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Week 6

During a pregnancy, your blood volume increases by about two liters (two quarts). After six weeks, the blood volume has lessened, and the uterus has gone back to its original pre-pregnancy size.

If you breastfeed, the uterus is more contracted—the hormones released during breastfeeding have this effect and this will help the uterus to gradually regain its normal size over the next few months.

Women typically gain weight during a pregnancy. The average weight gain is about 14 kilos (31 pounds), but this varies greatly from woman to woman and pregnancy to pregnancy. The weight gain that remains now is stored in fat deposits. Postpartum weight loss is highly personal, and more lasting and healthier if done slowly. Some women even lose too much weight while breastfeeding and struggle to eat enough to maintain their weight.

Postpartum checkup

Have you made an appointment for a checkup with your midwife? About six to eight weeks is a good time to have a postpartum checkup. Ahead of this appointment, review your needs and write down answers to questions like: How was your pregnancy? How was labor? Do you have any questions about what happened? How are things at home? How have you been feeling?

At this point, it may feel like a distant issue, but now is a good time to start thinking about types of contraception. If you don’t breastfeed, you can expect ovulation to resume after six to eight weeks. When you breastfeed, it takes about six months, but this varies immensely and how much you nurse affects ovulation.

It’s worth noting that you can ovulate before you bleed, which means that it is theoretically possible to conceive before you have your period. Give some thought to what works for you. Your midwife will be able to answer your questions, but you can also schedule a family planning meeting if you prefer to discuss the matter at a different time.

If you gave birth with a Cesarean delivery, we want to recommend at this point that you wait at least one year after giving birth before your next pregnancy. This is to reduce the risks of complications that can arise related to the scar from a Cesarean delivery.

Pelvic exam

The pelvic exam after childbirth and pregnancy is important, regardless of whether you had a vaginal delivery or a Cesarean delivery. The midwife will look at any tears and do a pap test if enough time has passed and the bleeding has stopped. During the exam, you will also receive information about other complications, such as delicate or dry mucous membranes or feelings of heaviness.

This feeling of vaginal heaviness is common after childbirth. It feels like something is pressing on the vagina, or as if there is something there that was not there before. This is usually perfectly normal, and because your uterus and mucous membranes are swollen. However, it could be a sign of a pelvic prolapse or a weakness in the vaginal walls. There are also uncommon injuries to muscles in the pelvic floor that can be difficult to discover in connection with childbirth. Such injuries show up weeks or months after.

Trust how you’re feeling. If something does not feel right, get medical attention. It can be difficult to put into words what feels different, so be confident, ask questions and explain what you’re feeling. Your midwife will be able to answer your questions and follow up if you need it.

Pelvic floor exercises

It’s important to check your clench and your pelvic floor. Pregnancy has been a great strain and when you regain your strength again, you should use the right clenches. You will also receive advice about how to do this during this checkup. This is part of the basic healthcare program during and after a pregnancy, and offered to all women who have given birth, regardless of whether it was a vaginal delivery or a Cesarean delivery.

Source: - Hatice Kahyaoglu Sut. & Petek Balkanli Kaplan. (2016). Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol Urodyn.l Mar;35(3):417-22. DOI: 10.1002/nau.22728 - Janson, P.O. & Landgren, B. (red.) (2010). Gynekologi. (1. uppl.) Lund: Studentlitteratur. - Kaplan, A. (red.) (2009). Lärobok för barnmorskor. (3., omarb. uppl.) Lund: Studentlitteratur. - Myles, M.F., Marshall, J.E. & Raynor, M.D. (red.) (2014). Myles textbook for midwives. (16th edition). Edinburgh: Elsevier. - Savage S. J. (2020). A Fourth Trimetser Action Plan for Wellness. The Journal of Perinatal Education. Apr 1;29(2):103-112. DOI: 10.1891/J-PE-D-18-00034