Postnatally, I normally see my patients one week and 3 months after delivery.
At the first postnatal visit
I check the following:
Return to normal functions
Normal urinary function or bowel function.
Reducing amount and flow of lochia (vaginal bleeding due to the membranes and blood contained within the uterine cavity).
Reducing pain over the Caesarean section scar, or episiotomy repair (repair of the tears over the perineum, if any), and examination to confirm the normal healing of the scars and to check for infection.
Normal establishment of breastfeeding - if breastfeeding is still not adequate despite frequent feeding, Fenugreek or Domperidone may be used to improve the milk flow.
Postnatal Blues / Depression
Postnatal blues is a temporary condition characterized by mild, and often rapid, mood swings from elation to sadness, irritability, anxiety, decreased concentration, poor sleep, tearfulness, and crying spells. Up to 80% women develop these mood changes generally within two to three days of delivery. These usually are wost on the fifth postpartum day and resolve within two weeks. Some of the causes for this include hormonal changes after delivery (there is a change in the hormonal levels after the placenta is removed) and adjustment issues (e.g. figuring out baby's responses to hunger and toileting habits, poor sleep, adjusting to having new domestic helper, confinement nanny, having concerned family members offering help and advice, feeling that the partner is not concerned nor helping out). During this trying period, it is good for everyone to be more understanding and patient.
Postnatal depression is a more serious condition with prolonged periods of more serious depressed mood occasionally with suicidal thoughts. It may affect 5-20 % of mothers after delivery. It usually begins within 4 weeks after delivery (around 2 weeks) and may last for months to years. Risk factors for developing this include prior history of depression, prior history of postnatal depression and / or a bad birth experience. Treatment includes antidepressant medications from a psychiatrist and sharing with friends. Sometimes, postnatal depression affects fathers too. So do look out for one another!
At the second postnatal visit
The following are usually done:
Well women screening for breast lumps and a HPV test with an ultrasound scan of the pelvis.
Discussion on contraceptive options:
Total breastfeeding provides adequate contraception for most for the first 6 months.
For short term contraception up to 3 years of age, the use of condoms and oral contraceptive pills / EVRA contraceptive patches are useful. Oral contraceptive pills, while breastfeeding, may be associated with a reduced milk flow. Hence during breastfeeding, use of condoms or the use of mini-pill (progesterone only pill with no effect on breastmilk production) is ideal.
For long term contraception for 3 years or more, the use of intrauterine contraceptive device (IUCD) is useful. There are 2 types of IUCD: either the copper IUCD or Mirena IUS. The Mirena IUS is ideal for patients with heavy painful periods as it tends to reduce the pain and amount of bleeding during periods. The copper IUCD may be useful for patients with normal periods that are not too heavy or painful. Other options include 12-weekly intramuscular Depo-Provera injections and 3-yearly Implanon(R) subcutaneous implants.