After 6 weeks of getting to grips with being a new parenthood and new-born fog, it’s time to have a 6-week check up with your GP. Here’s what to expect and how to get the most out of your postnatal appointment.
Often the 6-week postnatal appointment will be paired with your baby’s 6-week check-up. If possible, book a double appointment so you and your baby have enough time to have your needs addressed. If able, take a friend or relative with you who can help to look after the baby during your appointment so you can focus on your own health. Breast or bottle-feeding your baby before the appointment will often help to settle them and give you some peaceful minutes to chat to your GP.
You should be given a copy of your maternity discharge summary – bring this with you in case there have been any issues with the GP receiving this. Depending on the practice, you may only have 10-20 minutes for your postnatal review. It can be helpful to prepare a list of important questions you have for the GP and present this to them at the beginning of the consultation so they can try and get through as many as possible.
Topics to discuss at your postnatal appointment
How are you feeling?
All postnatal check-ups should ask about your mental wellbeing and screen for postnatal depression. For me, the first question I ask is “How are you feeling? How is your mental health?” Post-partum mood disorders affect 1 in 10 women and it’s really important they are identified and treated early. Please speak to your GP if you have been struggling as there is lots of help available.
Your GP may ask you questions about the support you have at home, whether you are getting enough sleep and how lifestyle questions such as your diet, and whether you smoke or drink alcohol.
Feeding your baby
Let’s take a moment to recognise how challenging breastfeeding can be. Issues with latch, sore nipples, nipple thrush, breast engorgement, mastitis… These are all things that can affect the success, enjoyment and journey of breastfeeding. Take time to discuss any of these concerns with your GP – there is lots of breastfeeding support available including support groups and advisors and charitable organisations such as La Leche League that you can be referred to.
Bleeding after birth
All women bleed after birth – this is known as lochia. Your GP should ask you about this to ensure it is settling. It can take between 6-12 weeks to completely settle. If the bleeding has been settling but then suddenly gets very heavy again, is associated with a smell or pelvic pain, speak to your GP straight away – this could represent retained products of the birth (e.g., placenta) or a womb infection and needs to be assessed.
If you have had an episiotomy or tear, let the GP know how this is feeling and whether you still have any pain. Your GP may examine you to ensure this is healing well.
Bladder weakness after birth
It’s not something women commonly talk about, but in the first few months after birth up to a third of women experience bladder leaks or urinary incontinence. This is often when we cough, sneeze, jump or do exercise. Urinary incontinence is often due to pelvic floor weakness relating to your pregnancy or birth, particularly if you have had a vaginal birth where you may have sustained a tear or episiotomy. The pelvic floor is a sling of muscles supporting the bladder, uterus and bowel. Whilst you may feel self-conscious discussing this, please do let your GP know if you are experiencing any urinary or faecal incontinence or if you have a dragging or bulging feeling in the vagina (this could indicate a prolapse). These are common issues that often get better with pelvic floor exercises and your GP can refer you to a women’s health physio to support.
Some women may have developed haemorrhoids during pregnancy which do normally shrink and resolve after delivery but can still be problematic at the time of the 6-week check-up. Haemorrhoids or piles often cause itchiness and discomfort around the anus and can lead to bleeding on wiping or with defecation. If you think you could have haemorrhoids please discuss this with your GP as there are creams that can support.
Sex and contraception
It’s normal not to feel ready to have sex again at the 6-week check-up, but if you would like to, it’s a good opportunity to discuss contraception. Breastfeeding should not be relied on as a contraceptive and so your GP can support you to find a contraception that’s appropriate for you.
You can ask your GP to check your scar if you have had a c-section and if you have any concerns or pain. Many women get an abdominal separation called diastasis recti during their pregnancy, and for most this will start to resolve by 8 weeks post-partum. Whilst not checked for routinely, you can ask your GP to examine for this.
Complications during your pregnancy
Not all pregnancies are straight forward and some women may have had medical complications during their pregnancy that need to be followed up on. Complications such as Hypertension in pregnancy or Gestational diabetes may require further follow up tests and these should be discussed at this appointment.
Returning to exercise
Many women I see during their postnatal check-ups are keen to get exercising again. Exercise may need to be modified depending on your personal circumstances and the delivery you have. You can ask your GP about what exercise they recommend you can safely return to.
You may have missed a cervical smear test due to pregnancy and it is important to get this scheduled at your 6-week postnatal review appointment.