New-Mom Checkup

Why your own first medical exam after having a baby is as important as your newborn's.

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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.

Exercise, nutrition and weight: 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.

Your feelings: This visit is a perfect opportunity to ask any questions that may be nagging at you. If you're very sad, anxious or irritable and the feelings don't go away within a few weeks, speak up. Don't dismiss them as "baby blues"; you might be suffering from postpartum depression, which requires treatment. If you have no desire for sex and your partner is pressuring you, be sure to discuss the situation with your doctor. You also may want to talk about stretch marks, breast changes, scars, weight gain and other body-image issues. If your doctor dismisses your concerns, makes you feel uncomfortable or doesn't take the time to listen, ask to speak with a nurse instead.

Do NOT ignore Don't wait until your scheduled postpartum checkup to report any of the following: "¢Fever above 100.4° F "¢Nausea and vomiting "¢Pain or burning during urination "¢Bleeding that increases or is heavier than a normal menstrual period "¢Severe pain in your lower abdomen "¢Pain, swelling or tenderness in your legs "¢Red streaks on your breasts or painful new lumps "¢Redness, discharge or pain from an episiotomy, perineal tear or abdominal incision that doesn't subside or that worsens "¢Foul-smelling vaginal discharge "¢Severe depression

Source: The American College of Obstetricians and Gynecologists' Planning Your Pregnancy and Birth (2000).

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