6 Week Check for Baby and Mama
We go through a lot when we are pregnant and when we give birth. Having the right advice and support in terms of who we see and what we should do really helps to expedite or otherwise our recovery. In this article, Rosie Dumbrell, founder of Lenny Rose Active, has put together a summary of what to expect and also her recommendations on who to see to really help with your recovery as well.
This check is typically focused on some physical checks for you. So that might be conducted by your GP or your obstetrician or your midwife in terms of just general health and wellbeing.
Wound Care, Pelvic Floor Muscle Assessment and Abdominal Separation
So in terms of what to expect, you will be looking at any wound care, whether or not you had stitches from a vaginal delivery or if you've got a caesarean section that you're recovering from. They ask you about blood loss. It's quite common to still be having some blood loss leading up to the six weeks, but it should be resolving by around then. It's something to definitely be checking with your health care provider if you're still experiencing significant blood loss or it's not starting to taper off by about six weeks.
You might want to bring up any worries about infection. Mention if you've got redness, swelling, pain that is persistent. If you've got a temperature, just feeling a little bit off, things like that. If you've got a strange odour, those can all be signs that you definitely need to have your wounds checked. And I certainly wouldn't wait until the six weeks if you're getting any of those symptoms, immediately go and see your health care provider for sure.
It’s also very important to ensure you're getting a thorough pelvic floor assessment in terms of its functionality. So the strength and endurance and the overall tone of the pelvic floor should be assessed at that six week mark. You're probably not going to get that from your GP - a women’s health physio is the best place to start.
They'll be looking at your abdominal separation or diastasis which in most women will still be present at six weeks. But for around 60 percent of women, it will spontaneously heal by about eight weeks. That's also something that a women's health physio is probably more adept at assessing as well and giving adequate rehab advice as well.
Mental Health, Breast Health and Blood Checks
In assessing your mental health, there will be some questionnaires that you’re asked to fill out, and these should all be things that are already underway before the six week mark. Your maternal health nurse will usually have started this process earlier on and flagged any need for referral. They're really great in helping with a mother's emotional and physical well-being and chatting to you about that. So if you're on the fence about maternal health visits, certainly at least in those early weeks and months, they can be a really good way to keep your own physical and mental health in check as well.
Sometimes the advice can be a little bit antiquated, so it can be best to take things with a grain of salt, but it is a really great way to make sure your wellness is not slipping through the cracks in terms of making sure your own mental and emotional health is on track.
They might ask you also about your breast health, if you've got any issues like mastitis, and if that's something that's sort of an issue for you or recurring. That's something to talk to them about as well.
It’s also a really good time to have some blood checks. It's a great time to check, particularly for iron, thyroid and some other key hormonal and vitamin levels to help ensure that we're on the right track to recovery as well. Particularly if you had a lot of blood loss or a caesarean section, you do tend to lose a decent amount of blood. So it's really great to check those at that six week check too.
Cervical Screen, Continence, Constipation and Third Degree Tears or Greater
They should also bring up the cervical screen. There’s a new program rolled out in Australia, where they only screen once every five years now as opposed to the previous every two years, which is great. And if you need to have that done, that's a good time to knock it over as well..
It would also be good to discuss continence. We know that 50 percent of women who are first time moms in pregnancy have experienced stress and urinary incontinence. Up to 85 percent of women who have birthed multiple times have had urinary leakage in pregnancy. And we're often told that this will clear up after having a baby. But evidence doesn't support this.
It is not normal to have ongoing incontinence after having a baby, whether that’s urinary or fecal incontinence. It is very common, however, but it is not normal. It's not something that you need to put up with.
And some research suggests that if you've had some degree of incontinence, around forty four percent of those women will still have some degree of incontinence 5 - 7 years after delivery. And then if you're incontinent at 12 weeks after having a baby, 92 percent of women who are incontinent at 12 weeks remain so at five years later.
It's really, really important to get on top of it early and discuss it with your healthcare provider. This is where the women's health angels come in. This is also why women's health physiotherapists should be part of our normal practice to have a women's health referral postpartum. (C’mon Australia!)
Another really big impact on the pelvic floor is if we have constipation, especially if we're chronically constipated and having to strain to go to the toilet. They might ask you about that, but there are a lot of things that will impact our bowel movements in the postpartum period.
It’s about making sure that we are eating more fiber. We can have a fiber supplement if we need to, drinking plenty of water and breastfeeding. We really want to be on top of our fluid intake as much as possible, and that's definitely going to help with our bowel movements too.
The other thing is making sure that you're not straining on the toilet, and putting a foot stool under your feet or leaning slightly forward, and then letting your bowel movements happen rather than forcing them. You've got to let yourself have the time to do that. Pushing and straining to the toilet is only going to make the situation worse. So that's also something you can talk to your woman's health care provider about when you go to have that 6 week check.
If you've had a 3rd degree tear or greater, you should automatically have a women's health referral at least to the public health system. You tend to get much more follow up with a 3rd degree tear, but some second degree tears can be problematic/ symptomatic and require referral as well, so don’t let this get missed.
When the pelvic floor is torn, right to the edge of the anus that goes through, it's called 4th degree tear, and that's when you're more likely to have anal incontinence as well or fecal incontinence. So it is quite common to talk about urinary incontinence, but fecal incontinence can be an issue as well.
Birth Trauma, Sexual Intercourse and Contraception
If you've had any birth trauma or if anything sort of happened that you weren't comfortable with or you've got questions about the way things happened in birth, or you're feeling a bit down, your mood’s not great, then this is definitely the time to be chatting about it and getting on top of it early. A debrief about the birth is really, really important. And you can get a referral for psychological help if you need it, and you can get that partially funded provided by Medicare, up to 6 visits so ask your GP.
So sometimes GPs don't have a lot of time. If you're lucky, they do, but sometimes their appointment schedules are really, really back to back and they might not have time to sit there in that moment and listen to all of your worries and needs. And so asking them about a referral, if they don't have the time and make sure you are getting someone to chat to and to help yourself feel heard and listened to, respected and supported is really very important.
You’ll also be talking about whether or not you've got the all clear to get back into sexual intercourse. And we think six weeks is that sort of magic time where infection risk is low and basic tissue healing has occured. So sex isn't going to be painful. But for a lot of women, it's just absolutely not in the realm of what they came to do at six weeks. If you are given the all clear, don’t think that it's something that you need to get straight back into. And for a lot of women, it might take months or even over a year to feel like that's what they're ready for. So there’s no normal. Especially if you've got significant trauma, it might not be that six weeks is the green light. With trauma, you're probably not interested at that point anyway. If you have persistent pain with intercourse (not fixed by a slathering of lubricant- see your women’s health physio :)
And then contraception, a biggie and one that you really should be thinking about, even if you are exclusively breastfeeding. Whilst breastfeeding exclusively in the absence of ovulation is a good contraceptive, it's not foolproof. If you're not sure if you're ovulating again and if you are stretching out longer than six hours between feeds then it means your cycle is more likely to kick back to its regular rhythm. Chatting about what your options are is definitely important. It’s about making sure you've got a plan in place from six weeks onwards.
Women’s Health Physio
Women's health physio specialises in pelvic floor. They specialize in the pelvis and all of the woman's form and particularly the pre and post natal changes that happen to your body through the pregnancy to motherhood journey.
It is highly recommended that you make a relationship with the woman’s health physio during your pregnancy, because they can give you great tips to help get strong for birth and prepare your pelvic floor prior to having a baby. This is so you've got a really good base to start with, back after having a baby as well. So if you haven't already made that relationship in pregnancy, the second trimester is a really great time to see a women's health physio, and especially if you are in that group that are experiencing incontinence. But even if you're not,it’s also a great way to prevent it.
Women's health physiotherapists think it should be part of our normal normal practice to have a women's health referral. And ideally, it will be government funded or rebated, at least. If we look at France, they get six women's health physio visits covered and we're just really behind the eight ball in terms of that in Australia.
Cost is often a prohibitor for women to go and see a healthcare professional. So something you can chat to your GP about is something called a specific Medicare benefits scheme where you can get up to 6 visits rebated by Medicare for an allied health professional with a GP referral.
So sometimes that might be for psychology. So, again, if you need some help in terms of struggling your mood after having a baby, you can get rebated psychology appointments through that. You can get rebated women's health physio appointments through that, whoever falls under that allied health banner. So really make sure that if cost is a prohibitor for you to get these assessments done about this program where you can get a lot of the cost covered by Medicare.
In terms of bub, the 6 week check is also about checking up on your beautiful growing infant. In Australia, we have a maternal health care program which is managed by the local council, and every baby is followed up by their local council to have a visit in the home.
And then you have a set schedule of follow up appointments to check on both the baby and you, so that's usually in the first couple of days when you come home. And then there will be a two, four or an eight week checkup. They get a little bit less frequent as the baby grows, but sometimes it may not justify how you're tracking with everything. So make sure you follow that up. If somehow you've been through the system, that's really, really key.
The things that they'll be checking with the baby's development is basically just follow up on the checks that were done at birth. They're around the weight, height, and the head circumference. The basic developmental milestones in six weeks is to be able to track and to follow an object by making some basic little noises, are they feeding well, and they will also check if you have had that six week vaccination yet, or chat to you about necessary vaccinations at that point in time.
They'll be checking or chatting to you about hearing and if you have any other concerns. The hearing tests are done in the hospital, of course. But if for whatever reason, you didn't have a hospital birth or you couldn’t go to the hospital after having a birth, then hearing checks are something to follow up with the maternal health nurse as well. They will have some great recommendations for you.
They will be checking the hips to check for any abnormal clicking or excursion of the hip joint or other gluteal folds even. They will refer you for hip ultrasound automatically. And it's usually best to wait till about eight weeks because you have a too soon and you often have to have a repeat one because it's not they sometimes might not be able to pick up any issues by six weeks.
They’ll also be checking the heart and its rhythm. For the boys, checking if the testicles just descended. For checking a little girl, checking any signs of swelling, blood discharge or anything that's abnormal that's still occurring at this point in time.
Milk spots are really common, so they might ask you about that or check your baby’s skin. This is not to do with how well you're washing your baby's face, but it's more to do with hormones still coming from the mum. It’s rather normal. And they do usually start to resolve about that six week mark.
The 6 week check has a lot to do with you and your bub. Make sure that equal care is given to both. You are the first line of defense for everything, so you need to be in good shape as well. Make sure that you're definitely not skipping out on your 6 week check up and you are asking for those appropriate referrals. You need to be getting on top of things early so that you'll recover faster and have a more pleasant experience.
You do deserve to be in the best health that you can be. You can be the best version of you for your kids and your family and for whatever else it is that you want to do as a woman.
For more information and tips on how to navigate the postpartum journey, you can check out more blogs on our website www.lennyroseactive.com.au too. If you are interested in what breastfeeding activewear you need as new mama, see: