June 4, 2023

The Doctors Bjorkman are a board-certified OB/GYN and Pediatrician couple who have shared their recent experience of TTC, pregnancy, birth, and life as new parents with their first baby. This week they continue their new weekly series — Sunday Q&A, where they answer your questions.

Hello we are the doctors bjorkman and this is our sit down sunday q a where we take the time every week to answer some of your questions this week we’re going to answer three questions yes one about breastfeeding and kind of the return of fertility or getting pregnant again yep the next is going to be about eczema and skin care and infants and last but not least

Talking about what to expect if you are going to have an hsg or a hysterocell pingogram yeah and just in case it’s your first time meeting us i’m kurt i’m board certified pediatrician i’m sarah i’m a board-certified ob gyn and we are the doctors bjorkman foreign let’s get right into it this week we actually had a bunch of questions about breastfeeding and kind

Of trying to conceive again and the return of your fertility um and so you know abby p said does breastfeeding affect your next pregnancy asmrk said do you think breastfeeding impacts natural family planning can you talk about trying to conceive while breastfeeding sandy mejia said i’m six months postpartum and breastfeeding full-time my cycle has not come in yet

But we want to get pregnant is it possible so maybe is the answer um you the thing that like trigger triggers a period is ovulation and so when you’re breastfeeding and you haven’t been having cycles regularly eventually at some point your body ovulates and that and then after that you get a period so if you ovulate you may get pregnant before you get that first

Period and so possible hard to tell if you’re not like regularly tracking um your hormones a little bit and so it’s really tricky when you’re breastfeeding so we’ll come back to that a little more in a minute sarah martin also said how long does it typically take for your cycle to go back to normal post-pregnancy for reference i have an 11 month old got my cycle

Back when she was six months always had a short cycle 24 to 25 days and pre-pregnancy ovulated around day 12. post-pregnancy ovulation is not happening until around day 16 to 18. still with a cycle around 24 days we want to try for another baby soon and know that a cycle like that makes that tough and impossible so many things to unpack there so how long does it

Take for your cycle to go back to normal post-pregnancy is so highly variable for every single person um often it is somewhere between kind of 6 and 18 months if you are breastfeeding some women who are breastfeeding get their cycles back at six weeks some do not get their cycles back until they completely stop breastfeeding whether that’s 18 months or two years

Or however long they’re breastfeeding a lot so highly highly variable there is something called the lactational amenorrhea method that is says that if you are exclusively breastfeeding meaning going no more than about four hours that is the only nutrition baby is getting and you are less than six months postpartum there’s probably it’s 99 effective in saying you

Are probably not ovulating yet so full-time breastfeeding moms most of the time don’t get their periods back before six months again of course there are people that do so um i said surprise babies out there for some i’m sure yes so the thing that you mentioned and kind of the why to all of this is when you are breastfeeding the hormone prolactin is elevated that

Helps um develop breast tissue as well as milk production and so that elevated prolactin is really really important for milk production and feeding your baby but it also inhibits the reproductive hormones that tell your body hey we want you to ovulate and things like that so a hyperlactin is good for milk production but it inhibits the directions from your brain

That we should ovulate so that prolactin being elevated as you said sometimes your cycles do come back as babies start to sleep longer you don’t breastfeed quite as much and so your cycles return but since you are still breastfeeding that prolactin is still a little elevated and often women have a short luteal phase which is what you described so the luteal phase

Is the part of the menstrual cycle after ovulation um so the first part is the follicular phase when that follicle is growing then you ovulate and then there is the luteal phase and so when prolactin is high and a normal luteal phase is really between 12 and 14 days when it’s less than that we it’s often called a short luteal phase and we know that we need a good

Strong luteal phase to support an a embryo in implantation and starting a pregnancy so as you described if you are ovulating on day 18 and your periods showing up around day 25 or six that’s really only a six to seven day luteal phase which is short and very commonly seen with breastfeeding moms with prolactin elevation so even though your cycles are back it’s

As you said tough to start um a family so the moral of that story is it’s different for every woman some people’s fertility does not truly return until they’ve completely completely weaned from breastfeeding some people get pregnant at four months while they’re breastfeeding it’s different for everyone which is why we always talk about postpartum contraception at

That six week visit because we don’t know where you’re going to fall i think it’s also important to think about even like the timing of that second baby we did a video all about like when should you have the next baby what is the evidence are there any benefits of risks of like having babies early or waiting longer um when is the best time for mom in terms of letting

Her body recover recovery breastfeeding there’s so much to weigh like do i want to breastfeed my baby till two maybe and maybe that’s a wonderful relationship that you have but maybe it’s slightly impacting your fertility and you can’t get pregnant again and so that was something i think we also ran into you know when we started trying around the six month mark i

Had short cycles i was like my prolactin’s elevated this is probably part of it so we quit breastfeeding because i thought maybe that was also for tech affecting some of our fertility so i’ve been there i know it’s so frustrating to love breastfeeding and also want to have another baby so check out our videos and we wish you the best yeah yeah but you’ve continued

To breastfeed until a year of age and sort of um i i’d like direct breastfed until she was about 9 or 10 months old and then had milk in the freezer that i had stored i continued getting up in the night to pump even after she had gone started sleeping through the night and so we we had a bunch of milk in the freezer that so she got breast milk until she was one

Um but i had kind of quit pumping i gave up pumping is not always fun and i think it was like she was 9 or 10 months old when i quit pumping so great yeah so the next question this comes from katie h and she says not sure if you’ve already covered this but how to care for baby skin i’ve got a three month old and a two-year-old is bathing every night necessary also

When should i call the doctor about a rash what types of products should i use and what to avoid yes and i saw a couple questions as well about eczema and babies being uncomfortable so this is a great one yeah absolutely and so this is something that i think every parent is going to run into with their little one as you’re going to see rashes at some point in time

We’ve done a video about diaper rash and things like that before check that out but in terms of like kind of rashes elsewhere in the body outside of the diaper area especially as we’re going into fall and the winter months when the dry skin is going to pop up the question is what can you do for your child how do you help keep their skin healthy and when do you need

To act on it right so the first thing is moisture is critical like keeping the skin like appropriately hydrated and so the first part of that is to not dry it out and so thinking about things that are really harsh on baby’s skin can be things that have scents or fragrances in them and dyes or other chemicals like that so try to use scent free dye free things and so

This is everything from your laundry detergent that you’re washing the baby’s clothes in to the soap you’re using in the bathtub to the moisturizer you put on their skin at night or in the morning whenever you’re doing that routine i know there’s even it’s really interesting there’s like baby marketed brands of laundry detergent that have tons of fragrance in them

That smell wonderful and make your baby smell so fragrant and beautiful but that fragrance itself can actually be really irritating to the skin and so we used free and clear brand of laundry detergent that we’ve just always used for ourselves but that just was rather than buying the baby laundry detergent free and clear is the best way to go from that standpoint

Also the same thing for soaps and her shampoo that we use in the bathtub again free and clear no sense snow fragrances then other things are hold on do you buy baby yeah yeah okay and then like this leads us to the question of what about baths how often do you need to bathe them so definitely early in infancy you do not need to bathe your baby every night like

The only part of them that really gets dirty is the diaper area and so keep it clean etc different people’s skin types like can tolerate more bathing versus less but as long as your baby is clean the skin doesn’t need to be washed every night and actually there’s some benefit of the healthy skin oils that help keep the skin healthy having said that when our little

One was i don’t know by the time two months of age we had like a nighttime bath as just part of our bedtime routine and so and she’s been able to tolerate that one thing that we’ve worked with though is like a really good moisturizing routine for her especially in those winter months and for us that was we got a scent free dye free ointment okay again this is an

Ointment not a lotion it just means it’s thicker and does a lot better job of like coating the skin and staying on the skin we like aquaphor a lot we’re not sponsored by them obviously but you certain is a good brand anything that is again scent free die free you can use vaseline even is the same concept it’s got no sense no dyes no fragrances and just like helps

Keep the skin’s natural moisture inside creating this protective barrier over it um if you’ve got a kiddo that’s got eczema and you’re really struggling with it i would say get a big tub use it at least twice a day if not three times a day keep things moisturized from that standpoint right um if you’re having you’re really struggling you say gosh despite doing

This we’re still having lots of dry skin lots of eczema everywhere be sure to see your pediatrician there are times where you might need to use something more like a steroid cream or even special washes to help prevent infection in really severe cases of eczema but at the end of the day just to say it one last time for the tenth time the best thing you can do is

Scent free dye free and then a lots of moisturizing we loved aquaphor twice a day especially during the dry fall and winter months yes so to circle back when do you call your pediatrician about a rash yeah so most dry skin obviously you’re going to be able to handle at home most diaper rashes we’ve talked about if you feel like that rash is persisting it’s been a

Week it’s not getting better is a great time to just call even check in with the nurse line and they may say they can help you triage is this something that needs to be seen in clinic or not there are times where even eczema can be really itchy and antihistamines may be helpful they just help your toddler sleep or your young child sleep and can help calm some of

That response down and i think generally as physicians we don’t want you to worry alone at home and so if you have a question that is why you have a pediatrician they have a nurse triage line they we want to answer your questions and help you figure this out that’s our job we love doing it so don’t hesitate to call your pediatrician with a question anytime goes

For the obs too so last question here we’ll do real quick sarah ridge says what to expect from an hsg mine is monday all right sarah yes um i’m sure you’ve read or heard some horror stories my hope is it’s not going to be as bad as you expect so an hsg if you and for those of you who don’t know is a hystero sell pingogram which is a fancy word for it’s kind of a

Tubal dye test what we’re doing is injecting contrast into the uterus so it fills up the uterus and hopefully goes out the tubes to look and see are the tubes open is kind of the big thing and it kind of can show the inside uterine architecture to make sure it’s normal so to do an hsg usually you have to go to the hospital or somewhere where they have kind of what

We call a c arm or a radiologist because they are taking x-ray pictures as they’re injecting this die this could be in some offices some clinics have a small crm in their office so it may talk may be at an office sometimes it’s at a hospital it just depends so definitely if you don’t have a contra indication to recommend taking 600 milligrams of motrin or ibuprofen

Before going for your hsg because it can be kind of crampy anytime you put something in the uterus that isn’t supposed to be here there the uterus gets mad about it and tends to cramp so you get there for your hsg you’ll take a pregnancy test because they want to make sure you’re not pregnant the best time to do an hsg is really between kind of day 6 and 12 of

Your cycle we don’t like to go much farther than that because we don’t want you to ovulate or disrupt a pregnancy so you show up to the hospital you take your pregnancy test they will have you get undressed usually in a hospital gown and then get up on a table in stirrups such a fun time um you’ll sign a consent form you will the provider will place a speculum so

That they can see your cervix just like how you start out going to get a pap smear they place a speculum so they can see your service cervix and then pass a very small catheter it’s kind of like a long straw a long straw but it’s like cooked spaghetti so it’s very flexible and they pass that through your cervix often they’ll inflate a little balloon so that that

Catheter doesn’t fall out and that part can be crampy because again uterus gets a little mad um that there’s a balloon blowing up um and then radiologist comes in and they start to inject some contrast through that catheter and while that’s happening the radiologist is taking x-ray pictures and the contrast is just radio opaque dye that fills the space and then

X-rays shows us exactly where the spaces are so we can see what the inside of your uterus looks like and then we watch that die as it moves out through the tubes and if your tubes are dilated or if they’re blocked then we see them they kind of fill up they get dilated and that contrast doesn’t flow out into your pelvis and i know you’re like oh i’m getting contrast

Into my pelvis the amount of contrast required is like the amount a teaspoon it’s a tiny tiny amount so it’s safe and they take pictures to find out if those tubes are open are they dilated are they blocked and it gives us a lot of information about are those tubes open can you know when you’re ovulating can that sperm get to the egg so can be crampy especially

If your tubes are blocked because that dye doesn’t get out and it gets stuck there and so that can be a little crampy the good thing about all of this is usually it takes five minutes or less to do the whole thing and then i always tell patients keep taking your motrin and tell your partner that they owe you a back rub or something when you get home because it’s

Not always a fun time jewelry or yeah at least a good back rub so good luck we’ll hope for sparkly tubes the dye goes right through and if not go talk with your rei about next steps so we’ll be thinking of you that’s going to be it for us this week make sure you’re subscribed so you catch our regular wednesday content yeah please feel free to leave us questions we

Try to get to a few of those every week and we were answering yours too bye guys we’re doctors but not your doctors anything we’ve said in this video is for education or entertainment purposes only it is not medical advice any specific medical questions you have should be directed to your provider

Transcribed from video
Breastfeeding and Fertility, Baby Skin Care/Eczema Tips, and HSGs: OBGYN & Pediatrician Answer By The Doctors Bjorkman