Transcript: Postpartum Care and Recovery After Twins
Twin Talks
Postpartum Care and Recovery After Twins
[00:00:00]
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
DR. WADE SCHWENDEMANN: If you are pregnant with twins now, you are most likely focused on staying healthy and anticipating the arrival of your twins. But, what about your health immediately after giving birth? What can you expect? How does your recovering body after twins compare to the recovery from a singleton pregnancy?
I’m Dr. Wade Schwendemann, perinatologist for Sharp Mary Birch in the San Diego Perinatal Centre and I’m here to talk about: “Postpartum recovery after twins, the first six weeks.” This is Twin Talks Episode Number Eleven.
[Theme Music/Intro]
CHRISTINE STEWART-FITZGERALD: If you’re pregnant with twins or you’re an experienced twin parent, odds are you have heard it all before. Now, it’s time to hear from the experts. This is Twin Talks, parenting times two.
Welcome to Twin Talks broadcasting from the Birth Education Centre of San Diego. Twin Talks is your weekly online on-the-go support group for expecting and new parents to twins. So, I’m your host Christine Stewart-Fitzgerald.
Have you heard about the Twin Talks Club? Our members get bonus content after each new show plus special giveaways and discounts. Subscribe to our monthly Twin Talks Newsletter and learn about the latest episodes available.
Another way you can stay connected is by downloading our free Twin Talks app available on the Android and iTunes Marketplace. I will turn it over to Shelly our producer to tell you about our special program.
SHELLY STEELY: Hi. So, you can follow us on Twitter or like us on Facebook at Twin Talks or you can join on the conversation at home using hash tag #TwinTalksVP. We’ve also got a new promotion where you can actually win a free one month membership to Twin Talks just by following along at home.
CHRISTINE STEWART-FITZGERALD: Thank you. Well, before we dive into our discussion. We’ve got some panellists here. So, I’d like to do a little introduction here. I’ll start with Sunny. Welcome.
SUNNY GAULT: Welcome to the club. Last time, we were talking I was pregnant with twins and now they are here in the flesh. Exciting stuff – so, I’m a mommy of four now. I have two little boys at home; Sayer who is three, Urban is just about 21 months now.
Once I get into those upper years and half, two year marks – I forget the months. Then, my girls I guess they’re infants now although it’s so sad I like calling them newborns. They are just over two months old; twin girls, identicals.
CHRISTINE STEWART-FITZGERALD: I can see you’re keeping them apart with the toe nail polish.
SUNNY GAULT: Yes and I have a kind of a funny story, a real quick about that. I really like the idea but I was doing this little wrist band different colours. They still have the wristbands on them because at a glimpse, I wanted to see who was who. I really can’t tell. It sounds horrible but I really can’t still tell.
CHRISTINE STEWART-FITZGERALD: You’re a horrible mom.
SUNNY GAULT: Well, one day I was changing the ribbons and I lost the ribbons and I didn’t know who was who and for four days, I was calling the child by the wrong name. I ended up going to our paediatrician and they were just slightly – their weight was just a little bit different. That’s how I now know, who’s who.
So, my fail-safe now is the toe nail polish. But, I’m still doing the ribbons. I don’t want everyone to have to pull off their sock to see who it is, right?
CHRISTINE STEWART-FITZGERALD: That’s a great story for our Pregnancy Oops.
SUNNY GAULT: I know. I probably share that on that.
SHELLY STEELY: Hi. I’m Shelly the producer here. I have identical twin boys who are a year and a half now; Greyson and Sawyer getting into everything. I’m actually expecting my third.
CHRISTINE STEWART-FITZGERALD: Just one.
SHELLY STEELY: Just one this time. I’m really excited about that.
CHRISTINE STEWART-FITZGERALD: Just one. Okay.
MISHELL RUDDEN: My name is Mishell Rudden and I’m 34 years old. I work as a part time as a kindergarten children. I’m also the mother to Sunny and Mathew; my 21 month old boy-girl twins.
CHRISTINE STEWART-FITZGERALD: All right. As your host, so, I’m Christine Stewart-Fitzgerald and I’ve got four year old identical girls. I also have a singleton who is now 15 months. So, I just have to say: “I hear these stories about the preschoolers and the interaction.” Gosh, my girls they just spend so much time with each other. It’s so hard to get their attention right now. So, that’s my biggest challenge. Hello, I’m over here.
[Theme Music]
So, today we’re going to review an app and it’s called GS Preschool Games. It’s found in the Android Marketplace as well as in iTunes. It’s for preschoolers and it’s got an educational focus. I’m going to toss it out to our panellists here who’ve had a chance to take a look. What do you guys think?
MISHELL RUDDEN: I like the games a lot. They’re really simple. It’s a lot of touch the largest item. Touch the smallest item. So, comparisons which doesn’t fit in, which is the same and which are really good activities to do for little ones.
There’s also puzzle pieces but just real small only. Three pieces at the time which I think might be better for the younger preschoolers definitely.
CHRISTINE STEWART-FITZGERALD: The fact that – the assortment of games. I think there’s total of 10 games within the whole package.
MISHELL RUDDEN: They all really simple bright colours, easy to pick the pictures. So, that’s a definitely plus.
CHRISTINE STEWART-FITZGERALD: Yes, definitely. Because you guys are they are in a year in a half. So, if they were able to do that on a phone. It sounds like; we’ve got some mid ranged.
SUNNY GAULT: I was playing around with it. First thing, you mention Christine, the bright colours. I think that that’s really eye-catching. I think my toddler would really appreciate this illustrations whatever really cute. I don’t know. My kids like illustrations of other kids and stuff. There are a lot of kids playing games and whatever that’s kind of cool.
I notice my older son loves to play puzzles. There are some games in here that kind of mimic what a puzzle would do. You’re trying to build an image of an elephant. When you’ve got all these squares and they’re all mixed up. They’re trying to mix and match them so it makes an elephant. Well, my son has a puzzle like that at home and he loves it.
So, this is kind of a nice on-the-go type of thing where I don’t want to take a puzzle out in the car. Can you imagine puzzle pieces everywhere? It would be nice to just take this and they can kind of do the same kind of thing incognitively? I’m not a doctor, Mister Schwendemann. I can give you all the specifics on that.
But, I do think I would have to get another phone though because I think both of my little boys would fight over this. It’s like whenever one person wants it then the other person wants it as well. I would think: “When the twins are old enough to do this, it might be a show.”
MISHELL RUDDEN: We actually, my husband and I instead of trading in our phones when we upgraded; kept the old ones both of them. We would have gotten the trade-in credit but the flipside is now, each of my toddlers have their own play phone that’s loaded with apps.
SUNNY GAULT: So, you can do the app usually you don’t have to pay for a thing.
MISHELL RUDDEN: Once you deactivate your contract on the phone, you can just turn the wifi on and it works just like an iPad.
SHELLY STEELY: That is really smart.
MISHELL RUDDEN: They don’t care that it’s not the newest version. They will just hand it. It plays music and they can play games on it too.
SUNNY GAULT: Yes, totally.
CHRISTINE STEWART-FITZGERALD: I downloaded it and I give it to my four year old. They’ve been pretty good at getting right. They just jump right into it. It amazes me how kids need no instruction whatsoever.
SUNNY GAULT: It has to be intuitive in order for kids to use this. They have to be able to figure it out.
CHRISTINE STEWART-FITZGERALD: I felt like it’s also something. It’s not just entertainment but they are actually learning and developing their skills. Now, that’s great. Now, my only complaint though is that: “What I notice is that if they answer a few of these questions, they perform some of these actions then it gives a little of pop up screen. Hey, congrats. You did it fantastic. Then you have to click the screen to advance to the next question.” So, that’s a little bit tedious.
There are also some pop up ads for free software. I found it covers – it’s very difficult to get rid of that, the pop ups screen. So, within less than 10 minutes; I had to assist my girls in getting rid of the screen. In fact they actually started to download some software on my phone.
SUNNY GAULT: My gosh
MISHELL RUDDEN: Is this free software?
CHRISTINE STEWART-FITZGERALD: Yes.
SUNNY GAULT: That would be the next question. So, they’re in charge or anything to your phone and doing it and it was some sort of software or something.
CHRISTINE STEWART-FITZGERALD: It’s a free software. But, it does make me very nervous knowing that they have the ability to just start downloading things onto my phone. I happen to be there.
SHELLY STEELY: I actually notice similar problems. I just in playing around whether that I tried to click the X Screen and I ended up with a weight loss advertisement. Not what I need right now. So, that was a little bit just not what I want to see inside a kids’ app necessarily.
I would love to see an upgrade, an ad-free one. It’s a definitely a good enough app. I would be willing to pay for it if they have that available.
SUNNY GAULT: All right. Were we going to give these two thumbs up then?
CHRISTINE STEWART-FITZGERALD: Two thumbs up. All right; today’s topic is: “Postpartum recovery after twins in the first six weeks.” We’re talking with Dr. Wade Schwendemann who’s explaining some of the common postpartum complaints and giving us some tips on the faster recovery. So, hey thanks for joining us Dr. Schwendemann.
DR. WADE SCHWENDEMANN: Thanks for having me. I appreciate it.
CHRISTINE STEWART-FITZGERALD: You see women throughout the different stages of pregnancy. Once they have the baby, what’s the biggest complaint that you hear from the twin moms especially?
DR. WADE SCHWENDEMANN: Without a doubt, the biggest complaint that we hear is: “Lack of sleep.” It’s bad for moms with singleton. But, once you have two babies that needed your attention and needing demands. Even if you have help, it’s for sure everyone has constantly tired.
With that being said, the great majority of twin moms have very similar but more frequent or worst symptoms in the postpartum period; just like you would have more of your pregnancy complications with twins. You’re going to have more of your postpartum complications. They’re going to be worse in most cases.
SUNNY GAULT: I mean without getting too technical, what causes that? I’m just curious.
DR. WADE SCHWENDEMANN: It depends on the complication of course.
But, when you have twins you have:
• Twice as much baby
• Twice as much placenta
• Twice as much circulating hormones and a
• Substantial increase in the changes that go along with all of those things.
For example, an average person has there are blood volume goes from 5 years of blood to about 7 1/2 when you carry one baby. Well, it goes even higher or when you’re carrying twins and then the pregnant uterus compresses your blood vessels even more with twins than it does with one baby.
So, you end up with way more swelling with twins because the blood can’t get back through your heart as officially. That type of thing is what makes all of those changes happen.
SUNNY GAULT: Got it.
CHRISTINE STEWART-FITZGERALD: Twice as much of everything; we know the pregnancy morning sickness intensified. So, getting your body back – it’s just taking; does it take longer?
DR. WADE SCHWENDEMANN: It depends. I think it’s harder. It takes more effort. I think it does take a little bit longer to recover because it takes your body longer to return to its pre-pregnancy state. For example, say you’re worried about breast engorgement for example. You’re breastfeeding and then you stopped whatever you choose to stop breastfeeding whether it’s six months or a year to years or whatever it is – that’s fine.
But, it’s going to take longer for that to go down because you’ve been using it more and doing it more.
CHRISTINE STEWART-FITZGERALD: Then, you mentioned you got the blood circulating; I didn’t realize that’s pretty significant if you’re getting what 30% more blood volume somewhere in there. So, does that also mean that – in the immediate period afterwards that you have a longer or more of the Lochia am I saying that right?
DR. WADE SCHWENDEMANN: Lochia is the right word. You do have a little bit more Lochia. Lochia refers to the bleeding that comes after delivery. Most of that comes from the sloughing of the lining of the uterus. So, there’s a slight a bit more because the placenta’s bigger. So, there’s more of the placental surface area attachment. So, you ended up having a little bit more Lochia from that.
But, for example if your Anaemia of pregnancy where your blood gets thinner, that is going to be much more pronounced with twins rather than with a singleton and after delivery when you lose some blood, even if you happen to have Lochia and have a vaginal delivery with twins or if you have a C Section, you’re going to lose more blood.
So, your blood volume and your anaemia is going to be much more worst.
SHELLY STEELY: I actually ended up; I had a C Section and ended up haemorrhaging which I was going to ask if that was from increase risk because of the increase blood volume. I was anaemic for three months after delivery. I had to take iron supplements which they said was pretty common with twin deliveries.
CHRISTINE STEWART-FITZGERALD: It sounds like that’s something that twin moms really need to talk to their doctor. Maybe not even wait till the sixth week follow-up exam. But, so we can find out that are there things that they can do proactively? It might be anaemic.
DR. WADE SCHWENDEMANN: Absolutely there are. Yes, it’s always a great idea to talk to your doctor because nothing can replace that getting your questions answered and doctors – that’s our job. That’s what we love to do as explain; release me personally and hopefully, most of our colleagues. What we love to do is: “Explain what’s going on to help you understand the changes that your body’s going through and why they’re happening and what should we do about them.”
Most doctors if not all doctors were put twin moms on prophylactic iron even before delivery to kind of build up their blood count because we know that’s coming. To get to your question, it absolutely does increase the risk for postpartum bleeding when you carry twins because the uterus is over distended. It’s more full and bigger than it would be just one baby.
So, the uterus is a muscle so it needs to contract down to prevent postpartum haemorrhage or bleeding. If it doesn’t contract as efficiently because it’s stretched out, you have an increase for more blood loss. The average blood loss for the time of the caesarean section is 800 to a 1000 millilitres.
For moms with twins, it’s very easy for them to lose a 1.5 litters or more just because of the over dissention of the uterus because it’s more full, it’s harder for the uterus to clamp down all the way. So, you end up with greater blood loss. That greater blood volume isn’t replaced with blood and most cases because most people don’t want a blood transfusion and very few of them actually need one.
So, instead we replace that with fluid by doing so, we dilute moms’ blood even more until you get more anaemic. Because we’re placing more of that the fluid than we want of for our singleton, you end up with more Anaemia for twins.
CHRISTINE STEWART-FITZGERALD: That’s really good to know. Iron rich foods, what are some of your top favourites?
DR. WADE SCHWENDEMANN: Leafy green vegetables are the big thing aside from red meat. Things like broccoli and spinach are going to be very rich in iron. An important thing to know if you’re taking iron supplementation is that: “Iron is incredibly poorly absorbed by your stomach. It’s basically the last thing that get’s absorbed in.”
So, if you’re taking iron pills, you don’t want to take them with food or milk.
CHRISTINE STEWART-FITZGERALD: Really?
DR. WADE SCHWENDEMANN: Yes, because if you do that, you’re going to absorb other things first and all that’s going to happen is that the iron is just going to go through your GI track and not be absorbed as well. You’d end up with a lot more constipation without any real benefit.
CHRISTINE STEWART-FITZGERALD: I had no idea. I mean I’m just curious, anyone here?
MISHELL RUDDEN: I quit my iron because I was having issues with constipation. My doctor recommend it more an in and out burgers. So, that route.
DR. WADE SCHWENDEMANN: That is probably the first time I’ve heard that recommendation from a doctor.
CHRISTINE STEWART-FITZGERALD: Well, we’re talking about having C Sections because a lot of twin moms do end up having a C Section. What’s some of the best things we can do to help that incision site heal?
DR. WADE SCHWENDEMANN: The biggest thing is to help an incision site heal is to keep it clean and dry. Get it exposed to air as much as you can. You don’t want it to be covered up. It doesn’t have to be dressed. Usually, we take the dressing of after the first 12 to 24 hours after surgery and leave it open to the air.
CHRISTINE STEWART-FITZGERALD: Really?
DR. WADE SCHWENDEMANN: What you don’t want is that you don’t want – say you have a staple’s closing your incision. You don’t want those to get caught out into anything. So, you put a little pat over there to kind of cover it. But, take that off as much as you can.
It’s safe to shower the next day and you can wash it with your hands using soap and water. I would not let the showers treat them directly because that can cause it to separate. But, if you just hang it out with the water and back roll forward onto your front, use your hand and then blot it dry. Treat it like you would in any other open cut or sore.
CHRISTINE STEWART-FITZGERALD: It’s good to know. So, don’t keep it all bandaged out.
DR. WADE SCHWENDEMANN: In terms of the scar formation, there are some evidences that suggest that steroid shots will help to decrease that some of them are prone to keloiding or forming very thick scars. But, those are things that you really don’t do right away. Usually, there’s a coating that you can purchase and put that on a couple of weeks after.
CHRISTINE STEWART-FITZGERALD: Is that the key coat?
DR. WADE SCHWENDEMANN: There’s kilo coat and there’s another trademark brand out on the trademark.
CHRISTINE STEWART-FITZGERALD: If it’s a liquid, it’s a liquid silicone.
DR. WADE SCHWENDEMANN: There’s that one and then there’s also like a silicone patch that you can put it on as well.
SUNNY GAULT: That’s what I did. I did that this last time. I’ve had two C Sections; one with the twins and then one with the singleton. They didn’t do anything with my singleton and I actually got a free box of this stuff.
It’s just like a long band aid, stretchy kind of band aid. I don’t know. I guess normally, its two and a half month’s out. So, it’s kind of hard to tell.
DR. WADE SCHWENDEMANN: You really have to wait at least to six months to see if there’s any kind of difference at all. When you come in at your six week postpartum visit which I hear in your incision but your scar is not finished forming. Then, so it’s usually 3 to six months before you see the final scar.
CHRISTINE STEWART-FITZGERALD: Okay, I know you’re talking about keeping the incisions like open and dry. So, when can we start using some of those silicone treatments?
DR. WADE SCHWENDEMANN: Usually, you’d go around about four to six weeks.
CHRISTINE STEWART-FITZGERALD: Okay, how about for vaginal delivery? So, what are some of the best techniques to reduce the pain and inflammation in that area? Also, the perinatal stitches too?
DR. WADE SCHWENDEMANN: Well, the good news is that: “Almost everybody uses perinatal stitches that dissolve on their own.” You don’t have to have them taken out or removed in any way. The best way to avoid any sort of issues with wound breakdown or abnormal healing is to give it time to heal.
You can use spray bottles, if you put – if you have an incision near the urethra – those will help a lot because you’ll see some sinning and burning when you go to the bathroom. That can really help to kind of decrease that.
CHRISTINE STEWART-FITZGERALD: Spray bottles with water? Just clean water, okay.
DR. WADE SCHWENDEMANN: Also you would use like sit-spazz. You can do a little tub soaps to kind of cool things down a little bit.
CHRISTINE STEWART-FITZGERALD: So, not a warm bath just a cool bath.
DR. WADE SCHWENDEMANN: Just lukewarm water is fine.
CHRISTINE STEWART-FITZGERALD: Okay.
DR. WADE SCHWENDEMANN: The most important thing is not just started using [inaudible] again,
SUNNY GAULT: So, by that area.
CHRISTINE STEWART-FITZGERALD: No getting busy.
DR. WADE SCHWENDEMANN: Exactly, that’s generally the furthest thing from everybody’s mind when they’re a new mom but sometimes especially with twins, you might have been on bed rest or pelvic rest for 3 months, 4 months, 6 months and those dads can get to be kind of a bit just trouble.
CHRISTINE STEWART-FITZGERALD: How are you doing?
DR. WADE SCHWENDEMANN: Give yourself at least four to six weeks to heal. The bigger the tear the longer it takes to heal.
CHRISTINE STEWART-FITZGERALD: Are there any ointments or even I’ve seen inflammation. I think I’ve heard some natural treatments like with Arnica some of the natural
SUNNY GAULT: The homeopaths.
CHRISTINE STEWART-FITZGERALD: Homeopathic type of treatments.
DR. WADE SCHWENDEMANN: I’m not familiar with that. When it comes to medications like that, a lot of times there’s work for me and it’s what we call anecdotal evidence. But, I’m one of those people who’s not opposed to something that you wanted to try as long as it’s safe.
I’m also not aware of anything wrong with trying things like that. So, I think it’s perfectly fine to do it as long as you’re comfortable with it. It doesn’t cause you any side effects. I think it can be very useful.
CHRISTINE STEWART-FITZGERALD: Definitely.
SUNNY GAULT: Christine, you were talking about tearing. I’m just curious for our twin mamas out there that gave birth vaginally, is there anything statistics-wise or anything that shows us that twin moms tear more because there are two babies? They’re obviously not coming at the same time. But, because there’s more pressure or whatever
CHRISTINE STEWART-FITZGERALD: Two birds, you’re doing it twice
DR. WADE SCHWENDEMANN: Well, generally with twin moms; a lot of the tearing depends on whether it’s your first baby or not and if it’s not your first baby while you have a tear with your first one – size of the babies, that sort of thing. I don’t think that there’s any evidence that I’m aware of that mom’s with twins will have a more extensive tear.
Certainly, one thing that’s interesting and at least to think about is sometimes – moms with twins will deliver the first baby head down and the second baby breached. But, that also has not been shown to increase the risk of tearing.
Occasionally, you’ll see a scenario in which moms of twins will deliver their first baby and then it will be okay and then the second baby will require some assistance maybe with a vacuum or forceps rather than going to a C Section.
So, an operative delivery is going to increase service for tears as well. So, you have a higher chance for that especially for that second baby. The last thing we want is for mom to have a great, normal, vaginal delivery at the first baby and then having an emergency delivery at the second one. We really don’t want that to happen.
So, unfortunately the published statistics would caught your risk about 10 to 20 % for that to happen mostly because of the challenges to the second baby in descending quickly and you can see changes in the heart rate that kind of thing. So, it’s unlikely.
It’s rare but it does happen. So, it’s one of those things that has at least [inaudible] your mind when you’re considering on whether or not to have a C Section for your twins just to start with.
CHRISTINE STEWART-FITZGERALD: In overall, recovery I think that’s what we could talk about the differences and just recovery time for vaginal delivery versus a C Section. I think statistically, C Sections do take a little bit longer over all.
DR. WADE SCHWENDEMANN: Absolutely. I would say in most cases, mom with a vaginal delivery is really feeling pretty good by week two in a lot of cases. They’re up in walking and moving sometimes three. But, it takes 6 to 12 weeks to fully heal from a C Section.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. WADE SCHWENDEMANN: When a mom has a caesarean delivery, we generally recommend no directive abdominal workout or anything like that for 12 weeks.
CHRISTINE STEWART-FITZGERALD: Well, when we come back we’re going to talk about: “A common complaint that doesn’t have to be permanent.”
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Well, welcome back. So, today we’re talking about: “Postpartum recovery after twins in the first six weeks” with Wade Schwendemann.
Our discussion continues as we look at some common problems that many twin moms experience. Lots of times the moms, even a few months out and it goes: “My gosh. I look like I’m still pregnant.”
SUNNY GAULT: I’m in that stage right now. Like four months, I look like I’m about four months pregnant.
CHRISTINE STEWART-FITZGERALD: Still wearing maternity clothes. It’s like: “When is this belly going to go back to what it was?” The uterus is extended and the body is still reshaping. So, how can they help bring it back to its non-pregnancy size?
DR. WADE SCHWENDEMANN: Well, the uterus itself gets back to its non pregnancy size pretty quickly. Usually it’s back by six weeks in terms of the contractions that the uterus has done. What happens is that for a lot of women in pregnancy is that: “The pregnant uterus and especially in twin moms, the pregnancy will kind of separate the muscles of the midline” those muscles that give you all the six pack; not me personally but everybody else.
SUNNY GAULT: You’re no favour have those muscles.
DR. WADE SCHWENDEMANN: I never did. But, they’ll start to separate in the middle. Your body is expanding and the twin pregnancy needs more space. The space has to come from somewhere. So, if you can’t go up because it’s block by your diaphragm and your lungs; you can’t go back because your spine and ribs are there. It has to go forward.
So, by separating the muscles that the space gets a lot larger in the more potential space exist and so the twin pregnancy can continue to grow to the appropriate level. Then, that makes us very happy because we’re like purple ground babies. But, putting it back together is difficult because if you have a C Section, sometimes the doctors will put in an extra stitch in and kind of bring the muscles back together for you.
I’d like to make a joke to that covers about 500 sit-ups or so. But really just using those muscles is the way to bring them back. So, luckily for you – for moms, when you’re carrying the baby around in your arms or using your core muscles to hold that baby not just using your arms to hold the baby.
So, you’re bringing those muscles together even when you don’t realize you’re exercising them. So, it comes back. But, if you give you those orders; no direct crunches for 12 weeks, it’s going to take a long time.
SHELLY STEELY: Well, I think a part of it for me. I mean the uterus takes a while to go back down but that’s skin that’s stretches, it doesn’t disappear. You still have that. I definitely do not have the stomach that I used to have anymore. But even more so because of how much that extra skin that kind of doesn’t it’s never really going to go away; so, you kind of end up with this.
It’s like when we’re talking about scars, you can even see my scar with it goes my skin that hangs over it after delivering but that’s kind of something unless somebody wants to offer me like an all expense paid spa-cosmetic surgery procedure. You just kind of to deal with.
CHRISTINE STEWART-FITZGERALD: Now, earlier you had mentioned the separation of the abdominal muscles, can you tell us a little bit more about that? What do we call that?
DR. WADE SCHWENDEMANN: So, we call that – technically it’s called Diastasis Recti. The Recti refers to the Rectus Abdominis Muscle, the muscles that run up and down in the middle of your body and diastasis means separation or opening. It means that basically separated in the midline.
It happens for a variety of reasons at the time of the caesarean delivery which unfortunately a lot of twin moms do go through. You have to separate those muscles to deliver the twins; just carrying the pregnancy a lot of the time to be enough to cause those two muscles to separate in the midline or kind of mirror image or just one on each side.
Things to do that help the abdominal binders is definitely going to help bring those muscles back together. A lot of doctors will kind of bring the muscles back together at the time of the C section if you have one.
CHRISTINE STEWART-FITZGERALD: So, you can actually ask your doctor. If you know you’re going to have a C Section, then you could actually say: “Can we get the stitches ahead of time?” I think I’ve heard that while you’re in there.
DR. WADE SCHWENDEMANN: A lot of women ask for stitches to put the muscles back together and we can absolutely do that. A lot of women ask for a tummy tuck while they’re there.
MISHELL RUDDEN: Have you thought about offering that?
SUNNY GAULT: Seriously, an option that we could.
DR. WADE SCHWENDEMANN: That is not an option.
SUNNY GAULT: You can talk with another doctor. You don’t have to do it, just get a plastic surgeon in there at the same time.
DR. WADE SCHWENDEMANN: Unfortunately, because we’re [inaudible] uterus; it’s a slightly higher risk for infection and so, you don’t want to take out skin tissue and put things under tension because the risk for the wound to breakdown is just way too high.
SUNNY GAULT: So, there’s a real reason for it.
DR. WADE SCHWENDEMANN: There’s an actual medical reason not to do it. I may never be genius if I can find a way to do that and not increase my infection rate. I’d be able to retire.
SUNNY GAULT: Right.
CHRISTINE STEWART-FITZGERALD: But, you can bring the muscles back at least the internal part and then maybe we kind of back and get the whole – sort of the skin part later on, right?
DR. WADE SCHWENDEMANN: I recommend waiting into you’re completely done with deliveries, all deliveries before you do the skin part.
CHRISTINE STEWART-FITZGERALD: So, the baby making’s done.
DR. WADE SCHWENDEMANN: Right, let’s get all of your children and you sure you don’t want any more then go ahead and then get that affixed if you want to. But absolutely, we can put the muscles back together in the midline. Now, in terms of science, there is no scientific evidence that suggested in that it actually helps in any sort of recovery process or anything like that.
But again, speaking to twin moms; anyone who has had it or even non twin moms would – speaking to twin moms, anyone who has had it generally is a little happier than anyone who has it.
CHRISTINE STEWART-FITZGERALD: Well, you’re bringing it back so it helps everything. You get a flatter stomach, right?
DR. WADE SCHWENDEMANN: Absolutely, right.
CHRISTINE STEWART-FITZGERALD: I think there are a lot of things you can do on the non-surgical side. I’ll just say for me, personally I got physical therapy after my twin pregnancy and after my singleton too. So, we’ve worked on the Diastasis Recti and just through they call it “belly breathing.” It’s just this focusing on this really internal muscles and kind of imagining you’re zipping them up and bringing them together.
So, my physical therapist says: “It’s such a simple thing but if you do it every day, it’s really effective.” So, it’s okay. I put stickers. Okay, breathe. Switching gears a little bit, I think on the other side of recovery, we know a lot of new moms experienced fatigue especially twin moms. So, aside from not giving enough sleep the biggest complaint, are there some other reasons that might be causing that fatigue?
DR. WADE SCHWENDEMANN: There are. Certainly, we talked about Anaemia for a fair bit of time and any sort of Anaemia, if your body’s not able to carry; if your blood count is low – Anaemia means a low blood count. If your blood count is low, you’re not going to be able to carry as much as oxygen to your cells and as you otherwise could.
The problem with that of course is that every cell needs oxygen to function, so without it; you can’t function as efficiently as you otherwise would. So, some of the things that can – for example we talked about ways to address Anaemia with iron rich foods, often iron supplementation.
It’s impossible to do but getting out a quick sleep is critical to letting your brain function. We talked about calories and making sure that you’re actually eating enough. It’s very easy to be tired because if you eat as much when you’re two weeks postpartum as you ate when you were two weeks before delivery, it’s not going to be enough. You need more energy particularly if you’re breastfeeding.
CHRISTINE STEWART-FITZGERALD: Twins, yes absolutely.
DR. WADE SCHWENDEMANN: For a lot of women, so your diet is 1800 to 2000 calories a day. All of a sudden you’re postpartum with twins and you eat almost 3000. It’s incredibly important to do that.
CHRISTINE STEWART-FITZGERALD: So, eating and hydration. I mean I know when I was breastfeeding
SUNNY GAULT: That will kill your milk supply if you do not drink water. Even though you want to drink coffee like I want to drink coffee because I’m tired, I’ve got some stuff done but I have to like push the coffee away and drive pass Starbucks.
SHELLY STEELY: Wasn’t there just a new study that said that coffee is just as hydrating as water? I swear I saw that in the news. I’m not even joking. We should look in to this.
CHRISTINE STEWART-FITZGERALD: I don’t know but I’m buying it. Yes, coffee, water
MISHELL RUDDEN: If you’re getting like a latte, there’s a lot of milk. Milk’s pretty hydrating.
CHRISTINE STEWART-FITZGERALD: Sure, that’s we’re talking about survival here.
DR. WADE SCHWENDEMANN: I’m pretty sure that caffeine is a diuretic which means it’s going to make you pee more and make you a little more dehydrated. So, while you first drink it, I think you might feel the same type of hydration.
But, I think after a little while especially if you’re on your second or third cup because you’re really tired. I think I’d just stick to water.
CHRISTINE STEWART-FITZGERALD: Yes, definitely. Well, thanks so much Dr. Schwendemann for joining us today. I really appreciate all of your insights. For more information about the postpartum recovery after twins in the first six weeks or for more information about any of our expert panellist, visit our episode page on our website.
So, this conversation continues for members of our Twin Talks Club. After the show, Dr. Schwendemann will tell us about: “A common postpartum recovery practice found in Asia.” So, for more information about the Twin Talks Club, visit our website www.TwinTalks.com
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Okay, today we have a special segment called Twin Oops. This is stories about the twins that only twin parents can really appreciate and if you’ve got a Twin Oops that you’d like to share, give us a call on our voicemail at 619-866-4775 or you can now post it on our Facebook page.
We’ve got a note from Caroline in Louisiana. She wrote:
“My two-year old babies are obsessed with Sanitary towels and tampons. No matter where I hide them, they find them. They love unwrapping the towels and sticking them just about anywhere. I think tampons are large party poppers.
I can just live with all the mess they create but recently, I was waiting for a TV engineer to call. I waited in all day and the boys were restless and had unwrapped just about every towel and tampon incite for amusement. I clean it up for them just in case the door bell rang. It finally did ring.
The engineer came in and I just followed him into the lounge and I saw a towel complete with wings stuck to the wall above the sofa. How does this guy didn’t see it was beyond me? But, I never moved so fast and have never felt so embarrassed.
So, I can laugh now but at the time, I was mortified. I’m sure he never saw it because he did not flinched or look or act awkwardly and I’m sure seeing a winged towel on display in someone’s lounge like a treasured photo is not an everyday occurrence.”
-Caroline
CHRISTINE STEWART-FITZGERALD: So, that wraps up our show for today. We appreciate you listening to Twin Talks. Join in on the discussion by posting your comments on the Twin Talks Facebook page or you can call our voice mail at 619-866-4775.
Don’t forget to check our sister shows:
• Preggie Pals for expecting parents
• The Boob Group for moms who breastfeed their babies
• Parent Savers, it’s an online support group for the new parents.
This is Twin Talks, parenting times two.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line-up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or an organization interested in our network of our shows through a cobranded podcasts, visit www.NewMommyMedia.com .
[00:35:19]
[End of Audio]
Episode Transcript
Twin Talks
Postpartum Care and Recovery After Twins
[00:00:00]
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
DR. WADE SCHWENDEMANN: If you are pregnant with twins now, you are most likely focused on staying healthy and anticipating the arrival of your twins. But, what about your health immediately after giving birth? What can you expect? How does your recovering body after twins compare to the recovery from a singleton pregnancy?
I’m Dr. Wade Schwendemann, perinatologist for Sharp Mary Birch in the San Diego Perinatal Centre and I’m here to talk about: “Postpartum recovery after twins, the first six weeks.” This is Twin Talks Episode Number Eleven.
[Theme Music/Intro]
CHRISTINE STEWART-FITZGERALD: If you’re pregnant with twins or you’re an experienced twin parent, odds are you have heard it all before. Now, it’s time to hear from the experts. This is Twin Talks, parenting times two.
Welcome to Twin Talks broadcasting from the Birth Education Centre of San Diego. Twin Talks is your weekly online on-the-go support group for expecting and new parents to twins. So, I’m your host Christine Stewart-Fitzgerald.
Have you heard about the Twin Talks Club? Our members get bonus content after each new show plus special giveaways and discounts. Subscribe to our monthly Twin Talks Newsletter and learn about the latest episodes available.
Another way you can stay connected is by downloading our free Twin Talks app available on the Android and iTunes Marketplace. I will turn it over to Shelly our producer to tell you about our special program.
SHELLY STEELY: Hi. So, you can follow us on Twitter or like us on Facebook at Twin Talks or you can join on the conversation at home using hash tag #TwinTalksVP. We’ve also got a new promotion where you can actually win a free one month membership to Twin Talks just by following along at home.
CHRISTINE STEWART-FITZGERALD: Thank you. Well, before we dive into our discussion. We’ve got some panellists here. So, I’d like to do a little introduction here. I’ll start with Sunny. Welcome.
SUNNY GAULT: Welcome to the club. Last time, we were talking I was pregnant with twins and now they are here in the flesh. Exciting stuff – so, I’m a mommy of four now. I have two little boys at home; Sayer who is three, Urban is just about 21 months now.
Once I get into those upper years and half, two year marks – I forget the months. Then, my girls I guess they’re infants now although it’s so sad I like calling them newborns. They are just over two months old; twin girls, identicals.
CHRISTINE STEWART-FITZGERALD: I can see you’re keeping them apart with the toe nail polish.
SUNNY GAULT: Yes and I have a kind of a funny story, a real quick about that. I really like the idea but I was doing this little wrist band different colours. They still have the wristbands on them because at a glimpse, I wanted to see who was who. I really can’t tell. It sounds horrible but I really can’t still tell.
CHRISTINE STEWART-FITZGERALD: You’re a horrible mom.
SUNNY GAULT: Well, one day I was changing the ribbons and I lost the ribbons and I didn’t know who was who and for four days, I was calling the child by the wrong name. I ended up going to our paediatrician and they were just slightly – their weight was just a little bit different. That’s how I now know, who’s who.
So, my fail-safe now is the toe nail polish. But, I’m still doing the ribbons. I don’t want everyone to have to pull off their sock to see who it is, right?
CHRISTINE STEWART-FITZGERALD: That’s a great story for our Pregnancy Oops.
SUNNY GAULT: I know. I probably share that on that.
SHELLY STEELY: Hi. I’m Shelly the producer here. I have identical twin boys who are a year and a half now; Greyson and Sawyer getting into everything. I’m actually expecting my third.
CHRISTINE STEWART-FITZGERALD: Just one.
SHELLY STEELY: Just one this time. I’m really excited about that.
CHRISTINE STEWART-FITZGERALD: Just one. Okay.
MISHELL RUDDEN: My name is Mishell Rudden and I’m 34 years old. I work as a part time as a kindergarten children. I’m also the mother to Sunny and Mathew; my 21 month old boy-girl twins.
CHRISTINE STEWART-FITZGERALD: All right. As your host, so, I’m Christine Stewart-Fitzgerald and I’ve got four year old identical girls. I also have a singleton who is now 15 months. So, I just have to say: “I hear these stories about the preschoolers and the interaction.” Gosh, my girls they just spend so much time with each other. It’s so hard to get their attention right now. So, that’s my biggest challenge. Hello, I’m over here.
[Theme Music]
So, today we’re going to review an app and it’s called GS Preschool Games. It’s found in the Android Marketplace as well as in iTunes. It’s for preschoolers and it’s got an educational focus. I’m going to toss it out to our panellists here who’ve had a chance to take a look. What do you guys think?
MISHELL RUDDEN: I like the games a lot. They’re really simple. It’s a lot of touch the largest item. Touch the smallest item. So, comparisons which doesn’t fit in, which is the same and which are really good activities to do for little ones.
There’s also puzzle pieces but just real small only. Three pieces at the time which I think might be better for the younger preschoolers definitely.
CHRISTINE STEWART-FITZGERALD: The fact that – the assortment of games. I think there’s total of 10 games within the whole package.
MISHELL RUDDEN: They all really simple bright colours, easy to pick the pictures. So, that’s a definitely plus.
CHRISTINE STEWART-FITZGERALD: Yes, definitely. Because you guys are they are in a year in a half. So, if they were able to do that on a phone. It sounds like; we’ve got some mid ranged.
SUNNY GAULT: I was playing around with it. First thing, you mention Christine, the bright colours. I think that that’s really eye-catching. I think my toddler would really appreciate this illustrations whatever really cute. I don’t know. My kids like illustrations of other kids and stuff. There are a lot of kids playing games and whatever that’s kind of cool.
I notice my older son loves to play puzzles. There are some games in here that kind of mimic what a puzzle would do. You’re trying to build an image of an elephant. When you’ve got all these squares and they’re all mixed up. They’re trying to mix and match them so it makes an elephant. Well, my son has a puzzle like that at home and he loves it.
So, this is kind of a nice on-the-go type of thing where I don’t want to take a puzzle out in the car. Can you imagine puzzle pieces everywhere? It would be nice to just take this and they can kind of do the same kind of thing incognitively? I’m not a doctor, Mister Schwendemann. I can give you all the specifics on that.
But, I do think I would have to get another phone though because I think both of my little boys would fight over this. It’s like whenever one person wants it then the other person wants it as well. I would think: “When the twins are old enough to do this, it might be a show.”
MISHELL RUDDEN: We actually, my husband and I instead of trading in our phones when we upgraded; kept the old ones both of them. We would have gotten the trade-in credit but the flipside is now, each of my toddlers have their own play phone that’s loaded with apps.
SUNNY GAULT: So, you can do the app usually you don’t have to pay for a thing.
MISHELL RUDDEN: Once you deactivate your contract on the phone, you can just turn the wifi on and it works just like an iPad.
SHELLY STEELY: That is really smart.
MISHELL RUDDEN: They don’t care that it’s not the newest version. They will just hand it. It plays music and they can play games on it too.
SUNNY GAULT: Yes, totally.
CHRISTINE STEWART-FITZGERALD: I downloaded it and I give it to my four year old. They’ve been pretty good at getting right. They just jump right into it. It amazes me how kids need no instruction whatsoever.
SUNNY GAULT: It has to be intuitive in order for kids to use this. They have to be able to figure it out.
CHRISTINE STEWART-FITZGERALD: I felt like it’s also something. It’s not just entertainment but they are actually learning and developing their skills. Now, that’s great. Now, my only complaint though is that: “What I notice is that if they answer a few of these questions, they perform some of these actions then it gives a little of pop up screen. Hey, congrats. You did it fantastic. Then you have to click the screen to advance to the next question.” So, that’s a little bit tedious.
There are also some pop up ads for free software. I found it covers – it’s very difficult to get rid of that, the pop ups screen. So, within less than 10 minutes; I had to assist my girls in getting rid of the screen. In fact they actually started to download some software on my phone.
SUNNY GAULT: My gosh
MISHELL RUDDEN: Is this free software?
CHRISTINE STEWART-FITZGERALD: Yes.
SUNNY GAULT: That would be the next question. So, they’re in charge or anything to your phone and doing it and it was some sort of software or something.
CHRISTINE STEWART-FITZGERALD: It’s a free software. But, it does make me very nervous knowing that they have the ability to just start downloading things onto my phone. I happen to be there.
SHELLY STEELY: I actually notice similar problems. I just in playing around whether that I tried to click the X Screen and I ended up with a weight loss advertisement. Not what I need right now. So, that was a little bit just not what I want to see inside a kids’ app necessarily.
I would love to see an upgrade, an ad-free one. It’s a definitely a good enough app. I would be willing to pay for it if they have that available.
SUNNY GAULT: All right. Were we going to give these two thumbs up then?
CHRISTINE STEWART-FITZGERALD: Two thumbs up. All right; today’s topic is: “Postpartum recovery after twins in the first six weeks.” We’re talking with Dr. Wade Schwendemann who’s explaining some of the common postpartum complaints and giving us some tips on the faster recovery. So, hey thanks for joining us Dr. Schwendemann.
DR. WADE SCHWENDEMANN: Thanks for having me. I appreciate it.
CHRISTINE STEWART-FITZGERALD: You see women throughout the different stages of pregnancy. Once they have the baby, what’s the biggest complaint that you hear from the twin moms especially?
DR. WADE SCHWENDEMANN: Without a doubt, the biggest complaint that we hear is: “Lack of sleep.” It’s bad for moms with singleton. But, once you have two babies that needed your attention and needing demands. Even if you have help, it’s for sure everyone has constantly tired.
With that being said, the great majority of twin moms have very similar but more frequent or worst symptoms in the postpartum period; just like you would have more of your pregnancy complications with twins. You’re going to have more of your postpartum complications. They’re going to be worse in most cases.
SUNNY GAULT: I mean without getting too technical, what causes that? I’m just curious.
DR. WADE SCHWENDEMANN: It depends on the complication of course.
But, when you have twins you have:
• Twice as much baby
• Twice as much placenta
• Twice as much circulating hormones and a
• Substantial increase in the changes that go along with all of those things.
For example, an average person has there are blood volume goes from 5 years of blood to about 7 1/2 when you carry one baby. Well, it goes even higher or when you’re carrying twins and then the pregnant uterus compresses your blood vessels even more with twins than it does with one baby.
So, you end up with way more swelling with twins because the blood can’t get back through your heart as officially. That type of thing is what makes all of those changes happen.
SUNNY GAULT: Got it.
CHRISTINE STEWART-FITZGERALD: Twice as much of everything; we know the pregnancy morning sickness intensified. So, getting your body back – it’s just taking; does it take longer?
DR. WADE SCHWENDEMANN: It depends. I think it’s harder. It takes more effort. I think it does take a little bit longer to recover because it takes your body longer to return to its pre-pregnancy state. For example, say you’re worried about breast engorgement for example. You’re breastfeeding and then you stopped whatever you choose to stop breastfeeding whether it’s six months or a year to years or whatever it is – that’s fine.
But, it’s going to take longer for that to go down because you’ve been using it more and doing it more.
CHRISTINE STEWART-FITZGERALD: Then, you mentioned you got the blood circulating; I didn’t realize that’s pretty significant if you’re getting what 30% more blood volume somewhere in there. So, does that also mean that – in the immediate period afterwards that you have a longer or more of the Lochia am I saying that right?
DR. WADE SCHWENDEMANN: Lochia is the right word. You do have a little bit more Lochia. Lochia refers to the bleeding that comes after delivery. Most of that comes from the sloughing of the lining of the uterus. So, there’s a slight a bit more because the placenta’s bigger. So, there’s more of the placental surface area attachment. So, you ended up having a little bit more Lochia from that.
But, for example if your Anaemia of pregnancy where your blood gets thinner, that is going to be much more pronounced with twins rather than with a singleton and after delivery when you lose some blood, even if you happen to have Lochia and have a vaginal delivery with twins or if you have a C Section, you’re going to lose more blood.
So, your blood volume and your anaemia is going to be much more worst.
SHELLY STEELY: I actually ended up; I had a C Section and ended up haemorrhaging which I was going to ask if that was from increase risk because of the increase blood volume. I was anaemic for three months after delivery. I had to take iron supplements which they said was pretty common with twin deliveries.
CHRISTINE STEWART-FITZGERALD: It sounds like that’s something that twin moms really need to talk to their doctor. Maybe not even wait till the sixth week follow-up exam. But, so we can find out that are there things that they can do proactively? It might be anaemic.
DR. WADE SCHWENDEMANN: Absolutely there are. Yes, it’s always a great idea to talk to your doctor because nothing can replace that getting your questions answered and doctors – that’s our job. That’s what we love to do as explain; release me personally and hopefully, most of our colleagues. What we love to do is: “Explain what’s going on to help you understand the changes that your body’s going through and why they’re happening and what should we do about them.”
Most doctors if not all doctors were put twin moms on prophylactic iron even before delivery to kind of build up their blood count because we know that’s coming. To get to your question, it absolutely does increase the risk for postpartum bleeding when you carry twins because the uterus is over distended. It’s more full and bigger than it would be just one baby.
So, the uterus is a muscle so it needs to contract down to prevent postpartum haemorrhage or bleeding. If it doesn’t contract as efficiently because it’s stretched out, you have an increase for more blood loss. The average blood loss for the time of the caesarean section is 800 to a 1000 millilitres.
For moms with twins, it’s very easy for them to lose a 1.5 litters or more just because of the over dissention of the uterus because it’s more full, it’s harder for the uterus to clamp down all the way. So, you end up with greater blood loss. That greater blood volume isn’t replaced with blood and most cases because most people don’t want a blood transfusion and very few of them actually need one.
So, instead we replace that with fluid by doing so, we dilute moms’ blood even more until you get more anaemic. Because we’re placing more of that the fluid than we want of for our singleton, you end up with more Anaemia for twins.
CHRISTINE STEWART-FITZGERALD: That’s really good to know. Iron rich foods, what are some of your top favourites?
DR. WADE SCHWENDEMANN: Leafy green vegetables are the big thing aside from red meat. Things like broccoli and spinach are going to be very rich in iron. An important thing to know if you’re taking iron supplementation is that: “Iron is incredibly poorly absorbed by your stomach. It’s basically the last thing that get’s absorbed in.”
So, if you’re taking iron pills, you don’t want to take them with food or milk.
CHRISTINE STEWART-FITZGERALD: Really?
DR. WADE SCHWENDEMANN: Yes, because if you do that, you’re going to absorb other things first and all that’s going to happen is that the iron is just going to go through your GI track and not be absorbed as well. You’d end up with a lot more constipation without any real benefit.
CHRISTINE STEWART-FITZGERALD: I had no idea. I mean I’m just curious, anyone here?
MISHELL RUDDEN: I quit my iron because I was having issues with constipation. My doctor recommend it more an in and out burgers. So, that route.
DR. WADE SCHWENDEMANN: That is probably the first time I’ve heard that recommendation from a doctor.
CHRISTINE STEWART-FITZGERALD: Well, we’re talking about having C Sections because a lot of twin moms do end up having a C Section. What’s some of the best things we can do to help that incision site heal?
DR. WADE SCHWENDEMANN: The biggest thing is to help an incision site heal is to keep it clean and dry. Get it exposed to air as much as you can. You don’t want it to be covered up. It doesn’t have to be dressed. Usually, we take the dressing of after the first 12 to 24 hours after surgery and leave it open to the air.
CHRISTINE STEWART-FITZGERALD: Really?
DR. WADE SCHWENDEMANN: What you don’t want is that you don’t want – say you have a staple’s closing your incision. You don’t want those to get caught out into anything. So, you put a little pat over there to kind of cover it. But, take that off as much as you can.
It’s safe to shower the next day and you can wash it with your hands using soap and water. I would not let the showers treat them directly because that can cause it to separate. But, if you just hang it out with the water and back roll forward onto your front, use your hand and then blot it dry. Treat it like you would in any other open cut or sore.
CHRISTINE STEWART-FITZGERALD: It’s good to know. So, don’t keep it all bandaged out.
DR. WADE SCHWENDEMANN: In terms of the scar formation, there are some evidences that suggest that steroid shots will help to decrease that some of them are prone to keloiding or forming very thick scars. But, those are things that you really don’t do right away. Usually, there’s a coating that you can purchase and put that on a couple of weeks after.
CHRISTINE STEWART-FITZGERALD: Is that the key coat?
DR. WADE SCHWENDEMANN: There’s kilo coat and there’s another trademark brand out on the trademark.
CHRISTINE STEWART-FITZGERALD: If it’s a liquid, it’s a liquid silicone.
DR. WADE SCHWENDEMANN: There’s that one and then there’s also like a silicone patch that you can put it on as well.
SUNNY GAULT: That’s what I did. I did that this last time. I’ve had two C Sections; one with the twins and then one with the singleton. They didn’t do anything with my singleton and I actually got a free box of this stuff.
It’s just like a long band aid, stretchy kind of band aid. I don’t know. I guess normally, its two and a half month’s out. So, it’s kind of hard to tell.
DR. WADE SCHWENDEMANN: You really have to wait at least to six months to see if there’s any kind of difference at all. When you come in at your six week postpartum visit which I hear in your incision but your scar is not finished forming. Then, so it’s usually 3 to six months before you see the final scar.
CHRISTINE STEWART-FITZGERALD: Okay, I know you’re talking about keeping the incisions like open and dry. So, when can we start using some of those silicone treatments?
DR. WADE SCHWENDEMANN: Usually, you’d go around about four to six weeks.
CHRISTINE STEWART-FITZGERALD: Okay, how about for vaginal delivery? So, what are some of the best techniques to reduce the pain and inflammation in that area? Also, the perinatal stitches too?
DR. WADE SCHWENDEMANN: Well, the good news is that: “Almost everybody uses perinatal stitches that dissolve on their own.” You don’t have to have them taken out or removed in any way. The best way to avoid any sort of issues with wound breakdown or abnormal healing is to give it time to heal.
You can use spray bottles, if you put – if you have an incision near the urethra – those will help a lot because you’ll see some sinning and burning when you go to the bathroom. That can really help to kind of decrease that.
CHRISTINE STEWART-FITZGERALD: Spray bottles with water? Just clean water, okay.
DR. WADE SCHWENDEMANN: Also you would use like sit-spazz. You can do a little tub soaps to kind of cool things down a little bit.
CHRISTINE STEWART-FITZGERALD: So, not a warm bath just a cool bath.
DR. WADE SCHWENDEMANN: Just lukewarm water is fine.
CHRISTINE STEWART-FITZGERALD: Okay.
DR. WADE SCHWENDEMANN: The most important thing is not just started using [inaudible] again,
SUNNY GAULT: So, by that area.
CHRISTINE STEWART-FITZGERALD: No getting busy.
DR. WADE SCHWENDEMANN: Exactly, that’s generally the furthest thing from everybody’s mind when they’re a new mom but sometimes especially with twins, you might have been on bed rest or pelvic rest for 3 months, 4 months, 6 months and those dads can get to be kind of a bit just trouble.
CHRISTINE STEWART-FITZGERALD: How are you doing?
DR. WADE SCHWENDEMANN: Give yourself at least four to six weeks to heal. The bigger the tear the longer it takes to heal.
CHRISTINE STEWART-FITZGERALD: Are there any ointments or even I’ve seen inflammation. I think I’ve heard some natural treatments like with Arnica some of the natural
SUNNY GAULT: The homeopaths.
CHRISTINE STEWART-FITZGERALD: Homeopathic type of treatments.
DR. WADE SCHWENDEMANN: I’m not familiar with that. When it comes to medications like that, a lot of times there’s work for me and it’s what we call anecdotal evidence. But, I’m one of those people who’s not opposed to something that you wanted to try as long as it’s safe.
I’m also not aware of anything wrong with trying things like that. So, I think it’s perfectly fine to do it as long as you’re comfortable with it. It doesn’t cause you any side effects. I think it can be very useful.
CHRISTINE STEWART-FITZGERALD: Definitely.
SUNNY GAULT: Christine, you were talking about tearing. I’m just curious for our twin mamas out there that gave birth vaginally, is there anything statistics-wise or anything that shows us that twin moms tear more because there are two babies? They’re obviously not coming at the same time. But, because there’s more pressure or whatever
CHRISTINE STEWART-FITZGERALD: Two birds, you’re doing it twice
DR. WADE SCHWENDEMANN: Well, generally with twin moms; a lot of the tearing depends on whether it’s your first baby or not and if it’s not your first baby while you have a tear with your first one – size of the babies, that sort of thing. I don’t think that there’s any evidence that I’m aware of that mom’s with twins will have a more extensive tear.
Certainly, one thing that’s interesting and at least to think about is sometimes – moms with twins will deliver the first baby head down and the second baby breached. But, that also has not been shown to increase the risk of tearing.
Occasionally, you’ll see a scenario in which moms of twins will deliver their first baby and then it will be okay and then the second baby will require some assistance maybe with a vacuum or forceps rather than going to a C Section.
So, an operative delivery is going to increase service for tears as well. So, you have a higher chance for that especially for that second baby. The last thing we want is for mom to have a great, normal, vaginal delivery at the first baby and then having an emergency delivery at the second one. We really don’t want that to happen.
So, unfortunately the published statistics would caught your risk about 10 to 20 % for that to happen mostly because of the challenges to the second baby in descending quickly and you can see changes in the heart rate that kind of thing. So, it’s unlikely.
It’s rare but it does happen. So, it’s one of those things that has at least [inaudible] your mind when you’re considering on whether or not to have a C Section for your twins just to start with.
CHRISTINE STEWART-FITZGERALD: In overall, recovery I think that’s what we could talk about the differences and just recovery time for vaginal delivery versus a C Section. I think statistically, C Sections do take a little bit longer over all.
DR. WADE SCHWENDEMANN: Absolutely. I would say in most cases, mom with a vaginal delivery is really feeling pretty good by week two in a lot of cases. They’re up in walking and moving sometimes three. But, it takes 6 to 12 weeks to fully heal from a C Section.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. WADE SCHWENDEMANN: When a mom has a caesarean delivery, we generally recommend no directive abdominal workout or anything like that for 12 weeks.
CHRISTINE STEWART-FITZGERALD: Well, when we come back we’re going to talk about: “A common complaint that doesn’t have to be permanent.”
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Well, welcome back. So, today we’re talking about: “Postpartum recovery after twins in the first six weeks” with Wade Schwendemann.
Our discussion continues as we look at some common problems that many twin moms experience. Lots of times the moms, even a few months out and it goes: “My gosh. I look like I’m still pregnant.”
SUNNY GAULT: I’m in that stage right now. Like four months, I look like I’m about four months pregnant.
CHRISTINE STEWART-FITZGERALD: Still wearing maternity clothes. It’s like: “When is this belly going to go back to what it was?” The uterus is extended and the body is still reshaping. So, how can they help bring it back to its non-pregnancy size?
DR. WADE SCHWENDEMANN: Well, the uterus itself gets back to its non pregnancy size pretty quickly. Usually it’s back by six weeks in terms of the contractions that the uterus has done. What happens is that for a lot of women in pregnancy is that: “The pregnant uterus and especially in twin moms, the pregnancy will kind of separate the muscles of the midline” those muscles that give you all the six pack; not me personally but everybody else.
SUNNY GAULT: You’re no favour have those muscles.
DR. WADE SCHWENDEMANN: I never did. But, they’ll start to separate in the middle. Your body is expanding and the twin pregnancy needs more space. The space has to come from somewhere. So, if you can’t go up because it’s block by your diaphragm and your lungs; you can’t go back because your spine and ribs are there. It has to go forward.
So, by separating the muscles that the space gets a lot larger in the more potential space exist and so the twin pregnancy can continue to grow to the appropriate level. Then, that makes us very happy because we’re like purple ground babies. But, putting it back together is difficult because if you have a C Section, sometimes the doctors will put in an extra stitch in and kind of bring the muscles back together for you.
I’d like to make a joke to that covers about 500 sit-ups or so. But really just using those muscles is the way to bring them back. So, luckily for you – for moms, when you’re carrying the baby around in your arms or using your core muscles to hold that baby not just using your arms to hold the baby.
So, you’re bringing those muscles together even when you don’t realize you’re exercising them. So, it comes back. But, if you give you those orders; no direct crunches for 12 weeks, it’s going to take a long time.
SHELLY STEELY: Well, I think a part of it for me. I mean the uterus takes a while to go back down but that’s skin that’s stretches, it doesn’t disappear. You still have that. I definitely do not have the stomach that I used to have anymore. But even more so because of how much that extra skin that kind of doesn’t it’s never really going to go away; so, you kind of end up with this.
It’s like when we’re talking about scars, you can even see my scar with it goes my skin that hangs over it after delivering but that’s kind of something unless somebody wants to offer me like an all expense paid spa-cosmetic surgery procedure. You just kind of to deal with.
CHRISTINE STEWART-FITZGERALD: Now, earlier you had mentioned the separation of the abdominal muscles, can you tell us a little bit more about that? What do we call that?
DR. WADE SCHWENDEMANN: So, we call that – technically it’s called Diastasis Recti. The Recti refers to the Rectus Abdominis Muscle, the muscles that run up and down in the middle of your body and diastasis means separation or opening. It means that basically separated in the midline.
It happens for a variety of reasons at the time of the caesarean delivery which unfortunately a lot of twin moms do go through. You have to separate those muscles to deliver the twins; just carrying the pregnancy a lot of the time to be enough to cause those two muscles to separate in the midline or kind of mirror image or just one on each side.
Things to do that help the abdominal binders is definitely going to help bring those muscles back together. A lot of doctors will kind of bring the muscles back together at the time of the C section if you have one.
CHRISTINE STEWART-FITZGERALD: So, you can actually ask your doctor. If you know you’re going to have a C Section, then you could actually say: “Can we get the stitches ahead of time?” I think I’ve heard that while you’re in there.
DR. WADE SCHWENDEMANN: A lot of women ask for stitches to put the muscles back together and we can absolutely do that. A lot of women ask for a tummy tuck while they’re there.
MISHELL RUDDEN: Have you thought about offering that?
SUNNY GAULT: Seriously, an option that we could.
DR. WADE SCHWENDEMANN: That is not an option.
SUNNY GAULT: You can talk with another doctor. You don’t have to do it, just get a plastic surgeon in there at the same time.
DR. WADE SCHWENDEMANN: Unfortunately, because we’re [inaudible] uterus; it’s a slightly higher risk for infection and so, you don’t want to take out skin tissue and put things under tension because the risk for the wound to breakdown is just way too high.
SUNNY GAULT: So, there’s a real reason for it.
DR. WADE SCHWENDEMANN: There’s an actual medical reason not to do it. I may never be genius if I can find a way to do that and not increase my infection rate. I’d be able to retire.
SUNNY GAULT: Right.
CHRISTINE STEWART-FITZGERALD: But, you can bring the muscles back at least the internal part and then maybe we kind of back and get the whole – sort of the skin part later on, right?
DR. WADE SCHWENDEMANN: I recommend waiting into you’re completely done with deliveries, all deliveries before you do the skin part.
CHRISTINE STEWART-FITZGERALD: So, the baby making’s done.
DR. WADE SCHWENDEMANN: Right, let’s get all of your children and you sure you don’t want any more then go ahead and then get that affixed if you want to. But absolutely, we can put the muscles back together in the midline. Now, in terms of science, there is no scientific evidence that suggested in that it actually helps in any sort of recovery process or anything like that.
But again, speaking to twin moms; anyone who has had it or even non twin moms would – speaking to twin moms, anyone who has had it generally is a little happier than anyone who has it.
CHRISTINE STEWART-FITZGERALD: Well, you’re bringing it back so it helps everything. You get a flatter stomach, right?
DR. WADE SCHWENDEMANN: Absolutely, right.
CHRISTINE STEWART-FITZGERALD: I think there are a lot of things you can do on the non-surgical side. I’ll just say for me, personally I got physical therapy after my twin pregnancy and after my singleton too. So, we’ve worked on the Diastasis Recti and just through they call it “belly breathing.” It’s just this focusing on this really internal muscles and kind of imagining you’re zipping them up and bringing them together.
So, my physical therapist says: “It’s such a simple thing but if you do it every day, it’s really effective.” So, it’s okay. I put stickers. Okay, breathe. Switching gears a little bit, I think on the other side of recovery, we know a lot of new moms experienced fatigue especially twin moms. So, aside from not giving enough sleep the biggest complaint, are there some other reasons that might be causing that fatigue?
DR. WADE SCHWENDEMANN: There are. Certainly, we talked about Anaemia for a fair bit of time and any sort of Anaemia, if your body’s not able to carry; if your blood count is low – Anaemia means a low blood count. If your blood count is low, you’re not going to be able to carry as much as oxygen to your cells and as you otherwise could.
The problem with that of course is that every cell needs oxygen to function, so without it; you can’t function as efficiently as you otherwise would. So, some of the things that can – for example we talked about ways to address Anaemia with iron rich foods, often iron supplementation.
It’s impossible to do but getting out a quick sleep is critical to letting your brain function. We talked about calories and making sure that you’re actually eating enough. It’s very easy to be tired because if you eat as much when you’re two weeks postpartum as you ate when you were two weeks before delivery, it’s not going to be enough. You need more energy particularly if you’re breastfeeding.
CHRISTINE STEWART-FITZGERALD: Twins, yes absolutely.
DR. WADE SCHWENDEMANN: For a lot of women, so your diet is 1800 to 2000 calories a day. All of a sudden you’re postpartum with twins and you eat almost 3000. It’s incredibly important to do that.
CHRISTINE STEWART-FITZGERALD: So, eating and hydration. I mean I know when I was breastfeeding
SUNNY GAULT: That will kill your milk supply if you do not drink water. Even though you want to drink coffee like I want to drink coffee because I’m tired, I’ve got some stuff done but I have to like push the coffee away and drive pass Starbucks.
SHELLY STEELY: Wasn’t there just a new study that said that coffee is just as hydrating as water? I swear I saw that in the news. I’m not even joking. We should look in to this.
CHRISTINE STEWART-FITZGERALD: I don’t know but I’m buying it. Yes, coffee, water
MISHELL RUDDEN: If you’re getting like a latte, there’s a lot of milk. Milk’s pretty hydrating.
CHRISTINE STEWART-FITZGERALD: Sure, that’s we’re talking about survival here.
DR. WADE SCHWENDEMANN: I’m pretty sure that caffeine is a diuretic which means it’s going to make you pee more and make you a little more dehydrated. So, while you first drink it, I think you might feel the same type of hydration.
But, I think after a little while especially if you’re on your second or third cup because you’re really tired. I think I’d just stick to water.
CHRISTINE STEWART-FITZGERALD: Yes, definitely. Well, thanks so much Dr. Schwendemann for joining us today. I really appreciate all of your insights. For more information about the postpartum recovery after twins in the first six weeks or for more information about any of our expert panellist, visit our episode page on our website.
So, this conversation continues for members of our Twin Talks Club. After the show, Dr. Schwendemann will tell us about: “A common postpartum recovery practice found in Asia.” So, for more information about the Twin Talks Club, visit our website www.TwinTalks.com
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Okay, today we have a special segment called Twin Oops. This is stories about the twins that only twin parents can really appreciate and if you’ve got a Twin Oops that you’d like to share, give us a call on our voicemail at 619-866-4775 or you can now post it on our Facebook page.
We’ve got a note from Caroline in Louisiana. She wrote:
“My two-year old babies are obsessed with Sanitary towels and tampons. No matter where I hide them, they find them. They love unwrapping the towels and sticking them just about anywhere. I think tampons are large party poppers.
I can just live with all the mess they create but recently, I was waiting for a TV engineer to call. I waited in all day and the boys were restless and had unwrapped just about every towel and tampon incite for amusement. I clean it up for them just in case the door bell rang. It finally did ring.
The engineer came in and I just followed him into the lounge and I saw a towel complete with wings stuck to the wall above the sofa. How does this guy didn’t see it was beyond me? But, I never moved so fast and have never felt so embarrassed.
So, I can laugh now but at the time, I was mortified. I’m sure he never saw it because he did not flinched or look or act awkwardly and I’m sure seeing a winged towel on display in someone’s lounge like a treasured photo is not an everyday occurrence.”
-Caroline
CHRISTINE STEWART-FITZGERALD: So, that wraps up our show for today. We appreciate you listening to Twin Talks. Join in on the discussion by posting your comments on the Twin Talks Facebook page or you can call our voice mail at 619-866-4775.
Don’t forget to check our sister shows:
• Preggie Pals for expecting parents
• The Boob Group for moms who breastfeed their babies
• Parent Savers, it’s an online support group for the new parents.
This is Twin Talks, parenting times two.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line-up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or an organization interested in our network of our shows through a cobranded podcasts, visit www.NewMommyMedia.com .
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