, my son's gonna be diabetic if I don't give him breast milk. And I would pump for like three hours a day. And I think that that sort of extends you feel like there's an extreme result there's potential catastrophic complications to every choice you make. And so parents, Put a ton of time and thought into every decision they make for their child and what can be an unfortunate side effect of that is then when you see someone else doing it differently, you're like, I know the right way to do it, and that's not it. Okay. I love a lot of what you said and also I love that way Sara's staring at you like she was trying to internalize every word you're saying for her child in the future. But yeah, I think that's really true one the breast milk thing. It's true. There are lots of benefits to breast milk it can help with. It helps with like allergies, diabetes, it helps build their immune systems. It's like a complete nutritional, nice work profile. You need like less of it. It's honestly a power tool. It's free. It's free, but. I also think we're so obsessed with telling people to breastfeed, if you can breastfeed, that's so great. That's amazing. But for a lot of people, it's just not that easy. Mm-hmm. Causes pain, infection, causes, it's so painful. Literally the number one thing that I see women torture themselves about. Yeah. Like when I see women so hard, postpartum, three things. One, do they have good support at home? Two, are they sleeping? And three, how's breastfeeding going? If they're breastfeeding? And it's, I mean, and I was seeing you, I think I'm torturing themselves this pregnancy, like every appointment I was like, I really wanna breastfeed this baby. And I think my response to you was like, well, you know, well just see what happens. Let's make realistic expectation we can't predict. We're just way better at quantifying things like. You know, allergies or like some sort of really direct medical consequence we're less good at quantifying. How much stress does this put on the person who's breastfeeding? Are they sane in their mind to take care of themselves and this child? Like what are the impacts of having a parent that is really, really stressed is not coping well? We don't really capture that well. And so I do think it should be like a much more nuanced conversation. Also just like society normalizing that for people who have uteruses, this is just what's expected of you and you should be grateful for it. Yes, that there's so many factors that influence it and it's unlikely, it's hard for me to internalize, but , Very unlikely that any one decision you make is gonna make that big a difference. I did have to supplement formula with Tarak because I didn't have enough milk supply and I was so stressed and upset and carried so much shame about it at the time. But like, Tarik is fine, he's very smart, he's very fancy music. I think he has perfect pitch. Oh my gosh. I think he's no, he like literally has perfect pitch. He's thriving. He does have eczema, which I still like, still am like is this because I exclusively pumped and like supplemented. Like, it's ridiculous. And at the end of the day, every mom just has to be like, you know, you and your child. And the decision can be different., do you feel like the approach you've taken been more graceful with yourself with Avera than you have been with Tarak? Um, I think Avera's Pavi's second baby. My daughter who is nine months. Yes., I do think that the second time around you're like, it doesn't matter that much. That being said, like they'll be fine. That's how people treated me and you, Pavi. Our aunt was just telling me today, she's like, when Pavithra was born, we all rushed to be with her. She was the only one. So we got to put, there was like the oldest in like our whole generation of family, at least in the United States. And like she was like, we all got to be with her, me, this uncle, this aunt, this aunt. I did get a lot of attention. Yeah. She's like, she moved was so, she was like glowing and I was like, what about me? There was like seven babies by the time came around. People were like, oh, there's another one I. I definitely think I'm less intense with Avera, but I've also just been fortunate with Avera in that she took to the boob right away. She loves it. Boober bust. Like she like won't take a bottle. I've had to leave work. I literally have to tell my boss like, I can't stay the whole day 'cause I have to go home and breastfeed my daughter. So it's like, but I think the most important thing that I would want people to tell me is every decision you make is not the right decision for everybody. Like for your child, it may be better to breastfeed, for another's child. It may be better to do formula like you're not sleeping at all and you're not the best version of yourself and you're just going to, or you have like severe body issues or whatever it is. Like formula may be the right option for you. Breastfeeding may not be the right option for you. And that's fine. You and your baby will be just fine. You know what's right for your baby. You know your baby and you know you, and you should trust that instinct. Like, don't let anybody tell you otherwise. I love it. Yeah. I'm down. Well, one of the other things I just mentioned that I wanna touch base on is, support and how women get through this and what have been the things that you found more, most crucial to survive this? So I am, um, to survive this, just to clarify. We think having babies is great. We love Pavithra's, children and all the other children. We've all, I love my babies, but I'm not gonna like, I like, I love my babies and their worth, everything I've had to give up for them, including my body, my home. I sacrificed my body and I, this, it is actually completely worth it. Um, I am very fortunate in terms of support in that. Like our mom is phenomenal. Our aunt is also basically our mom. I remember. What do you think they'll show up and take care of my babies too. Yeah, I do. I mean, your babies are my babies also. But like, I do, I remember at the hospital when like, because after your second they're like, are you sure you don't wanna stay a day? Like, we'll take care of you. And my sister, who's a doctor was like, no, no. She has way more support at home, which is accurate. Like, I remember when I was super postpartum, in immediately with Avera, that my aunt would literally, I'd feed her in the morning and my aunt would come in and just like swoop her up and then I would pass out for two more hours. Which those two hours, those first couple weeks, I mean, it is , I can't explain to you how important that is. Yeah. So. I am very fortunate to have support. I literally remember sitting in your bed postpartum one, one week postpartum. Yeah. And your mom comes up, she's like, do you want tea? Do you want toast? Yeah. What do you want? Milk in your tea? Like to leave the bed? They would put food in my mouth. Yeah. Like, I literally would just sit there opening my mouth and they would put food in it and then I'd like pass out. So I have, um, I'm incredibly grateful for like the unbelievably strong and nurturing women in my life and recognize that a lot of moms do it on their own and I don't know how they do it, like props to them and even more so , you know what's right for you and your baby and like have grace for yourself in every decision you have to make to survive that. Yeah. So, and for people who might not have my awesome fam, she's talking about my family. Uh, uh or just, you know, like your parent doesn't have as much ability to travel, whatever it might be. Um, there are other things to do for support too. Like people, some people talk about night nurses, which we almost did that. So you almost did that. Mm-hmm. Oh, I didn't know that. Yeah. Like going into Avera. We were so sleep starved after Tarak that going into a Vera was like, we cannot go back to that place where we're just too tired to function. We are also financially fortunate, and I was like, let's just make a plan. If we are really tired, let's hire the night nurse, have them come in and like get a night of sleep. Like, it's so important. And I, I know women that have done it and swear by it. Yeah. And I think too, like it is, Cost something, it's about $200 a night on average, which is a lot of money. And some people that's just not an option. But other times you might be able to scrounge up $200 for one night, like one night of good rest. You know, it makes a difference. So even in small increments, knowing that there are ways to just reset is really helpful., and then you also had someone come, lactation support at home, right? Yes. Yeah. So I highly recommend the lactation consultant because weirdly also, nature doesn't set us up, but the hardest part of breastfeeding is the very beginning. It's brutal. Yeah. I think at one point every time Avera would latch, I would scream so loudly that I nearly made my mom cry. Um, there are like medical things you can do. Like I think I waited too long to get the fancy medication for it. Like the Apno cream or whatever it is. Oh yeah. For the pain, which did help a lot.'cause I was, had a lot of blisters that she was sucking open every time. the lactation consultant was fantastic. Sometimes you can go to them, sometimes they come to your house, they look at the baby. They actually, like, another thing that I feel like many are worried about is like, is my baby getting enough milk? Because it's completely on you to sustain the life of this child, which is so much pressure. Like your boobs have to magically, like, okay. Any of my patients who listen, if anything I see say, seems relatable, it's just 'cause I just parrot this woman. Yeah. I'm just like, is she sucking the life out of you? She is. You love her. And it's actually like breastfeeding. I've really enjoyed it actually with Avera and with Tarak, I came to enjoy it too. But those first 10 days, like you're sleep starved it hurts so much. And you have to keep doing it. They will come in, they'll look at your baby's mouth, make sure that they don't have like a tongue tie that can make it even more painful um, I genuinely love it. And it's a power tool. Like anytime she, even Sara doesn't believe you, she's looking away. No, I genuinely love it. Okay. I believe you. I know that it's complicated. You can hold more than one. Yeah. I have more than one feeling. The other thing that the lactation consultant did for me, um, 'cause I was worried about her getting enough.'cause at the beginning she wasn't gaining enough weight, is that they bring us a very sensitive scale so that you can weigh the baby, before the baby drinks milk, and then after the baby drinks milk. Which I have to say like brought me so much comfort 'cause I was like, okay, like she's getting enough milk. Let's talk about sex. Oh, wait, okay okay, so at your six week postpartum visit Oftentimes what we'll do is, you know, we do a full physical exam. A a lot of people have had vaginal delivery, some people have had C-sections, but we're looking at the integrity of the skin. Mm-hmm. We're looking at that. Tears have repaired, and I'm also telling patients, or at least I'm mentioning, you know, your body may be physically. Healed and okay to have sex, but you may not be emotionally and mentally ready. Right. And that may not be for months, or years. or years, yeah. That's another thing I think we're, there's an expectation that you, like go back to like pleasing or whatever it is. And I, I've heard anecdotally an experience that like breastfeeding kind of tamps down that whole vibe. Your body's like, , you don't wanna do this again. Well, I was gonna say I feel like with your first it was so important to you to just like get right back at it as soon as you were cleared. You were so worried about that part of your life. Yeah. Being changed forever. And then with the Aveera, your second, you really took more of your time. Wait until you felt ready. I had more grace with myself. I was with my first. I was scared of the changes in my life. So when the doctor told me I was ready, I was like, whether or not I feel ready, like we're doing this. I think my husband was scared her 'cause he had watched me tear in delivery and was like, I don't want to hurt you. And I was like, no, this is going down now. And then with Avera I was kind of like, we will get back to it. A lot of people come and see me and say, or, and I try to warn people now at their six week visit to be like, sometimes it is really dry down there if you're, especially if you're breastfeeding'cause you have less estrogen, which is what makes that area not dry. Yeah. Um, and I'll tell people like, let me know if it's painful or uncomfortable because there's things we can do about it. Like using lots more lubricant using vaginal moisturizers. You have a really good lubricant, you recommend. Uber Lube. Yeah. Oh, Uber Lube sponsor us. That's actually our dream sponsorship. Sara. Don't wanna say anything. UberLube. I do love UberLube. It's the number one, uh, one that I recommend, and it's number one on my lubricant list. What I want for Christmas. Yeah. Hypo allergenic. And it comes in a beautiful vial. Very discreet, it's very good. Uber is spectacular. You can slip and slide on it. Okay. But also, I tell people who are candidates,. You can have a short course of estrogen cream and that can really help as well. I can honestly say I was scared of my vagina after my second birth. Like, I was literally terrified I was like, I don't want anybody going near her. I don't, I don't wanna see her. I don't wanna interact with her like she's., I also had an incident with the yeast infection, so that exacerbated everything. The yeast infection really traumatized you. It was real bad. So like, p s A any person who has a baby, postpartum. If you are unfortunate enough to get a yeast infection, do not, do not use the most intense suppository. Like just call your doctor and get the pill. Because I made the mistake, I think like less than a week postpartum of using the Yeah, she called me screaming and sobbing. And Vita has a big pain tolerance, like not normal from her. Like her ovary was like twisting and growing huge. And it took a long time for her to see 35 weeks pregnant., I know I've never heard that before. Have you heard it? A hundred percent. You have essentially what? Whenever somebody's, uh, wanting to get treated for yeast, you should always do the longer course. Don't ever get the one or three over the day, three days. I think if days the one, even if you're not postpartum, the one burn, you should never do it.' cause essentially what they're doing is they're super concentrating., longer treatment into one dose. So you're getting a extreme amount of medication and it can cause a contact or irritant dermatitis. It was a Vulvar specialist over here. Yeah. No, I felt like I had set my bare vagina on the sun. It was awful. I like, I was reading to my son and I just, tears were streaming down my face.'cause I was in so much pain. I'm not the bursting bear, what's his name? It was so bad. I had to ask my mom to take over and then I was talking to Supri and she was like, just take it out. She kept saying, I can't find my vagina. I was like, well, sorry. Because it burned so bad that I like didn't wanna like. It gets so puffy, the skin gets a devil. Well, I wasn't gonna like reach, dig around there while I literally did just, the whole area was like on the sun. It was real bad. So don't, if you're postpartum, like call and you get a yeast infection, like call your doctor for the good meds that incident was like I luckily still had the ice packs. And that helped. I basically was like bent over my bed crying for like a good hour and a half after that. It was rough. Did you know about this, Sara? I think I learned after, yeah. I mean, I tell everybody this story 'cause it's like, first of all, everybody should know. And also it's kind of hysterical in retrospect. Well, yeast infection can like blow your mind. I think they're way, they're not pleasant out people. Like, it's like no big deal. It can really be crazy. And especially if you have, you've recently torn, you know? Yeah, yeah. Like your tissue is really dry and sensitive. Like of course that feels horrible. So I think that all of this, like the postpartum and the yeast infection, like, and also just, I. Wasn't that interested in sex after I had a baby. I have patients who, well, you, you know, we usually recommend dont sex until six weeks until we've done your exam. Patients are like, oh, we already had sex a week or two ago. I'm like, really? Okay. Um, but some people are like quick at it and other people are like, Nope, it's been 6, 7, 8 months. And, and they're, you know, you just have to do what's right for you and it changes from baby to baby honestly, it's like a marvel to me that people do because you're not sleeping, you're not eating properly. You're not having time to connect with your partner. Someone is screaming in your room all the time. Yeah. Like how are you supposed to have a drive? I was like, my vagina's in remission, but , her vagina's back. Back. My vagina's back. Yeah. She's happy back and beautiful. She's working great. Well, I guess the other thing I wanted to plug in terms of being sexually active again, postpartum is for some people it doesn't come back because they're physically uncomfortable. Tell your g y n.. Even if you've passed your six week postpartum visit, bring it up because it's important. Don't suffer and don't grit. You don't need to suffer.'cause a lot of people need pelvic floor pt, which is much more,, standardized in other countries. It's not in the United States, unfortunately. Oh. I mean, that's another part of your body that kind of changes, right? Like urinary incontinence issues. Yep. That have like, I don't, I don't think your vagina. Goes back the muscles change, the tissue changes. So pelvic PT ... can be good for either incontinence or for pain, or sometimes people have both. And so don't be afraid to ever bring it up. And I love it when my patients bring it up. Yeah. And one of the things I've been doing is bringing it up really early, even in pregnancy because you can prep people for it and then certainly postpartum. And I agree with you. It's like in Europe and other places it's way more common. Yeah. So we should all talk about it more, ask your doctor. Well, moving on from sexy time, let's talk about our feelings and our emotions postpartum. Aw, that's our time. But let's talk about postpartum depression, anxiety. Oh yeah. P T S D, I have all of them. Trauma, all of them. Damn girl. Let's get into it. Um, well I think, I think, and you guys know more than me, but I think postpartum depression, anxiety, P T S D, it's incredibly common. I think it's super common. It actually affects up to some studies show up to 15% of women in the United States, one in five women. Um, and I think that's probably under reporting list. I gonna say, like anecdotally, all the people that have delivered, that I have spoken with, like very few of them don't have some kind of delivery trauma. Y'all take very urgent action and that we just, we're not usually prepped for that going in., we're just not thinking about it. And it's always scary when you're talking about your body and your baby. I know very few women who don't have like something dramatic that happened to them that they still live with. Well, I think too, it's really generally when people come in for delivery, they're often people who have not interacted with the healthcare system that much. Like it's you younger people, you know, who are just less likely to be in the hospital, less likely to have emergent health conditions. Mm-hmm. And the delivery process can be so emerge, so intense. So. Yeah, so intense and also just feels so out of your control. People are like, oh, this is happening now. This is happening. Turn this way now this way. Now you have to have a C-section and all this stuff. I don't wanna make it sound like it's happening 'cause it's at a hospital. Just the process of delivery is extreme. Like there's an eight pound child coming out of a hole, a tampon headed for, I just wanna clarify what you're, just to make it clear that it's like labor in and of itself is naturally an incredibly intensive, dramatic process. Even if you're doing it at home, , it doesn't matter if you're doing a ho it's, it's a out of body , Everything is taken over by this thing.. And, and also the consequences mean so much to people. It's like, The most important thing.. Your child.. You know?. I think the thing that bums me out the most is when we're on call, we take care of other people's patients. Mm-hmm. And so we don't know those patients. We don't have rapport built with them. We don't know their whole story. Mm-hmm. And you're just learning about them in the moment. And you can tell some people have been traumatized from their prior birth experiences. And as you get to know them, you're like, something's up. Like something seems odd and you realize, you know, some, I've had some patients eventually reveal to me things that, happened in prior deliveries or nobody debriefed with them, or nobody explained Why the baby's shoulder got stuck, or why they bled so much after, or they, when they recount the story to, you're like, that doesn't. That doesn't make a lot of sense. You know, and you feel bad that nobody ever even explained what happened. Mm-hmm. Yeah. And I think that's the unfortunate circumstance of like, how crazy healthcare can be sometimes. Like, sometimes people don't go back into the room to just say like, do you wanna talk about what just happened? Mm-hmm. Um, and I try so hard to do that with patients, whether you're my patient or I'm just taking care of you for a 12 hour shift. But, um, I think that's so painful for patients. I think you were so wonderful and kind to me about my labor trauma because with my first, I had preeclampsia postpartum it came on very suddenly. It was like a very, it was a very scary thing that happened. Because some of the consequences of me having preeclampsia postpartum is that I can't be around blood pressure cuffs. I get really, really, really anxious, like to the point where I will disassociate when I see a blood pressure cuff, which unsurprisingly is not great for my blood pressure reading. Um, and so we had a lot of trouble when I was pregnant because I would take my blood pressure at home and it would be like low, and then I would come into the office and get like hypertensive readings and Sara would literally be like, I don't know what to do with you 'cause we can't medicate this. But like, but also I remember when I first had my consult with you that I was like, yeah, uh, so I had preeclampsia and I'm really scared and I don't want that to happen again. And I, I can't be around a blood pressure cuff. And Sara was so understanding and she was like, you know, a lot of women have labor trauma and here's how we're gonna deal with the preeclampsia and here's what we're gonna do to try to prevent it and here's how we're gonna like take care of you emotionally through your thing. And then she probably came home and cried. She's probably like that girl's really? Yeah, I mean it's affected me like to this day I just feel like so much of it is like tailoring. The care to each individual and realizing everybody needs something a little bit differently and that's okay. Um, and you can adjust the pro, there's no one textbook plan for everybody. Yeah. And we do have more flexibility and we like, okay, we're not gonna check your blood pressure the moment you walk in. Let's give it 10, 15 minutes I think the other thing though that's important is like setting realistic expectations for patients and people will, you know, really stress about, I'm worried this is gonna happen again, and I will tell patients. This could happen again. You have a higher risk if you have it one time. It just could. And these are the things we're doing to protect you. And if it doesn't work out that way, these are the next few steps. And I always review plan B, C, D, this is what we're gonna do. And I try to like, you're a very good doctor, Sara. I just try to like, what would I want? What would my family want?'cause I've seen some of my family get care where they don't get an interpreter, they don't explain the pros and cons, what the options are. And that's really upsetting to me. Yeah. And so that's not what I would want for myself or my family. And so I try to like really provide that for every patient. And so whether you're like my besties sister or somebody I've never met, but yeah, I feel like everybody, patient's entitled to that. Trauma is super prevalent in pregnancy, but also depression and anxiety., and sometimes we treat it with therapy, sometimes with medications. Sometimes there's., not a lot of information about this or stigma, but I think it was really exciting to hear that there's a new FDA approved medication for postpartum depression and it's, you know, bringing a lot of awareness. Gimme that. I know. Do you still need it? No. Do we need to have an, an actual doctors visit? I'm weaning off my other depression medication right now, I mean, I just, I, anxiety and depression postpartum, like, first of all, the baby blues are brutal. And then on top of that, I think it's very normal. Like whatever, I mean, people don't focus on this, but like labor, it's like running a marathon and then you don't get to go to a spa. You're like sleep starved. There's a baby sucking your boobs raw. You're under pressure to keep the baby alive. It's on you. And so like, There's there. I don't think there's a lot of room to be in an emotionally, super healthy place at that time. Like I think it's quite easy to tip over into feeling overwhelmed and slightly depressed, especially if you don't have a ton of support. I had a ton of support and I still needed anti-anxiety meds. Yeah. I, I think one of the things my clinic had done in the last year, which I really loved, and I'm hoping more and more places start to integrate, is we started having an A psychiatrist who specializes in obstetrical and postpartum care visit our clinic twice a month. Hmm. And so then when we would bring it up to patients, we would say, They come automatically and they see our patients. It's part a standard of care for a lot of our patients. If there's a lot of mental health stigma, I think. Yeah. And there's also a societal expectation that you're happy and breastfeeding on like a, a pony or whatever it is that you're doing. Like Yeah, I think if we need to like normalize this and have the conversations and like, you know, it's great to ask about the baby, but like, how are you doing? That's like literally the first thing I ask patients when they come to postpartum visits. Yeah. Are you sleeping? How are you doing? Yeah. Is your partner actually helping you? Like, the questionnaire is hard too'cause you have to be an idiot to answer those questions honestly. Or like super like, I'm sorry, but like are you thinking answer Honestly, I think I did answer honestly and the doctor actually was like, you clearly have some anxiety, you need to take some meds. I remember the first time that quiz, I don't feel like the questionnaire lends itself to super honest or nuanced answers because there's such, some of them are really extreme answers. Mm-hmm. And I think people feel nervous being really honest with that. Some of those questions. Yeah. Because I'm like, are you gonna come take my kid away if I answer yes on this? Like, oh my God. Okay. And just to clarify, we're we're not gonna take your kid away. Good. Yeah. Good to know. Yeah. Um, but I, I can understand why the stakes seem really high and some of the language is extreme. Well that and know there's, you kind just want someone you trust of saying yes. Yeah. It's societally for sure. Mm-hmm. And I think it's so important then to have providers who like ask you open-ended questions and that you feel comfortable sharing that with, or that you could say like, I am uncomfortable answering this 'cause I don't know what you're gonna do with that information. Mm-hmm. I feel like there's stigma. And one thing that really helped me with my first, because I had so much postpartum trauma, , and my labor was like 36 hours long, and I pushed for four and a half hours. By the time he came out, I was not functional and did not have that immediate like, oh my God, my baby oxytocin rush again, my therapist. But she prepped me before I had the baby where she said some had that immediate moment where they bond with their baby. And some it takes a little longer, like if you've had a really tough labor or whatever it is or if you have a lot of trauma. And I think being aware of that and having grace for yourself for , however it is that you relate to your baby and wanna take care of your baby is okay. Like the feelings you're having are okay. How you love your child is okay, or if it's really not okay, or if you're concerned, talk to your doctor. But, um, I think like having grace for yourself actually, like having that grace for myself helped me with my postpartum depression with the first. Yeah, absolutely. Well, the other thing that I found interesting when I was going through some of this stuff is like, the rates of depression can be just as high even before the delivery as they are after the delivery. Oh yeah. So I feel like, you know, I can vouch for this. I was really depressed at the end of both my pregnancies. And so I feel like it's, you know, important. I think you can bring, we bring, we talk about it all the time, a lot of our prenatal visits. But I also think, you know, I want patients to bring it up too, if it's something of concern for them or if their partner's concerned. And there are medications, right, that you can take that are safe or. Mostly safe when you're pregnant and when you're postpartum in terms of depression, medicine? Yeah. Oh, yeah. I mean, like SSRIs, things like that. And people take it a different lengths. And you know, I, so some people take it for a short period of time. Some people stay on it for longer. And I also think, yeah, there's so much stigma around medication for mm-hmm. Mental health, especially in a time so sensitive as this, where people just assume that you should be over the moon. That's all the feeling that you have. Well, again, like every decision feels monumental, so you're like, mm-hmm my child, by doing this. But in general, it's very safe. And also it's just another tool. You know, it's another tool, another way for you to take care of you and the baby so that you're the best version you can be for yourself and for the people who depend on you.. Actually, when I was looking into it, there's also risks to not getting treated.. The risks include babies that are of low birth weight, a preterm delivery, or higher risk of preeclampsia. I didn't realize all of these things were on the list of ignoring the depression, ignoring the anxiety because of so much concern and stigma against taking the medication. All of you pushed me very hard to take depression medication after I had a vera. Um, and I was very resistant and I was so much better of a parent once I started. Hmm. I was so scared she was gonna die all the time. I couldn't function. I hear that all the time from people. Yeah. It's very hard.'cause you, there's so much pressure to keep the baby. I mean, you wanna keep the baby alive, obviously. Um, and I remember like the doctor that I saw, she was like, okay, so you need to make a plan to get on those. I remember my therapist was telling me I needed to take them and Supraja was getting very irritated that I wasn't starting, I wasn't I mean, you're my sister, I love you. And I was just like nervous for you, you know? Yeah. I was so much happier once I started taking the medication, it just was like, I could enjoy my baby without being worried. Her face was turning blue. Mm-hmm. All the time. Which, you know, it's, it's, again, do what's best for you and your baby. And there are safe medications to take. Okay. Well final tips. Final tips. My favorite thing to say to people, number one, grace for yourself. Mm-hmm. Give your, be good to yourself. That includes your body when you wanna have sex, um, and breastfeeding. I hate seeing women torture themselves about breastfeeding. It's so hard. It's give yourself some grace about it. Number two, everything is temporary. Mm-hmm. This too shall pass. Yes. Okay. Uh, number three. You can say this one, Pavi. Do not use the highest potency yeast infection medication repository, a week postpartum for the love of God. For the love of God, I think is what I typed on there. Number four. Should I say it again? No, that was perfect. Number four, you know what's right for you and your baby. Okay. Um, and do what I always tell people. Do what's gonna make you most mentally sane and like, well, because that's the most important thing. If you're not well, your kids know. Yeah. Your baby will not be well. Yeah. And then finally, love yourself. Love yourself. And loving, loving in general doesn't mean that you need to self-sacrifice. That's a big one. Yeah. Of course, everything involves some sacrifice, but taking care of yourself is important. You are someone's child. You know, you don't stop being, you just 'cause you have a child. And also your child benefits from you taking care of yourself. I have one more. Okay. Go. Which is, if you have a, a child with a penis, point the penis down. Do you wanna get pee in your mouth? Otherwise, like, you'll learn the hard way that the pee will go in your mouth yeah, the baby's penis may point in any direction, but when you diaper the baby, you wanna make sure to manually point the penis down so that the you in the diaper. Yeah. Thanks Pavi, thanks for having me on.