Dr. Sasha Davenport, MD with commentary from the Ohnut Team

Ahhhh, the postpartum visit. You’ve had a baby and now you’re back at the doc’s office 6 weeks later. But why is it important? And what can you expect at your visit? Dr. Sasha (Sabir) Davenport, OBGYN extraordinaire at Atrium Health Women's Care in North Carolina, gives us the low-down.

• Why is the postpartum visit typically scheduled at 6 weeks?
• What is the purpose of my postpartum visit?
• What type of physical exam and testing will my physician do?
• How will I know when I can resume intercourse?
• What about birth control?
• Why did my physician recommend waiting to get pregnant for a certain interval?
• My provider asked me seemingly personal questions, is this normal?
• In what scenarios will my provider recommend ongoing follow up?

Why is the postpartum visit typically scheduled at 6 weeks?

Historically, many cultural traditions observe 40 days of recovery after birth—and that’s generally why doctor’s visits are scheduled about 40 days out as well. At that 6-week mark, your doctor is generally looking to make sure everything is healed up and that nothing is infected (especially if you’ve had a c-section). 

If there were any pregnancy complications, your provider may want to see you a few times before the six week mark. Otherwise, depending on your clinic, your postpartum visit may be scheduled as early as 4 weeks, or sometimes later than 6 weeks.

TLDR; it’s historically a cultural thing, but nowadays your doc is looking to make sure everything is healed up. This 6-week timing might vary depending on the clinic or if you had any complications.

What is the purpose of my postpartum visit?

Your body has gone through (and is still going through) a ton of changes! So the main goal of this visit is to make sure you’re doing okay physically, socially, and psychologically.

Physical, Social, + Psychological Well-Being

Your provider should assess your ability to resume regular activities like exercise and intercourse. Providers will generally also screen all patients for depression and anxiety to assess your psychological well-being.

Oh! And don’t be alarmed if your OB provider asks you questions about your support system, if you feel safe at home, or have ever experienced any type of abuse. These are things doctors should be screening all patients for at their postpartum visit. (More on this below.)

Additional Concerns + Referrals

Everyone’s recovery is different, so this is also an opportunity for you to bring up any of your concerns. Your provider may offer community resources, like postpartum support groups, a referral to a mental health practitioner, or a referral to a pelvic floor physical therapist. If you’re interested in community resources, but your doc doesn’t bring it up—go ahead and ask! This appointment is for you :)

Every healthcare provider is different, so if your doc doesn’t mention something that you think is important (from sexual concerns to pain to your emotional wellbeing)—feel free to say something or ask questions. If you don’t feel like your OB is giving you the care you need, it’s okay to seek an appointment from a different provider. It’s important to receive care from a practitioner who cares about and wants to address your individual goals. 

Infant Feeding Plan + Help

Your provider will also likely ask you what your infant feeding plan is, and how it’s going. Trouble breastfeeding? Many clinics have lactation specialists that can help troubleshoot those breastfeeding challenges.

What type of physical exam and testing will my physician do?

Your physical exam will likely involve a complete physical, including a breast and pelvic exam. 

Pelvic Exam

The pelvic exam should include looking at the vulva and perineum (the “outside”), looking at the vaginal vault, and potentially looking at the cervix if there are concerns. There should also be a bimanual exam, which involves two hands (a digital exam from below [inside the vagina] and a uterine exam from above [a hand pressing gently on your belly]).

If your doctor does not perform a pelvic exam and you want one, just ask! Your request should absolutely be honored. And if not, again it’s okay to seek care elsewhere. 

Pap Smear + Sexually Transmitted Infection Test (Maybe)

A pap-smear (cervical cancer screen) may also be recommended if you’re not up-to-date, and your doc may want to test for STIs, if indicated. Depending on if you have any medical conditions or had any complications in your pregnancy, your provider may recommend additional testing and care.

Additional Concerns

If something still feels “not-quite-right,” but your doctor doesn’t see or feel anything wrong—please say so! There may be some solutions your doctor can give you then and there, like local estrogen supplementation. It’s also totally reasonable to request a follow-up with your provider to address the concern if it persists (or request a referral to a specialist or other healthcare provider like a pelvic floor physical therapist). If your concern isn’t resolved, it’s also completely within your rights and power to seek out a second opinion.

How will I know when I can resume intercourse after having a baby?

Your doctor will give you a “green light” when they deem it’s safe to resume intercourse. This green light just means that there are no signs of infection and any lacerations have healed—it doesn’t necessarily mean that you’ll feel ready (mentally or physically) to have sex right after that 6-week mark. That’s 100% normal.

Sexual Challenges

Most people experience sexual challenges after giving birth. There may be low desire or arousal because of lack of sleep, new life stressors, and/or fluctuating hormone levels. Sex can also be more painful or uncomfortable because of healing, the physiological changes your body has gone through, and again—hormones. 

The first time you have sex after birth, be sure to go slow and use lots of lube. It might be uncomfortable, but should not be painful. Any pain or ongoing discomfort is not something you have to deal with, so please discuss this with your provider. Remember, anything bothersome is absolutely worth talking about.

If you’re experiencing any of the above, you’re not alone and you should schedule an appointment to follow up with your provider or ask for a referral to a pelvic floor physical therapist. If your provider isn’t well-equipped to talk about sex (most should be, as this should be part of their training), ask for a referral to an in-network OBGYN who specializes in sexual health.

What about birth control after birth?

You and your provider will discuss birth control at the postpartum visit if you don’t already have a birth control plan in place. 

Birth Control

This might mean you’ll get a prescription or a device (like an IUD or an implant) placed at your postpartum visit

Family Planning

Your provider will also talk to you about your future fertility plans. They are likely to discuss what a safe interval is to get pregnant again if you want more children. Your provider may advise you and make recommendations for future pregnancies if your pregnancy was complicated (ex. you had preeclampsia or a preterm birth). 

You have choices, and your provider will work with you to find the best birth control option (or not) for you!

Why did my physician recommend waiting to get pregnant for a certain interval?

Your provider may advise you to avoid getting pregnant in the 6 months after pregnancy because there’s reliable data demonstrating intervals between pregnancies that are shorter than 6 months are associated with increased risk of complications such as preterm birth, low birth weight, and small for gestational age (1). They will also likely discuss the risk and benefits of getting pregnant within 18 months after the birth of your most recent child. 

My provider asked me seemingly personal questions at my postpartum visit, is this normal?

Yes! This is called universal screening, meaning providers ask everybody these questions to ensure we have a plan and are keeping you as safe and healthy as possible. 

Safety Plan

This might include bringing in other professionals like social workers to help create and carry out a safety plan. Don’t be surprised if they ask about things like substance use, social support systems, thoughts of hurting yourself or others, if you feel safe at home, if you have ever experienced any type of abuse or domestic violence, if you have resumed intercourse, etc.

Your provider will also screen to ensure you have stable housing, utilities, food and supplies for taking care of your baby.

In what scenarios will my provider recommend ongoing follow up?

Pregnancy Complications

People who had complications in their pregnancy, or various medical conditions such as gestational diabetes (diabetes that develops during pregnancy), hypertensive (high blood pressure) disorders, or infection will likely need ongoing care and possible lab tests because some of these disorders are associated with an increased lifetime risk of cardiac and metabolic diseases. Your OB provider may refer you to see certain specialists if appropriate.

Depression + Anxiety

If your screen for anxiety or depression is positive, your provider should schedule follow up and/or possibly discuss other therapeutic interventions.

Pregnancy Loss

If you experienced a pregnancy loss, your provider will likely offer you referral to a counselor or support group. It’s okay to accept help if you’re struggling.

Vaccination

Your provider may also review any recommended vaccines that you were unable to get in pregnancy. For example, the MMR or Measles-Mumps-Rubella vaccine.

The postpartum period can be isolating and overwhelming, but it can also be wonderful! It’s completely normal to feel like you’re not on Cloud 9, so try to give yourself some grace. While postpartum care varies across the United States and by provider, your OBGYN is there to provide support, advice, and resources to make your postpartum experience safe and healthy. 

Citations: 

1. Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006 Apr 19;295(15):1809-23. doi: 10.1001/jama.295.15.1809. PMID: 16622143.

2. Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140–50.