Your Breasts & Your Health
3. Your Breasts. Your breasts go through so many changes during pregnancy and after delivery that it's important for your doctor to keep track of what's normal and what isn't. First, your doctor will give your breasts a thorough exam for blocked milk ducts, which feel like little knots. According to Dr. Dolan, these can develop into mastitis, an infection that occurs when bacteria gets trapped in a milk duct. If you have it, the area around the infection becomes red and hot, and you may also develop flu-like symptoms, such as a fever and body aches. This can occur any time postpartum, so report any breast pain to your doctor or midwife. An antibiotic that's safe for nursing mothers can clear up the infection. Your doctor will also check your breasts for lumps or masses.
4. Your General Health. As you've probably surmised, pregnancy affects just about every body function you can think of, which is why it's so important to get an overall health check. Much of this exam is just like a regular physical: Your doctor checks your weight and blood pressure, and she may even take your pulse or listen to your chest.
From there, the exam addresses more specific postpartum concerns. Your doctor will ask if you're still taking your prenatal vitamins; if you're nursing, it's especially important that you replenish your body with calcium, iron, and other vital nutrients.
Next on the list are your bladder and intestines. Pregnancy and delivery can really take their toll on these organs, even if you've been religious about your Kegel exercises, so your healthcare provider will ask whether or not you've had any leaking urine, extreme bowel urgency, or bothersome constipation. "It's also important that your doctor manually check your thyroid, a butterfly-shaped gland in your neck that is very active in producing hormones during pregnancy, to make sure it's a normal size," according to midwife King. If it's oversized, it might not be working properly, and you may need some blood work to determine if you need medication.
Women who had special health conditions during pregnancy will likely need follow-up care. For example, if you had gestational diabetes, your doctor may check your blood sugar and suggest continued drug treatment or a diet regimen if the problem continues.
Your Mental Health
5. Your Mental Health. Assessing a woman's emotional welfare at a postpartum checkup is just as vital as checking her physical health, experts say. "It's important for everyone's well-being to talk about how motherhood is going," says Dr. Dolan. If you're feeling overwhelmed, your doctor may be able to put you in touch with postpartum helpers, such as doulas or baby nurses.
You may also undergo screening for postpartum depression. "It's one of the most important things to look for at this checkup, and it's a common problem," says King. Up to 30 percent of moms may experience depression within one year after the birth of a child, according to a recent study by Cheryl T. Beck, a midwife and professor of nursing at the University of Connecticut at Storrs, who has studied the issue for two decades. Beck has devised a depression scale to evaluate new moms on a range of symptoms, including anxiety, mood swings, feelings of isolation, or thoughts of suicide.
She refers women who score high on the survey to mental health providers who can prescribe and monitor antidepressants and offer therapy and support groups. "If every postpartum checkup included such a scale, we wouldn't have women out there suffering in silence," says Beck. Maria Scappaticci, of West Wyoming, Pennsylvania, chose to get help. When her second daughter was born two years ago, she was hit hard with a bout of depression just a few days after she delivered.
"I felt like I didn't know myself anymore," she says. "I didn't want to leave my house; I didn't want anyone to see the baby. I didn't want to share her." Scappaticci was prescribed an antidepressant and spoke to her doctor's office regularly throughout her ordeal. Her doctor's response at her checkup made a difference. "He put an arm around me and said, 'You're not going crazy,'" says Scappaticci. "It really helped."