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Delivered (Part One): Podcast Transcript

Anita Rao
I grew up with no shortage of access to information about the physical body. My dad is a gastroenterologist and talk about poop farts and all things in between was kosher any time of day, dinner table or not. Before I was born, my mom was a midwife, and in my early years, worked as a labor and delivery nurse. When she had my younger brother, I often sat next to her reading aloud Berenstain Bears books while she was nursing.

Yet, and still, I knew next to nothing about what childbirth actually looks like until my own friends started having kids. You tear where? You poop when? Why hasn't anyone told me about this? Their response? "I know. But trust me, there's a whole lot more. Let me know if you ever want to talk about it." Well, I do. And, we should.

This is Embodied — our show about sex, relationships and your health. I'm Anita Rao.

Kyesha Jennings
During the first few days of my postpartum period, I remember thinking frequently, "How come no one ever told me?" Pushing for two hours caused me to have a second degree tear. The following day after birth, I learned that the pain from sitting down was caused by a hemorrhoid. I also had experienced tremors, or what are referred to as the shakes. And, apparently this is caused by an imbalance in your hormone levels, and it is also a side effect of having an epidural.

Brianna Battles
There's just a lot of changes. It's not just maybe some loose skin or a different shape, and that can be really hard to figure out. Who am I? What is this new body that I'm in? And what can I do about that?

Anita Rao
Listener Kyesha Jennings, and founder of "Pregnancy and Postpartum Athleticism" Brianna Battles. Growing and then birthing a child opens up many new worlds for parents — mentally and physically. There are so many challenges and adjustments in the postpartum period, we didn't even want to attempt to talk about them in one episode. So, for now, we're doing two. Part one: the physical.

Lydia-Carlie Tilus
Your blood flow changes, the amount of blood that your body produces increases. And that's to accommodate the growing baby — growing fetus — as they are developing, because you're also growing a new organ, which is the placenta.

Anita Rao
Lydia-Carlie Tilus is not a doctor. But, she knows near everything about the postpartum body, from her work as a birth and postpartum doula and certified neuromuscular massage therapist.

Lydia-Carlie Tilus
So, not only is a fetus developing into a baby, but you also have an entire organ that is also developing in the body. And, to that point, it's also an organ that has — in addition to delivering your baby — you would also have to deliver your placenta. And, with that shift and, like, increase in blood flow, circulation can become challenging depending on how someone's body was before they were pregnant. So, you can develop things based on the losing of space, to a point. And, I'm sure pregnant people can relate to this of, like, that sense of, like, your body is being encroached on, in a way. And so, you know, that feeling of, like, there's less room in your ribs because now your organs have been shifted, right. And, as the pregnancy progresses, the ability to take deep breaths feels far more challenging. And also, the way that you walk will change, because your pelvis is being shifted. In terms of, like, the angle of your pelvis and the way your muscles will need to support your walking, your gait, will all change too to accommodate the fact that your center of gravity is shifting. And, you have a different shape to your body in a very simple way.

Anita Rao
The body is not done changing once the baby is born. It can take a long time for tears, stitches or surgery wounds to heal, for stretched muscles to recover. And, hormones are still very much in flux. No matter how many momfluencers share tips for bouncing back, your body is not going to be the same as it was before pregnancy. It's not a fact meant to be scary, it's just the truth. As part of her postpartum doula work, Lydia-Carlie makes space for the transformations that start in the first few weeks after giving birth.

Lydia-Carlie Tilus
One of the things I ask my clients when I'm working with them is, "Does your family have any postpartum traditions? Is there anything culturally specific to you?" And, I say that because we see across many cultures that there's this sort of lying-in period — like, the first 40 days, or in some cases, we'll call it the fourth trimester. And so, it's this, like, time of bonding and orienting to the fact that you're now — there's an additional person in your family. But also, I tell my clients, like, this is your birth too, and that you will wake up one day pregnant and the next day not. And, that is a new sense of self that you have to integrate in a new identity. And, that comes with physical changes that I don't know that are always expressed in terms of, there's going to be a lot of bleeding, there's going to be some discomfort, there's going to be a lot of fatigue. The adrenaline of just giving birth, like, it's there for some time, but then it drops. And, then you're with the reality that, like, you may not be sleeping for more than a few hours at a time for several days or even a few weeks.

Taylor Matthews
Both my children were born via C-section. My son was an emergency C-section, and my daughter was a scheduled C-section. When you have a C-section and you're cut from hip to hip, you're completely awake. And then, not even eight hours later, you're expected to care for a child.

Kyesha Jennings
Despite the fact that my overall pregnancy was free from complications, for about a month, I had no feelings or strength in my abs, and it was challenging to walk. The first two weeks, it was spent using all the things: the Dermoplast spray, the tuck pads, high dosage pain medicine, the peri bottle, the witchhazel spray. I used maxi pads, Depends, boy shorts. You name it, I had it, I needed it.

Anita Rao
Those were listeners Taylor and Kyesha. Those first few weeks post-birth are tough. You're trying to physically heal while learning to care for a newborn, or caring for a newborn on top of older siblings. Just making time to eat a meal or take a shower can be really difficult. And then, there's the reorienting to this new body.

ash luna
I thought, certainly I could find some visual representation of what my body looked like in those moments, or perhaps what it would look like down the road. And unfortunately, the images that Google returned for me, then hundreds — probably 1,000s of results — not one image that returned was beautiful, was positive, in any kind of way.

Anita Rao
ash luna is a photographer. When they were 17 weeks into their second pregnancy, ash learned that they were carrying twins. At 19 weeks, they were diagnosed with twin-to-twin transfusion syndrome, had to have an emergent surgery and only one of their daughters, named Nova, survived.

ash luna
Finding myself in this space, where I felt quite alone and unsure about my physical body and what our story was even going to be, really sparked something in me to find the space where those other people existed. Knowing that as alone as I felt in those moments, I certainly couldn't be the only one who was navigating that space.

Anita Rao
And, you told a story that I read, about during your grieving and healing process, turning to Google at one point to look up cesarean scars. Take me into that moment. What inspired you to do that Google search and what you found when you did it?

ash luna
Absolutely. I was sitting up one night while my surviving daughter, Nova, was in the NICU. And, very often, would just hop online and try to do something productive to distract myself or bore myself to a place where I could try to get some rest. And, that day was just feeling really difficult about my own body having had an unexpected emergency cesarean that had some complications and had to be revised and was still really struggling to heal. I thought, certainly I could find some visual representation of what my body looked like in those moments, or perhaps what it would look like down the road. And unfortunately, the images that Google returned for me were alarming. It was either those "beach body" magazine cover images or images that were really kind of grotesque and medicalized. Or, lots of ads showing bodies that looked more like mine that were actually, like, adverts for plastic surgeons, doing, you know, "mom body makeovers" and that sort of thing.

Anita Rao
That moment came at an interesting point in ash's professional journey. They'd spent years working as a pin-up and boudoir photographer, hearing dozens of women talk about their own poor body image and not feeling at home in their skin. Before ash's second postpartum experience, they couldn't really relate. But now, they could. And with those thoughts and experiences, their next personal and professional chapter began: The 4th Trimester Bodies Project. It's a documentary photo project that's working to start conversations with postpartum folks about their relationships to their bodies, communities, families and selves. It's also become a podcast and a book. And, it all started with a self portrait of ash in their underwear.

ash luna
So, that photo was taken in my studio just a few months after Nova came home from NICU. As a self-employed person, I had to return to work pretty much straight away, and was working in tandem with Nova and caring for her medical needs. But, I had begun talking to my studio mate and business partner at the time about wanting to create some kind of representation that didn't exist. And one day, in the midst of those conversations, she challenged me to just do it like, why are you talking about this, you need to just do it. And, I think I realized, as a person who doesn't particularly enjoy being on the other side of the camera, that I did just need to do it right then or I never would. And so, without too much production or planning, I stripped down to my underwear. I love to jokingly out myself, that if you look closely it's, like, a super ratty pair of underwear that I never would have chosen ever for people to see, let alone be photographed in. But, there we were. So, the photo is kind of a close crop of my shoulders down to just below my cesarean scar, and Nova is cradled across my bare chest. In closely, there's details on that photo that I think other people don't ever see. You can see some of Nova's brain injury scars, you can see a necklace that is representing Nova's twin, who passed away. So, there's little details there that I see that you know our big markers of where we were then, and looking back on those things now to see how we've — how far we've come. You know, it's really remarkable, but it really froze a moment in time that was painful and vulnerable and empowering, all the same.

Anita Rao
So, you have photographed more than 4,000 families at this point, and there are a number of photographs in your collection of folks who have experienced pregnancy loss. And, in some they're holding a stuffed animal and others may be holding an older child, and, in the caption, you learn that they experienced an earlier pregnancy loss. I'd love for you to take us into the process of those photoshoots and what you heard from folks about the physical experience of postpartum after a pregnancy loss.

ash luna
Absolutely. It's a challenge, you know, having these physical markers of this experience and not, you know, the baby in your arms to show for it, I think, is painful for folks in a wide range of emotions and experiences. For me, really early on, I decided to have conversations with the people who are coming to photograph these particular sessions — all of the sessions, but particularly when we knew there was a loss involved — and encourage them to think about how they would like to represent the baby that they had lost, the pregnancy that they had lost, in a way that was meaningful to them, versus, you know, in some artistic way that I had dreamt up. Because, particularly for folks who gave birth in hospitals, you know, we heard this story time and again, and I lived a version of it myself, where you go in pregnant expecting to leave with your baby and go on with your life. And, the physical act of having to leave the hospital — go into the hospital pregnant and then leave the hospital alone really was, kind of, a breaking point for a lot of the parents that I've worked with. And, I think that they found in time, getting a stuffed animal to signify that child, or a piece of jewelry, or a photograph if they'd been fortunate enough to be able to capture some moments together, that marker was a more private depiction of the child that they had always hoped their friends and family members would see.

Anita Rao
With this project, ash is intentional about inclusivity of all kinds: parents who have lost children, parents who have adopted children and postpartum folks who are trans and non-binary, who have distinct challenges in their postpartum period — including difficulty accessing gender affirming holistic care.

ash luna
I think we have built some really wonderful communities online to seek support during pregnancy, to access doulas and education advocacy. But, in folks' communities where they live, very often, there's huge gaps in accessing care. And of course, situations where you may have built care that is affirming and supportive, but have something arise that shifts you to a different model of care. And, those clients very often feel that their experiences and their identity — their humanity in many cases — are overshadowed, kind of, by the norms, the processes, the agendas of the system they find themselves in, when it's something as important and integral to our stories, as you know, pregnancy and birth can be. It's really unfortunate that those experiences persist, and I certainly hope that we continue to see change in that area.

Anita Rao
Lydia-Carlie, how do you approach conversations with folks who are experiencing dysmorphia and that postpartum body, whether that is gender dysphoria, or dysmorphia because of its shape or size?

Lydia-Carlie Tilus
I think that one of the ways to approach that is to remind them that their body is still their body. And, I know that can be — and I don't say that as, like, a way to placate — but that, their body is still their body, and they are still who they are. And that, the choices that they've made are valid. I think that there's this idea of like, when you're going through recovery, that like, there could have been something that you chose differently, or something you could have done differently. Also, that their experience of their body is allowed to exist outside of what they're being told it should look like. Your postpartum body, your postpartum experience, should look like what it looks like for you.

Now, that being said, I will always remind my clients, if there's something that doesn't feel right, then you need to say something to your nearest medical professional. But, for the most part, what you're experiencing is part of your journey, and it doesn't have to look any certain way. Now with, like, body dysmorphia and body dysphoria, it's challenging because part of that is very psychological. I think that affirming the experience of being a new parent that is their experience, and that it does not need to be influenced by what media purports to be the correct way as part of that. And, I think any other gender affirming ways that they engage in gender euphoria — finding a way to translate that to the postpartum experience. So, if it means, you know, that bodyfeeding needs to happen in a way that does not feel outside of their gender expression, I think that's part of it. So, that could be the choice to not body feed, to use formula instead if this person still has lactating tissue, and that's okay.

Anita Rao
How your postpartum period goes is shaped by many things that are not in your control, including the abysmal state of parental leave in this country. We are one of the few industrialized nations with no paid parental leave. Recent attempts to pass federal legislation on this front failed. Where things stand now is that how much leave you get and whether any of it is paid is highly dependent upon who your employer is.

I didn't quite realize the magnitude of this problem until I saw how different things were for my sister-in-law who gave birth in Norway. She and her partner got ample time to put the needs of their family first, prioritize health appointments and recovery without worrying about having to rush back to work. Side note, they also weren't overwhelmed with medical debt the way many families in the U.S. are, but that is a whole other episode. So yes, parental leave is an issue. Some folks get paid time off, but the body takes more than just a few weeks to recover from childbirth.

Priyanka Rao
In my mind, I felt like postpartum was the amount of time that I had off from work. I was very, very fortunate to work somewhere that I did get 12 weeks of paid leave. But, when that time was up, I definitely did not feel like my postpartum time was done.

Amanda Magnus
I feel like my body is taking a really long time to recover from the pregnancy itself, the way that my guts were all, like, thrown out of whack and the way that my muscles were not able to work themselves while carrying a baby in my body. It's something that's been significant in my postpartum journey, and it's been difficult to come to terms with.

Anita Rao
That was my sister, Priyanka Rao, and our editor, Amanda Magnus. Neither of them felt physically ready to go back to work after 12 weeks, and their job doesn't require anything physical of them. So, what's it like when your job does?

Letticia Solomon
At the end of that six months, you're expected to be within a certain weight, and you're expected to meet the physical performance standards. Which at the time, I had to be able to run three miles in under 31 minutes.

Anita Rao
Meet Letticia Solomon. She served in the Marine Corps for a decade starting in 2009. During that period, she had two kids. Her first birth was to her son in 2012, and at that time, she was only given six weeks of leave.

Letticia Solomon
During that six week maternal period, I knew I for sure wasn't ready. That had to have been the worst of my two pregnancies when it came to breastfeeding and stuff like that, because all I could focus on was getting back to work within that six weeks and not giving my body the proper time to heal, the proper nourishment to breastfeed the right way. So, I was only able to breastfeed for about three weeks before we just went to straight bottle feeding because of the physical demands of having to go back to work. And then, I do remember, I didn't gain much weight at all during that pregnancy — I probably gained 10 pounds during that pregnancy. So, when I was at my full term, I wasn't even above the weight standard, I was still within weight standards nine months pregnant. And, once I had my baby, I was even more under because my baby was eight pounds. On the scale, it looked good, the numbers looked amazing. I didn't have to worry about losing the weight to get back into military height and weight standards. However, my physical strength, my muscular endurance, all that stuff, was like a no-go, like, I didn't have it at all.

Anita Rao
There's so much in what you've said that I want to unravel. So, you mentioned, you know, feeling this pressure to be able to get your body back to a state that it would need to be in to go back to work. And, that is these fitness and body composition standards that are required by the Marine Corps. So, what did knowing that that was coming mean for your experience postpartum?

Letticia Solomon
It was scary, because all I could focus on while postpartum was, "Am I going to be able to run in time, are they going to make me show up for this run, knowing that I'm not at my top performance?" That's all you can think about while you're home with your baby, and you're supposed to be bonding, it's supposed to be, you know, building those moments with your baby, enjoying your baby, breastfeeding, nourishing them, but all you can focus on is, "Is my body going to be able to run these three miles within this certain time period?"

Anita Rao
Six months after giving birth to her son, Letticia had to go on a battalion run.

Letticia Solomon
The very day of, my six months was up, I was required to participate in the battalion run, because my paperwork said this was the date. So they were like, "Alright, you're back in the fight." And, it was about a three mile run, and it's a formation run. So, you have, like, someone in the front leading it, and hundreds of Marines just following behind. Which, they say they pace it, but as you get further back in the line, you have the ripple effect. So, some people are running faster than others, some people are stepping on other people's toes. And, I was not at my top peak performance yet. I was not physically ready to be back in that yet, and I was falling behind — I was falling behind a lot. And you know, they threatened me with a, you know, "That's going to be negative paperwork, because your six months is up, so you should be able to keep up with a battalion run." But at the end of the day, the battalion run wasn't the physical fitness standards. The physical fitness standards was determined by me performing my own personal physical fitness test.

Anita Rao
So, there are multiple standards that you're required to meet in that period. And, in February of last year, the Marines announced they now do allow a year instead of six months for postpartum folks to meet these body comp and fitness standards. So, there has been an extension, but what do you think about that increase in the grace period from six months to a year, and what have you heard from other folks?

Letticia Solomon
I think that is awesome, because what I truly believe is: it took nine months for your body to get into that state, so it's going to take at least minimum nine months for your body to get back. And then, adding that additional time at the end compensates for the time that you spent bonding with your baby, where you're not just focusing on working out and getting into shape. So, I feel like that's an awesome new change and awesome new standard, because it gives you time to bond with your baby, focus on your nutrition and take the time to gradually increase to get back into those physical fitness standards.

Anita Rao
There have been some Marine Majors and one Marine Captain who have been pushing back against some of these standards saying that, yeah, even though, you know, there is this increase, it still is a bit of an arbitrary measure for women to be measured in this body composition way for their bodies. I'm curious about your thoughts on that on the body comp standards just generally and how they affect postpartum parents.

Letticia Solomon
Honestly, I would say they're unrealistic, and they don't fit today's women at all. Because, what I would tell you is that myself only gaining 10 pounds during pregnancy, I still never met the body taping percentage. I was always over that, because of the fact that I had a small waist, and I had bigger hips, and I had a very tiny neck. Because, those are the three things they measure. So once again, I had a small neck, a small waist and I have wider hips, but I was still way under the max weight. So, they can't come up with these standards that are like so unrealistic, because we're all just shaped so differently. So yeah, I 100% don't agree with that, and I think it's unrealistic.

Anita Rao
Letticia gave birth again in 2015. She still had only six months to meet the required body comp standards, but her maternity leave was longer. This time, she had 18 weeks before she had to be back on the job.

Letticia Solomon
I had lots of time to bond with my daughter, and I was able to get a gym membership where they had childcare. So, I would take her with me to the gym, and she was hanging out for an hour or so while I worked out. And, that was a great time, I felt like we bonded a lot. That breastfeeding journey lasted about seven months, so it actually lasted up until I got to work. I was only able to breastfeed going back to work a few weeks before I had to quit again because of the workload being so demanding. But, that was a totally different experience just because it was 18 weeks of maternity leave not six.

Anita Rao
Totally. And I mean, there's so many ways in which, kind of, pregnancy in the postpartum period can shape how you are able to show up for work after — you need to be able to make space for potentially pumping if you need to, you need to be able to, kind of, cater to the needs of your body in that moment. How about just the day to day needs of your — taking care of your kid, once you were back at work?

Letticia Solomon
I would say they made it sound good on paper. If you need a pump, you can go take time to pump, which at the time I had to pump in my car, because we didn't have the services or the room set up at the time. Further on down the line, I think they did get better with that and did start building things to help the newer moms and give them that area to pump. But, with either of my kids, I didn't have that, and the workload was so demanding that I just had to give up on it.

Anita Rao
What was giving up on it like for you and for your relationship with your body?

Letticia Solomon
Oh, it's depressing. It was really depressing, because it felt like I was putting the needs of the Marine Corps above the needs of my own child at the time.

Anita Rao
Letticia left the military in 2020, and she says that her postpartum experience is one of the driving factors. And she's not alone in that. The Government Accountability Office released a study a few years ago looking at the experiences of enlisted women from 2004 to 2013. And pregnancy was one of the top three reasons given for their separation.

Letticia Solomon
I just felt like — I just had to give back to my kids wholeheartedly, because I had wasted so much of my career just trying to be in the best shape, going to the gym multiple times a day, just trying to stay up to standards. And, I feel like I missed out a lot of my kids because of doing that, and me getting out was solely to give back to them. That was 100% why I made the decision.

Anita Rao
And, my last question is just — I'd love to know about, kind of, your relationship with your postpartum body today. I know it's been a while since you had your daughter in 2015, but we've heard from a lot of folks that, you know, the postpartum period is, kind of, from your last birth ever forward. So, I'd love to hear about your relationship with your postpartum body now.

Letticia Solomon
Since leaving the military, I'm finally at a place where I love my body. And, what makes that really interesting is that I look back at pictures from almost seven years ago when I had my daughter, and I was super, super, super slim. And just remembering, during those days thinking I was overweight, I was not attractive. And, now I'm 20 pounds heavier than those days, and I'm at such a healthy and happy place with my body and my image. I love what I look like, I don't talk down on my body. And, it's just really weird to know that back then I was 20 pounds lighter — I had no weight left to lose — and I had such an unhealthy relationship with my weight. All because I was scared of not being within those military standards.

Anita Rao
It can take a good long while to get where Letticia is now with her body. My sister, who you met earlier, is almost two years out from her second pregnancy, and our conversation about postpartum body image and body changes is still ongoing. As you know from listening to this show, there is no quick fix for any of this. There are so many systems at play trying to get us to believe certain things about how our body should look and when. So, we'll leave you with some tips from postpartum doula Lydia-Carlie Tilus.

Lydia-Carlie Tilus
The first thing is to — as much as someone can — is congratulate your body. Like, really praising yourself for the journey your body has taken, because it is no small undertaking to be pregnant, no small undertaking to go through labor and delivery. And pregnancy is not always like a walk in the park. Some people spend their entire pregnancies with morning sickness, constant dehydration, nausea. And so it's like, you've endured all of that, you've gone through labor and delivery and now you're here. Your baby has arrived, and you've arrived as well.

Anita Rao
Embodied is a production of North Carolina Public Radio-WUNC, a listener-supported station. If you want to lend your support to this podcast or WUNC's other shows on demand, consider a contribution at wunc.org now. Incredible storytelling like you hear on Embodied is only possible because of listeners like you.

This episode was produced by Kaia Findlay. Audrey Smith also produces for our show, Amanda Magnus is our editor and Jenni Lawson is our sound engineer. Quilla wrote our theme music.

If you enjoyed this show, share it with a few postpartum friends or anyone in your life who could use more information about that experience, AKA, all of us. You sharing our show with other folks is how we spread the word and grow this community. So, we really appreciate your support.

Until next time, I'm Anita Rao, taking on the taboo with you.

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