6-week postpartum visit convo guide
Dr. Michele Torosis
Obstetrician-gynecologist
You might be tempted to skip going to the doctor at your six-week postpartum checkup, especially if you’re consumed by your new responsibilities, and you’re feeling pretty good. Please don’t! Like your two-week postpartum checkup, this visit is important, regardless of where you are in your recovery, because it gives you an opportunity to talk about what you can expect at this stage of the journey and how to plan for the future. Here are some questions you might want to come prepared with—and a preview of responses your provider might have for you.
Exercising postpartum can help you boost energy, stave off postpartum depression, improve your sleep quality, relieve stress, and shed pregnancy pounds.
If you had a healthy pregnancy and an uncomplicated vaginal delivery, you can start exercising as soon as you feel comfortable. You can start with 20 to 30 minutes of light activity per day of pelvic-floor and abdominal exercises, and walking. Once comfortable with these low-intensity exercises, you can slowly work your way back to your normal activities.
If you had a C-section, I will evaluate today whether you are ready to resume exercise. Until this point, to allow your incision to heal, you should have avoided exerting yourself beyond lifting the weight of your baby in the car seat. After this appointment, you likely may return to vigorous activity or begin a new exercise program. If at any time you feel pain, however, stop the activity.
Postpartum “baby blues” are commonly experienced in the first two weeks after delivery. If you are still experiencing feelings of depression or hopelessness, you are not alone; one in seven women experience perinatal mood and anxiety disorders (PMADs), which are more serious and long-lasting conditions that require treatment.
For half of women diagnosed with a PMAD, this will be their first episode of the illness. It is important to know that if you have a PMAD, it is not your fault. It is equally important to understand that it is a real and treatable psychological disorder.
Today we will be screening you for postpartum depression and anxiety, as PMADs are also called, with a standard questionnaire. Answer these questions honestly so that you can get the help you need, from an appointment with a licensed mental-health provider to medication such as an antidepressant.
Also consider talking openly with your partner, friends, and family about how you are feeling. And feel free to ask a relative or close friend to help take care of the baby so you can take a break to rest and be you for a bit.
You can also call or text the Postpartum Support International HelpLine at 800-944-4773, find a trained perinatal mental-health provider through the PSI directory, or join the Postpartum Progress private online community to connect with other moms around the world.
If you are having suicidal thoughts or experiencing a psychological emergency in the United States, please immediately get help by texting HOME to the National Crisis Text Line at 741741, or by calling or texting the Suicide and Crisis Lifeline at 988.
Current guidelines recommend waiting at least six months between pregnancies, with some studies showing that waiting until your newborn is 18 months old decreases risks for your next baby, including preterm birth, low birth weight, and NICU admission.
If you had a C-section, waiting a year before getting pregnant allows time for your uterus to heal and decreases the risk of your incision scar rupturing during labor.
Yes! Only exclusively breastfeeding around the clock delays ovulation, with time between feedings no longer than four hours during the day and six hours at night. Otherwise, ovulation usually resumes within the first few weeks after childbirth—before you get your first period.
If you are currently relying on breastfeeding as birth control, let’s discuss the pros and cons of this approach.
Ideally, you decided on your postpartum birth control method while you were still pregnant. But if you haven’t yet decided, this visit is the time to discuss it with me. For the first six weeks after delivery, birth control methods that contain estrogen are not recommended because of an increased risk of blood clots. After today’s appointment, all options are available to you.
Long-acting reversible contraceptive options are the most effective forms of impermanent birth control. This includes a copper and progesterone intrauterine devices (IUD), as well as a progesterone arm implant. Depending on availability, I likely can provide you with either during this appointment or a future appointment.
Other hormonal options include: birth control pills, the patch, a vaginal ring, or a progesterone shot.
If you decided to use birth control pills, you may have been discharged from the hospital with the progesterone-only “mini pill.” At this point, you can consider switching over to a combined estrogen-progesterone pill.
Many breastfeeding moms stay on the mini pill while nursing, out of concerns that estrogen may impact their milk supply. If you share this concern, let’s talk about it. The American College of Obstetricians and Gynecologists also provides a great resource for learning more about your birth control options.
Postpartum pain during intercourse is experienced by more than 60 percent of women in the first three months after delivery. Sex after delivery can feel different and painful for a lot of reasons.
If you are exclusively breastfeeding, you are in a pseudo-postmenopausal state, and vaginal dryness is very common. Using a silicone-based lubricant can help. I could also prescribe you a vaginal estrogen cream. A small daily application can help strengthen and re-lubricate your vagina for the duration of your breastfeeding days, without worry of reducing your milk supply.
Pain along the perineum during intercourse is also common, particularly if you have a childbirth-related tear that isn’t fully healed, or if there is extra inflammatory tissue in the area. I’ll check today whether everything has healed.
Even if everything appears back to normal, you may still experience pain in this area, particularly during intercourse, as nerves commonly are still regrowing. Pain can also occur as a result of sensitivity, tightness, or trauma along the pelvic floor.
Certain treatments can help reduce this pain. Pelvic-floor physical therapists are helpful in examining these muscles and working on certain trigger points. They can also suggest vaginal suppositories for pain relief or muscle relaxation, as you work to retrain your muscles.
Getting your groove back after pregnancy can be a challenge. Your body feels and looks different, and you might not be feeling your best. Furthermore, breastfeeding can make it tricky to think of your breasts in a sexual way. Open communication with your partner about not feeling ready is key. You can also explore ways to be intimate, physically and otherwise, that don’t involve intercourse.
Women lose an average of 13 pounds during childbirth (baby, placenta, and amniotic fluid!). During the first postpartum week, you will lose a few more pounds from shedding retained fluids. The fat you gained and stored during pregnancy will take the longest time to shed.
One common goal among mothers is to reach pre-pregnancy weight by 12 months postpartum. This milestone may be important, if you are planning for a future pregnancy. Post-pregnancy weight retention and gains have been associated with issues in subsequent pregnancies or postpartum recoveries, including gestational diabetes, high blood pressure, stillbirths, C-sections, and long-term obesity.
It’s important to avoid crash diets in the postpartum period—you need appropriate nutrients to care for your baby and breastfeed. Stock up on healthy proteins and fiber-rich foods. Keep healthy snacks such as cut veggies, Greek yogurt, mixed nuts, and popcorn available. Prioritizing sleep will also help you return to your normal weight.
Women are routinely screened in pregnancy for immunity to childhood illnesses like rubella and varicella (chickenpox).
If you were found not to be immune, vaccination was likely offered postpartum before you left the hospital. The measles, mumps and rubella (MMR) vaccine is a single-dose vaccine. If you are a health care provider, or you engage in frequent international travel, a second dose of MMR vaccine is recommended after 28 days.
Varivax, the varicella vaccine, is a two-dose vaccine separated by 28 days. If you received your first dose in the hospital, you can get your second today. Depending on the time of year, you can also get your flu shot at your postpartum visit. You may also consider getting vaccinated against Covid-19, or receiving a booster shot of the vaccine, if you are due for it.
Today is a good time to check on the status of your tetanus, diphtheria, and pertussis (Tdap) immunizations; we likely can bring you up-to-date with shots during this visit, if necessary.
Women who had gestational diabetes are seven times more likely to develop “type 2” diabetes. A two-hour oral glucose tolerance test (similar to what you took when pregnant) is recommended now, between 4 and 12 weeks postpartum, and may be administered during this visit. Beyond that, routine screening with a blood test is recommended every one to three years.
Women with a history of preeclampsia have an increased risk of preeclampsia in their subsequent pregnancies. These women also are twice as likely to develop cardiovascular disease over their lifetime.
We will monitor your blood pressure today to ensure that it has returned to normal. You should follow up regularly with your primary-care physician to make sure that blood pressure issues don’t pop up in the future. You can also use the Preeclampsia Foundation’s tracking toolkit.
Ask me to ensure that your preeclampsia diagnosis is noted in your health history, as doing so triggers additional screening and monitoring for the rest of your life to optimize your heart health.
This is a highly individualized question, but one that you should be proactive about asking me.
If you had high blood pressure in this pregnancy, I may recommend that you start taking baby aspirin starting at the 12th week of your next pregnancy. If you’ve had a C-section, we can discuss what this may mean for your next pregnancy. Some of this may have been discussed with you right after delivery, but it’s a good idea to circle back to the topic today or in the future.
It is normal to have tenderness along your C-section incision until now. You may even feel pins-and-needles numbness around the incision, which is normal and can last for a few months after delivery.
Persistent pain that interferes with daily living could be a sign of nerve entrapment. Studies have shown that up to 8 percent of patients with C-section incisions will have chronic inguinal pain from nerve entrapment that is moderate to severe.
I can offer you a trigger point injection of a numbing medication into this area. It is typically very effective at relieving pain. In rare cases, surgical correction is needed. If you are being limited daily by severe pain, please let me know. There are options for relief.