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Dr Huh (Host): Hello everyone. It's Dr. Huh again, and I'm the chair of the department of ob GYN here at the University of Alabama Birmingham, and want you to welcome you to this monthly episode of Women's Health with Dr. Recording this on Valentine's Day and wishing you all a very happy Valentine's Day. So today we're gonna talk about, what to expect after, you have your baby.

I think this is something that's probably somewhat underemphasized. We spend so much time talking about prenatal care and talking about. What to expect during your delivery experience, but probably this doesn't get as much attention, and that's why we're talking about this today. And so with me today is Dr.

Simon Babai, who is an assistant professor, in the division of Women's Reproductive Health, here in the Department of obgyn here at uab b. Dr. Babai is a true veteran of the UAB system. She, is actually from the state of Alabama originally. She went to Vanderbilt for undergrad and then went to medical school and did her residency here at UAB B and then, took a job up in New York City, ironically during Covid and then came back and we were just absolutely thrilled that she wanted to return back to Birmingham to join our faculty, within the department.

So again, she also serves as the associate director for the OBGYN residency program and has done. truly fantastic work with our resident trainees. So welcome to the podcast, Dr.

Dr Sima Baalbaki: Babai. Hi, good morning. Thank you for having me, Dr. Ha.

Dr Huh (Host): So this is great, and as I mentioned earlier, this is something that I wanna spend some time.

discussing with our listeners and so after pregnancy, medical care, often known as either postpartum or post-pregnancy care is I think sometimes overlooked. I think there's a lot of stuff going on. The mom is worried about the baby, the father's worried about the baby, and sometimes the mother puts their health and kind of on the back burner and rightfully so, but is exciting.

You get a lot of stuff going on. Before I start asking some questions, just I would love to know, are there things that you would like to point out to our listeners today?

Dr Sima Baalbaki: Yeah, so I think one of the most important things for, new moms in repeat moms to know, is that the postpartum period really is like the fourth trimester of pregnancy, and similar to pregnancy, the experience is gonna be somewhat different for every mother, even if they've been through the postpartum period.

And that being said, it's important for moms to know that the postpartum period is a time of many changes, both physical and emotional. And with regards to physical changes, mom can expect her body to start returning to kind of that normal, pre-pregnancy state following delivery.

But it's a process that takes several months to occur, and many moms will find that their bodies just aren't exactly. What they were before, and it's kind of a new normal. a lot of women will come into their six week postpartum visit and they. why am I not back to my normal? Like, what's going on is something wrong?

And it's not, I mean, it took several months for your body to, develop and grow a baby and then have a delivery. And so it's gonna take several months for your body to recover. and that's the normal process. And in addition to physical things, there's a lot of emotional things going on.

it's exciting and generally a happy time. but there's a lot of adjustments going. Just changes in sleep, energy level appetite. And so it kind of causes a lot of different things for moms, as they adjust to life with their new baby. and then also, of course there's postpartum, blues and postpartum depression that may occur as well.

So that's actually

Dr Huh (Host): a great launching point for my next question to you, which is that exact topic of postpartum depression, of postpartum blues. know, I. In the not so distant past, you know, we just wrote off, oh, you just got the blues. You'll get over it. But I think, and I hope you agree, that postpartum depression is a real thing.

It's a real entity and it affects millions and millions of women, during their, pregnancy journey. can you talk about a little bit about one, the difference between postpartum blues and postpartum depression, if there is difference and steps to recognize it, and also steps to basically get managed or.

Dr Sima Baalbaki: Yeah, definitely. So I think you're right. I think postpartum depression and postpartum blues are one of the most common medical conditions that can occur in the postpartum period. postpartum depression affects one in seven women. so it is really very common. We talked a little bit about postpartum blues versus postpartum depression.

So generally postpartum blues are mild depressive symptoms, so things like feelings of sadness, crying, some insomnia or having difficulty sleeping, difficulty concentrating, increased fatigue, those are usually mild and develop in the first two to three days after delivery. And generally resolve within the first two weeks.

However, some women do experience more severe or prolonged depressive symptoms that can include thoughts of self harm or harm to others, and in that case, it's really important to seek medical attention as these are signs of postpartum depression, women with a history of anxiety and depression, or increased risks for developing postpartum depression.

So it's particularly important for these women and their support systems to be aware of the signs of postpartum depress. if a new mom or someone in her support system is concerned about the development of postpartum depression, I think one of the first, steps is to obviously make sure that the mom is safe and then reach out to the patient's obstetrician cuz we can serve as really good resources for getting, women connected with counseling centers.

And then also talking about starting medications to help with symptom management. if someone is having thoughts of hurting themself or hurting anybody else, then obvious. going to the emergency room so they can seek professional help. very quickly is, the most important. .

Dr Huh (Host): Yeah, I mean, I think as, the chair of this department, I fully recognize that this is a somewhat under-resourced area, not under-recognized, but under-resourced and I think mental health in general in the United States, particularly also in, in the state.

Of Alabama and in the city of Birmingham. I think we're challenged in terms of providing those adequate resources and it's my hope in the upcoming months and years that we'll actually have internal resources as a part of our obstetrical program for individuals to provide this type of expertise.

So it's long overdue and it's much needed. so let's talk about something that I know we talk a lot about and it's important, which is breastfeeding. I'm not gonna get into the heralded benefits of breastfeeding. I think that's pretty well-documented and well known, and something that we encourage.

but I think a lot of women are concerned about what they can do and not do while they're breastfeeding, right? So they're providing this incredible bond with their baby, but yet the same time as a mother, they need to know like, what can I take, what can I not take? What's allowable? What's not allowable?

And so I thought maybe you could talk a little bit about this, and while you're at it, maybe comment on, how contraception and that choice of contraception plays into breastfeeding.

Dr Sima Baalbaki: So, with regards to just breastfeeding in general and, medications that are safe, the best resources just to ask if you're not sure can I take this, can I not take this, reach out to your obstetrician, to the clinic office, we'll be able to tell you if something's safe or not.

and so that's really the best thing to do. Anything that we prescribe, if we're going to send you home with something that we're concerned, could have an effect on your breast. , we should talk about that before you leave the hospital. And if we're sending you home with something, then you can generally assume that it's safe if we haven't mentioned it.

with regards to contraception, I think this is a really great, question because, I think it's a really common one that women have and, thankfully most contraceptive options are safe to use in breastfeeding. Really the only thing that we try to limit is estrogen, containing contraceptives and really only in the first six weeks Of the postpartum period. and that's because women are increased risk for blood clots at that time, just from the normal postpartum state. and there is, a potential, risk to milk supply kind of in that early, postpartum period when, women receive estrogen. So we try to only use Progesterone only contraceptives in that period.

but then once you're kind of out of that six week period, any type of contraception is, acceptable. and fine to use. It's really what the mom is gonna be able to use easily. obviously some women do have contraindications to different types of contraceptives, but from a breastfeeding standpoint, there's really not a limitation after that.

Dr Huh (Host): So, one medical concern that we have kind of picked up on over the last many years is the issue of thyroid disease after pregnancy, particularly hypothyroidism. And so for our listeners, what I mean by that is when your thyroid is underactive, and it could be underactive for a multitude of different reasons, but that can affect Your tolerance to cold and heat, and it can make you tired and lethargic and it can affect your diet.

it has a pretty wide systemic effect if you're hypothyroid or again, if you have an underact thyroid. Dr. Babai, could you, like, for our listeners, just talk about the significance of that, your thoughts on how that should be checked? Is that important for our listeners to

Dr Sima Baalbaki: recognize? Yeah. So, postpartum thyroid dysfunction is fairly common.

It can occur anytime in the first 12 months following delivery. It's usually. Stages, but it can be overactive thyroid and then turn into underactive thyroid. and a lot of times, like you said, it's not diagnosed because a lot of the symptoms that you mentioned are things that new moms, are experiencing just related the postpartum period, fatigue, difficulty sleeping.

They've got a new baby. So a lot of the symptoms can be vague and non-specific, which can make it more difficult to diagnose. symptoms of hyper or overactive thyroid are generally a little bit easier to diagnose, or at least to be aware of because things like fatigue or irritability, weight loss, diarrhea, things like that, are a little bit more concerning to women.

but some of the symptoms, especially of hypothyroidism, like you said, are. a little bit more vague. luckily for most women, hypothyroidism that develops in the postpartum period will generally resolve on its own. but some women do become symptomatic and do require medication.

in women who do have concerning symptoms or have a history of thyroid dysfunction prior to pregnancy. We will check, your thyroid function at your postpartum visit and make sure that those are normal. and that you don't require any changes in your medical management or to initiate medication.

Dr Huh (Host): Any other things that you wanna highlight for our listeners today when it relates to postpartum care,

Dr Sima Baalbaki: so I think one of the things that I try to emphasize with my patients is be patient with yourself, be patient with your baby. You're both going through a lot of changes.

You're both learning a lot of new things. and so it's okay to not be perfect at everything the first time you try it. it's gonna take time for you both to figure yourselves out. It's gonna take time for the people around you to figure out what's going on as well. and so. , it's okay to ask for help.

It's okay to need some additional support. your family and your obstetrician are here for you, and if you need us, just reach out. .

Dr Huh (Host): That's great. I couldn't agree more. You know, a couple topics that I just wanted to get out to our listeners and these are things that Dr. Bobak and I have discussed in the past, and one of which is, I think we all know that there's a concern of, an increased maternal mortality rate, particularly in the US population, and some of that mortality actually exists in the postpartum period.

and we all know that it's higher in black women. And so one of the plugs I want to make for our listeners is to listen to your obstetrician right. If you don't feel right, you need to be evaluated. We know that there are issues related to blood pressure management that can definitely contribute to some of that morbidity and mortality.

But one of the major reasons we're doing this is to highlight that that period after you have your baby is really critically important. Not just for yourself, your baby, but just really your, just your general health going forward. The second thing I just want to comment on to the broader audience, and I've seen this and this is my public health pitch, is I think a lot of women.

they don't do this intentionally. They go see their ob after their postpartum visit, and they never see anyone ever again. Or a classic scenarios. when women have had multiple babies and they get their tubes tied, they think they're done. They don't need to see their obgyn.

It couldn't be further from the truth. And so even though we're talking about care in that immediate period after you have your baby, It's really important that you continue to see your provider in the years to come and not see anybody. And we see that a lot in the state of Alabama, but there's a lot of health maintenance that unfortunately is, not being followed by patients.

And I want to make sure our listeners understand that, that continued follow up. I dunno if you have any further feelings, you might not Dr. Babai, but I just think those are two important points to recognize to the audience. .

Dr Sima Baalbaki: Yeah. And I completely agree with you. women know their body's the best.

If something doesn't feel right, let us know. We'll get you in for an evaluation. it really is such an important time and we make such an emphasis like Dr has said earlier on pregnancy and delivery. But the postpartum period really is so important for women and for their overall health in the future.

And yeah, don't skip out on your appointments. We want to see you each year so you can bring us nice pictures of the baby. I love

Dr Huh (Host): that. Thank you. That's great. All right, well, again, I want to thank Dr. Babai for really discussing these, c important topics related to care after having a baby. And as always, please rate the podcast and we welcome any comments that you may have, particularly on topics that you're interested in.

please reach out to us if there are things that you don't think that we're covering or we need to cover. And so important information on the obstetrical services that we have here in the Department of UAB Medicine and other. Clinical services, please check out uab medicine.org. And until next time, have a great day.

Again, happy Valentine's Day and we'll see you next month. Take care. Peace out. Bye-bye.