The 6 week check up after baby is one of the most confusing appointments. Like, it’s been a month and a half since you delivered your baby. You’ve been doing this thing for 42 long days and it’s the first time you are seen and the focus of your provider. Your lochia has usually stopped by this point, you may have even gone back to work, or started fitness again. What is the purpose of this appointment?
ACOG has recently changed their recommendations for the postnatal period, below is an excerpt from ACOG Committee Opinion, in it you will find that this check up is actually recommended to be had earlier in the postnatal period and to be seen as a process of visits and not a “one and done” approach which can feel very pointless.
To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs. It is recommended that all women have contact with their obstetrician–gynecologists or other obstetric care providers within the first 3 weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance.Read the full article here
As you read, the purpose should be a comprehensive assessment of your mind, body and emotional state. In this post, I want to give you the tools you need to advocate for yourself. There is a good chance you may need to as this is a recent recommendation and normal practices take around 20 years to adopt.
What to Expect
You can expect your doctor to ask about your mental and emotional state and may be as vague as, “How are you doing?” or “Are you adjusting okay?” This will be hard for some to express if they aren’t but this is your window to say “No, I’m not fine, I need help with x.” Remember you are stronger for reaching out.
The doctor may also check your stitching or incision depending if you had a vaginal or abdominal delivery. If you want this to happen, I would recommend bringing it up if they haven’t – remember this visit is for you.
Other things your provider may bring up as mentioned above, birth space (how far they recommend to have your children apart) birth control, returning to sex and exercise. I’ll be frank with you – they may have very general recommendations for both sex + fitness. Do not be discouraged, this just isn’t there expertise. You can get a referral to a Pelvic Floor PT (make sure they specialize in the pelvic floor and not just a regular physical therapist). You may need to advocate for yourself as they may not see it as necessary. Sadly a lot of this is just political or ideological. Remember, this visit is for you.
Questions to Ask
Before birth: Can I see you within three weeks postpartum?
At initial check up: Can I see you in a couple weeks just to make sure everything is healing well?
If you are having pain, leakage, or any discomfort in your abdominal wall, pelvic floor or vagina, ask, “This is bothering me, could you take a look at it?”
Could you refer me to a Pelvic Floor PT for intentional rehab of my core + pelvic floor?
Do you have any resources on x*? *Breastfeeding, sleeping, baby care, anything you want or need.
If you get frustrated easily, have outbursts of anger, have trouble sleeping and resting while the baby is sleeping, or anxious, compulsive and/or persistent thoughts – start a discussion on signs + symptoms for postpartum mood disorders and ask what resources they have.
Most OB’s will not be qualified to assess the state of your pelvic floor muscles and diagnose anything. If you are concerned about prolapse or things not feeling “right” post birth – get a referral to a Pelvic Floor PT.
Remember momma, 6 weeks is not the end of postpartum but the very beginning to connecting to your new body, rehabbing and rebuilding a strong foundation. Have any questions? Please reach out!