Gynecological examination after childbirth, why do it

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Catherine Le Nevez
@catherinelenevez
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Contents

  • 1 What is the puerperium 
  • 2 When to do the gynecological examination after childbirth 
  • 3 Why do the gynecological examination after childbirth 
  • 4 Gynecological examination after childbirth: how it happens 
  • 5 Typical disorders of the puerperium
  • 6 Gynecological examination after childbirth and mood swings
  • 7 Gynecological examination after childbirth and sexual intercourse 
  • 8 Gynecological examination after childbirth and contraception 

The gynecological examination after childbirth is an appointment to mark on the agenda. Surely they will have recommended it to you at the time of discharge in the hospital or clinic after giving birth to your baby and we must not forget about it. It is very important to check that the body returns to its pre-pregnancy condition, that the mother is fine and that there is no particular problem. Look at it also from another point of view: going to the doctor is a way like any other to take care of yourself and get back in great shape as soon as possible. 



What is the puerperium 

Let's start with this small but fundamental premise: what the puerperium is. This word conventionally indicates the 40 days (or 6 weeks) following the birth. In other words, it is the period that, according to the definition of the Ministry of Health, goes from childbirth to the "return of the genital apparatus to pre-pregnancy anatomo-functional conditions". The puerpera is the woman who has just given birth. 

Post partum, on the other hand, is something else. These are the 2 hours that the new mother spends in observation to check that there are no bleeding, that the blood pressure and temperature are fine, to facilitate contact between mother and newborn and start breastfeeding. Typically this period of time is spent in a room near the delivery room. 



When to do the gynecological examination after childbirth 

Generally, the gynecological examination is done about 40 days after the birth, that is at the end of the puerperium. It is not a random choice. After this time, the reproductive system has returned to normal, the uterus is back to its size and postpartum losses are usually already over. Obviously, for a complete "remise en forme" it will still take a while, for example to lose a few remaining pounds or reduce hair loss. But from a functional point of view, the pieces are already starting to fall into place. 

Why do the gynecological examination after childbirth 

When we are pregnant we are always very careful and we hardly forget a visit (let alone if we would ever lose the thrill of the ultrasound!) Or to take the exams. Our health and that of our baby are always put in the foreground. So why not do the same thing after giving birth?

In addition to the purely physical check-up, the visit to the doctor also allows you to check how the mother is doing from a psychological point of view. After giving birth there is a breakdown of some hormones (including estrogen and progesterone), which can also destabilize our mood. The gynecologist will therefore be able to pick up any signs of baby blues or postpartum depression. In the latter case, timely diagnosis and intervention are very important. 

Gynecological examination after childbirth: how it happens 

If you think you can get away with a 10-minute check-up and go, know that this is not the case. There are several things your doctor needs to consider.


  • Gynecological examination. This is obviously the most important thing about meeting the gynecologist. First of all, the examination, possibly even with ultrasound, will allow him to understand if the size of the uterus has shrunk (it had grown 50 times during pregnancy), if the vagina is okay and if there are still leaks (the so-called lochiations). The physical examination then also allows to evaluate whether the lacerations caused by childbirth or the episiotomy have completely healed. If, on the other hand, your little one was born with a caesarean section, he will check that the wound has healed perfectly.
  • Examination of the perineum. During childbirth, the pelvic floor (the area between the vagina and the anus) is put under severe pressure. It happens very often that the muscles get weak. How do you know? Simply if you are leaking urine by sneezing or lifting a weight. It is important to take care of the pelvic floor already during pregnancy to strengthen it. During the visit after the birth, the gynecologist will ask you some questions to understand if there is any ailment that needs to be corrected.
  • Pap test: if it has been a year since you underwent the pap test (which is still one of the tests during pregnancy), it will do a new one to see if there is any infection or cellular alteration.
  • Breast palpation. Even if you are breastfeeding and therefore your breasts are very "full", the doctor will perform the palpation for suspicious lumps or hardening. It is therefore not true that during breastfeeding one cannot undergo a breast examination: a professional is able to do it accurately. In addition, the gynecologist will check for signs of mastitis, blockages or fissures, all of which can interfere with good breastfeeding. 
  • Blood tests. It is not excluded that you will be prescribed a blood sample to check some values ​​and your physical state in general. The tests are also useful for early diagnosis of possible anemias, related to childbirth (in particular if there has been copious blood loss) and breastfeeding (the baby also sucks the mother's iron "reserves").

Typical disorders of the puerperium

During the first gynecological examination after childbirth, the doctor will ask you if you suffer from some disorders that frequently occur in the puerperium. Let's see what they are. 



Irregular bowel

The intestinal system undergoes numerous changes throughout pregnancy due to the effect of hormones. One problem that can persist even after giving birth to your baby is constipation. Sometimes there is also a psychological component to the difficulty in evacuating: especially if they have put stitches on it, there is the fear of a further laceration or of feeling pain when you go to the bathroom. And, indeed, this can happen when the stool is hard. So the advice is to drink plenty of water, get plenty of fiber and do some exercise.

Hemorrhoids

Hemorrhoids are also "travel companions" for many expectant mothers and, in most cases, are directly linked to constipation. Other times, however, they appear right at the moment of childbirth (it is one of the great fears of pregnant women) due to the effort of pushing. And so they can be annoying once you get home. First of all, we must try to facilitate evacuation. In case of burning and pain, the doctor will prescribe some suitable product. 

Excessive sweating

Among the ailments after childbirth there could also be a very profuse sweating. Often, it occurs mostly at night. This is a normal body mechanism that tends to eliminate accumulated fluids. Furthermore, it is also a question of hormonal origin: it is the estrogen that falls quickly after giving birth that causes sweating. It will take a couple of months for the situation to return to normal.

Stretch Marks

The places where they occur most often are the abdomen, thighs and breasts. Stretch marks appear when there are major weight changes, which obviously happens after childbirth. The skin, which previously "pulled" on the stomach, tends to give way and the result is the unsightly whitish or reddish streaks. Sometimes, especially in those who are predisposed, they also occur during pregnancy. Once they pop up it is difficult to make them go away. It takes a lot of consistency.


Fatigue

No mother should be surprised if she feels tired and exhausted in the days following the birth. Whether it is natural or caesarean, it doesn't matter: it takes some time to get back in top shape. The body has to readjust itself and, in the meantime, the baby takes away a lot of energy. Feedings, diaper changes, crying, inconstant sleep also have repercussions on parents. Feeling fatigued is completely physiological. If you have the chance, the thing to do is rest when the little one does too. It doesn't matter if there is a kitchen to fix or a washing machine to start: every occasion must be good for a little rest. Asking the help of others with housework is not despicable, quite the opposite!

Gynecological examination after childbirth and mood swings

It is not only the body that suffers particular ailments after childbirth, but also the psyche. The puerperium is not always an easy period, it is useless to hide it because every mother then experiences it on her own skin. It is easy to get anxious when the baby cries or sleeps little, when breastfeeding seems like a titanic undertaking or when the first colic appears.

The mood swings are there and how in a new mother. The hormones remain upset for a while and it can happen that from one minute to the next one finds oneself from the maximum serenity to a river of tears. However, it is important to grasp the signs of this malaise and tell them to the gynecologist can be an idea for receiving advice. 

Postpartum depression is not always the basis of mood swings. Very often it is more simply what the English call baby blues, that kind of sadness that overwhelms almost all mothers after giving birth. Discomfort and crying can be there, it happens and you don't have to worry. The most serious alarm bells are others: apathy, negative feelings towards the child, anxiety, anger, sleep disturbances, eating disorders etc. In these cases, action must be taken as soon as possible to avoid more serious dangers. 

Gynecological examination after childbirth and sexual intercourse 

Many couples ask themselves: How long does it take after giving birth to start having sex again? This is a more than legitimate question, especially for those who, for some reason, have had to abstain from sex during all or part of their pregnancy. The good rule is to wait 40 days after the birth or in any case the visit with the gynecologist. With him we must also discuss contraceptive methods. Unless you want a new pregnancy right away. 

Gynecological examination after childbirth and contraception 

Let's start with what a contraceptive is not: breastfeeding. You can be fertile even without menstruation (the head of the ward) having returned and even if you are breastfeeding exclusively. The chances of getting pregnant are not very high but there are. So, be careful if you don't want surprises. There are birth control pills also suitable for breastfeeding (progestin-only minipill). 

The other contraceptives available are:

- condom and diaphragm: these are the so-called barrier methods. For the diaphragm it is advisable to wait about 6 weeks after delivery for the vagina to return to the size it was before pregnancy. To increase its effectiveness, a spermicidal substance must be associated.

- Subcutaneous implant: it is a kind of flexible stick that is implanted by the gynecologist in the arm and which releases progestin. Its convenience lies in the fact that, unlike the pill, you don't have to remember to take it.

- Levonorgestrel intrauterine system: it is a T-shaped device which, once inserted into the vagina, releases progestin.

- Copper spiral: the World Health Organization recommends that it be placed 4-6 weeks after giving birth or after the return of menstruation.

- Natural methods: there are several, from measuring the basal temperature to observing the cervical mucus. To use them you have to wait for the cycle to regularize, but their reliability does not reach 100%.

In addition to all these systems, those who are not breastfeeding also have the option of choosing estrogen-progestin hormonal methods, such as the classic pill, patch or vaginal ring. On the other hand, they are not recommended in breastfeeding because estrogen can negatively affect milk production, making it decrease.

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