The Postpartum CheckUp
The first three to four months of having a child are the most challenging by far, especially for first-time mothers. People usually talk about how wonderful it is to have a baby—and it is wonderful! But people don't always talk about the struggles and the isolation, the sleep deprivation and the monotony of spending time with a newborn who can't communicate their needs. These things can be difficult, especially with social media adding pressure to look like you're enjoying every minute—because that’s all you see in the snapshots from other moms and babies. Often a mother can feel like she is the only person struggling with such a big change to her life.
Many women experience a difficult child delivery, which can take a serious toll on the body and the mind. Doctors often place a great deal of importance on monitoring a baby’s health and development in the months after birth, but due consideration isn’t always given to the mother—and sometimes important medical issues can be missed while everyone’s focus is fixed on the baby.
In many developed countries, it’s now standard to perform a postpartum checkup on the mother around six weeks after delivery to ensure she is physically recovering from the pregnancy, as well as to check that her emotional needs are being met, while addressing any medical needs she may have going forward. These check-ups are a great opportunity to talk to mothers about how the labor went, to ask if there were any difficulties that she had in the first few months of the baby's life, and to discuss issues like contraception and psychological wellbeing. They also provide an opportunity to ensure there were no physical consequences of the labor, including checking scars, wounds, and so on. We can also perform a Pap smear or HPV screening, something that can otherwise tend to be skipped following childbirth.
Having a child can greatly change the dynamic of the relationship between a woman and her partner as well, and this can be another difficulty that people can't easily prepare for before the baby arrives. Being able to talk these things through with someone can provide a therapeutic reassurance that everything is completely fine—and that postnatal worries and sleep deprivation are all part of the normal spectrum.
Many mothers suffer from emotional difficulties in the months following birth. Sleep deprivation too can be brutal—which is why it’s a torture technique! By its nature, it reduces your ability to objectively assess what’s happening around you, and can result in stressful changes in hormone levels. This is when physical wellbeing and mental wellbeing can become intertwined and take a toll on the mother. This typically involves feeling overly worried about small matters, ruminating, and not being able to rest as a result. It’s often very important for mothers to reach out to other families for support and to meet with other moms in their situation, especially if they are going through emotional difficulties. If possible, they could also seek community support services such as playgroups or professionally led groups to share and discuss maternal and child care issues.
For mothers in this situation, the postpartum checkup can be an opportunity to assess these emotional upsets, restoring some perspective and relieving stress—or otherwise to initiate medical treatment in serious cases.
The check-up also allows the physician to examine any physical consequences of the birth. These can include recovery from stitches or scars, as well as check if there is any separation of the abdominal muscles. A doctor will also check for issues such as blocked ducts that may interfere with breastfeeding. We can give advice on the types of exercises that a mother can do to aid recovery of normal movement, or refer the mother to a physiotherapist if the need is there.
Contraception is also an issue that can be overlooked by new mothers, which is why a postpartum check-up can be helpful in providing information on this issue—it’s not unheard of for a woman to find herself pregnant again just two months after giving birth, which can be quite a surprise! Generally, if a mother is exclusively breastfeeding, the body’s own hormones will work to prevent conception—although this method is not particularly reliable, especially when the baby is taking even a little supplemental formula milk. Mothers can consider taking a contraceptive pill from six weeks after delivery—and while combined oral contraceptive medicines used to be not recommended for breastfeeding mothers, it has recently been shown to be a safe method of contraception even at this time. This can be a relief for mothers who experience negative side-effects of progesterone-only pills, as evidence suggests combined pills have no detrimental effect on mother or child.
The beauty of this examination is that so many issues can be dealt with during a single consultation at six weeks after delivery. If any issues are identified then—either physical or mental—it provides the opportunity to follow up in a structured way.
While postpartum checkups are rarely done as a matter of course in Vietnam, new mothers can schedule appointments with physicians who have experience in the procedure overseas. Additionally, our practice’s SIMBA group for new mothers is currently the only professional lead support network for women with babies, helping mothers to network and support each other during this challenging and rewarding experience.
Dr. Anna Donovan - Internist, Family Medical Practice Ho Chi Minh City
Dr. Anna Donovan studied at the University of Manchester and Liverpool School of Tropical Medicine before serving the San bushmen as a volunteer physician in Namibia. She has extensive experience in giving postpartum check-ups from her time working in the UK.