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It is the 27th January 2006 and my twins sons are 6 weeks old and it is time for me to visit my OB, Dr Emeka Okaro (http://www.womenswellnesscentre.com/eokaro.htm) for my post-partum checkup. My sons were delivered by emergency C-section. At this time, Ryan and Joshua are on four hourly feedings. We make the appointment to fit in with the feeding schedule of the boys. As we did not have any paid help with the babies, and I cannot drive, all four of us got ready to go to visit Dr Okaro in his private practice.

"This is what to expect from your Postpartum Visit:

About six weeks after giving birth you will visit your doctor or midwife for a check up. You will have a pelvic exam, breast exam and a physical review of your cesarean scar if you gave birth by c-section. This is typically your last visit with your OB or midwife, unless you are having complications. (If you had earlier complications you may have seen your practitioner earlier than this visit.)

What to expect from Your Physical Exam:

Your practitioner will check your vagina, perineum and do a pap smear and breast exam. You may also have other testing as needed, including blood work to screen for anemia. Be sure to ask about any pains or soreness you are still experiencing. Ask your doctor or midwife when you can have sex again.

10 Tips for Great Postpartum Sex :

During pregnancy you may have wondered what the effects of the pregnancy on your body and mind, not to mention a new little one would have on your sex life postpartum. The good news is that many women find that they have better sex lives, just different, after the birth of a baby. Just remember it will be different. Here are some tips to enhancing your postpartum sex life!

1.Don't rush into anything. Take your time.

2.Shower together! Or bathe together. Not only will it save time and money for water but you might have a lot of fun.

3.Plan for birth control. Don't be someone who is caught 2 months after the birth of your baby wondering if you got pregnant because you took a chance.

4.Try to plan some time alone, even if it's just to cuddle. Having a baby may leave you feeling "touched out," but some special snuggle time with your main guy can help revive that, even before sexual intercourse is allowed or wanted.

5.Get to know each other a bit better. Remember you're both having to adjust your life to being parents, even if it's not your first child.

6.Be spontaneous! Bedtime might not always be the right time. Nor will the bedroom always be the right place. Add some spice to your sex life, act like a teenager!

7.Lubrication! Make sure you and your partner take enough time to get into the mood and that you're feeling moist enough to handle it. If you think you need some more help than what mother nature is providing, be sure to use an over the counter lubricant rather than worry needlessly. If you're still concerned talk to your practitioner.

8.Remember it's quality not quantity.

9.Talk about your fears of sexual intercourse. Maybe you're worried about the repair of an episiotomy or some stitches that you had or the fact that you had a cesarean section. Perhaps you're concerned about how your partner feels after watching you give birth.

10.Never hesitate to say no. Maybe you need the freedom to say no once in awhile. Your partner might also need the same freedom. There are also compromises that can be made along the way. Maybe intercourse is out but some good old-fashioned kissing and necking isn't?

Opportunity to Discuss Birth Control Options:

Your doctor will want to discuss your birth control options. Breastfeeding may alter your options so be sure to talk to them about your breastfeeding status. For example, you may be limited in which hormonal methods of birth control are better for you and your milk supply. Common options include:

•Birth control pills

•Diaphragm

•Injectable birth control

•Condoms

•Intrauterine Devices (IUD)

Review Your Labor & Birth:

This is also your chance to talk about your labor and delivery. You can clarify what happened or ask questions about what happened if you aren't sure or didn't understand at the time. You may also want to ask for a copy of your medical record. (Your hospital will have a separate record.)

You can ask your practitioner's opinion for how your most recent birth will affect your options for future pregnancies and births. For example, if you had a cesarean, can you have a vaginal birth next time.

Mental Health Check:

While some providers forget to ask about your mental health, a good screening for postpartum depression is important. If your provider doesn't say anything, be sure to bring up your questions and concerns.

Look out for Signs of Postpartum Depression:

True postpartum depression can strike at anytime in the year after birth. So simply because a mother feels well a few weeks or months after her baby is born doesn't mean that she is completely out of the woods. Signs of postpartum depression include:

•Being very irritable

•Being tired or unmotivated, beyond normal

•Feeling hopeless or overwhelmed

•Feeling sad or anxious (including racing heart, tight chest)

•Sleeping too much or too little

•Crying easily over anything or for no reason

•Eating too much or too little

•Inability to concentrate or make decisions

•No interest in activities, particularly those that were previously pleasurable

•Withdrawing from family and friends

•Lack of interest in the baby

If you or someone you know has these signs after giving birth and they don't get better in a week or two, seek professional help. If the mother has thoughts of harming herself or the baby seek help immediately.

Generally you can call your midwife or doctor for help or a referral to a qualified practitioner.

(http://pregnancy.about.com/od/postpartumdepress/a/ppdsigns.htm)

We meet Emeka who sits there beaming at the babies who are at that point napping. Here are the pictures he took that day for us.

Emeka gives me a the all clear and tells us the boys has my shading (they were darker skin toned at that age) and we again thank him for being the most amazing OB parents can have!!:D Ofcourse all was clear as it was Emeka himself who did my stitching and I was told by several other medics they looked perfecy - neat job!!! Almost 5 years later, the scars are hardly noticeable - very neat indeed.

In London, where the boys were born and we lived at the time, I had several visits at home by a midwife along with access to a GP as well as my OB. IF, I was vulnerable to post-natal depression, then one of these professionals would have picked up on it and most likely I would have had the diagnosis and the treatment. There are also outlets for new Moms in the UK to meet at minimal cost, whether to get online support or in person. Two organizations I joined were the National Childbirth Trust which hosted 'coffee' mornings for new Moms in my neighbourhood along witht he Twins and Multiple Births association (TAMBA). On a investment in total of less than $100, I had access to online parenting comminities as well as to make contact with fellow new Moms right on my doorstep which was a lifeline. I made some amazing friends who are still in touch with us after nearly 5 years!!!:D

New Mom? Feeling Down? Just had a baby? Do not feel under control? Do not feel like a Mom? Wish the baby would stop crying all night long? Maybe your spouse or partner seems unapproachable? Feel fat and ugly? Or just exhausted?

Maybe you no longer feel sexual? Maybe you feel your husband does not have any desire for you any more? Maybe you are worried about your own lack of desire after giving birth?

You expected to feel the euphoria everyone told you about when you delivered your baby. Days, weeks and months have gone by and you hardly leave the apartment?

Being a new Mom can be very frightening and isolating. Our therapist, Alisa will be able to make a visit to your home for a 'good chat' - confidentially. Alisa is a qualified post partum doula, qualified LCSW, Mom to a son and daughter aged 18 and 21 and specialises in the issues related to fertility, pregnancy and post-partum.

Alisa works with individuals, who are experiencing difficulty with depression, anxiety, low self-esteem, work and interpersonal conflicts, all within the context of the conception, pregnancy and the post-partum period. She says how you feel about your self, your life, your relationships and your pursuits can drastically change when trying to conceive, during pregnancy and after delivery.

Alisa's expertise with individuals & couples during their childbearing years developed from over seven years experience as a doula (teacher, guide, caregiver for pre & post partum families). Forming a trusting bond during this vulnerable time period enables Alisa to help people understand and cope with the feelings such as powerlessness while undergoing fertility treatments, anxiety about the future during pregnancy, helplessness when dealing with a newborn and confusion about relationships and roles.

Alisa says many individuals and couples struggle with powerful emotions that emerge during this time in their lives. She says if you feel sad, over whlemed, confused, angry, stuck or afraid, you may need help dealing with this significant change in your life. Together, with Alisa, you CAN uncover your personal resources that will provide you with feelings of competence and insight as you progress through this period in your life.

To book an appointment to have a 'chat' with the lovely Alisa, please e-mail Alisa@momtomomsadvisor.com. Please give a contact number and a convenient time to return the call.

BIO

Alisa earned her Master of Social Work degree from Fordham University. She combines her phychotherapy practice with seven years experience as a doula to create a unique expertise with individuals and couples preparing and/or deaing with pre and post pregnancy issues. Her distinctive practice includes home based therapy sessions when office visists are not feasible. In addition, Alisa works in the creative arena, providing therapy for muscians through The Jazz Foundation of America. Alisa maintains a private practice in Manhattan's Upper West Side.