Gynecologist

During pregnancy, a woman thinks that everything will end with childbirth - heavy weight, swelling, back pain, trips to the doctor. Some of this will indeed disappear, but not as quickly as you would like. But you need to visit doctors. And no less than during pregnancy. After all, the period of postpartum recovery is no less important than the “interesting situation” itself.

Many mothers make an excuse by saying that after the birth of a baby there is not enough time even to eat properly, not to mention going to the clinic. But, as you know, a healthy mother means a healthy child. And if you feel unwell, will you be able to fully care for your beloved baby and husband? There is no need to visit all the doctors in the clinic, but it is worth visiting the main specialists. So, whose office should you not miss?

Gynecologist's office

I understand perfectly well how women after childbirth are afraid of this particular doctor. How can you climb onto a chair when you’ve just given birth? However, upon discharge from the maternity hospital, an obstetrician-gynecologist examines women in labor in a chair and performs a pelvic ultrasound. The doctor makes a decision on discharge if the uterus contracts well and no pathologies are detected on ultrasound.

But if during the first week after discharge there are complaints of increased body temperature, increased bleeding, abdominal pain or bursting pain in the mammary gland, then you need to contact a gynecologist at the clinic. Take with you an extract from the maternity hospital, which contains information about the birth.

During pregnancy, the uterus enlarges twenty times. It must contract dynamically for the bleeding to stop. Otherwise, the doctor may diagnose uterine subinvolution - insufficient contraction. When examined by a gynecologist, a loose, enlarged uterus may be alarming. Sometimes there is an elevated body temperature, which signals the presence of an inflammatory process.

In addition, endometritis may occur - inflammation of the uterine mucosa, which also needs to be identified promptly and treatment started. The doctor should also examine the stitches, if any, internal or external, and treat them if necessary.

A breast examination is also the prerogative of a gynecologist; the doctor will give advice on breastfeeding and explain what to do if there are cracked nipples or lumps in the breast. As a rule, these symptoms, combined with bursting pain and often elevated temperature, may indicate mastitis, an infectious and inflammatory disease. The reason for it is stagnation of milk, poor emptying of the breast.

The next visit to the gynecologist should occur 30-40 days after birth. During this time, the woman’s body practically returns to its “original” state. During this appointment, the doctor will examine the young mother in a chair, determine how the genital organs are being restored, whether there are any gynecological diseases or conditions requiring medical intervention, and take a smear from the vagina. The gynecologist will advise you on contraceptive methods during breastfeeding, since previous contraceptives may not be suitable due to the start of breastfeeding, and their need is clear: contrary to the myth that it is impossible to get pregnant while breastfeeding, ovulation can occur even before menstruation begins.

What affects the number of days until release?

Maternal health

How many days after birth they stay in a medical facility is determined using various factors. First of all, this is the general condition of the woman, the quality and speed of healing of the sutures, the nature of the discharge, the degree of uterine contractions. The doctor examines the female breast to identify cracks or inflammatory processes.

Before discharge, the woman is sent for an ultrasound to determine whether the surface of the uterus is clean and whether there are any postpartum residues.

A general blood and urine test is prescribed. A urine test will show the presence of diseases of the genitourinary system, gestosis, a blood test to detect inflammatory processes and anemia.

These manipulations will make it clear to the gynecologist whether it is time to discharge the woman or whether she should be left for a more complete period of recovery.

Read also: How to correctly collect a urine test after childbirth without blood and stitches?

For what reasons can a woman be left in a hospital for a longer period:

Pathology, possible complications after delivery.
Sutures on the genitals, both external and internal.
Presence of bleeding. In the case of difficult childbirth, with manual removal of the placenta, for example, large blood losses often occur, and as a result, anemia. Vitamins and iron-containing medications are prescribed to treat this disease, and severe anemia may warrant a blood transfusion.

If inflammatory processes occur, the period for which the woman remains in the hospital becomes uncertain. If antibiotics are prescribed, as in case of inflammation of the uterine cavity, for example, or when the scar is not healing well, discharge is postponed. With gestosis, high blood pressure is observed, and the patient has to be under medical supervision to reduce it.

Health status of the newborn

The health of the baby also influences how many days later they are discharged from the hospital. Caring for the health of a new person should also be careful and attentive, just like taking care of the mother. The neonatologist checks the skin, muscle tone, weight changes, stool and urine. Examinations are prescribed that will help to timely identify dangerous diseases (adrenogenital syndrome, for example, hypothyroidism, galactosemia, etc.) Before being discharged, vaccinations are given, and only after a complete and satisfactory examination is a conclusion made about the possibility of being discharged and sent home.

For what reasons can a newborn stay in the maternity hospital?

Jaundice. This disease is a common occurrence when there is a conflict between the Rh factors of the baby and his mother. Treatment involves the appointment of a drip and phototherapy. Until complete recovery occurs, the woman remains here.
Weight loss. The maximum weight a newborn can lose after birth is 8% of what it was initially. If weight is lost in large quantities, an examination is necessary to identify the reasons for this, which will also take some time.
The baby is premature. If a baby is born before the due date, weight loss is also quite likely; the baby is placed in a special incubator, where he is fully nursed.
Oxygen starvation of the fetus (hypoxia). Usually observed during childbirth. If there was such a factor, the baby may have nervous system disorders, and very serious ones at that. And he remains in the institution for treatment.
Infections. Any infection during this period requires treatment with antibiotics and antiviral drugs. It also requires the child to be in the clinic.

Read also: What should I give to a woman in labor at the maternity hospital during her visit and upon discharge?

It's better to stay a little longer than to leave the clinic early.

Mammologist's office

Since we are talking about breastfeeding and the breast itself, then it’s time to remind about this specialist. A mammologist is a doctor who specializes in the diagnosis, prevention and treatment of tumor formations. In general, it is believed that you need to visit a mammologist, like a gynecologist, regularly, regardless of the past birth. Until the age of 35, you need to regularly (once a year) have an ultrasound of the mammary glands, and after 35, a mammogram.

You can contact the same doctor about breastfeeding if you have problems such as milk stagnation, cracked nipples, or mastitis. After finishing breastfeeding, you should definitely contact a mammologist, especially if the woman has had breast diseases before. In addition, you need to go for an examination if, several months after the end of feeding, there is still discharge from the breast.

For example, white cloudy discharge is considered normal for a year after the end of feeding. And after this period, discharge may indicate an increased level of the hormone prolactin in the body, which is responsible for lactation, or fibrocystic mastopathy, a benign tumor-like formation. Discharge of other colors, such as bloody or amber, may indicate more serious problems, including cancer.

As for lactation, you can also contact a breastfeeding specialist who will help establish lactation from the first days and teach you how to put your baby to the breast correctly to avoid cracks, stagnation of milk and other problems.

Recovery after childbirth - a gynecologist answers your questions

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The birth of a baby is a serious test for the female body. The baby that is born requires the mother’s attention and strength, and therefore recovery after childbirth must be successful so that the woman can enjoy life and her motherhood. As part of the Hotline “Question and Answer”, gynecologist Alexandra Vitalievna Plotnikova visited MomExpert. She answered questions about modern methods of recovery after childbirth.

Multidisciplinary medical provides services such as:
consultations with specialists for children and adults, home visits by therapists and pediatricians, collection of tests at home, research conducted in our own laboratory.

Question: After childbirth, when sneezing, coughing, etc., spontaneous urination occurs a little, Kegel exercises do not help, what else can be done to cure this ailment? And after childbirth, sexual desire is almost absent due to severe physical fatigue, orgasm does not occur during sexual intercourse, what can be done to make both desire and orgasms appear?

Answer: Your symptoms are most likely directly related to childbirth. Immediately after the birth of the baby, the vagina becomes more voluminous. Over time, when recovery takes place after childbirth, it narrows significantly, but does not reach its original size.

The faster the recovery after childbirth occurs, the more the woman will enjoy intimacy, and regular sex life is important both for well-being and for preserving the family. In this case, the condition of the pelvic floor muscles is very important. Kegel exercises will help keep them in good shape.

These are exercises to improve the tone of the pelvic floor muscles. In everyday life, these muscles are practically not used, and over time they can lose their elasticity and become weak. Deterioration of elasticity and weakening of the pelvic floor muscles leads to a deterioration in sexual life even to various diseases.
How can a woman find the muscles she needs?
If you place a finger in the vagina, the target muscles should contract around the finger, but should not involve the muscles of the abdomen, buttocks or back. Those. if you feel the muscles around your finger tightening, then you are training the right thing. All other muscles at this moment should be relaxed, breathing should remain deep and even.
Kegel exercises are:
Slow squeezes: Tighten your muscles as you did to stop urination, then slowly count to three and relax.
Contractions: Tighten and relax the same muscles as quickly as possible.
Pushing: Push as you would when passing urine or stool.
Where can you do Kegel exercises?
You can practice anywhere: while driving, on a walk, sitting in front of the TV, at the table, in bed.
Training scheme
Start your workout with 10 slow squeezes, contractions, and thrusts. Repeat the exercises 5 times a day. If your muscles get tired quickly, rest for a few seconds and continue the exercises.
After a week, repeat each exercise 15 times. In another week, 20 each. Bring the number of repetitions to 30. Thus, every day you will perform 150 Kegel exercises.
At the beginning of classes, it may be difficult for you to tense your muscles with slow contractions and perform contractions quickly and rhythmically, because the necessary muscles are not yet toned. Over time, the skill will improve. You need to perform exercises at least 3-4 times a week. You can achieve noticeable results after 6-12 weeks of training. When performing these exercises, only the necessary muscles should be involved; you should not squeeze the muscles of the buttocks, abdomen and anal muscles.

Strengthening the pelvic floor muscles helps normalize sex life, cure stress urinary incontinence (spontaneous urination) and sexual dysfunction.

An alternative to Kegel exercises can be vaginal cones. This is a kind of exercise machine, the set of which includes 4 cones of different weights. The woman inserts the cone into the vagina (for easy removal it is equipped with a cord, like a tampon), stands up and tries to keep the object inside. At the same time, just the right muscle group is tensed.

In terms of effectiveness, both methods are approximately the same, but cones give the effect much faster (in about a week), and Kegel exercises - in 6-12 weeks. A set of cones online costs an average of 70 rubles.

You can start exercising with cones after childbirth only when the genital tract has completely healed and there are no infections in the vagina, uterus, or tubes. If you give birth without complications, you can start after about 2 months. At this time, the doctor already allows sexual activity and removes all other restrictions, it is believed that recovery after childbirth has occurred.

At the same time, it is recommended to do Kegel exercises during pregnancy and, in the absence of injuries, you can do them immediately after childbirth.

Another extremely effective method is the Femilift laser correction procedure. This is an effective modern way to get rid of discomfort without surgery. The procedure helps with:

Urinary incontinence due to stress (sneezing, sudden laughter)
Atrophy of the mucous membrane and dryness in the vagina
Initial forms of prolapse of the vaginal walls
Age-related changes in the vaginal mucosa and labia
Repeated infections

It has been used by leading clinics in the world since 2009, its effectiveness has been clinically proven. “Kravir” has been practicing it for 3.5 years and has managed to collect its own statistics. It is noted that laser correction is not inferior in effectiveness to surgical plastic surgery of the genital tract.

Three virtually painless twenty-minute treatments spaced one month apart eliminate urinary incontinence and sexual dysfunction. Read more about the procedure at the link and watch the video at the end of the article (time 9.47).

Great news for our mothers - a 30% discount on the Femilift procedure!

Question: What are the modern and safe (for the child) methods of contraception for breastfeeding?

Answer: The methods are the same as for all others with the exception of oral contraceptives. So-called mini-pills were previously recommended, but due to side effects they are no longer prescribed. You can use: a condom, vaginal rings, vaginal caps, spermicides (for dry vaginal mucosa), intrauterine contraceptive device (spiral). To insert the IUD, the gynecologist must assess the condition of the cervix and the absence of contraindications, preferably after the end of the postpartum period (6-8 weeks after birth).

If it is the 2nd or 3rd caesarean section, the issue of surgical sterilization is discussed with the woman before the operation.

Question: What are the pros and cons of the IUD contraceptive method?

Answer: The advantage is that this is a very reliable method of contraception, however, if the IUD is inserted incorrectly and is located in the cervical canal, then pregnancy is possible.

The disadvantages are that the IUD can be a conductor of infection between the vagina and fallopian tubes and, against the background of a banal infection in the vagina, cause a serious inflammatory process in the appendages. There is also a certain risk of ectopic pregnancy.

Question: If there were cervical ruptures in 2 births. What should be done next with her and how soon after birth?

Answer: It all depends on the severity of the tears (sometimes no action is required). What to do will be determined by the gynecologist during a gynecological examination and colposcopy if necessary. Options for surgical correction or radio wave excision (excision) of the cervix are possible. If there is no need for emergency interventions (dysplasia, precancerous conditions), then this is performed no earlier than 2 months after birth, when the postpartum period ends, and if possible, it is not necessary to postpone all measures until the period when the child becomes relatively independent (about a year). will carry it in his arms, since after the operation it is necessary to limit lifting heavy objects.

Question: What is the likelihood of getting pregnant during breastfeeding if you don’t use protection?

Answer: It is impossible to indicate the exact percentage, but there is a possibility. Unfortunately, breastfeeding is not a contraceptive. Even if you think that pregnancy is possible in 1 case in 100, there is no guarantee that you will not be that one case. You don't have to use protection if you're ready for your next baby. However, it should be noted that when breastfeeding there is a possibility of a non-developing pregnancy.

Question: I am 40 years old. They did IVF due to low AMH (anti-Mullerian hormone). At the end of March, my daughter was born, at 40 weeks, natural birth, everything was ok. The dosage of hormones during stimulation is significant. Although at the ultrasound at 12 weeks the gynecologist said that no changes were visible in the ovaries, and that the dosage was chosen very correctly. During pregnancy, many papillomas appeared on my body, not 10 or 20, they appeared every day, on my neck, stomach and chest. After childbirth, they partially fall off, but not all. Tell me, given that this virus causes cervical cancer, am I at risk? Maybe I should consult a specialist, or have more frequent cytology tests, or other tests (markers). What do you recommend?

Answer: Almost all people are carriers of HPV (human papillomavirus). Like all viruses, it can become more active during periods of decreased immunity. This is precisely the reason for the appearance of papillomas during pregnancy. The body of a pregnant woman is in a state of immunosuppression because she is carrying a “foreign body.” To prevent fetal rejection, a natural mechanism of immune suppression is activated. Hence the appearance of papillomas; many pregnant women suffer from thrush for the same reason. After giving birth, the body will return to normal and will be able to suppress the virus itself, but it will not be a bad idea to go to an appointment with an oncologist-dermatologist. To find out whether you have cervical cancer, you need to take a smear for high-carcinogenic risk HPV and oncocytology. If both tests are good, then the next time they can be taken only after 5 years.

Question: Is it necessary to treat cervical erosion after childbirth? If yes, what modern methods can it be cured? It was the first birth. The erosion was there before pregnancy.

Answer: It is impossible to resolve this issue without additional examination. Erosion in the simplest sense is redness on the cervix, but underneath it can hide either a banal congenital ectopia, which goes away on its own, or cervical cancer. Extended pulposcopy will help determine the nature of the redness. Depending on the results of the examination, the procedure for further actions will be clear.

Question: A month ago I had a planned CS, but I am still bleeding. Sometimes it doesn’t, but then it bleeds for two days. Then again there is nothing for a while. Tell me, is this normal? I don't feel any pain.

Answer: After a cesarean section, discharge is normal for up to 6-8 weeks (during the entire postpartum period). This is the norm.

Question: After giving birth, painful sensations appeared during intimacy. (There was a rapid birth, cesarean section. I also have a one-horned small uterus.) What could cause this?

Answer: Painful sensations during sexual intercourse are called dyspareunia. After childbirth it occurs in 45% of cases. It can be psychogenic or organic. Psychogenic is caused by the fear of repetition of the pain experienced during childbirth, fear of repeated ruptures during coitus, fear of unwanted pregnancy. And also organic, which can be caused by inflammation of the mucous membrane of the genital tract, thrush, dry mucous membranes due to altered hormonal levels during lactation. Deep dyspareunia is the location of the uterus in the back, varicose veins of the small pelvis, endometriosis, uterine fibroids, inflammatory diseases of the pelvic organs, adhesions, cystitis, uterine prolapse, incorrectly sized condom, allergy to the condom, intrauterine contraceptive, spermicides, vaginal caps , diaphragms and rings, as well as sexual technique, partner behavior, lack of love and trust. Sometimes the joint work of a psychologist, sexologist, and gynecologist is required.

Question: 2 weeks after giving birth, the discharge became scanty, even every other day. Is this the norm? A month later, rare, insignificant, but bright red discharge appeared. The birth was natural, there were stitches, on the fifth day, according to ultrasound, the clots were removed in a chair. Injected with oxytocin.

Answer: An ultrasound of the pelvic organs and a gynecological examination will help determine whether this is normal or not.

Question about contraception after childbirth: What advice do you have for breastfeeding women?

Question: I gave birth a year ago, now I am pregnant again. How does this affect the body? I understand that until he has fully recovered, what can you advise during this period for recovery and strengthening? GW ended in the 2nd month after the first birth .

Answer: Stay pregnant and enjoy motherhood. When monitoring your pregnancy, your gynecologist will give you recommendations on correcting iron and calcium deficiency, and taking vitamins according to your test data. Consultation with an endocrinologist and therapist is required for proper management of pregnancy.

Question: The child is already one year and 3 months old, there is still no menstruation, we are breastfed. Tell me how normal/abnormal this is? Any tests may be needed? And tell me how to restore vaginal elasticity (what procedures/surgery are needed)?

Answer: As long as you are breastfeeding, the absence of menstruation is normal. High levels of prolactin during lactation suppress the production of estrogens, which determine the hydration and elasticity of the vaginal mucosa, so when lactation stops, the condition of the vaginal mucosa will significantly improve. If symptoms of insufficient elasticity persist, laser correction (Femilift procedure), PRP therapy (injection of platelet-rich plasma) or injection of fillers with hyaluronic acid into the area under the scar is possible.

Question: What to do with chronic cystitis? How can I help myself if my bladder sometimes becomes inflamed? I am also breastfeeding (child is 1 year 3 months old).

Answer: When breastfeeding, only herbal uroantiseptics are used: phytolysin paste, bear ears, bearberry, canephron. If you have chronic cystitis, you should consult a specialist in the field - a urologist.

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Therapist's office

In the first month after giving birth, it is also worth going to a therapist, especially if the birth was difficult or there were pathologies during childbirth or pregnancy. The doctor should monitor the general condition of the body: pressure indicators (is there a tendency to hypertension), hemoglobin level (especially if there was bleeding during the postpartum period), possible inflammation in the kidneys or genitourinary system, which will allow you to see a urine test; sugar level

In addition, you should consult a therapist if you have problems such as nausea, heartburn, constipation, or a feeling of discomfort or heaviness after eating food. It is important to ensure that the young mother’s body has enough useful substances, and here you cannot do without tests and a doctor.

The therapist will also monitor the functioning of the heart and lungs, especially if a woman has been diagnosed with chronic diseases of the cardiovascular system, digestive tract, genitourinary system, blood circulation, etc. before or during pregnancy.

Which specialists should I visit after childbirth?

All young mothers need to know about the list of doctors and specialists who should be visited after childbirth. You need to go for an examination not only if you have problems or unpleasant symptoms, but also for preventive purposes.

The following specialists are required to visit:

Gynecologist. It is recommended to visit this doctor a week after giving birth. During the examination, you need to hand over an exchange card and be observed by a doctor to identify postpartum diseases or complications. In addition, your gynecologist can provide advice regarding breastfeeding and mastitis. You should visit your doctor for the second time six weeks after giving birth;
Therapist. This doctor will help monitor the functioning of the heart and lungs. In addition, he will issue a referral for a general blood and urine test. It is especially recommended to visit a therapist for those who have had complications during their pregnancy;
Gastroenterologist. Some women suffer from constipation, heartburn and heaviness after childbirth. A specialist will help identify the problem and fix it in a timely manner;
Endocrinologist. If diabetes mellitus occurs during pregnancy or the woman has gained a lot of weight, an endocrinologist will be able to help with treatment;
Oculist. After childbirth, some women's vision deteriorates, and only ophthalmologists can help correct it after a full examination;
Dentist. To improve the condition of your teeth, eliminate periodontitis and other complications that arise during pregnancy, you should visit a dentist;
Psychiatrist. If after giving birth a young mother feels increased fatigue, confusion, absent-mindedness, or irritability, she should consult a psychologist or psychiatrist. Because these may be signs of postpartum depression, which requires professional treatment.

If a woman suffers from certain symptoms, it is worth visiting additional specialists. For example, if you have pain in the heart and shortness of breath, you need to contact a cardiologist. A referral for examination can be issued by a therapist after collecting an anamnesis.

Endocrinologist's office

A visit to an endocrinologist in the first month after childbirth is necessary for those women who had endocrine disorders during pregnancy. Often they are the reason for the threat of termination of pregnancy. Most likely, the doctor will prescribe a hormone test and an ultrasound of the thyroid gland. If necessary, the endocrinologist will prescribe drug treatment.

It is definitely worth visiting an endocrinologist if a woman has gained a lot of weight during pregnancy or, conversely, has lost a lot of weight after childbirth, if her hair is falling out, and also if the child was born weighing more than four kilograms.

Gynecologist

An examination by a gynecologist after childbirth should ideally occur within 2-3 days.
He will carefully examine you, tell you how to properly attach the baby and how to care for your breasts, how to get rid of cracks if there are any (and this, alas, is not a rare occurrence). He will also examine the suture after dissection or after cesarean section, assess its condition, and tell you how to properly care for it in order to prevent suppuration or dehiscence. In addition, the gynecologist will remind you that you should abstain from sex for one and a half to two months after giving birth.

In addition, the gynecologist can refer you to other specialists if something makes him suspicious. Do not neglect this recommendation - after childbirth you need to take special care of yourself.

A visit to the gynecologist after childbirth is mandatory

It is advisable to visit a gynecologist for the second time 1.5-2 months after birth (if there are no complaints or discomfort before that). At this time, the postpartum period will officially end, so an examination by a gynecologist will be very helpful.

He will see whether the uterus has contracted well, whether it has returned to its previous position, whether the sutures have healed, whether additional treatment is needed and whether it is already possible to return to intimate life.

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Office of a neurologist/neurologist

You should visit this doctor if you suffer from headaches or dizziness, as well as back or neck pain. Often this may indicate pathologies of the spine that occurred during pregnancy. By the way, you can also visit a chiropractor so that the doctor examines the spine and corrects the changes. You can also take a course of massage, which will come in handy - you shouldn’t cause back pain, as it will only get worse due to physical activity. And they will only grow - along with your baby.

Dentist's office

Yes Yes! During pregnancy and lactation, the child “takes” minerals from the mother, such as calcium, phosphorus, etc. In order not to lose teeth with age, it is better to treat them in time, carry out examination and prevention. Therefore, in the first couple of months it is worth visiting a dentist who, if necessary, will carry out treatment; perhaps he will advise adding foods that contain the necessary minerals to the diet: cheeses, yoghurts, milk, sea fish. Your doctor may recommend changing your toothpaste and mouthwash to prevent tooth decay.

Psychologist's office

Postpartum depression is not a myth, but a reality that can poison the joy of motherhood. After giving birth, a woman’s usual way of life changes dramatically; against the background of hormonal changes in the body, this can result in real psychological problems. They can lead to loss of interest in your own child, sleep disturbances, loss of appetite, and so on.

Don’t be shy and think that going to a psychologist is the final stretch to a clinic for the mentally ill, far from it. And in a situation with postpartum depression, it is especially important to visit a family psychologist together with your spouse.

Don’t forget about your health - during pregnancy, so many changes occur in a woman’s body that the time after childbirth is called the tenth month of pregnancy - when the body returns to its original state. In order for him to return to really good condition, you need to monitor your health and visit the necessary specialists on time.