A postpartum check-up is usually recommended 4 to 6 weeks after delivery. This is done to check any incisions or tears, do a PAP test as required, discuss and arrange for birth control as needed.
Birth Control
Use a birth control method the first time you have intercourse whether breast or bottle feeding your baby. After childbirth, a woman’s first menstrual period may be longer and heavier than usual. If a woman is bottle feeding her baby, her menstrual period will likely return 4 to 6 weeks after the birth. Ovulation and pregnancy may occur before this time. Breastfeeding often delays the return of ovulation, however, this is unpredictable. Therefore, there is a risk of pregnancy, even when breastfeeding. The contraceptive effect of breastfeeding 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.
Discuss with your doctor 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 reduce the quality and volume of breastmilk. 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.
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.
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 spermicidal foam, effectiveness against pregnancy approaches that of the pill.
Use methods other than natural family planning, if breastfeeding and periods have not returned, because there will not be predictable monthly changes in cervical mucous or body temperature. Non-breastfeeding women need to wait until their cycles are re-established and signs of fertility return.
The I.U.D. is 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.
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 postnatally and thereafter, as advised by your doctor.
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. Most lumps will decrease in size after nursing. A lump that does not go down 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.
In most cases, lumps in a nursing mother’s breasts are signs of a plugged duct or a breast infection.
References
Baby’s Best Chance. The Province of British Columbia, Ministry of Health Toronto. MacMillan Canada, 1992.
The Breastfeeding Answer Book. La Leche League International, April 1993.
The Canadian Medical Association Complete Book of Mother and Baby Care. Montreal: Reader’s Digest Association Ltd., 1992.
Contraceptive Technology. Robert A. Hatcher et al. New York, Irvington Publisher’s Inc.
Nova Scotia Gynaecological Cancer Screening Program Quick Reference Card.
Adapted from the former Muskoka- Parry Sound Health Unit. July 2005
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