When you have a baby, some doctors and midwives will see you a few days or a week after the birth. Some will want to see you at two weeks postpartum, especially if you had a cesarean birth, but the majority of women will see their doctor or midwife at six weeks postpartum for a checkup. You might be wondering what happens at the six-week checkup or when you can have sex again after having a baby. If that’s the last thing on your mind, that’s ok too.
At the six-week postpartum checkup, your healthcare provider will likely do a physical exam, assess your mental health, and talk to you about sex and birth control, breastfeeding and exercise if they are applicable.
Physical Exam
If you have had a vaginal birth, your perineum will be checked and if you had an episiotomy that area will be looked at to make sure it is healing. If you have had a cesarean birth, your incision will be checked. Most women will have a pelvic exam including a pap smear and examination of the uterus, cervix and ovaries to make sure everything has returned to its pre-pregnancy state. You might also have a breast exam done, especially if you’re breastfeeding to check for any clogged ducts that might lead to mastitis, an infection in the breast. It’s customary to treat yourself to a cupcake or your favorite coffee treat after this exam. At least it’s customary for us.
Mental Health
Your healthcare provider may or may not have you fill out a survey like the Edinburgh Postnatal Depression Scale. They might just ask you questions about your mood, emotions, thoughts and ability to enjoy your baby. This is a time of huge transition. Babies often have issues sleeping at night around this time and it coincides with the time a lot of mothers are returning to work and hiring nannies or setting up childcare. It can be hard to tell if what you are feeling is the normal stress and exhaustion that comes with a new baby or if it is actually postpartum depression or anxiety. “Baby Blues” only last a couple of weeks, so if you’re at the six-week mark and you are thinking that might be what you’re feeling, it’s likely postpartum depression. It is so important to talk with your healthcare provider about your mood and feelings. If you aren’t feeling like yourself or you are struggling to get enough rest, care for yourself or your baby or you are overwhelmed with anxiety, tell your healthcare provider. They can set you up with referrals for a therapist, support group or postpartum doula. In our area, Kim Kertsburg, LCSW with Dallas Postpartum Support is an incredible resource for postpartum depression and postpartum anxiety.
Sex After Childbirth
At this appointment, your healthcare provider will usually tell you it’s ok to resume sexual activity or that it is ok as soon as you are ready. You will also talk about different options for birth control and your personal choices. It is possible to become pregnant again very soon after your baby is born, so take any precautions you might need. Some women are eager to have sex soon after the baby is born, but it is important to wait until after your bleeding (lochia) has stopped to avoid potential infection. Others have no desire for sex or would rather sleep than have sex. Each woman is different in the way her body heals and in how her libido is affected by pregnancy, birth and breastfeeding. It is normal to have some degree of lowered libido due to the hormones involved with breastfeeding. “Does sex hurt after childbirth?” is a question we are asked pretty often. Some women experience no pain when they resume having sex and some are surprised by pain. You can experience pain with sex after childbirth whether you had an uncomplicated vaginal birth, an episiotomy or even a cesarean birth. The muscles of the pelvic floor change after pregnancy and hormonal changes can cause vaginal dryness that makes sex uncomfortable. It is important to communicate with your partner and ease back into things. Take things slow and be open to different forms of intimacy and affection if you are still uncomfortable or not ready. Your body has just gone through something pretty impressive and it might take time to find your new normal.
Exercise After Childbirth
During the six-week postpartum checkup, your healthcare provider will let you know if you are ready to resume or begin exercising. It is important to ask your healthcare provider to check you for diastasis recti, a separation of the left and right abdominal muscles. If you have diastasis recti and you begin a core workout, some exercises and motions can make the separation worse, so it’s good to know beforehand. If you are breastfeeding, new research tells us that moderate exercise is fine. If you are exercising to the point of exhaustion and breastfeeding, talk with your healthcare provider or an IBCLC (International Board Certified Lactation Consultant) about how it might affect your milk supply. Exercise is so important for not only your health, but also your emotional wellbeing. You can start as slow as you want with just walks around the neighborhood or dive in head-first with classes. Some classes, like the Oh Baby Fitness Classes at Texas Health hospitals even include your baby in the workout.
This appointment is a great time to ask your healthcare provider any questions you have about your recovery, your baby or breastfeeding. Call us today to get set up with a postpartum doula for extra support as you find your new routine.