Dr. Candace Westgate, board-certified OB-GYN, joins Alexandra Galeazzi to explain what actually happens to a woman's body after childbirth: a two-year recovery, a hormonal cliff into a post-menopausal state, and a set of signals that predict her health risks decades later. Most women get one postpartum visit to navigate all of it.
Postpartum is one of the most misunderstood and under-supported phases of a woman's life. In this episode of Cascaid Effect, host Alexandra Galeazzi welcomes back Dr. Candace Westgate, a board-certified OB-GYN specializing in women's health and hormonal transitions, for a conversation about what actually happens to a woman's body after childbirth and why the fourth trimester shapes her health for decades.
A woman's body does not fully recover from pregnancy for close to 24 months. Yet in the United States, most women receive a single postpartum visit. Within minutes of delivery, a woman goes from the highest estrogen and progesterone state of her life to an extremely low one, and for breastfeeding mothers, that low-estrogen state continues, placing the body into what is effectively a post-menopausal state.
In this conversation on postpartum health and women's longevity, Dr. Westgate explains the hormonal cliff that follows delivery, genitourinary syndrome of lactation and the painful symptoms nobody warns women about, the difference between normal baby blues and postpartum depression, and why postpartum brain fog is real, backed by brain imaging that has been mistaken for early neurocognitive decline.
She also explains how pregnancy functions as a pressure cooker that reveals future health risks. Gestational diabetes predicts earlier type 2 diabetes. Gestational hypertension and pre-eclampsia are established risk factors for cardiovascular disease later in life. Persistent postpartum depression foreshadows what a woman may face during perimenopause. Dr. Westgate makes the case that a woman's pregnancy history belongs in her medical record with the same weight as a family history of cancer.
The episode also covers bone health, why peak bone density occurs around age 27, and how pregnancy and breastfeeding create a bone loss window that most women never address. Dr. Westgate shares her own experience of developing osteopenia at 45 after five years without exercise, and why self-care during postpartum is not selfish but essential.
Topics include postpartum recovery, the fourth trimester, postpartum depression, perimenopause, hormonal health, breastfeeding and estrogen, maternal health, bone density, preventive care, and women's longevity.
If you're a woman who has had a baby, is planning to, or loves someone who has, this is the conversation you didn't know you needed.
00:00:00:04 - 00:00:28:11
Speaker 1
Hello and welcome back to the Cascade Effects Podcast. I'm your host, Alexandra Galati, and joining me again today is the amazing Doctor Westgate, a board certified OB-GYN and all around expert in all things women's health. Look forward to talking to her today about postpartum. Not specifically pregnancy, but postpartum itself and the importance that that has on women's health, longevity and their overall health span.
00:00:28:13 - 00:00:45:13
Speaker 1
Doctor Westgate so we had you on for a previous episode where we talked a lot about perimenopause. And in that episode we mentioned briefly postpartum and the significance that it has on a woman's life. And it felt so significant that I know we chatted a bit after the episode, was like we needed to just do a whole episode on that.
00:00:45:13 - 00:00:47:11
Speaker 1
So I think that's what this is going to be now.
00:00:47:12 - 00:00:49:12
Speaker 2
Absolutely, absolutely.
00:00:49:13 - 00:01:01:08
Speaker 1
So to start us off, if you wouldn't mind teeing up like, you know, I think in pregnancy, at least from what I've seen. Right. A lot of the focus is on the actual pregnancy. But tell me what is postpartum and why is it so important?
00:01:01:09 - 00:01:36:17
Speaker 2
Absolutely. So postpartum obviously. Post and pardon signifies the the time span after delivery. And really a woman's body hasn't fully recovered. You know, for a full 24 months after after delivery, you know and many countries have have different approaches when it comes to how long women get or off of work and from returning to leave and those kind of things here in the US, it's how do I put it?
00:01:36:19 - 00:01:38:00
Speaker 2
We don't get very long.
00:01:38:05 - 00:01:43:08
Speaker 1
That's great. That's great. I'd say I'll say it. It's not great right now.
00:01:43:09 - 00:02:00:02
Speaker 2
So, you know, from a work perspective, I remember getting six weeks off after a normal spontaneous vaginal delivery. And those are my friends who had a C-section. They, you know, were allotted eight weeks off because you were recovering from from a major surgery as well. You know, you could could a lot to take more time off of that.
00:02:00:03 - 00:02:03:17
Speaker 2
You know, I think state dependent, you could get more time off of that.
00:02:03:21 - 00:02:15:22
Speaker 1
I'm sorry to interrupt you so real quick just because I was ignorant to that. But so if you if you have a C-section, you actually get more time off work. Correct. So ladies, always tell your employer you got a C-section. That's what I'm hearing, right? That's just I would I mean, I can't give medical advice, but that's what I would do.
00:02:15:22 - 00:02:43:20
Speaker 2
But that really doesn't demarcate anything, right? And as I said previously, for full healing of a woman's body, it's it's closer to 24 months. But postpartum is this time frame where one day you're at super high estrogen and progesterone levels, you've got a baby, you've got the placenta creating all these amazing hormones. And literally within one period of time, that baby's delivered.
00:02:44:00 - 00:03:22:23
Speaker 2
Maybe ten minutes later, the placenta is delivered. And you go from this extremely high hormone state to an extremely low hormone state, right. Then on top of that, for those women that are that are breastfeeding and lactating, prolactin is extremely high and that blocks of and prevents ovulation. And so again, this very important function of keeping a baby alive, you know, when being able to produce breast milk causes our ovaries to, to shut down and places our body and the rest of our tissues in a post-menopausal state.
00:03:22:23 - 00:03:54:20
Speaker 2
And so hence the importance of understanding not only the hormonal shift that occurs in the postpartum, but understanding how that is a foretelling of what we're going to have to struggle with when it comes to the menopause transition, when those ovaries do stop working, and estrogen and progesterone are extremely low. So what happens in the postpartum period? Well, all of the attention is on this brand new bundle of absolute pure bliss and joy, right?
00:03:54:22 - 00:04:24:12
Speaker 2
And then all the sleepless nights and the end to end. Right. But the amazing amount of brain chemicals and hormones that naturally occur in that postpartum period that really help mom and baby to bond, it helps you to forget, right? What number one happened during childbirth and the trauma of childbirth and your trauma in your body, but also helps you to forget those sleepless nights in being woken up every two hours to to nurse, change diapers, burp babies, colic, you know, all.
00:04:24:12 - 00:04:29:23
Speaker 1
Of helps you forget about the sleep hygiene thing we also talked about in another episode. Yeah, yeah. Makes sense.
00:04:30:01 - 00:05:08:01
Speaker 2
Now, what women don't understand is the immense changes going on in their body and what that results in. So for example, there is this thing called instead of genitourinary syndrome of menopause. It is lactation induced janitor urinary syndrome. Right. So genital urinary syndrome of lactation not genital urinary syndrome of menopause okay. So what is that all about. Well not only the changes that occur in the vaginal tissue genital, but also in the urinary bladder because of the low estrogen state.
00:05:08:01 - 00:05:28:21
Speaker 2
So for a lot of women, after delivering and returning to being sexually active with their partner, it feels awful. It is extremely dry, extremely painful that the tissue in the vagina has actually changed, not just from the trauma of childbirth if they had a vaginal delivery, but now because of the lack of estrogen and the tissue becoming very thin and dry.
00:05:28:21 - 00:05:57:20
Speaker 2
So most women are encouraged to breastfeed, right, for as long as possible. Right. At least six months. You know, some some women breastfeed for for a lot longer. But during that time frame the estrogen stays low as long as women are still nursing throughout the night, usually when the baby's sleeping through the night and they're not nursing during the night, then prolactin levels are lower and then women can start ovulating themselves and can start cycling again themselves.
00:05:57:20 - 00:06:27:08
Speaker 2
But the changes that occur in a woman's body postpartum and during pregnancy are not just physical, but also mental. And the reason for this, again, is because there is an estrogen receptor in just about every single cell of the body, right. And so that low estrogen state on the brain in that direct postpartum period, we counsel patients that is completely normal to go through something called the baby blues.
00:06:27:08 - 00:06:52:16
Speaker 2
So for the first two weeks of delivering a baby, it is completely normal to feel very teary, very emotional, very emotionally dysregulated, to have anxiety. But then it should get better. Okay. And for a lot of women, it does. You know, that loss for about about two weeks. I remember a week after my son was born, my mom kicked me out of the house and she said, go to your favorite coffee shop.
00:06:52:16 - 00:07:06:06
Speaker 2
I've got Hudson. He's sleeping. You've got an hour because, you know, you didn't even want to leave those little guys for for ten minutes. And I was walking down the street and I saw another pregnant woman, and I started to cry.
00:07:06:08 - 00:07:06:21
Speaker 3
Oh, wow.
00:07:06:22 - 00:07:31:08
Speaker 2
And my head is saying, I don't understand why you're crying. And there's just like tears streaming down my face. And I realized that I was emotional because I couldn't feel Hudson kicking in my uterus anymore. So, you know, little things like that will trigger a woman. So anyone listening this is completely normal for you to feel emotionally dysregulated.
00:07:31:08 - 00:07:53:17
Speaker 2
You've gone from extreme high highs, right, with hormones to extreme low lows. And now there's a whole lot of new neurochemicals oxytocin, prolactin, and a whole lot of new neurochemicals swimming around in your brain that you haven't had before in that postpartum period. And it causes a significant amount of brain changes. So for those women listening, I'm sure all of you experienced it, because I certainly did.
00:07:53:17 - 00:08:19:15
Speaker 2
I remember being Saturn was six weeks old, came back to work, saw a patient. She had a quintessential yeast infection. I must have treated 30,000 of those. I'm over exaggerating, but right. This is, you know, bread and butter OBGYN stuff. And I remember this was the patient's first yeast infection. So I wanted to give her a little bit more education, explain to her what was going on, and then actually talk to her about the medication because she'd never had to use any before.
00:08:19:16 - 00:08:27:15
Speaker 2
And Alex, I could not recall the name of literally the first medication I ever learned as really.
00:08:27:16 - 00:08:29:06
Speaker 3
Yes. Oh my God, not pull.
00:08:29:06 - 00:08:30:11
Speaker 2
It out of my brain.
00:08:30:12 - 00:08:31:07
Speaker 3
Oh, wow.
00:08:31:11 - 00:08:33:04
Speaker 1
Just left it completely,
00:08:33:06 - 00:08:40:19
Speaker 2
Couldn't even tell. I knew that it start to. It started with a D. It's different can or metronidazole. I could not even pull it out of my brain.
00:08:40:20 - 00:08:41:14
Speaker 3
Oh my gosh.
00:08:41:15 - 00:08:58:17
Speaker 2
So what does your brain do? It starts to work around it. Right. And so speaking to you about a medication that you would take, it would be one pill. And in 72 hours of her symptoms head and resolved, then she's going to take another one of this pills in. When she gets to the pharmacy, they'll show her the, you know, the medication.
00:08:58:17 - 00:09:16:18
Speaker 2
These are the side effects of it. You know, this is what you need to look out for. And they'd see how you do. And I gently walked out of the room and then sprinted down the hallway to my office and pulled out my residency like pocket handbook. And when searching for the name of this medication that I prescribed hundreds and hundreds.
00:09:16:18 - 00:09:18:17
Speaker 3
Of times. Oh, that's so funny. And it.
00:09:18:17 - 00:09:20:10
Speaker 2
Didn't just stop there. It continued.
00:09:20:11 - 00:09:20:20
Speaker 3
Sure.
00:09:20:21 - 00:09:28:23
Speaker 2
Right. I was, you know, noticing throughout the night. At that point, my hormones were extremely low and I honestly felt like I had earlier onset dementia.
00:09:29:00 - 00:09:29:19
Speaker 3
Wow.
00:09:29:21 - 00:09:58:06
Speaker 2
Thankfully, I had some wonderful coworkers. They were midwives, and I just happened in passing to say, I don't know what's happening to my brain. I'm really concerned. And they patted me on the shoulder and said, no, Kenneth, this is real. You know that that pregnancy brain. Because when we can even experience that in pregnancy and that postpartum brain is real, and we actually have experience of seeing a postpartum brain go through an MRI machine.
00:09:58:07 - 00:09:58:17
Speaker 3
Oh, wow.
00:09:58:18 - 00:10:14:16
Speaker 2
And the report from the radiologist who didn't know that this patient was postpartum six weeks and six months and breast feeding said concerning for early signs of neurocognitive decline. It's the fancy word for saying ultimate center.
00:10:14:18 - 00:10:17:23
Speaker 3
No. Yes. Oh.
00:10:18:01 - 00:10:21:03
Speaker 1
That's a heck of a miss. Heck of a miss thing to see.
00:10:21:04 - 00:10:21:20
Speaker 3
You know, I.
00:10:21:20 - 00:10:43:05
Speaker 2
Think it was also for me, it was extremely justifying because, you know, we don't oftentimes put a postpartum lady through an MRI brain scan. Right. But extremely justifying for me as well as for this patient or this client that we were working with to show know this is legitimate and this is real. There's a significant hormone strain on your brain during this postpartum time frame.
00:10:43:10 - 00:11:12:13
Speaker 2
And even with that, you're still functioning at work, right? So the super power that is a woman's body, despite the significant hormone changes that occur and the ability for the brain to adapt and to come out of it. Right. This isn't something that's going to last forever for for a postpartum lactating woman. But start with grace. Start with understanding your body and knowing that this isn't permanent.
00:11:12:18 - 00:11:14:19
Speaker 1
Yeah. No, this too shall pass.
00:11:14:20 - 00:11:15:15
Speaker 3
Exactly.
00:11:15:17 - 00:11:50:07
Speaker 2
I think too. It also speaks to allowing ourselves the opportunity to say no more. Because as females don't don't do that. You know, a lot of us live far away from our family. You know, maybe we don't have a good support system. We're high functioning career woman. We are go getters, right? And we don't allow ourselves the grace to be able to say no, and to be able to step back and be like, this is not the season in my life where I'm going for a new promotion, or I'm going to get a master's in something.
00:11:50:08 - 00:11:51:19
Speaker 2
Right. And could you do it?
00:11:51:20 - 00:11:52:13
Speaker 3
Absolutely.
00:11:52:14 - 00:11:53:01
Speaker 1
Sure.
00:11:53:01 - 00:11:53:14
Speaker 3
Yeah.
00:11:53:15 - 00:12:04:19
Speaker 2
And how many women have done it? Thousands of women have done it. But I think that saying you can have your cake and you can eat it. Sure you can. But what is the fallout from that?
00:12:04:20 - 00:12:05:01
Speaker 3
Yeah.
00:12:05:02 - 00:12:26:13
Speaker 2
So I would challenge more women, not only postpartum. Right. Understanding your body and supporting in the way that it needs so that you can optimize your health and your wellness and the wellness of your whole family during that phase, not just pushing through more, not just being a rushing woman and missing out on the joy that is around you, but instead.
00:12:26:14 - 00:12:44:13
Speaker 2
And if we understand where our bodies are, these crazy hormonal fluctuations going on, we can make educated decisions that can optimize our health of where we are and say, you know what? I'm going to go for that master's in three years time when I'm done with my childbearing and early development. Right. And two three year olds. Does that make sense?
00:12:44:14 - 00:12:45:17
Speaker 3
No. Yeah.
00:12:45:18 - 00:13:09:11
Speaker 2
But also understanding, too, that what you're going through now is preparing yourself for the future. Educating yourself about it and what's going on so that when the first inkling of signs and symptoms start to develop in that period menopausal time, you're not blindsided by it. You're expecting it. And we're going to make small course adjustments, right? Not huge.
00:13:09:13 - 00:13:11:03
Speaker 2
Slam on the brakes.
00:13:11:03 - 00:13:11:14
Speaker 3
Right.
00:13:11:15 - 00:13:35:19
Speaker 1
And 90 degree turning cold turkey on something that's never fun. Helpful in a lot of cases. Right. And I want to touch on something you had mentioned before, which is that, you know, with Cascade, and obviously we're always thinking for signals before they become symptoms and thinking ahead. You had mentioned in our last episode with postpartum how it can sort of be a good indicator for things later in life for women, or that there's important things they should track and be aware of during their postpartum.
00:13:35:19 - 00:13:45:12
Speaker 1
I'd love to hear from you a little bit on that, because I think that'd be a really valuable topic for our listeners to hear. So what should they be on the lookout for, and what can it sort of frame up for them for the rest of.
00:13:45:12 - 00:13:45:22
Speaker 3
Their life?
00:13:45:23 - 00:14:11:07
Speaker 2
So think of that pregnancy and postpartum as your pressure cooker time for your body and anything that is a quote unquote, your Achilles heel, you know, or a little bit more of a weakness is going to show itself. So those women who have gestational diabetes, right. You really have to pay attention and watch you closely because you're going to develop type two diabetes earlier, and especially within that perimenopausal time.
00:14:11:08 - 00:14:38:03
Speaker 2
Okay. For those women who have high blood pressure associated with pregnancy, even if it's just gestational hypertension or pre-eclampsia, we really need to pay attention for you as you're going through that period of puzzle transition, because you're at much higher risk for your blood pressure to rise, right? But also for cardiovascular disease. So there's some really good research looking at cardiovascular disease backing it up.
00:14:38:03 - 00:14:57:06
Speaker 2
And where are some of the big risk factors that we need to pay attention to and actually poor pregnancy outcomes. So preterm birth issues with placenta gestational hypertension, all of those things are actual precursors or risk factors for developing cardiovascular disease. As a woman later in life in earlier than than your age.
00:14:57:06 - 00:14:58:11
Speaker 3
Metacarpal part.
00:14:58:12 - 00:14:59:07
Speaker 2
Correct.
00:14:59:08 - 00:14:59:16
Speaker 3
Okay.
00:14:59:17 - 00:15:38:08
Speaker 2
Then in the postpartum phase, if woman is moving and continuing along the depression and anxiety realm, it's not just that two weeks of that postpartum blues, right? Which is normal, but that continues on. That is indicative of what's going to come your way in perimenopause because of the big hormonal shifts that are going on there. Right. If you really battled with bladder issues or vulva issues, vaginal issues, dry, painful sex in while you elect eating, we've got to pay attention because that might be your first sign in symptom of hormonal shifts in your body in perimenopause and menopause.
00:15:38:09 - 00:15:44:00
Speaker 2
So using the past to help guide our future is going to help keep us ahead.
00:15:44:00 - 00:15:44:23
Speaker 3
Of the game. Yeah.
00:15:45:00 - 00:16:05:06
Speaker 1
Is there any sort of resource out there right now? I in my mind, I'm picturing sort of this like line chart right where it's like, oh, if you had this, you should go look up breast arterial calcification later on, or you should go for a mammogram earlier or things like that. Is there any sort of just quick index you might be able to give for the listeners, or is that just too vastly complicated for us to sort of try to rifle through?
00:16:05:07 - 00:16:28:23
Speaker 2
Yeah, that's a great question. I think we're still learning a lot more about those kind of risk factors. But it it's I know in the cardiology space, those preventative cardiologists, a lot of them actually part of their intake questionnaire now is did you have any adverse pregnancy outcomes like preterm birth, preeclampsia, hypertension. And so part of my menopause clinic that we're that's all included.
00:16:28:23 - 00:16:33:16
Speaker 2
Tell me all of our pregnancy and women don't look at me like why are we going back and talking about pregnancy? I'm here for.
00:16:33:16 - 00:16:35:01
Speaker 3
My period. Interesting.
00:16:35:02 - 00:16:38:03
Speaker 1
So there's even a social combo where they're kind of surprised that that's even on.
00:16:38:04 - 00:16:39:04
Speaker 3
Their right.
00:16:39:05 - 00:16:55:07
Speaker 2
Because they don't see the connection. But as a clinician, because I know what to look out for in the future and to guide them and to miss those potholes, I need to know what we're what we're at risk for so that we can make some course adjustments and change the outcome for them in the future.
00:16:55:08 - 00:17:09:05
Speaker 1
I mean, to me, obviously someone who's never been to medical school, but to me it sounds just as important as if I were to tell my doctor there's like a cancer risk in my family. They need to know that, right? So it sounds similar, where it's just as important for them to know that you had pregnancy complications or postpartum things to talk about these long.
00:17:09:06 - 00:17:13:18
Speaker 1
That's so interesting. It's surprising to me that that's sort of something that isn't more common right now.
00:17:13:19 - 00:17:16:05
Speaker 2
It's well, hopefully it's going to become.
00:17:16:05 - 00:17:17:15
Speaker 3
More exactly.
00:17:17:17 - 00:17:20:04
Speaker 2
Standing. The whole the whole person in the whole picture.
00:17:20:05 - 00:17:21:16
Speaker 3
Yeah. No, I said, okay.
00:17:21:17 - 00:17:39:01
Speaker 1
So I think I kind of want to throw it back to you, even in thinking about this connection where you want to tie back to what happened in your postpartum chapter, to how that helps your health. Let's talk about yours. Have you been so openly willing to discuss your journey thus far? I'd love to ask you to. What were some things that maybe you wish you were aware of in your postpartum chapter?
00:17:39:02 - 00:18:16:08
Speaker 2
I think the first thing I wish I knew sooner was that was the importance of self-care. And like we spoke about even in the last podcast, that estrogen is our superhero hormone that makes us superheroes as women, but it also makes us focus on other people and not ourselves in our own needs. And so when we're constantly doing that, and we are constantly and our health and our mental health and our nutrition and our sleep hygiene is constantly chosen, second, we crash and burn and then the whole family crashes.
00:18:16:08 - 00:18:21:22
Speaker 3
It burns. Right? So what is my cascade effect then? Yeah, I was like, oh yeah.
00:18:22:01 - 00:18:25:01
Speaker 2
Alex, my husband always says, I hope happy wife a.
00:18:25:01 - 00:18:26:09
Speaker 3
Happy life. Yep. I think all.
00:18:26:09 - 00:18:26:22
Speaker 1
Good husband.
00:18:26:23 - 00:18:28:07
Speaker 3
Say that. Correct.
00:18:28:09 - 00:18:44:17
Speaker 2
And you know, I initially I was offended by that because I was like, no, it isn't all about me, right? And then I was like, no way. It actually is because I'm the man making your doctor's appointments and getting in. You're in for your annual screening, right? I'm the one encouraging you to write to eat healthier, commonly during the gym together.
00:18:44:17 - 00:19:12:06
Speaker 2
And so the health of a of the mother is that domino that affects the entire entire family. And so even though everything in our brain and our body is screaming for us to pay only attention to this beautiful newborn that needs us desperately to survive, right, we have to take care of ourselves too. And so that means finding a ritual where self-care is part of who you are.
00:19:12:08 - 00:19:34:08
Speaker 2
You're able to fool your tank emotionally, physically, mentally before so that you have something to give out to the rest of the family, right? Otherwise, you're only ever idling. You're really not going at the speed. You know that that you can. But what that means is you have to step back. Right. So that would be the first.
00:19:34:08 - 00:19:35:11
Speaker 3
Thing, right?
00:19:35:12 - 00:19:45:05
Speaker 2
The second thing would be the importance of establishing those lifestyle habits. Then. Because it is I didn't exercise for five years. Alex.
00:19:45:06 - 00:19:45:15
Speaker 3
Wow.
00:19:45:18 - 00:19:59:00
Speaker 2
Five years because I was a full time working physician. And every breathing, waking moment when I got home was about my family and my son because I didn't get to see him during the day. Right. I was a working parent.
00:19:59:01 - 00:20:01:18
Speaker 1
Sure do. Incredibly demanding full time jobs. Yeah.
00:20:01:19 - 00:20:15:12
Speaker 2
And so I was exhausted. Number one, coming home anyway, trying to give as much energy as I could to my son. So the thought of getting up at 5 a.m. for some me time was wasn't. It didn't even cross my mind.
00:20:15:13 - 00:20:16:20
Speaker 3
Right? Yeah, right.
00:20:17:02 - 00:20:43:09
Speaker 2
And until emotionally I had to stop because I was using as my therapist sit. Right. I was using the importance of self-care is not selfish. It is the furthest thing from that, right? Having the grace for your body and to understand the the breath that we need to take every day. Right. And then what that enables you to do is to show up better.
00:20:43:09 - 00:21:05:18
Speaker 2
It enables you to be a stronger partner. It enables you to be a stronger parent. Right? You're not constantly, constantly exhausted because there is fuel in that tank of yours, right? But I also went for a full year of not exercising. You know, I had ice cream every night because I was nursing and losing all this weight. It was fantastic.
00:21:05:20 - 00:21:31:22
Speaker 2
But what was I doing? I was not restoring any of my bone health. I wasn't getting back to the muscle fitness and the muscle strength that I needed to support my bones. So now where do I find myself as a 45 year old man and puzzle woman with osteopenia? Because I never took care of myself. Then I was taking care of everybody else.
00:21:31:22 - 00:21:59:04
Speaker 2
So again, Alex, this is where risk assessment is one of those quintessential things. Look back. See what's coming your way. Right. What's the family history? Right. Is there a big elephant in the room? Because if there's a bracken mutation or some kind of, you know, hereditary cancer gene, right? That is increasing your chances of getting cancer, right? But also look, look back and see what the rest of your family has.
00:21:59:05 - 00:22:06:01
Speaker 2
My mom's had osteoporosis for for many years. Right. And that's the disease of the elderly.
00:22:06:02 - 00:22:09:08
Speaker 3
Right, right, right. But you don't think about that.
00:22:09:08 - 00:22:11:08
Speaker 1
Until later on. But that is too late.
00:22:11:09 - 00:22:12:00
Speaker 2
Absolutely.
00:22:12:02 - 00:22:12:05
Speaker 3
Yeah.
00:22:12:06 - 00:22:47:06
Speaker 2
And our highest bone density is around the age of 27. And so if we are going for, you know, lengthy periods of time, not getting enough calcium, not getting enough weight bearing activity, multiple rounds of, you know, breastfeeding, not getting your period, low estrogen states during that time, not nutritionally supplementing our bodies appropriately. There's another huge hole in huge gap in that postpartum period where with good nutrition, with good sleep, with appropriate exercise, we can prevent that huge dip that occurs with every pregnancy from even a bone health perspective.
00:22:47:07 - 00:23:01:23
Speaker 2
Right. And then of course, the mental health component to it. Right. And just the importance of understanding number one. Our bodies are made for this. Alex. Our bodies as a woman, we are superheroes.
00:23:02:00 - 00:23:13:02
Speaker 1
You guys are way tougher. The man. I'll say it. I mean, I know it sounds contrived from a guy, but, like, I get a paper cut and I'm whining about it. You know, I mean, like, women deal with so much that's such a high tolerance. It's credible. It really is.
00:23:13:02 - 00:23:14:07
Speaker 3
Correct. Yeah.
00:23:14:09 - 00:23:30:08
Speaker 1
But is it that I know one thing people like what women deal with? I would love to just sort of take a moment to sort of speak to the social effect I think of during these chapters, because a lot of things you pointed out, I can imagine there's probably a lot of gaslighting and misdirection that women endure in these moments, like dismissing of feelings or things.
00:23:30:09 - 00:23:47:03
Speaker 1
Right? But wanting to sort of speak to how can we encourage our listeners to find the right support and feel encouraged in moments of, like in postpartum, when maybe they are dealing with some of those symptoms? If people don't, if they don't have those cool colleagues around them to pat you on the back and boost you up, they might not have that system.
00:23:47:05 - 00:23:48:07
Speaker 1
What would you say to them?
00:23:48:07 - 00:24:01:22
Speaker 2
I say a first place to go to is your mom if she's there, right? She's walked through a lot of what what you wrote through, maybe in a different manner. Maybe in a whole different generation. Right. But no one knows your bed then your.
00:24:01:22 - 00:24:04:13
Speaker 3
Mother does. Very true, very true.
00:24:04:14 - 00:24:27:14
Speaker 2
The second one is to really find that healthcare provider that you trust. And what I do see for a lot of women is that healthcare provider that they trusted in their younger years, and to help them with pregnancy and delivery may not necessarily be that right provider to help them in the next hormonal transition. Number one, because we weren't trained appropriately for.
00:24:27:14 - 00:24:28:18
Speaker 3
It, right.
00:24:28:19 - 00:24:58:20
Speaker 2
Most of our training as OB gyns is all about pregnancy, postpartum and then doing surgery for women's health related issues. There was maybe a few hours in residency training, you know, every year on on menopause, some of the symptoms and then you know, what medication to treat. But but that's it. There was never information about preparation. There was never information about risk assessment and health span and preparing for that next section.
00:24:58:21 - 00:25:08:18
Speaker 2
Right. I still it's still baffles my mind how getting prepared for puberty. You all know how many books there are out there and.
00:25:08:18 - 00:25:10:16
Speaker 3
How many books.
00:25:10:17 - 00:25:31:22
Speaker 2
Everything to help prepare children go through puberty, right? Think of the millions of dollars in the pregnancy industry and fertility industry and, you know, getting you pregnant and pregnancy books and, you know, books on how to raise kids for the first year. And then what do we have with perimenopause? Nothing. But what do we even have for postpartum women?
00:25:32:00 - 00:25:32:06
Speaker 3
True.
00:25:32:07 - 00:25:33:19
Speaker 2
Not very much at all.
00:25:33:21 - 00:25:34:05
Speaker 3
Well, because.
00:25:34:05 - 00:25:42:10
Speaker 1
To your point, so overshadowed by the pregnancy itself and becoming a mother, right. There's this whole untapped wealth of knowledge that needs to be expanded upon. That's I mean, that's interesting to me.
00:25:42:11 - 00:26:02:23
Speaker 2
Even in addition, I'd say just keep asking questions, keep being curious about your body. Keep keep searching for that right provider who's going to come alongside you and and support you in your health journey. Right. We don't want to just wait until we're sick to get the care that we need. We want to be empowered. We want to work with our bodies, not against it.
00:26:03:00 - 00:26:09:03
Speaker 2
We want to understand what's going on so that we can make the choices to to support our bodies appropriately.
00:26:09:04 - 00:26:16:06
Speaker 1
Yeah. Don't be afraid to. I don't want to say break up with your provider, but don't be afraid to go find a provider that fits where you are.
00:26:16:06 - 00:26:17:00
Speaker 3
In life that.
00:26:17:00 - 00:26:18:04
Speaker 2
Meets your needs a way you're.
00:26:18:10 - 00:26:38:03
Speaker 1
Yeah, because your needs will evolve and change. Like we'd say a lot of cascade, right? You have a path in life towards your goals and your health. And that's going to change as you go. And you need to be aware that your provider might not be the right one at all times. So you might may look elsewhere. So okay, so wrapping it up here, there's one more thing I want to talk to you about, which is I have in my notes that you really don't get much care for postpartum.
00:26:38:05 - 00:26:47:03
Speaker 1
Can you talk to me a little bit? I mean, I don't have any insight as to what that care is, so. I mean, maybe it's more than I realize. Maybe it's less. But what does a woman get in postpartum right now? What's the standard?
00:26:47:05 - 00:27:09:11
Speaker 2
So the standard is one visit after a vaginal delivery. And usually that's between 4 to 6 weeks. They do a blood pressure check a check and how everything is healing. See how you know the lactation or nursing is going to talk to you about contraception at that point of time, and then then you're off on your own. And pretty much it's like, okay, we'll see you next year for your annual.
00:27:09:11 - 00:27:11:15
Speaker 3
That's it. One plus one. Okay.
00:27:11:16 - 00:27:29:20
Speaker 2
If you've had a C-section, then usually you get brought back sooner. So within 1 to 2 weeks after the C-section because that's the surgery. So check and make sure the incision is healing okay. Right. And then you'll get a second visit around the 6 to 8 week mark, you know, and all organizations that have a different cadence. Right.
00:27:29:22 - 00:27:48:19
Speaker 2
But you'll get that second visit where they'll do the contraception talk. What are you going to use now? And, you know, make sure that the the bleeding is stopped or is minimal and how things going, they usually do a postpartum depression check at that that 6 to 8 week visit as well. And then again you're off on.
00:27:48:19 - 00:27:50:03
Speaker 3
Your own. So it's two.
00:27:50:04 - 00:27:51:10
Speaker 1
If you've had a surgery, one.
00:27:51:10 - 00:27:52:16
Speaker 3
If you did it correct.
00:27:52:20 - 00:27:53:06
Speaker 1
That sounds.
00:27:53:06 - 00:27:53:14
Speaker 3
A little.
00:27:53:15 - 00:27:54:14
Speaker 1
White to me.
00:27:54:15 - 00:28:08:09
Speaker 2
Yes. But Alex, remember me talking about well, but it takes a full 24 months for your body, your mind, your brain, everything to recover and recuperate from the immense stress that has occurred over the last month.
00:28:08:09 - 00:28:10:17
Speaker 3
Of growing and.
00:28:10:17 - 00:28:11:07
Speaker 2
Delivering.
00:28:11:07 - 00:28:11:18
Speaker 3
It.
00:28:11:20 - 00:28:17:12
Speaker 1
Like two months of time. When you're healing for two years, that feels very. I mean, why is it structured.
00:28:17:12 - 00:28:18:22
Speaker 3
That way?
00:28:19:00 - 00:28:38:03
Speaker 2
Access to care, you know, the busyness of providers, but also because, let's be honest, because of our sick care model. Yeah, right. So I started a while ago when I was still doing obstetrics. I'm not doing that anymore, but I started a six month check in. And so I made all of my postpartum patients when they left that visit.
00:28:38:04 - 00:28:40:11
Speaker 2
Schedule the annual exam in six months.
00:28:40:12 - 00:28:41:09
Speaker 3
Nice. Okay.
00:28:41:10 - 00:29:06:21
Speaker 2
Right. And so do another big check in there. By that stage, we would also want to see a significant amount of weight loss at that point for for our patients. But everyone's body is very unique right. And so the 30 to 50 pounds of weight gain during pregnancy for some woman comes off extremely easy just with breastfeeding. For some women it doesn't come off until they stop breastfeeding.
00:29:06:22 - 00:29:31:16
Speaker 2
Right. So there's you know, we're as unique as our own fingerprints. Right. And so that personalized care, that touch base back at that six month mark can really help to get that woman back on track, to show her the importance of taking care of herself and not just constantly being focused on that newborn and their baby and the baby meeting its milestones because the little one has had.
00:29:31:17 - 00:29:35:19
Speaker 2
I'm going to over exaggerate now, but, you know, 7 to 10 visits at the pediatrician or.
00:29:35:20 - 00:29:36:13
Speaker 3
Yeah.
00:29:36:14 - 00:29:39:19
Speaker 1
I don't even know if that's exaggerated. That's just I mean, yeah, the comparison.
00:29:39:21 - 00:29:40:08
Speaker 3
Wow.
00:29:40:10 - 00:29:51:22
Speaker 2
So I would, I would say to postpartum women seek out more care, seek out more frequent care, seek out a provider who's going to partner with you in your health journey. Not just come to me when.
00:29:51:22 - 00:29:52:08
Speaker 3
You're sick.
00:29:52:09 - 00:30:08:13
Speaker 1
Yeah, I think that is another huge testament to the fact that we wait for symptoms. We don't treat signals, and that ongoing care can be so important because you can tell Mikey you said earlier, right? You can identify something in that ongoing care that could lead to other discussions you need to have about your health and other departments like your hormones, things like that.
00:30:08:14 - 00:30:30:08
Speaker 1
Well, Doctor Westgate, as always, thank you so much for coming on. It's been tremendous speaking with you about postpartum, and I hope our listeners feel as educated as I do on the importance of postpartum and the effect it has on their health span. As always, thank you so much for listening. I'm your host, Alexandra Galaxy. Join us next time on the Cascade Effects podcast, where we are on the never ending pursuit of the best way to live longer, healthier, and enjoy life along the way.
00:30:30:14 - 00:30:36:14
Speaker 1
Smash, subscribe and engage in all forms of whatever platform you're listening. We greatly appreciate it and we will see you next time.