Your postnatal check

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

Some GP surgeries do not routinely offer a postnatal check.

You can always request an appointment for a check, especially if you have any concerns. It's a good idea to make a list of questions to take along with you.

There are no set guidelines for what a postnatal check for mothers should involve. However, there are guidelines for your baby's 6 to 8 week check.

This check repeats your baby's newborn physical examination. You may find that your GP combines the two checks at the same appointment.

What happens at your postnatal check

The following is usually offered, though this may vary according to where you live:

  • You will be asked how you are feeling as part of a general discussion about your mental health and wellbeing.
  • You will be asked if you still have any vaginal discharge and whether you have had a period since the birth.
  • Your blood pressure will be checked if you had problems during pregnancy or immediately after the birth.
  • You may be offered an examination to see if your stitches have healed if you had an episiotomy or caesarean section.
  • If you were due for a cervical screening test while pregnant, this should be rescheduled for 12 weeks after the birth.
  • You will be asked about contraception.
  • If you are overweight or obese, with a BMI of 30 or more, you may be weighed. Your doctor should give you weight loss advice and guidance on healthy eating and physical activity.   

Tell your doctor if...

  • you are feeling sad or anxious – looking after a baby can sometimes feel overwhelming. Don't feel you have to struggle alone or put on a brave face. It's not a sign that you are a bad mother. You need to get help, as you may have postnatal depression. Your doctor or health visitor can provide help and support.
  • you are having trouble holding urine or wind, or you are soiling yourself
  • having sex is painful
  • you're not sure if you have had two doses of the MMR vaccination – if you have not had these, your practice nurse will offer them, with a gap of at least one month between doses. You should avoid becoming pregnant for one month after having the MMR vaccination.

Your post-pregnancy body

Having a baby changes your body. Some things may never be quite the same again, but other changes don't need to be permanent.

You can tighten your tummy with exercise, for example, and any weight you've gained will gradually drop off if you eat healthily 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.

Physical problems after pregnancy

Some women have physical problems after having a baby.

These can be related to pregnancy or birth, or because of the things you do while caring for young children, such as lifting and bending.

For some problems, you can do a lot to help yourself. For example, if you're experiencing a leaky bladder (incontinence) or a heavy feeling in your perineum (the area between your vagina and anus), you may need to strengthen the muscles around your bladder, vagina and anus with pelvic floor exercises.

Back pain can often be helped by exercise and learning to look after your back, too.

If something's bothering you, don't hesitate to ask your GP or health visitor for help at any time. They can advise you and refer you to a specialist if necessary.

Your postnatal check

Your postnatal check at around six to eight weeks after the birth is a good time to talk to your GP about any physical or mental health problems you've had since the birth.

See what's offered in your postnatal check

Separated stomach muscles (diastasis recti)

It's common for the two muscles that run down the middle of your stomach to separate during pregnancy. This is sometimes called diastasis recti, or divarication.

The amount of separation varies from one woman to another. It happens because your growing womb (uterus) pushes the muscles apart, making them longer and weaker.

Most women don't notice any problems as their stomach muscles separate in pregnancy. But you might notice a bulge developing down the front of your bump, above and below your belly button.

After you have had your baby, you can check the size of the separation with this simple technique:

  • Lie on your back with your legs bent and your feet flat on the floor.
  • Raise your shoulders off the floor slightly and look down at your tummy. Using the tips of your fingers, feel between the edges of the muscles, above and below your belly button. See how many fingers you can fit into the gap between your muscles.
  • Do this regularly to check that the gap is gradually decreasing.

The separation between your stomach muscles will usually go back to normal by the time your baby is eight weeks old. If the gap is still obvious at eight weeks, the muscles may still be long and weak. This can put you at risk of back problems.

Have a word with your health visitor or GP. Your GP can refer you to a physiotherapist, who will give you some specific exercises to do.

Regular pelvic floor and deep stomach muscle exercises can help to reduce the size of the separation between your stomach muscles. It's also important to stand up tall and be aware of your posture now you're no longer pregnant.

Pelvic floor muscle exercises

Pelvic floor muscle exercises strengthen the muscles around your bladder, vagina and back passage. This can help to stop incontinence, treat prolapse and make sex better, too.

You can do this exercise lying down, sitting or standing. With practise, it can be done anywhere and at any time – even while you're watching TV:

  • Squeeze and draw in your back passage as if you're holding in wind.
  • Squeeze around your vagina and bladder tube (urethra) as if you're stopping the flow of urine or squeezing during intercourse. 
  • Now relax. This is a short squeeze. Rest for a second, then repeat these squeezes until you feel the muscles get tired.  
  • After a short rest, squeeze again as above. This time, hold the squeeze for as long as you can, but no longer than 10 seconds, then relax. 
  • It's important to keep breathing normally while you do these exercises. Make sure you don't pull in your stomach or squeeze your buttocks when you squeeze.
  • Aim to build up to 10 repeats of each exercise, four to six times a day.

In the past, women were taught to practise these squeezes while having a wee. This isn't the best way to do these exercises as you may not empty your bladder completely.

Sitting on the toilet can be a good reminder to do your exercises, though. Just make sure you do them after you've finished.

Visit the Chartered Society of Physiotherapists website for more tips to strengthen your pelvic floor.

Deep stomach exercises

These exercises can help you tone up your stomach muscles:

  • lie on your side with your knees slightly bent
  • let your tummy relax 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 muscles at the same time
  • hold for a count of 10, breathing normally, then gently release
  • repeat up to 10 times

Ways to ease back pain

These practical tips may help to relieve an aching back:

  • While feeding your baby, always sit with your back well supported and straight. Put a small pillow or cushion behind your waist to support your lower back. Make sure your feet can reach the floor.
  • 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 do the work instead.
  • Change nappies on a raised surface. You could kneel on the floor next to a sofa or bed. Never leave your baby unattended on a raised surface, in case they fall off.
  • To lift heavy objects, such as a baby car seat 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. Squeeze your pelvic floor and deep stomach muscles as you prepare to lift.
  • Keep your back straight when you push your pram or buggy. Alternatively, carry your baby in a well-fitting sling. 

Feeling depressed

During the first week after childbirth, many women get what's often called the ‘baby blues’. Women can feel down or depressed at a time when they expect they should feel happy at having a baby to look after. 'Baby blues' are 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.

Is it postnatal depression?

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. Emotional signs of postnatal depression may include: 

  • loss of interest in the baby
  • feelings of hopelessness
  • not being able to stop crying
  • feelings of not being able to cope 
  • not being able to enjoy anything
  • memory loss or being unable to concentrate
  • excessive anxiety about the baby

Other signs of postnatal depression may also include:

  • panic attacks
  • sleeplessness
  • extreme tiredness
  • aches and pains
  • feeling generally unwell
  • anxiety
  • loss of appetite 

Getting help for postnatal depression

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. Or ask your health visitor to call in and visit you. Many health visitors have been trained to recognise postnatal depression and have techniques that can help. If they can't help, they'll know someone in your area who can.

It's also important to see your GP. If you don’t feel up to making an appointment, ask someone to do it for you. 

Treatment for postnatal depression

Milder cases of postnatal depression can be treated with counselling. This can be given by the health visitor or a therapist. More severe cases often require antidepressants and you may need to see a specialist.

It's important to let your GP 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.

You may also find it helpful to contact the Association for Post-Natal Illness or the National Childbirth Trust.

Your local children's centre can put you in touch with your nearest postnatal group. These groups provide contact with other new mothers and encourage mums to support each other. They offer social activities and help with parenting skills.

Avoiding alcohol

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.

Postpartum psychosis

Postpartum psychosis, which is also called puerperal psychosis, is extremely rare. Only one or two 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)

Postnatal post-traumatic stress disorder (PTSD) is often the result of a traumatic birth, such as a 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 can develop straight after the birth or months afterwards.

It's extremely important to talk to someone about how you're feeling. Your midwife, GP or health visitor 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.

There are effective treatments available, such as cognitive behavioural therapy (CBT) and medications. Read more about treatments for PTSD.

Sex and contraception

There are no rules about when to start having sex again after you've given birth.

You'll probably feel sore as well as tired after your baby is born, so don't rush into it. If sex hurts, it won't be pleasurable.

You may want to use a personal lubricant, available from pharmacies, to begin with. Hormonal changes after birth can make your vagina feel drier than usual.

You may be worried about changes to your body or getting pregnant again. Men may worry about hurting their partner.

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

If you or your partner have any worries, talk about them together. You can talk with your health visitor or GP if you need some more help.

Tips for starting sex again after birth

  • If penetration hurts, say so. If you pretend that everything's alright when it isn't, you may start to see sex as a nuisance or unpleasant, rather than a pleasure. You can still give each other pleasure without penetration – for example, by mutual masturbation.
  • Take it gently. Perhaps explore with your own fingers first to reassure yourself that sex won't hurt. You may want to use some personal lubricant. Hormonal changes after childbirth may mean you aren't as lubricated as usual.
  • Make time to relax together. You're more likely to make love when your minds are on each other rather than other things.
  • Get help if you need it. If you're still experiencing pain when you have your postnatal check, talk to your GP.

Contraception after having a baby

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.

Unless you want to get pregnant again, it's important to use some kind of contraception every time you have sex after giving birth, including the first time.

You'll usually have a chance to discuss contraception before you leave hospital after your baby is born, and again at your postnatal check.

You can also talk to your GP or health visitor, or go to a family planning clinic, at any time.

Read more about contraception after having a baby.

Sexual health charities Brook and FPA have interactive tools that can help you decide which method of contraception is best for you: 

Contraception and breastfeeding

You're unlikely to have any periods if you breastfeed exclusively (give your baby breast milk only) and your baby is under six months old. Because of this, some women use breastfeeding as a form of natural contraception. This is known as the lactational amenorrhoea method, or LAM.

It's important to start using another form of contraception if:

  • your baby is more than six months old
  • you give them anything else apart from breast milk, such as a dummy, formula or solid foods
  • your periods start again

The effect of expressing breast milk on LAM isn’t known, but it may make it less effective.

Sleep and tiredness

Looking after a baby can be really tiring – especially in the first few months after the birth when your child is likely to wake several times during the night.

Most parents cope with a certain level of 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 that may help you feel more rested.

Sleep when your baby sleeps

Try to rest when your child sleeps. It might be tempting to use this time to catch up with housework or other chores but sometimes getting rest is more important. Set an alarm if you're worried about sleeping too long.

Get an early night

Try to 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 a hot bath.

Share the nights if you can

If you have a partner, ask them to help. If you're formula feeding, they could share the feeds. If you're breastfeeding, ask your partner to help with nappies or dressing in the morning so you can go back to sleep.

Once you're into a good breastfeeding routine, your partner could occasionally give a bottle of expressed breast milk during the night. Find out more about expressing and storing breast milk.

Ask friends and relatives for extra support

You could ask a relative or friend to come round and look after your baby while you have a nap. 

If you're on your own, you could see if a friend or relative could stay with you for a few days so you can get more sleep.

Understand your baby's sleep patterns

The phase when your baby wakes several times a night won't last forever. As babies get older they will sleep for longer stretches. Find out more about how much sleep babies need, what to expect, and how to help your baby to sleep.

Try to do more exercise

When you're feeling tired, doing more exercise may be the last thing you feel like doing. But regular exercise can help you feel less tired. Walking is one of the easiest forms of exercise. Try to get out for a walk every day with your baby even if it's just to the shops. Read more about keeping fit and healthy after having a baby.

Try relaxation exercises

As little as five to 10 minutes of deep relaxation may help refresh you. You can learn relaxation techniques online, or go to the library for books or DVDs. Start by trying this simple breathing exercise that you can do anywhere.

Don't let stress get on top of you

Sometimes you can feel tired because you're stressed. If you can do something about the stress, you might find it easier to cope, even if you can't get any more sleep. Find out more about coping with stress.

Be aware of the symptoms of postnatal depression

If you can't sleep at night even when your baby is asleep or you feel tired all the time, these could be signs of postnatal depression. Other signs include feeling down or hopeless and not enjoying the things you normally enjoy.

If you think you may be depressed, talk to your health visitor or GP as soon as possible so you can get the help you need to make a quick recovery. Read more about postnatal depression

Where to get further help

  • If you are feeling really tired and struggling to cope, talk to your health visitor or GP. Find out about the many services and organisations that support parents.
  • Cry-sis offers advice on coping with a crying or restless baby. You can call their helpline on 08451 228 669. It's open seven days a week from 9am-10pm.
  • Family lives has a free 24-hour helpline you can call on 0808 800 2222 for information and support on any parenting or family issue.
  • Home-Start offers support to parents and carers through a parent-helper visiting scheme. Contact your local Home-Start.

Coping with stress

Coping with the demands of a new baby and everything else that's going on around you can be stressful.

You can spend a whole day trying (and failing) to get one job done. Just as you start something, your baby wakes up, a nappy needs changing, or they need a bit of attention.

Sometimes you can feel as though life is completely out of control. If you're the sort of person who likes to be in control and worries about getting things done, this can make you feel very tense and frustrated.

Worry and unhappiness can also cause stress. Maybe you're worried about where you're living, money or relationships.

Or perhaps you're worried about a lot of small things that nevertheless make a big difference to your life. You may not be able to do anything about some of these things, but there are ways you can deal with the stress.

Some of the following suggestions may help:

  • Unwind. Spend half an hour each evening doing something you enjoy. This helps you put other things out of your mind and relax. Have a bath, read a magazine, watch TV or do whatever else helps you unwind. Borrow a book, CD or DVD about relaxation from the library. Ignore any housework – it can wait. Make some time for yourself.
  • Seeing other people can help relieve stress. Your health visitor or other parents may be able to recommend local mother and baby or mother and toddler groups. If you're not keen on organised groups, get together with people you meet at the clinic, playgroup or nursery school.
  • Make time for your partner. Relationships can suffer when you're tense, tired and don't spend much time together. Make time to be with your partner, even if all you manage to do is fall asleep together in front of the TV.
  • Express yourself. Talking about how you're feeling can help, at least for a while. You and your partner need to understand how each other is feeling and work out how you can support each other. Sometimes it's better to talk to someone outside the family.
  • Accept help. Make the most of all the help you can get. You can't do everything yourself, so there's no point in trying.
  • Relax – there are no prizes for being a supermum or superdad. It can be difficult if you're a perfectionist, but being a parent is the one thing that nobody is perfect at.

Keeping fit and healthy

When you're feeling tired, being active may seem like the last thing you need.

But regular activity can relax you, keep you fit and help you feel more energetic.

It can also help your body recover after childbirth and may help prevent postnatal depression.

When can I start exercising after birth?

If you had a straightforward birth, you can start gentle exercise as soon as you feel up to it. This could include walking, gentle stretches, pelvic floor exercises and deep stomach exercises.

It's usually a good idea to wait until after your 6-week postnatal check before you start any high-impact exercise, such as aerobics or running.

If you exercised regularly before giving birth and you feel fit and well, you may be able to start earlier. Talk to your midwife, health visitor or GP.

If you had a caesarean, your recovery time will be longer, so talk to your midwife, health visitor or GP before starting anything too strenuous.

What should I be aware of before exercising?

Your lower back and core abdominal muscles may be weaker than they used to be.

Your ligaments and joints are also more supple and pliable in the months after birth, 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.

How do I know if I'm overdoing exercise after having a baby?

If your postnatal bleeding (lochia) gets heavier or changes colour (becomes pink or red) after activity, you could be overdoing it. You're also likely to feel very tired.

Listen to your body. Pace yourself and make sure you get plenty of rest, too.

Exercise ideas for new mums

  • Do some postnatal exercises. They'll strengthen vital muscles and help get you in shape. See your post-pregnancy body for ideas, or ask your midwife or health visitor.
  • Join a postnatal exercise class. Lots of postnatal classes let you do the exercise class with your baby at your side. Some include your baby and their pram or buggy 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, make sure you tell the instructor that you've recently had a baby. 
  • Push the pram or buggy briskly, remembering to keep your arms bent and your back straight. Make sure the handles are at the right height for you – your elbows should be bent at right angles. 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.
  • Build activity into your day. Use the stairs instead of the lift or, for short journeys, walk instead of taking the car.
  • Bend down to pick things up, rather than bend over. Picking things up off the floor is something you're likely to be doing a lot. If you bend down (bent knees and straight back) instead of bending over (straight knees and a bent spine), you'll strengthen your thigh muscles and avoid damaging your back. Hold heavy objects close to your body.
  • Try swimming. Swimming is good exercise and it's relaxing, too, but you'll need to wait until seven days after your postnatal lochia has stopped. If you take your baby with you, try to have someone else there with you so 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.

Look after your mental health

It's important to look after your mental health as well as your physical health. About 1 in 10 women get depressed in the year after having a baby.

Learn about the symptoms of postnatal depression.

Doing some gentle exercise can help to boost your mood. Other things that may help are:

  • making time to rest
  • not trying to "do it all"
  • accepting help with caring for your baby from friends, family or your partner
  • going out to meet friends or going to postnatal groups – your midwife or health visitor can tell you what's available in your area
  • talking to people about your feelings

If you're worried about how you're feeling, feel like you're struggling to cope, or think you may be depressed, it's important that you talk to your midwife, health visitor or GP – effective help is available.

Healthy eating for new parents

Try to make eating well a priority. It will make you feel better, and healthy eating is important for the whole family. Aim to eat at least five portions of fruit and vegetables a day.

If you think you need to lose weight, there's lots of help available, including individual and group support. Your health visitor, midwife or GP should be able to give you more information about options near you. 

If you attend a group, be sure to tell them that you have recently had a baby – and let them know if you're breastfeeding – so they can give you the right advice.  

Time-saving food tips for new parents

  • 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. 
  • Steaming is a healthy and quick way to cook vegetables and fish.

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

Breastfeeding and your diet

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 – including 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 each day. This won't affect the quality or quantity of your breast milk.

Read more about breastfeeding and diet, including which foods to avoid.

Stop smoking for you and your baby

The best thing you can do for you and your new baby's health is to stop smoking.

Children whose parents smoke are three times more likely to become smokers themselves.

Passive smoking is especially harmful to babies as they have less well-developed airways, lungs and immune systems. Smoking has also been linked to sudden infant death syndrome (SIDS, or cot death).

You're up to four times more likely to stop smoking successfully if you do it with NHS support.

Phone Quit Your Way Scotland on 0800 84 84 84 for details of your local NHS stop smoking service. This service is available from 8.00am to 10.00pm, every day.

Get more advice and help with quitting smoking