6 Questions to Ask at Your 6-Week Postpartum Checkup
Considering how often you saw your OBGYN before delivery, you might be shocked at how infrequently you'll see them after. The only visit you're likely to be encouraged to schedule is one 6-week postpartum checkup. After that, you may not see them for another year. So it's super important to make the most of every minute of this short visit.
That's easier said than done, given that 1. busy OBGYNs are typically in a rush, and 2. being out of the house and away from your baby (maybe even for the first time) can be disorienting and distracting. If you don't plan ahead, you'll be asked a list of standard questions — How are you feeling? Has your wound or incision healed? Are there any signs of infection? — and sent on your way without the answers and resources you need to support a successfull, feel-good postpartum recovery.
To prevent that from happening, making a list of concerns ahead of time is a must-do. To get you started, below are the questions that I wish all my postpartum patients would ask their OBGYN at their 6-week visit.
Can I have a referral for pelvic floor physical therapy?
As a postpartum pelvic floor physical therapist, this one is naturally going to be on the top of my list. At 6 weeks post-childbirth, the expectation is that any tissue damage will have healed and common symptoms that can occur after delivery like pain, bleeding, bladder leeks, and pelvic pressure, will have resolved. But that often isn't the case — and just because you're not bleeding or in pain, does not mean that your body is ready to get back to activities like sex and exercise.
A pelvic floor PT can fully assess how your abdominals and pelvic floor muscles are recovering and what kind of support you need to restore your strength and balance your body after 10 months of pregnancy and the strain of a vaginal or Cesarean birth. A PT can also help you lift, carry, bathe, and feed your baby in ways that won't strain your body and lead to injury.
Even if you're not planning to see a PT in the immediate future, it's best to get a referral while you're in the office, so it won't be a hassle later. If your referral is lost or expires before you use it, asking for a replacement over the phone is much easier than having to schedule an appointment and go in person in order to request a new one.
Would I benefit from topical estrogen cream?
Immediately after delivery, your estrogen levels dramatically drop. Lower levels of estrogen are often associated with increased pain during sex, vaginal dryness, vaginal irritation and recurrent UTIs. While there are many benefits to breast/chest feeding your baby or pumping, during lactation, your estrogen levels will continue to remain low and so you may be at risk of developing some of these symptoms. Ask your OB/GYN if they think you may be a good candidate for topical estrogen cream during lactation. They may encourage you to first try having sex before they write a prescription, but starting that conversation at your 6 week follow up will make it easier to reach back out to your doctor, if you do notice vaginal pain or discomfort later on.
Should I be using silicone for my cesarean scar?
Several studies have shown that using silicone sheets or gel in the first 8-12 weeks following surgery can reduce the risk of hypertrophic (thick and raised) scars and reduce pain. While these studies are not the highest quality, for many people, if anything has even a remote chance of improving the appearance of their scar, they are willing to try it. Also, applying a gel or sheet to the scar daily is fairly easy and can be very affordable too. You may even have received a few sheets at the hospital after delivery, but you can also ask your doctor if they have a brand or type they recommend and if they have any suggestions for how often or long postpartum to apply the product, as well.
Can I see where I tore?
If you experienced a tear or had an episiotomy during delivery, it can be daunting to look at your perineum. But if you're up for it, I would highly encourage asking your OBGYN to use a mirror to let you see how your wound is healing. This is your body and, between pregnancy and then hours (or days) of labor and delivery, it's been through a lot. Taking a close look at how your anatomy has changed can help you feel a connection with and ownership over your own body.
You'll also be better equipped to begin scar massage or apply prescribed topical ointments to your scar. And, if by your 6 week appointment, your wound has not fully healed, knowing where it is and being comfortable looking at it can be valuable for monitoring the healing process. If something does not look right at the scar site, you'll know to reach out to your OB/GYN right away.
Just as important, if you notice discomfort when you try to insert a tampon or have penetrative sex, knowing the position of your tear will help you determine if it may be causing that sensation. If that happens, you can use your referral to book a visit with a pelvic floor PT and address the pain, ASAP.
What degree was my tear?
This is important information because the degree of your perineal tear explains which muscles of your pelvic floor were impacted. Depending on the part of your pelvic floor that was affected, dramatically different symptoms can arise, ranging from pain with wiping to pelvic pressure to fecal incontinence. Understanding your tear and the degree can help you understand why your symptoms may be so different from someone else's.
- 1st degree: involves injury to the skin and vaginal wall
- 2nd degree: involves injury to the skin, vaginal wall and perineal body
- 3rd degree: involves injury to the skin, vaginal wall, perineal body and anal sphincter
- 4th degree: involves injury to the skin, vaginal wall, perineal body, anal sphincter and rectal wall
Again, if you have had a perineal tear and are experiencing symptoms of any kind, reach out to a pelvic floor physical therapist. Keep in mind that, regardless of the degree of your tear, your body and you are resilient and, with support and guidance, your symptoms can improve.
Do I have a prolapse?
A prolapse occurs when the connective tissue and musculature that support your pelvic organs become compromised so that those organs are able to lean into your vaginal canal to varying degrees. The risk of developing a prolapse increases if you have been pregnant or delivered vaginally but it is unclear how many people actually have pelvic organ prolapse. Some studies suggest as many as 50% of women are living with prolapse, although most of them have no symptoms at all. This is important to understand because having a prolapse does not automatically mean you will need surgery and it does not guarantee you will have pelvic issues and it does not mean you are doomed to have your vagina fall out one day.
So if you don't have symptoms and you don't need surgery, what is the actual benefit of learning that you have a prolapse? For some people, knowing they have prolapse is not positive- this information may make them stressed or obsessively focused on their pelvic floor symptoms which can be unhealthy and is surely unhelpful. But for others, understanding their body and how it changed after delivery can be empowering. They can make informed decisions about future pregnancies, exercise choices, and lifestyle modifications that can reduce exacerbation of their prolapse. In addition, learning they have a prolapse may prompt someone to reach out to a pelvic floor physical therapist. Learning how to strengthen your pelvic floor can be an important step towards reducing prolapse symptoms or preventing them from appearing in the first place.