MoonDragon's Pregnancy Information
4 TO 6 WEEKS POSTPARTUM VISIT
(Instruction For Midwives)
For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.
The timing of this visit depends on the mother's rate of recuperation. If her flow ceased at least a week prior to contacting the midwife, the midwife can assume her uterus is well involuted, her cervix firmed up, and that she is ready for her final checkup.
But if the mother had stitches, scheduling this checkup also depends on the condition of her perineum. If she is willing, ask her to wash her hands and gently insert her fingers to see if the area is sensitive to pressure; if so, she probably is not ready for sexual intercourse or barrier method contraceptive fittings.
Nevertheless, wait no longer than six weeks to see her, for if adequate healing has not taken place by this time, the midwife must determine the reason. Perhaps the mother had deep second degree tears. These can take a while to heal, but if her lochia flow has stopped and she is feeling fine, the midwife should have no worries.
- MoonDragon's Contraception Information: Cervical Cap
- MoonDragon's Contraception Information: Diaphragm
Sometimes emotional conditions precipitate scheduling this visit sooner than later. For example, if a woman calls at four weeks to report feeling severely depressed or emotionally incapacitated, she should be seen at once, even though her physical recovery may still be weeks away.
One important reason for this checkup is to give the mother the OK for sexual relations with her partner, along with suggestions on how to make the first occasion as pleasurable as possible. Recommend that she use plenty of lubrication, as breastfeeding will cause dryness and fragility of her tissues no matter how intense her desire. The midwife can also raise the issue of birth control for heterosexual women. Although rare, ovulation can occur as early as six weeks after a woman has given birth. It has been known that a few nursing mothers (giving no formula or anything else to the baby) have conceived in the first two months postpartum. It would be wise to recommend to the parents that if they are to resume sexual relations before considering future contraception, that using condoms is a choice available to them.
Things to check at the final exam include:
1. The Uterus.
It should be out of range of palpation, except by bimanual exam. If it is enlarged, she is probably still bleeding, and her cervix will feel soft by bimanual exam. All of these are signs of poor recovery. Pale discharge, or lochia alba, is all that should be present at this time. Prescribe rest, long relaxed nursing sessions to allow oxytocin to do its work, optimal nutrition, supplements as indicated, and involuting tea or tincture of Black Haw and Shepherd's Purse.
2. The Cervix.
It should feel firm, closed, and situated high in the vaginal vault as with initial pelvic assessment. However, some women do not regain their pre-pregnant cervical tone until they either stop or cut back significantly on breastfeeding, e.g., when solid foods are introduced to the baby.
3. Internal Muscle Tone.
This should almost be back to normal by now if the woman has been doing vaginal exercises (kegels). If not, explain the importance of using the pelvic floor muscles for maintaining the uterus in its proper position, as well as revitalizing sexual desire and sensitivity. Check for tone high in the vaginal vault and just inside the vaginal opening. Often a woman has good tone in one area but little in the other.
4. Lacerations or Episiotomy, For Complete Healing.
If the woman sustained labial skin splits, they may still be somewhat tender as newly formed skin takes time to toughen up. This may cause some discomfort with sex, but adequate lubrication and creative positioning can help.
If the perineum feels rigid with scar tissue, encourage the woman to do perineal massage using Evening Primrose Oil to soften the area, and to prepare for intercourse. This practice can be emotionally and physically reassuring for any woman nervous about having sex again.
5. The Abdominal Muscle Tone.
Have the woman lie down, then lift just her head and shoulders as you place fingertips along the juncture of abdominal muscles running from the umbilicus to the pubic bone. If there is any gaping, suggest simple abdominal exercises, starting with single leg lifts progressing slowly to full sit-ups (with knees bent). Most women have about half an inch separation in their abdominals, while others have very little. The mother may be referred to a postpartum exercise group or yoga class, if such are available, or suggest she meet informally with several other new mothers for exercise interspersed with baby massage and conversation.
6. The Breasts, For Tenderness or Lumps.
It is said that the hormones of pregnancy tend to accelerate abnormal cell growth if any is pre-existing. Even if the mother has seen a health care practitioner since the birth she may not have had a thorough breast exam, so the midwife should do this herself. This is also a good time to review self-breast exam techniques with her.
7. The Cervix, by Pap Smear.
For reasons stated above, do a repeat Pap even if the mother was screened in early pregnancy.
8. The Hemoglobin or Hematocrit.
This is especially crucial to check for anemia if the mother appears weak or exhausted, or if she has history of hemorrhage either with delivery or during the postpartum period.
9. The Diet.
It is common for a new mother to forget her own needs once pregnancy is over and she becomes completely focused on the baby. Often, she finds she has no time to cook, and hardly any time to eat. This may prompt her partner to take over food preparation, though perhaps not methodically enough to meet the breastfeeding mother's nutritional requirements. If she complains of chronic fatigue, nervous irritability, or upper respiratory infection, prescribe more Protein, more calories, good sources of Vitamin Bs and Vitamin C, and Trace Mineral supplements. If her hematocrit is less than 37 or hemoglobin below 12 (non-pregnant standards), treat her for anemia with nutritional recommendations, herbal tinctures or teas, and supplements. If she is breastfeeding her baby, she should continue with her pregnancy diet plus 200 extra calories (preferably from a protein source).
MoonDragon's Nutrition Information Index
Nutrition guidelines and recommendations, diets, food analysis, supplements, recipes, and other helpful information for pregnant and lactating women.
10. Adjustment To Parenting.
This is a broad category of evaluation, but a few well-chosen questions will reveal any disturbing trends. Ask the mother how well she has been sleeping, how she and her partner are getting along, and how she is coping with the frustrations of mothering. It is wise to have the mother's partner present as you discuss these important issues, unless there is a reason to believe that the mother needs privacy to express herself candidly.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER
You or your family member has questions about postpartum care. You or a family member develops any unexpected and/or unusual symptoms or problems.
POSTPARTUM CARE INFORMATION
Postpartum Care: Index Postpartum Care: Weight Postpartum Care: Diet Postpartum Care: Bowel Movements & Urination Postpartum Care: Bathing Postpartum Care: Breasts & Breastfeeding Postpartum Care: Perineal Care Postpartum Care: Vaginal Bleeding (Lochia) & Menstruation Postpartum Care: Exercise & Back Care Postpartum Care: Sexual Intercourse Postpartum Care: Contraception
PostPartum Visit: Day One PostPartum Visit: Day Three PostPartum Visit: Day Seven PostPartum Visit: 4 to 6 Week Visit
Baby Care & Concerns Fatigue & Exhaustion Postpartum Depression (The "Baby Blues")
MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
MoonDragon's Pregnancy Index
MoonDragon's Womens Pregnancy Health Information Index
MoonDragon's Pediatric Information Index
MoonDragon's Parenting Information Index
MoonDragon's Nutrition Information Index
QUALITY SUPPLIES & PRODUCTS
POSTPARTUM NUTRITIONAL SUPPLEMENTS & PRODUCTS
Supplements and products for postpartum women (mothers of newborn babies) to help with depression, a mood disorder that is often triggered by a hormonal fluctuations, chemical imbalance or stressful situations. Supplement recommended are to help regain strength following childbirth and optimal health, assist in balancing hormones, and correct nutritional deficiencies. Consult with your midwife or health care provider if you are taking medications for depression. Some supplements are contraindicated with certain medications.
POSTPARTUM SUPPLEMENT PRODUCTS
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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