A troublesome truth regarding American prenatal and postnatal care is that our nation has the highest maternal mortality rate among developed countries, with a large share of those deaths occurring post-birth. Due to the overall shortage of maternal care providers –think obstetricians, gynecologists, and midwives– compared to the number of births, women in the postpartum period can easily fall through the cracks when it comes to postnatal healthcare. So how can you ensure you’re making the most out of each interaction with your healthcare provider? We’ve gathered some information to help you understand what to expect at your postpartum exams, and how to maximize this fleeting time with your doctor.
Why You Need a Postpartum Exam
As many as 40% of new mothers never receive a postpartum exam; this can be a result of not having a designated OB/GYN throughout pregnancy to follow up with, geographic barriers such as lack of transportation, cultural traditions, limited healthcare coverage, or the assumption that it’s not needed because they’re “feeling fine.” The reality is, pregnancy can act as a window into your health for the rest of your life. If you experience preeclampsia (high blood pressure) while pregnant, this can indicate issues with heart health later on down the road for you. This same rule applies to gestational diabetes and the potential link to developing Type II diabetes. More pressing is the need to check your overall mental, physical, and emotional health in the weeks following delivery. New moms are at risk for serious and sometimes fatal complications after giving birth, and catching those issues early is critical.
How Often Should You See Your Provider After Delivery?
Previously, women were only recommended to come in for a single, four to six-week postpartum exam. New guidelines set forth by The American College of Obstetricians and Gynecologists (ACOG) recommend a more staggered exam schedule spanning several weeks.
The ACOG now recommends new mothers meet with their OB/GYN several times within the first 12 weeks postpartum:
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The initial exam should be scheduled within 3 weeks postpartum.
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The second exam should be scheduled at week 6 postpartum –additional exams can be scheduled as needed between this point and your final checkup.
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The final checkup should be scheduled for the 12-week mark.
If you experienced loss –miscarriage, stillbirth, or neonatal death, it’s advised you see your healthcare provider within 3 - 10 days after delivery. Your OB/GYN may recommend you speak with a genetic counselor to establish the reason for your loss, and determine if you’re at risk for complications in future pregnancies.
What Happens At a Postpartum Exam?
During a postpartum exam, your medical provider should conduct a physical exam, including a pelvic exam, and a breast exam.
The physical exam will be similar to your annual physical minus bloodwork. They’ll chart your blood pressure, and weight, take your pulse, and listen to your heart and lungs. Additionally, the doctor will want to check your abdomen to see that your uterus is contracting to its pre-pregnancy state –if you had a c-section they’ll inspect the incision to check for any signs of infection. The breast examination looks for lumps, redness, tenderness, cracked nipples, or abnormal discharge. Depending on where you’re at in your healing journey, your doctor may clear you to return to work, and for physical activity such as exercise, and sexual activity. Capitalize on this opportunity to speak with your provider at this time by:
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Discussing breastfeeding concerns: If you’re having trouble getting into a routine with nursing, ask your doctor to refer you to a lactation consultant. If there is one on staff, request to meet with them briefly before you leave.
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Seeking helpful tools: Ask if they can recommend any literature or apps for tracking things like sleep, feeding, infant milestones, etc. Is there a nipple guard or cream they recommend for cracked nipples? An exceptional postnatal vitamin? What technology exists today that can assist you as a new parent?
During the pelvic exam they’ll check your exterior genitalia –if you had an episiotomy or a tear that required stitching, they’ll inspect that. They’ll also check how you’re healing internally with a speculum exam. They’re looking to see that your vagina and cervix are healed (or healing) from any injury inflicted during childbirth and if you’re due for your annual pap smear they may conduct that as well. Questions to ask during this portion of your exam that can help you feel like you’re getting the most out of your appointment include:
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Ways to encourage healing: Do they recommend sitz baths? Frozen maxi pads? What works vs. what doesn’t? Asking them how to help your body heal after delivery is a proactive question they should be happy to answer.
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Voice your concerns: Are you still bleeding a lot? How much blood loss is normal at the stage you’re in? Are you experiencing any odor or discharge that concerns you? Speak up. You know your body and you are your best advocate. Don’t waste this opportunity because you’re embarrassed or otherwise.
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Discuss family planning: It’s possible to become pregnant at any point postpartum (spoiler alert: even if you’re breastfeeding, or haven’t gotten your period back yet). Talk about birth control options –if you’re planning on placing an intrauterine device or an implant, ask if they can take care of that while you’re in the office. If you’re nursing, ask about the ‘mini pill,’ which is safe for breastfeeding mothers, and get that prescription ordered while you’re there.
Additionally, they should conduct a mental and emotional health screening to determine if you’re experiencing any perinatal depression or postpartum anxiety. It’s important to be honest with your provider while completing the screening questionnaire. If you’re experiencing even mild postpartum depression or anxiety, it can get much worse if left untreated. Take advantage of this one-on-one time with your provider by:
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Being forthcoming: Offer information regarding your mental state, and be vocal about your questions and concerns. If your exhaustion, depression, or anxiety feels excessive, now is the time to let your doctor know.
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Bringing notes: If you worry that you’ll forget important details, or find it difficult to talk with your physician about how you’re feeling, a practical way to avoid this issue is to bring notes with your questions and concerns jotted down.
How to Support Healing Between Postpartum Exams
Your body is a self-healing organism, but that doesn’t mean it doesn’t benefit from a little help along the way. Ways you can encourage healing between your postpartum appointments include:- Taking a postnatal vitamin: OBGYNs recommend postnatal vitamins for at least six months postpartum –and breastfeeding mothers should continue as long as they are nursing or pumping breast milk. Our Total Postnatal Gummies are a yummy way to obtain vital nutrients for postpartum health and lactation support.
- Prioritize your recovery: Our Postpartum Recovery Tea is an excellent addition to your recovery strategy. With key herbs to support you after labor –like Red Raspberry Leaf to promote uterine toning and help ease postpartum cramps, and Ginger to stimulate healing and decrease inflammation.
- Take it easy: Don’t overdo it between appointments, one quick way to set your postpartum recovery back is to go too hard. It’s perfectly ok to ease back into the day-to-day at a gingerly pace, and please, accept help whenever possible.
If you’re interested in learning more about the postpartum period of pregnancy read on:
What is Postpartum and How Long Does it Last?