An appointment three months after the postnatal visit is usually given to check the coil or give further supplies of contraceptive pills. For physical reasons, the method chosen may be no longer appropriate. Bleeding with a coil or with the injectable contraceptive may be unacceptable, and a decision to stop breast feeding may mean a change from the progestogen-only to the combined Pill. However, now that physical healing has taken place, lactation well established or stopped, the baby often sleeping through the night so that tiredness is less, it can be a time when emotional problems and anxieties may be revealed. Tobert has described some of the feelings that can occur after the birth of a baby, and which may present with psychosexual problems such as loss of libido (Tobert, 1983). The woman may have strong feelings of pain, rage, humiliation or disappointment about her delivery. These feelings can be especially acute for the woman whose delivery has been with the use of forceps or by caesarian section, so that the hoped-for natural delivery has not been possible. Feelings of damage to the body may have been reinforced by insensitive words at the postnatal examination such as ‘of course you have not been stitched up too tight; you could drive a cart and horses through there.’

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