Hello and welcome to our sit down Sunday Q+A again another week where we answer your questions
this week we're going to be talking about birth control after pregnancy postpartum birth control
yeah and then also talking about daycare child care when is it safe to go to a daycare or are
there times when you need to do something else for child care to keep your kiddo safe yes if
this is your first time meeting us I'm Sarah I'm a board-certified ob gyn and Mama to one with one
on the way yep and I'm Kurt, a board certified pediatrician and we are the Doctors Bjorkman
our first question comes from Arya Montoya and she says I got my IUD the liletta put in at my
six week postpartum appointment my cousin told me she was on something called a mini pill because
it only has one hormone which is preferred for breastfeeding moms is there research that says
certain hormones and certain birth controls are bad or can affect babies through breastfeeding
I wasn't told about any of this LOL I love you guys gosh there's so much to know and think about
right totally so postpartum contraception though is something that your OB GYN and myself love
um because of kind of the data out there about pregnancy spacing and you know allowing your
body time to heal we want to make sure you don't get pregnant again right away yeah and we actually
did an episode all about the best time to have the next baby that you guys can check out will
put a card up for you if you want to check that out yes so as for con postpartum contraception yes
there are some different options in general we think about birth control pills patches rings iuds
and implants is like General contraception and postpartum there are some special considerations
that we think about so after you give birth you are at a higher risk of getting a blood clot
is one of those considerations so birth control containing estrogen in it which is many combined
birth control pills we try generally try to avoid those in the first four to six weeks postpartum
just a month and a half is what you need to avoid those fish yes that six week Mark is where that
risk is elevated this is not a high risk but just compared to someone who's not pregnant your risk
postpartum and during pregnancy is higher so generally try to avoid birth control pills
that contain estrogen during that time the other thing and so this mini pill is a birth
control pill that only contains progesterone okay it doesn't have that estrogen component
it is just progesterone so that's great in terms of blood clot risk the other thing to think about
for postpartum breastfeeding moms is that there is some data and and experience from other moms
out there that estrogen in the birth control pills can actually kind of be detrimental to your supply
um yes and can affect your breast milk supply so not that it's dangerous to baby it's totally
safe to be on birth control pills with estrogen in terms of safety to passing it in the milk to
baby that isn't a concern but it it makes and some women can take combined birth control pills with
estrogen and progesterone and it doesn't affect their supply some women are much more sensitive
to those hormones and find that it does so to be on the safe side for multiple reasons we generally
start with the mini pill at least for those first six weeks to make sure your supply is established
before we introduce any fluctuations women sometimes notice a dip in their supply around
the time of their period and different things and that again is because of some hormone fluctuations
in terms of your IUD awesome postpartum contraception it is a set it and forget it method
um that is super super effective 99 effective at preventing another pregnancy
iuds the liletta marina kyleena Skyla all of them are all progesterone only containing devices and
the interesting thing about those is that the hormone they release from the little device that's
in your uterus is local so those hormones are just really acting on your uterus and not system wide
so again long answer to that question another progesterone only option is the implant like
a nexplanon that is also something that sometimes we can do while you're in the hospital immediately
postpartum and we should do a whole episode about postpartum contraception options because
it is really important and that actually dovetails really well into our next question so this is from
Valeria who says hi I have two questions to an OB GYN and to a mom number one what are your birth
control options right after the delivery if you have horrible PMs and if the monocompetent pills
give you PPD before so I think you just talked about all of those things number two did you put
your daughter to a daycare or hire a nanny what are your plans for the upcoming baby what is an
okay age for baby to start daycare thank you so I'm gonna take the second question there so
we've been really fortunate right away in terms of our own schedules in terms of being home for the
first couple months either one of us was able to actually be the primary parent for quite a while
and lots of help from Grandma with number one with number one and then we're able to hire a
couple different high schoolers college students college students actually who um the wonderful
College who came and helped us out between classes and just worked really well um that was largely
she was a coveted baby a little bit and I was I was I was nervous about sending her to daycare
all the same things you are asking about hey her immune system getting sick whatever
um and so just because of our life and daycare availability and covid my again we had a family
member my mom was able to come and live with us for the first six months of her life and so and
then now we're kind of hybrid where we've got some in-home help and then also like goes to daycare
preschool for a couple days a week too which is nice and so I think the question that you might
be answered asking or that many people are asking are twofold like one when is it safe for them to
go to daycare from a health standpoint and two is there a time when they need to go for a social
socialization standpoint so from a safety virus thing so of course this is well known if they go
to daycare you're going to give half your salary to pay for it and then they're going to come home
with a new cold every week because the meme I just saw a couple days ago and felt that to my core for
sure yeah um definitely there are like the first couple weeks of life course when you are hopefully
home on your maternity leave are the times in your baby is most vulnerable to infections so the first
two weeks especially of Life of course if you can avoid them being around a lot of people and if you
can go two months even is even better because they get those two-month vaccines two-month
vaccines okay and even just your immune system is really developing and there's actually this
barrier between the bloodstream and then the the brain and the food around the brain the CSF that's
really developing over those first two to eight weeks kind of throughout that process and the risk
of getting an infection in the cerebral spinal fluid after two weeks drop significantly and
then more after 30 days and then even more after 60 days and so that's kind of if you're able to
like 60 days is two months eight weeks somewhere in that ballpark so if they're like generally
lines up with most people's maternity leave is a nice time to be home to be safe for them if
you can if that's an option for you um the other thing is if they get a fever in those first couple
weeks of Life the really the pediatrician or the emergency department would bring them into would
have to be really thoughtful about do they need to do blood work urine work or even potentially check
the fluid in the spinal column with the lumbar puncture to check that fluid to look for serious
bacterial infections if they get a fever then and are sick in those first couple weeks of life after
that is kind of up to you and what's going to work best for your family if you're able to have them
home it just limits the number of viral illnesses that they're giving to you I know we've each been
sick a couple times with different illnesses this fall um and as part of a child building their own
immunity and that's that's okay and every child is going to have their own path to that yes
there's really not a perfect time when they like need to go like definitely like they're going to
be better able to weather some of those viral illnesses as they get a little bit older once
or a couple months of age they should be able to do most of it but of course if you have concerns
about your baby breathing fast you're not able to keep up with hydration call your pediatrician
and that being said many many people I mean I feel like six weeks is such a common maternity
leave you know in the United States at least um which isn't long enough um but it's pretty common
have lots of friends whose babies go right back to daycare at six weeks they do just fine generally
at daycare ratios with infants are much much smaller um and you know instead of one caregiver
to eight it's one caregiver to four the tiny babies or less and things like that um little tiny
infants also aren't like playing with other little snot nose toddlers sharing toys things like that
they're you know hanging out with the caregivers in a crib doing different things so I think that
kind of helps them it helps a little cocoon them in terms of if your baby has to go in there a
little tiny because that's what you need for your life that's okay they they will be fine there is
not a recommendation from the AAP or anyone else that says try to keep your baby out of daycare
until eight weeks like that's not a thing so don't feel guilty about that um in terms of daycare in
general find somewhere you feel very comfortable with that people you trust and if want something I
think is helpful is kind of trying a run through you know like your last week of maternity leave
say hey can I bring the baby for three hours this morning just to try it so that you know like hey
here's what I need to pack here's my drive there here's how it goes I can cry about this a little
less because I feel more comfortable minutes to practice when that day comes you know what
I mean so just something to think about as you're getting ready to go back to work whenever that is
is to see if you can try a run through of where baby's gonna be taking a bottle taking the baby
getting there all of those things it doesn't have to be the full day just even to ease yourself into
it and make just make sure you feel comfortable with the place you're leaving your sweet little
one to be loved on and it will just make your life so much better if you feel like your baby
is in good hands yeah and the other Pizza that too if you're really worried about hey I really want
my baby to get their first round of vaccines you can technically give them as early as six weeks
we were actually like when Cecilia was young we were going to be out of town at her eight week
two month visit and so we gave those vaccines actually two weeks before that two-month visit
which is well within kind of the normal time frame for that if that's something you're interested in
the other piece of this question is when do they need to be around other children for socialization
um in the first 18 to even maybe 24 months of life really that child's biggest thing is to learn a
language and and interact with their world around them maybe they do some parallel play but not a
whole lot of interactive play especially in the first year and a half and so a lot of that social
interaction they can get it home from parents or love care providers that are able to just interact
with them reading to them lots narrating life that they hear language they don't necessarily
need to be around other children for that right and that's been studied in terms of like is this
socialization required tired and again before the 18 to 24 month mark it does not appear to be
detrimental all these little coveted kids that didn't get to go to daycare are going to turn
out just fine but if you are at home with your child try to find ways to make sure you're doing
different things with them every day like in the house in terms of like Hey we're gonna play this
game we're gonna go touch all the Fabrics in the house today or we're gonna look at all the colors
in the house today just to find ways to make sure you're exposing them to different things that you
as a parent at home are able to do yeah and even around other kids at a at an indoor park at the
playground where they are around other kids um I know I think cease had her mind get a little bit
blown when she went to school this year and the whole world did not revolve around her constantly
and so there are certainly opportunities even when they are little um even though they're not like
playing with other kids to kind of learn about the world around them in different boundaries
um is it needed to make sure your kid you know turns out fine not really before or 18 to 24
months but there are opportunities for them to you know learn some boundaries outside of
the home when there are other little people around so that's it for us this week thank
you so much for your questions as always we will answer more questions next Sunday look
forward to seeing you guys then and on a regular Wednesday episodes have a great week 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