Female Body Diagram
|What Is The Postpartum Checkup?
The postpartum checkup will be scheduled by your practitioner 4 to 6 weeks after delivery. The purpose of the examination is to ensure your body is healing without issues. If you had a C-section delivery you may be scheduled earlier (sometimes at 2 weeks and again at 6 weeks) than if you had a vaginal delivery. It is a good opportunity to ask any questions you have about breastfeeding, postpartum exercises, birth control methods and any other concerns. Be sure to make a list of your questions before your appointment.
Weight Is Monitored
Returning to your pre-pregnancy weight is a key goal, this usually takes about 6 months. The aim is to lose weight gradually, about 4.5 pounds a month (maximum) after the first month of delivery, unless you had a particularly high pre-pregnancy weight. Losing weight after childbirth is best achieved by following a healthy, low fat balanced diet.
A routine check to see if your blood pressure is in the normal range. The symptoms of hypertension are usually silent which is why a regular screening is important.
Your doctor will perform a clinical breast examination to check for lumps and nipple problems. You will also be shown how to do a breast self-examination to give yourself every month after your period. This is the opportunity to discuss any breast feeding problems like blocked milk ducts or engorgement. If you are breastfeeding your breasts will still feel full and firm at the 6 week checkup. If you are bottle feeding and not pumping your breasts will probably have returned to their pre-pregnancy size.
Other Physical Problems
Your doctor will ask if you are experiencing any other physical problems that may have resulted from childbirth such as constipation, hemorrhoids, hair loss, varicose veins, vaginal discharge or urinary incontinence.
Next your doctor will perform a pelvic examination to check for postpartum complications. There is a list of areas that need special attention after childbirth. He will check:
Any incisions or tears that occurred during delivery will be monitored for healing. If you had a C-section you will probably have an incision inspection at 2 weeks and again at 6 weeks. If you had an episiotomy or tear during a vaginal delivery this will be checked at the 6 week appointment. If at any time however you experience signs of incision infection, such as unusual redness, pain or leaking pus, call your doctor immediately. Most incision problems, if they do occur, do so within 10 days of delivery.
This is the area between the anus and vagina. Your doctor will examine around it, inspecting the vagina, rectum and urethra (the opening where urine comes out) for healing. Your vagina will have contracted and regained much of its muscle tone.
Your Uterus, Ovaries and Cervix
Your doctor will want to see if your reproductive organs are returning to their prepregnant shape. The cervix will be on its way back, but at week 6 will still be slightly engorged. Your uterus should have returned to its prepregnant size, shape and location. He will also check for signs of infection such as tenderness and discharge. As this is checkup counts as your annual exam, he may also perform a Pap smear test to check for abnormal cervix cells. Postpartum bleeding or lochia has usually stopped by week 6, but it is not unusual for it to come and go until week 8.
Your doctor will want to discuss any postpartum emotions you are feeling. If have been feeling tired, sad, isolated or overwhelmed, don't be embarrassed to say so. He may ask you to complete a postpartum depression questionnaire to rule out a more serious underlying cause for your emotions. He can then offer practical advice such as giving you details of postpartum support groups in your area and tips on avoiding depression.
Sexuality and Contraception
Not being interested in sex after having a baby (even for several months) is common. Most women experience a gradual return of prepregnancy sexual desire within a year, but each persons timetable is unique. If you are worried about postpartum sex, use this opportunity to talk to your doctor about your concerns. Or you may have been told to wait until this checkup before being given the green light to resume sexual activity. The outcome of your physical examination will determine if this is given.
As the return to fertility is unpredictable, even if you are breastfeeding, this is also a good opportunity to discuss contraception. If you want to use a contraceptive diaphragm, and your cervix has recovered, you will be fitted with a new one. The old one will not fit anymore as your cervix will have changed shape. If you are not yet fully healed you will need to use condoms until you can be refitted (don't forget there are female condoms too!). If you prefer a hormone-based contraception this is the time to ask for a prescription. If you are breastfeeding your oral contraceptive options will be limited to the progesterone only mini-pill. Other safe options include the birth control injection or birth control implant which are progesterone only.
Before You Leave
Once the examination is over, check that the following have been covered:
• A return to work date if you are on maternity leave.
• Scheduled the next gynecological checkup.
• Clarified if you have been given the green light to resume normal activities like sex or favored sports.
• Birth control methods.
• Any postpartum baby care concerns you have.