The health care for your pregnancy which you began many months ago will end with a last postpartum visit to your doctor or midwife. The purpose of the visit is to assess your physical recovery, your beginning efforts at parenting, and your future contraceptive needs. Usually, your doctor or midwife will see you at a 2-, 4- and/or 6-week interval after birth, depending on your situation.
By the 6-week postpartum visit, your body should be well on its way to recovery. The process of “involution” is the body’s effort to return to the non-pregnant state. Specifically, the term refers to the return of the uterus to its non-pregnant size, shape and location. However, other body parts go through their own involution, too. If you are breastfeeding, some of this process is delayed a bit due to the new role of the breasts, and the hormonal effects of lactation. In the non-breastfeeding woman, the lack of breast stimulation allows the reproductive system to revert to its prepregnant state…..which is the state of getting ready for another pregnancy! In these women, the ovaries awake from their 10-12 month slumber and prepare to release a new egg……sometimes before the first period! This is why choosing a birth control method prior to this time is so important. A woman most definitely can become pregnant before she sees her first period after childbirth!
Usually, the uterus is well involuted by 6-weeks postpartum. It should be non-pregnant size, and back in its place in the pelvis. It should be firm and non-tender. Although, your postpartum bleeding should have stopped well before this time, some breastfeeding mothers will continue to spot for a few months after delivery. In the absence of signs of infection or “sub-involution”, this is normal.
Your doctor or midwife may do a Pap smear at this visit. If you are not breastfeeding, a breast exam will be done, and you should begin your own Breast-Self-Examinations after this visit. You should be instructed on how to do Kegel exercises at this visit if you do not already know how. Kegel exercises help improve and maintain the tone of the muscles in the pelvis. Kegel exercises may prevent future problems with urinary and fecal incontinence. All women (and maybe men, too) should do Kegel exercises daily for life. There’s a saying in the health care business regarding muscles, “If you don’t use it, you lose it.” Why do think there are so many ads for adult diapers?!
Finally, if you are considering a future pregnancy, you may want to consider staying on your prenatal vitamin or a vitamin supplement which provides at least 0.4 mg of folic acid. This may prevent neural tube defects in your next pregnancy.