Postpartum

The 6-Week Postpartum Check-Up: How to Maximize Your Postpartum Care

How to prepare for your postpartum exam. Do you need to go to your 6 week check up? How to know when you need more checkups after giving birth.

C is for Check-Up: The 6 week Postpartum Check Up at

Transcript from video:
Oh, hey, it’s time for another blog on the taboo ABCs of postpartum. C is for checkup, and we’re going to be talking about that usually only one postpartum checkup you get which is usually a 6 week check up (sometimes between 4-8 weeks). Now, for the record, I don’t think one checkup is sufficient at all. But we are going to talk about how to maximize that checkup. Also we discuss what to talk to your provider about and how to be your own best advocate.

If you’re new here, my name is Chelsea Skaggs. I am a postpartum coach and the founder of Postpartum Together. And we are freaking committed to making sure that the postpartum narrative changes so that women are more educated, normalized, supported and empowered in the postpartum season.

Now, reminder, postpartum is not just a few weeks. Postpartum is the year ish after baby. And postpartum is not just related to depression, postpartum is a season we all go through regardless of a diagnosis or not. So postpartum is the season after baby full of transitions that we all go through as birthing humans.

Related: Where do we learn about postpartum?

We Believe Women Deserve More Check Ups After Baby

A whole other tangent is that one postpartum checkup is not enough. The ACOG (American College of Obstetricians and Gynecologists) recommend comprehensive follow-ups after having a baby. One appointment is not comprehensive follow up. However, we still have this issue of insurance and providers and the communication and honoring the postpartum season. We know that postpartum is a time that is often just kind of disregarded and pushed under the rug, and we’re not given full on comprehensive support. So we’re going to talk today about how to make that one 6 week check up appointment the best it possibly can be. We also discuss if and when you need to how to advocate for more appointments and more care for yourself.

Now, usually, this appointment happens between four and eight weeks. If you had a belly birth, you might have an earlier appointment. Depending on circumstances, it’s probably going to be somewhere between four and eight weeks. At this point, you’re still healing in a lot of ways. You are still living in a lot of a fog. This is kind of a survival mode.

I know from my own experience, and from some of my clients that when we go to that appointment, it’s hard to even know where to start what to ask. Chances are your provider is going to ask some questions, checking on you, but they may not address all the things that you actually need them to address in that appointment. It’s important that you come in proactively knowing what you need answers to and what you need checked on so that you can feel confident to leave that appointment and continue healing and continue growing as a new mom.

What to ask at your Postpartum 6-Week Check Up

So the first thing is that physical healing, right, they’re likely going to check your whether it’s a belly incision, whether it’s in the vaginal tearing and repair that is happening in that area. No matter how you gave birth, there is recovery, they’re probably going to check how your bleeding is- is it down to very minimal or has it stopped at this point? They’re going to check if everything is healing- scars are healing, how is that doing? If you’re still experiencing pain, this is a good time to bring that up like hey, I’m still feeling this way. Is there something that I should be concerned about? Do you know something I can do about it?

Related: Postpartum Plan Checklist

While we’re talking about physical healing, I want you to bring up your pelvic floor. This doesn’t always come up in appointments from a lot of my clients, we actually have to go out and self advocate for this. You carry the baby, right in this vicinity, resting on your pelvis. And regardless of if you gave vaginal or belly birth, you had a baby resting on your pelvis, affecting your organs, affecting the tissue in the muscle and everything that makes up your pelvic floor.

Asking about the Pelvic Floor at your 6-week checkup

In some countries, pelvic floor therapy is standard care for everyone after baby. Here in the US, we often have to either have a big problem we bring up or we have to advocate.
Hey, I know my body went through a lot of stress, I think that pelvic floor therapy would be beneficial for me.
Chances are, it would be beneficial for you. But we know that especially if you’re feeling:
-Bearing down weight called prolapse.
-Experiencing pain & incontinence.
-Once you’re ready to start having sex again, if that is painful and uncomfortable.
These are good times to talk about pelvic floor therapy.

Be that bridge, again, be your own best self advocate.

Related: What is the pelvic floor?

Ask about Mental Health at your Postpartum Check Up

Now, also at this appointment, you’re likely going to get a mental health screening, this is for postpartum depression. I’m going to tell you right now, it has some language in it that can be suggestive, and in my opinion, a little tricky. Some questions are like, I feel sad for no good reason. And you’re like, well, I don’t know everything in my life just changed. Is that a good reason? Or is that not a good reason? I don’t know who’s the judge of whether this is a good reason.

If you’re feeling off, don’t feel ashamed of how you need to answer those questions. And don’t feel like there’s not room to press into it more and ask your provider to talk more with you about your mental health.  Depression is not just feeling sad, it can be rage or other experiences.

It doesn’t have to be: “I can’t get out of bed.” It sometimes is, and that’s worth addressing, too. But know that in motherhood, you’re going to feel off, you’re going to feel different. But if you’re just really feeling like your day to day is compromised, bring that up. Don’t let that screening be where it stops. I passed screenings in situations where I likely needed more support. That phrasing like “for no good reason” really threw me off. Like my whole life just changed, and my vagina is falling apart, and I haven’t slept like that feels like a good reason. So talk more about that.

Mental Health and Birth Trauma

If you experienced birth trauma, it is important to consider how that could have impact you. It could impact your bond and your relationship with your baby, your relationship with your body, your confidence as a mom. So these are all important things to bring up in the 6 week check up. If you feel like you would benefit from therapy that’s okay, too. There’s no shame in that. Ask your provider if they have a maternal health therapists that they would recommend. Maybe it’s someone in the network.

Related: Postpartum Anxiety Story

Sex & Exercise After the 6-Week Check Up

I want you to make sure that you are talking about more than just your reengagement.  We think of this six weeks as like, check mark, you can have sex and exercise now. But you guys, it’s not that simple. You don’t have to start your same intense workouts right after baby and you don’t have to get back to sex in the same way right after baby. So don’t look at this as just like this green light means go full force, I’m healed. You are not healed at six weeks.

It takes intention and it takes getting back into things. So ask your provider, “What would be an appropriate way to get back into exercise? What would be an appropriate way to move back towards intimacy. Again, we want this to be a positive experience for you. Do not be afraid to ask more questions and go a little bit deeper. Your provider is probably going to also talk to you about family planning. Go into it knowing-what do you want? Know that you have a say and you can ask those questions about what are what are the risks, what are the benefits and find the best solution for you.

Purpose of the Postpartum 6-Week Check Up

I want you to feel like this checkup is about you and that you are worthy of the time and the space that it takes and that it is not rushed, that it is not blown off. If you need more appointments, make another appointment. Tell them that you need their support.

A lot of people think that postpartum depression, anxiety, OCD, bipolar, like all of these things happen in the first few weeks. And that’s not always the case, it can have an onset at three or six or nine months.

And then your pelvic floor- if you are three months out, and you start to have sex again and it’s really painful, you need to talk to them about getting that pelvic floor therapy. If, you’re having incontinence, which means that you’re not holding your fluids in- peeing, pooping, farting without control, you can schedule that appointment and continue to talk about those things.

Be Your Own Best Advocate: Prepare for Postpartum and Maximize the 6 Week Check up

Don’t feel like your postpartum care has to be limited. We have to be our own best advocates. And that comes from understanding what to bring to the table advocating for our own best needs, and really using that time.

So I hope that this helps you to be more prepared for your postpartum checkup. Whether it’s coming up in a day a week, or you’re you know, just right now expecting or thinking about conceiving, know that this is a space where you deserve time, you deserve attention, and you deserve to have the resources and support.

Again, I am Chelsea Skaggs and the founder of Postpartum Together if you are pregnant girl, get my postpartum planning ecourse that is going to walk you through all the things you need to have prepared for an empowered and supported postpartum and life after baby. If you are you know already postpartum, Maybe you want to grab the postpartum sex Back in the Sack eCourse where we talk about the mental, the emotional, and the physical implications of intimacy again after baby. Maybe you need some extra support, some guidance, some tips, resources and empowerment, check out our postpartum together small groups.

Postpartum

How to Find a Great Pelvic Floor Therapist After Having a Baby

What is the Pelvic Floor?

The pelvic floor is a group of muscles and tissues that support your organs, support urine and stool movement, and impact sexual function. Throughout pregnancy and birth, the pelvic floor goes through a number of changes. The muscles can tighten and loosen, the tissue lengthens and the function of the pelvic floor can be compromised through the pressure it undergoes. After birth, changes in your pelvic floor may lead to complications with sex, urination, pain and discomfort. Whether you have a vaginal or cesarean birth, a pelvic floor therapist can be helpful in healing. Both tissue damage around the vagina and cesarean incisions can create complications for women.

Related: Postpartum Resource Planner

Disclaimer: (I am not a medical provider. I am a mom, a researcher, a coach. My goal is to help you have the information so you can seek your medical provider if needed. Information from this site should not replace your regular medical care.) Also, this post may contain affiliate links which means, at no additional cost to you, we may make commission on any purchases made through links. 

during pregnancy, the baby can cause changes to a woman’s pelvic floor

Why pelvic floor therapy?

If your shoulder or knee went through as much physical trauma as your pelvic floor does, you would likely receive a referral for physical therapy. It is totally normal to need to “retrain” your pelvic floor after the weight of bearing and birthing a child.

This is even standard care in some parts of the world. According to this article in HuffPost, For decades, the French government has subsidized “perineal re-education,” i.e., physiotherapy that helps strengthen a new mother’s pelvic floor.“This is a kind of physical therapy designed to retrain the muscles of the pelvic floor, including the vagina, and is one of the cornerstones of French postnatal care,” she (French mother and writer, Claire Lundberg) wrote.

For mothers in the US and many other countries, pelvic floor therapy is not standard care and we are often left to hear about it from a friend, a blog, etc. and find our own way. However, it is important to be able to gain confidence and comfort in the pelvic floor after birth. Some women go years without giving the pelvic floor attention and healing and then deal with things like pelvic floor prolapse even 10 years after birth or incontinence for years. While things like peeing while jumping or painful sex may be common, these are not normal and you don’t have to live with it forever. Pelvic floor therapy is designed to help you through these issues.

RELATED: The Pelvic Floor, Kegels, and What Happens in Pelvic Floor Therapy

pelvic floor physical therapy

How to Find a Pelvic Floor Therapist

When looking for a pelvic floor therapist there are a few things you want to consider.

  • Do you need your therapist to take insurance or will you use private pay?

  • What days and hours are you able to attend an appointment?

  • What do you need to feel comfortable at this type of appointment (gender, personality of therapist)

Where to Look for Pelvic Floor Therapist

Maybe you already know a pelvic floor therapist or have a friend who can give you a recommendation, but if you’re starting from square one, let me help you out a bit!

Databases

I found that there are a few “databases” online where you can put in your location and look for a provider. Unfortunately, I found the results to be very limited both in number of results and ability to filter and find specialties. Pelvicguru.com and pelvicrehab.com turned up better results, but still felt quite limited.

Google Search

You can try a Google search in your area. Example: Women’s Pelvic Floor Therapist Columbus, Ohio. This will likely bring up both individual therapists and offices that provide this service. Once you find options, take a look at the website and look at their services, specialties and/or staff to see if there is mention of pelvic floor and/or women’s health.

Social Media

Sometimes the best information you can get is from finding recommendations from others. If you’re area has a local moms Facebook group, this can be a great place to ask for recommendations. You can also follow the #pelvicmafia on Twitter or Instagram for posts from and regarding pelvic floor specialists.

Your OB/Midwife/PCP Referrals

If you’re experiencing symptoms that lead you to seek out pelvic floor therapy, you can talk about these symptoms to your medical provider. This may be your OB/Midwife and/or your primary care provider. Many providers are not trained in pelvic floor and therefore may not have answers, but you can directly ask them to write you a referral for pelvic floor therapy.

*Note I have had some clients share that they were told there pain/discomfort/worry was “normal” and were not written a referral. Know that there is no degree to which you need to experience these things to warrant pelvic floor therapy. Remember, this is standard care in some areas of the world. If your provider doesn’t believe you need it, but you do, go with your gut and seek out a therapist.

RELATED: Sex After Baby: Am I Ready?

Normalizing Pelvic Floor Therapy

While many parts of the world still do not see pelvic floor therapy as standard postpartum care, many women are speaking up about the importance of this healing. It can be awkward to talk about painful sex, peeing yourself, feeling heavy “down there” and other things that come with pelvic floor complications, but the more we speak up for ourselves and speak with one another, the less awkward it becomes and the more women know they don’t have to suffer with those issues forever.

Many providers and women see birth as the goal in a pregnant woman’s health, but truly the goal should be a supported and healed mother to take care of her new baby.

RELATED: Best comfy clothes for postpartum moms


best clothes for a new mom
Postpartum

Sex After Birth: When & How to Approach Postpartum Sex

How do you know when you’re ready to have sex after birth?

husband wants to have sex but i just had a baby and i’m not sure if i’m ready

Do you need to be ready to have sex again 6 weeks after giving birth? If you get an “all clear” from your doctor or midwife at your checkup, does that mean you should feel ready for sex again?

A lot of women find themselves confused and feeling isolated when it comes to the conversation of sex after baby. Who can you talk to about sex when you’re a new mom? Can you bring it up at playgroup or with your friends? Women feel like they should be ready, even if they aren’t. This leaves new moms wondering if they’ve done something wrong, if their body is “broken” or if they are disappointing their partner.

The pressure to be ready for sex after birth can come from many places.

  1. Many providers mark the 6-week check up with an “all clear” to return to sex and exercise.

    While some providers take time to discuss all the changes a woman has experienced after having a baby, many women have felt rushed in these appointments and deduced to being sexual and fit again. This conversation of “your vagina is healed, you can have sex and exercise” creates a layer of pressure for a mom to be ready for intercourse.

  2. Pressure can come from a society that prioritizes sex in many ways

    There is an underlying assumption that a new mom “owes” sex to her partner because the partner has waited until mom is physically able again.

  3. Some women feel pressure from partners who don’t understand all the changes of new motherhood.

    A partner may feel like an “all clear” from a doctor is the green light everyone needs. When women are taught so little about their natural changes in postpartum, partners have even less understanding. This can be confusing and cause resentment in couples.

RELATED: Is this Weird for Everybody? Postpartum Sex

mom is not sure what to expect having sex after giving birth.

So What Does It Mean to be “Ready” for Sex Again?

A woman needs more than healed stitches to be ready for sex. It is a mental, emotional AND physical experience and transition. Some women are ready to get “back in the sack” right away, but for many women this is complicated and takes more time than the prescribed “all clear.”

Physically Ready

Being physically ready for sex includes healed birth sites- whether that is vaginal or cesarean (or both). This is usually what your medical provider is checking for you and giving an “all clear” for at a follow up appointment. Your pelvic floor undergoes a lot of changes and sometimes damage through birth and delivery. Many countries have pelvic floor physical therapy as standard care. In America, this is often something the new mom must seek-out. Pelvic floor physical therapy can be extremely beneficial if you’re struggling with incontinence, a “bearing down” weight on your pelvis and/or if sex is painful at any point. Many women (including myself) find sex to be significantly better after pelvic floor rehab. Breastfeeding can create a different feeling in your breast. If your breasts have been players in sexual experiences previously, you may need to address the change in sensation, feeling or even breast pain as you adapt to breastfeeding. Breastfeeding can also cause more vaginal dryness meaning- lots of lube is needed!

RELATED: Do I need to Exercise My Pelvic Floor?

Mentally Ready

Motherhood, especially early motherhood, takes a lot from you mentally. Your day is filled with figuring out how to take care of baby, set new schedules, making appointments, figuring out naps and feedings, etc. On top of this, your hormones are continuing to shift and many women are met with some mental health struggles in postpartum.

It is just as important for a new mom to be mentally ready for sex as it is for her to be physically ready.

When you are thinking about engaging sex again, consider what mental roadblocks you are facing. Is it hard to find time to think about anything sexual and therefore, get in the mood? Are you facing anxiety, depression or another struggle impacting your libido and mood? Is your changed body creating self-talk that is impacting your confidence?

Once you are able to identify these mental roadblocks, they are important conversations to have with yourself, a trusted friend and your partner. Working through these things not only has a positive impact on your sex life, but your life and motherhood overall.

feel like i’m not ready for sex after birth but my husband really wants it

Emotionally Ready

If we feel depleted, it can be hard for us to connect. If we feel resentment or like our needs aren’t being met, we can shut down. Being emotionally prepared for sex can mean having our cup filled and feeling safe and accepted. This could be seeking self-acceptance, acceptance from our partner, etc.

If you are feeling depleted and/or disconnected, prioritize intimacy that is not necessarily sexual, but creates space for you to be seen and feel connected. This could be intentional conversations with your partner, foreplay, body acceptance practices and self-talk, etc.

RELATED: Postpartum Emotions

Words from the Postpartum Together Community

When I asked my online community what they would like to say to a mom who is thinking about sex again after baby, here is what they had to say. May these words help you remember you’re never alone, motherhood and relationships are messy, and there’s no one “right” way or timeline for you.

  • Listen to your body and take the time you need (before and during)

  • Talk to your spouse about your insecurities and what they can do to help

  • Use lots of lube

  • Stop if you’re in pain or uncomfortable

  • Start by taking a shower and appreciating this new you

  • It’s okay to not be ready. Your body is a priority.

  • Don’t feel bad if you need to stop

  • Don’t force anything

  • Sometimes your mind is your biggest enemy. If you feel ready, try. If it’s not comfortable, stop.

  • Lots of foreplay

  • It can be scary and overwhelming

  • Talk about it. A Lot. Take it slow. Try and relax.

  • You create your own timeline

  • Your husband doesn’t care that things are in different places- he loves all of you, not parts of you.

  • Go for it if you’re ready. It can help you return to parts of yourself that you have forgotten in motherhood.

  • Speak up about what feels good and what needs to be different

  • Decide to make it more about you and have fun

  • It’s okay if you don’t want to have intercourse but do find other ways to connect with your partner

  • You are still sexy

  • Just because there is societal pressure doesn’t mean you’re ready

  • Everyone’s experience is different and that is okay

Related: Setting Boundaries After Baby

Everyone’s experience is different. 

That is okay. Your experience is valid. 

There are ways to move into intimacy and sex, but there are not timelines or guidelines you need to abide by.

Having sex after birth is different for everyone, but there are a number of things you can evaluate to help you know if you are ready, what your needs are, and how to communicate that with your partner.

FREE DOWNLOAD:
6 Questions to Help You Get Back in the Sack

(Click to download)

sex after baby hurts, i don’t know if i’m ready for sex after birth, postpartum mom wants more time before sex again
Postpartum

Your Pelvic Floor After Having a Baby

WHAT IS THE PELVIC FLOOR?


pelvic model

If you would have asked me 4 years ago what the pelvic floor is, I probably would have told you it’s the back room in a club where shady dancing happens. After my first child, I remember peeing myself a little when I was working out, and honestly, I just thought that was my forever because #motherhood.

During my second pregnancy, I started working with a trainer who specialized in pregnancy and postpartum and she started teaching me about the muscles that hold everything together. Little did I know, it is so much more than kegels.

According to the Continence Foundation of Australia, “The floor of the pelvis is made up of layers of muscle and other tissues. These layers stretch like a hammock from the tailbone at the back, to the pubic bone in front. A woman’s pelvic floor muscles support her bladder, womb (uterus) and bowel (colon). The urine tube (front passage), the vagina and the back passage all pass through the pelvic floor muscles. Your pelvic floor muscles help you to control your bladder and bowel. They also help sexual function. It is vital to keep your pelvic floor muscles strong.”

RELATED: Back in the Sack:Guide to Postpartum Sex

Supporting my bladder, womb and bowel?
Helping sexual function?
Sounds like an important part of the body.

It’s kind of a disgrace that we don’t really learn about this in sex ed. Or anatomy. Or the OB office or… anywhere unless we actively seek it out.

BODY CHANGES IN PREGNANCY AND BIRTH

During pregnancy and childbirth, a baby is bearing down on your pelvis which impacts the tissue and muscles. Whether you deliver vaginally or have a cesarean birth, you experience a change. This function is also closely tied to your abdomen which often experiences separation during pregnancy and postpartum, adding to issues such as incontinence. As you carry and deliver a baby, there are a number of shifts- these shifts cause the muscles and tissue to adapt through the changes.

RELATED: Where We Learn About Postpartum

woman prepares pelvic floor by kegels

WHEN DO YOU NEED PELVIC FLOOR THERAPY?

If you’re experiencing painful sex, a heavy weight feeling in your pelvic area, or are experiencing urinary or bowel incontinence, it’s a good idea to seek out physical or occupational therapy. If you’re feeling out of touch with your body after giving birth, you may benefit from pelvic floor PT. Many professionals recommend that all mothers get some level of PT after giving birth, regardless of red flags, because of all of the changes and impact on that area during pregnancy and childbirth. In countries such as France, this therapy is standard care after birth for every mother. While many women are thinking about weight loss and outward appearance after baby, there is much more and by actually addressing the internal, you set yourself up for a stronger, connected body.

ARE KEGELS ENOUGH TO FIX MY PELVIC FLOOR?

The pelvic floor is so much more than kegels. I’ve been doing kegels for as long as I can remember and when I went to PT, she told me I needed to RELAX my pelvic muscles. Everything was holding tension and not being able to relax my floor muscles was contributing to painful sex and bladder issues. Come to find out, I hold stress in my shoulders, hips and my pelvic floor. Kegels can be a great part of strengthening and healing IF that is what you need. Seeing a pelvic floor therapist allows them to examine your muscles and tissue and give you insight as to what will help it best function.

After seeing my therapist for 3 months, I “graduated” with exercises to do at home and then started using the Perefit Kegel exerciser to gamify my exercises- it helps you to both contract and relax the muscles and helps you to build endurance. And honestly, kegels are more fun when you’re collecting stars.

Are you looking for a virtual way to learn about proper postpartum exercise? Check out the 6 week course from Strong Body Strong Mama Fourth Trimester Restore (and tell her Chelsea sent you!)

WHAT DO THEY DO IN PELVIC FLOOR THERAPY?

Does the idea of having someone “evaluate” and help you “repair” that whole area, “down there” feel a little intimidating? I know. But let’s face it, if you’ve given birth you’ve already had someone else “down there” so giving it attention to improve its function doesn’t have to be scary.

There are different approaches to pelvic floor therapy. To get an accurate understanding of your function and needs, your therapist will most likely want to do an internal exam. (If you’re uncomfortable with this, there are ways to talk about your pain/function and provide ideas without an internal exam, however your assessment may not be as accurate and therefore your treatment may not be as effective.)

BIOFEEDBACK

Some pelvic floor therapists use biofeedback to gauge your function. With biofeedback, sensors and a computer monitor are used to show muscle activity and allows you to see what areas need attention.

DRY NEEDLING

Dry needling is a method of relieving tension that involves inserting a thin needle into the muscle tissue.

MANUAL MANIPULATION

Similar to dry needling, manual manipulation targets the release of muscle tissue but the therapist will use hands or another tool as opposed to needles.

STRENGTHENING EXERCISES

Your therapist will teach you exercises you can do in your therapy as well as at home to exercise your pelvic floor. This may emphasize contraction strengthening and endurance or relaxation of the pelvic floor muscles (or a combination.) While I highly recommend seeing a therapist who can help you with an individualized plan, you can also find resources online. Please find exercises from someone specifically trained in prenatal and postpartum care such as Strong Body Strong Mama.

CHAT WITH A PELVIC FLOOR EXPERT

Sarah from Pelvic Floor and More answers questions just like yours so that moms can understand their pelvic floor and be empowered to take care of it- from understanding to advocacy to practice. Listen in and learn- because you deserve to!

ARE YOU CURRENTLY PREGNANT AND NEED TO MAKE YOUR POSTPARTUM PLAN SO THAT YOU’RE PREPARED FOR THINGS LIKE THE PELVIC FLOOR AND MORE? GRAB MY FREE POSTPARTUM PLAN CHECKLIST TO GET YOU READY!


pelvic floor after baby pinterest.png

RELATED: What You Shouldn’t Say to New Moms

Providing free content is a priority at Postpartum Together. This page may contain affiliate links which means, at no additional cost to you, we may receive a commission for your purchase. Don’t worry, we only promote things we believe in because we love you!