After spending nine months in and out of doctors' offices, sonography rooms, and, finally, the hospital, you may very well be sick of donning that ubiquitous blue gown. But your six-week postpartum checkup is one appointment you definitely shouldn't miss. While giving birth may be a normal process, some women experience a few health aftershocks, and it's important that they be examined and treated promptly.
"Now that you have a baby to take care of, you need to take even better care of yourself," says Judith Reichman, M.D., a gynecologist at Cedars-Sinai Medical Center in Los Angeles and the author of Relax, This Won't Hurt: Painless Answers to Women's Most Pressing Health Questions. The consequences of skipping your postpartum appointment can be serious: incomplete healing, an unwanted pregnancy, an overlooked infection, undiagnosed postpartum depression and more. Taking the time to keep this appointment can pay off in many ways, physically and emotionally.
In addition, "six weeks seems to be that point when you start to feel like a human being again," notes Ally Zevin, a mother of three from Takoma Park, Maryland. For that reason, it's a good time for your doctor to check in on how motherhood is treating you emotionally. It's also an excuse to get out of the house and enjoy a bit of adult indulgence. Zevin gave herself a treat, such as coffee at a cafe, after each checkup.
"It was my way of celebrating coming out of the fog of giving birth," she says.
Most doctors and midwives have a laundry list of areas that need special attention after you give birth. That list includes the following:
If you had an episiotomy or a tear during a vaginal delivery, "checking that incision is the first thing on your doctor's list," says Siobhan Dolan, MD, assistant medical director of the March of Dimes in White Plains, New York. "I thought that was going to be the worst part," says Dara Milton of Sarasota, Florida. "But my episiotomy was healing well, so it was painless."
Most incision problems occur within 10 days of giving birth, according to Tekoa King, a certified nurse-midwife in San Francisco. If at any time postpartum you notice unusual redness, pain, or fluid coming from an incision, contact your doctor.
If you've had a c-section, you'll probably have a preliminary incision checkup at around two weeks and another at six weeks.
Expect yet another pelvic exam, but this one has a twist — your doctor is making sure that your reproductive organs are returning to their prepregnancy state (amazingly, your uterus should shrink back to the size of a fist). She'll also check your uterus for signs of infection, such as tenderness. And since this checkup counts for your annual exam, your doctor will feel your ovaries for growths and perform a Pap smear to check for abnormal cervical cells.
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.
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.
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."
If all is well with your health and well-being, your doctor will likely give the all-clear sign for you to resume normal activity. Women who had vaginal deliveries can exercise again, and c-section patients can drive, lift heavy objects, and exercise as well.
And for all types of deliveries, your doctor will probably tell you it's safe to start having sex again, though it may very well be the last thing on your sleep-deprived mind. However, you'll get around to it sometime, so you'll need to have a talk about contraception.
"One of the most important parts of this checkup is family planning. It's possible to become pregnant right after coming home from the hospital," says Margaret Comerford Freda, a registered nurse and certified health-education specialist at Albert Einstein College of Medicine in New York City. Barrier methods of birth control, such as a diaphragm, need to be checked for fit since your cervix may have changed size after pregnancy.
You may want to change birth control methods entirely; what worked for you before may not fit your new life. If you used to take the Pill, for example, you may decide to try an IUD because taking medicine may now be the last thing you want to remember to do each day. It's also wise to ask your healthcare provider about new forms of contraception. Some may have come out during your pregnancy.
Don't even think about losing weight before six weeks postpartum. But because research shows that women who haven't lost their pregnancy weight by six months after giving birth are more likely to become overweight or obese in the future, this visit is a good opportunity to look ahead, talk with your doctor about nutrition and exercise and get the green light to resume working out. Ferrara helps her breastfeeding patients come up with a weight-loss plan that makes sure the baby still gets adequate nutrition.
Before you leave your doctor's office, be sure to take the opportunity to ask any lingering questions you may have about your new post-baby body — and new life as a mom. Getting the answers you need will make the transition to motherhood that much smoother.
You don't want to wait until your scheduled postpartum checkup to report any of the following: