WOMEN'S HEALTH AFTER CHILDBIRTH

• A postpartum check-up is usually recommended 4 to 6 weeks after birth.
• This is done to check any incisions or tears, do a PAP test as required, discuss and arrange for contraceptives (birth control) as needed. 

Postpartum Mood Disorders (PPMD)

• See Postpartum Mood Disorders

Contraceptives (Birth Control)

• Lochia, made up of blood and tissue from the lining of the uterus, will flow after birth.
• At first, lochia is bright red and may have a few clots. Bright red blood may flow again for short periods during, or after, breastfeeding – breastfeeding causes mild contractions in the uterus, helping to get rid of the lining. This is normal for the first few days.
• Your flow will begin to slow down and become darker. It is normal to see some bloody spotting.
• Your flow will turn whitish or yellow and will slowly stop – this can last from 10 days to 5 weeks.
• It is important to know that lochia is NOT your menstrual period returning. 
• If a woman is breastfeeding her baby, her menstrual period may not start again for months, or until she stops breastfeeding altogether.
• If a woman is bottle feeding her baby, her menstrual period will likely return 4 to 9 weeks after the birth.
• After childbirth, a woman’s first menstrual period may be longer, shorter, lighter or heavier than usual. It should return to what is normal for you after a few cycles.
• Your ovaries may begin to work before your period returns. You could become pregnant again without ever having a period.
• Use a birth control method the first time you have intercourse whether breast or bottle feeding your baby.

Breastfeeding

• Breastfeeding often delays the return of ovulation, however, this is unpredictable. Therefore, there is a risk of pregnancy, even when breastfeeding.
• The contraceptive effect breastfeeding has seems to depend on the strength of the infant’s sucking and the length of time between breastfeeding sessions.
• The addition of supplements and solid food increases the chance that ovulation will occur because your baby is not feeding as often as before.

The “pill”, the “patch”, and the “ring”

• The “pill” is taken by mouth, the “patch” is applied to the skin, and the “ring” is placed in the vagina.
• If you are not breastfeeding, you can begin using either of these birth control options 3-4 weeks after your baby is born.
• Discuss with your health care provider the pros and cons of taking the pill while breastfeeding.
• Combined (estrogen-progestin) pills should not be taken in the first few weeks after delivery because the risk of blood clots is greater at this time.
• Recent studies show that combined birth control pills, even low dose pills, may redu ce milk production. This effect seems to be less if the pills are not taken until breastfeeding is well established.
• A better choice for a breastfeeding woman is probably the progestin-only pill. Although small amounts of the hormones in birth control pills are present in the breastmilk, studies show that this does not seem to be harmful to the infant.

 Injectable contraceptives (the “shot”)

• This is also a hormonal-type birth control.
• Your health care provider will give you a “shot” every 3 months.

Intrauterine device (IUD)

• A highly effective birth control method and may be the method of choice for some postpartum women.
•  It can be inserted at the postpartum examination (about 6 weeks after birth).

Condoms (male and female)

• These are available for men and women.
• These protect both partners from sexually transmitted diseases.
• Try a lubricated condom or use a water soluble lubricant with a condom to help ease penetration when there is vaginal dryness.
• When combined with a spermicide, effectiveness against pregnancy is close to that of the pill.

Spermicides

• Kill sperm and work best to prevent pregnancy when used with a latex condom.

Diaphragms or cervical caps

• These cover the opening to the uterus to prevent sperm from entering.
• You can be fitted for a diaphragm or cervical cap at your six week check-up.
• If you used one of these methods before becoming pregnant it may no longer fit properly.
• The diaphragm and cap cannot be safely used until postpartum bleeding has stopped because of the risk of toxic shock syndrome.
• These work best when combined with spermicides.

Natural family planning (NFP)

• Requires abstinence during the woman’s fertile time (ovulation).
• You can tell when you’re ovulating by using a calendar to maintain a record of your cycle, measuring your body temperature, and watching changes in the vaginal discharge.
• Use methods other than natural family planning, if breastfeeding and periods have not returned, because there will not be predictable monthly changes in cervical mucus or body temperature.

Monitoring Your Health

• Non-breastfeeding women need to wait until their cycles are re-established and signs of fertility return before trying to have another baby.

The Pap Smear

• A Pap smear is a swab of cells taken from the cervix and examined under a microscope for pre-cancerous cell changes.
• It is a test that is important in the prevention of cancer of the cervix.
• A Pap smear is recommended pre or post-natally and thereafter, as advised by your health care provider.

Breast Self-Exam

• When breastfeeding, continue to examine your breasts every month.
• Lactating breasts feel differently than non-lactating breasts.
• A lump is more difficult to detect in a breastfeeding mother.
• It is important to become familiar with the feel of your breasts.
• In most cases, lumps in a nursing mother’s breasts are signs of a plugged duct or a breast infection.
• Most lumps will decrease in size after nursing. A lump that does not go away may need to be checked by a doctor.
• Breastfeeding immediately before a medical examination or mammogram makes it easier to feel a lump and makes the mammogram easier to read.

For more information:

• Call the North Bay Parry Sound District Health Unit at 474-1400 or 1-800-563-2808 to speak to a Public Health Nurse
• The Society of Obstetricians and Gynaecologists of Canada: Sexuality and U – www.sexualityandu.ca