Your six-week postnatal check

Your body after childbirth

The postnatal check

Physical problems

Pelvic floor exercises

Deep stomach exercises

Easing back pain

Deep vein thrombosis

The baby blues

Postnatal depression

Puerperal psychosis

Postnatal post-traumatic stress disorder (PTSD)

Having sex after childbirth

Contraception

Healthy diet and fitness for new mums

Healthy time-saving tips for new parents

Breastfeeding and diet

Physical activity

When can I start exercising?

What should I be aware of before exercising?

How do I know if I’m overdoing it?

Quitting smoking for you and your family

Getting help for postnatal depression

Treatment

Avoiding alcohol

Postnatal check

You should have your postnatal check about six weeks after your baby’s birth to make sure that you feel well and are recovering properly.

You may be offered an appointment to go back to the hospital where you gave birth, but otherwise you should see your doctor. It's time to introduce your baby to your doctor as the new member of the family.

It's also a good opportunity to ask any questions and sort out any problems you may have. You may want to make a list of questions to take along with you so that you don't forget what you want to ask.

You can also ask the doctor about contraception. You may wish to choose a different method from the one you previously used, especially if your pregnancy was not planned. The doctor or nurse can help you decide which method is right for you now.

What usually happens at your postnatal check:

you will be weighed and can get weight loss advice if you need it
your urine will be tested to make sure your kidneys are working properly and that you haven't got an infection
your blood pressure will be checked
you may be offered an examination to see if your stitches have healed (if you had any), and that all the muscles used during labour and delivery are returning to normal
your breasts probably won't be examined unless you have a particular concern about them
your doctor may discuss carrying out a cervical screening test (smear test) with you if you have not had one in the past three years – the test won't usually take place until three months after delivery
if you are not immune to rubella (German measles) and were not given an immunisation before you left hospital, you will be offered one now – you should avoid becoming pregnant for one month after this immunisation
you will be asked if you still have any vaginal discharge and whether you have had a period since the birth

Tell your doctor if:

you are having trouble holding urine or wind, or you are soiling yourself
having sex is painful
you are feeling very tired, low or depressed
you are worried about anything

Having a baby changes your body. You may not like the changes, or you may enjoy feeling different and feeling like a mother. If you’re happy the way you are, that's great.

If you feel uncomfortable with your body, though, you might want to make some changes. Some things will never be quite the same again. For example, your stretch marks will fade but will never go away completely. But other changes don't need to be permanent. You can tighten a saggy tummy with exercise, and any weight you've gained will gradually drop off if you eat sensibly and exercise. It won't happen overnight. It took nine months to make a baby and it could take at least that long to get back into shape again.

In the meantime, give your body some little treats to cheer you up. It could be something as simple as painting your toenails. If it makes you feel good, then taking time to do it might be more important to you than getting 20 minutes extra sleep.

You’ll be very busy looking after your baby, but remember to go for your postnatal check with your GP at around six to eight weeks after the birth.

It's a time to talk to your GP about any health problems you’ve had since the birth, such as perinatal pain or pain following episiotomy, backache, piles or incontinence.

It’s also a chance to talk about how you’re feeling and to discuss family planning. You can get pregnant again within three weeks of giving birth so it’s important to sort out your contraception before you start having sex again. See Sex and contraception for more information.

A lot of women experience physical problems as a result of labour and birth or because of the kind of work involved in caring for young children. Problems such as recurring infections, back pain, a leaky bladder and painful intercourse are more common than people may think.

For some problems, you can do a lot to help yourself. For example, if you’re suffering from a leaky bladder or getting that ‘falling out’ feeling, you may need to strengthen the muscles around your bladder, vagina and back passage (perineum). Pelvic floor exercises can help. A bad back can also be helped by exercise and by learning to use your back carefully.

If something’s really bothering you, don’t be afraid to ask for help. Your doctor may be able to suggest treatment or refer you to a specialist or an obstetric physiotherapist, who can help with back and bladder problems and painful stitches.

Pelvic floor exercises strengthen these muscles, which can help to stop incontinence, and make sex better too. You can do this exercise either sitting or standing. It can be done anywhere and at any time. For example, when you’re washing up, queuing in the supermarket or watching TV.

Squeeze and draw in your back passage at the same time. Close up and draw your vagina (front passage) upwards.
Do it quickly, tightening and releasing the muscles immediately.
Then do it slowly, holding the contractions for as long as you can (but not more than 10 seconds) before you relax.
Repeat each exercise 10 times, four to six times a day.

You may find it helps to imagine you’re stopping a bowel movement, holding in a tampon or stopping yourself passing water. In fact, the best way to find the muscles is to try stopping and starting (or slowing down) the flow of urine while you’re on the toilet.

This exercise will help to firm your stomach:

Lie on your side with your knees slightly bent.
Let your tummy sag and breathe in gently.
As you breathe out, gently draw in the lower part of your stomach like a corset, narrowing your waistline.
Squeeze your pelvic floor at the same time.
Hold for a count of 10 then gently release.
Repeat 10 times.

The following tips will help relieve an aching back:

While feeding, always sit with your back well supported and straight. Place a pillow or cushion behind your waist.
Kneel or squat to do low-level jobs, such as bathing your baby or picking things up off the floor. Avoid bending your back.
Make your knees work instead. Change nappies on a waist-level surface or while kneeling on the floor.
To lift heavy objects, such as a carrycot or an older child, bend your knees, keep your back straight and hold the object close to your body. Make your thigh muscles work as you lift.
Keep a straight back when you push a pram or buggy. Alternatively, carry your baby in a sling.

Deep vein thrombosis (DVT) is a serious condition where clots develop in the deep veins of the legs. It can be fatal if the clot travels from the legs to the lungs.

Flights that last over five hours, where you sit still for a long time, may increase your risk of DVT. Pregnant women and women who have recently had a baby are among those who are more at risk, so if you intend to travel by air, it's important to consult your GP or health visitor before the trip. They can give you advice on in-seat exercises to keep your circulation moving.

If you develop swollen, painful legs or have breathing difficulties after a trip, see a GP urgently or go to the nearest Accident and Emergency department.

Feeling depressed after childbirth

During the first week after childbirth, many women get what's often called the ‘baby blues’. This is probably due to the sudden hormonal and chemical changes that take place in your body after childbirth.

Symptoms can include:

feeling emotional and irrational
bursting into tears for no apparent reason
feeling irritable or touchy
feeling depressed or anxious

All these symptoms are normal and usually only last for a few days.

Depression after a baby is born can be extremely distressing. Postnatal depression is thought to affect around one in 10 women (and up to four in 10 teenage mothers).

Many women suffer in silence. Their friends, relatives and health professionals don't know how they're feeling.

Postnatal depression usually occurs two to eight weeks after the birth, though sometimes it can happen up to a year after the baby is born.

Symptoms such as tiredness, irritability or poor appetite are normal if you've just had a baby. But these are usually mild and don't stop you leading a normal life.

When you have postnatal depression, you may feel increasingly depressed and despondent. Looking after yourself or your baby may become too much. Other signs of postnatal depression are:

anxiety
panic attacks
sleeplessness
extreme tiredness
aches and pains
feeling generally unwell
memory loss or being unable to concentrate
feelings of not being able to cope
not being able to stop crying
loss of appetite
feelings of hopelessness
not being able to enjoy anything
loss of interest in the baby
excessive anxiety about the baby

If you think you have postnatal depression, don’t struggle alone. It's not a sign that you're a bad mother or are unable to cope. Postnatal depression is an illness and you need to get help, just as you would if you had the flu or a broken leg.

Talk to someone you trust, such as your partner or a friend. Then contact your doctor to ask for advice.

Milder cases of postnatal depression can be treated with counselling. More severe cases often require antidepressants and you may need to see a specialist.

It's important to let your doctor know if you're breastfeeding. If you need to take antidepressants, they'll prescribe a type of medication that's suitable while you're breastfeeding.

Alcohol may appear to help you relax and unwind. In fact, it’s a depressant that affects your mood, judgement, self-control and co-ordination. It has even more of an effect if you’re tired and run-down. Be careful about when and how much you drink, and don't drink alcohol if you're taking anti-depressants or tranquillisers.

This condition is extremely rare. Only 1 or 2 mothers in 1,000 develop a severe psychiatric illness that requires medical or hospital treatment after the birth of a baby. This illness can develop within hours of childbirth and is very serious, needing urgent attention.

Other people usually notice it first as the mother often acts strangely. It is more likely to happen if you have a severe mental illness, a past history of severe mental illness or a family history of perinatal mental illness. Specialist mother and baby units can provide expert treatment without separating you from your baby.

Most women make a complete recovery, although this may take a few weeks or months.

Postnatal post-traumatic stress disorder (PTSD) is often the result of a traumatic birth, such as a very long or painful labour, or an emergency or problematic delivery. It can also develop after other types of trauma, such as:

a fear of dying or your baby dying
life-threatening situations

The symptoms of postnatal PTSD can occur alone or in addition to the symptoms of postnatal depression.

The symptoms of PTSD include:

nightmares
flashbacks
panic attacks
sleeping problems
lack of emotions
severe irritability or anger

The symptoms can develop straight after the birth or months afterwards.

It's very important to talk to someone about how you're feeling. Your doctor will be able help you. If you're worried about talking to a health professional, consider asking a close friend or family member to come with you for support.

Sex and contraception

There are no rules about when to start having sex again after you've given birth. Immediately after the baby is born, many women feel sore as well as tired. Don’t rush into it. If sex hurts, it won’t be pleasurable. The first time, you may want to use a lubricating jelly (available from pharmacies) because hormone changes can make your vagina feel drier than usual.

You may be worried about the state of your body or about getting pregnant again. Men can have problems too. Apart from tiredness, a father’s sexual feelings will probably be much the same as before his baby’s birth. But many men worry about what’s right for their partner. They're unsure what to do and they feel worried and frustrated.

It might be some time before you want to have sex. Until then, both of you may feel happier being loving and close in other ways.

The following suggestions may help:

If penetration hurts, say so. It’s not pleasant to have sex if it causes pain. If you pretend everything's all right when it isn’t, you may start to see sex as a nuisance or unpleasant rather than a pleasure, which won’t help either of you.
Be careful the first few times you have sex. Explore with your own fingers first to reassure yourself that it won’t hurt. Use plenty of extra lubrication, such as lubricating jelly. Hormonal changes after childbirth may mean that you won't be as lubricated as usual.
Make time to relax together. There’s little point trying to make love when your minds are on other things and not on each other.
Take your time. If you still experience pain two months or so after the birth, talk to your doctor. You can get treatment for a painful episiotomy scar. Ask to see an obstetric physiotherapist.

You can get pregnant as little as three weeks after the birth of a baby, even if you’re breastfeeding and your periods haven’t started again.

Use some kind of contraception every time you have sex after giving birth, including the first time (unless you want to get pregnant again). You’ll usually have an opportunity to discuss the options before you leave hospital after your child’s birth and at the postnatal check.

Sleep and tiredness

Getting enough sleep

Most of the time, parents put up with tiredness. But if you’re feeling low, bad tempered and unable to cope or enjoy things, you need to find a way of getting more sleep, or at least more rest. Here are some tips:

Go to bed really early for, say, one week. If you can’t sleep when you go to bed, do something relaxing for half an hour beforehand, such as soaking in the bath.
Try deep relaxation. As little as five to 10 minutes’ deep relaxation can refresh you. You can learn relaxation techniques online, or go to the library for books or DVDs.
Sleep when your baby sleeps. Rest when your child has a daytime rest or when they’re at playgroup or nursery school. You could ask a relative or friend to take your child for a while and spend the time sleeping (not doing housework). Take turns with other parents to look after the children in order to give yourself time to rest. Set an alarm if you’re worried about sleeping too long.
If you can, share the responsibility of getting up in the night with your partner. Take alternate nights or weeks. If you’re on your own, a friend or relative may be prepared to have your children overnight occasionally.
Don’t let stress get on top of you. Tiredness is often a sign of stress. If you can do something about the stress, you might find it easier to cope, even if you can’t get any more sleep.

If you can’t sleep at night even when your baby is sleeping, it could be a sign of postnatal depression.

Being a parent is exhausting. It's easy to find that you have no time or energy to cook or eat properly. But eating well doesn't need to take lots of time or effort.

Try to make eating well a priority. It will make you feel better, and healthy eating is important for the whole family. Eat a healthy, well-balanced diet that includes at least five portions of fruit and vegetables a day.

If you think you need to lose weight, talk to your doctor. Cut down on fat and sugar, but don’t go on a crash diet. Regular small meals will keep up your energy without adding to your weight.

Try cooking more than you need and freeze a couple of extra portions for another day.

Tinned and frozen fruit and vegetables are quick to prepare and they count towards your five portions a day. Choose vegetables that can be eaten raw – for example, carrots and celery - and snack on these between meals if you get peckish. Remember, steaming is a healthy and quick way to cook vegetables, meat and fish.

If friends or family are keen to help, take up their offer of a healthy home-cooked dinner once in a while.

If you're breastfeeding and you’re a healthy weight for your height, you don't need to eat a special diet. Eat a healthy, well-balanced diet, drink plenty of fluids (ideally water) and get lots of rest.

If you're breastfeeding and you're overweight, the best way to lose weight healthily is by eating a healthy, well-balanced diet and taking regular moderate exercise (such as a brisk walk for 30 minutes every other day). This won't affect the quality or quantity of your milk.

When you’re feeling tired, being active or taking more exercise may seem like the last thing you need. But activity can relax you; it can help your body recover after childbirth, keep you fit or improve your fitness, and make you feel better and more energetic. The following suggestions may help:

Keep up your postnatal exercises. They’ll strengthen vital muscles and improve your shape.
Join a postnatal exercise class. It may help to be with other new mums. Many postnatal classes let you do the exercise class with your baby at the side of the room. Some exercise classes sometimes allow the baby and buggy in as part of the workout. Ask your health visitor if she knows of any in your area. If you’re going to a class that isn't a special postnatal class, tell the person running the class if you’ve had a baby in the last few months. You’ll need to take special care of your back and avoid exercises that could damage it.
Push the pram or buggy briskly, remembering to keep your back straight. Walking is great exercise, so try to get out as much as you can.
Play energetic games with older children. You can exercise by running about with them. Find outdoor space if there’s no space at home.
Run upstairs. You probably go up and down the stairs several times a day, so think of it as good exercise!
Squat down to pick things up from the floor. Hold heavy objects close to your body. This is also something you’re likely to be doing a lot. If you squat rather than stooping, with your knees bent and your back straight, you’ll strengthen your thigh muscles and avoid damaging your back.
When your lochia (postnatal bleeding) has stopped, you can try swimming. Swimming is good exercise and it's relaxing too. If you take your child with you, try to have someone else there too so that you get a chance to swim.
Borrow or buy an exercise DVD. This is a good way to work out at home. You could get a friend or your children to join in.

It's a good idea to wait until after your six-week postnatal check before you start to exercise regularly again. If you exercised regularly before giving birth and you feel fit and well, you might be able to start earlier. Talk to your doctor.

If you had a caesarean delivery, your recovery time will be longer, so talk to your doctor before starting anything too strenuous.

Your lower back and core abdominal muscles are weaker than they used to be. Your ligaments and joints are also more supple and pliable, so it's easier to injure yourself by stretching or twisting too much.
Don’t rely on your pre-pregnancy sports bra. Your back and cup size are likely to have changed, so get measured for a new one.

If you’re doing too much, you’ll experience extreme fatigue, feel run-down and take longer to recover from workout sessions.

If your lochia (the bleeding after birth) flows more heavily or changes colour (becomes pink or red) after activity, you could be overdoing it. Take it easy.

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Lots of people smoke because they think it calms their nerves, but this isn't the case. Smoking just calms the cravings for nicotine, the addictive substance in cigarettes. The best thing you can do for your and your family's health is to stop smoking.

The children of smokers are three times more likely to grow up to be smokers themselves.