The Post-Partum Checkup: What You Need to Know

By Ruth A. Mack

Congratulations – you’ve done the hard work of labor and now you have a beautiful baby to nurture and love. But your health is important too. Your body endured the physical demands of labor and delivery – you may even have undergone a surgical cesarean section or episiotomy – so your doctor will want to see you again soon after delivery to make sure you’re healing properly and to ask about your emotional well being and adjustment to motherhood.

Post-partum Checkup: An Overview

The frequent OB/GYN visits you had during pregnancy are almost a thing of the past. You’ll need a post-partum checkup roughly six weeks after delivery, possibly sooner if you’ve had a C-section or some other complication.

“This exam is the graduation from a woman thinking of herself as an ‘ob’ patient to a ‘gyn’ patient,” says Shari Brasner, MD, associate professor of Obstetrics and Gynecology at Mount Sinai Hospital in New York, NY, and author of Advice From a Pregnant Obstetrician.

You may not return to the doctor for another year after the post-partum checkup, so it’s important to get all of your questions answered during this visit. You’ll want to tailor this discussion to your own individual situation, but some common questions and issues to come armed with during this visit include:

Outstanding Issues

Any outstanding questions/issues surrounding delivery, such as the healing of a surgical incision from cesarean section or episiotomy
Any questions/issues surrounding breastfeeding, including how long you plan to breastfeed and whether you’re experiencing any difficulties or pain with breastfeeding
Any outstanding issues you may have put on hold during pregnancy, including mammography, surgery or medication

Questions

When can I resume sex with my partner?
When do I need to start birth control again?
What birth control options are right for me?
When can I resume an exercise regimen?
When can I begin a weight loss program and when can I expect to lose the weight gained during pregnancy?

Physical Exam

At the post-partum checkup, your practitioner will perform a thorough physical examination, including an abdominal, pelvic and breast exam. Your practitioner will check to see that any tears or surgical incisions from labor and delivery are healing properly, and check your breasts to determine whether there is any infected breast tissue. This is the perfect time to ask any questions about breastfeeding, particularly if you are experiencing problems with the baby latching on, bleeding or pain. A referral to a lactation consultant may be necessary.

In addition, your doctor will take a pap smear because this visit typically serves as a woman’s yearly gynecologic exam as well. Many health care providers also take a thyroid-stimulating hormone (TSH) blood test, which detects problems affecting the thyroid gland. This is done because frequently thyroid hormones fluctuate during pregnancy and your doctor will want to make sure levels have returned to normal. Other tests may be needed if you experienced a complication during pregnancy, such as gestational diabetes.

Sex and Intimacy

If you’ve had a C-section, your clinician will probably say it’s okay to resume sexual intercourse at the 6-week mark. If you’ve had a vaginal delivery with no stitches or tears, you may receive your doctor’s okay earlier, at 2-4 weeks. In reality, many women may not feel like having sex for quite some time. The emotional and physical demands of caring for an infant, lack of sleep and dramatic hormonal shifts may all contribute to a decreased sex drive. This is normal, so try to be patient. Get help caring for your baby if you can, and make time for you and your spouse to enjoy a night out or some time alone. For some women, it can take months to feel like having sex again.

At some point, though, you will need to start thinking about birth control. Since you’re not likely to see your healthcare practitioner again for another year, it’s important to review birth control options during the post-partum checkup. There are some newer birth control options – including birth control patches, extended-cycle birth control regimens and vaginal rings – that may be particularly appealing to new mothers. Here is a general overview of birth control options:

Condom – A barrier method of birth control that is inexpensive, doesn’t require a prescription and can be used during breastfeeding. Condoms also can reduce the risk of sexually transmitted diseases. Some couples find them frustrating to use and say they dull sensation. They are more effective with contraceptive foam.

Diaphragm and Cervical Cap – Latex or silicone barriers that cover the cervix. These must be placed in the vagina before any sexual intercourse and may be difficult for some women to use. The cervix may be larger post-pregnancy, so you will probably need to be refitted if you plan to continue to use either method after having a baby.

Injection – Progestin is given via an injection to prevent pregnancy for 12 weeks. This method can be used during breastfeeding, but women need to receive a shot every 3 months and it can take an average 9 to 10 months to become pregnant again after the last shot. In some women, it can take more than a year to become pregnant. If you think you might like to become pregnant again soon after having your baby, this option may not be best for you.

IUD – A small, T-shaped intrauterine device inserted by a clinician that is effective for 5 or 10 years, depending on the type of IUD used. This is only a good option for women who do not plan on conceiving again for several years after the birth of their baby.

Oral Contraceptives – Birth control pills come in 2 forms: combination pills containing estrogen and progestin, and progestin-only pills. Combination pills are not recommended for women who are breastfeeding because they can impact milk production. Birth control pills are simple, safe and convenient. Many women report fewer menstrual cramps and lighter periods. Oral contraceptives also may protect a woman against uterine cancer, cancer of the ovaries, and pelvic inflammatory disease.

Extended-cycle Birth Control Pills – New mothers seeking the convenience of fewer periods should consider an extended-cycle regimen. This is a newer type of combination birth control pill in which the active pills are taken for a longer period of time, usually 3 months, so the time between periods is extended. A woman may get only 4 periods a year but there is a risk of breakthrough bleeding. Fewer periods a year, less pain and bleeding may be a real plus for the busy new mom.

Sterilization – A permanent method of birth control (tubal sterilization for women and vasectomy for men) that should be considered only if a woman is certain she does not want children in the future.

Vaginal Ring – A newer form of birth control, a flexible ring is inserted into the vagina that releases continuous doses of estrogen and progestin, similar to the active ingredients in some oral contraceptives. Women must insert a new ring themselves every month.

When a woman begins ovulating again after pregnancy depends on whether she is breastfeeding. If a woman is not breastfeeding, she usually will get her first period around 6 weeks postpartum. Many women think they can’t become pregnant if they’re breastfeeding, which is not always the case. “If a woman is still breastfeeding, I tell her that fertility can return at any time. By the time she has that first period, she will have already ovulated. I counsel all women to assume that they are fertile again after they leave my office for the 6-week post-partum checkup,” says Dr. Brasner.

Exercise and Diet

The post-partum checkup is usually the time when healthcare practitioners ease any restrictions they may have placed on women concerning exercise during pregnancy. If you had a vaginal delivery, your doctor may tell you it’s okay to start light exercise, such as brisk walking, as soon as 2 weeks after delivery.

Be sure to take it slow, exercise gradually at first and realize it may take time to resume your previous fitness level as well as your pre-pregnant shape. It can take 9 months or more for a woman to lose the weight gained during pregnancy.

Talk to your doctor about nutritional needs if you are breastfeeding. Women will need an extra 500 calories a day for lactation.

Emotional Well-being

Your clinician may ask how you’re handling the emotional demands of motherhood. The “baby blues” are common, affecting 50-80% of new mothers during the first few days and weeks after delivery. Symptoms are usually mild and short-lived and include insomnia, fatigue, sadness and trouble concentrating. Approximately 10-15% of new mothers develop true postpartum depression within six months of delivery. Symptoms of postpartum depression include overly intense worries about the baby, lack of interest in the baby and fear of harming the baby. If you have been diagnosed with clinical depression, you may be at greater risk for postpartum depression. Your doctor can refer you to counseling if necessary.

e sure to get plenty of rest. Lack of sleep can make you more irritable and compound any stress you may be feeling as a new mother caring for an infant, so be sure to take naps when the baby sleeps and, if possible, enlist the help of friends and relatives or hire a babysitter. Stay connected with friends and try to build a network of other new mothers for emotional support.

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