Dr. Roger Goldberg (NorthShore)
Good morning and welcome, Believe it or not, even after an "uneventful" vaginal birth, many women notice a change in bladder control -- somewhere from 30 to 50% of childbearing women by age 40. In your case, the prolonged pushing (more than 2 hours), and vacuum, and manual extraction all do tend to take a greater toll on the pelvic supports. At this early stage, you need to give your body a chance to heal. Starting with gentle Kegel exercises is a great idea. But if you truly have 'zero' bladder control, I'd advise aligning yourself with a physical therapist who deals with female pelvic health / strengthening, and also seeing a urogynecologist if things don't improve after 6-12 weeks. We do see a good percentage of postpartum incontinence cases resolve within the first several months; but if your symptoms persist after 12 weeks, then the odds are you'll need some help. Realize that this condition WILL improve with the number of therapies we have these days.

Dr. Roger Goldberg (NorthShore)
Although we don't discuss it much during pregnancy, in fact childbirth is a common reason for nerve injury. The good news, is that the vast majority of these injuries heal on their own -- there's lots of research on the pudendal nerve, in fact, showing that up to 80% of women after delivery have proven nerve dysfunction, but this resolves within the first year for the vast majority. You're at a very early stage of healing -- 1.5 weeks is just the beginning, and in general most women with your symptoms notice steady improvement over the next 6 weeks. General advise is to void on a 'scheduled' basis; not too often, not too little. With average fluid intake, around every 3 hours is a nice interval to strive for. If your sensations aren't improving in the months ahead, or are getting worse, or if you feel an inability to void, then I'd seek a basic evaluation from your gynecologist or a urogynecologist.

Dr. Roger Goldberg (NorthShore)
Great question, unfortunately as you can imagine there's not just one answer and much of this boils down to 'common sense' advise. Breast feeding does, indeed, reportedly burn up to 500 calories per day (these estimates vary, but most breastfeeding moms attest to this 'boost'). It is generally OK to get right back to exercise if your obstetrician approves, but from a pelvic floor standpoint I generally advise to avoid very high-impact exercises for the first 6-12 weeks -- so that the pelvic supports have a full chance to heal. Perhaps the hardest adjustment is finding time to exercise, and also resuming (or starting) healthy eating patterns as your schedule will now revolve around the newborn. Try and stick to the basics - sensible meals, lots of water, avoid snacking, and chart out a fitness routine. Take a 'slow but sure' approach and remember that you need to be well nourished not only for nursing, but also to function well during the newborn period.

Dr. Roger Goldberg (NorthShore)
Postpartum is a great time to focus on the core -- not only to reduce the 'belly fat', but also to strengthen the key muscles that lie deeper in the body. This is the 'pelvic floor' and if you rehabilitate this area now, it will have a big impact on your functioning in the decades ahead. My advise: 1. Obviously, general weight loss and fat-burning / aerobic exercise will be key. 2. Core specific: Aside from the usual abdominal exercises / crunches, I'd recommend pilates, combined with "kegel" type pelvic strengthening. This is a great combination. One local organization (Women's Health Foundation) has developed an exercise program that combines these elements ("total control") and they had experts from around the world help to develop the pelvic fitness routine. Their website is www.womenshealthfoundation.org, and they have adapted material as well from my book ('ever since I had my baby').

Dr. Roger Goldberg (NorthShore)
These days, we all "set the bar" very high for our own functioning, and sometimes overlook that childbirth is a HUGE physical, emotional, and life adjustment. Those of us who become parents do, in fact, sign up for a slightly more exhausted and chaotic and moody life than we had before ... but with great rewards! When you're in the thick of the postpartum, please realize that you are juggling an incredible number of tasks -- don't expect to be perfect, and don't be hard on yourself, just do your best and remember you must find little ways to take care of yourself, too. It does get easier! Most importantly, you raise such an important topic by mentioning postpartum depression. If you EVER feel that you're too overwhelmed, or question whether you're slipping into a depression, we live in a world where you have a tremendous number of resources to help. NorthShore has a dedicated confidential hotline for postpartum depression 24/7: the number is 1-866-364-MOMS or NorthShore.org

Dr. Roger Goldberg (NorthShore)
Yes - there are MANY things you can do before, during and after delivery. This is a big question, in fact I wrote a whole book to try and answer it ('Ever Since I Had My Baby'); get a copy for free at the library, on amazon, or from a friend. But here are a few key recommendations: 1. Learn about your pelvic floor before delivery - i.e. the 'right' kegel exercise, so you can rehab these muscles afterwards 2. Be sure you're not "setup" for a difficult delivery (i.e. very small pelvis, huge baby, or both). Most women do great with vaginal childbirth, but there are some circumstances for which discussion of a cesarean is reasonable to consider. 3. Talk to your doc about laboring strategies (try to avoid very long pushing period), use of forceps and episiotomy ("only if needed" approach is best). I'm personally a believer in 'laboring down' which means relaxing with an epidural and delaying pushing until the baby's head is fairly low down. 4. Heal your pelvis afterwards!

Dr. Roger Goldberg (NorthShore)
Up to 25% of women report some continued change in their sexual function, even 6 months after a 'normal' vaginal delivery. Clearly there are both physical and psychological / social reasons underlying this. In terms of the physical recovery: you still have plenty of healing to do. The nerves are calming down and regenerating (remember the pudendal nerve is commonly injured and heals over time), the muscles and tissues are healing, and if you're breastfeeding then also realize that a lack of estrogen takes a temporary toll on your lubrication / vaginal comfort and therefore also your desire. In terms of the "non-physical elements", no question that the exhaustion and distraction of parenting will naturally take a temporary toll on your sex drive. Give it time and plan a few date night as a couple -- it's going to take more effort at your early stage. All of these factors will improve over time ...

Dr. Roger Goldberg (NorthShore)
Deliveries routinely involve blood loss, but the odds of a significant hemorrhage are relatively low. Some women are known to be at higher risk (i.e. older age at the time of delivery, multiple deliveries, placental abnormalities or bleeding disorders), and in this case preparations would be made to anticipate a possible hemorrhage. You should ask this question of your obstetrician if you're concerned.