Sometimes after having your baby, it can feel like you get a bit abandoned after you get discharged from midwifery care! Many women don’t realise, but you should have a postnatal check 6 to 8 weeks after your baby’s birth with your GP.
Some GP surgeries do not routinely offer a postnatal check. You can always request an appointment for a check, especially if you have any concerns. It’s a good idea to make a list of questions to take along with you.
Sometimes a mum’s postnatal check is done at the same time as her baby’s 6 to 8 week check.
When I asked my followers on Instagram if they were satisfied with their 6 week check, an overwhelming 75% from almost 1000 women said No!
There is probably not enough information about what we should expect from this appointment, combined with the fact that at the moment GPs do not get paid for providing this appointment. This means that the care offered is so variable and can feel rushed and impersonal.
I asked for your views on what your 6 week check should have covered and was blown away with the responses. A lot of areas came up consistently, including not feeling able to talk about your mood, and many women felt a physical examination would have been helpful.
I have created this post in collaboration with 2 other experts – @the_gp_mum and @physiomumuk to bring you information about postnatal checks and what to expect.
Armed with these tools, you can go to your appointment ready to ask the questions and talk about the topics that really matter.
Maternal 6-week Check
The aim of this appointment is to review your physical and mental health, discuss the events of your birth, arrange any tests or ongoing treatment required and plan for the future.
A recent BMJ article was published to standardize the checks and advice GPs give – this post has been written using that information.
These are the areas your doctor should cover:
Social/ emotional symptoms
• Social—They should ask about your support, and what you plan to do in terms of getting out and about.
• Mood—Your doctor will be looking to identify any possible postnatal depression so should ask questions such as:
- During the past month, have you often been bothered by feeling down, depressed, or hopeless?
- During the past month, have you often been bothered by having little interest or pleasure in doing things?
• Labour and birth—Your doctor should use this opportunity to ask how your experience was of birth. It is a perfect opportunity to ask for a de-brief consultation with a midwife or obstetrician if you have unanswered questions.
Physical symptoms
• Breastfeeding— They should inquire if you are breastfeeding or formula feeding, and how it is going and offer you advice, or signpost you to people who may help.
• Wound healing— Your doctor should ask about your wounds and if they feel comfortable. They may not need to review the wound itself routinely, but if you still have pain or discomfort then ask them to check it for you.
• Vaginal bleeding—lochia after childbirth should have stopped by six weeks. If ongoing or purulent, consider referral to the emergency gynaecology unit for assessment.
• Bladder function—you should be asked if you leak small amounts of urine when you cough or sneeze? If urinary symptoms are severe and/or persist, you should return to your GP for referral to physiotherapy for further assessment.
• Bowel function—if you have ongoing constipation, faecal incontinence or haemorrhoids this is a good opportunity to discuss these issues.
• Pregnancy complications – If you had any issues such as gestational diabetes, anaemia or pre-eclampsia your GP should discuss what this means for the future and any medication or tests required.
Sexual intercourse and contraception
• Sex– You can have sexual intercourse again when you feel emotionally and physically ready. Usually it takes a few weeks for any perineal stitches to heal, and it may take longer for you to feel interested in resuming sexual intercourse. If intercourse is painful, a lubricant may help. If you want the ‘all clear’ from your doctor then the 6 week check is a good opportunity to discuss this.
Periods – Vaginal blood loss (lochia) following childbirth should have ceased by six weeks. If you are breastfeeding, your periods may not return until you reduce or stop breastfeeding. This post has more information on breastfeeding, periods and fertility.
• Contraception— If you wish to avoid pregnancy, then even if you arent having periods you should be using contraception. This post summarises the options.
Tips for this 6-8 week check:
- Ask your doctor to assess you for Diastesis Recti and check your stitches. If your doctor doesnt offer a physical examination you can ask for one!
- Dont be afraid to mention the symptoms you feel embarassed about, such as incontinence or haemorrhoids. The sooner they are dealt with the better!
- Talk about how you are feeling – your GP is likely to know many places you can go for support such as local breastfeeding drop-ins. If you arent sure if you need help, you can ask about the difference between baby blues and PND.
- Discuss your plans for exercise. You can usually start low impact exercise, such as brisk walking, as soon as you feel ready—typically within two weeks of vaginal delivery and after the six week check for women who have had a caesarean section. For exercise such as swimming, and cycling, build up gradually to your pre-pregnancy levels. Limit high impact exercise (for example, using heavy weights) until at least six weeks after childbirth
The Baby Check
The aim of the 6-week baby check is to identify any physical/developmental concerns and a chance to discuss any concerns you have and things such as immunisations.
Birth/postnatal details
The GP will check when baby was born, mode of delivery and if there were any complications during delivery or any prolonged hospital stay.
Examination
Baby needs to be in a nappy. It’s a head-to-toe examination to detect any problems with the heart, hips, eyes and genitalia for example. The GP will want to move baby around a bit to check their tone and neck strength as well as these things. There is also a test for something called the Moro reflex which involves lowering baby fairly abruptly – your GP should warn you about this beforehand!
Weight and head circumference
Measured and plotted on the growth chart in the red book to review weight gain. GPs may not do this if baby has been weighed recently. The most important aspect here is what is normal for your baby and are they tracking the same centile (curved line) on the growth chart.
Development
Most babies will have a hearing test before leaving hospital or have this organised shortly after. You should be asked; if baby startles to loud noises, if they follow your face with their eyes and if they have started smiling yet.
Your concerns
A chance to bring up any concerns you have about the baby or feeding for example. If you know you have some things to discuss, I would recommend trying to book a double appointment. All of the above has to be squeezed into a 10 minute slot which is essentially impossible!
Tips for this 6-8 week check:
- Remember the red book!
- Dress baby in clothes that can be easily removed
- Bring spare nappies
- Write down any questions you have – it can be a hectic appointment so easy to forget things
- You might have to wait! Inevitably clinics run late so bring milk/be prepared to breastfeed if needed and don’t plan to be anywhere soon after the appointment
Women’s Health Physiotherapy/ Mummy MOT
Your body changes very quickly during pregnancy to support your growing baby. To accommodate these changes your posture alters, muscles get lengthened, muscles get weakened and then…. you give birth.
Whether you have a ‘textbook’ vaginal delivery, perineal tear or C-section, the birthing process places incredible demands on your system and often causes trauma and injury.
As a result of these changes and demands on your body it is very common to develop symptoms after childbirth like urinary and / or faecal incontinence, Pelvic Organ Prolapse, Diastasis Recti (tummy separation), back pain and painful sex.
Not every woman will develop these symptoms but they are at risk of developing them at some stage in their lifetime if the effects of pregnancy and delivery are not addressed.
In an ideal world, it would be amazing if all women see a Women’s Health Physiotherapist post-baby.
If you have just had a baby or had a child years ago, it would still be beneficial to have a women’s health postnatal check. Your GP can refer you, especially if you have any ongoing symptoms from your delivery, or you can see one privately.
What to expect from a post-natal physio check
Your postnatal check with a Women’s Health Physiotherapist is recommended from 6 weeks post birth. It will involve a head-to-toe assessment. We assess:
- Posture
- How you move
- How well your joints move
- General muscle strength
- Abdominal wall – to check for diastasis recti and assess c section scar if you have one
- Vulva – This ideally requires an internal vaginal assessment. This does not hurt and does not involve the use of a speculum. We assess any scars, quality of tissue, strength of pelvic floor and whether you may have a pelvic organ prolapse
A rehabilitation program will be developed after your assessment that meets your specific needs and addresses any symptoms you may have. Your physiotherapist will also guide you on your return to exercise.