INTERVIEW WITH DR. HEIDI WITTENBERG – OB-GYN AND GYNECOLOGIC SURGEON

PART I – PERMANENT CHANGES IN A WOMAN’S BODY WITH PREGNANCIES:  WHAT TO EXPECT?

What type of permanent changes in their bodies can new Moms expect following their first pregnancy?

I interviewed my colleague Dr. Heidi Wittenberg, an OB & GYN surgeon, about her experience with how women’s bodies change with multiple pregnancies.  As a mother of twins myself, I was curious about what to expect when I was getting ready to have my babies!

Here are her answers to questions about pregnancy, motherhood and how a woman’s body changes after pregnancy:

A Head-to-Toe Discussion of the “Battle Scars from Birth”:

1.  Breasts change shape after breastfeeding is completed. While breast increases in size initially, overall decrease in size and shape occur afterwards with loss of upper roundness/fullness of the breasts.  This change is expected, regardless of whether mothers nurse their babies or not!

2.  Stomach: Rectus abdominis muscles (the “six pack”) can flatten but lose a little of their original elasticity. So if there is extra gas distension in the abdomen, or as commonly happens with second and +++ pregnancies, the pressure of the bowels is not held in by the stomach muscles, so women can appear 7 months pregnant, even though they are only 2 months.

The skin over the stomach also loses elasticity so that even the flattest stomachs have little extra skin folds or a crepe-like effect in the lower abdomen. These aforementioned changes are PERMANENT so unfortunately all the working out and dieting in the world will not help you regain elasticity!  Only the help of your friendly local Plastic Surgeon can help with this if it is bothering you in the form of a tummy tuck.

3.  Next on the list is pelvic muscles and their dysfunction: Depending on many factors with carrying a pregnancy, route of delivery, weight of baby and your own genetic factors; many women can have urinary incontinence, gas/fecal incontinence, and/or prolapse of the vagina. Most women this recovers in the first few months post delivery; however, many women, continue to experience a variation of these that range from mild to severe. In France, women are automatically sent for pelvic floor education and physical therapy to help strengthen their muscles. Here we send women if they are complaining of any incontinence of urine, gas, fecal material or feelings of prolapse after their 6 week postpartum checkup. If this does not help, more formal diagnostics and therapies are discussed. Surgery can often be performed robotically, minimizing downtime and risks associated with an open procedure.

Also pelvic muscles give a little easier with subsequent pregnancies because they also have lost elasticity. So after the first pregnancy and other pregnancy feels “lower”. “I feel pressure” is a common complaint. ” I feel like I’m walking around with a bowling ball between my legs” and “I feel like if I reach down between my legs the baby is going to high five me” are two of my quotables for this. Luckily feeling resolves postpartum.

4.  Body types: Sometimes women get back quickly to their pre-pregnancy weight but notice that clothes fit differently. In the last month of pregnancy, a hormone called Relaxin, appropriately named, is released. It relaxed the ligaments around the hips and pelvic bones to allow some stretching and give with birth. ( This is the reason women get achy hips at night and feel like they are sleeping on cold cement, and also the feeling like someone punched them in the pubic bone. This is also the reason women get clumsy and fall in the third trimester because their center of gravity is off and their joints are ‘gimpy)’. This resolves by 6 week post-partum but their might be slight changes in the ligaments and this explains why some women get “hip spreading” after a pregnancy and delivery, no matter the route.

5.  Veins in the lower extremities get the brunt of a 50% blood volume increase and the fact that pregnancy shunts everything downwards. Vein walls get pushed and dilated to the limit. During the first pregnancy varicose veins may or may not be noticeable, but by the second, they have lost much of their reserve. That’s why with each subsequent pregnancy, varicose veins worsen.  Compression stockings can alleviate some of these symptoms.

6.  “Barefoot and Pregnant”: Feet get swollen in the last few months. While the feet swelling will go away by 6 weeks postpartum, the additional weight and changes sometimes increase a woman’s shoe size permanently. An excuse for a whole new wardrobe of shoes!

To learn more about Dr. Wittenberg and her San Francisco Gynecologic Surgery practice, visit her website at http://www.pacificgynsurgicalgroup.com/index.php or call 415-923-3130.

Stay tuned for part II of my interview with Dr. Wittenberg, where she will answer additional questions about changes with pregnancy and what can be done to reverse/correct issues Moms might be facing!