Your postpartum checkup

What is the six-week postpartum checkup?

The six-week postpartum checkup is a comprehensive visit with your OB or midwife. The purpose of this appointment is to check on your physical recovery from pregnancy and delivery, see how you're doing emotionally, and address your needs going forward. Many women think of it as the "go-ahead" visit, meaning your practitioner can verify that you're ready for more intense postpartum exercise and having sex again.

This shouldn't be your first postpartum checkup with your provider, though: The American College of Obstetricians and Gynecologists recommends that all women talk to their provider within three weeks after delivery and continue to receive follow-up care as needed, including a comprehensive checkup by 12 weeks postpartum. In many cases, that comprehensive visit happens at six weeks. (Your first contact is generally less comprehensive and may simply be a phone call or a virtual visit.)

Don't feel constrained by appointment dates, though. Sometimes physical or emotional issues come up that need immediate attention, like excessive bleeding, a potential postpartum infection, and any feelings that may lead you to think you might have postpartum depression or another postpartum mood disorder. Never hesitate to call your provider if you have concerns.

Why is a postpartum checkup so important?

When you're busy caring for a newborn – and especially if you're feeling fine – it's easy to think about skipping your postpartum checkup. But this is an important visit. It's an opportunity for your provider to check on you, physically and emotionally. There are potential problems, such as infections and mental health issues, that could be missed without a visit and lead to more serious complications.

Your postpartum checkup is also an opportunity for you to ask questions about your birth experience and recovery, especially if you're recovering from a difficult birth experience. Are you wondering why something went the way it did during labor (why your contractions stopped for a bit or why your doctor used forceps, for example)? Worried about the chances of a repeat (preterm delivery or cesarean, for example) next time?

You may still be dealing with some pregnancy- or childbirth-related aches and pains, too, and you may have some questions about how your body has changed. You may also have questions about postpartum issues like breastfeeding, birth control, exercise, sex, and going back to work. It helps to jot down the questions you want to ask and any other issues you'd like to discuss ahead of time.

If you've had a miscarriage, stillbirth, or neonatal death (when a baby dies in the first 28 days of life), it's important to see your provider to learn more about why it happened and to determine if you're at risk for it happening again in the future.

What happens at the six-week postpartum checkup?

Here's what will typically happen at your postpartum checkup:

You'll undergo a physical exam.

During your physical exam, your healthcare provider will:

• Check your weight and blood pressure. They may also take your pulse and listen to your chest.
• Check your abdomen. They'll feel your belly to be sure that there's no tenderness and check your incision if you had a c-section. (Your provider would also have checked your incision a week or two after delivery to make sure it was healing properly.)
• Examine your breasts. They'll be on the lookout for lumps, tenderness, redness, and cracked nipples or abnormal discharge.
• Inspect your external genitalia, including your perineum. If you had an episiotomy, they'll check to see that it's healed.
• Do a speculum exam to look at your vagina and cervix. They'll be checking to see that any bruises, scratches, or tears have healed. And, if you're due for a Pap smear, they'll do that during the speculum exam.
• Do an internal pelvic exam to feel your uterus and check that it has shrunk appropriately, feel your cervix and ovaries to identify any problems, and check your vaginal muscle tone. They may also do a rectal exam.
• Manually check your thyroid (a gland in your neck responsible for hormone production) to make sure it's a normal size.

Your provider will also ask what physical symptoms you're having, such as whether you're still bleeding on occasion, having any abdominal discomfort, vaginal or perineal pain, urinary incontinence or anal incontinence, or breast pain. If you have a bothersome symptom that your healthcare provider didn't cover, don't be afraid to speak up. They'll also ask if you're breastfeeding and how it's going. If you're having any trouble, they can refer you to a lactation consultant.

Your provider will check on your mental health.

How you're doing emotionally is an important element of your follow-up care. Your provider will want to know how you're adjusting to the demands of motherhood and about any emotional problems you may be having. They'll ask you questions – or have you fill out a questionnaire – to screen for postpartum depression.

Don't be shy. Talk about the baby blues, if you felt them. Especially talk about any lingering sadness or depression you're still feeling. It's important to let your provider know if you're feeling overwhelmed, anxious, or depressed. They can provide medication that's safe to take now, even if you're breastfeeding. They can also refer you to a mental health specialist for ongoing care.

Your provider will order any tests or immunizations you need.

You may need lab tests if your provider is concerned about any conditions you had during pregnancy or delivery that might continue to affect you. If you had gestational diabetes, you'll need a glucose tolerance test. Your OB or midwife will provide you with any necessary follow-up care you need for special health conditions.

They'll also offer any immunizations you may need, such as a tetanus, diphtheria, and pertussis booster shot, a flu shot, a COVID-19 shot or booster (the COVID vaccine is safe for pregnant or breastfeeding women), or a rubella or chicken pox vaccine. (If you were not immune to rubella or chicken pox before your pregnancy, you should have been vaccinated before you left the hospital after delivery. If that didn't happen, it's highly recommended that you get vaccinated now.) The chicken pox vaccine requires two doses, so if you got your first dose immediately postpartum, you'll get the second dose now.

Getting vaccinated can help prevent you from getting sick and passing the illness to your baby. In some cases, it can also help you provide your baby with some immunity if you're breastfeeding.

You'll discuss birth control and family planning.

Talk with your provider about if and when you'd like to have more children. Because it's possible to become pregnant at any time postpartum (even if you haven't gotten your first postpartum period yet or you're breastfeeding), it's important to talk about birth control.

You may need to make changes. For example, if you took the pill before pregnancy and are breastfeeding now, your practitioner will change your prescription to the "minipill" (progesterone only). Or you may decide it's time to try a different method. Talk with your provider about the pros and cons of each method you're considering. If you are planning on getting an IUD or an implant (like Nexplanon), let your OB provider know and they can insert it during this visit.

You'll get the okay to start exercising and having sex. 

If all is well, you'll get the go-ahead for exercise, weightlifting, and sex. Ask your provider if there are any restrictions, because of complications you may have had or chronic conditions you have, for example. If you were active throughout pregnancy and had a vaginal delivery without complications, you've probably been able to do light exercise within days of having your baby, if you felt up to it. But if you had a c-section or weren't exercising all along, then your provider may want you to wait until your six-week postpartum checkup to begin exercising.

Don't worry if you don’t feel up to having sex yet, despite your clearance. Many women have little to no interest in sex for several months after giving birth. Wait until you feel ready.

Finishing up

Your provider will let you know when you should return for routine gynecological care (including any follow-up for your chosen contraceptive method) and give you any necessary referrals. Many women may benefit from physical therapy, such as pelvic floor physical therapy, especially if you had (or have) significant perineal tearing, a forceps delivery, diastasis recti, or urinary incontinence, for example. Talk to your provider to see if you need a referral.

They'll take care of necessary paperwork: If you're on maternity leave, for example, you may have forms for your healthcare provider to fill out, stating that you gave birth. The office team at your provider's office will know what to do to get this taken care of.

If you need a prescription refilled, make sure it's taken care of before you leave. And before you go, look at your notes and make sure that your provider has addressed all of your concerns.

Questions to ask your healthcare provider at your six-week postpartum checkup

Again, your postpartum visit is a great opportunity to ask your provider about your labor and delivery and your health. Come prepared with a list of questions that have come up in the past six weeks. Jot them down or note them on your smartphone.

Here are some examples:

• Can you check me for diastasis recti?
• Can you provide a referral to a lactation consultant?
• Can you provide a referral for pelvic floor therapy?
• Why were forceps (or a vacuum, or any other procedure) used to delivery my baby? It may have been explained to you at the time, but it's understandable if you don't remember! (Now's the time to get any lingering questions about your labor and delivery answered.)
• Will the fact that I had a preterm birth (or emergency c-section, or any other complication) mean that my next birth will be the same?
• How might the condition I had during pregnancy (gestational diabetes or preeclampsia, for example) affect my health now and in the future?
• What do you suggest for constipation? (Or headaches, or any other discomfort you're having.)
• What supplements should I be taking now?

Can I bring my baby with me to my postpartum checkup?

Most practitioners will be fine with bringing your infant to your follow-up appointment, but ask ahead of time to make sure.

If possible, consider asking someone to take care of your baby during your visit so you can be totally focused on yourself during your time with your provider. If you want to bring your baby along, have someone come with you to hold your baby and comfort them, if needed, during the visit. But don't neglect this follow up. Taking care of yourself now is just as important as taking care of your newborn.

Concerns that shouldn't wait for the six-week postpartum checkup

Some postpartum complications are dangerous and warrant immediate action. Don't wait for your six-week postpartum checkup if you have any concerns about something not being quite right. Call your provider and ask. Also get in touch with your provider right away if you have any of these postpartum warning signs or symptoms:

• Excessive bleeding (blood flow that isn't slowing or that increases after three days, passing large clots, passing bright red blood after three days, or soaking more than one sanitary pad in an hour)
• Fever
• Abdominal pain or tenderness
• Foul-smelling discharge
• A painful, hard, warm, red area or red streaks on your breast, which are signs of mastitis
• Painful urination or difficulty urinating or feeling of having to urinate often
• Swelling or tenderness in your legs and feet
• Pain, red streaks, or discharge from a tear or incision
• Dizziness
• Severe, persistent headaches
• Chest pain
• Changes in vision
• Pain in the upper right abdomen or shoulder
• Shortness of breath
• Nausea and vomiting
• Signs of postpartum depression, such as extreme sadness or despair, frequent crying, or extreme anxiety or panic

Call for emergency help if you have excessive bleeding and signs of shock (dizziness, chills, heart palpitations, blurry vision, pale or clammy skin, confusion), or if you ever have thoughts of harming yourself or your baby.

Read more:

How long does postpartum recovery last?

Diet for healthy post-baby weight loss

How to use a sitz bath for postpartum relief