The early weeks of pregnancy are fragile—and confusing. Here, the answers to your questions.
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You wouldn’t think of not taking your newborn to the pediatrician for his first checkup. Yet you may find lots of reasons to skip your own postpartum exam, which usually should take place six weeks after childbirth (sooner, if you’ve had a Cesarean). Perhaps you’re healing well and breastfeeding without a problem. Maybe you’ve just returned to work and don’t have the time. Or you have visiting relatives and you don’t want to miss being with them. None of these excuses is a good enough reason to miss your checkup.
“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 (Quill, 2001). 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. Here’s what should be addressed at your visit.
Your body Your doctor will check to see if your uterus has returned to its prepregnancy size, bleeding has stopped and any vaginal tears and/or incisions from an episiotomy or a C-section have healed properly, Reichman says. She may perform a Pap smear and a blood test to rule out anemia or thyroid problems. Whether or not you’re nursing, you should discuss any problems with your breasts. Your doctor will be able to determine if you have normal lumpiness or if you actually have mastitis, a painful infection.
Your sex life and birth control Many doctors advise new mothers to hold off on having sex until after this visit, so if you’re eager to get your love life going again, use that as incentive to keep your appointment. For one thing, you may not be completely healed. And if you’re experiencing vaginal dryness, which is common after having a baby—especially if you’re nursing—you can ask about creams and lubricants that may help.
Even if you haven’t resumed menstruating, you need to talk about birth control, Reichman says. Many women think they don’t need to use contraception if they’re breastfeeding. But you can start ovulating again as soon as six weeks after giving birth, even if you are nursing.
You also might need to rethink your previous method of contraception. “If you are breastfeeding, you will need to take a progesterone-only [birth control] pill,” says Andrea Ferrara, R.N., a certified nurse-midwife with Kaiser Permanente in Los Angeles. That’s because pills containing estrogen can interfere with milk production. If you used a diaphragm before your pregnancy, it may no longer fit properly and you will need a new one. And because sex when there’s a new baby in the house is often of the now-or-never variety, or because you may be too distracted by your new duties to remember your birth control, you might want to consider an IUD, vaginal ring or other long-lasting method.