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When you’re pregnant and you think about delivering your baby, you might worry about the pain during childbirth. But many women might not think too much about the pain that can continue after childbirth. Right after you have a baby, whether you’ve had a regular vaginal delivery or if you’ve had a Caesarean section, which requires abdominal surgery, women typically feel very tired and pretty sore for a few days.

Jade Elliott spoke with Kim Compagni, a pharmacist and executive operations director of pain management services for Intermountain Healthcare and Amy Campbell, a nurse and the Interim executive director for the women’s health clinical program at Intermountain Healthcare, about the things you can do to manage the pain after childbirth.

How does the pain after childbirth vary depending on the kind of delivery you have? What’s typical for a vaginal delivery?

Uterine cramping is the most common pain women experience after childbirth. The body releases oxytocin after your baby is born to begin the process of shrinking the uterus back to its pre-pregnancy size. There is also pain as the uterus begins to contract and tighten back up. This also slows post-partum bleeding. This cramping pain may also increase during breastfeeding. Uterine cramping is typically described as dull, aching pain. Women typically also have perineum pain and some swelling. Most women describe it as a stinging type pain, sometimes throbbing pain. It’s common to have pain in the vaginal wall from an episiotomy or tearing of the perineum.

And what about if you have complications like delivering by Caesarean section, how can that affect your pain level?

Uterine cramping is normal after a Caesarean section as well. A C-section procedure is done by making a horizonal incision just above the pubic bone. The pain from a C-Section is incisional pain or surgical pain in that lower abdominal muscle. Women describe this as stinging, throbbing or sharp shooting pain.

How does pain tolerance vary from woman to woman?

Pain tolerance varies from person to person. Every woman is different and the trauma to the mother’s body varies during every birth. Typically, when it’s a second or subsequent birth, women have more cramping and after pains. Pain varies from woman to woman by her ability to cope and her endurance for pain as well. Rest is so important to improve pain tolerance. Many women have adopted the practice of meditation and hypnosis to prepare for the birth experience, and these same methods can be used after birth. Pain tolerance can be improved greatly with these practices.

In childbirth, the amount of after pains depend on if it’s your first birth. Typically, when it’s a second or subsequent birth, women have more cramping and after pains.

What should new moms know about alleviating pain after childbirth?

Pain is part of childbirth. It’s normal. Have realistic expectations afterward. Talk to your doctor, midwife and pharmacist to help determine if you might need pain control after childbirth.

Your postpartum nurses can help teach you simple ways to help alleviate postpartum pain. Positioning your body is important. You can use pillows for your back, or under your arms or knees. Ice packs placed on your perineal area or Caesarean incision are very helpful. Witch hazel pads help both soothe perineal pain and keep the area clean. Lidocaine spray or gel can be applied for instant topical pain relief.

5 Simple Ways to Relieve Pain After Childbirth

1. Use ice packs for soreness
2. Apply topical Lidocaine spray or gel
3. Use witch hazel pads to soothe and clean the perineal area
4. Use over the counter pain relievers like ibuprofen
5. For complications, use non-opioid prescription pain relievers.

What types of pain relief may be used?

The key to pain management is to take scheduled acetaminophen and Ibuprofen around the clock for 2-3 days postpartum. The scheduled doses of medications will allow for an opioid free postpartum period. Rotate every 3-4 hours taking 1000 mg acetaminophen and alternating with 600 mg of ibuprofen. Ibuprofen also reduces swelling. You should only rarely need an opioid after childbirth and usually only for one to two days.

After childbirth is a time period where constipation can be troublesome, and opioids compound the problem. Taking stool softeners, drinking plenty of fluids and getting a short walk in each day can alleviate the constipation.

Over the counter topical medications such as dibucaine ointment and witch hazel can provide some additional pain relief and can help with swelling. We want women to be comfortable, so discuss on-going pain issues with your provider.

Why might postpartum women be at risk for becoming addicted to prescription pain relievers?

Childbirth is difficult. You’re tired, you’re in pain, especially with a c-section. Your hormones are fluctuating. It’s a big life change and adjustment. The combination of all those things could lead to postpartum depression, anxiety or addiction.

In the past, opioids were a common solution for pain. But now, we know more of the risks about opioids and about many opioid alternatives.

Are opioids safe for your baby if you plan to breastfeed?

When you’re nursing, medications can end up in your breastmilk and affect your baby. Check with your provider or pharmacist about what medications are safe when breastfeeding. If opioids are used by the mother, the infant should be monitored for sedation and respiratory depression. Withdrawal symptoms can occur in breast-fed infants when moms stop taking an opioid or when breast-feeding is stopped.

Is it safe for moms to take opioids short term after delivery?

In recent years, we’ve become much more aware of the risks of prescription opioids and opioid addiction. We recommend not taking opioids for more than three days after childbirth. If you have an opioid prescription and it says you can take it every four hours, you don’t need to take it every four hours. As your pain lessens, you should cut back the dose and frequency.

Why is it good to avoid opioids?

A side effect of opioids is drowsiness. Women have oxytocin in their body naturally after delivery and that makes you tired. So those things combined, can make it hard to take care of your baby. Your baby needs your full attention.

Opioids can be highly addictive. Taking opioids can lead to addiction, which can lead to other problems that could interfere with your ability to take care of your baby or family, maintain relationships, make good decisions, keep yourself and your baby safe, go to work or school or achieve your goals.

What is the potential for opioid addiction?

Physical dependence typically takes about seven days. The likelihood of developing opioid use disorder increases with time and dose. That is why it’s best to try to limit the number of opioids prescribed.

If your pain continues or increases after you get home from the hospital, when should you call your provider?

It’s normal to have perineal pain or C-section incision pain. But call your provider if you have chest pain or a hard time breathing, or pain or a lump in your legs or if you notice any redness, swelling, or heat on your body.

For more information about women’s health services and postpartum care at Intermountain Healthcare visit:

https://intermountainhealthcare.org/services/womens-health/

https://intermountainhealthcare.org/services/women-newborn/conditions/postpartum-care/

https://www.youtube.com/watch?v=dX22DuYu1Yk&list=PLIWYdYatjvoNTVyRVDOPeDfuER5vLTgum&index=3

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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If you’re expecting more than one baby or think you might end up with multiples due to beginning fertility medication or treatment, you’ll want to listen in.

Jade Elliott is joined by Dr. Helen Feltovich, a maternal fetal medicine physician with Intermountain Healthcare who specializes in high-risk pregnancies to answer common questions about expecting multiples.

Is the Number of Twins and Multiples Increasing?

Actually, the number of multiples being born has decreased slightly in recent years, probably due to responsible assisted reproductive technologies.

What Increases Your Chances of Having Twins or Multiples?

While fertility medication or in vitro fertilization may increase your chance for carrying multiples, there are other factors, like genetics or demographics that can come into play.

• Family history of twins or multiples
• Over age 35
• Previous pregnancy
• Taller than average
• Obesity – Body mass index of 30 or higher
• African American women are slightly more likely to have twins

If you have multiple factors, your odds of having multiples, multiplies!

Types of Twins

Identical twins is the common name for “monochorionic” twins, which means one placenta. These twins result from the fertilization of a single egg that splits in two. Identical twins share all of their genes and are of the same sex.

Fraternal twins is the common name for “dichorionic” twins, which means two placentas. These twins result from the fertilization of two separate eggs during the same pregnancy. They share genes just like any other siblings. Fraternal twins can be of the same or different sexes.

The only way to really know if your twins are identical is through genetic testing. In some very rare cases, there can be identical twins that are different in some important ways, like sex.

With Good Prenatal Care, Most Twin Pregnancies Result in Healthy Babies

Most twins are delivered past 36 weeks. The estimated due date is at 40 weeks of pregnancy, and 37 weeks is considered term. Half of twins are delivered after 36 weeks, and half before then, either because of spontaneous labor or because of a maternal or fetal problem that requires delivery. Multiples higher than twins often arrive earlier.

Risks of Carrying Multiples

• Preterm labor
• Pre-eclampsia (high blood pressure)
• Gestational diabetes
• Miscarriage
• Placenta complications
• Fetal growth concerns, especially for monochorionic (identical) twins
• Increased risk for postpartum depression or anxiety due to complications

Prenatal Visits Are Even More Important If You’re Expecting Multiples

When you’re expecting twins or multiples, your doctor will likely want you to have more prenatal visits than for a singleton pregnancy due to a higher chance for complications. You’ll also likely need additional ultrasounds and fetal monitoring during pregnancy to check for any complications. That’s why it’s important to not skip prenatal appointments.

When to See a Maternal Fetal Medicine Specialist

If your doctor is not comfortable with managing or delivering twins, or if you have additional complications, you’ll probably be invited to see a maternal fetal medicine (MFM) specialist. This is especially true if your babies are monochorionic (identical). MFM specialists are trained in obstetrics and gynecology like general obstetricians, but then they do an additional three years of training specific to high risk pregnancies and deliveries. If you’re expecting three or more babies, it’s highly recommended you see an MFM specialist.

If there is not an MFM specialist in your area, ask your doctor about consulting with one through telehealth. We try to keep patients close to their home.

Things to Do at Home If You’re Expecting Multiples

• Take prenatal vitamins as you would for a single pregnancy.
• Drink plenty of water to stay hydrated
• Eat well. Don’t focus on the number of pounds to gain. Your provider will watch the weight of your babies with growth ultrasounds.
• Get enough exercise
• Bed rest is not recommended just because you’re expecting multiples.

Be Aware of the Signs of Preterm Labor

If you feel more pressure or have cramping, bleeding, or are leaking fluid, or have decreased fetal movement, call your doctor.

Prepare for the Postpartum Period

Set up social support for after the babies arrive. Your chances of having premature babies or a Caesarean delivery are higher when you are carrying multiples. If your babies are born prematurely, one or more of your babies may need to stay in a neonatal intensive care unit. You may want to think about how close you live to a hospital with a NICU or ask your provider if they have access to telehealth consultations for your baby.

You may be at higher risk for postpartum depression or anxiety due to increased stress or complications.

Breastfeeding

Breastfeeding is best for babies, especially premature babies. It is possible to nurse multiples successfully. If breastfeeding is not working, there’s no shame in needing to supplement with formula.

For more information, here are some helpful links:

https://intermountainhealthcare.org/

https://intermountainhealthcare.org/services/womens-health/intermountain-moms/

https://intermountainhealthcare.org/locations/intermountain-medical-center/medical-services/women-and-newborn-care/women-and-newborn-services/high-risk-pregnancy/

https://intermountainhealthcare.org/primary-childrens/programs-specialties/fetal-program

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Having a first baby is exciting. Having a second baby and introducing them to the sibling brings its own set of stresses for some. How will the sibling respond? How best to introduce the baby to the family?

Jade Elliott spoke with Peter Lindgren, pediatrician, Intermountain Healthcare, to learn about the best ways to introduce a new baby to the family on this episode of the Baby Your Baby Podcast.

“It’s an adventure, and perfectly normal for parents to feel anxious about having another baby,” said Lindgren.. “My sister’s first response when I came home from the hospital was, ‘Send him back.’ But there also are many more stories of children who adore their new baby sibling, and often reflect the care and love that they have received.”

A new baby changes the family’s structure. Siblings might respond with feelings of betrayal or that they’ve been replaced or a regression in behavior. Mothers often experience a change in their relationship with an older child. Many fathers take on a more important role with older children, particularly as mothers feed a newborn.

There is no one recipe for how to introduce baby to his or her siblings. But here are some tips on how you can help children – and yourselves – through change:

Involve Siblings

• Before the baby is born, talk to your children about having a new sibling. For children under 2 years, it’s helpful to wait until the baby is closer to delivery (around 30 weeks of pregnancy).
• Read books together, such as “Peter’s Chair” by Ezra Jack Keats and “I’m a Big Brother/Sister” xx by Joanna Cole.
• Make caring for baby a team sport by including older siblings.

Reassure and teach

• Play it cool, but don’t be afraid to show your feelings. Children learn to navigate the world by watching their parents.
• Acting out is normal. Recognize the behaviors that you want to see.
• Jealousy can’t be avoided. Reassure, spend time with, hug, and make physical contact with older siblings.
• Keep your sense of humor!

More to think about

-Showering siblings with gifts is likely to make them feel like something really ominous is going on.

-Some wonder if the newborn should give a gift to the older sibling. Consider your older child’s personality before deciding.

Be Kind to Yourself

It’s okay to let your child respond in whatever way they are going to respond. Give them time to process their feelings, and yourself time to find your family’s new equilibrium. Remember that you get to do all of this in a sleep-deprived state, while recovering from a physically and emotionally intense experience. Above all, be kind to each other and yourselves.

For more information, please visit IntermoutainHealthcare.org.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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There’s nothing like the pure, beautiful, soft skin of a baby! But your baby’s skin is still developing and that makes it very sensitive and prone to some skin conditions.

Jade Elliott spoke with Dylan Alston, a dermatologist with Intermountain Healthcare to help us learn about some common baby skin conditions, and know which of these are normal, and how to treat them and when you should see a dermatologist.

“Baby Acne”

The medical term for “baby acne” or erythema toxicorum neonatalis is a benign acne-like eruption on the central part of the face. It typically starts 1-2 days after delivery. It is thought to be related to the immaturity of the oil glands of the newborn. No treatment is necessary, and the condition improves over the next 7-10 days of life.

There is another condition, neonatal cephalic pustulosis that looks similar to “baby acne.” Eruption occurs a little later, at 2-3 weeks after birth. The baby’s face and scalp can be affected. Neonatal cephalic pustulosis is thought to be related to skin colonization of a common yeast known as malassezia. Again, no treatment is necessary and the condition resolves without intervention.

Cradle cap

Cradle cap for all intents and purposes is baby dandruff. It again is thought to be related to the baby’s immune system reacting towards a common yeast on the skin. If the baby is over three months, using a safe dandruff shampoo would be helpful but not necessary. Under three months of age, just use a regular baby shampoo. Leave it on the head a about 2-3 minutes for best results. This is good advice for adults who have dandruff too.

Eczema

Because the newborn baby’s skin barrier is still developing, they are particularly susceptible to eczema. In infants, eczema often starts on the face, especially the cheeks and over time, moves to more common locations like the arms and legs. It has a red, rashy look. Introducing new foods to the child can make the eczema flare, so introducing one new food at a time and watching for skin rashes afterward can help provide clues to a potential food allergy. Steroid creams can help. Vaseline is a good moisturizer can reduce the risk of eczema later in life.

Diaper rash

The diaper area of a baby is particularly prone to developing rashes and irritation. The key is to change the diaper often enough to keep the baby’s skin from being injured by the alkaline nature of urine by keeping the area clean and dry. Skin protectants such as zinc oxide are great for creating a barrier between the delicate skin and the diaper contents.

Yeast can cause diaper rash. The chubby creases are susceptible to yeast. If the rash is in the crease, it may be caused by yeast. If the rash is not in the crease, then an irritant may be causing it.

Contact dermatitis from wet wipes

Unfortunately, dermatologists are seeing a significant increase in contact dermatitis in babies, or a rash that occurs when the skin is in contact with something irritating. A common ingredient that can cause contact dermatitis in babies is methylchloroisothiazolinone or MCI/MI, an ingredient in many manufactured wet wipes. Wipes should be hypoallergenic and preservative free. Parents with sensitive skin are more likely to have babies with sensitive skin.

Sunscreen sensitivity

Babies under six months have skin that is still developing and is very sensitive. Avoid using sunscreen on your baby until after six months of age. Instead, use hats and clothing. UV protective fabrics are best and should have a UPF (ultra-violet protection factor) rating of 50+. These fabrics have a higher thread count that can better block the sun’s rays than regular clothing. To learn more about these clothes, click here.

After six months of age, you can use sunscreen on your baby, but a mineral-based sunscreen with zinc or titanium oxide is least likely to cause a skin reaction in your baby. Avoid using chemical-based sunscreens on babies.

If your baby has a skin condition that persists and you have questions or are concerned about, see a board-certified dermatologist, as they are specially trained to diagnose skin conditions.

For more information: https://intermountainhealthcare.org/services/dermatology/

Additional links mentioned during the podcast:

https://www.aap.org/en-us/Pages/Default.aspx

https://www.aad.org/

https://www.instagram.com/igskindoc/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Infertility or having difficulty becoming pregnant is common. In the U.S., about 9 percent of men and 11 percent of women have experienced infertility. For couples who struggle with infertility, it may seem like everyone around them is able to have children, but them. Infertility means lots of waiting, and is often accompanied by feelings of disappointment, worry, confusion, impatience, stress, and/or frustration.

Jade Elliott spoke with Jessie Dorais, MD, Intermountain Healthcare, about trying to get pregnant.

“Many people are surprised when I tell them some average pregnancy statistics,” said Dr. Jessie Dorais, a reproductive endocrinologist affiliated with Intermountain Healthcare.

“There is a 20 to 25 percent probability of getting pregnant of the first couple of tries. And 85 percent of couples will conceive within 12 months. So, that means 15 percent won’t get pregnant right away. And after a couple has tried and failed to achieve a pregnancy for 12-14 months, the monthly probability goes down to 2 to 4 percent,” she adds.

Possible causes of infertility

Infertility is commonly caused by complexities with ovulation or sperm production or function. There are a combination of factors that may prevent pregnancy. In the United States, 10 to 15 percent of couples are infertile.

Female factors, male factors or both may contribute to infertility. The Association for Reproductive Medicine reports that female infertility accounts for about 35 percent of infertility, and male infertility accounts for about 35 percent of infertility, and the remaining percentages are either a combination of both or are unexplained. Some causes may be due to a combination of male or female factors, and some causes of infertility cannot be explained.

Often, tests may be performed on both partners to help determine if there’s a root cause to not being able to conceive naturally. A thorough fertility evaluation will include a complete medical history, and physical health assessment for the female and male partner. After pinpointing some contributing barriers, the fertility specialist will explain some possible fertility treatments.

Some factors that can affect fertility are:

• Maternal age
•  A history of Sexually Transmitted Diseases
• Body Mass Index (BMI)
•  Reproductive problems such as Endometriosis

However, it’s vital to recognize that every couple is different and has unique situations, so there is not a one-size fits all scenario when it comes to infertility. It’s helpful for women and their partner to discuss any underlying medical conditions with their primary care provider, obstetrician or midwife prior to trying to conceive.

Couples in their 20s or early 30s don’t struggle with infertility as much as those in their 30s and older, due to age affecting reproductive outcomes. Generally, miscarriage rates are about 20 percent for women who are in their 20s and increase to a 35 to 40 percent likelihood for those in their 40s. And genetic mistakes or chromosomal abnormalities (such as down syndrome) in babies also tend to be more common in older women.

Couples may experience primary or secondary infertility

Infertility (or primary infertility), refers to couples who have not been able to become pregnant after twelve months of trying without the use of birth control. This is typically common with first time parents to be.

Secondary infertility applies to couples who have been able to have a child or children in the past but are now unable to conceive. Sometimes, medications that are used to treat medical conditions as well as age in women can contribute to the infertility.

Increasing the chance of getting pregnant before seeing a fertility specialist

Couples who can’t get pregnant easily within a few months, may want to take some steps at home to increase the likelihood of getting pregnant. Women can track their menstrual cycle and ovulation. There are many apps available on smartphones to help with this. Pregnancy is most likely to happen if intercourse occurs within the six days prior to ovulation day. To help track ovulation, there are urinary ovulation predictor kits that may be purchased at drugstores. Women can try using the basal body temperature method to help identify when they’re ovulating, but women are generally most fertile two to three days prior to ovulation, so this method is not very effective for promoting or preventing pregnancy.

When to see a fertility specialist

How long to wait to see a fertility specialist depends on how old a woman is. For women less than 35 years old, it’s recommended to try to conceive naturally for 12 months.

“Consider seeing a specialist 12 months after trying naturally, if menstrual cycles are regular. For women with irregular cycles, they can be seen sooner than 12 months,” said Dr. Dorais. “For women in the 35 to 40-year age range, it’s recommended to see a specialist after trying to conceive naturally for six months without a positive pregnancy test. If women are 40 years of age or older they may want to see a specialist even sooner after trying to conceive.”

What to do before starting infertility treatments

Try to reach an ideal body mass index (BMI) prior to beginning infertility treatments, so don’t be too much over or under the recommended weight for your height and age. Getting adequate exercise, eating a balanced diet, and living a healthy lifestyle are best. That includes not smoking, drinking alcohol or using illegal drugs. These types of lifestyle choices may have an impact on fertility and the baby.

Women who are taking prescription medication will want to consult with their provider about whether it’s safe to continue their medications while trying to become pregnant. Women can begin taking prenatal vitamin supplements prior to conceiving.

“Infertility treatments depend on what’s causing the infertility, how long a woman has been infertile, her age and her partner’s age, and personal preferences. Everything that can be done is a bit elective. There’s a lot of room for personal preference,” said Dr. Dorais.

Some fertility treatment options include:

•  Fertility drugs
•  Artificial insemination (AI) and intrauterine insemination (IUI)
•  In vitro fertilization (IVF)
•  Donor eggs
• Egg freezing
• Surrogacy
•  Fertility preservation for cancer patients.

It’s vital to recognize that infertility treatment may take time and have high costs. Many insurance plans don’t cover infertility treatments and it’s important to look into costs and plans to cover treatment.

For more information or to find a doctor, visit: https://intermountainhealthcare.org/services/womens-health/reproductive-medicine/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Women’s bodies change and expand as they grow a baby for the typical nine months of pregnancy. When having a baby, not only do women deal with incorporating their new addition into their lifestyle, but they also need to navigate how their postpartum body looks, as well as all the emotions that come into the mix of new motherhood. As time passes, moms tend to wonder when their bodies will align and “shrink” back to what they were pre-pregnancy, and can become disappointed to learn they will rarely ever be what they were before.

Jade Elliott spoke with Natalie Lanham, DSW, LCSW, Intermountain Healthcare, about postpartum body image.

The postpartum body myth

It’s a myth to think that one’s body will look as it did pre-pregnancy. As moms grow and give birth to their babies, their bodies change. Everyone has a different body type. And no two pregnancy and postpartum experiences are alike. Some women need to go on bedrest or have caesarean sections or experience other pregnancy or childbirth complications that affect how their body recovers. Plus, factor in nursing or bottle feeding, or returning to work, which can all affect how a woman’s body recovers.

“I’ve done a lot of counseling with moms over the years, and there seems to be a greater amount of pressure in the culture in Utah than across the U.S., for women to look a certain way in a certain amount of time post-childbirth,” said Natalie Lanham, DSW, LCSW, a licensed clinical social worker with Intermountain Healthcare.

“Moms need to look at their bodies and realize they birthed their beautiful babies. It’s normal to gain weight in pregnancy. It takes nine months to grow a baby, so bouncing back right away isn’t realistic. It’s helpful for women to understand they don’t need to be “perfect” or fit a certain mold,” added Lanham.

According to Lanham, it’s important to focus on what bodies can do instead of what they look like. And accepting a postpartum body is closely tied to many aspects of a woman’s new identity as a mother.

“Social media tends to portray false narratives about what a postpartum body should look like. Take a break from social media if needed. Consider unfollowing any accounts that promote dieting or weight loss that include aspects of toxic diet culture,” she added.

Diet and exercise

Lanham encourages women to find healthy ways to work towards a healthier body. This may include eating a nutritious diet, slowly easing back into an exercise routine during the postpartum recovery period, and being patient and kind with themselves.

“Exercise can help women feel stronger, happier, and more energized, when they find a type of exercise they enjoy. It helps to listen to the body’s cues. Do physical activities that bring those good feelings. Figure out what triggers negative feelings. Get rid of those first,” she added.

Dieting is one of the most important predictors for eating disorders. Having a distorted body image doesn’t help moms who are going through postpartum body changes.

Having a sudden urge to do whatever it takes to regain their former body can lead to unhealthy behaviors. Keep things in balance. Eat balanced meals. When pregnant or nursing, moms need to eat for themselves and their growing babies.

“If you’re concerned about overeating, half the portion and save the other half for another meal or someone else,” said Lanham.

“While working towards physical fitness goals, find clothes that are flattering and fit well. Wear what’s comfortable and embrace it,” she added.

Goal setting

When it comes to settling goals, it’s vital to be realistic.

• Discover what contributes to a healthy body image first
• Talk it out with someone else
• Don’t engage in negative self-talk about goals
• Get a partner to set goals with – they can provide perspective
•  Women need to be patient with their body because it’s healing

Affirmations

Affirmations can be helpful when wanting to maintain a positive outlook on body image and self-worth. And different affirmations work for different people.

When thinking about affirmations, it’s important to think about the reasoning negative thoughts are happening. It’s helpful if women identify the top five things they beat themselves up about.

“When negative thoughts begin, women can identify them, and then tell themselves to stop. Turn it around and say, “I am beautiful because…”, “I have a great___ because…” Turn the negative things into positive affirmations. At the end of the day, it helps if women congratulate themselves about the positive things they love about themselves,” said Lanham.

Some examples of affirmations include:

• “I will enjoy the present moment…”
• “My body went through an amazing change and created a beautiful baby”
•  “I am enough”
•  “My body image is not my body”

Postpartum mental health and disorders

According to Lanham, postpartum blues typically last about two weeks. However, some women may get into a downward spiral with hormone changes, since estrogen and progesterone spike upon having a baby, causing significant hormone fluctuations. The body needs to adjust to new hormone changes which is normal to a degree. Some symptoms of the baby blues are mood swings, anxiety, sadness, irritability, feeling overwhelmed, appetite problems and trouble sleeping.

If a mom feels these feelings for more than two weeks, it’s wise for her to reach out to her provider for a referral to a behavioral health specialist who can help screen her for peripartum anxiety or depression.

Symptoms of peripartum mood disorders include:

• Severe mood swings
•  Difficulty time bonding with baby
•  Overwhelming fatigue
• Reduced interest in previously enjoyable activities
• Hopelessness
•  Feelings of guilt and inadequacy
•  Difficulty making decisions
•  Severe anxiety (panic attacks)
• Thoughts of harming self or baby
•  Recurrent thoughts of suicide.

The difference between the baby blues and a mood disorder is that these feelings may last for months or longer. If such is the case, get immediate help.

Call a local behavioral health hotline such as the Intermountain Healthcare Behavioral Health Services Navigation line available from 7 a.m. to 7 p.m. at 833.442.2211.

Sometimes, moms experience an extreme mood disorder that’s a more severe long-lasting depression called postpartum psychosis. Insomnia or undiagnosed or treated mood disorders may contribute to moms experiencing hallucinations, delusions, extra energy or paranoia. If a loved one is noticing this in a mom, then it needs to be addressed immediately.

If symptoms are severe and urgent, go to a walk-in behavioral health clinic or a hospital emergency department.

Moms who feel they are high strung or tend toward anxiety will want to talk to their provider while pregnant. It’s best to call the provider when anxiety kicks up a little more than usual, and they can make a referral to a behavioral health provider. Or sometimes postpartum anxiety can kick in after the baby is born.

While moms struggle with hormone fluctuations during the postpartum period, fathers too may struggle with this period as they adjust to this major life change. Some common feelings fathers who struggle in this period are:

•  Sadness
•  Fatigue
• Overwhelmed
•  Anxiety

These symptoms can trigger changes in eating and sleeping and dads can exhibit similar symptoms to moms in the postpartum period. Dads most at risk are those with previous anxiety problems. This can have negative effects with partners and babies since dads can have high anxieties over how to care for and provide for their family. Dads need time with their friends too and it’s okay. They often find nurture as a pack.

Self-Care

Self-care is vital for moms. Make time for it. It looks different for everyone, but it helps maintain some grounding between the different roles that people play in their life.

“It’s helpful if you think of there being 10 little buckets that make up self-care: psychological, social, emotional, mental, spiritual, familial, financial, physical, educational, personal. And you can’t fill every bucket, every day,” said Lanham.

“Each morning, choose to put a marble in four of the buckets. By the end of each week, at least one marble should be in each of these buckets to fulfill self-care. We struggle with sticking a few in one or more of these buckets and making these unbalanced. The idea is to have at least one in each bucket by the end of the week for balance. This helps people realize how much time is being spent in one category and focus on creating a balance,” she added.

Moms often don’t take enough time to practice self-care. Meditate, listen to music, stretch, bathe, put on lotion that smells good, or use a good product for body self-care. This helps take the stress from the day. Keep in mind that each body deserves to be honored, respected, and nurtured and that life is here to be enjoyed.

For more information about Intermountain behavioral health and women’s health services visit Intermountainhealthcare.org. Or call the Intermountain Healthcare Behavioral Health Services Navigation line, available from 7 a.m. to 7 p.m. at 833.442.2211.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Breastfeeding has many benefits for babies and also for moms. The antibodies in breastmilk help protect babies from illness. Breastmilk has just the right amount of fat, sugar, water, and protein to help babies continue to grow. The research and evidence is clear, breast milk is the best food for infants and breastfeeding is associated with decreased risk for infant morbidity and mortality.

But when moms are unable to breastfeed, or need to supplement breastfeeding or stop breastfeeding before a baby turns one year old, it’s important to give their baby infant formula because it’s the closest nutritionally to breastmilk. It is not recommended to give babies under age one cow’s milk, juice or soda.

New parents are often bombarded with choices for infant formulas: Organic, probiotic, plant-based, generic or brand name options. Which is best for baby?

Jade Elliott spoke with Becky Hurst-Davis, registered dietitian nutritionist and clinical nutrition manager at Intermountain Primary Children’s Hospital about the simple advice: there’s no “right” formula, but parents can find the right fit.

“Breastfeeding is best for babies. We encourage breastfeeding whenever possible – and we support parents in choosing formula by giving them good information to make the most informed decision,” Hurst-Davis said. “All formulas marketed in the United States must meet specific nutrition standards and labeling laws, so the choice really comes down to the baby’s needs and parent preference.”

Baby formulas marketed in the United States share these characteristics:

•  Protein, which comes in three forms:

1.  whole protein from cow’s milk or soy;
2.  hydrolyzed protein, or broken-down protein, which helps with digestion or allergy concerns; or
3.  100 percent synthetic amino acids, or fully broken-down protein, which helps with digestion issues, and are hypoallergenic.

• Carbohydrate/sugar sources, including lactose, corn syrup solids – different from high fructose corn syrup – maltodextrin, or sucrose.
•  Fat for calories, brain growth, and eye development.
•  Vitamins and minerals.

Beyond these staples, Hurst-Davis offers the following information to help parents choose what’s best for their babies:

• Generic formulas marketed in the U.S. are safe and adhere to the same guidelines as brand-name formulas, and often are less expensive.
• European infant formulas have different guidelines and standards including labeling standards. If they are not marketed or sold in the United States, Hurst-Davis says it’s not clear whether they meet FDA safety and nutritional standards.
•  Aside from soy formula, there are no plant-based infant formulas available in the United States.
• Several infant formulas include prebiotics and probiotics, which research has found help support healthy bacteria in the gut.
• Oligosaccharides: Some new formulas are touting synthetic human milk oligosaccharides, which are prebiotics. Human milk oligosaccharides have been associated with fighting infection.
• DHA/ARA, a long-chain fat found in human milk, is added to most infant formulas. DHA/ARA supports vision and cognitive development.
• Organic formulas: Hurst-Davis has not seen studies to indicate they are more or less nutritious than other formulas. These tend to be more expensive.

Hurst-Davis reminds parents that formula benefits may not present for several weeks. If a baby is experiencing formula intolerance, diarrhea, rash or bloody stools, parents should contact their health care provider.

For mothers with questions about breastfeeding, pumping, or milk supply, Hurst-Davis recommends contacting a lactation consultant or la leche league.

For more information, visit PrimaryChildrens.org.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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The longer a child has a seizure after 5 minutes, the harder it is to stop with medications. This fact is why developing protocols and eliminating barriers for Emergency Medical services to provide anti-seizure rescue medications quickly is so important. Primary Children’s’ Emergency Department hopes a new clinical trial will further empower EMS pre-hospital providers to treat child seizures in a safe and timely manner.

Jade Elliott spoke with Dr. Maija Holsti, MD, MPH, Professor of Pediatrics at the University of Utah, about this clinical trial.

The Pediatric Dose Optimization for Seizures in EMS (PediDOSE) study created by Primary Children’s Hospital in collaboration with Salt Lake City Fire, West Valley Fire, and Unified Fire EMS will run over a period of 4 years at Primary Children’s Emergency Department and 20 other sites across the country.

Paramedics currently perform multiple calculations to determine the dosing for anti-seizure medications, which has led to under-dosing and delays in treatment of pediatric seizures. About a ⅓ of pediatric patients on average are transported to Emergency Departments still seizing due to these delays and under-dosing.

The study will compare dosing of the anti-seizure medication, midazolam, based on age versus conventional dosing based on weight. Age-based dosing will eliminate steps and simplify the protocols for EMS prehospital providers, supporting paramedics to give the correct dose in a timely manner.

Special rules for emergency research by the FDA allows patients to be enrolled in research without prior consent if there is not time to consent. Because a seizure is an emergency and requires immediate treatment, all eligible patients will be consented after enrollment at Primary Children’s Hospital. We will be studying these patients until they leave the hospital to ensure that it is effective and safe.

To be eligible for enrollment in this study, patients must be:

• Age: 6 months to 13 years old
• Actively having a seizure in the presence of a paramedic EMS provider
•  Transported by Salt Lake City Fire, West Valley Fire, and Unified Fire Emergency Medical Services to Primary Children’s Hospital

Click here for more information.

Link to feedback survey.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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The ways that women experience menstrual periods vary from person to person. Symptoms may vary quite a bit and the intensity of those symptoms may vary from month to month.

Jade Elliott spoke with Leah Moses, CNM, Intermountain Healthcare, about uterine fibroids and endometriosis on this episode of the Baby Your Baby Podcast.

“Some patients describe their periods as barely noticeable, slightly uncomfortable, or that they just feel a bit off. Other patients experience significant cramping, bleeding, discomfort, bloating and/or headaches that prevent them from doing the things they want and need to do in day-to-day life. Most women fall somewhere in between. Symptoms and pain tolerance really vary,” said Moses.

Because periods typically happen every month for several decades throughout what are considered the “childbearing years” – from the time a woman starts menstruating until she’s completely in menopause – many women may feel like their period symptoms are normal because that’s all they know.

It’s important that women talk to their doctor or midwife about their period symptoms at their annual visit and let them know if they notice significant changes in their periods. Providers can explain what is normal and identify symptoms that might be related to underlying conditions. Keeping track of menstrual frequency, duration and flow amounts in a journal or on an app can be very helpful to track changes over time to help determine what is normal.

There are often emotional benefits for women when they talk to friends and family members about their period symptoms. Most can sympathize and relate to symptoms and compare notes to notice if something is unusual. Women should see their provider if they think their symptoms seem worse or different, have dramatically changed, or even just have a gut feeling that something needs to be addressed.

“Don’t just depend on your family or friends alone to give you advice, go talk to a provider. It may turn out your experience is in the range of normal, but identifying conditions that need attention is best done early. There may be some genetic similarities passed on in families, but that doesn’t mean those conditions are normal, or that you have to suffer. And family members or same-age friends can have a lot of variation in cycle bleeding and general health,” said Moses.

Women are often the main caregiver in their family and may not make time for formal healthcare and haven’t had an exam in several years. Many women don’t seek healthcare often, except during pregnancy or the occasional simple urgent care visit. It’s important to have regular annual exams outside of those big events or small crises.

When periods might get heavier

“The years when women may experience unusual bleeding patterns and sometimes heavier periods are during the bookends of life, or in other words, during the beginning year or so of starting periods and the final years—or perimenopause. During the middle years most of the time periods tend to regulate,” said Moses.

“For young women, the body is just getting used to menstrual cycles and experiencing a new flood of hormones. When shedding the uterine lining for the first several times, periods can be heavy. For older women no longer bearing children or breastfeeding, it’s not uncommon that as hormones change, periods vary and can sometimes get heavier,” she added.

Other factors that affect bleeding include genetics, number of pregnancies and overall health, as well as life changes month to month.

When to seek care for heavy menstrual bleeding

If symptoms of pain or bleeding are severe, or are not going away with home remedies and over-the-counter medications, contact a women’s health provider.

“If you’re bleeding so much you’re filling a regular sanitary pad in an hour, you need to be seen immediately. Heavy bleeding can cause women to become anemic or have low iron levels over time, or can be a symptom of something more serious, like fibroids, endometriosis, polyps, or malignancies,” said Moses.

A primary care doctor, an OB/Gyn or a midwife is a great place to start, then patients can be referred to other specialists as needed. Women who are experiencing severe, persistent abdominal pain or unusually heavy bleeding during their period should go to an urgent care or emergency room.

Common causes of painful periods and heavy bleeding

Two of the most common causes of painful periods and heavy bleeding can be fibroids and endometriosis. Other causes are polyps and malignancies.

Fibroids

Fibroids are non-cancerous tumors of muscular and fibrous tissues that can occur in other parts of the body, and can commonly develop in the wall of the uterus.

Uterine fibroids are the most common tumor of the reproductive tract. Approximately 40 to 80 percent of women have fibroids over their lifetime, however, most are small, asymptomatic, and not concerning.

Fibroids can occur in many locations, outside and inside the uterus. Depending on location and size, fibroids can create different symptoms of varied severity. Medical imaging is necessary to diagnose them. Certain sizes of fibroids and locations are normal, while others need medical attention. Fibroids can range in size from 1 mm to more than 20 cm (8 inches) in diameter or even larger.

Fibroids often appear during the childbearing years, and are most common between ages 30-40. Some women are relieved to know symptoms of uterine fibroids usually stabilize or go away completely after menopause as hormone levels decline.

Symptoms of uterine fibroids

Most fibroids are small and don’t cause symptoms or require treatment, other than annual observation. Larger fibroids can cause a variety of symptoms, including:

• Longer, heavier or more painful, frequent periods
•  Painful abdominal cramps
•  Bleeding between periods
• Boating or feeling of fullness in lower abdomen or abdominal enlargement
• Nausea
• Fever
•  Pain during sex
• Low back pain
•  Constipation
•  Frequent urination, inability to urinate or to completely empty the bladder

Side effects of fibroids

• Anemia from blood loss
• Miscarriage or Infertility

The causes of fibroids are unknown but could be genetic or hormone-related, specifically tied to estrogen and progesterone levels. Hormones are a big cause, and that’s one reason why fibroids can change in size. Imaging results can also vary during monthly cycles and over longer periods of time, so seeing the same provider could help track results and streamline care.

Risk factors

• Obesity – defined as 20% over healthy body weight
•  Heredity, or family history of fibroids
• Not having children
•  Early onset of menstruation younger than age 11
•  Late age for menopause
• Vitamin D deficiency
•  Poor diet, high in red meat or not enough fresh fruits and green vegetables
•  Alcohol use
• Race: Black women are more likely to have fibroids younger or more severe. Additional studies are needed in black and minority populations to more completely understand all the risk factors.

In general, fibroids can’t be completely prevented, but women can reduce their risk by maintaining a healthy body weight with a healthy diet and having annual exams.

Treatment or monitoring of fibroids may be needed

Depending on location and size of the fibroid, treatment may or may not be needed. They are not usually dangerous, but it can vary from person to person. If women have small fibroids, it’s a good idea to make a plan for how often to monitor them.

It’s ok for women to get pregnant if they have uterine fibroids, but they should be especially conscious to have regular prenatal care with proper imaging as there are some risks of pregnancy complications, such as placenta abruption, fetal growth restriction or preterm birth.

Endometriosis can cause painful periods and heavy bleeding and affects 1 in 10 women

Endometriosis can be a devastating, often painful condition when the lining of the uterus or endometrium grows outside of the uterus. It affects 1 in 10 women in the U.S.

“In endometriosis, the displaced tissue grows, thickens, breaks down and bleeds, but then has no way to exit a woman’s body and is trapped, and can irritate surrounding tissue, causing pelvic pain, scar tissue or cysts,” said Moses.

Common symptoms of endometriosis

• Painful menstrual periods
• Pain with sexual intercourse
• Pain with bowel movements or urination
• Excessive bleeding during or between periods
• Fatigue, diarrhea, constipation, bloating, nausea especially during periods
• Infertility

When to see a doctor or midwife

If women experience more than one of these symptoms, or even if just one symptom is very severe, they should see their provider. Severe pelvic pain or heavy bleeding can impact a woman’s daily function and possibly her long-term health.

Risk factors for endometriosis

• Starting menstruation at an early age
• Going through menopause at an older age
• Heavy menstrual periods
• High estrogen levels
•  Low body mass index
•  Family history of endometriosis

The causes of endometriosis remain elusive. Hormones or immune system factors that affect the lining of the abdomen can sometimes play a role, as well as scar tissue from abdominal surgery.

Early diagnosis is important because endometriosis can be complex and difficult to treat

Early diagnosis may result in better management of symptoms. Women should see a specialist if their symptoms are severe and other remedies aren’t working.

Start with low intervention help. Keep track of symptoms over time. Note what helps or makes them worse and keep track of the bleeding or pain pattern. The more accurate data women give to their healthcare provider, the better they can get help ruling out other issues or determining if a specialist is recommended.

Treatments can include a series of injections over a few months or more recently, oral pills. There are also various surgical options.

Some endometriosis is microscopic in nature, so it can’t be seen. Trying out medication can help determine if it’s endometriosis and treat what can’t be seen. Endometriosis can go hand in hand with infertility, many women will pursue treatments that can preserve fertility.

There are different schools of thought on how to surgically treat endometriosis. There is very precise excision surgery to remove what can be microscopic endometriosis. Other surgical options are the less-invasive laparoscopy or major surgery, such as a hysterectomy.

If a woman believes she has endometriosis, it’s very important for her to bring as much accurate information about her symptoms to her provider early to determine more about her case and refer her to a specialist for care.

For more information visit:

https://intermountainhealthcare.org/services/womens-health/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Menstrual cramps are common for women who experience periods. Sometimes, the range of normal discomfort may interfere with daily life, and leave some wondering if or when they should see a provider, or if what they are experiencing is normal.

Jade Elliott  spoke with Leah Moses, a certified nurse midwife with Intermountain Healthcare, about how to navigate through the pesky aches that menstrual cramps can bring, what they could mean, and ways to manage them.

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About menstrual cramps

Menstrual cramps are also referred to as dysmenorrhea. This can include pain in the hips, lower back, inner thighs, and abdomen. Abdominal pain may also be accompanied by pressure and even loose stools, an upset stomach, nausea, headaches, as well as vomiting in severe cases.

During a period, the uterus sheds its lining. Hormones released during this time can sometimes cause pain and inflammation, also causing cramps.

Although most menstrual cramps are manageable, some common conditions may cause normal menstruation cramps to become more painful. These include pelvic inflammatory diseases, uterine fibroids, polyscystic ovarian syndrome (PCOS) and endometriosis.

Home remedies

Period pain without an underlying cause tends to improve with age, and sometimes menstrual cramps improve after a woman has had children.

For those who are dealing with the discomfort that menstrual cramps can bring, there are various types of home remedies that may help alleviate pain, including:

• Exercise, stretching, or sexual intercourse
•  Heating pad, hot compress or warm baths
•  Over the counter pain relievers (Motrin, Tylenol)
• Consider Midol and Pamprin for bloating and muscle aches
• Acupuncture or chiropractic adjustments
• Herbal teas
•  Natural supplements such as magnesium, fish oil, vitamin B1 and B6
•  Avoid alcohol, caffeine, and stress

“If women experience other underlying health conditions, it’s important to check with their providers to know which medication may be best. Following the dosage directions on the label of over-the-counter medication is also important,” said Moses.

When to see a provider

“If full doses of over-the-counter medicine is needed more than a few times a day for several days in a row, then women should see their provider to review their symptoms,” added Moses.

Another reason to see a provider is to discuss birth control options. Birth control can be an option to help alleviate normal to severe cramps and may be pursued when home remedies don’t relieve the pain. These methods may include an intrauterine device (IUD), an implant, or birth control pills. Most women don’t have to wait until things get severe to consider using birth control as an option to reduce menstrual pain.

“Consider seeing your provider when your menstrual cramps are unusual or severe, or if your monthly flow lasts much longer or is much heavier than usual. Painful period cramping can be treatable,” said Moses.

It’s important to seek immediate care if cramping becomes dramatically worse such as severe abdominal pain that isn’t going away, or menstrual flow is filling a regular sanitary pad in as fast as one hour.

Additionally, pelvic and physical exams may be performed to help identify abnormalities or infections of the reproductive areas. Often, an ultrasound or other imaging will be needed to know more.

Sometimes women don’t realize they may be experiencing cycle or menstrual cramp irregularities until discussing their symptoms. Find out what is physically normal by discussing symptoms and concerns with a women’s healthcare provider at an annual exam.

For more information or to find a provider, visit https://intermountainhealthcare.org/services/womens-health/