What kind of postnatal support should you expect your doctor to provide you? Here are 7 items your doctor should discuss with you during your postnatal examination visits.
1. The lochia, its color and duration
The doctor will want to know whether or not the uterine bleeding is persisting if you are breastfeeding, and if you are not, whether you have had your menstruation.
The menstruation is distinguished from the lochia by a sudden heavier flow, starting from about the 28th day after delivery. Most women will be advised to wear an external sanitary pad to avoid possible infection during this initial period.
2. Breastfeeding mums
If you are breastfeeding, your doctor would want to find out if you are having any problems related with it. Generally, the lochia or uterine bleeding stops more quickly for a woman who is breastfeeding. This is due to the rapid involution of the uterus caused by hormones released as a result of breastfeeding.
If you are not breastfeeding, your lochia could continue for as long as four to six weeks, in the form of a brownish discharge. The first menstruation could appear on the 28th day following delivery, and the flow is heavier and longer. When it ends, there is usually no further uterine bleeding.
3. Pelvic discomfort and discharge
Your doctor will also ask if you experience pelvic or perineal discomfort and the amount and color of any vaginal discharge. If you had an episiotomy or stitches during the delivery, the doctor would want to know if you still feel any pain or discomfort.
4. Bowel habits
Where your bowel habits are concerned, your doctor would be interested to know if they have returned to normal.
Stress incontinence or leakage of urine, especially on coughing or sneezing, may begin during pregnancy and continue after delivery. It may also occur for the first time after delivery, due to weakness of the pelvic floor muscles. These muscles should return to normal if pelvic floor exercises are performed regularly.
5. Weight
If you have gained any excess weight during your pregnancy, you could ask for appropriate advice regarding weight loss. Women who are breastfeeding are generally not encouraged to go on crash diets as it could suppress milk flow.
6. Sex
Sexual intercourse may be resumed any time after delivery. But for most women, the inhibiting factor could be fear of pain from the episiotomy. The episiotomy would usually heal after about a week but soreness and discomfort could continue for up to three weeks.
For women who have undergone a Caesarean section, the abdominal incision would take about two weeks to heal. If there are no medical complications, sexual intercourse could resume after that.
However, most women find that it takes up to six to 12 weeks after delivery before their libido returns to pre-pregnancy levels. In addition to physical and hormonal factors, a woman’s libido could be further dampened by fatigue, anxiety, a crying baby, lack of sleep and financial worries. Patience, communication and love should gradually overcome most postnatal sexual problems.
7. Contraception
It is very rare that a woman ovulates within six weeks after she has delivered. Even for women who do not breastfeed and have their first menstruation 28 days after delivery, studies have shown that ovulation rarely occurs prior to the first menstruation. Since the risk of pregnancy during the first six postnatal weeks is extremely unlikely, the types of contraception that can be used before the postnatal check-up include condoms, spermicidal jellies or creams.
Though breastfeeding may reduce the possibility of getting pregnant, it is not a recommended form of contraception as ovulation, and hence conception, can occur several weeks before your first period. Contraceptive methods such as the intrauterine device, the diaphragm or the pill may be used after consultation with your doctor.
