September 24, 2019

Reviewed by Kimberly Langdon M.D.

The vast majority of births in the US are attended by a physician, who then handles the postpartum care as well. Generally, this includes one check-up around six weeks postpartum. If you had any pregnancy complications, your doctor may want to see you earlier, and if you had a cesarean birth, you may see your provider around 2 weeks postpartum to check on your c-section incision. Otherwise, the expectation is just one visit at 6 weeks. It can be a little shocking to go from frequent prenatal visits to just one after giving birth, so we’ll walk you through how to get the most out of it.

What to expect

The visit may start with a postpartum depression screen, where you fill out a questionnaire about how you’re feeling emotionally. The standard is the Edinburgh Postnatal Depression Scale (EPDS) and you can find it here, if you’d like to fill it out ahead of time to discuss with your doctor.

Related: 7 Postpartum Depression Myths Debunked

The main part of the visit is the physical exam. In addition to checking your blood pressure and weight, your doctor will also examine your uterus and vagina. Your uterus generally takes 6 weeks to return to its pre-pregnancy size, so that’s one of the things they’re checking for. Also, if you had an episiotomy or any tearing, they’ll make sure the cut is healing well.

Related: How a perineal tear or episiotomy affects your recovery

If so, they will likely give you the green light to resume sex (it’s not recommended before this). However, this just means that it’s safe to have sex, but you can and should wait until you’re ready physically and emotionally.

Another conversation that is expected at this visit is about contraception. It’s a great time to ask questions and make a plan. Depending on your birth control method of choice and breastfeeding plans, it can be the right time to start, since you’ll want to be sure that it’s effective before you start having sex again. Just because your period hasn’t started yet doesn’t mean that you can’t get pregnant.

Related: All about postpartum birth control

How is postpartum care different between a doctor and a midwife?

While the majority of births are attended by a physician (90% in the US), the other 10 percent are attended by a midwife, usually a certified nurse-midwife (CNM). The standard of a 6-week check-up applies to CNMs as well, but they are more likely to include more frequent visits. Also, midwives are more likely to do home visits for postpartum care. While home visits are the norm in northern and eastern Europe, they are generally less common in the US.

How to prepare

If you’re only expecting to see your doctor once after birth, you’ll want to be sure to cover all the bases at the visit. Here are some ways to prepare:

• Fill out an Edinburgh Postnatal Depression Scale (EPDS) and bring it with you. Keep in mind, it’s not perfect, so if you have any emotional symptoms like sadness, rage, anxiety, let your doctor know.
• In fact, reflect on how you’ve been feeling and be sure to bring up any other symptoms you’ve noticed. It’s helpful to do this ahead of time and write them down so you don’t forget. Your doctor will ask you questions, but they might not cover everything.
• Your lochia (postpartum bleeding) may have stopped already at this point, but if not, it should be lightening up. If not, it’s a good idea to bring it up to your doctor.
• If you’re having any issues breastfeeding, now is a good time to mention them. If you’re having nipple pain, your doc can examine them for trauma and signs of infection. If you’re concerned about how well your baby is latching, you can ask for a referral to a lactation consultant.
• Think about whether you’d like to have more children (you don’t have to decide right away) and what you’d like to do for birth control. If you’re not sure, your doctor can go through the pros and cons of different methods.

Changes are coming

While the 6-week check-up is currently the norm, changes are coming. In April 2018, the American College of Obstetricians and Gynecologists (ACOG) released a new recommendation for postpartum care. The new recommended strategy is for ongoing care over the first 12 weeks postpartum, including contact within the first 3 weeks. It may take a while for insurance companies to catch up, so in the meantime, don’t hesitate to see your doctor outside of the 6-week check-up if anything looks or feels off.

Sources:

American College of Obstetricians and Gynecologists (2018). ACOG Redesigns Postpartum Care. Retrieved from https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/ACOG-Redesigns-Postpartum-Care?IsMobileSet=false

Centers for Disease Control and Prevention (2018). National Vital Statistics Reports Volume 67, Number 1, January 31, 2018. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01_tables.pdf

March of Dimes. Your postpartum checkups. Retrieved on September 20, 2019 from
https://www.marchofdimes.org/pregnancy/your-postpartum-checkups.aspx

Handler, A., Caskey, R., Rankin, K., Haider, S. (2015). Postpartum Visit and Contraception Study. Retrieved from
https://www.healthmanagement.com/wp-content/uploads/postpartum-visit-and-contraception-study-final-report.pdf

Kimberly Langdon M.D. is a retired University-trained obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine and then completed her OB/GYN residency program at The Ohio State University Medical Center. Recently, she founded a medical device start-up company that focuses on non-drug treatment for common maladies.