After giving birth, it’s standard practice to have a 6 week postpartum checkup. This checkup has become somewhat infamous: It’s known as the mark after which you get cleared for exercise and sex.
You can expect that your provider will make sure you’re healing properly, talk to you about your first weeks of motherhood, and give you an opportunity to voice any concerns. But it’s a lot more complicated than that. After all, doctors and midwives aren’t fitness experts, and the old adage to use “a bottle of lube and a bottle of wine” to ease the postpartum return to sex is, to put it mildly, horrifying. To ensure that you get the most of your visit, we recommend making a list of postpartum checkup questions to bring with you—and figure out where you need to go next.
The eight questions below will give you an excellent starting point at your 6 week postpartum checkup, but remember to add to this list if you have other health concerns. It can be hard to trust yourself when you’re experiencing something for the first time, but if something doesn’t feel right, advocate for yourself or get the support of someone who will.
1. Here’s how my delivery went, what do you think?
It’s important to process your labor and delivery experience. Even if your provider was present during delivery, you may have had questions that went unasked simply because there was so much going on. Address them at your checkup.
For women who plan to have future pregnancies, this is extra important. Get as much information about your labor and delivery as you can. If there were any complications during your delivery, understanding them now can make your next childbirth easier.
2. Is my postpartum bleeding normal?
Postpartum bleeding lasts from four to six weeks, though it’s generally heaviest in the first 10 days. You’ll have it regardless of whether you had a vaginal or c-section delivery, because it has nothing to do with the birth mechanism itself — it results from the uterus shedding the lining of mucus and blood, and it’s called lochia.
In addition, when you deliver your placenta at birth, it leaves a wound roughly the size of a dinner plate! During and after birth, it’s not uncommon for women to lose a tenth of her total blood volume (compared to just XX during a normal menstrual cycle).
Your body will signal you that you are doing too much too soon after your baby’s birth by passing more bright red blood from this wound.
By six weeks, you may be experiencing some light spotting. If you are bleeding more profusely, ask your provider about this, because you’re still at risk of hemorrhaging at six weeks.
3. What degree did I tear?
The odds of tearing vaginally during labor are fairly high, especially for first-time moms. In fact, first-time moms have a 95 percent chance of experiencing some level of tearing during delivery. Severe tears into the rectum and vagina can cause pelvic floor dysfunction and prolapse, and they’ve also been shown to contribute to postpartum depression. if you’re experiencing urinary problems or difficulties with bowel movements, or any pressure or pain in your pelvic region, this 6 week postpartum appointment is a good time to speak up.
Healthcare professionals are trained to understand your vagina before and after birth, so if you’re curious about what degree you tore and how well you’re recovering, we recommend inquiring during your 6 week postpartum checkup. You can also ask for a referral to a specialist.
4. Has my scar healed? And how do I mobilize my scar?
C-section scars typically take anywhere from six weeks to three months to heal, so if you had a C-section your doctor will check on its healing during your 6 week postpartum check-up. Depending on how long its been since your last postpartum appointment, your doctor might also remove the stitches during this 6 week postpartum appointment. Episiotomy scars heal at a similar rate.
If you have any questions about incision care or how to mobilize your scar, be sure to bring them up during this check-up. If you experience any signs of infection, including a fever, a foul smell from the incision site, or a fever higher than 100.4 F, make an appointment with your doctor immediately.
5. Do I have Diastasis Recti, if so, how many finger widths?
All women experience some degree of abdominal separation and expansion of the abdominal wall in pregnancy. Although you can check yourself for diastasis recti, it’s helpful to have your doctor take a look during your check-up.
In case you do want to self-diagnose before your 6 week postpartum appointment, here’s the process:
- Lie on your back with your knees bent and your feet on the floor
- Place your palm down over your belly with your fingers pointing toward your toes
- Press your fingers gently into your navel area
- Slowly lift your head, drawing your chin to your chest
- If you feel a gap of at least two finger widths between the muscles as they contract, you have a diastasis. If it’s wider than four or five fingers, it’s considered severe.
6. Do I have, or am I at risk for prolapse?
The biggest cause of prolapse is pregnancy and birth, so it’s not surprising that many new moms are curious about whether or not they’re at risk for it. Mild uterine prolapse typically doesn’t cause symptoms, but those with more severe uterine prolapse can experience sensation of heaviness or pulling in their pelvis, urinary problems, and trouble having a bowel movement. A 2002 study found that at six weeks postpartum, 83% of people had pelvic organ prolapse, and 52% had grade two POP.
If you’re concerned about any of the above or are curious about your risk for prolapse as you age, check in with your doctor.
7. When can I begin exercising again?
As you recover, you’ll want to move your body when your body allows. And many women will want to get to their prior routines, which may have included vigorous exercise, which can help relieve stress, be fun, and lose pregnancy weight.
You may have heard that the 6 week postpartum appointment is stereotypically the time that exercise is cleared. While you may get clearance from your provider at that point, it’s also OK and normal if you don’t completely feel up to it—especially if you had a Cesarean section, vaginal tearing, or other issues during labor and delivery. If you had a C-section, it’s generally recommended to avoid lifting more than 10 pounds for the first six weeks of recovery.
One signal from your body will be bleeding. You may find, for example, that your postpartum bleeding intensifies on days when you do more physical activity. That’s a sign you may need to slow down.
Note: if you’re a serious trainer or enjoy partaking in strenuous exercise, remember that doctors aren’t fitness experts. If you fall into this category, we recommend reaching out to a physical therapy for a more hands-on postpartum appointment.
8. When can I have sex again?
Common postpartum checkup questions also cover sex. Usually, you’ll get the OK to resume sexual intercourse with your partner after six weeks postpartum checkup.
If you’re experiencing any pain or discomfort in your pelvic area, or other issues that you feel may prevent you from resuming sex, try to bring them up.
Dyspareunia, or recurrent and persistent pain during sexual intercourse marked by distress or interpersonal conflict, is never normal and shouldn’t be tolerated. Approximately 10-20 percent of women in the US are affected by dyspareunia, and it can be triggered by a variety of factors in new moms, including vaginal dryness, fluctuating hormones, and the psychological effects of labor. Women diagnosed with dyspareunia will likely need to see a pelvic floor physical therapist, so if you’re struggling with painful sex your doctor may be able to refer you to one that’s in-network.
9. Speaking of sex, what about birth control and family planning?
If you aren’t breastfeeding, your periods may begin again within six to eight weeks of giving birth. However, women who are exclusively breastfeeding may not begin to menstruate again for six months or more. Discuss your cycle with your doctor so you can understand what to expect.
Whether or not you plan to resume having sex right away, use your 6 week postpartum checkup to discuss birth control options and family planning with your doctor. If you’re breastfeeding, there are certain types of birth control that you may wish to avoid because of the effect they can have on your hormone levels. By asking your doctor, you can determine the best options for you. Although breastfeeding can suppress fertility, particularly during the first three months of nursing, this form of birth control is 98-99.5% effective as long as all conditions are met perfectly. If you don’t want anymore kids (or simply don’t want one anytime soon) we recommend getting back on birth control as soon as your provider clears it.
Additionally, if you plan to have more children, your doctor can advise you and direct you to more family planning resources. If you hope to expand your family within five years, some birth control methods may not be recommended.
10. Check we check-in on breastfeeding?
If you’re breastfeeding, ask your OB-GYN if you have any concerns about your diet or medication. Although you may have already been given a list of safe substances by your doctor or a lactation consultant, it’s common to have follow-up questions at your 6 week postpartum appointment.
If you’re recovering from a C-section, or are simply having difficulty finding a comfy breastfeeding position, this is a good time to check in with your doctor on any breastfeeding tips or advice he or she may be able to offer.
11. How do I distinguish between baby blues and postpartum depression, and who can I talk to about it?
Next, remember to include mental health in your list of postpartum checkup questions. Talk to your doctor about how you’re feeling: do you have normal baby blues, or are you experiencing postpartum depression?
Remember that postpartum depression is very common and normal. New mothers are often pressured to feel happy and excited about their baby, but if you don’t have these feelings, there’s nothing wrong with you. Your doctor can help you understand your complicated postpartum emotions. They can also refer you to a therapist or psychiatrist if you need help managing your depression.
12. What can I expect for my body as I recover?
Finally, ask your doctor what you can expect for your body as you continue your postpartum recovery. Although every woman is unique, there are certain “milestones” you can expect. Your OB-GYN can help you prepare for these changes.
It’s also recommended to ask about additional medical postpartum appointments you need. For example, when do you need to have your next pap smear and pelvic exam? Should you have a mammogram? If you’re healing from a C-section, do you need another follow up?
When it comes to your body and your health, always speak up. It’s better to ask more questions than wake up the next day, wishing you’d talked to your doctor about a certain issue. Remember to be your own advocate for postpartum health.
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